Establishes as an independent executive agency a Medicare Prescription Drug Agency to administer the new part D program through the Commissioner. Authorizes appropriations.
Amends SSA title XVIII part B (Supplementary Medical Insurance) to provide for the exclusion of new part D costs from the determination of the Medicare part B monthly premium.
Revises Medicare supplemental health insurance (Medigap) requirements with respect to revision of the 1991 National Association of Insurance Commissioners Model Regulation to accord with this Act.
[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[S. 2836 Introduced in Senate (IS)]
106th CONGRESS
2d Session
S. 2836
To amend title XVIII of the Social Security Act to provide medicare
beneficiaries with access to affordable outpatient prescription drugs.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 30, 2000
Mr. Hagel (for himself, Mr. Abraham, Mr. Hutchinson, Mr. Burns, Mr.
Coverdell, Mr. McCain, Mr. Ashcroft, and Mr. Kyl) introduced the
following bill; which was read twice and referred to the Committee on
Finance
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to provide medicare
beneficiaries with access to affordable outpatient prescription drugs.
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 Rx Drug
Discount and Security Act of 2000''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Voluntary Medicare Outpatient Prescription Drug Discount and
Security Program.
``Part D--Voluntary Medicare Outpatient Prescription Drug Discount and
Security Program
``Sec. 1860. Definitions.
``Subpart 1--Establishment of Voluntary Medicare Outpatient
Prescription Drug Discount and Security Program
``Sec. 1860A. Establishment of program.
``Sec. 1860B. Enrollment.
``Sec. 1860C. Providing information to beneficiaries.
``Sec. 1860D. Annual enrollment fee.
``Sec. 1860E. Benefits under the program.
``Sec. 1860F. Selection of entities to provide outpatient drug
benefit.
``Sec. 1860G. Payments to eligible entities for administering
the catastrophic benefit.
``Sec. 1860H. Determination of income levels.
``Sec. 1860I. Appropriations.
``Subpart 2--Establishment of the Medicare Prescription Drug Agency
``Sec. 1860L. Medicare Prescription Drug Agency.
``Sec. 1860M. Commissioner; Deputy Commissioner; other
officers.
``Sec. 1860N. Administrative duties of the Commissioner.
``Sec. 1860O. Duties and authority of the Secretary.''.
Sec. 3. Exclusion of part D costs from determination of part B monthly
premium.
Sec. 4. Medigap revisions.
SEC. 2. VOLUNTARY MEDICARE OUTPATIENT PRESCRIPTION DRUG DISCOUNT AND
SECURITY PROGRAM.
(a) Establishment of Program.--Title XVIII of the Social Security
Act (42 U.S.C. 1395 et seq.) is amended by redesignating part D as part
E and by inserting after part C the following new part:
``Part D--Voluntary Medicare Outpatient Prescription Drug Discount and
Security Program
``definitions
``Sec. 1860. In this part:
``(1) Commissioner.--The term `Commissioner' means the
Commissioner of Medicare Prescription Drugs established under
subpart 2.
``(2) Covered outpatient drug.--
``(A) In general.--Except as provided in
subparagraph (B), the term `covered outpatient drug'
means--
``(i) a drug that may be dispensed only
upon a prescription and that is described in
clause (i) or (ii) of subparagraph (A) of
section 1927(k)(2); or
``(ii) a biological product or insulin
described in subparagraph (B) or (C) of such
section.
``(B) Exclusions.--
``(i) In general.--The term `covered
outpatient drug' does not include drugs or
classes of drugs, or their medical uses, which
may be excluded from coverage or otherwise
restricted under section 1927(d)(2), other than
subparagraph (E) thereof (relating to smoking
cessation agents).
``(ii) Avoidance of duplicate coverage.--A
drug prescribed for an individual that would
otherwise be a covered outpatient drug under
this part shall not be so considered if payment
for such drug is available under part A or B
(but shall be so considered if such payment is
not available because benefits under part A or
B have been exhausted), without regard to
whether the individual is entitled to benefits
under part A or enrolled under part B.
``(3) Eligible beneficiary.--In this section, the term
`eligible beneficiary' means an individual who is--
``(A) eligible for benefits under part A or
enrolled under part B; and
``(B) not eligible for medical assistance
consisting of prescribed drugs under title XIX.
