[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 1634 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                S. 1634

To amend titles XVIII and XIX of the Social Security Act to protect and 
 improve the benefits provided to dual eligible individuals under the 
                    Medicare and Medicaid programs.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             August 6, 2009

Mr. Rockefeller (for himself, Mr. Akaka, and Mr. Brown) introduced the 
 following bill; which was read twice and referred to the Committee on 
                                Finance

_______________________________________________________________________

                                 A BILL


 
To amend titles XVIII and XIX of the Social Security Act to protect and 
 improve the benefits provided to dual eligible individuals under the 
                    Medicare and Medicaid programs.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare 
Prescription Drug Coverage Improvement Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
              TITLE I--MEDICARE AND MEDICAID IMPROVEMENTS

Sec. 101. Providing Federal coverage and payment coordination for low-
                            income Medicare beneficiaries.
Sec. 102. Creating a Medicare operated prescription drug plan option.
Sec. 103. Accreditation requirement for all specialized Medicare 
                            Advantage plans and revisions relating to 
                            specialized Medicare Advantage plans for 
                            special needs individuals.
Sec. 104. Providing better care coordination for low-income 
                            beneficiaries in Medicare part D.
Sec. 105. Improving transition of new dual eligible individuals to 
                            Medicare prescription drug coverage and 
                            presumptive eligibility for low-income 
                            subsidies.
Sec. 106. Required information on transition from skilled nursing 
                            facilities and nursing facilities to part D 
                            plans.
Sec. 107. Streamlined pharmacy compliance packaging.
Sec. 108. Lowering covered part D drug prices on behalf of Medicare 
                            beneficiaries.
Sec. 109. Correction of flaws in determination of phased-down State 
                            contribution for Federal assumption of 
                            prescription drug costs for dually eligible 
                            individuals.
Sec. 110. No impact on eligibility for benefits under other programs.
Sec. 111. Quality indicators for dual eligible individuals.
        TITLE II--ADDITIONAL MEDICARE AND MEDICAID IMPROVEMENTS

Subtitle A--Improving the Financial Assistance Available to Low-Income 
                         Medicare Beneficiaries

Sec. 201. Improving assets tests for Medicare Savings Program and low-
                            income subsidy program.
Sec. 202. Eliminating barriers to enrollment.
Sec. 203. Elimination of part D cost-sharing for certain non-
                            institutionalized full-benefit dual 
                            eligible individuals.
Sec. 204. Exemption of balance in any pension or retirement plan from 
                            resources for determination of eligibility 
                            for low-income subsidy.
Sec. 205. Cost-sharing protections for low-income subsidy-eligible 
                            individuals.
                     Subtitle B--Other Improvements

Sec. 211. Enrollment improvements under Medicare parts C and D.
Sec. 212. Medicare plan complaint system.
Sec. 213. Uniform exceptions and appeals process.
Sec. 214. Prohibition on conditioning Medicaid eligibility for 
                            individuals enrolled in certain creditable 
                            prescription drug coverage on enrollment in 
                            the Medicare part D drug program.
Sec. 215. Office of the Inspector General annual report on part D 
                            formularies' inclusion of drugs commonly 
                            used by dual eligibles.
Sec. 216. HHS ongoing study and annual reports on coverage for dual 
                            eligibles.
Sec. 217. Authority to obtain information.

              TITLE I--MEDICARE AND MEDICAID IMPROVEMENTS

SEC. 101. PROVIDING FEDERAL COVERAGE AND PAYMENT COORDINATION FOR LOW-
              INCOME MEDICARE BENEFICIARIES.

    (a) Establishment of Federal Coordinated Health Care Office.--
            (1) Establishment.--
                    (A) In general.--Not later than October 1, 2009, 
                the Secretary of Health and Human Services (in this 
                section referred to as the ``Secretary'') shall 
                establish a Federal Coordinated Health Care Office.
                    (B) Establishment and reporting to cms 
                administrator.--The Federal Coordinated Health Care 
                Office shall--
                            (i) be established within the Centers for 
                        Medicare & Medicaid Services; and
                            (ii) report directly to the Administrator 
                        of the Centers for Medicare & Medicaid 
                        Services.
            (2) Purpose.--The purpose of the Federal Coordinated Health 
        Care Office is to bring together officials of the Medicare and 
        Medicaid programs at the Centers for Medicare & Medicaid 
        Services in order to--
                    (A) more effectively integrate benefits under the 
                Medicare program under title XVIII of the Social 
                Security Act and the Medicaid program under title XIX 
                of such Act; and
                    (B) improve the coordination between the Federal 
                Government and States for individuals eligible for 
                benefits under both such programs in order to ensure 
                that such individuals get full access to the items and 
                services to which they are entitled under titles XVIII 
                and XIX of the Social Security Act.
            (3) Goals.--The goals of the Federal Coordinated Health 
        Care Office are as follows:
                    (A) Providing dual eligible individuals full access 
                to the benefits to which such individuals are entitled 
                under the Medicare and Medicaid programs.
                    (B) Simplifying the processes for dual eligible 
                individuals to access the items and services they are 
                entitled to under the Medicare and Medicaid programs.
                    (C) Improving the quality of health care and long-
                term services for dual eligible individuals.
                    (D) Increasing beneficiary understanding of and 
                satisfaction with coverage under the Medicare and 
                Medicaid programs.
                    (E) Eliminating regulatory conflicts between rules 
                under the Medicare and Medicaid programs.
                    (F) Improving care continuity and ensuring safe and 
                effective care transitions.
                    (G) Eliminating cost-shifting between the Medicare 
                and Medicaid program and among related health care 
                providers.
                    (H) Improving the quality of performance of 
                providers of services and suppliers under the Medicare 
                and Medicaid programs.
            (4) Specific responsibilities.--The specific 
        responsibilities of the Federal Coordinated Health Care Office 
        are as follows:
                    (A) Providing States, specialized MA plans for 
                special needs individuals (as defined in section 
                1859(b)(6) of the Social Security Act (42 U.S.C. 1395w-
                28(b)(6))), physicians and other relevant entities or 
                individuals with the education and tools necessary for 
                developing programs that align benefits under the 
                Medicare and Medicaid programs for dual eligible 
                individuals.
                    (B) Working with the Director of the Congressional 
                Budget Office and the Director of the Office of 
                Management and Budget, and in consultation with the 
                Medicare Payment Advisory Commission and the Medicaid 
                and CHIP Payment and Access Commission, to, not later 
                than January 1, 2011, establish dynamic scoring for 
                benefits for dual eligible individuals to account for 
                total spending and savings for comparable risk groups 
                under the Medicare program.
                    (C) Supporting State efforts to coordinate and 
                align acute care and long-term care services for dual 
                eligible individuals with other items and services 
                furnished under the Medicare program.
                    (D) Providing support for coordination of 
                contracting and oversight by States and the Centers for 
                Medicare & Medicaid Services with respect to the 
                integration of the Medicare and Medicaid programs in a 
                manner that is supportive of the goals described in 
                paragraph (3).
            (5) Report.--The Secretary shall, as part of the budget 
        transmitted under section 1105(a) of title 31, United States 
        Code, submit to Congress an annual report containing 
        recommendations for legislation that would improve care 
        coordination and benefits for dual eligible individuals.
    (b) Addition of Medicaid Representatives to Medicare Payment 
Advisory Commission and Consultation With Medicaid and CHIP Payment and 
Access Commission.--
            (1) Addition of medicaid representative to medicare payment 
        advisory commission.--Section 1805(c)(2)(B) of the Social 
        Security Act (42 U.S.C. 1395b-6(c)(2)(B)) is amended by adding 
        at the end the following sentence: ``Such membership shall also 
        include at least 2 individuals who are nationally recognized 
        for their expertise in financing, benefits, and provider 
        payment policies under the program under title XIX.''.
            (2) Consultation with medicaid and chip payment and access 
        commission.--Section 1805(b) of the Social Security Act (42 
        U.S.C. 1395b-6(b)) is amended by adding at the end the 
        following new paragraph:
            ``(9) Consultation with medicaid and chip payment and 
        access commission.--In carrying out the duties of the 
        Commission under this subsection, the Commission shall consult 
        with the Medicaid and CHIP Payment and Access Commission 
        established under section 506 of the Children's Health 
        Insurance Program Reauthorization Act of 2009 (Public Law 111-
        3) on an ongoing basis.''.
    (c) MACPAC Funding and Technical Amendments.--
            (1) Funding.--Section 1900(f) of the Social Security Act 
        (42 U.S.C. 1396(f)) is amended--
                    (A) in the subsection heading, by striking 
                ``Authorization of Appropriations'' and inserting 
                ``Funding'';
                    (B) in paragraph (1), by inserting ``(other than 
                for fiscal year 2009)'' before ``in the same manner''; 
                and
                    (C) by striking paragraph (2) and inserting the 
                following:
            ``(2) Appropriation.--Out of any funds in the Treasury not 
        otherwise appropriated, there is appropriated to MACPAC 
        $11,403,000 for fiscal year 2009 to carry out the provisions of 
        this section.
            ``(3) Authorization.--In addition to amounts made available 
        under paragraph (2), there are authorized to be appropriated 
        for fiscal years beginning with fiscal year 2010, such sums as 
        may be necessary to carry out the provisions of this section.
            ``(4) Availability.--Amounts made available under 
        paragraphs (2) and (3) to carry out the provisions of this 
        section shall remain available until expended.''.
            (2) Technical amendments.--Section 1900(b) of such Act (42 
        U.S.C. 1396) is amended--
                    (A) in paragraph (1)(D), by striking ``June 1'' and 
                inserting ``June 15''; and
                    (B) by adding at the end the following:
            ``(10) Consultation with medpac.--
                    ``(A) In general.--MACPAC shall regularly consult 
                with the Medicare Payment Advisory Commission (in this 
                paragraph referred to as `MedPAC') established under 
                section 1805 in carrying out its duties under this 
                section.
                    ``(B) Data sharing.--MACPAC and MedPAC shall have 
                unrestricted access to all deliberations, records, and 
                nonproprietary data of the other such entity, 
                respectively, immediately upon the request of the 
                either such entity.''.
    (d) Rule of Construction.--Nothing in this section--
            (1) requires mandatory integrated care under the Medicare 
        or Medicaid programs under titles XVIII and XIX, respectively, 
        of the Social Security Act;
            (2) promotes enrollment in specialized MA plans for special 
        needs individuals (as defined in section 1859(b)(6) of the 
        Social Security Act (42 U.S.C. 1395w-28(b)(6)));
            (3) promotes the development of Medicaid managed care for 
        dual eligible individuals; or
            (4) prevents dual eligible individuals from electing to 
        remain in the original Medicare fee-for-service option, or the 
        right to make such election being protected.

