II

106TH CONGRESS

1ST SESSION S. 1204

To promote general and applied research for health promotion and disease

prevention among the elderly, to amend title XVIII of the Social Security

Act to add preventive benefits, and for other purposes.

IN THE SENATE OF THE UNITED STATES

JUNE 10, 1999

Mr. GRAHAM introduced the following bill; which was read twice and referred

to the Committee on Finance

A BILL

To promote general and applied research for health promotion and disease prevention among the elderly, to

amend title XVIII of the Social Security Act to add

preventive benefits, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Healthy Seniors Promotion Act of 1999’’.

6 (b) TABLE OF CONTENTS.—The table of contents is

7 as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Finding.

Sec. 3. Definitions.
2

•S 1204 IS

TITLE I—HEALTHY SENIORS PROMOTION PROGRAM

Sec. 101. Healthy seniors promotion program.

Sec. 102. Sense of Congress regarding the response of HCFA to preventive

health issues.

Sec. 103. Sense of Congress regarding the efforts of HCFA to study health

promotion and disease prevention for medicare beneficiaries.

Sec. 104. Sense of Congress regarding the establishment of a medicare health

promotion and disease prevention clearinghouse.

TITLE II—MEDICARE COVERAGE OF PREVENTIVE SERVICES

Sec. 201. Medicare coverage of counseling for cessation of tobacco use.

Sec. 202. Medicare coverage of screening for hypertension.

Sec. 203. Medicare coverage of counseling for hormone replacement therapy.

Sec. 204. Medicare coverage of screening for glaucoma.

Sec. 205. National falls prevention education and awareness campaign.

Sec. 206. Program integrity.

TITLE III—PREVENTIVE OUTPATIENT PRESCRIPTION DRUG

BENEFIT

Sec. 301. Medicare coverage of preventive outpatient prescription drugs.

Sec. 302. Selection of entities to provide preventive outpatient drug benefit.

Sec. 303. Access of low-income beneficiaries to preventive outpatient prescription drugs.

Sec. 304. Allocation of Federal proceeds from global tobacco settlement to enhance preventive outpatient prescription drug benefit.

Sec. 305. Medicare drug benefit study.

Sec. 306. Effective date.

TITLE IV—STUDIES AND REPORTS ADVANCING ORIGINAL

RESEARCH IN PREVENTION AND THE ELDERLY

Sec. 401. MedPAC biannual report.

Sec. 402. National Institute on Aging study and report.

Sec. 403. Institute of Medicine 5-year medicare prevention benefit study and

report.

Sec. 404. Fast-track consideration of preventive benefit legislation.

1 SEC. 2. FINDING.

2 Congress finds that despite significant advancements

3 in general research for health promotion and disease pre4 vention among the elderly, there has been a failure in

5 translating that research into practical intervention.

6 SEC. 3. DEFINITIONS.

7 As used in this Act:
3

•S 1204 IS

1 (1) MEDICARE BENEFICIARY.—The term

2 ‘‘medicare beneficiary’’ means any individual who is

3 entitled to benefits under part A or enrolled under

4 part B of the medicare program, including any indi5 vidual enrolled in a Medicare+Choice plan offered

6 by a Medicare+Choice organization under part C of

7 such program.

8 (2) MEDICARE PROGRAM.—The term ‘‘medicare

9 program’’ means the health care program under title

10 XVIII of the Social Security Act (42 U.S.C. 1395 et

11 seq.).

12 (3) SECRETARY.—The term ‘‘Secretary’’ means

13 the Secretary of Health and Human Services.

14 TITLE I—HEALTHY SENIORS

15 PROMOTION PROGRAM

16 SEC. 101. HEALTHY SENIORS PROMOTION PROGRAM.

17 (a) DEFINITIONS.—As used in this section:

18 (1) ELIGIBLE ENTITY.—The term ‘‘eligible enti19 ty’’ means an entity that the Working Group deter20 mines has demonstrated expertise in research re21 garding health promotion and disease prevention

22 among the elderly.

23 (2) WORKING GROUP.—The term ‘‘Working

24 Group’’ means the Healthy Seniors Working Group

25 established under subsection (d).
4

•S 1204 IS

1 (b) PROGRAM AUTHORIZED.—The Secretary, subject

2 to the general policies and criteria established by the

3 Working Group and in accordance with the provisions of

4 this Act, is authorized to make grants to eligible entities

5 to pay for the costs of the activities described in subsection

6 (c).

7 (c) USE OF FUNDS.—An eligible entity may use pay8 ments received under this section in any fiscal year to

9 study—

10 (1) the effectiveness of using different types of

11 providers of care who are not physicians and the use

12 of alternative settings (including community based

13 senior centers) for the implementation of a success14 ful health promotion and disease prevention strat15 egy, including implications regarding the payment of

16 such providers;

17 (2) the most effective means of educating medi18 care beneficiaries and providers of services regarding

19 the importance of health promotion and disease pre20 vention among the elderly and identification of in21 centives that would increase the use of new and ex22 isting preventive services by medicare beneficiaries;

23 and

24 (3) other topics designated by the Secretary.

25 (d) HEALTHY SENIORS WORKING GROUP.—
5

•S 1204 IS

1 (1) ESTABLISHMENT.—There is established

2 within the Department of Health and Human Serv3 ices a Healthy Seniors Working Group.

4 (2) COMPOSITION.—Subject to paragraph (3),

5 the Working Group established pursuant to sub6 section (b) shall be composed of 5 members as fol7 lows:

8 (A) The Administrator of the Health Care

9 Financing Administration.

10 (B) The Director of the Centers for Dis11 ease Control and Prevention.

12 (C) The Administrator of the Agency for

13 Health Care Policy and Research.

14 (D) The Assistant Secretary for Aging.

15 (E) The Director of the National Institute

16 on Aging.

17 (3) ALTERNATIVE MEMBERSHIP.—

18 (A) APPOINTMENT.—Any member of the

19 Working Group described in a subparagraph of

20 paragraph (2) may appoint an individual who is

21 an officer or employee of the Federal Govern22 ment to serve as a member of the Working

23 Group instead of the member described in such

24 subparagraph.
6

•S 1204 IS

1 (B) DEADLINE.—If a member described in

2 subparagraph (A) elects to appoint an indi3 vidual under such subparagraph, such indi4 vidual shall be appointed not later than Decem5 ber 31, 1999.

