[Congressional Record Volume 152, Number 32 (Tuesday, March 14, 2006)]
[Senate]
[Pages S2124-S2125]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. SMITH (for himself, Mr. Bingaman, Mrs. Clinton, Mr. Nelson 
        of Florida, and Mrs. Lincoln):
  S. 2409. A bill to amend title XVIII of the Social Security Act to 
reduce cost-sharing under part D of such title for certain non-
institutionalized full-benefit dual eligible individuals; to the 
Committee on Finance.
  Mr. SMITH. Mr. President, today I am proud to join with my 
colleagues, Senators Bingaman, Clinton and Nelson, to introduce the 
Home and Community Based Services Copayment Equity Act of 2006. This 
important piece of legislation addresses a significant oversight in the 
Medicare Part D prescription drug benefit. While nearly 22 million 
seniors now have access to affordable prescription drug coverage under 
the program, many of the most vulnerable Medicare beneficiaries are 
being charged unnecessary copayments simply based upon how they choose 
to receive their long-term care services.
  Under current law, dual eligible Medicare beneficiaries, those who 
qualify for both Medicaid and Medicare coverage, receive a subsidy from 
the government to pay the benefit's required $250 deductible. These 
individuals also qualify for reduced copayments for both generic and 
brand named drugs in the amount of one and three dollars respectively. 
If a dual-eligible beneficiary receives long-term care services in an 
institutional setting, such as a nursing home, he or she is exempt from 
paying the required copayment. Congress decided to provide this 
assistance because dual-eligible beneficiaries residing in nursing 
homes live off of very limited incomes. For instance, in Oregon the 
personal needs allowance beneficiaries receive each month for 
incidentals, including medications, is only $30. As many 
institutionalized beneficiaries are on multiple medications, they would 
not be able to meet their share of drug costs.
  This is the very reason Congress provided institutionalized dual-
eligible beneficiaries with an exemption from all copayments under 
Medicare Part D. However, many dual eligible beneficiaries choose to 
receive long-term care services in home or community-based settings, 
such as assisted living or resident care program facilities. Almost all 
states have chosen to establish Home and Community Based Services 
Medicaid demonstration projects that have expanded access to community 
based alternatives to an even greater number of low-income elderly 
Americans. The State of Oregon operates one of the Nation's most 
successful HCS waivers, serving approximately 23,500 dual eligible 
beneficiaries this year. My State has a thriving community based care 
industry that has provided many dual eligible Oregonians the freedom to 
choose the care setting that best meets their own physical and social 
needs.
  While dual eligible beneficiaries are exempted from prescription drug 
copayments under Medicare Part D, those choosing community based 
alternatives are required to pay them. This is despite the fact that 
beneficiaries choosing community based care options typically live off 
of the same limited incomes as those residing in nursing homes. Despite 
the fact that some States provide HCS beneficiaries a larger personal 
stipend each month, they may have greater financial demands. At the end 
of the day, they are in no better position to pay the costs of 
prescription drugs than those beneficiaries living in nursing homes.

[[Page S2125]]

  I should also note that their less restrictive living environments 
may require them to take additional medications to support their daily 
routines. It is not uncommon for dual eligible beneficiaries in 
community-based care settings to be on 8 to 10 medications at a given 
time. At that level, even minimal copayments create a significant 
financial burden to these individuals.
  The current dual-eligible copayment exemption policy is not only 
creating inequity in Medicare Part D, it is potentially restricting 
access to life-saving medications. This is certainly not what Congress 
intended when it created the new prescription drug benefit, especially 
for this incredibly vulnerable population. If Congress does not act 
quickly to extend the exemption to dual eligible beneficiaries in 
community based care, individuals may begin to gravitate toward 
institutional options simply because they can have their drugs costs 
paid in those settings. I believe we need to do everything possible to 
support choice in long-term care, and by applying the current 
institutional copayment exemption more uniformly, Congress will ensure 
the Medicare drug benefit does not adversely affect beneficiaries 
choices.
  I ask my colleagues to improve the fairness of the Medicare 
prescription drug benefit for all dual eligible beneficiaries by 
supporting the Home and Community Based Copayment Equity Act. I hope 
you will join me in calling for its quick passage in the Senate.
