To amend titles XVIII and XIX of the Social Security Act to provide for equitable treatment of residents of territories with respect to transitional assistance and low-income subsidies under the Medicare prescription drug benefit program.

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``MMA Territorial Equity for Low-
Income Individuals Act of 2004''.

SEC. 2. EQUITABLE TREATMENT OF RESIDENTS OF TERRITORIES UNDER MEDICARE 
              PRESCRIPTION DRUG TRANSITIONAL ASSISTANCE PROGRAM.

    (a) In General.--Subsection (b)(2)(A) of section 1860D-31 of the 
Social Security Act (42 U.S.C. 1395w-141) is amended by inserting after 
``or the District of Columbia'' the following: ``or in Puerto Rico, the 
Virgin Islands, Guam, American Samoa, or the Commonwealth of the 
Northern Mariana Islands''.
    (b) Conforming Change in Availability of Funds.--Subsection (j)(2) 
of such section is amended--
            (1) by striking ``for the entire period of the operation of 
        this section'' and inserting ``for 2004''; and
            (2) by striking subparagraph (D).
    (c) Additional Conforming Amendments.--(1) Subsection (b) of such 
section is amended--
            (A) by adding at the end of paragraph (2)(A) the following: 
        ``The poverty line to be applied under this subparagraph to an 
        individual residing in a territory shall be the same as the 
        poverty line applicable to individuals residing in the 
        continental United States.''; and
            (B) by adding at the end of paragraph (3) the following: 
        ``The poverty line to be applied under this paragraph to an 
        individual residing in a territory shall be the same as the 
        poverty line applicable to individuals residing in the 
        continental United States.''.
    (2) Subsection (f)(3)(C)(ii) of such section is amended by striking 
``that is one of the 50 States or the District of Columbia''.
    (d) Effective Date.--The amendments made by this section shall take 
effect on January 1, 2005.

SEC. 3. EQUITABLE TREATMENT OF RESIDENTS OF TERRITORIES IN PREMIUM AND 
              COST-SHARING SUBSIDIES UNDER MEDICARE PRESCRIPTION DRUG 
              PROGRAM.

    (a) In General.--Section 1860D-14(a)(3) of the Social Security Act 
(42 U.S.C. 1395w-114(a)(3)) is amended by striking subparagraph (F).
    (b) Conforming Amendments.--
            (1) Section 1935 of such Act (42 U.S.C. 1396v) is amended--
                    (A) in subsections (a) and (c)(1), by striking 
                ``subject to subsection (e)'';
                    (B) in subsection (c)(1)(A), by striking ``Each of 
                the 50 States and the District of Columbia'' and 
                inserting ``Each State'';
                    (C) in subsection (c)(2)(A)(i), by striking ``and'' 
                at the end of subclause (I), and by adding after 
                subclause (II) the following new subclause:
                                    ``(III) in the case of a territory 
                                subject to a limitation on payments 
                                under this title under subsections (f) 
                                and (g) of section 1108, the ratio of 
                                the total amounts of the payment 
                                limitations under such subsections for 
                                such territory for fiscal year 2003, to 
                                the total amounts that would be payable 
                                to such territory under this title for 
                                such fiscal year but for such payment 
                                limitations; and''; and
                    (D) by striking subsection (e).
            (2) Section 1108(f) of such Act (42 U.S.C. 1308(f)) is 
        amended by striking ``and section 1935(e)(1)(B)''.
            (3) Section 1860D-14(a)(3)(C) of such Act (42 U.S.C. 1395w-
        114(a)(3)(C)) is amended by adding at the end the following: 
        ``The poverty line to be applied in the territories shall be 
        the same as the poverty line applied to States in the 
        continental United States.''.
    (c) Effective Date.--The amendments made by this section shall be 
effective as if included in the enactment of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173).

SEC. 4. INSTITUTE OF MEDICINE REPORT ON ACCESS OF MEDICARE 
              BENEFICIARIES IN TERRITORIES TO PRESCRIPTION DRUGS.

    (a) In General.--The Secretary of Health and Human Services shall 
request the Institute of Medicine of the National Academy of Sciences 
to undertake a study that examines the access of medicare beneficiaries 
residing in the United States territories to prescription drugs during 
each of 3 periods:
            (1) Before mma.--The period before the date of the 
        enactment of the Medicare Prescription Drug, Improvement, and 
        Modernization Act of 2003 (Public Law 108-173).
            (2) Discount card and transitional assistance.--The period 
        during the implementation of the discount card and transitional 
        assistance program (under section 1860D-31 of the Social 
        Security Act).
            (3) Implementation of prescription drug benefit.--The 
        period beginning on January 1, 2006.
    (b) Report.--The study under subsection (a) shall include a report 
to the Secretary, the Committees on Ways and Means and Energy and 
Commerce of the House of Representatives, and the Committee on Finance 
of the Senate, on the results of such study. Such report shall include 
information on--
            (1) the relative cost of prescription drugs to medicare 
        beneficiaries residing in the territories, both retail and as 
        affected through benefit changes effected under the Medicare 
        Prescription Drug, Improvement, and Modernization Act of 2003 
        (Public Law 108-173); and
            (2) statistical health improvements of such beneficiaries 
        as a result of the enactment of such law.

Summary: MMA Territorial Equity for Low-Income Individuals Act of 2004 - Amends title XVIII (Medicare) of the Social Security Act to treat Medicare-eligible citizens of Guam, the Virgin Islands, American Samoa, the Commonwealth of Puerto and the Commonwealth of the Northern Mariana Islands the same as low-income citizens in the 50 States and the District of Columbia with respect to the Medicare prescription drug transitional assistance program, and premium and cost-sharing subsidies under the Medicare prescription drug program. Directs the Secretary of Health and Himan Services to request the Institute of Medicine of the National Academy of Sciences to undertake a study for a report to the Secretary and Congress on access of Medicare beneficiaries in territories to prescription drugs.