[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1144 Introduced in House (IH)]






109th CONGRESS
  1st Session
                                H. R. 1144

 To continue State coverage of Medicaid prescription drug coverage to 
Medicare dual eligible beneficiaries for 6 months while still allowing 
      the Medicare part D benefit to be implemented as scheduled.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 8, 2005

  Mr. Allen 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

_______________________________________________________________________

                                 A BILL


 
 To continue State coverage of Medicaid prescription drug coverage to 
Medicare dual eligible beneficiaries for 6 months while still allowing 
      the Medicare part D benefit to be implemented as scheduled.

    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 Dual Eligible Prescription 
Drug Coverage Act of 2005''.

SEC. 2. FINDINGS.

    The Senate finds the following:
            (1) Individuals who are dually eligible for benefits under 
        the medicare program and full benefits under the medicaid 
        program--
                    (A) are among the most vulnerable populations in 
                our society; and
                    (B) require adequate outreach, education, and 
                timing in order to adjust to changes in our health care 
                delivery system.
            (2) The transition of 6,400,000 dual eligibles from 
        prescription drug coverage under the medicaid program to 
        prescription drug coverage under part D of the medicare program 
        is the largest transition ever of individuals from one 
        insurance program to another.
            (3) In its June 2004 report to Congress, the Medicare 
        Payment Advisory Commission (MedPAC) suggested that large, 
        private employers with 75,000 employees or less need at least 6 
        months to transition their employees' drug coverage from one 
        pharmacy benefit management company to another such company. 
        The States and the Federal Government are taking on a far more 
        complex task with 6,400,000 dual eligibles having to make the 
        transition described in paragraph (2).
            (4) Timely access to prescription drugs leads to higher 
        quality of life and prevents avoidable emergency room visits, 
        hospitalizations, and premature nursing home placements.
            (5) Since even a short-term gap in prescription drug 
        coverage could have serious health consequences for dual 
        eligibles, Congress must work to guarantee as smooth a 
        transition as possible for dual eligibles so that no dual 
        eligible is without prescription drug coverage even for one 
        day.

SEC. 3. CONTINUING STATE COVERAGE OF MEDICAID PRESCRIPTION DRUG 
              COVERAGE TO MEDICARE DUAL ELIGIBLE BENEFICIARIES FOR 6 
              MONTHS.

    (a) Six-Month Transition.--For prescriptions filled during the 
period beginning on January 1, 2006, and ending on June 30, 2006, 
section 1935(d) of the Social Security Act (42 U.S.C. 1396u-5(d)) shall 
not apply and, notwithstanding any other provision of law, a State (as 
defined for purposes of title XIX of such Act) shall continue to 
provide (and receive Federal financial participation for) medical 
assistance under such title with respect to prescription drugs as if 
such section 1935(d) had not been enacted.
    (b) Application.--
            (1) Medicare as primary payer.--Nothing in subsection (a) 
        shall be construed as changing or affecting the primary payer 
        status of a prescription drug plan or an MA-PD plan under part 
        D of title XVIII of the Social Security Act with respect to 
        prescription drugs furnished to any full-benefit dual eligible 
        individual (as defined in section 1935(c)(6) of such Act (42 
        U.S.C. 1396u-5(c)(6)) during the 6-month period described in 
        such subsection.
            (2) Third party liability.--Nothing in subsection (a) shall 
        be construed as limiting the authority or responsibility of a 
        State under section 1902(a)(25) of the Social Security Act (42 
        U.S.C. 1396a(a)(25)) to seek reimbursement from a prescription 
        drug plan, an MA-PD plan, or any other third party, of the 
        costs incurred by the State in providing prescription drug 
        coverage described in such subsection.

SEC. 4. DELAY IN IMPLEMENTATION OF MEDICAID CLAWBACK PAYMENTS.

    Notwithstanding section 1935(c) of the Social Security Act (42 
U.S.C. 1396u-5(c)), a State or the District of Columbia shall not be 
required to provide for a payment under such section to the Secretary 
of Health and Human Services for any month prior to July 1, 2006.

SEC. 5. EDUCATION AND OUTREACH TO DUAL ELIGIBLES REGARDING PRESCRIPTION 
              DRUG COVERAGE AND MONITORING OF THE TRANSITION OF DUAL 
              ELIGIBLES TO PRESCRIPTION DRUG COVERAGE UNDER MEDICARE.