``(4) Eligible entity.--The term `eligible entity' means
any entity that the Commissioner determines to be appropriate
to provide the benefits under this part, including--
``(A) pharmaceutical benefit management companies;
``(B) wholesale and retail pharmacist delivery
systems;
``(C) insurers;
``(D) Medicare+Choice organizations;
``(E) other entities; or
``(F) any combination of the entities described in
subparagraphs (A) through (E).
``(5) Poverty line.--The term `poverty line' means the
income official poverty line (as defined by the Office of
Management and Budget, and revised annually in accordance with
section 673(2) of the Omnibus Budget Reconciliation Act of
1981) applicable to a family of the size involved.
``Subpart 1--Establishment of Voluntary Medicare Outpatient
Prescription Drug Discount and Security Program
``establishment of program
``Sec. 1860A. (a) Provision of Benefit.--The Commissioner shall
establish a Medicare Outpatient Prescription Drug Discount and Security
Program under which an eligible beneficiary may voluntarily enroll and
receive benefits under this part through enrollment with a private
entity with a contract under this part.
``(b) Program To Begin in 2002.--The Commissioner shall establish
the program under this part in a manner so that benefits are first
provided for months beginning with January 2002.
``(c) Voluntary Nature of Program.--Nothing in this part shall be
construed as requiring an eligible beneficiary to enroll in the program
under this part.
``(d) Financing.--The costs of providing benefits under this part
shall be payable from the Federal Supplementary Medical Insurance Trust
Fund established under section 1841.
``enrollment
``Sec. 1860B. (a) Enrollment Under Part D.--
``(1) Establishment of process.--
``(A) In general.--The Commissioner shall establish
a process through which an eligible beneficiary
(including an eligible beneficiary enrolled in a
Medicare+Choice plan offered by a Medicare+Choice
organization) may make an election to enroll under this
part. Except as otherwise provided in this subsection,
such process shall be similar to the process for
enrollment in part B under section 1837.
``(B) Requirement of enrollment.--An eligible
beneficiary must enroll under this part in order to be
eligible to receive the benefits under this part.
``(2) Enrollment period.--
``(A) In general.--Except as provided in
subparagraph (B) or (C), an eligible beneficiary may
not enroll in the program under this part during any
period after the beneficiary's initial enrollment
period.
``(B) Open enrollment period in 2002 for current
beneficiaries.--The Commissioner shall establish a
period, which shall begin on the date on which the
Commissioner first begins to accept elections for
enrollment under this part and shall end on December
31, 2002, during which any eligible beneficiary may--
``(i) enroll under this part; or
``(ii) enroll or re-enroll under this part
after having previously declined or terminated
such enrollment.
``(C) Special enrollment period.--In the case of
eligible beneficiaries that have recently lost
eligibility for medical assistance consisting of
prescribed drugs under title XIX, the Commissioner
shall establish a special enrollment period in which
such beneficiaries may enroll under this part.
``(3) Period of coverage.--
``(A) In general.--Except as provided in
subparagraph (B) and subject to subparagraph (C), an
eligible beneficiary's coverage under the program under
this part shall be effective for the period provided in
section 1838, as if that section applied to the program
under this part.
``(B) Enrollment during open and special
enrollment.--Subject to subparagraph (C), an eligible
beneficiary who enrolls under the program under this
part pursuant to subparagraph (B) or (C) of paragraph
(2) shall be entitled to the benefits under this part
beginning on the first day of the month following the
month in which such enrollment occurs.
``(C) Limitation.--Coverage under this part shall
not begin prior to January 1, 2002.
``(4) Part d coverage terminated by termination of coverage
under parts a and b or eligibility for medical assistance.--
``(A) In general.--In addition to the causes of
termination specified in section 1838, the Commissioner
shall terminate an individual's coverage under this
part if the individual--
``(i) is no longer enrolled in either part
A or B; or
``(ii) is eligible for medical assistance
consisting of prescribed drugs under title XIX.
``(B) Effective date.--The termination described in
subparagraph (A) shall be effective on the effective
date of--
``(i) the termination of coverage under
part A or (if later) under part B; or
``(ii) the coverage under title XIX.
``(b) Enrollment With Eligible Entity.--
``(1) Process.--
``(A) In general.--The Commissioner shall establish
a process through which an eligible beneficiary who is
enrolled under this part shall make an annual election
to enroll with any eligible entity that has been
awarded a contract under this part and serves the
geographic area in which the beneficiary resides.
