[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1441 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 1441

To amend title XIX of the Social Security Act to allow States to permit 
 certain Medicaid eligible individuals who have extremely high annual 
  lifelong orphan drug costs to continue on Medicaid notwithstanding 
                           increased income.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 11, 2009

Mr. Marchant (for himself, Mrs. Emerson, Mr. Sessions, Ms. Granger, Mr. 
Braley of Iowa, and Mr. Ortiz) introduced the following bill; which was 
            referred to the Committee on Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To amend title XIX of the Social Security Act to allow States to permit 
 certain Medicaid eligible individuals who have extremely high annual 
  lifelong orphan drug costs to continue on Medicaid notwithstanding 
                           increased income.

    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 ``Ryan Dant Health Care Opportunity 
Act of 2009''.

SEC. 2. STATE OPTION TO DISREGARD CERTAIN INCOME IN PROVIDING CONTINUED 
              MEDICAID COVERAGE FOR CERTAIN INDIVIDUALS WITH EXTREMELY 
              HIGH PRESCRIPTION COSTS.

    Section 1902(e) of the Social Security Act (42 U.S.C. 1396b(e)), as 
amended by section 203(a) of the Children's Health Insurance Program 
Reauthorization Act of 2009 (Public Law 111-3), is amended by adding at 
the end the following new paragraph:
            ``(14)(A) At the option of the State, in the case of an 
        individual with extremely high prescription drug costs 
        described in subparagraph (B) who has been determined (without 
        the application of this paragraph) to be eligible for medical 
        assistance under this title, the State may, in redetermining 
        the individual's eligibility for medical assistance under this 
        title, disregard any family income of the individual to the 
        extent such income is less than an amount that is specified by 
        the State and does not exceed the amount specified in 
        subparagraph (C), or, if greater, income equal to the cost of 
        the orphan drugs described in subparagraph (B)(iii).
            ``(B) An individual with extremely high prescription drug 
        costs described in this subparagraph for a 12-month period is 
        an individual--
                    ``(i) who is covered under health insurance or a 
                health benefits plan that has a maximum lifetime limit 
                of not less than $1,000,000 which includes all 
                prescription drug coverage;
                    ``(ii) who has exhausted all available prescription 
                drug coverage under the plan as of the beginning of 
                such period;
                    ``(iii) who incurs (or is reasonably expected to 
                incur) on an annual basis during the period costs for 
                orphan drugs in excess of the amount specified in 
                subparagraph (C) for the period; and
                    ``(iv) whose annual family income (determined 
                without regard to this paragraph) as of the beginning 
                of the period does not exceed 75 percent of the amount 
                incurred for such drugs (as described in clause (iii)).
            ``(C) The amount specified in this subparagraph for a 12-
        month period beginning in--
                    ``(i) 2009 or 2010, is $200,000; or
                    ``(ii) a subsequent year, is the amount specified 
                in clause (i) (or this subparagraph) for the previous 
                year increased by the annual rate of increase in the 
                medical care component of the consumer price index 
                (U.S. city average) for the 12-month period ending in 
                August of the previous year.
        Any amount computed under clause (ii) that is not a multiple of 
        $1,000 shall be rounded to the nearest multiple of $1,000.
            ``(D) In applying this paragraph, amounts incurred for 
        prescription drugs for cosmetic purposes shall not be taken 
        into account.
            ``(E) With respect to an individual described in 
        subparagraph (A), notwithstanding section 1916, the State 
        plan--
                    ``(i) shall provide for the application of cost-
                sharing that is at least nominal as determined under 
                section 1916; and
                    ``(ii) may provide, consistent with section 1916A, 
                for such additional cost-sharing as does not exceed a 
                maximum level of cost-sharing that is specified by the 
                Secretary and is adjusted by the Secretary on an annual 
                basis.
            ``(F) A State electing the option under this paragraph 
        shall provide for a determination on an individual's 
        application for continued medical assistance under this title 
        within 30 days of the date the application if filed with the 
        State.
            ``(G) In this paragraph:
                    ``(i) The term `orphan drugs' means prescription 
                drugs designated under section 526 of the Federal Food, 
                Drug, and Cosmetic Act (21 U.S.C. 360bb) as a drug for 
                a rare disease or condition.
                    ``(ii) The term `health benefits plan' includes 
                coverage under a plan offered under a State high risk 
                pool.''.
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