SEC. 102. CREATING A MEDICARE OPERATED PRESCRIPTION DRUG PLAN OPTION.

    (a) Medicare Operated Prescription Drug Plan Option.--
            (1) In general.--Subpart 2 of part D of the Social Security 
        Act is amended by inserting after section 1860D-11 (42 U.S.C. 
        1395w-111) the following new section:

           ``medicare operated prescription drug plan option

    ``Sec. 1860D-11A.  (a) In General.--Notwithstanding any other 
provision of this part, for each year (beginning with 2011), in 
addition to any plans offered under section 1860D-11, the Secretary 
shall offer one or more Medicare operated prescription drug plans (as 
defined in subsection (b)) with a service area that consists of the 
entire United States and shall enter into negotiations in accordance 
with section 1860D-11A(i) with pharmaceutical manufacturers to reduce 
the purchase cost of covered part D drugs for eligible part D 
individuals who enroll in such a plan.
    ``(b) Medicare Operated Prescription Drug Plan Defined.--For 
purposes of this part, the term `Medicare operated prescription drug 
plan' means a prescription drug plan that offers qualified prescription 
drug coverage and access to negotiated prices described in section 
1860D-2(a)(1)(A).
    ``(c) Monthly Beneficiary Premium.--
            ``(1) Qualified prescription drug coverage.--The monthly 
        beneficiary premium for qualified prescription drug coverage 
        and access to negotiated prices described in section 1860D-
        2(a)(1)(A) to be charged under a Medicare operated prescription 
        drug plan shall be uniform nationally. Such premium for months 
        in 2010 and each succeeding year shall be equal to the product 
        of--
                    ``(A) the beneficiary premium percentage (as 
                specified in section 1860D-13(a)(3)); and
                    ``(B) the average monthly per capita actuarial cost 
                of offering the Medicare operated prescription drug 
                plan for the year involved, including administrative 
                expenses.
            ``(2) Premium subsidy for applicable subsidy eligible 
        individuals.--
                    ``(A) Full subsidy eligible individuals.--In the 
                case of an applicable subsidy eligible individual 
                described in paragraph (4)(A), the individual is 
                entitled under this section to an income-related 
                premium subsidy equal to 100 percent of the monthly 
                beneficiary premium of the Medicare operated 
                prescription drug plan.
                    ``(B) Other subsidy eligible individuals.--In the 
                case of an applicable subsidy eligible individual 
                described in paragraph (4)(B), the individual is 
                entitled under this section to an income-related 
                premium subsidy determined on a linear sliding scale as 
                follows:
                            ``(i) One hundred percent of the amount 
                        described in subparagraph (A) for individuals 
                        with incomes at or below 135 percent of such 
                        level.
                            ``(ii) Seventy-five percent of such amount 
                        for individuals with incomes above 135 percent 
                        of such level and at or below 140 percent of 
                        such level.
                            ``(iii) Fifty percent of such amount for 
                        individuals with incomes above 140 percent of 
                        such level and at or below 145 percent of such 
                        level.
                            ``(iv) Twenty-five percent of such amount 
                        for individuals with incomes above 145 percent 
                        of such level and below 150 percent of such 
                        level.
                            ``(v) Zero percent of such amount for 
                        individuals with incomes at 150 percent of such 
                        level.
            ``(3) Cost-sharing for applicable subsidy eligible 
        individuals.--
                    ``(A) Full-subsidy eligible individuals.--In the 
                case of an applicable subsidy eligible individual 
                described in paragraph (4)(A), the provisions of 
                section 1860D-14(a)(1) shall apply, except the premium 
                subsidy under paragraph (2)(A) shall be substituted for 
                the premium subsidy under subparagraph (A) of such 
                section 1860D-14(a)(1).
                    ``(B) Other subsidy eligible individuals.--In the 
                case of an applicable subsidy eligible individual 
                described in paragraph (4)(B), the provisions of 
                section 1860D-14(a)(2) shall apply, except the premium 
                subsidy under paragraph (2)(B) shall be substituted for 
                the premium subsidy under subparagraph (A) of such 
                section 1860D-14(a)(2).
            ``(4) Definition of applicable subsidy eligible 
        individuals.--For purposes of paragraphs (2) and (3), the term 
        `applicable subsidy eligible individual' means the following:
                    ``(A) Full-subsidy eligible individuals.--
                            ``(i) Individuals with income below 135 
                        percent of poverty line.--Any individual who--
                                    ``(I) is enrolled in a Medicare 
                                operated prescription drug plan;
                                    ``(II) is determined to have income 
                                that is below 135 percent of the 
                                poverty line applicable to a family of 
                                the size involved; and
                                    ``(III) meets the resources 
                                requirement described in section 1860D-
                                14(a)(3)(E), as amended by section 201 
                                of the Medicare Prescription Drug 
                                Coverage Improvement Act.
                            ``(ii) Certain other individuals.--Any 
                        individual who is enrolled in a Medicare 
                        operated prescription drug plan who--
                                    ``(I) is a full-benefit dual 
                                eligible individual (as defined in 
                                section 1935(c)(6));
                                    ``(II) receives benefits under the 
                                supplemental security income program 
                                under title XVI; or
                                    ``(III) is eligible for medical 
                                assistance under clause (i), (iii), or 
                                (iv) of section 1902(a)(10)(E).
                    ``(B) Other subsidy eligible individuals.--Any 
                individual who--
                            ``(i) is not described in paragraph (1);
                            ``(ii) is enrolled in a Medicare operated 
                        prescription drug plan;
                            ``(iii) is determined to have income that 
                        is below 150 percent of the poverty line 
                        applicable to a family of the size involved; 
                        and
                            ``(iv) meets the resources requirement 
                        described in section 1860D-14(a)(3)(E), as 
                        amended by section 201 of the Medicare 
                        Prescription Drug Coverage Improvement Act.
    ``(d) Use of a Formulary and Formulary Incentives.--
            ``(1) Use of a formulary.--
                    ``(A) In general.--With respect to the operation of 
                a Medicare operated prescription drug plan, the 
                Secretary shall establish and apply a formulary (and 
                may include formulary incentives described in paragraph 
                (5)(C)(ii)) in accordance with this subsection in order 
                to--
                            ``(i) increase patient safety;
                            ``(ii) increase appropriate use and reduce 
                        inappropriate use of drugs; and
                            ``(iii) reward value.
                    ``(B) Default initial formulary.--Until such time 
                as the Secretary establishes and applies the initial 
                formulary under paragraph (5), a Medicare operated 
                prescription drug plan shall be required to include all 
                drugs approved for safety and effectiveness as a 
                prescription drug under the Federal Food, Drug, and 
                Cosmetic Act that are covered part D drugs (and may 
                include formulary incentives described in paragraph 
                (5)(C)(ii)).
            ``(2) Requirements for formularies.--The Secretary shall 
        establish a formulary that meets the following requirements:
                    ``(A) Except as provided in subparagraph (B), the 
                formulary includes the covered outpatient drugs of any 
                manufacturer which has entered into and complies with 
                an agreement with the Secretary under this section.
                    ``(B) A covered outpatient drug may be excluded 
                with respect to the treatment of a specific disease or 
                condition for an identified population (if any) only 
                if, based on the drug's labeling (or, in the case of a 
                drug the prescribed use of which is not approved under 
                the Federal Food, Drug, and Cosmetic Act but is a 
                medically accepted indication (as defined in section 
                1860D-2(e)(4))), the excluded drug does not have a 
                significant, clinically meaningful therapeutic 
                advantage in terms of safety, effectiveness, or 
                clinical outcome of such treatment for such population 
                over other drugs included in the formulary and there is 
                a written explanation (available to the public) of the 
                basis for the exclusion.
                    ``(C) The Secretary permits coverage of a drug 
                excluded from the formulary pursuant to a prior 
                authorization program that is consistent with paragraph 
                (3).
                    ``(D) The formulary meets such other requirements 
                as the Secretary may impose in order to achieve program 
                savings consistent with protecting the health of 
                program beneficiaries.
        A prior authorization program established under paragraph (3) 
        is not a formulary subject to the requirements of this 
        paragraph.
            ``(3) Requirements of prior authorization programs.--The 
        Secretary may require, with respect to drugs dispensed on or 
        after July 1, 1991, the approval of the drug before its 
        dispensing for any medically accepted indication (as defined in 
        section 1860D-2(e)(4)) only if the system providing for such 
        approval--
                    ``(A) provides response by telephone or other 
                telecommunication device within 24 hours of a request 
                for prior authorization; and
                    ``(B) provides for the dispensing of at least a 72-
                hour supply of a covered outpatient prescription drug 
                in an emergency situation (as defined by the 
                Secretary).
            ``(4) Other permissible restrictions.--The Secretary may 
        impose limitations, with respect to all such drugs in a 
        therapeutic class, on the minimum or maximum quantities per 
        prescription or on the number of refills, if such limitations 
        are necessary to improve patient safety, discourage waste, or 
        address instances of fraud or abuse by individuals in any 
        manner authorized under this Act.
            ``(5) Development of initial formulary.--
                    ``(A) In general.--In selecting covered part D 
                drugs for inclusion in a formulary, the Secretary shall 
                consider clinical benefit and price.
                    ``(B) Role of ahrq.--The Director of the Agency for 
                Healthcare Research and Quality shall be responsible 
                for assessing the clinical benefit of covered part D 
                drugs and making recommendations to the Secretary 
                regarding which drugs should be included in the 
                formulary. In conducting such assessments and making 
                such recommendations, the Director shall--
                            ``(i) consider safety concerns including 
                        those identified by the Federal Food and Drug 
                        Administration;
                            ``(ii) use available data and evaluations, 
                        with priority given to randomized controlled 
                        trials, to examine clinical effectiveness, 
                        comparative effectiveness, safety, and enhanced 
                        compliance with a drug regimen;
                            ``(iii) use the same classes of drugs 
                        developed by United States Pharmacopeia for 
                        this part;
                            ``(iv) consider evaluations made by--
                                    ``(I) the Director under section 
                                1013 of Medicare Prescription Drug, 
                                Improvement, and Modernization Act of 
                                2003;
                                    ``(II) other Federal entities, such 
                                as the Secretary of Veterans Affairs; 
                                and
                                    ``(III) other private and public 
                                entities, such as the Drug 
                                Effectiveness Review Project and 
                                Medicaid programs; and
                            ``(v) recommend to the Secretary--
                                    ``(I) those drugs in a class that 
                                provide a greater clinical benefit, 
                                including fewer safety concerns or less 
                                risk of side-effects, than another drug 
                                in the same class that should be 
                                included in the formulary;
                                    ``(II) those drugs in a class that 
                                provide less clinical benefit, 
                                including greater safety concerns or a 
                                greater risk of side-effects, than 
                                another drug in the same class that 
                                should be excluded from the formulary; 
                                and
                                    ``(III) drugs in a class with same 
                                or similar clinical benefit for which 
                                it would be appropriate for the 
                                Secretary to competitively bid (or 
                                negotiate) for placement on the 