``(B) Rules.--In establishing the process under
subparagraph (A), the Commissioner shall use rules
similar to the rules for enrollment and disenrollment
with a Medicare+Choice plan under section 1851
(including special election periods under subsection
(e)(4) of such section).
``(2) Medicare+choice enrollees.--An eligible beneficiary
who is enrolled under this part and enrolled in a
Medicare+Choice plan offered by a Medicare+Choice organization
must enroll with an eligible entity in order to receive
benefits under this part. The beneficiary may elect to receive
such benefits from the Medicare+Choice organization in which
the beneficiary is enrolled if the organization has been
awarded a contract under this part.
``(3) Competition.--Eligible entities with a contract under
this part shall compete for beneficiaries on the basis of the
discounts, formularies, pharmacy networks, and other services
under the contract.
``(c) First Enrollment Period.--The processes developed under
subsections (a) and (b) shall ensure that eligible beneficiaries are
permitted to enroll under this part and with an eligible entity prior
to January 1, 2002, in order to ensure that coverage under this part is
effective as of such date.
``providing information to beneficiaries
``Sec. 1860C. (a) Activities.--The Commissioner shall provide for
activities under this part to broadly disseminate information to
eligible beneficiaries (and prospective eligible beneficiaries)
regarding the coverage provided under this part.
``(b) Special Rule for First Enrollment Under the Program.--To the
extent practicable, the activities described in subsection (a) shall
ensure that eligible beneficiaries are provided with such information
at least 60 days prior to the first enrollment period described in
section 1860B(c).
``annual enrollment fee
``Sec. 1860D. (a) Amount.--
``(1) In general.--Except as provided in subsection (c),
enrollment under the program under this part is conditioned
upon payment of a $35 annual enrollment fee.
``(2) Adjustment.--The Commissioner may, as determined
appropriate, annually adjust the dollar amount under paragraph
(1) to reflect inflation and changes in the costs and
utilization under the program over time.
``(b) Collection of Annual Enrollment Fee.--The annual enrollment
fee described in subsection (a) shall be collected and credited to the
Federal Supplementary Medical Insurance Trust Fund in the same manner
as the monthly premium determined under section 1839 is collected and
credited to such Trust Fund under section 1840.
``(c) Waiver.--The Commissioner shall waive the enrollment fee
described in subsection (a) in the case of an eligible beneficiary
whose income is below 200 percent of the poverty line.
``benefits under the program
``Sec. 1860E. (a) Access to Negotiated Prices.--
``(1) In general.--An eligible entity with a contract under
this part shall provide eligible beneficiaries enrolled with
the entity with access to negotiated prices (including
applicable discounts) used for payment for prescription drugs
for which coverage is not otherwise provided under this part.
``(2) Discount card.--An eligible entity shall issue such a
card that may be used by an enrolled beneficiary to assure the
access to negotiated prices under paragraph (1).
``(b) Catastrophic Benefit.--
``(1) In general.--Subject to paragraph (4) (relating to
eligibility for the catastrophic benefit)--
``(A) Beneficiaries with income below 200 percent
of poverty line.--In the case of an eligible
beneficiary whose income is below 200 percent of the
poverty line, the beneficiary shall not be responsible
for making a payment for a covered outpatient drug
provided to the beneficiary in a year to the extent
that the out-of-pocket expenses of the beneficiary for
such drug, when added to the out-of-pocket expenses of
the beneficiary for covered outpatient drugs previously
provided in the year, exceed $1,200.
``(B) Beneficiaries with income between 200 and 400
percent of poverty line.--In the case of an eligible
beneficiary whose income exceeds 200 percent but does
not exceed 400 percent of the poverty line, the
beneficiary shall not be responsible for making a
payment for a covered outpatient drug provided to the
beneficiary in a year to the extent that the out-of-
pocket expenses of the beneficiary for such drug, when
added to the out-of-pocket expenses of the beneficiary
for covered outpatient drugs previously provided in the
year, exceed $2,500.
``(C) Beneficiaries with income above 400 percent
of poverty line.--In the case of an eligible
beneficiary whose income exceeds 400 percent of the
poverty line, the beneficiary shall not be responsible
for making a payment for a covered outpatient drug
provided to the beneficiary in a year to the extent
that the out-of-pocket expenses of the beneficiary for
such drug, when added to the out-of-pocket expenses of
the beneficiary for covered outpatient drugs previously
provided in the year, exceed $5,000.
