[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4541 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 4541

To amend title XVIII of the Social Security Act to provide for patient 
protections under the Medicare prescription drug program for residents 
                     of long term care facilities.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           December 13, 2007

Mr. Davis of Kentucky 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 amend title XVIII of the Social Security Act to provide for patient 
protections under the Medicare prescription drug program for residents 
                     of long term care facilities.

    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 Part D Long-Term Care 
Patient Protection Act of 2007''.

SEC. 2. FINDINGS.

    Congress finds as follows:
            (1) Medicare beneficiaries who are enrolled in the Medicare 
        prescription drug program and who reside in long-term care 
        facilities are among the most senior and frail of Medicare 
        beneficiaries, and often are in need of the specialized 
        pharmacy services such as those provided by long-term care 
        pharmacies.
            (2) Since January 1, 2006, many of the approximately 65 
        percent of residents of long-term care facilities who are 
        dually eligible for Medicaid and Medicare have been ``auto-
        enrolled'' as ``dual eligibles'' in prescription drug plans 
        under Medicare part D.
            (3) For long-term care facility residents in particular, 
        enrollment in a prescription drug plan under Medicare part D 
        can be complex and confusing, and ensuring access to medically 
        necessary medication is vital to maintaining their health, 
        avoiding hospitalizations, and otherwise containing health care 
        costs.
            (4) Part D enrollees residing in long-term care facilities 
        may have been auto-enrolled in one of as few as 5 and as many 
        as 20 different prescription drug plans, which may not be 
        properly tailored to meet the specialized prescription drug 
        needs of residents of nursing homes and other long-term care 
        facilities.
            (5) Prescription drug plans under Medicare part D vary in 
        terms of their formulary coverage of the prescription drugs 
        most frequently prescribed for long-term care residents, their 
        prior authorization and other drug utilization management 
        controls, and their procedures for processing exceptions 
        requests and prior authorization requests.
            (6) The Medicare prescription drug program should be 
        strengthened to ensure that residents of long-term care 
        facilities enjoy access to a prescription drug plan that meets 
        their needs and the unique nature of the long-term care 
        facility setting in which they reside.
            (7) Robust oversight of the Medicare prescription drug 
        program is important to prevent fraud, protect beneficiaries, 
        and maintain the program's fiscal integrity, and the Federal 
        anti-kickback statute and False Claims Act provide critical 
        safeguards against potential abuse.

SEC. 3. INCLUDING DEFINITION FOR LONG-TERM CARE PHARMACY UNDER MEDICARE 
              PART D.

    Section 1860D-41(a) of the Social Security Act (42 U.S.C. 1395w-
151(a)) is amended by adding at the end the following:
            ``(19) Long-term care pharmacy.--The term `long-term care 
        pharmacy' means a pharmacy owned by or under contract with a 
        long-term care facility to provide prescription drugs to 
        residents of such facility.''.

SEC. 4. ENSURING MEDICARE BENEFICIARIES ACCESS TO ADEQUATE LONG-TERM 
              CARE PHARMACY NETWORKS.

    (a) In General.--Section 1860D-4(b)(1)(C) of the Social Security 
Act (42 U.S.C. 1395w-104(b)(1)(C)) is amended by striking clause (iv) 
and inserting the following clauses:
                            ``(iv) Adequate access for long-term care 
                        network pharmacies.--Such rules shall require 
                        the PDP sponsor of the prescription drug plan 
                        to include in its network an adequate number of 
                        long-term care pharmacies with sufficient 
                        capacity and experience with long-term care 
                        facilities in a PDP region to service at least 
                        90 percent of the number of residential beds in 
                        such facilities in such region.
                            ``(v) Convenient access for indian health 
                        services.--Such rules may include standards for 
                        pharmacies operated by the Indian Health 
                        Service, Indian tribes and tribal 
                        organizations, and urban Indian organizations 
                        (as defined in section 4 of the Indian Health 
                        Care Improvement Act).''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to plan years beginning on or after January 1, 2009.

SEC. 5. LONG-TERM CARE BENEFICIARY PROTECTION ARRANGEMENTS UNDER 
              MEDICARE PART D.

