[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 1204 Introduced in Senate (IS)]







106th CONGRESS
  1st Session
                                S. 1204

   To promote general and applied research for health promotion and 
   disease prevention among the elderly, to amend title XVIII of the 
Social Security Act to add preventive benefits, and for other purposes.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 10, 1999

  Mr. Graham introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
   To promote general and applied research for health promotion and 
   disease prevention among the elderly, to amend title XVIII of the 
Social Security Act to add preventive benefits, 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; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Healthy Seniors 
Promotion Act of 1999''.
    (b) Table of Contents.--The table of contents is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Finding.
Sec. 3. Definitions.
               TITLE I--HEALTHY SENIORS PROMOTION PROGRAM

Sec. 101. Healthy seniors promotion program.
Sec. 102. Sense of Congress regarding the response of HCFA to 
                            preventive health issues.
Sec. 103. Sense of Congress regarding the efforts of HCFA to study 
                            health promotion and disease prevention for 
                            medicare beneficiaries.
Sec. 104. Sense of Congress regarding the establishment of a medicare 
                            health promotion and disease prevention 
                            clearinghouse.
           TITLE II--MEDICARE COVERAGE OF PREVENTIVE SERVICES

Sec. 201. Medicare coverage of counseling for cessation of tobacco use.
Sec. 202. Medicare coverage of screening for hypertension.
Sec. 203. Medicare coverage of counseling for hormone replacement 
                            therapy.
Sec. 204. Medicare coverage of screening for glaucoma.
Sec. 205. National falls prevention education and awareness campaign.
Sec. 206. Program integrity.
       TITLE III--PREVENTIVE OUTPATIENT PRESCRIPTION DRUG BENEFIT

Sec. 301. Medicare coverage of preventive outpatient prescription 
                            drugs.
Sec. 302. Selection of entities to provide preventive outpatient drug 
                            benefit.
Sec. 303. Access of low-income beneficiaries to preventive outpatient 
                            prescription drugs.
Sec. 304. Allocation of Federal proceeds from global tobacco settlement 
                            to enhance preventive outpatient 
                            prescription drug benefit.
Sec. 305. Medicare drug benefit study.
Sec. 306. Effective date.
TITLE IV--STUDIES AND REPORTS ADVANCING ORIGINAL RESEARCH IN PREVENTION 
                            AND THE ELDERLY

Sec. 401. MedPAC biannual report.
Sec. 402. National Institute on Aging study and report.
Sec. 403. Institute of Medicine 5-year medicare prevention benefit 
                            study and report.
Sec. 404. Fast-track consideration of preventive benefit legislation.

SEC. 2. FINDING.

    Congress finds that despite significant advancements in general 
research for health promotion and disease prevention among the elderly, 
there has been a failure in translating that research into practical 
intervention.

SEC. 3. DEFINITIONS.

    As used in this Act:
            (1) Medicare beneficiary.--The term ``medicare 
        beneficiary'' means any individual who is entitled to benefits 
        under part A or enrolled under part B of the medicare program, 
        including any individual enrolled in a Medicare+Choice plan 
        offered by a Medicare+Choice organization under part C of such 
        program.
            (2) Medicare program.--The term ``medicare program'' means 
        the health care program under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.

               TITLE I--HEALTHY SENIORS PROMOTION PROGRAM

SEC. 101. HEALTHY SENIORS PROMOTION PROGRAM.