    (a) MMA Amounts.--Notwithstanding any other provision of law, of 
the amounts appropriated for the Centers for Medicare & Medicaid 
Services under section 1015(a)(1) of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Public Law 108-173; 117 
Stat. 2446), the following rules shall apply:
            (1) Education and outreach to duals.--$100,000,000 shall be 
        used to provide education and outreach, including through one-
        on-one counseling and application assistance, to full-benefit 
        dual eligible individuals (as defined in section 1935(c)(6) of 
        the Social Security Act (42 U.S.C. 1396u-5(c)(6))) regarding 
        prescription drug coverage under part D of title XVIII of such 
        Act. Of such amount--
                    (A) at least $20,000,000 (but in no case more than 
                $50,000,000) shall be used to award grants to States 
                under section 4360 of the Omnibus Budget Reconciliation 
                Act of 1990 (42 U.S.C. 1395b-4) to provide such 
                education and outreach; and
                    (B) the remaining amount shall be used to provide 
                funding to community-based organizations that work with 
                full-benefit dual eligible individuals (as so defined) 
                in order to provide such education and outreach.
            (2) Monitoring impact on duals.--
                    (A) In general.--$50,000,000 shall be used by the 
                Centers for Medicare & Medicaid Services, in 
                consultation with the Centers for Disease Control and 
                Prevention, the Administration on Aging, and the Social 
                Security Administration, to develop and implement a 
                standardized protocol to collect data from health 
                departments and other sources in 10 representative 
                urban and rural communities on the impact of the 
                transition of full benefit dual eligible individuals 
                (as so defined) from prescription drug coverage under 
                the medicaid program to prescription drug coverage 
                under part D of the medicare program. Such protocol 
                shall be implemented by not later than July 1, 2005.
                    (B) Monitoring.--The protocol developed under 
                subparagraph (A) shall include for the monitoring of 
                the following information with respect to such full 
                benefit dual eligible individuals:
                            (i) Emergency room visit rates.
                            (ii) Hospitalization rates.
                            (iii) Nursing home placement rates.
                            (iv) Deaths.
                    (C) Collection by pdps and ma-pds.--The protocol 
                developed under subparagraph (A) shall require that 
                such data be collected by the prescription drug plans 
                and the MA-PDs in which the individuals are enrolled 
                and include information on race and ethnicity.
                    (D) Reports.--Not later than January 1, 2006, and 
                July 1, 2006, the Administrator of the Centers for 
                Medicare & Medicaid Services, in consultation with the 
                Centers for Disease Control and Prevention, the 
                Administration on Aging, and the Social Security 
                Administration, shall submit a report to Congress on 
                the implementation of the protocol under subparagraph 
                (A).
    (b) New Amounts.--There are appropriated to the Secretary of Health 
and Human Services, to be transferred from the Federal Hospital 
Insurance Trust Fund and the Federal Supplementary Medical Insurance 
Trust Fund, for fiscal year 2005 and each subsequent fiscal year, an 
amount not to exceed $50,000,000 (or if greater, an amount equal to $1 
multiplied by the number of individuals entitled to benefits under part 
A of title XVIII of the Social Security Act or enrolled under part B of 
such title for the year) in order to award grants to States under 
section 4360 of the Omnibus Budget Reconciliation Act of 1990 (42 
U.S.C. 1395b-4).
    (c) Extension of Availability of Amounts Appropriated Under MMA.--
Section 1015(b) of the Medicare Prescription Drug, Improvement, and 
Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2446) is 
amended by striking ``September 30, 2005'' and inserting ``September 
30, 2006''.

SEC. 6. COLLECTION AND SHARING OF DUAL ELIGIBLE DRUG UTILIZATION DATA.

    (a) In General.--Section 1860D-42 of the Social Security Act (42 
U.S.C. 1395w-152) is amended by adding at the end the following new 
subsection:
    ``(c) Collection and Sharing of Dual Eligible Drug Utilization 
Data.--
            ``(1) Plan requirement.--A PDP sponsor of a prescription 
        drug plan and an MA organization offering an MA-PD plan shall 
        submit to the Secretary such information regarding the drug 
        utilization of enrollees in such plans who are full-benefit 
        dual eligible individuals (as defined in section 1935(c)(6)) as 
        the Secretary determines appropriate to carry out paragraph 
        (2).
            ``(2) Collection and sharing of data.--The Secretary shall 
        collect data on the drug utilization of full-benefit dual 
        eligible individuals (as so defined). The Secretary shall share 
        such data with the States and the District of Columbia in as 
        close to a real-time basis as possible.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect as if included in the enactment of section 101(a) of the 
Medicare Prescription Drug, Improvement, and Modernization Act of 2003 
(Public Law 108-173; 117 Stat. 2071).

SEC. 7. GAO STUDY ON THE CLAWBACK FORMULA.

    (a) Study.--
            (1) In general.--The Comptroller General of the United 
        States shall conduct a study on the clawback formula contained 
        in section 1935(c) of the Social Security Act (42 U.S.C. 1396u-
        5(c)), as added by section 103(b) of the Medicare Prescription 
        Drug, Improvement, and Modernization Act of 2003 (Public Law 
        108-173; 117 Stat. 2155).
            (2) Requirements.--The study conducted under paragraph (1) 
        shall include a full examination of--
                    (A) disincentives for States to enroll full-benefit 
                dual eligible individuals (as defined in section 
                1935(c)(6) of the Social Security Act (42 U.S.C. 1396u-
                5(c)(6))) in the medicaid program or part D of title 
                XVIII of the Social Security Act;
                    (B) the 6-month delay in States receiving rebate 
                data;
                    (C) the prescription drug cost containment measures 
                implemented by States after 2003; and
                    (D) issues relating to States having to pay more 
                for prescription drug coverage for full benefit dual 
                eligible individuals (as so defined) than they 
                otherwise would have if the Medicare Prescription Drug, 
                Improvement, and Modernization Act of 2003 (Public Law 
                108-173; 117 Stat. 2066 et seq.) had not been enacted.
    (b) Report.--Not later than April 1, 2006, the Comptroller General 
of the United States shall submit to Congress a report on the study 
conducted under subsection (a) together with such recommendations as 
the Comptroller General determines appropriate.
                                 <all>