    (a) In General.--Section 1860D-4(c) of the Social Security Act (42 
U.S.C. 1395w-104(c)) is amended--
            (1) in paragraph (1), by inserting after subparagraph (D) 
        the following new subparagraph:
                    ``(E) A long-term care beneficiary protection 
                arrangement described in paragraph (3).''; and
            (2) by adding at the end the following new paragraph:
            ``(3) Long-term care beneficiary protection arrangement.--A 
        long-term care beneficiary protection arrangement described in 
        this paragraph is, with respect to a PDP sponsor of a 
        prescription drug plan, a policy that requires, at a minimum, 
        each long-term care pharmacy that participates in the network 
        of the plan and that is owned by or under contract with a long-
        term care facility to provide for the following:
                    ``(A) Comprehensive inventory and inventory 
                capacity.--A comprehensive inventory (and inventory 
                capacity) of covered part D drugs commonly used in the 
                long-term care facility (including in the case of a 
                prescription drug plan that uses a formulary, a 
                comprehensive inventory of all covered part D drugs 
                included in such formulary) and an appropriately 
                secured area for physical storage of such drugs, 
                including any necessary additional security for storing 
                controlled substances, as required by Federal and State 
                law, for routine storage and maintenance of such drugs 
                in the business setting of the pharmacy.
                    ``(B) Pharmacy operation and prescription orders.--
                Sufficient pharmacy operations and prescription orders 
                capabilities, including--
                            ``(i) the services of a dispensing 
                        pharmacist to meet the requirements of pharmacy 
                        practice for dispensing covered part D drugs to 
                        residents of the long-term care facility and 
                        for the performance of drug utilization review 
                        for routine screenings for allergies to such 
                        drugs and interactions of such drugs, to 
                        identify potential adverse reactions to such 
                        drugs, to identify inappropriate usage of such 
                        drugs by residents of the long-term care 
                        facility, and to promote cost effective therapy 
                        in the long-term care facility;
                            ``(ii) the use of pharmacy software and 
                        systems sufficient to meet the needs of 
                        ordering covered part D drugs for part D 
                        eligible individuals who are residents of the 
                        long-term care facility and distribution of 
                        such drugs to such facility;
                            ``(iii) the availability of written copies 
                        of the pharmacy's procedures manual at each 
                        nurses' unit in the long-term care facility;
                            ``(iv) the provision of ongoing inservice 
                        training to assure that the staff of the long-
                        term care facility is proficient in the long-
                        term care pharmacy's processes for ordering and 
                        receiving medications; and
                            ``(v) following procedures specified by the 
                        State Board of Pharmacy for the State in which 
                        the long-term care pharmacy is located for the 
                        appropriate handling of unused covered part D 
                        drugs following discontinuance of such drug by 
                        an individual or the transfer, discharge, or 
                        death of such individual.
                    ``(C) Special packaging.--The capacity to provide 
                covered part D drugs in packaging required by the long-
                term care facility (such as unit of use packaging, 
                bingo cards, cassettes, unit doses, or other special 
                packaging), including access to, or arrangements with, 
                a vendor to furnish supplies and equipment, including 
                labels, auxiliary labels, and packing machines, for 
                furnishing covered part D drugs in such packaging.
                    ``(D) Intravenous medications.--The capacity to 