                                formulary.
                    ``(C) Consideration of ahrq recommendations.--
                            ``(i) In general.--Not later than January 
                        1, 2011, the Secretary, after taking into 
                        consideration the recommendations under 
                        subparagraph (B)(v), shall establish a 
                        formulary, and formulary incentives, to 
                        encourage use of covered part D drugs that--
                                    ``(I) have a lower cost and provide 
                                a greater clinical benefit than other 
                                drugs;
                                    ``(II) have a lower cost than other 
                                drugs with same or similar clinical 
                                benefit; and
                                    ``(III) drugs that have the same 
                                cost but provide greater clinical 
                                benefit than other drugs.
                            ``(ii) Formulary incentives.--The formulary 
                        incentives under clause (i) may be in the form 
                        of one or more of the following:
                                    ``(I) Tiered copayments.
                                    ``(II) Prior authorization.
                                    ``(III) Step therapy.
                                    ``(IV) Medication therapy 
                                management.
                                    ``(V) Generic drug substitution.
                            ``(iii) Flexibility.--In applying such 
                        formulary incentives the Secretary may decide 
                        not to impose any cost-sharing for a covered 
                        part D drug for which--
                                    ``(I) the elimination of cost 
                                sharing would be expected to increase 
                                compliance with a drug regimen; and
                                    ``(II) compliance would be expected 
                                to produce savings under part A or B or 
                                both.
                            ``(iv) Development of transparent process 
                        to explain formulary incentives.--Not later 
                        than January 1, 2011, the Secretary shall 
                        develop and implement a transparent process to 
                        identify and explain to beneficiaries formulary 
                        incentives under clause (i). Such process shall 
                        be designed to assist beneficiaries in 
                        understanding how prior authorization requests 
                        and other formulary incentives will be 
                        evaluated.
            ``(6) Limitations on formulary.--In any formulary 
        established under this subsection, the formulary may not be 
        changed during a year, except--
                    ``(A) to add a generic version of a covered part D 
                drug that entered the market;
                    ``(B) to remove such a drug for which a safety 
                problem is found; and
                    ``(C) to add a drug that the Secretary identifies 
                as a drug which treats a condition for which there has 
                not previously been a treatment option or for which a 
                clear and significant benefit has been demonstrated 
                over other covered part D drugs.
            ``(7) Adding drugs to the initial formulary.--
                    ``(A) Use of advisory committee.--The Secretary 
                shall establish and appoint an advisory committee (in 
                this paragraph referred to as the `advisory 
                committee')--
                            ``(i) to review petitions from drug 
                        manufacturers, health care provider 
                        organizations, patient groups, and other 
                        entities for inclusion of a drug in, or other 
                        changes to, such formulary; and
                            ``(ii) to recommend any changes to the 
                        formulary established under this subsection.
                    ``(B) Composition.--The advisory committee shall be 
                composed of 9 members and shall include representatives 
                of physicians, pharmacists, and consumers and others 
                with expertise in evaluating prescription drugs. The 
                Secretary shall select members based on their knowledge 
                of pharmaceuticals and the Medicare and Medicaid 
                populations. Members shall be deemed to be special 
                Government employees for purposes of applying the 
                conflict of interest provisions under section 208 of 
                title 18, United States Code, and no waiver of such 
                provisions for such a member shall be permitted.
                    ``(C) Consultation.--The advisory committee shall 
                consult, as necessary, with physicians who are 
                specialists in treating the disease for which a drug is 
                being considered.
                    ``(D) Request for studies.--The advisory committee 
                may request the Agency for Healthcare Research and 
                Quality or an academic or research institution to study 
                and make a report on a petition described in 
                subparagraph (A)(ii) in order to assess--
                            ``(i) clinical effectiveness;
                            ``(ii) comparative effectiveness;
                            ``(iii) safety; and
                            ``(iv) enhanced compliance with a drug 
                        regimen.
                    ``(E) Recommendations.--The advisory committee 
                shall make recommendations to the Secretary regarding--
                            ``(i) whether a covered part D drug is 
                        found to provide a greater clinical benefit, 
                        including fewer safety concerns or less risk of 
                        side-effects, than another drug in the same 
                        class that is currently included in the 
                        formulary and should be included in the 
                        formulary;
                            ``(ii) whether a covered part D drug is 
                        found to provide less clinical benefit, 
                        including greater safety concerns or a greater 
                        risk of side-effects, than another drug in the 
                        same class that is currently included in the 
                        formulary and should not be included in the 
                        formulary; and
                            ``(iii) whether a covered part D drug has 
                        the same or similar clinical benefit to a drug 
                        in the same class that is currently included in 
                        the formulary and whether the drug should be 
                        included in the formulary.
                    ``(F) Limitations on review of manufacturer 
                petitions.--The advisory committee shall not review a 
                petition of a drug manufacturer under subparagraph 
                (A)(ii) with respect to a covered part D drug unless 
                the petition is accompanied by the following:
                            ``(i) Raw data from clinical trials on the 
                        safety and effectiveness of the drug.
                            ``(ii) Any data from clinical trials 
                        conducted using active controls on the drug or 
                        drugs that are the current standard of care.
                            ``(iii) Any available data on comparative 
                        effectiveness of the drug.
                            ``(iv) Any other information the Secretary 
                        requires for the advisory committee to complete 
                        its review.
                    ``(G) Response to recommendations.--The Secretary 
                shall review the recommendations of the advisory 
                committee and if the Secretary accepts such 
                recommendations the Secretary shall modify the 
                formulary established under this subsection 
                accordingly. Nothing in this section shall preclude the 
                Secretary from adding to the formulary a drug for which 
                the Director of the Agency for Healthcare Research and 
                Quality or the advisory committee has not made a 
                recommendation.
                    ``(H) Notice of changes.--The Secretary shall 
                provide timely notice to beneficiaries and health 
                professionals about changes to the formulary or 
                formulary incentives.
                    ``(I) Stability of benefit.--Once a covered part D 
                drug has been added to the formulary established under 
                this subsection, the drug may not be removed from the 
                formulary for at least a 3-year period, unless the 
                Secretary determines there are safety or efficacy 
                concerns with respect to the drug.
            ``(8) Non-excludable drugs.--The following drugs or classes 
        of drugs shall not be excluded from the default initial 
        formulary (as described in paragraph (1)(B)) or the initial 
        formulary established by the Secretary (as described in 
        paragraph (5)):
                    ``(A) Barbiturates.
                    ``(B) Benzodiazepines.
    ``(e) Informing Beneficiaries.--
            ``(1) In general.--The Secretary shall take steps to inform 
        beneficiaries about the availability of a Medicare operated 
        prescription drug plan or plans including providing information 
        in the annual handbook distributed to all beneficiaries and 
        adding information to the official public Medicare website 
        related to prescription drug coverage available through this 
        part.
            ``(2) Sole responsibility for marketing by the secretary.--
                    ``(A) In general.--The Secretary shall have sole 
                responsibility for marketing Medicare operated 
                prescription drug plans.
                    ``(B) Authorization.--There is authorized to be 
                appropriated to the Secretary such sums as are 
                necessary to carry out such marketing.
    ``(f) Application of All Other Requirements for Prescription Drug 
Plans.--Except as specifically provided in this section, any Medicare 
operated drug plan shall meet the same requirements as apply to any 
other prescription drug plan, including the requirements of section 
1860D-4(b)(1) relating to assuring pharmacy access.
    ``(g) Automatic Enrollment.--The Secretary shall establish 
procedures to provide for the automatic enrollment of subsidy eligible 
individuals (as defined in section 1860D-14(a)(3)) in a Medicare 
operated prescription drug plan in the case where such individuals lose 
their current prescription drug coverage, become part D eligible 
individuals, or in instances where the amount of the monthly 
beneficiary premium under the prescription drug plan the individual is 
enrolled in is greater than the premium subsidy amount described in 
section 1860D-14(b).
    ``(h) Rule of Construction Regarding Eligibility for Medical 
Assistance.--In no case may enrollment in a Medicare operated 
prescription drug plan affect the eligibility of an individual to 
receive medical assistance under a State plan under title XIX.''.
            (2) Effective date.--The amendment made by this subsection 
        shall take effect as if included in the enactment of section 
        101 of the Medicare Prescription Drug, Improvement, and 
        Modernization Act of 2003.
    (b) Conforming Amendments.--
            (1) In general.--
                    (A) Section 1860D-3(a) of the Social Security Act 
                (42 U.S.C. 1395w-103(a)) is amended by adding at the 
                end the following new paragraph:
            ``(4) Availability of the medicare operated prescription 
        drug plan.--A Medicare operated prescription drug plan (as 
        defined in section 1860D-11A(c)) shall be offered nationally in 
        accordance with section 1860D-11A.''.
                    (B)(i) Section 1860D-3 of the Social Security Act 
                (42 U.S.C. 1395w-103) is amended by adding at the end 
                the following new subsection:
    ``(c) Provisions Only Applicable in 2006, 2007, 2008, and 2009.--
The provisions of this section shall only apply with respect to 2006, 
2007, 2008, and 2009.''.
                    (C) Section 1860D-11(g) of such Act (42 U.S.C. 
                1395w-111(g)) is amended by adding at the end the 
                following new paragraph:
            ``(8) No authority for fallback plans after 2009.--A 
        fallback prescription drug plan shall not be available after 
        December 31, 2009.''.
                    (D) Section 1860D-13(c)(3) of such Act (42 U.S.C. 
                1395w-113(c)(3)) is amended--
                            (i) in the heading, by inserting ``and 
                        medicare operated prescription drug plans'' 
                        after ``Fallback plans''; and
                            (ii) by inserting ``or a Medicare operated 
                        prescription drug plan'' after ``a fallback 
                        prescription drug plan''.
                    (E) Section 1860D-14(a) of the Social Security Act 
                (42 U.S.C. 1395w-114(a)) is amended--
                            (i) in paragraph (1), by striking ``In 
                        the'' and inserting ``Subject to section 1860D-
                        11A(c)(2)(A), in the''; and
                            (ii) in paragraph (2), by striking ``In 
                        the'' and inserting ``Subject to section 1860D-
                        11A(c)(2)(B), in the''.
                    (F) Section 1860D-16(b)(1) of such Act (42 
                U.S.C.1395w-116(b)(1)) is amended--
                            (i) in subparagraph (C), by striking 
                        ``and'' after the semicolon at the end;
                            (ii) in subparagraph (D), by striking the 
                        period at the end and inserting ``; and''; and
                    (G) by adding at the end the following new 
                subparagraph:
                    ``(E) payments for expenses incurred with respect 
                to the operation of Medicare operated prescription drug 
                plans under section 1860D-11A.''.
                    (H) Section 1860D-41(a) of such Act (42 U.S.C. 
                1395w-151(a)) is amended by adding at the end the 
                following new paragraph:
            ``(19) Medicare operated prescription drug plan.--The term 
        `Medicare operated prescription drug plan' has the meaning 
        given such term in section 1860D-11A(c).''.
            (2) Effective date.--The amendments made by this subsection 
        shall take effect as if included in the enactment of section 
        101 of the Medicare Prescription Drug, Improvement, and 
        Modernization Act of 2003.