    (a) Definitions.--As used in this section:
            (1) Eligible entity.--The term ``eligible entity'' means an 
        entity that the Working Group determines has demonstrated 
        expertise in research regarding health promotion and disease 
        prevention among the elderly.
            (2) Working group.--The term ``Working Group'' means the 
        Healthy Seniors Working Group established under subsection (d).
    (b) Program Authorized.--The Secretary, subject to the general 
policies and criteria established by the Working Group and in 
accordance with the provisions of this Act, is authorized to make 
grants to eligible entities to pay for the costs of the activities 
described in subsection (c).
    (c) Use of Funds.--An eligible entity may use payments received 
under this section in any fiscal year to study--
            (1) the effectiveness of using different types of providers 
        of care who are not physicians and the use of alternative 
        settings (including community based senior centers) for the 
        implementation of a successful health promotion and disease 
        prevention strategy, including implications regarding the 
        payment of such providers;
            (2) the most effective means of educating medicare 
        beneficiaries and providers of services regarding the 
        importance of health promotion and disease prevention among the 
        elderly and identification of incentives that would increase 
        the use of new and existing preventive services by medicare 
        beneficiaries; and
            (3) other topics designated by the Secretary.
    (d) Healthy Seniors Working Group.--
            (1) Establishment.--There is established within the 
        Department of Health and Human Services a Healthy Seniors 
        Working Group.
            (2) Composition.--Subject to paragraph (3), the Working 
        Group established pursuant to subsection (b) shall be composed 
        of 5 members as follows:
                    (A) The Administrator of the Health Care Financing 
                Administration.
                    (B) The Director of the Centers for Disease Control 
                and Prevention.
                    (C) The Administrator of the Agency for Health Care 
                Policy and Research.
                    (D) The Assistant Secretary for Aging.
                    (E) The Director of the National Institute on 
                Aging.
            (3) Alternative membership.--
                    (A) Appointment.--Any member of the Working Group 
                described in a subparagraph of paragraph (2) may 
                appoint an individual who is an officer or employee of 
                the Federal Government to serve as a member of the 
                Working Group instead of the member described in such 
                subparagraph.
                    (B) Deadline.--If a member described in 
                subparagraph (A) elects to appoint an individual under 
                such subparagraph, such individual shall be appointed 
                not later than December 31, 1999.
            (4) General policies and criteria.--The Working Group shall 
        establish general policies and criteria with respect to the 
        functions of the Secretary under this section including--
                    (A) priorities for the approval of applications;
                    (B) procedures for developing, monitoring, and 
                evaluating research efforts conducted under this 
                section; and
                    (C) such other matters as are recommended by the 
                Working Group and approved by the Secretary.
            (5) Chairperson.--The Chairperson of the Working Group 
        shall be the Administrator of the Agency for Health Care Policy 
        and Research.
            (6) Quorum.--A majority of the members of the Working Group 
        shall constitute a quorum, but a lesser number of members may 
        hold hearings.
            (7) Meetings.--The Working Group shall meet at the call of 
        the Chairperson, except that--
                    (A) it shall meet not less than 4 times each year; 
                and
                    (B) it shall meet whenever a majority of the 
                appointed members request a meeting in writing.
            (8) Compensation of members.--Each member of the Working 
        Group shall be an officer or employee of the Federal Government 
        and shall serve without compensation in addition to that 
        received for their service as an officer or employee of the 
        Federal Government.
    (d) Application.--
            (1) In general.--Each eligible entity which desires to 
        receive a grant under this section shall submit an application 
        to the Secretary, at such time, in such manner, and accompanied 
        by such additional information as the Secretary may reasonably 
        require.
            (2) Contents.--Each application submitted pursuant to 
        paragraph (1) shall--
                    (A) describe the activities for which assistance 
                under this section is sought;
                    (B) describe how the research effort proposed to be 
                conducted will reflect the medical, behavioral, and 
                social aspects of care for the elderly, including cost-
                effectiveness and quality of life impacts stemming from 
                any initiative;
                    (C) provide evidence that the eligible entity meets 
                the general policies established by the Working Group 
                pursuant to subsection (d)(4);
                    (D) provide assurances that the eligible entity 
                will take such steps as may be available to it to 
                continue the activities for which the eligible entity 
                is making application after the period for which 
                assistance is sought; and
                    (E) provide such additional assurances as the 
                Secretary determines to be essential to ensure 
                compliance with the requirements of this Act.
            (3) Joint application.--A consortium of eligible entities 
        may file a joint application under the provisions of paragraph 
        (1) of this subsection.
    (f) Approval of Application.--The Secretary shall approve 
applications in accordance with the general policies established by the 
Working Group under subsection (d).
    (g) Payments.--The Secretary shall pay to each eligible entity 
having an application approved under subsection (f) the cost of the 
activities described in the application.
    (h) Evaluation and Report.--
            (1) Evaluation.--The Secretary shall conduct an annual 
        evaluation of grants made under this section to determine--
                    (A) the results of the overall applied research 
                conducted under this Act;
                    (B) the extent to which research assisted under 
                this section has improved or expanded the general 
                research for health promotion and disease prevention 
                among the elderly and identified practical 
                interventions based upon such research;
                    (C) a list of specific recommendations based upon 
                research conducted under this section which show 
                promise as practical interventions for health promotion 
                and disease prevention among the elderly;
                    (D) whether or not as a result of the applied 
                research effort certain health promotion and disease 
                prevention benefits or education efforts should be 
                added to the medicare program, including discussions of 
                quality of life and cost-effectiveness for each 
                proposed addition;
                    (E) the utility of, potential for, and issues 
                surrounding health risk appraisals sponsored under the 
                medicare program and targeted follow up; and
                    (F) how best to increase utilization of existing 
                and recommended health promotion and disease prevention 
                services, including an education and public awareness 
                component discussion of financial incentives for 
                providers of services and medicare beneficiaries to 
                improve utilization and other administrative means of 
                increasing utilization.
            (2)  Report.--Not later than December 31, 2002, the 
        Secretary shall submit a report to Congress based on the annual 
        studies made under paragraph (1), which shall contain a 
        detailed statement of the findings and conclusions of the 
        Working Group together with its recommendations for such 
        legislation and administrative actions as it considers 
        appropriate.
    (i) Authorization of Appropriations.--There are authorized to be 
appropriated $25,000,000 for fiscal years 1999, 2000, 2001, and 2002 to 
carry out the provisions of this section.

SEC. 102. SENSE OF CONGRESS REGARDING THE RESPONSE OF HCFA TO 
              PREVENTIVE HEALTH ISSUES.

    It is the sense of Congress that in administering the medicare 
program the Secretary should ensure that the Administrator of the 
Health Care Financing Administration encourages the inclusion of 
preventive measures as part of all treatments described in such 
program.

SEC. 103. SENSE OF CONGRESS REGARDING THE EFFORTS OF HCFA TO STUDY 
              HEALTH PROMOTION AND DISEASE PREVENTION FOR MEDICARE 
              BENEFICIARIES.

    It is the sense of Congress that the Secretary should ensure that 
the Administrator of the Health Care Financing Administration expands 
the study of the most promising behavioral modification of risk factors 
associated with health promotion and disease prevention for all 
medicare beneficiaries.

SEC. 104. SENSE OF CONGRESS REGARDING THE ESTABLISHMENT OF A MEDICARE 
              HEALTH PROMOTION AND DISEASE PREVENTION CLEARINGHOUSE.

    It is the sense of Congress that the National Library of Medicine 
should collect information regarding innovative and successful health 
promotion and disease prevention interventions from both published and 
unpublished sources, establish a clearinghouse targeting all medicare 
beneficiaries in a variety of settings for the consolidation and 
coordination of all such information, and make the clearinghouse 
available to the public and accessible through the Internet.

