II 109th CONGRESS 2d Session S. 2184 IN THE SENATE OF THE UNITED STATES January 25, 2006 Mr. Schumer 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 residents of long-term care facilities with assistance with respect to prescription drug coverage under part D of such title for the resident.

1.

Short title

This Act may be cited as the Long-Term Care Resident Part D Assistance Act of 2006.

2.

Part D assistance for residents of Long-Term care facilities

(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)

Assistance for Residents of Long-Term Care Facilities

(1)

Procedures and waiver of requirements

(A)

In general

The Secretary shall establish procedures and may waive requirements of this part as necessary to provide assistance to residents of long-term care facilities with respect to coverage under this part for the resident. (B)

Requirements

The procedures under subparagraph (A) shall include at least the following: (i)

Dedicated toll-free number

The establishment of a toll-free telephone number for staff members of long-term care facilities to request information regarding coverage under this part for the resident. (ii)

Assistance in selecting a plan rather than auto enrollment in a random plan

Notwithstanding section 1860D–1(b)(1)(C), in the case of a part D eligible individual who is a full-benefit dual eligible individual (as defined in section 1935(c)(6)), who is a resident of a long-term care facility, and who has failed to enroll in a prescription drug plan or an MA–PD plan, rather than randomly enrolling such an individual in a plan pursuant to such section, the Secretary shall coordinate with the resident and the long-term care facility to facilitate selection of and enrollment in the most appropriate plan under this part for the resident. (iii)

Reimbursement of certain costs

The provision of reimbursement to long-term care facilities for the following costs: (I)

Costs associated with new requirements

Costs associated with the requirements under paragraph (2). (II)

Prescription drug expenditures for covered part D drugs

The amount that the long-term care facility expends for payment for covered part D drugs for residents of the long-term care facility who are part D eligible individuals enrolled in a prescription drug plan under this part but were unable to access on a timely basis prescription drug benefits to which they were entitled under such plan. (III)

Providing part D assistance for residents of long-term care facilities

Costs associated with providing part D assistance for residents of long-term care facilities (including technical assistance in filling prescriptions, time spent waiting on the telephone or online to determine what plan a resident is enrolled in, and costs associated with advocating for residents by filing appeals or facilitating plan changes). (2)

Requirements for long-term care facilities

(A)

In general

In the case of a long-term care facility receiving reimbursement under this title, the facility shall have in place procedures for— (i)educating residents who are part D eligible individuals about the prescription drug coverage available through plans under this part; and (ii)providing technical assistance, phone support, and counseling for such residents to facilitate selection of and enrollment in the most appropriate plan under this part for the resident. (B)

Requirement

The procedures under subparagraph (A) shall include a requirement that the facility periodically ascertain (and inform the resident regarding) whether or not the plan in which the resident is enrolled in— (i)provides coverage of the covered part D drugs that the resident requires; and (ii)has a contract with a pharmacy that supports the facility. . (b)

Effective Date

The amendments made by this section shall take effect on the date of enactment of this Act.