6 (4) GENERAL POLICIES AND CRITERIA.—The

7 Working Group shall establish general policies and

8 criteria with respect to the functions of the Sec9 retary under this section including—

10 (A) priorities for the approval of applica11 tions;

12 (B) procedures for developing, monitoring,

13 and evaluating research efforts conducted under

14 this section; and

15 (C) such other matters as are rec16 ommended by the Working Group and approved

17 by the Secretary.

18 (5) CHAIRPERSON.—The Chairperson of the

19 Working Group shall be the Administrator of the

20 Agency for Health Care Policy and Research.

21 (6) QUORUM.—A majority of the members of

22 the Working Group shall constitute a quorum, but

23 a lesser number of members may hold hearings.

24 (7) MEETINGS.—The Working Group shall

25 meet at the call of the Chairperson, except that—
7

•S 1204 IS

1 (A) it shall meet not less than 4 times each

2 year; and

3 (B) it shall meet whenever a majority of

4 the appointed members request a meeting in

5 writing.

6 (8) COMPENSATION OF MEMBERS.—Each mem7 ber of the Working Group shall be an officer or em8 ployee of the Federal Government and shall serve

9 without compensation in addition to that received for

10 their service as an officer or employee of the Federal

11 Government.

12 (d) APPLICATION.—

13 (1) IN GENERAL.—Each eligible entity which

14 desires to receive a grant under this section shall

15 submit an application to the Secretary, at such time,

16 in such manner, and accompanied by such additional

17 information as the Secretary may reasonably re18 quire.

19 (2) CONTENTS.—Each application submitted

20 pursuant to paragraph (1) shall—

21 (A) describe the activities for which assist22 ance under this section is sought;

23 (B) describe how the research effort pro24 posed to be conducted will reflect the medical,

25 behavioral, and social aspects of care for the el-
8

•S 1204 IS

1 derly, including cost-effectiveness and quality of

2 life impacts stemming from any initiative;

3 (C) provide evidence that the eligible entity

4 meets the general policies established by the

5 Working Group pursuant to subsection (d)(4);

6 (D) provide assurances that the eligible en7 tity will take such steps as may be available to

8 it to continue the activities for which the eligi9 ble entity is making application after the period

10 for which assistance is sought; and

11 (E) provide such additional assurances as

12 the Secretary determines to be essential to en13 sure compliance with the requirements of this

14 Act.

15 (3) JOINT APPLICATION.—A consortium of eli16 gible entities may file a joint application under the

17 provisions of paragraph (1) of this subsection.

18 (f) APPROVAL OF APPLICATION.—The Secretary

19 shall approve applications in accordance with the general

20 policies established by the Working Group under sub21 section (d).

22 (g) PAYMENTS.—The Secretary shall pay to each eli23 gible entity having an application approved under sub24 section (f) the cost of the activities described in the appli25 cation.
9

•S 1204 IS

1 (h) EVALUATION AND REPORT.—

2 (1) EVALUATION.—The Secretary shall conduct

3 an annual evaluation of grants made under this sec4 tion to determine—

5 (A) the results of the overall applied re6 search conducted under this Act;

7 (B) the extent to which research assisted

8 under this section has improved or expanded

9 the general research for health promotion and

10 disease prevention among the elderly and identi11 fied practical interventions based upon such re12 search;

13 (C) a list of specific recommendations

14 based upon research conducted under this sec15 tion which show promise as practical interven16 tions for health promotion and disease preven17 tion among the elderly;

18 (D) whether or not as a result of the ap19 plied research effort certain health promotion

20 and disease prevention benefits or education ef21 forts should be added to the medicare program,

22 including discussions of quality of life and cost23 effectiveness for each proposed addition;

24 (E) the utility of, potential for, and issues

25 surrounding health risk appraisals sponsored
10

•S 1204 IS

1 under the medicare program and targeted fol2 low up; and

3 (F) how best to increase utilization of ex4 isting and recommended health promotion and

5 disease prevention services, including an edu6 cation and public awareness component discus7 sion of financial incentives for providers of serv8 ices and medicare beneficiaries to improve utili9 zation and other administrative means of in10 creasing utilization.

11 (2) REPORT.—Not later than December 31,

12 2002, the Secretary shall submit a report to Con13 gress based on the annual studies made under para14 graph (1), which shall contain a detailed statement

15 of the findings and conclusions of the Working

16 Group together with its recommendations for such

17 legislation and administrative actions as it considers

18 appropriate.

19 (i) AUTHORIZATION OF APPROPRIATIONS.—There

20 are authorized to be appropriated $25,000,000 for fiscal

21 years 1999, 2000, 2001, and 2002 to carry out the provi22 sions of this section.
11

•S 1204 IS

1 SEC. 102. SENSE OF CONGRESS REGARDING THE RESPONSE

2 OF HCFA TO PREVENTIVE HEALTH ISSUES.

3 It is the sense of Congress that in administering the

4 medicare program the Secretary should ensure that the

5 Administrator of the Health Care Financing Administra6 tion encourages the inclusion of preventive measures as

7 part of all treatments described in such program.

8 SEC. 103. SENSE OF CONGRESS REGARDING THE EFFORTS

9 OF HCFA TO STUDY HEALTH PROMOTION

10 AND DISEASE PREVENTION FOR MEDICARE

11 BENEFICIARIES.

12 It is the sense of Congress that the Secretary should

13 ensure that the Administrator of the Health Care Financ14 ing Administration expands the study of the most prom15 ising behavioral modification of risk factors associated

16 with health promotion and disease prevention for all medi17 care beneficiaries.

18 SEC. 104. SENSE OF CONGRESS REGARDING THE ESTAB19 LISHMENT OF A MEDICARE HEALTH PRO20 MOTION AND DISEASE PREVENTION CLEAR21 INGHOUSE.

22 It is the sense of Congress that the National Library

23 of Medicine should collect information regarding innova24 tive and successful health promotion and disease preven25 tion interventions from both published and unpublished

26 sources, establish a clearinghouse targeting all medicare
12

•S 1204 IS

1 beneficiaries in a variety of settings for the consolidation

2 and coordination of all such information, and make the

3 clearinghouse available to the public and accessible

4 through the Internet.

5 TITLE II—MEDICARE COVERAGE

6 OF PREVENTIVE SERVICES

7 SEC. 201. MEDICARE COVERAGE OF COUNSELING FOR CES8 SATION OF TOBACCO USE.

9 (a) COVERAGE.—Section 1861(s)(2) of the Social Se10 curity Act (42 U.S.C. 1395x(s)(2)) is amended—

11 (1) in subparagraph (S), by striking ‘‘and’’ at

12 the end;

13 (2) in subparagraph (T), by striking the period

14 at the end and inserting ‘‘; and’’; and

15 (3) by adding at the end the following:

16 ‘‘(U) counseling for cessation of tobacco use (as

17 defined in subsection (uu)).’’.