  Mrs. CLINTON. Mr. President, today I rise to introduce bipartisan 
legislation with my colleagues Senators Smith, Nelson, and Bingaman to 
address yet another serious flaw in the Medicare prescription drug 
benefit that has come to light.
  On January 1, the new Medicare prescription drug benefit went into 
effect. Overnight, millions of seniors and disabled Americans found 
themselves thrown into a confusing and complex transition.
  Some of our poorest and most vulnerable beneficiaries, those in 
assisted living facilities, have found themselves suddenly forced to 
produce co-payments to get the medications they need.
  These are beneficiaries with serious mental illnesses who have been 
stabilized on medications, and people with developmental and physical 
disabilities who have little or no incomes and no way to afford the 
medicines that they depend on.
  The bill we are introducing will fix this problem by waiving co-
payments for this group of vulnerable beneficiaries in the same manner 
that these co-payments are already waived for Medicare beneficiaries in 
nursing homes.
  This is just one of so many problems we have seen plaguing this 
program. I am working on all fronts to help Medicare beneficiaries 
weather this transition. Before this program went into effect, it was 
clear that those dually eligible for Medicare and Medicaid, our poorest 
and most vulnerable seniors and disabled, would have a particular 
challenge navigating this transition. I was very concerned that many of 
these Medicare recipients would walk up to their pharmacy counters on 
January 1 and be unable to get their prescriptions filled.
  In anticipation of these problems, I introduced legislation in 
December to keep these Medicare recipients from falling through the 
cracks by stepping up outreach and education to pharmacists and 
providing reimbursement to pharmacists who are charged a transaction 
fee to access beneficiary information through Medicare. I also co-
sponsored legislation to give Medicare beneficiaries more time to 
enroll in the new program.
  And I issued a resource guide, now available in both English and 
Spanish, to help New Yorkers navigate this new program. To date more 
than 75,000 copies of the guide have been distributed.
  Since the new program went into effect, I have repeatedly urged the 
Bush Administration to address the problems plaguing this program. And 
in January, I introduced comprehensive legislation along with several 
of my Senate colleagues, that includes my bill to help pharmacists help 
their customers, and makes the other fixes I have been calling for: 
provisions to improve outreach and education, fix problems with drug 
plans transition programs, protect the benefits of seniors who also 
have coverage from a retiree drug plan, and make sure that states and 
low income beneficiaries are reimbursed for excessive costs they have 
been forced to shoulder by the inept implementation of the new benefit.
  We owe it to our seniors and disabled Americans to get this right. 
And I will keep fighting to ensure that we do.
  Mr. NELSON of Florida. Mr. President, I am pleased to join my 
colleagues Senators Smith, Bingaman and Clinton as we introduce the 
Home and Community Services Co-payment Equity Act of 2006.
  For years now, I have advocated providing seniors and the disabled 
with meaningful prescription drug coverage. No one in this country 
should ever have to choose between their meals and their medications. 
In 2003, Congress passed the Medicare Modernization Act, which created 
a Medicare prescription drug program. I did not support this 
legislation, because I believe it created a program that contains 
several major flaws. However, I think that our job now is to do our 
best to help beneficiaries by fixing the underlying law.
  The Medicare prescription drug program exempts the lowest income 
nursing home residents from all prescription drug co-payments. However, 
it leaves out the equally vulnerable group of low-income beneficiaries 
who live in assisted living and other home and community-based 
facilities. These are often beneficiaries with serious mental illnesses 
who have been stabilized on medications, and people with developmental 
and physical disabilities who have little or no incomes and previously 
received prescription drug coverage under Medicaid.
  In my home State of Florida, thousands of individuals with mental 
illnesses are integrated into community-based programs such as 
assisted-living facilities. Unfortunately, many patients in these 
facilities are forgoing their medications on account of the new 
Medicare co-payments. Reports also indicate that patients have been 
hospitalized because they have been unable to afford their essential 
medications due to the new cost-sharing requirements.
  In response, we are introducing the Home and Community Services Co-
payment Equity Act of 2006. The legislation would waive co-payments for 
low-income beneficiaries residing in assisted living and other home- 
and community-based facilities. This bill is a small step that will go 
a long way towards ensuring that low-income patients get their 
prescription drugs.
  This issue boils down to just one goal--helping low-income seniors 
and people with disabilities afford the medications they need. I urge 
all of our colleagues, from both sides of the aisle, to join us in this 
vital effort.
                                 ______