           TITLE II--MEDICARE COVERAGE OF PREVENTIVE SERVICES

SEC. 201. MEDICARE COVERAGE OF COUNSELING FOR CESSATION OF TOBACCO USE.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) is amended--
            (1) in subparagraph (S), by striking ``and'' at the end;
            (2) in subparagraph (T), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(U) counseling for cessation of tobacco use (as defined 
        in subsection (uu)).''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
is amended by adding at the end the following:

               ``Counseling for Cessation of Tobacco Use

    ``(uu) The term `counseling for cessation of tobacco use' means 
diagnostic, therapy, and counseling services for cessation of tobacco 
use which are furnished by or under the supervision of a physician or 
other health care professional who is legally authorized to furnish 
such services under State law (or the State regulatory mechanism 
provided by State law) of the State in which the services are 
furnished, as would otherwise be covered if furnished by a physician or 
as an incident to a physician's professional service.''.
    (c) Payment.--Section 1833(a)(1) of such Act (42 U.S.C. 
1395l(a)(1)) is amended--
            (1) by striking ``and (S)'' and inserting ``(S)''; and
            (2) by striking the semicolon at the end and inserting the 
        following: ``, and (T) with respect to counseling for cessation 
        of tobacco use (as defined in section 1861(uu)), the amount 
        paid shall be 100 percent of the lesser of the actual charge 
        for the services or the amount determined by a fee schedule 
        established by the Secretary for the purposes of this 
        subparagraph;''.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after December 31, 2001.

SEC. 202. MEDICARE COVERAGE OF SCREENING FOR HYPERTENSION.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) (as amended by section 201(a)) is amended--
            (1) in subparagraph (T), by striking ``and'' at the end;
            (2) in subparagraph (U), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(V) screening for hypertension (as defined in subsection 
        (vv)).''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
(as amended by section 201(b)) is amended by adding at the end the 
following:

                      ``Screening for Hypertension

    ``(vv) The term `screening for hypertension' means diagnostic 
services for hypertension which are furnished by or under the 
supervision of a physician or other health care professional who is 
legally authorized to furnish such services under State law (or the 
State regulatory mechanism provided by State law) of the State in which 
the services are furnished, as would otherwise be covered if furnished 
by a physician or as an incident to a physician's professional 
service.''.
    (c) Payment.--Section 1833(a)(1) of such Act (42 U.S.C. 
1395l(a)(1)) (as amended by section 201(c)) is amended--
            (1) by striking ``and (T)'' and inserting ``(T)''; and
            (2) by striking the semicolon at the end and inserting the 
        following: ``, and (U) with respect to screening for 
        hypertension (as defined in section 1861(vv)), the amount paid 
        shall be 100 percent of the lesser of the actual charge for the 
        services or the amount determined by a fee schedule established 
        by the Secretary for the purposes of this subparagraph;''.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after December 31, 2001.

SEC. 203. MEDICARE COVERAGE OF COUNSELING FOR HORMONE REPLACEMENT 
              THERAPY.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) (as amended by section 202(a)) is amended--
            (1) in subparagraph (U), by striking ``and'' at the end;
            (2) in subparagraph (V), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(W) counseling for hormone replacement therapy (as 
        defined in subsection (ww)).''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
(as amended by section 202(b)) is amended by adding at the end the 
following:

              ``Counseling for Hormone Replacement Therapy

    ``(ww) The term `counseling for hormone replacement therapy' means 
diagnostic, therapy, and counseling services for hormone replacement 
which are furnished by or under the supervision of a physician or other 
health care professional who is legally authorized to furnish such 
services under State law (or the State regulatory mechanism provided by 
State law) of the State in which the services are furnished, as would 
otherwise be covered if furnished by a physician or as an incident to a 
physician's professional service.''.
    (c) Payment.--Section 1833(a)(1) of such Act (42 U.S.C. 
1395l(a)(1)) (as amended by section 201(c)) is amended--
            (1) by striking ``and (U)'' and inserting ``(U)''; and
            (2) by striking the semicolon at the end and inserting the 
        following: ``, and (V) with respect to counseling for hormone 
        replacement therapy (as defined in section 1861(ww)), the 
        amount paid shall be 100 percent of the lesser of the actual 
        charge for the services or the amount determined by a fee 
        schedule established by the Secretary for the purposes of this 
        subparagraph;''.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after December 31, 2001.

SEC. 204. MEDICARE COVERAGE OF SCREENING FOR GLAUCOMA.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) (as amended by section 203(a)) is amended--
            (1) in subparagraph (V), by striking ``and'' at the end;
            (2) in subparagraph (W), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(X) screening for glaucoma (as defined in subsection 
        (xx)).''.
    (b) Services Described.--Section 1861 of such Act (42 U.S.C. 1395x) 
(as amended by section 203(b)) is amended by adding at the end the 
following:

                        ``Screening for Glaucoma

    ``(xx) The term `screening for glaucoma' means diagnostic services 
for early detection of glaucoma which are furnished by or under the 
supervision of a physician or other health care professional who is 
legally authorized to furnish such services under State law (or the 
State regulatory mechanism provided by State law) of the State in which 
the services are furnished, as would otherwise be covered if furnished 
by a physician or as an incident to a physician's professional 
service.''.
    (c) Payment.--Section 1833(a)(1) of such Act (42 U.S.C. 
1395l(a)(1)) (as amended by section 201(c)) is amended--
            (1) by striking ``and (V)'' and inserting ``(V)''; and
            (2) by striking the semicolon at the end and inserting the 
        following: ``, and (W) with respect to screening for glaucoma 
        (as defined in section 1861(xx)), the amount paid shall be 100 
        percent of the lesser of the actual charge for the services or 
        the amount determined by a fee schedule established by the 
        Secretary for the purposes of this subparagraph;''.
    (d) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after December 31, 2001.