18 (b) SERVICES DESCRIBED.—Section 1861 of such

19 Act (42 U.S.C. 1395x) is amended by adding at the end

20 the following:

21 ‘‘Counseling for Cessation of Tobacco Use

22 ‘‘(uu) The term ‘counseling for cessation of tobacco

23 use’ means diagnostic, therapy, and counseling services for

24 cessation of tobacco use which are furnished by or under

25 the supervision of a physician or other health care profes-
13

•S 1204 IS

1 sional who is legally authorized to furnish such services

2 under State law (or the State regulatory mechanism pro3 vided by State law) of the State in which the services are

4 furnished, as would otherwise be covered if furnished by

5 a physician or as an incident to a physician’s professional

6 service.’’.

7 (c) PAYMENT.—Section 1833(a)(1) of such Act (42

8 U.S.C. 1395l(a)(1)) is amended—

9 (1) by striking ‘‘and (S)’’ and inserting ‘‘(S)’’;

10 and

11 (2) by striking the semicolon at the end and in12 serting the following: ‘‘, and (T) with respect to

13 counseling for cessation of tobacco use (as defined in

14 section 1861(uu)), the amount paid shall be 100

15 percent of the lesser of the actual charge for the

16 services or the amount determined by a fee schedule

17 established by the Secretary for the purposes of this

18 subparagraph;’’.

19 (d) EFFECTIVE DATE.—The amendments made by

20 this section shall apply to services furnished on or after

21 December 31, 2001.
14

•S 1204 IS

1 SEC. 202. MEDICARE COVERAGE OF SCREENING FOR HY2 PERTENSION.

3 (a) COVERAGE.—Section 1861(s)(2) of the Social Se4 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec5 tion 201(a)) is amended—

6 (1) in subparagraph (T), by striking ‘‘and’’ at

7 the end;

8 (2) in subparagraph (U), by striking the period

9 at the end and inserting ‘‘; and’’; and

10 (3) by adding at the end the following:

11 ‘‘(V) screening for hypertension (as defined in

12 subsection (vv)).’’.

13 (b) SERVICES DESCRIBED.—Section 1861 of such

14 Act (42 U.S.C. 1395x) (as amended by section 201(b))

15 is amended by adding at the end the following:

16 ‘‘Screening for Hypertension

17 ‘‘(vv) The term ‘screening for hypertension’ means di18 agnostic services for hypertension which are furnished by

19 or under the supervision of a physician or other health

20 care professional who is legally authorized to furnish such

21 services under State law (or the State regulatory mecha22 nism provided by State law) of the State in which the serv23 ices are furnished, as would otherwise be covered if fur24 nished by a physician or as an incident to a physician’s

25 professional service.’’.
15

•S 1204 IS

1 (c) PAYMENT.—Section 1833(a)(1) of such Act (42

2 U.S.C. 1395l(a)(1)) (as amended by section 201(c)) is

3 amended—

4 (1) by striking ‘‘and (T)’’ and inserting ‘‘(T)’’;

5 and

6 (2) by striking the semicolon at the end and in7 serting the following: ‘‘, and (U) with respect to

8 screening for hypertension (as defined in section

9 1861(vv)), the amount paid shall be 100 percent of

10 the lesser of the actual charge for the services or the

11 amount determined by a fee schedule established by

12 the Secretary for the purposes of this subpara13 graph;’’.

14 (d) EFFECTIVE DATE.—The amendments made by

15 this section shall apply to services furnished on or after

16 December 31, 2001.

17 SEC. 203. MEDICARE COVERAGE OF COUNSELING FOR HOR18 MONE REPLACEMENT THERAPY.

19 (a) COVERAGE.—Section 1861(s)(2) of the Social Se20 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec21 tion 202(a)) is amended—

22 (1) in subparagraph (U), by striking ‘‘and’’ at

23 the end;

24 (2) in subparagraph (V), by striking the period

25 at the end and inserting ‘‘; and’’; and
16

•S 1204 IS

1 (3) by adding at the end the following:

2 ‘‘(W) counseling for hormone replacement ther3 apy (as defined in subsection (ww)).’’.

4 (b) SERVICES DESCRIBED.—Section 1861 of such

5 Act (42 U.S.C. 1395x) (as amended by section 202(b))

6 is amended by adding at the end the following:

7 ‘‘Counseling for Hormone Replacement Therapy

8 ‘‘(ww) The term ‘counseling for hormone replacement

9 therapy’ means diagnostic, therapy, and counseling serv10 ices for hormone replacement which are furnished by or

11 under the supervision of a physician or other health care

12 professional who is legally authorized to furnish such serv13 ices under State law (or the State regulatory mechanism

14 provided by State law) of the State in which the services

15 are furnished, as would otherwise be covered if furnished

16 by a physician or as an incident to a physician’s profes17 sional service.’’.

18 (c) PAYMENT.—Section 1833(a)(1) of such Act (42

19 U.S.C. 1395l(a)(1)) (as amended by section 201(c)) is

20 amended—

21 (1) by striking ‘‘and (U)’’ and inserting ‘‘(U)’’;

22 and

23 (2) by striking the semicolon at the end and in24 serting the following: ‘‘, and (V) with respect to

25 counseling for hormone replacement therapy (as de-
17

•S 1204 IS

1 fined in section 1861(ww)), the amount paid shall be

2 100 percent of the lesser of the actual charge for the

3 services or the amount determined by a fee schedule

4 established by the Secretary for the purposes of this

5 subparagraph;’’.

6 (d) EFFECTIVE DATE.—The amendments made by

7 this section shall apply to services furnished on or after

8 December 31, 2001.

9 SEC. 204. MEDICARE COVERAGE OF SCREENING FOR GLAU10 COMA.

11 (a) COVERAGE.—Section 1861(s)(2) of the Social Se12 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec13 tion 203(a)) is amended—

14 (1) in subparagraph (V), by striking ‘‘and’’ at

15 the end;

16 (2) in subparagraph (W), by striking the period

17 at the end and inserting ‘‘; and’’; and

18 (3) by adding at the end the following:

19 ‘‘(X) screening for glaucoma (as defined in sub20 section (xx)).’’.