``(2) Adjustment.--The Commissioner may, as determined
appropriate, annually adjust the dollar amounts under
subparagraph (A) to reflect inflation and changes in the costs
and utilization under the program over time.
``(3) Eligible entity not at risk for catastrophic
benefit.--
``(A) In general.--The Commissioner, not the
eligible entity, shall be at risk for the provision of
the catastrophic benefit under this subsection.
``(B) Provisions relating to payments to eligible
entities.--For provisions relating to payments to
eligible entities for administering the catastrophic
benefit under this subsection, see section 1860G.
``(4) Catastrophic benefit not available to certain high
income individuals.--
``(A) In general.--An eligible beneficiary enrolled
under this part whose modified adjusted gross income
for a taxable year exceeds the applicable amount shall
not be eligible for the catastrophic benefit under this
subsection.
``(B) Beneficiary still eligible for discount
benefit.--Nothing in subparagraph (A) shall be
construed as effecting the eligibility of a beneficiary
described in such subparagraph for the benefits under
subsection (a).
``(C) Procedures for determining modified adjusted
gross income.--
``(i) In General.--The Commissioner shall
establish procedures for determining the
modified adjusted gross income of eligible
beneficiaries enrolled under this part.
``(ii) Consultation.--The Commissioner
shall consult with the Secretary of the
Treasury in making the determinations described
in clause (i).
``(iii) Disclosure of information.--
Notwithstanding section 6103(a) of the Internal
Revenue Code of 1986, the Secretary of the
Treasury may, upon written request from the
Commissioner, disclose to officers and
employees of the Medicare Prescription Drug
Agency such return information as is necessary
to make the determinations described in clause
(i). Return information disclosed pursuant to
the preceding sentence may be used by officers and employees of the
Medicare Prescription Drug Agency only for the purposes of, and to the
extent necessary in, making such determinations.
``(D) Definition of applicable amount.--For
purposes of this paragraph, the term `applicable
amount' means--
``(i) except as otherwise provided in this
subparagraph, $100,000;
``(ii) $200,000 in the case of a taxpayer
who files a joint return; and
``(iii) zero in the case of a taxpayer
who--
``(I) is married at the close of
the taxable year but does not file a
joint return for such year; and
``(II) does not live apart from his
spouse at all times during the taxable
year.
``(E) Definition of modified adjusted gross
income.--For purposes of this paragraph, the term
`modified adjusted gross income' means adjusted gross
income (as defined in section 62 of the Internal
Revenue Code of 1986)--
``(i) determined without regard to sections
135, 911, 931, and 933 of such Code; and
``(ii) increased by the amount of interest
received or accrued by the taxpayer during the
taxable year which is exempt from tax under
such Code.
``(F) Definition of joint return.--For purposes of
this paragraph, the term `joint return' has the meaning
given the term in section 7701(a)(38) of the Internal
Revenue Code of 1986.
``(5) Assuring catastrophic benefit in all areas.--The
Commissioner shall develop procedures for the provision of the
catastrophic benefit under this subsection to each eligible
beneficiary that resides in an area where there are no eligible
entities that have been awarded a contract under this part.
``selection of entities to provide outpatient drug benefit
``Sec. 1860F. (a) Establishment of Bidding Process.--The
Commissioner shall establish a process under which the Commissioner
accepts bids from eligible entities and awards contracts to the
entities to provide the benefits under this part to eligible
beneficiaries in an area.
``(b) Submission of Bids.--Each eligible entity desiring to enter
into a contract under this part shall submit a bid to the Commissioner
at such time, in such manner, and accompanied by such information as
the Commissioner may reasonably require.
``(c) Awarding of Contracts.--
``(1) In general.--The Commissioner shall, consistent with
the requirements of this part and the goal of containing
medicare program costs, award at least 2 contracts in an area,
unless only 1 bidding entity meets the terms and conditions
specified by the Commissioner pursuant to paragraph (2).
``(2) Terms and conditions.--
``(A) In general.--The Commissioner shall not award
a contract to an eligible entity under this section
unless the Commissioner finds that the eligible entity
is in compliance with such terms and conditions as the
Commissioner shall specify.
``(B) Procedures to ensure proper utilization and
to avoid adverse drug reactions.--The terms and
conditions established pursuant to subparagraph (A)
shall include a requirement that an eligible entity
have in place procedures to ensure--
``(i) the appropriate utilization of
prescription drugs by eligible beneficiaries
enrolled with the entity; and
``(ii) the avoidance of adverse drug
reactions among such beneficiaries.