SEC. 103. ACCREDITATION REQUIREMENT FOR ALL SPECIALIZED MEDICARE 
              ADVANTAGE PLANS AND REVISIONS RELATING TO SPECIALIZED 
              MEDICARE ADVANTAGE PLANS FOR SPECIAL NEEDS INDIVIDUALS.

    (a) Accreditation Requirement.--Section 1859(f) of the Social 
Security Act (42 U.S.C. 1395w-28(f)) is amended--
            (1) in paragraphs (2)(B), (3)(B), and (4)(B), by striking 
        ``paragraph (5)'' and inserting ``paragraphs (5) and (6)(B)'' 
        each place it appears; and
            (2) by adding at the end the following new paragraph:
            ``(6) Accreditation requirement for all snps.--
                    ``(A) Establishment of accreditation program.--Not 
                later than January 1, 2011, the Secretary, acting 
                through the Director of the Agency for Healthcare 
                Research and Quality and the Administrator of the 
                Centers for Medicare & Medicaid Services, shall enter 
                into a contract with the National Committee for Quality 
                Assurance under which the National Committee for 
                Quality Assurance shall develop an accreditation (and 
                reaccreditation) program for all specialized MA plans 
                for special needs individuals (as defined in subsection 
                (b)(6)), including specialized MA plans for special 
                needs individuals described in subsection 
                (b)(6)(B)(ii).
                    ``(B) Requirement.--The requirement described in 
                this subparagraph is that, effective for plan years 
                beginning on or after January 1, 2012, a specialized MA 
                plan for special needs individuals (as so defined) meet 
                the accreditation standards developed by the National 
                Committee for Quality Assurance under the contract 
                under subparagraph (A).''.
    (b) Revisions Relating to Specialized Medicare Advantage Plans for 
Special Needs Individuals.--Section 1859 of the Social Security Act (42 
U.S.C. 1395w-28) is amended--
            (1) in subsection (f)(3)--
                    (A) in subparagraph (D), in the first sentence, by 
                inserting ``and the plan provides for the coordination 
                of coverage for benefits under this title (including 
                this part) and such medical assistance'' before the 
                period at the end; and
                    (B) by adding at the end the following new 
                subparagraph:
                    ``(E) The plan meets the requirements described in 
                subsection (g).''; and
            (2) by adding at the end the following new subsection:
    ``(g) Additional Requirements for Dual SNPS.--The following 
requirements are described in this subsection:
            ``(1) Provision of information.--The plan provides special 
        needs individuals described in subsection (b)(6)(B)(ii) up-
        front information about formularies and utilization management 
        strategies under the plan as part of the information disclosed 
        under section 1852(c)(1).
            ``(2) Premium.--The premium under the plan does not exceed 
        the premium subsidy amount described in section 1860D-14(b).
            ``(3) Formulary.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                plan has a formulary that, based on the most recent 
                data available, covers at least--
                            ``(i) 95 percent of the 200 most commonly 
                        prescribed non-duplicative generic covered part 
                        D drugs for the population of individuals 
                        entitled to (or enrolled for) benefits under 
                        part A or enrolled under part B; and
                            ``(ii) 95 percent of the 200 most commonly 
                        prescribed non-duplicative brand name covered 
                        part D drugs for such population.
                    ``(B) Inclusion of drugs in certain categories and 
                classes.--The plan formulary shall include all covered 
                part D drugs in the categories and classes identified 
                by the Secretary under section 1860D-4(b)(3)(G)(i).
            ``(4) Pharmacy access.--The plan secures participation in 
        its network of a sufficient number of pharmacies that dispense 
        (other than by mail order) drugs directly to patients to ensure 
        convenient access by at least 90 percent of enrollees who are 
        residing in long-term care facilities within the region.
            ``(5) Operation of a dedicated customer assistance phone 
        line.--The plan shall maintain a toll-free number or numbers 
        for inquiries concerning the plan that is solely for the use of 
        such individuals, the designated representatives of such 
        individuals (including designated family members), advocates of 
        such individuals, providers of services, and suppliers.
            ``(6) E-prescribing.--The plan adopts electronic 
        prescribing for enrollees, in accordance with section 1860D-
        4(e), to coordinate care.
            ``(7) Demonstrate experience and expertise.--The plan 
        demonstrates, to the satisfaction of the Secretary, with input 
        from the States, sufficient experience and expertise in serving 
        low-income, publicly insured, or previously uninsured 
        populations.
            ``(8) Reducing health disparities.--The plan has 
        established and implemented systems and processes which have 
        been approved by the Secretary to address and reduce health 
        disparities based on race, ethnicity, gender, age, and socio-
        economic status.
            ``(9) Proficiency in care coordination.--The plan 
        demonstrates, to the satisfaction of the Secretary, proficiency 
        in care coordination for the purpose of providing, or arranging 
        for the provision of, services to assist individuals enrolled 
        in the plan in obtaining access to other public and private 
        benefits, including services to address non-medical and psycho-
        social needs.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to plan year beginning on or after January 1, 2011.

SEC. 104. PROVIDING BETTER CARE COORDINATION FOR LOW-INCOME 
              BENEFICIARIES IN MEDICARE PART D.