                provide intravenous covered part D drugs to part D 
                eligible individuals who are residents of the long-term 
                care facility, including access to specialized 
                facilities for the preparation of such intravenous 
                drugs and access to or arrangements with a vendor to 
                furnish special equipment and supplies as well as 
                pharmacists and technicians trained in administering 
                such drugs intravenously.
                    ``(E) Compounding and alternative forms of drug 
                composition.--The capacity to provide specialized 
                formulations for the administration of covered part D 
                drugs as required for part D eligible individuals who 
                are residents of the long-term care facility, including 
                such residents who are unable to swallow or ingest 
                covered part D drugs through normal routes or who may 
                require tablets to be split or crushed or provided in 
                suspensions or gel forms to facilitate effective 
                administration of the drug.
                    ``(F) Pharmacist on-call service.--A pharmacist who 
                is on-call 24 hours a day and 7 days a week to conduct 
                consultations by means of telephone or other similar 
                electronic communication device and fill prescription 
                requests.
                    ``(G) Delivery service.--The provision of covered 
                part D drugs to the long-term care facility, 
                including--
                            ``(i) regular delivery service seven days 
                        each week;
                            ``(ii) emergency delivery service available 
                        24 hours a day, 7 days a week;
                            ``(iii) specific delivery arrangements 
                        established through agreements between the 
                        long-term care pharmacy and the long-term care 
                        facility; and
                            ``(iv) safe and secure exchange systems for 
                        delivery of such drugs to the long-term care 
                        facility, including medication cassettes or 
                        other standard delivery systems that may be 
                        exchanged on a routine basis for automatic 
                        restocking.
                    ``(H) Emergency supplies.--Emergency supply of 
                covered part D drugs as required by the long-term care 
                facility in compliance with State requirements.
                    ``(I) Emergency log books.--A system for--
                            ``(i) logging covered part D drugs (and 
                        charges for such drugs) used from an emergency 
                        supply; and
                            ``(ii) a comprehensive record of the 
                        covered part D drugs ordered for and 
                        administered to each part D eligible individual 
                        who is a resident of the long-term care 
                        facility.
                    ``(J) Miscellaneous reports, forms, and 
                prescription ordering supplies.--Reports, forms, and 
                prescription ordering supplies necessary for the 
                delivery of quality pharmacy care in the long-term care 
                facility, including provider order forms, monthly 
                management reports to assist the long-term care 
                facility in managing orders, medication administration 
                records, treatment administration records, interim 
                order forms for new prescription orders, and boxes or 
                folders for order storage and reconciliation in the 
                facility.
        Notwithstanding any other provision of law, nothing in this 
        paragraph shall restrict a PDP sponsor and a long-term care 
        pharmacy from entering into an agreement to provide additional 
        protections as they deem appropriate and necessary for the 
        protection of part D eligible individuals residing in long-term 
        care facilities.''.
    (b) Conforming Amendment.--Section 1860D-4(c) of the Social 
Security Act (42 U.S.C. 1395w-104(c)) is amended in the heading by 
adding at the end the following: ``; Long-Term Care Beneficiary 
Protection Policy''.
    (c) Effective Date.--The amendments made by this section shall 
apply to plan years beginning on or after January 1, 2009.