``(C) Clinical guideline requirements and formulary
standards.--The terms and conditions established
pursuant to subparagraph (A) shall include clinical
guideline requirements and formulary standards.
``(3) Comparative merits.--In determining which of the
eligible entities that submitted bids that meet the terms and
conditions specified by the Commissioner pursuant to paragraph
(2) to award a contract, the Commissioner shall consider the
comparative merits of each of the bids.
``payments to eligible entities for administering the catastrophic
benefit
``Sec. 1860G. (a) Procedures.--The Commissioner shall establish
procedures for making payments to an eligible entity under a contract
entered into under this part for administering the catastrophic benefit
under section 1860E(b).
``(b) Administrative Fee.--
``(1) Procedures.--The procedures established pursuant to
subsection (a) shall provide for payment to the eligible entity
of an administrative fee for each prescription filled by the
entity for an eligible beneficiary--
``(A) who is enrolled with the entity; and
``(B) to whom subparagraph (A), (B), or (C) of
section 1860E(b)(1) applies with respect to a covered
outpatient drug.
``(2) Amount.--The fee described in paragraph (1) shall
be--
``(A) negotiated by the Commissioner; and
``(B) consistent with such fees paid under private
sector pharmaceutical benefit contracts.
``(c) Secondary Payer Provisions.--The provisions of section
1862(b) shall apply to the benefits provided under this part.
``determination of income levels
``Sec. 1860H. (a) Procedures.--The Commissioner shall establish
procedures for determining the income levels of eligible beneficiaries
for purposes of sections 1860D(c) and 1860E(b).
``(b) Periodic Redeterminations.--Such income determinations shall
be valid for a period (of not less than 1 year) specified by the
Commissioner.
``appropriations
``Sec. 1860I. There are authorized to be appropriated from time to
time, out of any moneys in the Treasury not otherwise appropriated, to
the Federal Supplementary Medical Insurance Trust Fund established
under section 1841, an amount equal to the amount by which the benefits
and administrative costs of providing the benefits under this part
exceed the enrollment fees collected under section 1860D.
``Subpart 2--Establishment of the Medicare Prescription Drug Agency
``medicare prescription drug agency
``Sec. 1860L. (a) Establishment.--There is established, as an
independent agency in the executive branch of the Government, a
Medicare Prescription Drug Agency (in this subpart referred to as the
`Agency').
``(b) Duty.--It shall be the duty of the Agency to administer the
Voluntary Medicare Outpatient Prescription Drug Discount and Security
Program under subpart 1.
``commissioner; deputy commissioner; other officers
``Sec. 1860M. (a) Commissioner of Medicare Prescription Drugs.--
``(1) Appointment.--There shall be in the Agency a
Commissioner of Medicare Prescription Drugs who shall be
appointed by the President, by and with the advice and consent
of the Senate.
``(2) Compensation.--The Commissioner shall be compensated
at the rate provided for level I of the Executive Schedule.
``(3) Term.--
``(A) In general.--The Commissioner shall be
appointed for a term of 6 years.
``(B) Continuance in office.--In any case in which
a successor does not take office at the end of a
Commissioner's term of office, such Commissioner may
continue in office until the appointment of a
successor.
``(C) Delayed appointments.--A Commissioner
appointed to a term of office after the commencement of
such term may serve under such appointment only for the
remainder of such term.
``(D) Removal.--An individual serving in the office
of Commissioner may be removed from office only
pursuant to a finding by the President of neglect of
duty or malfeasance in office.
``(4) Responsibilities.--The Commissioner shall be
responsible for the exercise of all powers and the discharge of
all duties of the Agency, and shall have authority and control
over all personnel and activities thereof.
``(5) Promulgation of rules and regulations.--
``(A) In general.--The Commissioner may prescribe
such rules and regulations as the Commissioner
determines necessary or appropriate to carry out the
functions of the Agency.
``(B) Rulemaking.--The regulations prescribed by
the Commissioner shall be subject to the rulemaking
procedures established under section 553 of title 5,
United States Code.
``(6) Determination of administrative organization.--The
Commissioner may establish, alter, consolidate, or discontinue
such organizational units or components within the Agency as
the Commissioner considers necessary or appropriate, except
that this paragraph shall not apply with respect to any unit,
component, or provision provided for by this Act.