    (a) Continuous Updating of Eligibility and Enrollment Data for Dual 
Eligible Individuals.--
            (1) State requirement.--Section 1935(a) of the Social 
        Security Act (42 U.S.C. 1396u-5(a)) is amended by adding at the 
        end the following new paragraph:
            ``(4) Updating of eligibility and enrollment information on 
        a rolling basis.--Beginning not later than October 1, 2011, the 
        State shall update information with respect to the eligibility 
        and enrollment of individuals receiving any kind of medical 
        assistance under the State plan, including medical assistance 
        for payment of Medicare cost-sharing described in section 
        1905(p)(3), in MA plans and prescription drug plans under parts 
        C and D, respectively, of title XVIII (including eligibility 
        determinations under paragraph (2) and screening and enrollment 
        under paragraph (3)) not less frequently than on a weekly 
        basis.''.
            (2) Secretarial requirements.--Section 1935(d) of the 
        Social Security Act (42 U.S.C. 1396u-5(d)) is amended by adding 
        at the end the following new paragraph:
            ``(3) Updating of eligibility and enrollment information on 
        a rolling basis.--The Secretary shall update information with 
        respect to the eligibility and enrollment of individuals 
        receiving any kind of medical assistance under this title, 
        including medical assistance for payment of Medicare cost-
        sharing described in section 1905(p)(3), in MA plans and 
        prescription drug plans under parts C and D, respectively, of 
        title XVIII as it is received, but not less frequently than on 
        a weekly basis.''.
    (b) Identifying Dual Eligible Individuals in Data Records.--
            (1) In general.--Section 1859 of the Social Security Act 
        (42 U.S.C. 1305w-28), as amended by section 103, is amended by 
        adding at the end the following new subsection:
    ``(h) Identifying Dual Eligible Individuals in Data Records.--
            ``(1) Identification by the secretary.--Beginning on 
        January 1, 2010, the Secretary shall clearly identify all dual 
        eligible individuals that are enrolled in MA plans and 
        prescription drug plans for the current plan year and reflect 
        the low-income subsidy status of such individuals for each plan 
        year in every data record file maintained in the Medicare 
        electronic database and every such file that is used to enroll 
        or adjudicate claims for such individuals.
            ``(2) Identification by ma plans and prescription drug 
        plans.--Beginning on January 1, 2010, each MA plan and 
        prescription drug plan shall clearly identify all dual eligible 
        individuals that are enrolled in the plan for the current plan 
        year and reflect the low-income subsidy status of such 
        individuals for the plan year in every data record file 
        maintained by the plan that is used to enroll or adjudicate 
        claims for such individuals under the plan.
            ``(3) Regulations.--The Secretary shall establish 
        regulations to carry out this subsection. Such regulations 
        shall require that--
                    ``(A) for each plan year and each dual eligible 
                individual, the Secretary identify on the Medicare 
                enrollment database dual eligible status that has been 
                verified with a State or the District of Columbia;
                    ``(B) for each plan year and each dual eligible 
                individual, the Secretary identify on the Medicare 
                enrollment database the low-income subsidy level of the 
                individual; and
                    ``(C) each data file that is necessary to ensure 
                that such dual eligible status is transmitted to an MA 
                plan or a prescription drug plan, at the time the 
                Secretary certifies the enrollment of the dual eligible 
                individual in the plan.
            ``(4) Definition of dual eligible individual.--The term 
        `dual eligible individual' means a special needs individual 
        described in subsection (b)(6)(B)(ii).''.
            (2) Conforming amendment.--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) Identifying Dual Eligible Individuals in Data Records.--For 
provisions regarding the identification by prescription drug plans of 
dual eligible individuals in data records, see section 1859(h).''.
    (c) Assuring Continuity of Prescription Drug Coverage for Dual 
Eligibles.--
            (1) In general.--Section 1935(d)(1) of the Social Security 
        Act (42 U.S.C. 1396u-5(d)(1)) is amended--
                    (A) by inserting ``on and after the date described 
                in subparagraph (B),'' after ``notwithstanding any 
                other provision of this title,'';
                    (B) by striking ``In the case of'' and inserting 
                the following:
                    ``(A) In general.--In the case of''; and
                    (C) by adding at the end the following:
                    ``(B) Date described.--For purposes of subparagraph 
                (A), the date described in this subparagraph is the 
                date on which the State confirms with a Medicare 
                Advantage plan under part C of title XVIII or a 
                prescription drug plan under part D of such title 
                (including a Medicare operated prescription drug plan 
                under section 1860D-11A), as applicable--
                            ``(i) that the part D eligible individual 
                        (as so defined) who is described in subsection 
                        (c)(6)(A)(ii) is enrolled with such plan; and
                            ``(ii) the cost-sharing and premiums 
                        applicable for the individual for such plan.''.
            (2) Effective date.--The amendments made by paragraph (1) 
        take effect on January 1, 2011.
    (d) Collection and Sharing of Drug Utilization Data and Formulary 
Information for Full-benefit Dual Eligible Individuals.--
            (1) In general.--Section 1860D-42 of the Social Security 
        Act, as amended by subsection (b), is amended by adding at the 
        end the following new subsection:
    ``(d) Collection and Sharing of Drug Utilization Data and Formulary 
Information for Full-benefit Dual Eligible Individuals.--
            ``(1) Plan requirement.--A PDP sponsor of a prescription 
        drug plan (including a Medicare operated prescription drug plan 
        under section 1860D-11A) 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)) and any formularies under the plans such 
        individuals are enrolled in as the Secretary determines 
        appropriate to carry out paragraph (2). Such information shall 
        be submitted--
                    ``(A) on a rolling basis (as determined appropriate 
                by the Secretary); and
                    ``(B) using a single, uniform reporting process.
            ``(2) Collection and sharing of data.--The Secretary shall 
        collect data on the drug utilization of full-benefit dual 
        eligible individuals (as so defined) and on any formularies 
        under the plans such individuals are enrolled in. The Secretary 
        shall share such data with the States and the District of 
        Columbia on as close to a real-time basis as possible.''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall take effect on January 1, 2010.

SEC. 105. IMPROVING TRANSITION OF NEW DUAL ELIGIBLE INDIVIDUALS TO 
              MEDICARE PRESCRIPTION DRUG COVERAGE AND PRESUMPTIVE 
              ELIGIBILITY FOR LOW-INCOME SUBSIDIES.

    (a) Updating the Point of Sale Facilitated Enrollment Process.--
            (1) Providing better initial protection for dual eligible 
        individuals.--Beginning January 1, 2011, each contractor under 
        the Point of Sale Facilitated Enrollment process of the 
        Department of Health and Human Services shall enroll full-
        benefit dual eligible individuals (as defined in section 
        1935(c)(6)) into a Medicare operated prescription drug plan 
        under section 1860D-11A of the Social Security Act, as added by 
        section 102.
            (2) Competitive bidding of point of sale contract.--The 
        Secretary of Health and Human Services shall establish 
        procedures to ensure that each contract entered into under such 
        process on or after January 1, 2010, under the Medicare program 
        under title XVIII of the Social Security Act is rebid every 3 
        years through a competitive bidding process.
            (3) Requiring better education about point of sale 
        facilitated enrollment process.--Not later than January 1, 
        2010, the Secretary of Health and Human Services shall have a 
        comprehensive plan in place for proactively educating 
        beneficiaries under the Medicare prescription drug program 
        under part D of title XVIII of the Social Security Act, 
        pharmacists, skilled nursing facilities (as defined in section 
        1819(a) of such Act (42 U.S.C. 1395i-3(a))), nursing facilities 
        (as defined in section 1919(a) of such Act (42 U.S.C. 
        1396r(a))), counselors under State health insurance assistance 
        programs (SHIPs), and other advocacy organizations (including 
        disability organizations) about the Point of Sale Facilitated 
        Enrollment process. Under such plan--
                    (A) information about the Point of Sale Facilitated 
                Enrollment process shall be included in all mailers to 
                the entities and individuals described in the preceding 
                sentence prior to the annual, coordinated election 
                period described in section 1851(e)(3) of the Social 
                Security Act (42 U.S.C. 1395w-21(e)(3)); and
                    (B) a description of such process and other 
                relevant information shall be prominently displayed on 
                the Medicare Internet website throughout the year.
            (4) Mandatory use of point of sale facilitated enrollment 
        process.--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 new subparagraph:
                    ``(F) Mandatory use of point of sale facilitated 
                enrollment process.--Notwithstanding any other 
                provision of law, beginning January 1, 2011, the terms 
                and conditions under subparagraph (A) shall require 
                participating pharmacies to use the Point of Sale 
                Facilitated Enrollment process of the Department of 
                Health and Human Services.''.
    (b) Presumptive Eligibility and Mandatory Transition Period for 
Subsidy Eligible Individuals.--Section 1860D-14 of the Social Security 
Act (42 U.S.C. 1395w-104) is amended--
            (1) by redesignating subsection (d) as subsection (e); and
            (2) by inserting after subsection (c) the following new 
        subsection:
    ``(d) Presumptive Eligibility and Mandatory Transition Period.--
            ``(1) Presumptive eligibility.--An individual shall be 
        presumed to be a subsidy eligible individual (as defined in 
        section 1860D-14(a)(3)) if the individual presents at the 
        pharmacy with--
                    ``(A) reliable evidence of--
                            ``(i) Medicaid enrollment, such as a 
                        Medicaid card, recent history of Medicaid 
                        billing in the pharmacy patient profile, a copy 
                        of a current Medicaid award letter, or 
                        confirmation from a Medicaid enrollment 
                        database; or
                            ``(ii) eligibility for an income-related 
                        subsidy under section 1860D-14, such as a low-
                        income subsidy notice from the Secretary or the 
                        Commissioner of Social Security, or 
                        confirmation from a Social Security enrollment 
                        database; and
                    ``(B) reliable evidence of Medicare enrollment, 
                such as a Medicare identification card, a Medicare 
                enrollment approval letter, a Medicare Summary Notice, 
                or confirmation from an official Medicare hotline or 
                Medicare database.
            ``(2) Making subsidy eligible individuals whole.--
                    ``(A) In general.--In the case of a subsidy 
                eligible individual (as so defined) who, between 
                November 15, 2005, and December 31, 2009, has wrongly 
                been forced to pay higher co-payments, premiums, and 
                deductibles than those applicable under this part and 
                part C for such individual, the subsidy eligible 
                individual shall be eligible for compensation under the 
                program under this title.
                    ``(B) Establishment of process for refund of amount 
                incorrectly paid.--The Secretary shall establish a 
                process under which--
                            ``(i) prescription drug plans and MA-PD 
                        plans are billed for copayments and deductibles 
                        inappropriately charged to subsidy eligible 
                        individuals during retroactive coverage 
                        periods;
                            ``(ii) the amounts incorrectly paid by the 
                        subsidy eligible individual as a result of 
                        those inappropriate charges are refunded 
                        directly to the individual, either through a 
                        rebate on future payments of premiums under 
                        part B or through a direct payment to the 
                        individual; and
                            ``(iii) prescription drug plans and MA-PD 
                        plans are required to provide detailed 
                        accounting to the Secretary of the basis for 
                        any rebate or payment to a subsidy eligible 
                        individual under this subparagraph, including 
                        the applicable period of retroactive coverage 
                        for the subsidy eligible individual and whether 
                        the rebate or credit is with respect to an 
                        inappropriately charged copayment or 
                        deductible.
                    ``(C) Notification.--Subsidy eligible individuals 
                shall be notified of the requirements of this 
                subsection in their 2010 plan year materials.
                    ``(D) No effect on eligibility for other 
                benefits.--Amounts refunded to a subsidy eligible 
                individual under this subsection shall be disregarded 
                for purposes of determining or continuing the 
                beneficiary's eligibility for receipt of benefits under 
                any other Federal, State, or locally funded assistance 
                program, including benefits paid under titles II, XVI, 
                XVIII, XIX, or XXI.''.