SEC. 6. LONG-TERM CARE BENEFICIARY ACCESS AND ASSISTANCE.

    (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) In general.--Nothing in this part shall prohibit a 
        part D eligible individual who is a resident of a long-term 
        care facility, or an authorized representative of such 
        individual, from seeking or receiving assistance from a health 
        care professional or other appropriate individual who works at 
        the facility or from the individual's physician for purposes of 
        selecting, enrolling, disenrolling, or changing enrollment in a 
        prescription drug plan or MA-PD plan.
            ``(2) Authority to advise in selection of and enrollment in 
        plans.--Any physician, health care professional, or other 
        appropriate individual who works at a long-term care facility 
        may--
                    ``(A) advise any part D eligible individual 
                residing in the facility, or an authorized 
                representative of such individual, regarding the 
                adequacy of the individual's prescription drug coverage 
                in meeting the individual's prescription drug needs 
                (including the individual's anticipated prescription 
                drug needs); and
                    ``(B) make recommendations to such an individual, 
                with respect to such coverage, including a 
                recommendation to change enrollment or enroll in a 
                specific prescription drug plan or MA-PD plan that best 
                meets the individual's current and anticipated 
                prescription drug needs.
            ``(3) Authority to assist certain auto-enrolled part d 
        eligible individuals in changes of enrollment.--
                    ``(A) In general.--In the case of a part D eligible 
                individual who is enrolled in a prescription drug plan 
                pursuant to section 1860D-1(b)(1)(C), if such 
                individual--
                            ``(i) resides in a long-term care facility,
                            ``(ii) is incapable of changing such 
                        enrollment, or filing a grievance or coverage 
                        determination, redetermination, or appeal under 
                        section 1860D-4, and
                            ``(iii) does not have an authorized 
                        representative available to assist the 
                        individual in changing such enrollment, or 
                        filing such a grievance or coverage 
                        determination, redetermination, or appeal, 
                        respectively,
                the individual's physician, health care professional, 
                or other appropriate individual who works at the long-
                term care facility may act on the individual's behalf 
                to facilitate the change of enrollment of the 
                individual to the most appropriate prescription drug 
                plan under this part for the individual or to file such 
                a grievance or coverage determination, redetermination, 
                or appeal, respectively.
                    ``(B) Clarification.--Nothing in this paragraph 
                shall be construed as modifying or altering the rights 
                and responsibilities of designated representatives and 
                authorized representatives under State law.
            ``(4) Requirements for assistance.--Any individual who 
        assists a Medicare part D eligible individual residing in a 
        long-term care facility pursuant to this subsection shall--
                    ``(A) inform the resident or the authorized 
                representative of the resident if such individual or 
                the facility has a contractual or financial 
                relationship with a prescription drug plan under this 
                part or an MA-PD plan under part C;
                    ``(B) not receive any remuneration from the 
                resident or the prescription drug plan or MA-PD plan 
                involved, with respect to the enrollment of such 
                resident in such plan;
                    ``(C) in the case of a resident who is a full-
                benefit dual eligible individual (as defined in section 
                1935(c)(6)), recommend the resident enroll in or change 
                enrollment to a prescription drug plan only if such 
                plan has a monthly beneficiary premium that does not 
                exceed the premium assistance available under section 
                1860D-14(a)(1)(A)); and
                    ``(D) provide the resident or the authorized 
                representative of the resident with a written copy of 
                any advice provided by the individual, with respect to 
                an enrollment, disenrollment, or change of enrollment 
                decision, which includes a statement that the resident 
                may decline such advice, change any decision made 
                pursuant to such advice, or request the assistance of a 
                different individual.
            ``(5) Clarifications.--
                    ``(A) In general.--Nothing in this subsection shall 
                be construed as superseding or otherwise impeding the 
                right of a part D eligible individual who resides in a 
                long-term care facility to make the individual's own 
                prescription drug plan enrollment decisions under this 
                part.
                    ``(B) Non-preemption of state laws.--Nothing in 
                this subsection shall be construed as superseding or 
                otherwise affecting any State law regarding the right 
                of an individual described in subparagraph (A) to make 
                decisions described in such subparagraph or the right 
                of a representative of such an individual (or other 
                designated person) to make such decisions on behalf of 
                the individual.''.
    (b) Immediate Coverage Upon Entry Into Long-Term Care Facilities.--
Section 1860D-1(b)(1)(A) of the Social Security Act (42 U.S.C. 1395w-
101(b)(1)(A)) is amended to read as follows:
                    ``(A) In general.--The Secretary shall establish--
                            ``(i) a process for the enrollment, 
                        disenrollment, termination, and change of 
                        enrollment of part D eligible individuals in 
                        prescription drug plans consistent with this 
                        subsection; and
                            ``(ii) in the case of a part D eligible 
                        individual who becomes a resident of a long-
                        term care facility, a process for the immediate 
                        enrollment of such individual in a prescription 
                        drug plan upon the establishment of such 
                        residency (and upon such enrollment, 
                        immediately effective coverage under such plan) 
                        or, in the case of a part D eligible individual 
                        who is a resident in a long-term care facility, 
                        who is enrolled in a prescription drug plan, 
                        and who changes such enrollment to a different 
                        prescription drug plan, a process for the 
                        immediate enrollment of such individual in the 
                        different prescription drug plan (and upon such 
                        enrollment, immediately effective coverage 
                        under such plan).''.
    (c) Effective Date.--The amendments made by this section shall 
apply to plan years beginning on or after January 1, 2009.

SEC. 7. LONG-TERM CARE FORMULARY STRUCTURE AND DESIGN FOR LONG-TERM 
              CARE RESIDENTS.