21 (b) SERVICES DESCRIBED.—Section 1861 of such

22 Act (42 U.S.C. 1395x) (as amended by section 203(b))

23 is amended by adding at the end the following:
18

•S 1204 IS

1 ‘‘Screening for Glaucoma

2 ‘‘(xx) The term ‘screening for glaucoma’ means diag3 nostic services for early detection of glaucoma which are

4 furnished by or under the supervision of a physician or

5 other health care professional who is legally authorized to

6 furnish such services under State law (or the State regu7 latory mechanism provided by State law) of the State in

8 which the services are furnished, as would otherwise be

9 covered if furnished by a physician or as an incident to

10 a physician’s professional service.’’.

11 (c) PAYMENT.—Section 1833(a)(1) of such Act (42

12 U.S.C. 1395l(a)(1)) (as amended by section 201(c)) is

13 amended—

14 (1) by striking ‘‘and (V)’’ and inserting ‘‘(V)’’;

15 and

16 (2) by striking the semicolon at the end and in17 serting the following: ‘‘, and (W) with respect to

18 screening for glaucoma (as defined in section

19 1861(xx)), the amount paid shall be 100 percent of

20 the lesser of the actual charge for the services or the

21 amount determined by a fee schedule established by

22 the Secretary for the purposes of this subpara23 graph;’’.
19

•S 1204 IS

1 (d) EFFECTIVE DATE.—The amendments made by

2 this section shall apply to services furnished on or after

3 December 31, 2001.

4 SEC. 205. NATIONAL FALLS PREVENTION EDUCATION AND

5 AWARENESS CAMPAIGN.

6 The Secretary, in consultation with the Director of

7 the Centers for Disease Control and Prevention, shall con8 duct a national falls prevention and awareness campaign

9 to reduce fall-related injuries among medicare bene10 ficiaries.

11 SEC. 206. PROGRAM INTEGRITY.

12 The Secretary, in consultation with the Inspector

13 General of the Department of Health and Human Serv14 ices, shall integrate the benefits described in sections 201,

15 202, 203, and 204 with existing program integrity meas16 ures.

17 TITLE III—PREVENTIVE OUT18 PATIENT PRESCRIPTION

19 DRUG BENEFIT

20 SEC. 301. MEDICARE COVERAGE OF OUTPATIENT PRE21 SCRIPTION DRUGS.

22 (a) COVERAGE.—Section 1861(s)(2) of the Social Se23 curity Act (42 U.S.C. 1395x(s)(2)) (as amended by sec24 tion 204(a)) is amended—
20

•S 1204 IS

1 (1) in subparagraph (W), by striking ‘‘and’’ at

2 the end;

3 (2) by striking the period at the end of sub4 paragraph (X) and inserting ‘‘; and’’; and

5 (3) by adding at the end the following:

6 ‘‘(Y) preventive outpatient prescription drugs

7 (as defined in section 1849(h)(1)) pursuant to the

8 procedures established under such section;’’.

9 (b) PAYMENT.—Section 1833(a)(1) of such Act (42

10 U.S.C. 1395l(a)(1)) (as amended by section 204(c)) is

11 amended—

12 (1) by striking ‘‘and (W)’’ and inserting ‘‘(W)’’;

13 and

14 (2) by striking the semicolon at the end and in15 serting the following: ‘‘, and (X) with respect to pre16 ventive outpatient prescription drugs (as defined in

17 section 1849(h)(1)), the amounts paid shall be the

18 amounts established by the Secretary pursuant to

19 such section;’’.

20 SEC. 302. SELECTION OF ENTITIES TO PROVIDE PREVEN21 TIVE OUTPATIENT DRUG BENEFIT.

22 Part B of title XVIII of the Social Security Act (42

23 U.S.C. 1395j et seq.) is amended by adding at the end

24 the following:
21

•S 1204 IS

1 ‘‘SEC. 1849. SELECTION OF ENTITIES TO PROVIDE PREVEN2 TIVE OUTPATIENT DRUG BENEFIT.

3 ‘‘(a) ESTABLISHMENT OF BIDDING PROCESS.—

4 ‘‘(1) IN GENERAL.—The Secretary shall estab5 lish procedures under which the Secretary accepts

6 bids from eligible entities and awards contracts to

7 such entities in order to provide preventive out8 patient prescription drugs to eligible beneficiaries in

9 an area. Such contracts may be awarded based on

10 shared risk, capitation, or performance.

11 ‘‘(2) AREA.—

12 ‘‘(A) REGIONAL BASIS.—The contract en13 tered into between the Secretary and an eligible

14 entity shall require the eligible entity to provide

15 preventive outpatient prescription drugs on a

16 regional basis.

17 ‘‘(B) DETERMINATION.—In determining

18 coverage areas under this section, the Secretary

19 shall take into account the number of eligible

20 beneficiaries in an area in order to encourage

21 participation by eligible entities.

22 ‘‘(3) SUBMISSION OF BIDS.—Each eligible enti23 ty desiring to provide preventive outpatient prescrip24 tion drugs under this section shall submit a bid to

25 the Secretary at such time, in such manner, and ac26 companied by such information as the Secretary may
22

•S 1204 IS

1 reasonably require. Such bids shall include the

2 amount the eligible entity will charge eligible bene3 ficiaries under subsection (e)(2) for preventive out4 patient prescription drugs under the contract.

5 ‘‘(4) ACCESS.—The Secretary shall ensure

6 that—

7 ‘‘(A) an eligible entity complies with the

8 access requirements described in subsection

9 (f)(4); and

10 ‘‘(B) an eligible entity makes available to

11 each beneficiary covered under the contract the

12 full scope of benefits required under paragraph

13 (5).

14 ‘‘(5) SCOPE OF BENEFITS.—The Secretary shall

15 ensure that all preventive outpatient prescription

16 drugs that are reasonable and necessary to prevent

17 or slow the deterioration of, and improve or main18 tain, the health of eligible beneficiaries are offered

19 under a contract entered into under this section.

20 ‘‘(6) NUMBER OF CONTRACTS.—The Secretary

21 shall, consistent with the requirements of this sec22 tion and the goal of containing medicare program

23 costs, award at least 2 contracts in an area, unless

24 only 1 bidding entity meets the minimum standards

25 specified under this section and by the Secretary.
23

•S 1204 IS

1 ‘‘(7) DURATION OF CONTRACTS.—Each con2 tract under this section shall be for a term of at

3 least 2 years but not more than 5 years, as deter4 mined by the Secretary.

5 ‘‘(b) ENROLLMENT.—

6 ‘‘(1) IN GENERAL.—The Secretary shall estab7 lish a process through which an eligible beneficiary

8 shall make an election to enroll with any eligible en9 tity that has been awarded a contract under this sec10 tion and serves the geographic area in which the

11 beneficiary resides. In establishing such process, the

12 Secretary shall use rules similar to the rules for en13 rollment and disenrollment with a Medicare+Choice

14 plan under section 1851.

