[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 1270 Introduced in Senate (IS)]







108th CONGRESS
  1st Session
                                S. 1270

To amend title XVIII of the Social Security Act to provide for coverage 
of medication therapy management services under part B of the medicare 
                                program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 16, 2003

  Mr. Johnson (for himself and Mr. Cochran) 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 provide for coverage 
of medication therapy management services under part B of the medicare 
                                program.

    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 ``Medication Therapy Management Act of 
2003''.

SEC. 2. MEDICARE COVERAGE OF MEDICATION THERAPY MANAGEMENT SERVICES.

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

     ``Medication Therapy Management Services; Qualified Pharmacist

    ``(ww)(1)(A) The term `medication therapy management services' 
means services or programs furnished by a qualified pharmacist to an 
individual described in subparagraph (B), individually or on behalf of 
a pharmacy provider, which are designed--
            ``(i) to ensure that medications are used appropriately by 
        such individual;
            ``(ii) to enhance the individual's understanding of the 
        appropriate use of medications;
            ``(iii) to increase the individual's compliance with 
        prescription medication regimens;
            ``(iv) to reduce the risk of potential adverse events 
        associated with medications; and
            ``(v) to reduce the need for other costly medical services 
        through better management of medication therapy.
    ``(2) The term `qualified pharmacist' means an individual who is a 
licensed pharmacist in good standing with the State Board of 
Pharmacy.''.
    (c) Covered Conditions and Treatments.--Section 1861(ww)(1) of such 
Act (42 U.S.C. 1395x(ww)(1)) (as added by subsection (b)), is amended 
by adding at the end the following:
    ``(B) For purposes of subparagraph (A), an individual described in 
this subparagraph is an individual who is receiving, in accordance with 
State law or regulation, medication for--
            ``(i) the treatment of asthma, diabetes, or chronic 
        cardiovascular disease, including an individual on 
        anticoagulation or lipid reducing medications; or
            ``(ii) such other chronic diseases as the Secretary may 
        specify.''.
    (d) Payment.--
            (1) In general.--Section 1833(a)(1) of the Social Security 
        Act (42 U.S.C. 1395l(a)(1)) is amended--
                    (A) by striking ``and'' before ``(U)''; and
                    (B) by inserting before the semicolon at the end 
                the following: ``, and (V) with respect to medication 
                therapy management services (as defined in section 
                1861(ww)(1)), the amounts paid shall be 80 percent of 
                the lesser of the actual charge or the amount 
                established under section 1834(n)''.
            (2) Establishment of fee schedule; payments prior to 
        implementation of fee schedule.--Section 1834 of the Social 
        Security Act (42 U.S.C. 1395m) is amended by adding at the end 
        the following new subsection:
    ``(n) Fee Schedules for Medication Therapy Management Services.--
            ``(1) Development.--The Secretary shall develop--
                    ``(A) a relative value scale to serve as the basis 
                for the payment of medication therapy management 
                services (as defined in section 1861(ww)(1)) under this 
                part; and
                    ``(B) using such scale and appropriate conversion 
                factors, fee schedules (on a regional, statewide, 
                locality, or carrier service area basis) for payment 
                for medication therapy management services under this 
                part, to be implemented for such services furnished 
                during years beginning after the expiration of the 3-
                year period which begins on the date of enactment of 
                this subsection.
            ``(2) Considerations.--In developing the relative value 
        scale and fee schedules under paragraph (1), the Secretary 
        shall consider differences in--
                    ``(A) the time required to perform types of 
                medication therapy management services;
                    ``(B) the level of risk associated with the use of 
                particular out-patient prescription drugs or groups of 
                drugs; and
                    ``(C) the health status of individuals to whom 
                medication therapy management services are provided.
            ``(3) Consultation.--In developing the fee schedule for 
        medication therapy management services under this subsection, 
        the Secretary shall consult with various national organizations 
        representing pharmacists and pharmacies and share with such 
        organizations the relevant data and data analysis being used in 
        establishing such fee schedule, including data on variations in 
        payments under this part by geographic area and by service.
            ``(4) Payments prior to implementation of fee schedule.--In 
        the case of a medication therapy management service (as defined 
        in section 1861(ww)(1)) that is furnished before the 
        implementation of the fee schedule developed under paragraph 
        (1)(B), the Secretary shall pay an amount equal to 80 percent 
        of the amount that the Secretary would pay for such service 
        under the fee schedule established under section 1848 if the 
        service were furnished by a physician or as an incident to a 
        physician's service.''.
    (e) Report to Congress.--Not later than 3 years after the date of 
enactment of this Act, the Secretary of Health and Human Services shall 
submit to Congress a report on the relative value scale and fee 
schedules developed under section 1834(n)(1) of the Social Security Act 
(as added by subsection (d)(2)) for medication therapy management 
services furnished under part B of the medicare program under title 
XVIII of the Social Security Act.
    (f) Effective Date.--The amendments made by this section shall 
apply to services furnished on or after January 1, 2004.
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