[Congressional Record Volume 151, Number 26 (Tuesday, March 8, 2005)]
[Senate]
[Pages S2270-S2272]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ROCKEFELLER (for himself, Mr. Kennedy, Mr. Corzine, and 
        Mr. Lautenberg):
  S. 566. A bill to continue State coverage of medicaid prescription 
drug coverage to medicare dual eligible beneficiaries for 6 months 
while still allowing the medicare part D benefit to be implemented as 
scheduled; to the Committee on Finance.
  Mr. ROCKEFELLER. Mr. President, millions of seniors and disabled 
Americans are facing a major disruption in their health care when the 
Medicare prescription drug law goes into effect on January 1, 2006. On 
that singular date, 6.4 million dual eligibles--individuals who are 
eligible for both Medicare and full Medicaid benefits--will lose their 
Medicaid prescription drug coverage regardless of whether they have 
obtained coverage through a Medicare Part D prescription drug plan and 
regardless of whether their Part D plan's coverage is as broad as their 
State's Medicaid coverage. Such a short transition period leaves no 
time to address the inevitable problems that will occur with a 
transition of this magnitude.
  Dual eligibles should have as smooth a transition as possible to 
Medicare prescription drug coverage. Unfortunately, a smooth transition 
is not what will happen under current law. The Medicare prescription 
drug law only requires a six-week transition period for dual eligibles, 
from November 15, 2005, to January 1, 2006. This is the largest 
transition of individuals from one insurance program to another, public 
or private, and it is unrealistic to believe that such a huge 
transition can take place in the span of six weeks.
  Moving a large number of seniors and people with disabilities to an 
entirely new system for prescription drug coverage is a major 
undertaking. Dual eligibles will require adequate outreach, education, 
and time to adjust to a change of this magnitude. The stakes are 
extremely high for this population. Over half are limited in activities 
of daily living. Many live alone or in nursing homes. And, in 
comparison to other Medicare beneficiaries, dual eligibles are much 
more likely to have heart disease, pulmonary disease, diabetes, or 
Alzheimer's. Therefore, it is absolutely critical that we get this 
transition right the first time.
  The Centers for Medicare and Medicaid Services (CMS) has taken 
several steps to improve the transition of the dual eligibles from 
Medicaid to Medicare. However, I fear these steps do not go far enough. 
Automatic enrollment does not guarantee that beneficiaries will know 
that they have been enrolled in a new Medicare drug plan or know how to 
access necessary prescription drugs using that drug plan. Once 
beneficiaries are enrolled, they are likely to experience ongoing 
confusion about covered drugs, authorized pharmacies, and the Medicare 
appeals process.
  In its June 2004 report to Congress, the Medicare Payment Advisory 
Commission (MedPAC) suggested that even large, private employers need 
at least six months to transition their employees' drug coverage from 
one pharmacy benefit manager to another. The two large employers that 
MedPAC studied had 25,000 and 75,000 employees, respectively. The 
states and the federal government are taking on a far more complex task 
with 6.4 million dual eligibles, and should have at least six months to 
transition the duals to Medicare in order prevent major disruptions in 
access to prescription drugs.
  I am pleased to be joined today by my distinguished colleagues in the 
Senate, Senators Kennedy, Corzine, and Lautenberg, as well my 
distinguished co-sponsor in the House of Representatives, Congressman 
Tom Allen of Maine, in introducing the Medicare Dual Eligible 
Prescription Drug Coverage Act of 2005. This important legislation 
would extend the dual eligible transition period to six months in order 
to achieve the best possible health outcomes for some of our Nation's 
most vulnerable citizens. An extended timeframe would give states 
enough time to carry out comprehensive education and outreach 
initiatives. It would also give seniors and individuals with 
disabilities time to explore their options and gradually transition to 
Medicare Part D.

  Specifically, the Medicare Dual Eligible Prescription Drug Coverage 
Act of 2005 would extend the availability of Medicaid prescription drug 
coverage for six months while still allowing the Part D benefit to be 
implemented as scheduled. Since states would be temporarily 
supplementing Medicare Part D, they would be fully relieved of any 
``clawback'' responsibilities during the six-month transition. This 
legislation would also provide dedicated resources

[[Page S2271]]

for education and outreach to the dual eligibles, including additional 
resources for State Health Insurance Assistance Programs (SHIPs). 
Finally, the Medicare Dual Eligible Prescription Drug Coverage Act 
would require CMS to share drug utilization data with state Medicaid 
programs so that states can appropriately coordinate non-prescription 
drug coverage for the duals.
  This is an issue of fundamental fairness. The Medicare law provides 
Medicare beneficiaries who are not dually eligible for Medicaid six 
months to transition to Medicare prescription drug coverage. Dual 
eligibles should not be treated any differently. Medicare's 
universality is something I fought hard for during the Medicare debate. 
I strongly believe low-income seniors and disabled individuals should 
not be excluded from Medicare benefits because of their income levels. 
The Medicare law should not merely support the principle of 
universality in statute. It must also support universality in fact, and 
that means Medicare beneficiaries who are dually eligible for Medicaid 
must also be given enough time to make a smooth transition to Medicare.
  I look forward to working with my colleagues to pass this important 
legislation. I ask that the full text of this bill, be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                 S. 566

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Medicare Dual Eligible 
     Prescription Drug Coverage Act of 2005''.

     SEC. 2. FINDINGS.

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

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

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

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

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

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

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

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

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

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     the Medicare Prescription Drug, Improvement, and 
     Modernization Act of 2003 (Public Law 108-173; 117 Stat. 
     2071).

     SEC. 7. GAO STUDY ON THE CLAWBACK FORMULA.

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