15 ‘‘(2) REQUIREMENT OF ENROLLMENT.—An eli16 gible beneficiary not enrolled in a Medicare+Choice

17 plan under part C must enroll with an eligible entity

18 under this section in order to be eligible to receive

19 preventive outpatient prescription drugs under this

20 title.

21 ‘‘(3) ENROLLMENT IN ABSENCE OF ELECTION

22 BY ELIGIBLE BENEFICIARY.—In the case of an eligi23 ble beneficiary that fails to make an election pursu24 ant to paragraph (1), the Secretary shall provide,

25 pursuant to procedures developed by the Secretary,
24

•S 1204 IS

1 for the enrollment of such beneficiary with an eligi2 ble entity that has a contract under this section that

3 covers the area in which such beneficiary resides.

4 ‘‘(4) AREAS NOT COVERED BY CONTRACTS.—

5 The Secretary shall develop procedures for the provi6 sion of preventive outpatient prescription drugs

7 under this title to eligible beneficiaries that reside in

8 an area that is not covered by any contract under

9 this section.

10 ‘‘(5) BENEFICIARIES RESIDING IN DIFFERENT

11 LOCATIONS.—The Secretary shall develop procedures

12 to ensure that an eligible beneficiary that resides in

13 different regions in a year is provided benefits under

14 this section throughout the entire year.

15 ‘‘(c) PROVIDING INFORMATION TO BENE16 FICIARIES.—The Secretary shall provide for activities

17 under this section to broadly disseminate information to

18 medicare beneficiaries on the coverage provided under this

19 section. Such activities shall be similar to the activities

20 performed by the Secretary under section 1851(d).

21 ‘‘(d) PAYMENTS TO ELIGIBLE ENTITIES.—The Sec22 retary shall establish procedures for making payments to

23 an eligible entity under a contract.

24 ‘‘(e) COST-SHARING.—
25

•S 1204 IS

1 ‘‘(1) DEDUCTIBLE.—Benefits under this section

2 shall not begin until an eligible beneficiary has met

3 a $50 deductible.

4 ‘‘(2) COINSURANCE.—

5 ‘‘(A) IN GENERAL.—Subject to subpara6 graph (B), an eligible beneficiary shall be re7 sponsible for making payments in an amount

8 not greater than 20 percent of the cost (as stat9 ed in the contract) of any preventive outpatient

10 prescription drug that is provided to the bene11 ficiary. Pursuant to subsection (a)(4)(B), an el12 igible entity may reduce the payment amount

13 that an eligible beneficiary is responsible for

14 making to the entity.

15 ‘‘(B) BASIC BENEFIT.—If the aggregate

16 amount of preventive outpatient prescription

17 drugs provided to an eligible beneficiary under

18 this section for any calendar year (based on the

19 cost of preventive outpatient prescription drugs

20 stated in the contract) exceeds $750—

21 ‘‘(i) the beneficiary may continue to

22 purchase preventive outpatient prescription

23 drugs under the contract based on the con24 tract price, but
26

•S 1204 IS

1 ‘‘(ii) the copayment under subpara2 graph (A) shall be 100 percent.

3 ‘‘(C) INFLATION ADJUSTMENT.—

4 ‘‘(i) IN GENERAL.—In the case of any

5 calendar year beginning after 2000, each

6 of the dollar amounts in subparagraph (B)

7 shall be increased by an amount equal to—

8 ‘‘(I) such dollar amount, multi9 plied by

10 ‘‘(II) an adjustment, as deter11 mined by the Secretary, for changes

12 in the per capita cost of prescription

13 drugs for beneficiaries under this title.

14 ‘‘(ii) ROUNDING.—If any dollar

15 amount after being increased under clause

16 (i) is not a multiple of $10, such dollar

17 amount shall be rounded to the nearest

18 multiple of $10.

19 ‘‘(3) COPAYMENT.—Each time a prescription is

20 filled, the eligible beneficiary shall be responsible for

21 making payments in an amount equal to the lesser

22 of—

23 ‘‘(A) the cost (as stated in the contract) of

24 any preventive outpatient prescription drug that

25 is provided to the beneficiary minus the deduct-
27

•S 1204 IS

1 ible described in paragraph (1) and the coinsur2 ance described in paragraph (2); or

3 ‘‘(B) $5.

4 ‘‘(f) CONDITIONS FOR AWARDING CONTRACT.—The

5 Secretary shall not award a contract to an eligible entity

6 under subsection (a) unless the Secretary finds that the

7 eligible entity is in compliance with such terms and condi8 tions as the Secretary shall specify, including the fol9 lowing:

10 ‘‘(1) QUALITY AND FINANCIAL STANDARDS.—

11 The eligible entity meets quality and financial stand12 ards specified by the Secretary.

13 ‘‘(2) INFORMATION.—The eligible entity pro14 vides the Secretary with information that the Sec15 retary determines is necessary in order to carry out

16 the bidding process under this section.

17 ‘‘(3) PROCEDURES TO ENSURE PROPER UTILI18 ZATION AND TO AVOID ADVERSE DRUG REAC19 TIONS.—The eligible entity has in place procedures

20 to ensure the—

21 ‘‘(A) appropriate utilization by eligible

22 beneficiaries of the benefits to be provided

23 under the contract; and
28

•S 1204 IS

1 ‘‘(B) avoidance of adverse drug reactions

2 among eligible beneficiaries enrolled with the

3 entity.

4 ‘‘(4) ACCESS.—The eligible entity ensures that

5 the preventive outpatient prescription drugs are ac6 cessible and convenient to eligible beneficiaries cov7 ered under the contract, including by offering the

8 services in the following manner:

9 ‘‘(A) SERVICES DURING EMERGENCIES.—

10 The offering of services 24 hours a day and 7

11 days a week for emergencies.

12 ‘‘(B) CONTRACTS WITH RETAIL PHAR13 MACIES.—The offering of services—

14 ‘‘(i) at a sufficient number (as deter15 mined by the Secretary) of retail phar16 macies; and

17 ‘‘(ii) to the extent feasible, at retail

18 pharmacies located throughout the eligible

19 entity’s service area.

