II

107TH CONGRESS

1ST SESSION S. 1177

To amend title XI of the Social Security Act to clarify that the Secretary

of Health and Human Services has the authority to treat certain State

payments made in an approved demonstration project as medical assistance under the medicaid program for purposes of a rebate agreement

under section 1927 of the Social Security Act, and for other purposes.

IN THE SENATE OF THE UNITED STATES

JULY 12, 2001

Ms. SNOWE (for herself, Ms. COLLINS, Mr. JEFFORDS, and Mr. LEAHY) introduced the following bill; which was read twice and referred to the Committee on Finance

A BILL

To amend title XI of the Social Security Act to clarify

that the Secretary of Health and Human Services has

the authority to treat certain State payments made in

an approved demonstration project as medical assistance

under the medicaid program for purposes of a rebate

agreement under section 1927 of the Social Security

Act, 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,
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1 SECTION 1. SHORT TITLE.

2 This Act may be cited as the ‘‘Access to Affordable

3 Prescription Drugs Act of 2001’’.

4 SEC. 2. FINDINGS.

5 Congress makes the following findings:

6 (1) Access to prescription drugs is important to

7 all Americans.

8 (2) Many low-income individuals cannot afford

9 to purchase the drugs prescribed by their doctors.

10 Others skip doses or split pills contrary to their doc11 tor’s orders because they cannot afford to refill their

12 prescriptions.

13 (3) Low-income individuals who use their lim14 ited financial resources to obtain needed drugs may

15 do so by foregoing other expenditures important to

16 their health and well-being.

17 (4) One of the objectives of the medicaid pro18 gram set forth in section 1901 of the Social Security

19 Act (42 U.S.C. 1396) is to enable each State, as far

20 as practicable under the conditions in such State, to

21 provide medical assistance on behalf of families with

22 dependent children and of aged, blind, or disabled

23 individuals, whose income and resources are insuffi24 cient to meet the costs of necessary medical services.

25 (5) As part of carrying out this objective, every

26 State has elected the option of providing prescription
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1 drugs as a benefit under the medicaid program,

2 thereby providing an important means of increasing

3 the access of low-income individuals to drugs pre4 scribed by their doctors.

5 (6) Section 1115 of the Social Security Act (42

6 U.S.C. 1315) provides the Secretary of Health and

7 Human Services with broad authority to—

8 (A) approve any experimental, pilot, or

9 demonstration project which, in the judgment

10 of the Secretary, is likely to assist in promoting

11 the objectives of the medicaid program; and

12 (B) waive compliance with any of the State

13 plan requirements of the medicaid program

14 under section 1902 of the Social Security Act

15 (42 U.S.C. 1396a), including paragraphs (14)

16 (relating to limitations on cost sharing under

17 section 1916 of that Act (42 U.S.C. 1396o))

18 and (54) (relating to applicable requirements of

19 section 1927 of that Act (42 U.S.C. 1396r–8)),

20 in order to conduct such a project.

21 (7) Medicaid demonstration projects help pro22 mote the objectives of the medicaid program, includ23 ing obtaining information about options for increas24 ing access to prescription drugs for low-income indi25 viduals.
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1 (8) Both Maine and Vermont have, with the ap2 proval of the Secretary of Health and Human Re3 sources, implemented demonstration projects to ex4 pand access to prescription drugs under the med5 icaid program. Thousands of individuals with no

6 other prescription drug insurance benefits are en7 rolled in those programs.

8 (9) Terminating medicaid demonstration

9 projects prior to their planned expiration dates may

10 result in a significant waste of public funds and may

11 be detrimental to those individuals who have come to

12 rely on such projects.

13 SEC. 3. CLARIFICATION OF SECRETARIAL AUTHORITY

14 WITH RESPECT TO TREATMENT OF CERTAIN

15 PAYMENTS MADE IN AN APPROVED DEM16 ONSTRATION PROJECT.

17 (a) IN GENERAL.—Section 1115 of the Social Secu18 rity Act (42 U.S.C. 1315) is amended by adding at the

19 end the following:

20 ‘‘(g) Notwithstanding any other provision of law, with

21 respect to any experimental, pilot, or demonstration

22 project conducted by a State that was approved by the

23 Secretary under subsection (a) prior to January 31, 2001,

24 and that waives compliance with, or makes inapplicable,

25 certain requirements of section 1902 for the purposes of
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1 establishing an outpatient prescription drug program for

2 residents of the State who are not otherwise eligible for

3 medical assistance under title XIX—

4 ‘‘(1) any expenditures, payments, or outlays by

5 the State for covered outpatient drugs under the

6 project shall be treated as payments made under the

7 State plan under title XIX for covered outpatient

8 drugs defined in section 1927(k)(2) for purposes of

9 a rebate agreement under section 1927, regardless

10 of whether such expenditures, payments, or outlays

11 of the State are offset or reimbursed, in whole or in

12 part, by rebates received under such an agreement;

13 ‘‘(2) any such expenditures, payments, or out14 lays by the State are consistent with the objectives

15 of the medicaid program set forth in section 1901;

16 ‘‘(3) any such expenditures, payments, or out17 lays by the State shall be considered amounts ex18 pended for medical assistance in the form of pre19 scribed drugs, as defined in section 1905(a)(12),

20 under the State plan under title XIX; and

21 ‘‘(4) the requirements of section 1916 shall not

22 apply with respect to any enrollment fees, premiums,

23 deductions, copayments, cost sharing, or similar

24 charges imposed upon individuals participating in

25 such project.’’.
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1 (b) EFFECTIVE DATE.—The amendment made by

2 subsection (a) takes effect on the date of enactment of

3 this Act and applies to State expenditures, payments, or

4 outlays under an experimental, pilot, or demonstration

5 project described in section 1115(g) of the Social Security

6 Act (as added by subsection (a)) made before, on, or after

7 such date.

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