article: 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 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 to 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 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.
summary: Medicare Dual Eligible Prescription Drug Coverage Act of 2005 - Provides that, for prescriptions filled between January 1 and June 30, 2006, requirements for the coordination of prescription drug benefits with Medicare as primary payor for dual eligible individuals under the new prescription drug benefit program (PDP) under Medicare part E (Voluntary Prescription Drug Benefit Program) shall not apply. Requires a State to continue to provide Medicaid medical assistance with respect to prescription drugs as if such coordination requirements had not been enacted. Declares that no State or the District of Columbia shall be required to pay (reimburse) the Secretary of Health and Human Services for Medicaid prescription drug costs for dual eligible individuals (Medicaid clawback payments) for any month before July 1, 2006. Earmarks specified amounts for education and outreach to dual eligibles regarding prescription drug coverage and monitoring of their transition to prescription drug coverage under Medicare. Requires a PDP sponsor and an MA organization offering an MA-PD plan to submit to the Secretary appropriate information regarding the drug utilization of enrollees in such plans who are full-benefit dual eligible individuals. Directs the Secretary to collect data on the drug utilization of full-benefit dual eligible individuals and share it with the States and District of Columbia in as close to a real-time basis as possible. Directs the Comptroller General of the United States to study and report to Congress on the clawback formula.