SEC. 205. NATIONAL FALLS PREVENTION EDUCATION AND AWARENESS CAMPAIGN.

    The Secretary, in consultation with the Director of the Centers for 
Disease Control and Prevention, shall conduct a national falls 
prevention and awareness campaign to reduce fall-related injuries among 
medicare beneficiaries.

SEC. 206. PROGRAM INTEGRITY.

    The Secretary, in consultation with the Inspector General of the 
Department of Health and Human Services, shall integrate the benefits 
described in sections 201, 202, 203, and 204 with existing program 
integrity measures.

       TITLE III--PREVENTIVE OUTPATIENT PRESCRIPTION DRUG BENEFIT

SEC. 301. MEDICARE COVERAGE OF OUTPATIENT PRESCRIPTION DRUGS.

    (a) Coverage.--Section 1861(s)(2) of the Social Security Act (42 
U.S.C. 1395x(s)(2)) (as amended by section 204(a)) is amended--
            (1) in subparagraph (W), by striking ``and'' at the end;
            (2) by striking the period at the end of subparagraph (X) 
        and inserting ``; and''; and
            (3) by adding at the end the following:
            ``(Y) preventive outpatient prescription drugs (as defined 
        in section 1849(h)(1)) pursuant to the procedures established 
        under such section;''.
    (b) Payment.--Section 1833(a)(1) of such Act (42 U.S.C. 
1395l(a)(1)) (as amended by section 204(c)) is amended--
            (1) by striking ``and (W)'' and inserting ``(W)''; and
            (2) by striking the semicolon at the end and inserting the 
        following: ``, and (X) with respect to preventive outpatient 
        prescription drugs (as defined in section 1849(h)(1)), the 
        amounts paid shall be the amounts established by the Secretary 
        pursuant to such section;''.

SEC. 302. SELECTION OF ENTITIES TO PROVIDE PREVENTIVE OUTPATIENT DRUG 
              BENEFIT.

    Part B of title XVIII of the Social Security Act (42 U.S.C. 1395j 
et seq.) is amended by adding at the end the following:

``SEC. 1849. SELECTION OF ENTITIES TO PROVIDE PREVENTIVE OUTPATIENT 
              DRUG BENEFIT.