20 ‘‘(5) RULES RELATING TO PROVISION OF BENE21 FITS.—

22 ‘‘(A) PROVISION OF BENEFITS.—In pro23 viding benefits under a contract under this sec24 tion, an eligible entity may—
29

•S 1204 IS

1 ‘‘(i) employ mechanisms to provide

2 benefits economically, including the use

3 of—

4 ‘‘(I) formularies;

5 ‘‘(II) alternative methods of dis6 tribution; and

7 ‘‘(III) generic drug substitution;

8 and

9 ‘‘(ii) use incentives to encourage eligi10 ble beneficiaries to select cost-effective

11 drugs or less costly means of receiving

12 drugs which are of equal clinical effective13 ness.

14 ‘‘(6) PROCEDURES REGARDING DENIALS OF

15 CARE.—The eligible entity has in place procedures to

16 ensure—

17 ‘‘(A) the timely review and resolution of

18 denials of care and complaints (including those

19 regarding the use of formularies under para20 graph (5)) by eligible beneficiaries, or providers,

21 pharmacists, and other individuals acting on be22 half of each such beneficiary (with the bene23 ficiary’s consent) in accordance with require24 ments (as established by the Secretary) that are

25 comparable to such requirements for
30

•S 1204 IS

1 Medicare+Choice organizations under part C;

2 and

3 ‘‘(B) that beneficiaries are provided with

4 information regarding the appeals procedures

5 under this section at the time of enrollment.

6 ‘‘(g) PROTECTION OF PATIENT CONFIDENTIALITY.—

7 Insofar as an eligible organization maintains individually

8 identifiable medical records or other health information re9 garding eligible beneficiaries under a contract entered into

10 under this section, the organization shall—

11 ‘‘(1) safeguard the privacy of any individually

12 identifiable beneficiary information;

13 ‘‘(2) maintain such records and information in

14 a manner that is accurate and timely; and

15 ‘‘(3) assure timely access of such beneficiaries

16 to such records and information.

17 ‘‘(h) DEFINITIONS.—In this section:

18 ‘‘(1) PREVENTIVE OUTPATIENT PRESCRIPTION

19 DRUG.—The term ‘preventive outpatient prescription

20 drug’ means any drug or biological not otherwise

21 covered under this title that may be dispensed only

22 upon prescription and as a direct result of the indi23 vidual’s participation in—

24 ‘‘(A) a screening mammography (as de25 fined in section 1861(jj));
31

•S 1204 IS

1 ‘‘(B) a screening pap smear or a screening

2 pelvic exam (as defined in section 1861(nn));

3 ‘‘(C) a prostate cancer screening test (as

4 defined in section 1861(oo));

5 ‘‘(D) a colorectal cancer screening test (as

6 defined in section 1861(pp));

7 ‘‘(E) a diabetes outpatient self-manage8 ment training service (as defined in section

9 1861(qq);

10 ‘‘(F) a bone mass measurement (as defined

11 in section 1861(rr));

12 ‘‘(G) a cessation of tobacco use program

13 (as defined in section 1861(uu));

14 ‘‘(H) a screening for hypertension (as de15 fined in section 1861(vv));

16 ‘‘(I) counseling for hormone replacement

17 therapy (as defined in section 1861(ww));

18 ‘‘(J) a screening for glaucoma (as defined

19 in section 1861(xx)); or

20 ‘‘(K) any other preventive service (as de21 fined by the Secretary).

22 ‘‘(2) ELIGIBLE BENEFICIARY.—The term ‘eligi23 ble beneficiary’ means an individual that is enrolled

24 under part B of this title.
32

•S 1204 IS

1 ‘‘(3) ELIGIBLE ENTITY.—The term ‘eligible en2 tity’ means any entity that the Secretary determines

3 to be appropriate, including—

4 ‘‘(A) any pharmaceutical benefit manage5 ment company;

6 ‘‘(B) any wholesale or retail pharmacist

7 delivery system;

8 ‘‘(C) any insurer; or

9 ‘‘(D) any combination of the entities de10 scribed in subparagraphs (A) through (C).’’.

11 SEC. 303. ACCESS OF LOW-INCOME BENEFICIARIES TO PRE12 VENTIVE OUTPATIENT PRESCRIPTION

13 DRUGS.

14 (a) ELIGIBILITY.—Section 1902(a)(10) of the Social

15 Security Act (42 U.S.C. 1396a(a)(10)) is amended—

16 (1) in subparagraph (E)(iv)(II), by striking

17 ‘‘and’’ at the end;

18 (2) in subparagraph (F), by inserting ‘‘and’’ at

19 the end; and

20 (3) by inserting after subparagraph (F), the fol21 lowing:

22 ‘‘(G) for making medical assistance avail23 able (but only for preventive outpatient pre24 scription drugs (as defined in section

25 1849(h)(1)) in the same amount, duration, and
33

•S 1204 IS

1 scope as such assistance for such drugs is made

2 available to any individual described in subpara3 graph (A)(i)) for any individual who—

4 ‘‘(i) is a qualified medicare beneficiary

5 described in section 1905(p)(1);

6 ‘‘(ii) would be a qualified medicare

7 beneficiary described in section 1905(p)(1)

8 except for the fact that the income of such

9 individual exceeds the income level estab10 lished by the State under section

11 1905(p)(2) but is less than 135 percent of

12 the official poverty line (referred to in such

13 section) for a family of the size involved,

14 and who is not otherwise eligible for med15 ical assistance for preventive outpatient

16 prescription drugs under the State plan;

17 and

18 ‘‘(iii) would otherwise satisfy the re19 quirements of clause (i) or (ii) except for

20 the fact that they are entitled to hospital

21 insurance benefits under part A of title

22 XVIII only pursuant to an enrollment

23 under section 1818A;’’.

24 (b) PAYMENTS TO STATES.—
34

•S 1204 IS

1 (1) IN GENERAL.—Section 1903 of such Act

2 (42 U.S.C. 1396b) is amended by adding at the end

3 the following:

4 ‘‘(x)(1) Subject to paragraph (2), with respect to

5 medical assistance that is attributable to the enactment

6 of section 1902(a)(10)(G), including an estimate of med7 ical assistance provided to additional individuals who en8 roll in the State plan under this title due to such enact9 ment, the Federal medical assistance percentage for such

10 medical assistance is equal to 100 percent.

11 ‘‘(2) No payment shall be made to a State for medical

12 assistance described in paragraph (1) unless the State

13 demonstrates to the satisfaction of the Secretary that,

14 with respect to a fiscal year, State expenditures for any

15 State-funded prescription drug program is not less than

16 the level of such expenditures for fiscal year 1999.’’.

