II 

113TH CONGRESS 

1ST SESSION S. 557 

To amend title XVIII of the Social Security Act to improve access to 

medication therapy management under part D of the Medicare program. 

IN THE SENATE OF THE UNITED STATES 

MARCH 13, 2013 

Mrs. HAGAN (for herself, Mr. ROBERTS, Mr. FRANKEN, Ms. KLOBUCHAR, Mr. 

JOHNSON of South Dakota, and Mr. BROWN) 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 improve 

access to medication therapy management under part 

D of the Medicare program. 

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. 

4 This Act may be cited as the ‘‘Medication Therapy 

5 Management Empowerment Act of 2013’’. 

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1 SEC. 2. IMPROVED ACCESS TO MEDICATION THERAPY MAN2 AGEMENT UNDER PART D OF THE MEDICARE 

3 PROGRAM. 

4 Section 1860D–4(c)(2) of the Social Security Act (42 

5 U.S.C. 1395w–104(c)(2)) is amended— 

6 (1) in subparagraph (A)(ii)(I), by striking 

7 ‘‘have’’ and inserting ‘‘subject to subparagraph (H), 

8 have’’; and 

9 (2) by adding at the end the following new sub10 paragraph: 

11 ‘‘(H) EXPANSION OF DEFINITION OF TAR12 GETED BENEFICIARY THE EXPANSION REDUCES

13 SPENDING.— 

14 ‘‘(i) CMS ACTUARY REPORT.—Not 

15 later than January 1, 2014, the Chief Ac16 tuary of the Centers for Medicare & Med17 icaid Services (in this subparagraph re18 ferred to as the ‘Chief Actuary’) shall sub19 mit to the Secretary and to Congress a re20 port on whether or not the expansion de21 scribed in clause (ii) would, if imple22 mented, reduce expenditures under this 

23 title. If the Chief Actuary determines that 

24 such expansion would reduce spending 

25 under this title, such report shall include a 

26 certification of such determination. 

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1 ‘‘(ii) EXPANSION DESCRIBED.—The 

2 expansion described in this clause is an ex3 pansion of the definition of targeted bene4 ficiary under subparagraph (A)(ii) by ap5 plying subclause (I) of such subparagraph 

6 as if the following were inserted before the 

7 semicolon at the end: ‘or a single chronic 

8 disease that accounts for high spending 

9 under this title, including diabetes, hyper10 tension, heart failure, dyslipidemia, res11 piratory disease (such as asthma, chronic 

12 obstructive pulmonary disease, or chronic 

13 lung disorders), bone disease-arthritis 

14 (such as osteoporosis or osteoarthritis), 

15 rheumatoid arthritis, and mental health 

16 (such as depression, schizophrenia, or bipo17 lar disorder)’. 

18 ‘‘(iii) APPLICATION IF THE CHIEF AC19 TUARY DETERMINES THAT THE EXPAN20 SION REDUCES SPENDING.—If the report 

21 under clause (i) contains the certification 

22 described in such clause, the following 

23 rules shall apply: 

24 ‘‘(I) IMPLEMENTATION OF EX25 PANSION.—Subject to subclause (III), 

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1 effective with respect to plan years be2 ginning on or after January 1, 2015, 

3 subparagraph (A)(ii)(I) shall be ap4 plied to include the expansion de5 scribed in clause (ii). 

6 ‘‘(II) UPDATED CMS ACTUARY

7 REPORT BASED ON IMPLEMENTA8 TION.—Not later than March 1, 2020, 

9 the Chief Actuary shall submit to the 

10 Secretary and to Congress a report on 

11 the implementation of the expansion 

12 under subclause (I). Such report shall 

13 include an analysis of whether or not 

14 such expansion reduces spending 

15 under this title. 

16 ‘‘(III) AUTHORITY TO TERMI17 NATE EXPANSION IF THE EXPANSION

18 DOES NOT REDUCE SPENDING.—If the 

19 Chief Actuary determines in the re20 port under subclause (II) that the ex21 pansion does not reduce spending 

22 under this title, the Secretary may, ef23 fective with respect to plan years be24 ginning on or after January 1, 2021, 

25 apply subparagraph (A)(ii)(I) as if 

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1 this subparagraph had never been en2 acted. In making the determination 

3 under the preceding sentence, the Sec4 retary shall take into account whether 

5 such expansion improves the quality 

6 of care furnished to, and the health 

7 outcomes of, individuals eligible for 

8 services under a medication therapy 

9 management program by reason of 

10 such expansion.’’. 

Æ 

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