    ``(a) Establishment of Bidding Process.--
            ``(1) In general.--The Secretary shall establish procedures 
        under which the Secretary accepts bids from eligible entities 
        and awards contracts to such entities in order to provide 
        preventive outpatient prescription drugs to eligible 
        beneficiaries in an area. Such contracts may be awarded based 
        on shared risk, capitation, or performance.
            ``(2) Area.--
                    ``(A) Regional basis.--The contract entered into 
                between the Secretary and an eligible entity shall 
                require the eligible entity to provide preventive 
                outpatient prescription drugs on a regional basis.
                    ``(B) Determination.--In determining coverage areas 
                under this section, the Secretary shall take into 
                account the number of eligible beneficiaries in an area 
                in order to encourage participation by eligible 
                entities.
            ``(3) Submission of bids.--Each eligible entity desiring to 
        provide preventive outpatient prescription drugs under this 
        section shall submit a bid to the Secretary at such time, in 
        such manner, and accompanied by such information as the 
        Secretary may reasonably require. Such bids shall include the 
        amount the eligible entity will charge eligible beneficiaries 
        under subsection (e)(2) for preventive outpatient prescription 
        drugs under the contract.
            ``(4) Access.--The Secretary shall ensure that--
                    ``(A) an eligible entity complies with the access 
                requirements described in subsection (f)(4); and
                    ``(B) an eligible entity makes available to each 
                beneficiary covered under the contract the full scope 
                of benefits required under paragraph (5).
            ``(5) Scope of benefits.--The Secretary shall ensure that 
        all preventive outpatient prescription drugs that are 
        reasonable and necessary to prevent or slow the deterioration 
        of, and improve or maintain, the health of eligible 
        beneficiaries are offered under a contract entered into under 
        this section.
            ``(6) Number of contracts.--The Secretary shall, consistent 
        with the requirements of this section and the goal of 
        containing medicare program costs, award at least 2 contracts 
        in an area, unless only 1 bidding entity meets the minimum 
        standards specified under this section and by the Secretary.
            ``(7) Duration of contracts.--Each contract under this 
        section shall be for a term of at least 2 years but not more 
        than 5 years, as determined by the Secretary.
    ``(b) Enrollment.--
            ``(1) In general.--The Secretary shall establish a process 
        through which an eligible beneficiary shall make an election to 
        enroll with any eligible entity that has been awarded a 
        contract under this section and serves the geographic area in 
        which the beneficiary resides. In establishing such process, 
        the Secretary shall use rules similar to the rules for 
        enrollment and disenrollment with a Medicare+Choice plan under 
        section 1851.
            ``(2) Requirement of enrollment.--An eligible beneficiary 
        not enrolled in a Medicare+Choice plan under part C must enroll 
        with an eligible entity under this section in order to be 
        eligible to receive preventive outpatient prescription drugs 
        under this title.
            ``(3) Enrollment in absence of election by eligible 
        beneficiary.--In the case of an eligible beneficiary that fails 
        to make an election pursuant to paragraph (1), the Secretary 
        shall provide, pursuant to procedures developed by the 
        Secretary, for the enrollment of such beneficiary with an 
        eligible entity that has a contract under this section that 
        covers the area in which such beneficiary resides.
            ``(4) Areas not covered by contracts.--The Secretary shall 
        develop procedures for the provision of preventive outpatient 
        prescription drugs under this title to eligible beneficiaries 
        that reside in an area that is not covered by any contract 
        under this section.
            ``(5) Beneficiaries residing in different locations.--The 
        Secretary shall develop procedures to ensure that an eligible 
        beneficiary that resides in different regions in a year is 
        provided benefits under this section throughout the entire 
        year.
    ``(c) Providing Information to Beneficiaries.--The Secretary shall 
provide for activities under this section to broadly disseminate 
information to medicare beneficiaries on the coverage provided under 
this section. Such activities shall be similar to the activities 
performed by the Secretary under section 1851(d).
    ``(d) Payments to Eligible Entities.--The Secretary shall establish 
procedures for making payments to an eligible entity under a contract.
    ``(e) Cost-Sharing.--
            ``(1) Deductible.--Benefits under this section shall not 
        begin until an eligible beneficiary has met a $50 deductible.
            ``(2) Coinsurance.--
                    ``(A) In general.--Subject to subparagraph (B), an 
                eligible beneficiary shall be responsible for making 
                payments in an amount not greater than 20 percent of 
                the cost (as stated in the contract) of any preventive 
                outpatient prescription drug that is provided to the 
                beneficiary. Pursuant to subsection (a)(4)(B), an 
                eligible entity may reduce the payment amount that an 
                eligible beneficiary is responsible for making to the 
                entity.
                    ``(B) Basic benefit.--If the aggregate amount of 
                preventive outpatient prescription drugs provided to an 
                eligible beneficiary under this section for any 
                calendar year (based on the cost of preventive 
                outpatient prescription drugs stated in the contract) 
                exceeds $750--
                            ``(i) the beneficiary may continue to 
                        purchase preventive outpatient prescription 
                        drugs under the contract based on the contract 
                        price, but
                            ``(ii) the copayment under subparagraph (A) 
                        shall be 100 percent.
                    ``(C) Inflation adjustment.--
                            ``(i) In general.--In the case of any 
                        calendar year beginning after 2000, each of the 
                        dollar amounts in subparagraph (B) shall be 
                        increased by an amount equal to--
                                    ``(I) such dollar amount, 
                                multiplied by
                                    ``(II) an adjustment, as determined 
                                by the Secretary, for changes in the 
                                per capita cost of prescription drugs 
                                for beneficiaries under this title.
                            ``(ii) Rounding.--If any dollar amount 
                        after being increased under clause (i) is not a 
                        multiple of $10, such dollar amount shall be 
                        rounded to the nearest multiple of $10.
            ``(3) Copayment.--Each time a prescription is filled, the 
        eligible beneficiary shall be responsible for making payments 
        in an amount equal to the lesser of--
                    ``(A) the cost (as stated in the contract) of any 
                preventive outpatient prescription drug that is 
                provided to the beneficiary minus the deductible 
                described in paragraph (1) and the coinsurance 
                described in paragraph (2); or
                    ``(B) $5.
    ``(f) Conditions for Awarding Contract.--The Secretary shall not 
award a contract to an eligible entity under subsection (a) unless the 
Secretary finds that the eligible entity is in compliance with such 
terms and conditions as the Secretary shall specify, including the 
following:
            ``(1) Quality and financial standards.--The eligible entity 
        meets quality and financial standards specified by the 
        Secretary.
            ``(2) Information.--The eligible entity provides the 
        Secretary with information that the Secretary determines is 
        necessary in order to carry out the bidding process under this 
        section.
            ``(3) Procedures to ensure proper utilization and to avoid 
        adverse drug reactions.--The eligible entity has in place 
        procedures to ensure the--
                    ``(A) appropriate utilization by eligible 
                beneficiaries of the benefits to be provided under the 
                contract; and
                    ``(B) avoidance of adverse drug reactions among 
                eligible beneficiaries enrolled with the entity.
            ``(4) Access.--The eligible entity ensures that the 
        preventive outpatient prescription drugs are accessible and 
        convenient to eligible beneficiaries covered under the 
        contract, including by offering the services in the following 
        manner:
                    ``(A) Services during emergencies.--The offering of 
                services 24 hours a day and 7 days a week for 
                emergencies.
                    ``(B) Contracts with retail pharmacies.--The 
                offering of services--
                            ``(i) at a sufficient number (as determined 
                        by the Secretary) of retail pharmacies; and
                            ``(ii) to the extent feasible, at retail 
                        pharmacies located throughout the eligible 
                        entity's service area.
            ``(5) Rules relating to provision of benefits.--
                    ``(A) Provision of benefits.--In providing benefits 
                under a contract under this section, an eligible entity 
                may--
                            ``(i) employ mechanisms to provide benefits 
                        economically, including the use of--
                                    ``(I) formularies;
                                    ``(II) alternative methods of 
                                distribution; and
                                    ``(III) generic drug substitution; 
                                and
                            ``(ii) use incentives to encourage eligible 
                        beneficiaries to select cost-effective drugs or 
                        less costly means of receiving drugs which are 
                        of equal clinical effectiveness.
            ``(6) Procedures regarding denials of care.--The eligible 
        entity has in place procedures to ensure--
                    ``(A) the timely review and resolution of denials 
                of care and complaints (including those regarding the 
                use of formularies under paragraph (5)) by eligible 
                beneficiaries, or providers, pharmacists, and other 
                individuals acting on behalf of each such beneficiary 
                (with the beneficiary's consent) in accordance with 
                requirements (as established by the Secretary) that are 
                comparable to such requirements for Medicare+Choice 
                organizations under part C; and
                    ``(B) that beneficiaries are provided with 
                information regarding the appeals procedures under this 
                section at the time of enrollment.
    ``(g) Protection of Patient Confidentiality.--Insofar as an 
eligible organization maintains individually identifiable medical 
records or other health information regarding eligible beneficiaries 
under a contract entered into under this section, the organization 
shall--
            ``(1) safeguard the privacy of any individually 
        identifiable beneficiary information;
            ``(2) maintain such records and information in a manner 
        that is accurate and timely; and
            ``(3) assure timely access of such beneficiaries to such 
        records and information.
    ``(h) Definitions.--In this section:
            ``(1) Preventive outpatient prescription drug.--The term 
        `preventive outpatient prescription drug' means any drug or 
        biological not otherwise covered under this title that may be 
        dispensed only upon prescription and as a direct result of the 
        individual's participation in--
                    ``(A) a screening mammography (as defined in 
                section 1861(jj));
                    ``(B) a screening pap smear or a screening pelvic 
                exam (as defined in section 1861(nn));
                    ``(C) a prostate cancer screening test (as defined 
                in section 1861(oo));
                    ``(D) a colorectal cancer screening test (as 
                defined in section 1861(pp));
                    ``(E) a diabetes outpatient self-management 
                training service (as defined in section 1861(qq);
                    ``(F) a bone mass measurement (as defined in 
                section 1861(rr));
                    ``(G) a cessation of tobacco use program (as 
                defined in section 1861(uu));
                    ``(H) a screening for hypertension (as defined in 
                section 1861(vv));
                    ``(I) counseling for hormone replacement therapy 
                (as defined in section 1861(ww));
                    ``(J) a screening for glaucoma (as defined in 
                section 1861(xx)); or
                    ``(K) any other preventive service (as defined by 
                the Secretary).
            ``(2) Eligible beneficiary.--The term `eligible 
        beneficiary' means an individual that is enrolled under part B 
        of this title.
            ``(3) Eligible entity.--The term `eligible entity' means 
        any entity that the Secretary determines to be appropriate, 
        including--
                    ``(A) any pharmaceutical benefit management 
                company;
                    ``(B) any wholesale or retail pharmacist delivery 
                system;
                    ``(C) any insurer; or
                    ``(D) any combination of the entities described in 
                subparagraphs (A) through (C).''.