``(7) Delegation of authority.--
``(A) In general.--The Commissioner may assign
duties, and delegate, or authorize successive
redelegations of, authority to act and to render
decisions, to such officers and employees of the Agency
as the Commissioner may find necessary.
``(B) Effect of delegation.--Within the limitations
of such delegations, redelegations, or assignments, all
official acts and decisions of such officers and
employees shall have the same force and effect as
though performed or rendered by the Commissioner.
``(8) Consultation with secretary of health and human
services.--The Commissioner and the Secretary shall consult, on
an ongoing basis, to ensure--
``(A) the coordination of the Voluntary Medicare
Outpatient Prescription Drug and Benefit Program under
subpart 1 with the programs administered by the
Secretary under parts A, B, and C and under title XIX;
and
``(B) that adequate information concerning benefits
under parts A, B, and C and title XIX is available to
the public.
``(b) Deputy Commissioner of Medicare Prescription Drugs.--
``(1) Appointment.--There shall be in the Agency a Deputy
Commissioner of Medicare Prescription Drugs (in this subpart
referred to as the `Deputy Commissioner') who shall be
appointed by the President, by and with the advice and consent
of the Senate.
``(2) Compensation.--The Deputy Commissioner shall be
compensated at the rate provided for level II of the Executive
Schedule.
``(3) Term.--
``(A) In general.--The Deputy Commissioner shall be
appointed for a term of 6 years.
``(B) Continuance in office.--In any case in which
a successor does not take office at the end of a Deputy
Commissioner's term of office, such Deputy Commissioner
may continue in office until the entry upon office of
such a successor.
``(C) Delayed appointment.--A Deputy Commissioner
appointed to a term of office after the commencement of
such term may serve under such appointment only for the
remainder of such term.
``(4) Duties.--
``(A) In general.--The Deputy Commissioner shall
perform such duties and exercise such powers as the
Commissioner shall from time to time assign or delegate.
``(B) Acting commissioner.--The Deputy Commissioner
shall be Acting Commissioner of the Agency during the
absence or disability of the Commissioner and, unless
the President designates another officer of the
Government as Acting Commissioner, in the event of a
vacancy in the office of the Commissioner.
``(c) Chief Actuary.--
``(1) Appointment.--
``(A) In general.--There shall be in the Agency a
Chief Actuary, who shall be appointed by, and in direct
line of authority to, the Commissioner.
``(B) Qualifications.--The Chief Actuary shall be
appointed from individuals who have demonstrated, by
their education and experience, superior expertise in
the actuarial sciences.
``(C) Duties.--The Chief Actuary shall serve as the
chief actuarial officer of the Agency, and shall
exercise such duties as are appropriate for the office
of the Chief Actuary and in accordance with
professional standards of actuarial independence.
``(D) Removal.--The Chief Actuary may be removed
only for cause.
``(2) Compensation.--The Chief Actuary shall be compensated
at the highest rate of basic pay for the Senior Executive
Service under section 5382(b) of title 5, United States Code.
``(d) Chief Financial Officer.--There shall be in the Agency a
Chief Financial Officer appointed by the Commissioner in accordance
with section 901(a)(2) of title 31, United States Code.
``(e) Inspector General.--There shall be in the Agency an Inspector
General appointed by the President, by and with the advice and consent
of the Senate, in accordance with section 3(a) of the Inspector General
Act of 1978.
``administrative duties of the commissioner
``Sec. 1860N. (a) Personnel.--
``(1) Appointment of additional officers.--
``(A) In general.--The Commissioner shall appoint
such additional officers and employees as the
Commissioner considers necessary to carry out the
functions of the Agency under this Act, and attorneys
and experts may be appointed without regard to the
civil service laws.
``(B) Compensation.--Except as otherwise provided
in subparagraph (A) or in any other provision of law,
such officers and employees shall be appointed, and
their compensation shall be fixed, in accordance with
title 5, United States Code.
``(2) Experts and consultants.--The Commissioner may
procure the services of experts and consultants in accordance
with the provisions of section 3109 of title 5, United States
Code.
``(b) Budgetary Matters.--
``(1) Annual budget.--
``(A) Submission.--The Commissioner shall prepare
an annual budget for the Agency, which shall be
submitted by the President to Congress without
revision, together with the President's annual budget
for the Agency.
``(B) Combatting fraud.--The Commissioner shall
include in the annual budget prepared pursuant to
subparagraph (A) an itemization of the amount of funds
required by the Medicare Prescription Drug Agency for
the fiscal year covered by the budget to support
efforts to combat fraud committed by applicants and
beneficiaries.