    (a) In General.--Section 1860D-4(b)(3) of the Social Security Act 
(42 U.S.C. 1395w-104(b)(3)) is amended by adding at the end the 
following:
                    ``(G) Long-term care formulary structure and 
                design.--
                            ``(i) Formulary structure.--The formulary 
                        must take into account the needs of part D 
                        eligible individuals who are residents of long-
                        term care facilities by including all covered 
                        part D drugs that are medically necessary to 
                        such residents at all levels of care, including 
                        alternative dosage forms, such as liquid that 
                        can be administrated through feeding tubes, 
                        intravenous medications, or intramuscular 
                        injections. Access to necessary medications for 
                        long-term care residents may be provided 
                        through formulary inclusion, utilization 
                        management tools, or exceptions processes. The 
                        PDP sponsor shall consider the special 
                        circumstances applicable to such individuals 
                        when making a coverage determination under 
                        subsection (g) and shall base such 
                        determination on the individual's health 
                        condition, and the interrelationship between 
                        the long-term care facility in which the 
                        individual resides, the individual's physician, 
                        and the individual's long-term care pharmacy, 
                        as well as applicable laws and regulations 
                        governing the operation of, and care furnished 
                        by, the long-term care pharmacy. The formulary 
                        of the prescription drug plan may not 
                        discourage enrollment in such plan by part D 
                        eligible individuals residing in long-term care 
                        facilities.
                            ``(ii) Coverage during exceptions 
                        process.--The PDP sponsor shall provide a 31-
                        day emergency supply of covered part D drugs 
                        not included in the formulary for a part D 
                        eligible individual who is a resident of a 
                        long-term care facility for any period not 
                        included in the period described in clause 
                        (iii) during which an exception for such 
                        individual is being processed.
                            ``(iii) Transition processes.--The PDP 
                        sponsor shall establish and implement an 
                        appropriate transition process, with respect to 
                        receiving benefits under this part, for part D 
                        eligible individuals who are residents (or who 
                        are becoming residents) in a long-term care 
                        facility and who first enroll in the 
                        prescription drug plan and for part D eligible 
                        individuals enrolled in such plan when such 
                        individuals become residents of long-term care 
                        facilities. Such transition process shall 
                        include the provision of appropriate temporary 
                        or emergency supplies of covered part D drugs 
                        included in the formulary, as well as of 
                        covered part D drugs not included in the 
                        formulary, for at least the 90-day period, or 
                        180-day period if clinically necessary, 
                        immediately following the date of enrollment in 
                        the plan or the date on which the individual 
                        first becomes a resident of the facility, as 
                        applicable.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to plan years beginning on or after January 1, 2009.

SEC. 8. ELIMINATION OF PART D COST-SHARING FOR CERTAIN NON-
              INSTITUTIONALIZED FULL-BENEFIT DUAL ELIGIBLE INDIVIDUALS.

    (a) In General.--Section 1860D-14(a)(1)(D)(i) of the Social 
Security Act (42 U.S.C. 1395w-114(a)(1)(D)(i)) is amended--
            (1) in the heading, by striking ``Institutionalized 
        individuals--In'' and inserting ``Elimination of cost-sharing 
        for certain full-benefit dual eligible individuals--''
                                    ``(I) Institutionalized 
                                individuals.--In''; and
            (2) by adding at the end the following new subclauses:
                                    ``(II) Certain other individuals.--
                                In the case of an individual who is a 
                                full-benefit dual eligible individual 
                                and who is a resident of a facility 
                                described in subclause (III) or who is 
                                receiving home and community-based 
                                services in a home setting provided 
                                under a home and community-based waiver 
                                approved for the State under section 
                                1915 or 1115, the elimination of any 
                                beneficiary coinsurance described in 
                                section 1860D-2(b)(2) (for all amounts 
                                through the total amount of 
                                expenditures at which benefits are 
                                available under section 1860D-2(b)(4)).
                                    ``(III) Facility described.--For 
                                purposes of subclause (II), a facility 
                                described in this subclause is an 
                                assisted living facility or a resident 
                                care program facility (as such terms 
                                are defined by the Secretary), a board 
                                and care facility (as defined in 
                                section 1903(q)(4)(B)), or any other 
                                facility that is licensed or certified 
                                by the State involved and is determined 
                                appropriate by the Secretary, such as a 
                                community mental health center that 
                                meets the requirements of section 
                                1913(c) of the Public Health Service 
                                Act, a psychiatric health facility, a 
                                mental health rehabilitation center, 
                                and a mental retardation developmental 
                                disability facility.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to drugs dispensed on or after the date of the enactment of this 
Act.

SEC. 9. PROVISIONS RELATED TO IMPROPER ASSESSMENT OF BENEFICIARY COST-
              SHARING OBLIGATIONS.