SEC. 303. ACCESS OF LOW-INCOME BENEFICIARIES TO PREVENTIVE OUTPATIENT 
              PRESCRIPTION DRUGS.

    (a) Eligibility.--Section 1902(a)(10) of the Social Security Act 
(42 U.S.C. 1396a(a)(10)) is amended--
            (1) in subparagraph (E)(iv)(II), by striking ``and'' at the 
        end;
            (2) in subparagraph (F), by inserting ``and'' at the end; 
        and
            (3) by inserting after subparagraph (F), the following:
                    ``(G) for making medical assistance available (but 
                only for preventive outpatient prescription drugs (as 
                defined in section 1849(h)(1)) in the same amount, 
                duration, and scope as such assistance for such drugs 
                is made available to any individual described in 
                subparagraph (A)(i)) for any individual who--
                            ``(i) is a qualified medicare beneficiary 
                        described in section 1905(p)(1);
                            ``(ii) would be a qualified medicare 
                        beneficiary described in section 1905(p)(1) 
                        except for the fact that the income of such 
                        individual exceeds the income level established 
                        by the State under section 1905(p)(2) but is 
                        less than 135 percent of the official poverty 
                        line (referred to in such section) for a family 
                        of the size involved, and who is not otherwise 
                        eligible for medical assistance for preventive 
                        outpatient prescription drugs under the State 
                        plan; and
                            ``(iii) would otherwise satisfy the 
                        requirements of clause (i) or (ii) except for 
                        the fact that they are entitled to hospital 
                        insurance benefits under part A of title XVIII 
                        only pursuant to an enrollment under section 
                        1818A;''.
    (b) Payments to States.--
            (1) In general.--Section 1903 of such Act (42 U.S.C. 1396b) 
        is amended by adding at the end the following:
    ``(x)(1) Subject to paragraph (2), with respect to medical 
assistance that is attributable to the enactment of section 
1902(a)(10)(G), including an estimate of medical assistance provided to 
additional individuals who enroll in the State plan under this title 
due to such enactment, the Federal medical assistance percentage for 
such medical assistance is equal to 100 percent.
    ``(2) No payment shall be made to a State for medical assistance 
described in paragraph (1) unless the State demonstrates to the 
satisfaction of the Secretary that, with respect to a fiscal year, 
State expenditures for any State-funded prescription drug program is 
not less than the level of such expenditures for fiscal year 1999.''.
            (2) Conforming amendment.--Section 1905(b) of such Act (42 
        U.S.C. 1396d(b)) is amended in the first sentence by inserting 
        ``and 1903(x)'' after ``1933(d)''.

SEC. 304. ALLOCATION OF FEDERAL PROCEEDS FROM GLOBAL TOBACCO SETTLEMENT 
              TO ENHANCE PREVENTIVE OUTPATIENT PRESCRIPTION DRUG 
              BENEFIT.

