I 

109TH CONGRESS 

2D SESSION H. R. 4660 

To provide for necessary beneficiary protections in order to ensure access 

to coverage under the Medicare part D prescription drug program. 

IN THE HOUSE OF REPRESENTATIVES 

JANUARY 31, 2006 

Mr. ALLEN (for himself, Mr. BROWN of Ohio, Mr. BERRY, Mr. ROSS, Mr. 

MICHAUD, Mr. STRICKLAND, and Mr. WYNN) introduced the following 

bill; which was referred to the Committee on Energy and Commerce, and 

in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of 

such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To provide for necessary beneficiary protections in order 

to ensure access to coverage under the Medicare part 

D prescription drug 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; TABLE OF CONTENTS. 

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

5 ‘‘Requiring Emergency Pharmaceutical Access for Indi6 vidual Relief (REPAIR) Act of 2006’’. 

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

8 this Act is as follows: 
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Sec. 1. Short title; table of contents 

Sec. 2. Transition requirements 

Sec. 3. Federal fallback for full-benefit dual eligible individuals for 2006 

Sec. 4. Identifying full-benefit dual eligible individuals in data records 

Sec. 5. Prohibition on conditioning Medicaid eligibility for individuals enrolled 

in certain creditable prescription drug coverage on enrollment 

in the Medicare part D drug program 

Sec. 6. Ensuring that full-benefit dual eligible individuals are not overcharged 

Sec. 7. Reimbursement of States for 2006 transition costs 

Sec. 8. Facilitation of identification and enrollment through pharmacies of fullbenefit dual eligible individuals in the Medicare part D drug 

program 

Sec. 9. State health insurance program assistance regarding the new Medicare 

prescription drug benefit 

Sec. 10. Additional Medicare part D informational resources 

Sec. 11. GAO study and report on the imposition of co-payments under part 

D for full-benefit dual eligible individuals residing in a longterm care facility 

Sec. 12. State coverage of non-formulary prescription drugs for full-benefit dual 

eligible individuals during 2006 

Sec. 13. Protection for full-benefit dual eligible individuals from plan termination prior to receiving functioning access in a new part D 

plan 

1 SEC. 2. TRANSITION REQUIREMENTS. 

2 (a) REQUIREMENTS.— 

3 (1) IN GENERAL.—Section 1860D–4(b) of the 

4 Social Security Act (42 U.S.C. 1395w–104(b)) is 

5 amended by adding at the end the following new 

6 paragraphs: 

7 ‘‘(4) TRANSITION PERIOD FOR DRUG COV8 ERAGE.— 

9 ‘‘(A) IN GENERAL.—In the case of an indi10 vidual who has made an election to enroll (or to 

11 change such an election) in a prescription drug 

12 plan under this part (or an MA–PD plan under 

13 part C) and who as of the effective date of such 

14 election (or change) has a prescription for a 
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1 drug that a physician has determined necesary 

2 to stabilize such individual on a course of treat3 ment, if such prescription would expire within 

4 the 30-day period beginning on the day after 

5 such effective date, the PDP sponsor of the 

6 plan shall provide at least a 30-day supply of 

7 such drug at the dosage previously prescribed 

8 by a physician without imposing any prior au9 thorization requirements or other access restric10 tions for such individual. 

11 ‘‘(B) APPLICATION TO LONG-TERM CARE

12 SETTING.—In the case of an individual de13 scribed in subparagraph (A) who is residing in 

14 a long-term care setting as of the effective date 

15 described in such subparagraph, any reference 

16 to a 30-day period or 30-day supply shall be 

17 deemed a reference to a 90-day period or a 90- 

18 day supply, respectively. 

19 ‘‘(5) CUSTOMER SERVICE.—The sponsor of a 

20 prescription drug plan under this part (or an MA– 

21 PD plan under part C) shall provide— 

22 ‘‘(A) accessible and trained customer serv23 ice representatives available for full business 

24 hours from coast to coast to provide knowledge25 able assistance to individuals seeking help with 
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1 Medicare part D including, beneficiaries, case2 workers, SCHIP counselors, pharmacists, doc3 tors, and caregivers; 

4 ‘‘(B) at least one dedicated phone line for 

5 pharmacists with sufficient staff to reduce wait 

6 times for pharmacists seeking Medicare part D 

7 assistance to no more than 20 minutes; and 

8 ‘‘(C) sufficient staff to reduce wait times 

9 for all Medicare part D-related calls to plan 

10 phone lines to no more than 20 minutes.’’. 

11 (2) APPLICATION.—The requirements under 

12 paragraphs (4) and (5) of section 1860D–4(b) of the 

13 Social Security Act (42 U.S.C. 1395w–104(b)), as 

14 added by subsection (a), shall apply to the plan serv15 ing as the national point of sale contractor under 

16 part D of title XVIII of such Act. 

17 (b) ENFORCEMENT.—The Secretary may impose a 

18 civil monetary penalty in an amount not to exceed $15,000 

19 for conduct that a sponsor of a prescription drug plan or 

20 an organization offering an MA–PD plan knows or should 

21 know is a violation of the provisions of paragraph (4) or 

22 (5) of section 1860D–4(b) of the Social Security Act (42 

23 U.S.C. 1395w–104(b)), as added by subsection (a). The 

24 provisions of section 1128A of the Social Security Act (42 

25 U.S.C. a–7a), other than subsections (a) and (b) and the 
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1 second sentence of subsection (f), shall apply to a civil 

2 monetary penalty under the previous sentence in the same 

3 manner as such provisions apply to a penalty or pro4 ceeding under subsection (a) of such section 1128A(a). 