SEC. 106. REQUIRED INFORMATION ON TRANSITION FROM SKILLED NURSING 
              FACILITIES AND NURSING FACILITIES TO PART D PLANS.

    (a) Skilled Nursing Facilities.--Section 1819(b) of the Social 
Security Act (42 U.S.C. 1395i-3(b)) is amended by adding at the end the 
following new paragraph:
            ``(9) Information on transition to prescription drug 
        coverage.--A skilled nursing facility must provide information 
        to residents and the families of residents on how to transition 
        to prescription drug coverage under MA-PD plans under part C 
        and prescription drug plans under part D upon discharge from 
        the facility.''.
    (b) Nursing Facilities.--Section 1919(b) of the Social Security Act 
(42 U.S.C. 1395i-3(b)) is amended by adding at the end the following 
new paragraph:
            ``(9) Information on transitioning to prescription drug 
        coverage.--A nursing facility must provide information to 
        residents and the families of residents on how to transition to 
        prescription drug coverage under MA-PD plans under part C and 
        prescription drug plans under part D upon discharge from the 
        facility.''.
    (c) Effective Date.--The amendments made by this section shall take 
effect on January 1, 2011.

SEC. 107. STREAMLINED PHARMACY COMPLIANCE PACKAGING.

    (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 new subparagraph:
                    ``(G) Streamlined pharmacy compliance packaging for 
                dual eligible individuals.--A PDP sponsor of a 
                prescription drug plan shall streamline pharmacy 
                compliance packaging for individuals enrolled in the 
                plan who--
                            ``(i) are entitled to medical assistance 
                        under a State plan under title XVIII; and
                            ``(ii) reside in a nursing home.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to drugs dispensed on or after January 1, 2010.

SEC. 108. LOWERING COVERED PART D DRUG PRICES ON BEHALF OF MEDICARE 
              BENEFICIARIES.

    (a) Repeal of Prohibition.--Section 1860D-11 of the Social Security 
Act (42 U.S.C. 1395w-111) is amended by striking subsection (i) and 
inserting the following:
    ``(i) Lowering Covered Part D Drug Prices.--
            ``(1) In general.--The Secretary shall reduce the purchase 
        cost of covered part D drugs by implementing 2 or more of the 
        following strategies on an annual basis (beginning with 2011):
                    ``(A) Negotiating directly with pharmaceutical 
                manufacturers for additional discounts, rebates, and 
                other price concessions that may be made available to 
                Medicare operated prescription drug plans under section 
                1860D-11A for covered part D drugs.
                    ``(B) Entering into rebate agreements with 
                manufacturers to provide to the Secretary a rebate for 
                any covered outpatient drug of a manufacturer dispensed 
                during a rebate period specified in the agreement to a 
                subsidy eligible individual described (or treated as 
                described) in section 1860D-14(a)(1) for which payment 
                was made by a PDP sponsor under part D of title XVIII 
                or an MA organization under part C of such title for 
                such period in an amount determined in the same manner 
                as the rebate amount for such drug would have been 
                determined under subsection (c) of section 1927 if the 
                dispensing of the drug to such individual was paid for 
                by a State and subject to a rebate agreement entered 
                into under such section (and allocating any such 
                rebates received among the prescription drug plans of 
                such PDP sponsors and MA-PD plans offered by such 
                organizations based on the enrollment of such 
                individuals in such plans).
                    ``(C) In consultation with the Director of the 
                Agency for Healthcare Research and Quality, using data 
                from relevant and unbiased studies on the comparative 
                clinical effectiveness of covered part D drugs to--
                            ``(i) educate physicians and pharmacists; 
                        and
                            ``(ii) provide information to PDP sponsors 
                        of prescription drug plans and MA organizations 
                        offering MA-PD plans for use in making 
                        decisions regarding plan formularies.
                    ``(D) Instituting prescription drug prices 
                negotiated under the Federal Supply Schedule of the 
                General Services Administration for the reimbursement 
                of covered part D drugs.
            ``(2) Rule of construction.--Nothing in this subsection 
        shall be construed as preventing the PDP sponsor of a 
        prescription drug plan or an MA organization offering an MA-PD 
        plan from obtaining a discount or reduction of the price for a 
        covered part D drug below the price negotiated by the Secretary 
        for a Medicare-operated plan under paragraph (1)(A).
            ``(3) Annual reports to congress.--Not later than January 
        1, 2012, and annually thereafter, the Secretary shall submit to 
        the Committee on Finance of the Senate and to the Committee on 
        Ways and Means, the Committee on Energy and Commerce, and the 
        Committee on Oversight and Government Reform of the House of 
        Representatives a report on the strategies implemented by the 
        Secretary under paragraph (1) to achieve lower prices on 
        covered part D drugs for beneficiaries, including the prices of 
        such covered part D drugs and any price concessions achieved by 
        the Secretary as a result of such implementation.''.

SEC. 109. CORRECTION OF FLAWS IN DETERMINATION OF PHASED-DOWN STATE 
              CONTRIBUTION FOR FEDERAL ASSUMPTION OF PRESCRIPTION DRUG 
              COSTS FOR DUALLY ELIGIBLE INDIVIDUALS.

    Section 1935(c) of the Social Security Act (42 U.S.C. 1396u-5(c)) 
is amended--
            (1) in paragraph (1), in the matter preceding subparagraph 
        (A), by striking ``Each'' and inserting ``Subject to paragraph 
        (7), each''; and
            (2) by adding at the end the following new paragraph:
            ``(7) Modification of determination of amount of state 
        contribution.--Not later than January 1, 2011, the Secretary of 
        Health and Human Services (in this section referred to as the 
        `Secretary'), acting through the Director of the Federal 
        Coordinated Health Care Office established under section 101 of 
        the Medicare Prescription Drug Reform Act of 2009, shall 
        promulgate regulations for modifying the factors used to 
        determine the product under paragraph (1)(A) for each State and 
        month that take into account the following with respect to each 
        State:
                    ``(A) Factoring into the determination of base year 
                State Medicaid per capita expenditures for covered part 
                D drugs for full-benefit dual eligible individuals 
                under paragraph (3) all payments collected by a State 
                under agreements under section 1927 for outpatient 
                prescription drugs purchased in 2003 (not just for such 
                payments that were collected by the State in 2003).
                    ``(B) Pharmacy cost savings measures implemented by 
                the State during the period that begins with 2003 and 
                ends with 2006.
                    ``(C) Substituting under paragraph (4) a State-
                specific growth factor in lieu of the national 
                applicable growth factor for 2004 and succeeding years 
                based on the annual percentage increase in the State's 
                average per capita aggregate expenditures for covered 
                outpatient drugs.
        Such regulations shall include procedures for adjusting 
        payments to States under section 1903(a) to take into account 
        any overpayments or underpayments which the Secretary 
        determines on the basis of such modifications were made by 
        States under this subsection for 2004 and succeeding years.''.

SEC. 110. NO IMPACT ON ELIGIBILITY FOR BENEFITS UNDER OTHER PROGRAMS.

    (a) In General.--Section 1860D-14(a)(3) of the Social Security Act 
(42 U.S.C. 1395w-114(a)(3)), is amended--
            (1) in subparagraph (A), in the matter preceding clause 
        (i), by striking ``subparagraph (F)'' and inserting 
        ``subparagraphs (F) and (H)''; and
            (2) by adding at the end the following new subparagraph:
                    ``(H) No impact on eligibility for benefits under 
                other programs.--The availability of premium and cost-
                sharing subsidies under this section shall not be 
                treated as benefits or otherwise taken into account in 
                determining an individual's eligibility for, or the 
                amount of benefits under, any other Federal program.''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on the date of enactment of this Act.

