IMOHM , I think we should support all of them.
If Bush ends up President, then John Breaux's Bill,
the one Sandy is talking about, stands a better chance.
Because he's already spent the day in Texas with "W".
Graham's Bill is good, and it lists 2003 as the year
it would start just as Breaux's does. Why can't they
get with it sooner??
just me,
Marjorie

SUMMARY AS OF: Graham's Bill S.2758
6/20/2000--Introduced.
Amends title XVIII (Medicare) of the Social Security Act (SSA) to add a new
part D (Outpatient Prescription Drug Benefit Program) to provide Medicare
coverage of certain outpatient prescription drugs and biological products
for individuals entitled to benefits under Medicare part A (Hospital
Insurance) or enrolled under Medicare part B (Supplementary Medical
Insurance).
(Sec. 2) Directs the Secretary of Health and Human Services (Secretary) to
provide for an outpatient prescription drug benefit program for eligible
Medicare beneficiaries.
Makes the cost of providing benefits under this part payable from the
Federal Supplementary Medical Insurance Trust Fund.
Directs the Secretary to establish a process for an eligible Medicare
beneficiary (including one enrolled in a Medicare+Choice plan under
Medicare part C (Medicare+Choice)) to elect to enroll under new SSA title
XVIII part D. Requires an eligible Medicare beneficiary to enroll under new
SSA title XVIII part D in order to be eligible for covered outpatient drugs
under Medicare.
Directs the Secretary to disseminate information to eligible and
prospective eligible beneficiaries. Authorizes appropriations.
Directs the Secretary to determine and promulgate a monthly premium rate
for the succeeding year in accordance with specified guidelines. Requires
monthly premiums to be credited to the Federal Supplementary Medical
Insurance Trust Fund. Directs the Secretary to increase the monthly premium
as outlined for certain high-income Medicare beneficiaries.
Outlines cost-sharing provisions, including those for a $250 deductible
waivable for generic drugs, coinsurance payments for the drug in an amount
equal to the applicable percentage of the cost of the drug, and inflation
adjustment.
Directs the Secretary to establish procedures for accepting bids and
awarding competitive contracts for benefit administration. Sets out patient
protections. Provides for: (1) accessibility of outpatient drugs; (2)
continuity of care; (3) medically necessary drugs; (4) denials of care; (5)
procedures to ensure a timely internal and external review and resolution
of denials of coverage and complaints regarding the use of formularies; (6)
confidentiality; (7) transfer of medical records; and (8) medical errors.
Requires the eligible entity, among other things, to have in place
procedures to control fraud, abuse, and waste.
Authorizes the Secretary to develop and implement a Employer Incentive
Program, including incentive payments, that encourages employers and other
sponsors of employment-based health care coverage to provide adequate
prescription drug benefits to retired individuals by subsidizing, in part,
the sponsor's cost of providing coverage under qualifying plans. Outlines
sponsor requirements. Authorizes appropriations.
Establishes a Medicare Pharmacy and Therapeutics Advisory Committee with
regard to the development of: (1) guidelines for administration of the
outpatient prescription drug benefit program; (2) standards for required
pharmacy and therapeutics committees of eligible entities; (3) procedures
for determining if a drug is medically necessary to prevent or to slow the
deterioration of, or improve or maintain, the health of an eligible
beneficiary; (4) standards for defining therapeutic classes and other
specified matters; (5) procedures to evaluate the bids submitted by
eligible entities under SSA title XVIII part D; and (6) procedures to
ensure that eligible entities under contract are in compliance with
requirements. Authorizes appropriations.
Applies to SSA title XVIII part D the exclusions from coverage under
Medicare parts A or B for any expenses incurred for certain items or
services. Provides that prescription drugs are not excluded from such
coverage if reasonable and necessary.
(Sec. 3) Amends SSA title XVIII part C to: (1) require each Medicare+Choice
plan, with specified exceptions, to provide enrolled members items and
services for which benefits are available under part D; (2) permit a
Medicare+Choice organization offering a Medicare+Choice plan to elect a
benefit provider as long as the organization complies with outpatient drug
access requirements; (3) require the Secretary to determine a
Medicare+Choice capitation rate for outpatient drug benefits for enrollees
in accordance with specified payment rules; and (4) prohibit a
Medicare+Choice organization from requiring an enrollee to pay an
outpatient prescription drug benefit deductible or a coinsurance percentage
exceeding the applicable amount.
(Sec. 4) Amends SSA title XVIII part D to exclude Medicare part D costs
from determination of the part B monthly premium.
(Sec. 5) Amends the Internal Revenue Code to authorize the Secretary of the
Treasury, upon the Secretary's written request, to disclose to officers and
employees of the Health Care Financing Administration (HCFA) certain
limited return information with respect to a taxpayer exclusively for use
in establishing the appropriate monthly premium under SSA title XVIII part D.
(Sec. 6) Amends SSA title XIX (Medicaid) to: (1) include in Medicare
cost-sharing for qualified Medicare beneficiaries premiums under the
Outpatient Prescription Drug Benefit Program; and (2) provide for expanding
medical assistance with regard to the coinsurance and deductible under such
Program. Sets at 100 percent the Federal Medicaid percentage with respect
to such medical assistance. Provides for the nonapplicability of payment
differential requirements to SSA title XVIII part D cost-sharing.
Amends SSA title XI to increase according to a certain formula Medicaid
payments to territories for FY 1998 and thereafter.
(Sec. 7) Amends SSA title XVIII to revise requirements for benefit packages
for Medicare supplemental (Medigap) policies.
(Sec. 8) Directs the Secretary of Health and Human Services to study and
report to Congress on the feasibility and advisability of: (1) establishing
a uniform format for pharmacy benefit cards provided to beneficiaries by
eligible entities under the Outpatient Prescription Drug Benefit Program,
and (2) developing systems to transfer prescriptions electronically under
such program from the prescriber to the pharmacist.
(Sec. 9) Authorizes appropriations.