17 (2) CONFORMING AMENDMENT.—Section

18 1905(b) of such Act (42 U.S.C. 1396d(b)) is amend19 ed in the first sentence by inserting ‘‘and 1903(x)’’

20 after ‘‘1933(d)’’.
35

•S 1204 IS

1 SEC. 304. ALLOCATION OF FEDERAL PROCEEDS FROM

2 GLOBAL TOBACCO SETTLEMENT TO EN3 HANCE PREVENTIVE OUTPATIENT PRESCRIP4 TION DRUG BENEFIT.

5 (a) TRANSFER OF FEDERAL PROCEEDS FROM GLOB6 AL TOBACCO SETTLEMENT.—The Secretary of the Treas7 ury shall transfer to the Federal Supplementary Medical

8 Insurance Trust Fund established under section 1841 of

9 the Social Security Act (42 U.S.C. 1395t) an amount

10 equal to 50 percent of any amount received by the Federal

11 Government as a result of any legislation providing for

12 a global tobacco settlement. Such transfer shall occur not

13 later than 60 days after each date on which the Federal

14 Government receives such amount.

15 (b) USE OF AMOUNT TRANSFERRED.—Any amount

16 transferred pursuant to subsection (a) shall be available

17 to enhance the drug benefit described in section 1849 of

18 the Social Security Act (as added by section 302) in a

19 manner that is consistent with the recommendations of the

20 Institute of Medicine of the National Academy of Sciences

21 developed under section 305.

22 SEC. 305. MEDICARE DRUG BENEFIT STUDY.

23 (a) IN GENERAL.—The Secretary shall contract with

24 the Institute of Medicine of the National Academy of

25 Sciences to conduct the study described in subsection (b)

26 and submit the report described in subsection (c).
36

•S 1204 IS

1 (b) STUDY.—The Institute of Medicine of the Na2 tional Academy of Sciences shall—

3 (1) conduct a study of the feasibility and issues

4 involved in the developing, administering, and fi5 nancing of a comprehensive outpatient prescription

6 drug benefit under the medicare program; and

7 (2) develop a prioritized list of drug categories

8 that could be added to the benefit based on the

9 availability of funding.

10 (c) REPORT.—Not later than June 30, 2001, the In11 stitute of Medicine of the National Academy of Sciences

12 shall submit a report to the Secretary which contains—

13 (1) a detailed statement of the findings and

14 conclusions of the study conducted under subsection

15 (b)(1);

16 (2) the list developed under subsection (b)(2);

17 and

18 (3) the recommendations of the Secretary for

19 such legislative and administrative actions as it con20 siders appropriate.

21 (d) SUBMISSION TO CONGRESS.—Not later than 30

22 days after the Secretary receives the report described in

23 subsection (c), the Secretary shall transmit the report to

24 Congress.
37

•S 1204 IS

1 SEC. 306. EFFECTIVE DATE.

2 Except as otherwise provided, the amendments made

3 by this title shall apply to items and services furnished

4 on or after January 1, 2001.

5 TITLE IV—STUDIES AND RE6 PORTS ADVANCING ORIGINAL

7 RESEARCH IN THE FIELD OF

8 PREVENTION AND THE EL9 DERLY

10 SEC. 401. MEDPAC BIANNUAL REPORT.

11 (a) IN GENERAL.—Section 1805(b) of the Social Se12 curity Act (42 U.S.C. 1395b–6(b)) is amended—

13 (1) in paragraph (1)—

14 (A) in subparagraph (C), by striking

15 ‘‘and’’ at the end;

16 (B) in subparagraph (D), by striking the

17 period and inserting ‘‘; and’’; and

18 (C) by adding at the end the following:

19 ‘‘(E) by not later than January 1, 2001,

20 and biannually thereafter, submit the report to

21 Congress described in paragraph (7).’’; and

22 (2) by adding at the end the following:

23 ‘‘(7) EVALUATION OF ACTUARIAL EQUIVALENCE

24 OF MEDICARE AND PRIVATE SECTOR BENEFIT PACK25 AGES.—
38

•S 1204 IS

1 ‘‘(A) EVALUATION.—The Commission

2 shall—

3 ‘‘(i) evaluate the benefit package of4 fered under the medicare program under

5 this title; and

6 ‘‘(ii) determine the degree to which

7 such benefit package is actuarially equiva8 lent to that offered by health benefit pro9 grams available in the private sector to in10 dividuals over age 65.

11 ‘‘(B) REPORT.—The Commission shall

12 submit a report to Congress that shall

13 contain—

14 ‘‘(i) a detailed statement of the find15 ings and conclusions of the Commission re16 garding the evaluation conducted under

17 subparagraph (A);

18 ‘‘(ii) the recommendations of the

19 Commission regarding changes in the ben20 efit package offered under the medicare

21 program under this title that would keep

22 the program modern and competitive in re23 lation to health benefit programs available

24 in the private sector; and
39

•S 1204 IS

1 ‘‘(iii) the recommendations of the

2 Commission for such legislation and ad3 ministrative actions as it considers appro4 priate.’’.

5 (b) EFFECTIVE DATE.—The amendments made by

6 this section shall take effect on the date of enactment of

7 this Act.

8 SEC. 402. NATIONAL INSTITUTE ON AGING STUDY AND RE9 PORT.

10 (a) STUDIES.—The Director of the National Institute

11 on Aging shall conduct 1 or more studies focusing on ways

12 to—

13 (1) improve quality of life for the elderly;

14 (2) develop better ways to prevent or delay the

15 onset of age-related functional decline and disease

16 and disability among the elderly; and

17 (3) develop new means of assessing the long18 term cost-effectiveness of health promotion and dis19 ease prevention efforts among the elderly.

20 (b) REPORT.—Not later than January 1, 2005, the

21 Director of the National Institute on Aging shall submit

22 a report to the Secretary regarding each study conducted

23 under subsection (a) and containing a detailed statement

24 of research findings and conclusions that are scientifically
40

•S 1204 IS

1 valid and are demonstrated to prevent or delay the onset

2 of chronic illness or disability among the elderly.

3 (c) TRANSMISSION TO INSTITUTE OF MEDICINE.—

4 Upon receipt of each report described in subsection (b),

5 the Secretary shall transmit such report to the Institute

6 of Medicine of the National Academy of Sciences for con7 sideration in its effort to conduct the comprehensive study

8 of current literature and best practices in the field of

9 health promotion and disease prevention among the medi10 care beneficiaries described in section 403.

11 (d) AUTHORIZATION OF APPROPRIATIONS.—

12 (1) IN GENERAL.—There are authorized to be

13 appropriated $100,000,000 for fiscal years 2000

14 through 2005 to carry out the purposes of this sec15 tion.