SEC. 111. QUALITY INDICATORS FOR DUAL ELIGIBLE INDIVIDUALS.

    Section 1154(a) of the Social Security Act (42 U.S.C. 1320c-3(a)) 
is amended by inserting after paragraph (11) the following new 
paragraph:
            ``(12) For all contracts entered into on or after August 1, 
        2011, the organization shall produce a statistically valid 
        subsample of quality indicators applicable to dual eligible 
        beneficiaries under titles XVIII and XIX.''.

        TITLE II--ADDITIONAL MEDICARE AND MEDICAID IMPROVEMENTS

Subtitle A--Improving the Financial Assistance Available to Low-Income 
                         Medicare Beneficiaries

SEC. 201. IMPROVING ASSETS TESTS FOR MEDICARE SAVINGS PROGRAM AND LOW-
              INCOME SUBSIDY PROGRAM.

    (a) Application of Highest Level Permitted Under LIS.--
            (1) To full-premium subsidy eligible individuals.--Section 
        1860D-14(a) of the Social Security Act (42 U.S.C. 1395w-114(a)) 
        is amended--
                    (A) in paragraph (1), in the matter before 
                subparagraph (A), by inserting ``(or, beginning with 
                2010, paragraph (3)(E))'' after ``paragraph (3)(D)''; 
                and
                    (B) in paragraph (3)(A)(iii), by striking ``(D) 
                or''.
            (2) Annual increase in lis resource test.--Section 1860D-
        14(a)(3)(E)(i) of the Social Security Act (42 U.S.C. 1395w-
        114(a)(3)(E)(i)) is amended--
                    (A) by striking ``and'' at the end of subclause 
                (I);
                    (B) in subclause (II), by inserting ``(before 
                2010)'' after ``subsequent year'';
                    (C) by striking the period at the end of subclause 
                (II) and inserting a semicolon;
                    (D) by inserting after subclause (II) the following 
                new subclauses:
                                    ``(III) for 2010, $27,500 (or 
                                $55,000 in the case of the combined 
                                value of the individual's assets or 
                                resources and the assets or resources 
                                of the individual's spouse); and
                                    ``(IV) for a subsequent year, the 
                                dollar amounts specified in this 
                                subclause (or subclause (III)) for the 
                                previous year increased by the annual 
                                percentage increase in the consumer 
                                price index (all items; U.S. city 
                                average) as of September of such 
                                previous year.''; and
                    (E) in the last sentence, by inserting ``or (IV)'' 
                after ``subclause (II)''.
            (3) Application of lis test under medicare savings 
        program.--Section 1905(p)(1)(C) of the Social Security Act (42 
        U.S.C. 1396d(p)(1)(C)) is amended by striking ``subparagraph 
        (D)'' and all that follows through the period at the end and 
        inserting the following: ``section 1860D-14(a)(3)(E) applicable 
        to an individual or to the individual and the individual's 
        spouse (as the case may be)''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to eligibility determinations for income-related subsidies and 
Medicare cost-sharing furnished for periods beginning on or after 
January 1, 2010.

SEC. 202. ELIMINATING BARRIERS TO ENROLLMENT.

    (a) Encouraging Application of Procedures Under Medicare Savings 
Program.--Section 1905(p) of the Social Security Act (42 U.S.C. 
1396d(p)) is amended by adding at the end the following new paragraph:
    ``(7) The Secretary shall take all reasonable steps to encourage 
States to provide for administrative verification of income and 
automatic reenrollment (as provided under subparagraphs (C)(iii) and 
(G) of section 1860D-14(a)(3) in the case of the low-income subsidy 
program).''.
    (b) Ensuring That SSA and States Can Electronically Process All 
Low-Income Subsidy Program Applications.--Section 1860D-14(a)(3)(B)(i) 
of the Social Security Act (42 U.S.C. 1395w-114(a)(3)(B)(i)) is amended 
by inserting after the first sentence the following new sentence: ``Not 
later than January 1, 2012, the State plan and the Commissioner shall 
have in place procedures to ensure the capacity to process all 
applications for determinations (including all applications that are 
not in English) electronically.''.

SEC. 203. 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 being provided medical 
                                assistance for home and community-based 
                                services under subsection (c), (d), 
                                (e), (i), or (j) of section 1915 or 
                                pursuant to section 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)).''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to drugs dispensed on or after January 1, 2010.

SEC. 204. EXEMPTION OF BALANCE IN ANY PENSION OR RETIREMENT PLAN FROM 
              RESOURCES FOR DETERMINATION OF ELIGIBILITY FOR LOW-INCOME 
              SUBSIDY.

    (a) In General.--Section 1860D-14(a)(3) of the Social Security Act 
(42 U.S.C. 1395w-114(a)(3)) is amended--
            (1) in subparagraph (D), in the matter before clause (i), 
        by striking ``life insurance policy exclusion provided under 
        subparagraph (G)'' and inserting ``additional exclusions 
        provided under subparagraphs (G) and (H)'';
            (2) in subparagraph (E)(i), in the matter before subclause 
        (I), by striking ``life insurance policy exclusion provided 
        under subparagraph (G)'' and inserting ``additional exclusions 
        provided under subparagraphs (G) and (H)''; and
            (3) by adding at the end the following new subparagraph:
                    ``(H) Pension or retirement plan exclusion.--In 
                determining the resources of an individual (and the 
                eligible spouse of the individual, if any) under 
                section 1613 for purposes of subparagraphs (D) and (E), 
                no balance in any pension or retirement plan shall be 
                taken into account.''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on January 1, 2010, and shall apply to determinations of 
eligibility for months beginning with January 2010.

SEC. 205. COST-SHARING PROTECTIONS FOR LOW-INCOME SUBSIDY-ELIGIBLE 
              INDIVIDUALS.

    (a) In General.--Section 1860D-14(a) of the Social Security Act (42 
U.S.C. 1395w-114(a)) is amended--
            (1) in paragraph (1)(D), by adding at the end the following 
        new clause:
                            ``(iv) Overall limitation on cost-
                        sharing.--In the case of all such individuals, 
                        a limitation on aggregate cost-sharing under 
                        this part for a year not to exceed 2.5 percent 
                        of income.''; and
            (2) in paragraph (2), by adding at the end the following 
        new subparagraph:
                    ``(F) Overall limitation on cost-sharing.--A 
                limitation on aggregate cost-sharing under this part 
                for a year not to exceed 2.5 percent of income.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply as of January 1, 2010.

                     Subtitle B--Other Improvements

SEC. 211. ENROLLMENT IMPROVEMENTS UNDER MEDICARE PARTS C AND D.

    (a) Special Election Period During First 60 Days of Enrollment in a 
New Plan.--
            (1) In general.--Section 1851(e)(4) of the Social Security 
        Act (42 U.S.C. 1395w(e)(4)) is amended--
                    (A) in subparagraph (C), by striking ``or'' at the 
                end;
                    (B) by redesignating subparagraph (D) as 
                subparagraph (E); and
                    (C) by inserting after subparagraph (C) the 
                following new subparagraph:
                    ``(D) the individual has been enrolled in such plan 
                for fewer than 60 days; or''.
            (2) Effective date.--The amendments made by paragraph (1) 
        shall take effect on the date that is 90 days after the date of 
        enactment of this Act.
    (b) Extension of the Annual, Coordinated Election Period.--
            (1) In general.--Section 1851(e)(3)(B)(iv) of the Social 
        Security Act (42 U.S.C. 1395w-1(e)(3)(B)(iv)) is amended by 
        striking ``November 15'' and inserting ``October 1''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply to annual, coordinated election periods beginning 
        after the date of enactment of this Act.
    (c) Coordination Under Parts C and D of the Continuous Open 
Enrollment and Disenrollment Period for the First 3 Months of the 
Year.--
            (1) In general.--Section 1860D-1(b)(1)(B)(iii) of the 
        Social Security Act (42 U.S.C. 1395w-101(b)(1)(B)(iii)) is 
        amended by striking ``, (C),''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall take effect on January 1, 2010.

SEC. 212. MEDICARE PLAN COMPLAINT SYSTEM.