    (a) Resolution of Inappropriate Assessment of Long-Term Care 
Beneficiary Cost-Sharing Obligations.--Section 1860D-12(b) of the 
Social Security Act (42 U.S.C. 1395w-112(b)) is amended by adding at 
the end the following:
            ``(4) Resolution of inappropriate assessment of long-term 
        care beneficiary cost-sharing obligations.--
                    ``(A) In general.--The Secretary shall not enter 
                into a contract with a PDP sponsor for the offering of 
                a prescription drug plan for a year unless the PDP 
                sponsor provides assurances to the satisfaction of the 
                Secretary that--
                            ``(i) to the extent the PDP sponsor, or 
                        information provided to the PDP sponsor by or 
                        on behalf of the Secretary, fails to correctly 
                        identify a part D eligible individual who is 
                        residing in a long-term care facility and who 
                        is receiving covered part D drugs from a long-
                        term care pharmacy, as a full benefit dual 
                        eligible individual (as defined in section 
                        1935(c)(6)) or as a subsidy-eligible individual 
                        (as defined in section 1860D-14(a)(3)), and any 
                        cost-sharing obligation is incorrectly assessed 
                        against such individual, the PDP sponsor shall 
                        accept from the long-term care pharmacy any 
                        applicable evidence described in subparagraph 
                        (B) and the attestation described in 
                        subparagraph (C) to demonstrate that the 
                        individual is eligible for an adjustment to (or 
                        exempt from) such cost-sharing;
                            ``(ii) upon receipt of such evidence that 
                        demonstrates the individual is so eligible (or 
                        so exempt), the PDP sponsor shall make such 
                        adjustment to (or exempt the individual from) 
                        any such cost-sharing; and
                            ``(iii) not later than 60 days after 
                        receipt of such evidence that demonstrates such 
                        eligibility, the PDP sponsor will reimburse the 
                        individual any improperly assessed cost-sharing 
                        or, in the case that the individual (or a 
                        representative of such individual) has not paid 
                        the improperly assessed cost-sharing amount, 
                        timely reimburse the long-term care pharmacy 
                        for such improperly assessed amount, but in no 
                        case may the PDP sponsor send payments under 
                        this clause directly to a full benefit dual 
                        eligible individual or a subsidy eligible 
                        individual residing in a long-term care 
                        facility unless the PDP sponsor has direct 
                        evidence that such individual has actually paid 
                        such cost-sharing amount.
                    ``(B) Evidence described.--For purposes of 
                subparagraph (A), evidence described in this 
                subparagraph is the following:
                            ``(i) For purposes of determining the 
                        status of an individual as a full benefit dual 
                        eligible individual, a plan ID number to 
                        establish such individual has coverage for 
                        covered part D drugs under a prescription drug 
                        plan or under an MA-PD plan and a Medicaid ID 
                        number to establish such individual is 
                        determined eligible by the State involved for 
                        medical assistance for full benefits under 
                        title XIX.
                            ``(ii) For purposes of determining 
                        institutionalized status of an individual, the 
                        date on which the individual entered a long-
                        term care facility, or any medical institution 
                        for which payment is made under this title or 
                        title XIX, including intermediate care 
                        facilities for the mentally retarded, 
                        psychiatric hospitals, and assisted living 
                        facilities.
                    ``(C) Attestation.--For purposes of subparagraph 
                (A), the attestation described in this subparagraph, 
                with respect to a pharmacy and a prescription drug plan 
                is an attestation from the pharmacy, subject to audit, 
                that the evidence described in subparagraph (B) that is 
                provided by such pharmacy to the plan is accurate.''.
    (b) Immediate Reduction in Cost-Sharing Upon Admission Into 
Institution.--Section 1860D-14(a)(1)(D)(i) of the Social Security Act 
(42 U.S.C. 1395w-114(a)(1)(D)(i)) is amended by inserting ``upon the 
admission of such individual or couple, respectively, to the 
institution,'' before ``the elimination of''.
    (c) Effective Date.--The amendments made by this section shall 
apply to plan years beginning on or after January 1, 2009.

SEC. 10. REPORT TO CONGRESS.

    (a) In General.--Section 1860D-4(b)(1) of the Social Security Act 
(42 U.S.C. 1395w-104(b)(1)) is amended by adding at the end the 
following:
                    ``(F) Annual report on access to covered part d 
                drugs for long-term care residents.--The Secretary 
                shall submit to Congress an annual report on the 
                adequacy of the access to covered part D drugs 
                available to part D eligible individuals who are 
                residents of long-term care facilities through long-
                term care pharmacies participating in networks of 
                prescription drug plans. Such a report shall include--
                            ``(i) the extent to which part D long-term 
                        care performance and service standards 
                        governing the delivery of specialized long-term 
                        care services, as specified by the Secretary, 
                        to part D eligible individuals, including any 
                        guidance issued by the Secretary and industry 
                        best practices, are being met;
                            ``(ii) the percentage of such residents who 
                        are enrolled in a prescription drug plan that 
                        meets the prescription drug needs of such 
                        residents; and
                            ``(iii) the number of exceptions and prior 
                        authorization requests submitted by such 
                        residents and the number of such exceptions and 
                        requests that are approved by the prescription 
                        drug plans involved.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to plan years beginning on or after January 1, 2009.
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