``(2) Appropriations requests.--
``(A) Staffing and personnel.--Appropriations
requests for staffing and personnel of the Agency shall
be based upon a comprehensive work force plan, which
shall be established and revised from time to time by
the Commissioner.
``(B) Administrative expenses.--Appropriations for
administrative expenses of the Agency are authorized to
be provided on a biennial basis.
``(c) Employment Restriction.--
``(1) In general.--The total number of positions described
in paragraph (2) in the Agency (other than positions
established under section 1860M) may not exceed at any time the
equivalent of 20 full-time positions.
``(2) Positions described.--The positions described in this
paragraph are as follows:
``(A) Noncareer appointees.--Positions that are
held by noncareer appointees (within the meaning of
section 3132(a)(7) of title 5, United States Code) in
the Senior Executive Service.
``(B) Excepted positions.--Positions that have been
determined by the President or the Office of Personnel
Management to be of a confidential, policy-determining,
policy-making, or policy-advocating character and that
have been excepted from the competitive service.
``(d) Seal of Office.--
``(1) In general.--The Commissioner shall cause a seal of
office to be made for the Agency of such design as the
Commissioner shall approve.
``(2) Judicial notice.--Judicial notice shall be taken of
the seal made under paragraph (1).
``(e) Data Exchanges.--
``(1) Disclosure of records and other information.--
Notwithstanding any other provision of law (including
subsection (b), (o), (p), (q), (r), and (u) of section 552a of
title 5, United States Code)--
``(A) the Secretary shall disclose to the
Commissioner any record or information requested in
writing by the Commissioner for the purpose of
administering the Voluntary Medicare Outpatient
Prescription Drug Discount and Security Program under
subpart 1; and
``(B) the Commissioner shall disclose to the
Secretary or to any State any record or information
requested in writing by the Secretary to be so
disclosed for the purpose of administering any program
administered by the Secretary.
``(2) Quality data.--
``(A) Agreement.--The Commissioner and the
Secretary shall enter into an agreement under which the
Commissioner provides the Secretary data concerning the
quality of the services and information provided to
beneficiaries of the Voluntary Medicare Outpatient
Prescription Drug Discount and Security Program under
subpart 1 and the administrative services provided by
the Agency in support of such program.
``(B) Terms and conditions.--The agreement entered
into under subparagraph (A) shall stipulate the type of
data to be provided and the terms and conditions under
which the data are to be provided.
``(3) Exchange of other data.--The Commissioner and the
Secretary shall periodically review the need for exchanges of
information not referred to in paragraph (1) or (2) and shall
enter into such agreements as may be necessary and appropriate
to provide information to each other or to States in order to
meet the programmatic needs of the requesting agencies.
``(4) Routine use.--
``(A) In general.--Any disclosure from a system of
records (as defined in section 552a(a)(5) of title 5,
United States Code) pursuant to this subsection shall
be made as a routine use under subsection (b)(3) of
section 552a of such title (unless otherwise authorized
under such section 552a).
``(B) Computerized comparison.--Any computerized
comparison of records, including matching programs,
between the Commissioner and the Secretary shall be
conducted in accordance with subsections (o), (p), (q),
(r), and (u) of section 552a of title 5, United States
Code.
``(5) Timely action.--The Commissioner and the Secretary
shall each ensure that timely action is taken to establish any
necessary routine uses for disclosures required under paragraph
(1) or agreed to pursuant to paragraph (3).
``duties and authority of the secretary
``Sec. 1860O. (a) Duties.--The Secretary shall perform the duties
imposed upon the Secretary by this Act.
``(b) Authority.--
``(1) In general.--The Secretary is authorized to appoint
and fix the compensation of such officers and employees, and to
make such expenditures as may be necessary for carrying out the
functions of the Secretary under this Act.
``(2) Appointment of attorneys and experts.--The Secretary
may appoint attorneys and experts without regard to the civil
service laws.''.
(b) Conforming References to Previous Part D.--
(1) In general.--Any reference in law (in effect before the
date of enactment of this Act) to part D of title XVIII of the
Social Security Act is deemed a reference to part E of such
title (as in effect after such date).