    (a) Transfer of Federal Proceeds From Global Tobacco Settlement.--
The Secretary of the Treasury shall transfer to the Federal 
Supplementary Medical Insurance Trust Fund established under section 
1841 of the Social Security Act (42 U.S.C. 1395t) an amount equal to 50 
percent of any amount received by the Federal Government as a result of 
any legislation providing for a global tobacco settlement. Such 
transfer shall occur not later than 60 days after each date on which 
the Federal Government receives such amount.
    (b) Use of Amount Transferred.--Any amount transferred pursuant to 
subsection (a) shall be available to enhance the drug benefit described 
in section 1849 of the Social Security Act (as added by section 302) in 
a manner that is consistent with the recommendations of the Institute 
of Medicine of the National Academy of Sciences developed under section 
305.

SEC. 305. MEDICARE DRUG BENEFIT STUDY.

    (a) In General.--The Secretary shall contract with the Institute of 
Medicine of the National Academy of Sciences to conduct the study 
described in subsection (b) and submit the report described in 
subsection (c).
    (b) Study.--The Institute of Medicine of the National Academy of 
Sciences shall--
            (1) conduct a study of the feasibility and issues involved 
        in the developing, administering, and financing of a 
        comprehensive outpatient prescription drug benefit under the 
        medicare program; and
            (2) develop a prioritized list of drug categories that 
        could be added to the benefit based on the availability of 
        funding.
    (c)  Report.--Not later than June 30, 2001, the Institute of 
Medicine of the National Academy of Sciences shall submit a report to 
the Secretary which contains--
            (1) a detailed statement of the findings and conclusions of 
        the study conducted under subsection (b)(1);
            (2) the list developed under subsection (b)(2); and
            (3) the recommendations of the Secretary for such 
        legislative and administrative actions as it considers 
        appropriate.
    (d) Submission to Congress.--Not later than 30 days after the 
Secretary receives the report described in subsection (c), the 
Secretary shall transmit the report to Congress.

SEC. 306. EFFECTIVE DATE.

    Except as otherwise provided, the amendments made by this title 
shall apply to items and services furnished on or after January 1, 
2001.

TITLE IV--STUDIES AND REPORTS ADVANCING ORIGINAL RESEARCH IN THE FIELD 
                     OF PREVENTION AND THE ELDERLY

SEC. 401. MEDPAC BIANNUAL REPORT.

    (a) In General.--Section 1805(b) of the Social Security Act (42 
U.S.C. 1395b-6(b)) is amended--
            (1) in paragraph (1)--
                    (A) in subparagraph (C), by striking ``and'' at the 
                end;
                    (B) in subparagraph (D), by striking the period and 
                inserting ``; and''; and
                    (C) by adding at the end the following:
                    ``(E) by not later than January 1, 2001, and 
                biannually thereafter, submit the report to Congress 
                described in paragraph (7).''; and
            (2) by adding at the end the following:
            ``(7) Evaluation of actuarial equivalence of medicare and 
        private sector benefit packages.--
                    ``(A) Evaluation.--The Commission shall--
                            ``(i) evaluate the benefit package offered 
                        under the medicare program under this title; 
                        and
                            ``(ii) determine the degree to which such 
                        benefit package is actuarially equivalent to 
                        that offered by health benefit programs 
                        available in the private sector to individuals 
                        over age 65.
                    ``(B) Report.--The Commission shall submit a report 
                to Congress that shall contain--
                            ``(i) a detailed statement of the findings 
                        and conclusions of the Commission regarding the 
                        evaluation conducted under subparagraph (A);
                            ``(ii) the recommendations of the 
                        Commission regarding changes in the benefit 
                        package offered under the medicare program 
                        under this title that would keep the program 
                        modern and competitive in relation to health 
                        benefit programs available in the private 
                        sector; and
                            ``(iii) the recommendations of the 
                        Commission for such legislation and 
                        administrative actions as it considers 
                        appropriate.''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

SEC. 402. NATIONAL INSTITUTE ON AGING STUDY AND REPORT.

    (a) Studies.--The Director of the National Institute on Aging shall 
conduct 1 or more studies focusing on ways to--
            (1) improve quality of life for the elderly;
            (2) develop better ways to prevent or delay the onset of 
        age-related functional decline and disease and disability among 
        the elderly; and
            (3) develop new means of assessing the long-term cost-
        effectiveness of health promotion and disease prevention 
        efforts among the elderly.
    (b) Report.--Not later than January 1, 2005, the Director of the 
National Institute on Aging shall submit a report to the Secretary 
regarding each study conducted under subsection (a) and containing a 
detailed statement of research findings and conclusions that are 
scientifically valid and are demonstrated to prevent or delay the onset 
of chronic illness or disability among the elderly.
    (c) Transmission to Institute of Medicine.--Upon receipt of each 
report described in subsection (b), the Secretary shall transmit such 
report to the Institute of Medicine of the National Academy of Sciences 
for consideration in its effort to conduct the comprehensive study of 
current literature and best practices in the field of health promotion 
and disease prevention among the medicare beneficiaries described in 
section 403.
    (d) Authorization of Appropriations.--
            (1) In general.--There are authorized to be appropriated 
        $100,000,000 for fiscal years 2000 through 2005 to carry out 
        the purposes of this section.
            (2) Availability.--Any sums appropriated under the 
        authorization contained in this subsection shall remain 
        available, without fiscal year limitation, until September 30, 
        2004.