    (a) System.--Section 1808 of the Social Security Act (42 U.S.C. 
1395b-9) is amended--
            (1) in subsection (c)(2)--
                    (A) in subparagraph (B)(iii), by striking 
                ``adjustment; and'' and inserting ``adjustment);'';
                    (B) in subparagraph (C), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(D) develop and maintain the plan complaint 
                system under subsection (d).''; and
            (2) by adding at the end the following new subsection:
    ``(d) Plan Complaint System.--
            ``(1) System.--
                    ``(A) In general.--The Secretary shall develop and 
                maintain a plan complaint system, (in this subsection 
                referred to as the `system') to--
                            ``(i) collect and maintain information on 
                        plan complaints;
                            ``(ii) track plan complaints from the date 
                        the complaint is logged into the system through 
                        the date the complaint is resolved; and
                            ``(iii) otherwise improve the process for 
                        reporting plan complaints.
                    ``(B) Timeframe.--The Secretary shall have the 
                system in place by not later than the date that is 6 
                months after the date of enactment of this subsection.
                    ``(C) Plan complaint defined.--In this subsection, 
                the term `plan complaint' means a complaint that is 
                received (including by telephone, letter, e-mail, or 
                any other means) by the Secretary (including by a 
                regional office, the Medicare Beneficiary Ombudsman, a 
                subcontractor, a carrier, a fiscal intermediary, and a 
                Medicare administrative contractor) from a Medicare 
                Advantage eligible individual or a part D eligible 
                individual (or an individual representing such an 
                individual) regarding a Medicare Advantage 
                organization, a Medicare Advantage plan, a prescription 
                drug plan sponsor, or a prescription drug plan, 
                including, but not limited to, complaints relating to 
                marketing, enrollment, covered drugs, premiums and 
                cost-sharing, and plan customer service, grievances and 
                appeals, participating providers. Such term also 
                includes plan complaints that are received by the 
                Secretary directly from the organization offering the 
                plan relating to complaints by such individuals.
            ``(2) Process criteria.--In developing the system, the 
        Secretary shall establish a process for reporting plan 
        complaints. Such process shall meet the following criteria:
                    ``(A) Accessible.--The process is widely known and 
                easy to use.
                    ``(B) Investigative capacity.--The process involves 
                the appropriate experts, resources, and methods to 
                assess complaints and determine whether they reflect an 
                underlying pattern.
                    ``(C) Intervention and follow-through.--The process 
                triggers appropriate interventions and monitoring based 
                on substantiated complaints.
                    ``(D) Quality improvement orientation.--The process 
                guides quality improvement.
                    ``(E) Responsiveness.--The process routinely 
                provides consistent, clear, and substantive responses 
                to complaints.
                    ``(F) Timelines.--Each process step is completed 
                within a reasonable, established timeframe, and 
                mechanisms exist to deal quickly with complaints of an 
                emergency nature requiring immediate attention.
                    ``(G) Objective.--The process is unbiased, 
                balancing the rights of each party.
                    ``(H) Public accountability.--The process makes 
                complaint information available to the public.
            ``(3) Standard data reporting requirements.--
                    ``(A) In general.--The Secretary shall establish 
                standard data reporting requirements for reporting plan 
                complaints under the system.
                    ``(B) Model electronic complaint form.--The 
                Secretary shall develop a model electronic complaint 
                form to be used for reporting plan complaints under the 
                system. Such form shall be prominently displayed on the 
                front page of the Medicare.gov Internet website and on 
                the Internet website of the Medicare Beneficiary 
                Ombudsman.
            ``(4) All complaints required to be logged into the 
        system.--Every plan complaint shall be logged into the system.
            ``(5) Casework notations.--The system shall provide for the 
        inclusion of any casework notations throughout the complaint 
        process on the record of a plan complaint.
            ``(6) Medicare beneficiary ombudsman.--The Secretary shall 
        carry out this subsection acting through the Medicare 
        Beneficiary Ombudsman.''.
    (b) Funding.--There are authorized to be appropriated such sums as 
may be necessary for the costs of carrying out section 1808(d) of the 
Social Security Act, as added by subsection (a).
    (c) Reports.--
            (1) Secretary.--
                    (A) Ongoing study.--The Medicare Beneficiary 
                Ombudsman (under subsection (c) of section 1808) of the 
                Social Security Act (42 U.S.C. 1395b-9) shall conduct 
                an ongoing study of the plan complaint system 
                established under subsection (d) of such section (as 
                added by subsection (a)), in this subsection referred 
                to as the ``system''. Such study shall include an 
                analysis of--
                            (i) the numbers and types of complaints 
                        reported under the system;
                            (ii) geographic variations in such 
                        complaints;
                            (iii) the timeliness of agency or plan 
                        responses to such complaints; and
                            (iv) the resolution of such complaints.
                    (B) Quarterly reports.--Not later than 6 months 
                after the implementation of the system, and every 3 
                months thereafter, the Secretary of Health and Human 
                Services shall submit to Congress a report on the study 
                conducted under subparagraph (A), together with 
                recommendations for such legislation and administrative 
                actions as the Secretary determines appropriate.
            (2) Inspector general.--The Inspector General of the 
        Department of Health and Human Services shall conduct an 
        evaluation of the system. Not later than 1 year after the 
        implementation of the system, the Inspector General shall 
        submit to Congress a report on such evaluation, together with 
        recommendations for such legislation and administrative actions 
        as the Inspector General determines appropriate.

SEC. 213. UNIFORM EXCEPTIONS AND APPEALS PROCESS.

    (a) In General.--Section 1860D-4(b)(3) of the Social Security Act 
(42 U.S.C. 1395w-104(b)(3)), as amended by section 107, is amended by 
adding at the end the following new subparagraph:
                    ``(G) Use of single, uniform exceptions and appeals 
                process.--Notwithstanding any other provision of this 
                part, a PDP sponsor of a prescription drug plan or an 
                MA organization offering an MA-PD plan shall--
                            ``(i) use a single, uniform exceptions and 
                        appeals process with respect to the 
                        determination of prescription drug coverage for 
                        an enrollee under the plan; and
                            ``(ii) provide instant access to such 
                        process by enrollees through a toll-free 
                        telephone number and an Internet website.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to exceptions and appeals on or after January 1, 2011.

SEC. 214. PROHIBITION ON CONDITIONING MEDICAID ELIGIBILITY FOR 
              INDIVIDUALS ENROLLED IN CERTAIN CREDITABLE PRESCRIPTION 
              DRUG COVERAGE ON ENROLLMENT IN THE MEDICARE PART D DRUG 
              PROGRAM.

    (a) In General.--Section 1935 of the Social Security Act (42 U.S.C. 
1396v) is amended by adding at the end the following:
    ``(f) Prohibition on Conditioning Eligibility for Medical 
Assistance for Individuals Enrolled in Certain Creditable Prescription 
Drug Coverage on Enrollment in Medicare Prescription Drug Benefit.--
            ``(1) In general.--A State shall not condition eligibility 
        for medical assistance under the State plan for a part D 
        eligible individual (as defined in section 1860D-1(a)(3)(A)) 
        who is enrolled in creditable prescription drug coverage 
        described in any of subparagraphs (C) through (H) of section 
        1860D-13(b)(4) on the individual's enrollment in a prescription 
        drug plan under part D of title XVIII or an MA-PD plan under 
        part C of such title.
            ``(2) Coordination of benefits with part d for other 
        individuals.--Nothing in this subsection shall be construed as 
        prohibiting a State from coordinating medical assistance under 
        the State plan with benefits under part D of title XVIII for 
        individuals not described in paragraph (1).''.

SEC. 215. OFFICE OF THE INSPECTOR GENERAL ANNUAL REPORT ON PART D 
              FORMULARIES' INCLUSION OF DRUGS COMMONLY USED BY DUAL 
              ELIGIBLES.

    (a) Ongoing Study.--The Inspector General of the Department of 
Health and Human Services shall conduct an ongoing study of the extent 
to which formularies used by prescription drug plans and MA-PD plans 
under part D include drugs commonly used by 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))).
    (b) Annual Reports.--Not later than July 1 of each year (beginning 
with 2010), the Inspector General shall submit to Congress a report on 
the study conducted under paragraph (1), together with such 
recommendations as the Inspector General determines appropriate.

SEC. 216. HHS ONGOING STUDY AND ANNUAL REPORTS ON COVERAGE FOR DUAL 
              ELIGIBLES.

    (a) Ongoing Study.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary'') shall 
        conduct an ongoing study to track--
                    (A) how many of the new full benefit dual eligible 
                individuals (as defined in section 1935(c)(6) of the 
                Social Security Act (42 U.S.C. 1395u-5(c)(6))) enroll 
                in a plan under part D of title XVIII of such Act and 
                receive retroactive prescription drug coverage under 
                the plan; and
                    (B) if such retroactive coverage is provided to 
                such individuals--
                            (i) the number of months of coverage 
                        provided; and
                            (ii) the amount of reimbursements to 
                        individuals and to individuals that made 
                        payments for prescription drugs on their behalf 
                        for costs incurred during retroactive coverage 
                        periods.
            (2) Data to use.--In conducting the study with respect to 
        the requirements under paragraph (1)(B), the Secretary shall 
        examine prescription drug utilization data reported by Medicare 
        part D plans.
    (b) Annual Reports on Ongoing Study.--Not later than March 1 of 
each year (beginning with 2010), the Secretary shall submit a report to 
Congress containing the results of the study conducted under subsection 
(a), together with recommendations for such legislation and 
administrative action as the Secretary determines appropriate.
    (c) Annual Reports on Spending and Outcomes.--Not later than 
January 1 of each year (beginning with 2013), the Secretary shall 
collect data and submit a report to Congress that includes the 
following information:
            (1) Annual total expenditures (disaggregated by Federal and 
        State expenditures) for dually eligible beneficiaries under 
        title XVIII and under State plans and waivers under title XIX.
            (2) An analysis of health outcomes for dually eligible 
        beneficiaries, disaggregated by subtypes of beneficiaries (as 
        determined by the Secretary).
            (3) An analysis of the extent to which dually eligible 
        beneficiaries are able to access benefits under title XVIII and 
        under State plans and waivers under title XIX.

SEC. 217. AUTHORITY TO OBTAIN INFORMATION.

    Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is 
amended by adding at the end the following new section:

      ``authority of the comptroller general to obtain information

    ``Sec. 1899. No provision in this Act in effect on the date of 
enactment of this section or enacted after such date shall be construed 
to limit, amend, or supersede the authority of the Comptroller General 
of the United States to obtain agency records pursuant to section 716 
of title 31, United States Code, including any information obtained by, 
or disclosed to, the Secretary under part C or D of this title, except 
to the extent that such provision expressly and specifically refers to 
this section and provides for such limitation, amendment, or 
supersession.''.
                                 <all>