16 (2) AVAILABILITY.—Any sums appropriated

17 under the authorization contained in this subsection

18 shall remain available, without fiscal year limitation,

19 until September 30, 2004.

20 SEC. 403. INSTITUTE OF MEDICINE 5-YEAR MEDICARE PRE21 VENTION BENEFIT STUDY AND REPORT.

22 (a) STUDY.—

23 (1) IN GENERAL.—The Secretary shall contract

24 with the Institute of Medicine of the National Acad25 emy of Sciences to conduct a comprehensive study of
41

•S 1204 IS

1 current literature and best practices in the field of

2 health promotion and disease prevention among

3 medicare beneficiaries including the issues described

4 in paragraph (2) and to submit the report described

5 in subsection (b).

6 (2) ISSUES STUDIED.—The study required

7 under paragraph (1) shall include an assessment

8 of—

9 (A) clinical and cost-effectiveness issues;

10 (B) utilization of covered benefits (includ11 ing any barriers to or incentives to increase uti12 lization); and

13 (C) quality of life issues associated with

14 both health promotion and disease prevention

15 benefits or outpatient prescription drugs cov16 ered under the medicare program and those

17 that are not covered under such program that

18 would affect all medicare beneficiaries.

19 (b) REPORT.—

20 (1) IN GENERAL.—Not later than 5 years after

21 the date of enactment of this section, and every fifth

22 year thereafter, the Institute of Medicine of the Na23 tional Academy of Sciences shall submit to the

24 President a report that contains a detailed state25 ment of the findings and conclusions of the study
42

•S 1204 IS

1 conducted under subsection (a) and the rec2 ommendations for legislation described in paragraph

3 (2).

4 (2) RECOMMENDATIONS FOR LEGISLATION.—

5 The Institute of Medicine of the National Academy

6 of Sciences, in consultation with the Partnership for

7 Prevention, shall develop recommendations in legis8 lative form that—

9 (A) prioritize the preventive benefits under

10 the medicare program, including outpatient pre11 scription drugs; and

12 (B) modify preventive benefits offered

13 under the medicare program based on the study

14 conducted under subsection (a).

15 (c) TRANSMISSION TO CONGRESS.—

16 (1) IN GENERAL.—On the day on which the re17 port described in subsection (b) is submitted to the

18 President, the President shall transmit the report

19 and recommendations in legislative form described in

20 subsection (b)(2) to Congress.

21 (2) DELIVERY.—Copies of the report and rec22 ommendations in legislative form required to be

23 transmitted to Congress under paragraph (1) shall

24 be delivered—
43

•S 1204 IS

1 (A) to both Houses of Congress on the

2 same day;

3 (B) to the Clerk of the House of Rep4 resentatives if the House is not in session; and

5 (C) to the Secretary of the Senate if the

6 Senate is not in session.

7 SEC. 404. FAST-TRACK CONSIDERATION OF PREVENTION

8 BENEFIT LEGISLATION.

9 (a) RULES OF HOUSE OF REPRESENTATIVES AND

10 SENATE.—This section is enacted by Congress—

11 (1) as an exercise of the rulemaking power of

12 the House of Representatives and the Senate, re13 spectively, and is deemed a part of the rules of each

14 House of Congress, but—

15 (A) is applicable only with respect to the

16 procedure to be followed in that House of Con17 gress in the case of an implementing bill (as de18 fined in subsection (d)); and

19 (B) supersedes other rules only to the extent

20 that such rules are inconsistent with this section;

21 and

22 (2) with full recognition of the constitutional

23 right of either House of Congress to change the

24 rules (so far as relating to the procedure of that

25 House of Congress) at any time, in the same man-
44

•S 1204 IS

1 ner and to the same extent as in the case of any

2 other rule of that House of Congress.

3 (b) INTRODUCTION AND REFERRAL.—

4 (1) INTRODUCTION.—

5 (A) IN GENERAL.—Subject to paragraph

6 (2), on the day on which the President trans7 mits the report pursuant to section 403(c) to

8 the House of Representatives and the Senate,

9 the recommendations in legislative form trans10 mitted by the President with respect to such re11 port shall be introduced as a bill (by request)

12 in the following manner:

13 (i) HOUSE OF REPRESENTATIVES.—In

14 the House, by the majority leader of the

15 House, for himself and the minority leader

16 of the House, or by Members of the House

17 designated by the majority leader and mi18 nority leader of the House.

19 (ii) SENATE.—In the Senate, by the

20 majority leader of the Senate, for himself

21 and the minority leader of the Senate, or

22 by Members of the Senate designated by

23 the majority leader and minority leader of

24 the Senate.
45

•S 1204 IS

1 (B) SPECIAL RULE.—If either House of

2 Congress is not in session on the day on which

3 such recommendations in legislative form are

4 transmitted, the recommendations in legislative

5 form shall be introduced as a bill in that House

6 of Congress, as provided in subparagraph (A),

7 on the first day thereafter on which that House

8 of Congress is in session.

9 (2) REFERRAL.—Such bills shall be referred by

10 the Presiding Officers of the respective Houses to

11 the appropriate committee, or, in the case of a bill

12 containing provisions within the jurisdiction of 2 or

13 more committees, jointly to such committees for con14 sideration of those provisions within their respective

15 jurisdictions.

16 (c) CONSIDERATION.—After the recommendations in

17 legislative form have been introduced as a bill and referred

18 under subsection (b), such implementing bill shall be con19 sidered in the same manner as an implementing bill is con20 sidered under subsections (d), (e), (f), and (g) of section

21 151 of the Trade Act of 1974 (19 U.S.C. 2191).

22 (d) IMPLEMENTING BILL DEFINED.—In this section,

23 the term ‘‘implementing bill’’ means only the recommenda24 tions in legislative form of the Institute of Medicine of the

25 National Academy of Sciences described in section
46

•S 1204 IS

1 403(b)(2), transmitted by the President to the House of

2 Representatives and the Senate under subsection 403(c),

3 and introduced and referred as provided in subsection (b)

4 as a bill of either House of Congress.

5 (e) COUNTING OF DAYS.—For purposes of this sec6 tion, any period of days referred to in section 151 of the

7 Trade Act of 1974 shall be computed by excluding—

8 (1) the days on which either House of Congress

9 is not in session because of an adjournment of more

10 than 3 days to a day certain or an adjournment of

11 Congress sine die, and

12 (2) any Saturday and Sunday, not excluded

13 under paragraph (1), when either House is not in

14 session.

Æ