(2) Submission of legislative proposal.--Not later than 6
months after the date of enactment of this Act, the
Commissioner of Medicare Prescription Drugs and the Secretary
of Health and Human Services shall submit to the appropriate
committees of Congress a legislative proposal providing for
such technical and conforming amendments in the law as are
required by the provisions of this title.
SEC. 3. EXCLUSION OF PART D COSTS FROM DETERMINATION OF PART B MONTHLY
PREMIUM.
Section 1839(g) of the Social Security Act (42 U.S.C. 1395r(g)) is
amended--
(1) by striking ``attributable to the application of
section'' and inserting ``attributable to--
``(1) the application of section'';
(2) by striking the period and inserting ``; and''; and
(3) by adding at the end the following new paragraph:
``(2) the Voluntary Medicare Outpatient Prescription Drug
Discount and Security Program under part D.''.
SEC. 4. MEDIGAP REVISIONS.
Section 1882 of the Social Security Act (42 U.S.C. 1395ss) is
amended by adding at the end the following new subsection:
``(v) Modernization of Medicare Supplemental Policies.--
``(1) Promulgation of model regulation.--
``(A) NAIC model regulation.--If, within 9 months
after the date of enactment of the Medicare Rx Drug
Discount and Security Act of 2000, the National
Association of Insurance Commissioners (in this
subsection referred to as the `NAIC') changes the 1991
NAIC Model Regulation (described in subsection (p)) to
revise the benefit package classified as `J' under the
standards established by subsection (p)(2) (including
the benefit package classified as `J' with a high
deductible feature, as described in subsection (p)(11))
so that--
``(i) the coverage for outpatient
prescription drugs available under such benefit
package is replaced with coverage for
outpatient prescription drugs that compliments
but does not duplicate the benefits for
outpatient prescription drugs that
beneficiaries are otherwise entitled to under
this title;
``(ii) a uniform format is used in the
policy with respect to such revised benefits;
and
``(iii) such revised standards meet any
additional requirements imposed by the Medicare
Rx Drug Discount and Security Act of 2000;
subsection (g)(2)(A) shall be applied in each State,
effective for policies issued to policy holders on and
after January 1, 2002, as if the reference to the Model
Regulation adopted on June 6, 1979, were a reference to
the 1991 NAIC Model Regulation as changed under this
subparagraph (such changed regulation referred to in
this section as the `2002 NAIC Model Regulation').
``(B) Regulation by the secretary.--If the NAIC
does not make the changes in the 1991 NAIC Model
Regulation within the 9-month period specified in
subparagraph (A), the Secretary shall promulgate, not
later than 9 months after the end of such period, a
regulation and subsection (g)(2)(A) shall be applied in
each State, effective for policies issued to policy
holders on and after January 1, 2002, as if the
reference to the Model Regulation adopted on June 6,
1979, were a reference to the 1991 NAIC Model
Regulation as changed by the Secretary under this
subparagraph (such changed regulation referred to in
this section as the `2002 Federal Regulation').
``(C) Consultation with working group.--In
promulgating standards under this paragraph, the NAIC
or Secretary shall consult with a working group similar
to the working group described in subsection (p)(1)(D).
``(D) Modification of standards if medicare
benefits change.--If benefits (including deductibles
and coinsurance) under part D of this title are changed
and the Secretary determines, in consultation with the
NAIC, that changes in the 2002 NAIC Model Regulation or
2002 Federal Regulation are needed to reflect such
changes, the preceding provisions of this paragraph
shall apply to the modification of standards previously
established in the same manner as they applied to the
original establishment of such standards.
``(2) Construction of benefits in other medicare
supplemental policies.--Nothing in the benefit packages
classified as `A' through `I' under the standards established
by subsection (p)(2) (including the benefit package classified
as `F' with a high deductible feature, as described in
subsection (p)(11)) shall be construed as providing coverage
for benefits for which payment may be made under part D.
``(3) Application of provisions and conforming
references.--
``(A) Application of provisions.--The provisions of
paragraphs (4) through (10) of subsection (p) shall
apply under this section, except that--
``(i) any reference to the model regulation
applicable under that subsection shall be
deemed to be a reference to the applicable 2002
NAIC Model Regulation or 2002 Federal
Regulation; and
``(ii) any reference to a date under such
paragraphs of subsection (p) shall be deemed to
be a reference to the appropriate date under
this subsection.
``(B) Other references.--Any reference to a
provision of subsection (p) or a date applicable under
such subsection shall also be considered to be a
reference to the appropriate provision or date under
this subsection.''.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line