SEC. 403. INSTITUTE OF MEDICINE 5-YEAR MEDICARE PREVENTION BENEFIT 
              STUDY AND REPORT.

    (a) Study.--
            (1) In general.--The Secretary shall contract with the 
        Institute of Medicine of the National Academy of Sciences to 
        conduct a comprehensive study of current literature and best 
practices in the field of health promotion and disease prevention among 
medicare beneficiaries including the issues described in paragraph (2) 
and to submit the report described in subsection (b).
            (2) Issues studied.--The study required under paragraph (1) 
        shall include an assessment of--
                    (A) clinical and cost-effectiveness issues;
                    (B) utilization of covered benefits (including any 
                barriers to or incentives to increase utilization); and
                    (C) quality of life issues associated with both 
                health promotion and disease prevention benefits or 
                outpatient prescription drugs covered under the 
                medicare program and those that are not covered under 
                such program that would affect all medicare 
                beneficiaries.
    (b) Report.--
            (1) In general.--Not later than 5 years after the date of 
        enactment of this section, and every fifth year thereafter, the 
        Institute of Medicine of the National Academy of Sciences shall 
        submit to the President a report that contains a detailed 
        statement of the findings and conclusions of the study 
        conducted under subsection (a) and the recommendations for 
        legislation described in paragraph (2).
            (2) Recommendations for legislation.--The Institute of 
        Medicine of the National Academy of Sciences, in consultation 
        with the Partnership for Prevention, shall develop 
        recommendations in legislative form that--
                    (A) prioritize the preventive benefits under the 
                medicare program, including outpatient prescription 
                drugs; and
                    (B) modify preventive benefits offered under the 
                medicare program based on the study conducted under 
                subsection (a).
    (c) Transmission to Congress.--
            (1) In general.--On the day on which the report described 
        in subsection (b) is submitted to the President, the President 
        shall transmit the report and recommendations in legislative 
        form described in subsection (b)(2) to Congress.
            (2) Delivery.--Copies of the report and recommendations in 
        legislative form required to be transmitted to Congress under 
        paragraph (1) shall be delivered--
                    (A) to both Houses of Congress on the same day;
                    (B) to the Clerk of the House of Representatives if 
                the House is not in session; and
                    (C) to the Secretary of the Senate if the Senate is 
                not in session.

SEC. 404. FAST-TRACK CONSIDERATION OF PREVENTION BENEFIT LEGISLATION.

    (a) Rules of House of Representatives and Senate.--This section is 
enacted by Congress--
            (1) as an exercise of the rulemaking power of the House of 
        Representatives and the Senate, respectively, and is deemed a 
        part of the rules of each House of Congress, but--
                    (A) is applicable only with respect to the 
                procedure to be followed in that House of Congress in 
                the case of an implementing bill (as defined in 
                subsection (d)); and
            (B) supersedes other rules only to the extent that such 
        rules are inconsistent with this section; and
            (2) with full recognition of the constitutional right of 
        either House of Congress to change the rules (so far as 
        relating to the procedure of that House of Congress) at any 
        time, in the same manner and to the same extent as in the case 
        of any other rule of that House of Congress.
    (b) Introduction and Referral.--
            (1) Introduction.--
                    (A) In general.--Subject to paragraph (2), on the 
                day on which the President transmits the report 
                pursuant to section 403(c) to the House of 
                Representatives and the Senate, the recommendations in 
                legislative form transmitted by the President with 
                respect to such report shall be introduced as a bill 
                (by request) in the following manner:
                            (i) House of representatives.--In the 
                        House, by the majority leader of the House, for 
                        himself and the minority leader of the House, 
                        or by Members of the House designated by the 
                        majority leader and minority leader of the 
                        House.
                            (ii) Senate.--In the Senate, by the 
                        majority leader of the Senate, for himself and 
                        the minority leader of the Senate, or by 
                        Members of the Senate designated by the 
                        majority leader and minority leader of the 
                        Senate.
                    (B) Special rule.--If either House of Congress is 
                not in session on the day on which such recommendations 
                in legislative form are transmitted, the 
                recommendations in legislative form shall be introduced 
                as a bill in that House of Congress, as provided in 
                subparagraph (A), on the first day thereafter on which 
                that House of Congress is in session.
            (2) Referral.--Such bills shall be referred by the 
        Presiding Officers of the respective Houses to the appropriate 
        committee, or, in the case of a bill containing provisions 
        within the jurisdiction of 2 or more committees, jointly to 
        such committees for consideration of those provisions within 
        their respective jurisdictions.
    (c) Consideration.--After the recommendations in legislative form 
have been introduced as a bill and referred under subsection (b), such 
implementing bill shall be considered in the same manner as an 
implementing bill is considered under subsections (d), (e), (f), and 
(g) of section 151 of the Trade Act of 1974 (19 U.S.C. 2191).
    (d) Implementing Bill Defined.--In this section, the term 
``implementing bill'' means only the recommendations in legislative 
form of the Institute of Medicine of the National Academy of Sciences 
described in section 403(b)(2), transmitted by the President to the 
House of Representatives and the Senate under subsection 403(c), and 
introduced and referred as provided in subsection (b) as a bill of 
either House of Congress.
    (e) Counting of Days.--For purposes of this section, any period of 
days referred to in section 151 of the Trade Act of 1974 shall be 
computed by excluding--
            (1) the days on which either House of Congress is not in 
        session because of an adjournment of more than 3 days to a day 
        certain or an adjournment of Congress sine die, and
            (2) any Saturday and Sunday, not excluded under paragraph 
        (1), when either House is not in session.
                                 <all>