5 SEC. 3. FEDERAL FALLBACK FOR FULL-BENEFIT DUAL ELI6 GIBLE INDIVIDUALS FOR 2006. 

7 (a) IN GENERAL.— 

8 (1) IN GENERAL.—If a full-benefit dual eligible 

9 individual (as defined in section 1935(c)(6) of the 

10 Social Security Act (42 U.S.C. 1396u–5(c)(6))), or 

11 an individual who is presumed to be such an indi12 vidual pursuant to subsection (b), presents a pre13 scription for a covered part D drug (as defined in 

14 section 1860D–2(e) of such Act (42 U.S.C. 1395w– 

15 102(e))) at a pharmacy in 2006 and the pharmacy 

16 is unable to locate or verify the individual’s enroll17 ment through a reasonable effort, including the use 

18 of the pharmacy billing system or by calling an offi19 cial Medicare hotline, or to bill for the prescription 

20 through the plan serving as the national point of 

21 sale contractor, the pharmacy may provide a 30-day 

22 supply of the drug to the individual. 

23 (2) REFILL.—The pharmacy may provide an 

24 additional 30-day supply of a drug if the pharmacy 

25 continues to be unable to locate the individual’s en-
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1 rollment through such reasonable efforts or to bill 

2 for the prescription through the plan serving as the 

3 national point of sale contractor when a prescription 

4 is presented on or after the date that a prescription 

5 refill is appropriate, but in no case after December 

6 31, 2006. 

7 (3) COST-SHARING.—The cost-sharing for a 

8 prescription filled pursuant to this subsection shall 

9 be cost-sharing provided for under section 1860D– 

10 14(a) of the Social Security Act (42 U.S.C. 1395w– 

11 114(a)). 

12 (b) PRESUMPTIVE ELIGIBILITY.—An individual shall 

13 be presumed to be a full-benefit dual eligible individual 

14 (as so defined) if the individual presents at the pharmacy 

15 with— 

16 (1) a government issued picture identification 

17 card; 

18 (2) reliable evidence of Medicaid enrollment, 

19 such as a Medicaid card, recent history of Medicaid 

20 billing in the pharmacy patient profile, or a copy of 

21 a current Medicaid award letter; and 

22 (3) reliable evidence of Medicare enrollment, 

23 such as a Medicare identification card, a Medicare 

24 enrollment approval letter, a Medicare Summary No-
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1 tice, or confirmation from an official Medicare hot2 line. 

3 (c) PAYMENTS TO PHARMACISTS.— 

4 (1) IN GENERAL.—The Secretary of Health and 

5 Human Services shall reimburse pharmacists, to the 

6 extent that such pharmacists are not otherwise reim7 bursed by States or plans, for the costs incurred in 

8 complying with the requirements under subsection 

9 (a), including acquisition costs, dispensing costs, and 

10 other overhead costs. Such payments shall be made 

11 in a timely manner from the Medicare Prescription 

12 Drug Account under section 1860D–16 of the Social 

13 Security Act (42 U.S.C. 1395w–116) and shall be 

14 deemed to be payments from such Account under 

15 subsection (b) of such section. 

16 (2) RETROACTIVE APPLICATION TO BEGINNING

17 OF 2006.—The costs incurred by a pharmacy which 

18 may be reimbursed under paragraph (1) shall in19 clude costs incurred during the period beginning on 

20 January 1, 2006, and before the date of enactment 

21 of this Act. 

22 (d) RECOVERY OF COSTS FROM PLANS BY SEC23 RETARY NOT PHARMACIES.—The Secretary of Health and 

24 Human Services shall establish a process for recovering 

25 the costs described in subsection (c)(1) from prescription 
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1 drug plans (as defined in section 1860D–1(a)(3)(C) of the 

2 Social Security Act (42 U.S.C. 1394w–101(a)(3)(C))) and 

3 MA–PD plans (as defined in section 1860D–41(a)(14) of 

4 such Act (42 U.S.C. 1395w–151(a)(14))) if the Secretary 

5 determines that such plans should have incurred such 

6 costs. Amounts recovered pursuant to the preceding sen7 tence shall be deposited in the Medicare Prescription Drug 

8 Account described in subsection (c)(1). 

9 SEC. 4. IDENTIFYING FULL-BENEFIT DUAL ELIGIBLE INDI10 VIDUALS IN DATA RECORDS. 

11 (a) IN GENERAL.—The Secretary of Health and 

12 Human Services and a prescription drug plan or an MA– 

13 PD plan shall clearly identify all full-benefit dual eligible 

14 individuals (as defined in section 1935(c)(6) of the Social 

15 Security Act (42 U.S.C. 1396u–5(c)(6))) and reflect the 

16 low-income subsidy status of such individual for each cal17 ender year (beginning with 2006) in every data record file 

18 used to enroll or adjudicate claims for such individuals. 

19 (b) ENROLLMENT.—For each calendar year (begin20 ning with 2006) and for each Medicaid beneficiary who 

21 is a full-benefit dual eligible individual (as so defined), the 

22 Secretary of Health and Human Services shall— 

23 (1) identify in the Medicare enrollment data24 base that such individual has dual eligible status 
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1 that has been verified with a State, including the 

2 District of Columbia; and 

3 (2) ensure that such dual eligible status is re4 flected in each data file necessary to ensure that 

5 such status is transmitted to a prescription drug 

6 plan or an MA–PD plan when the Secretary certifies 

7 the enrollment of such an individual in a plan. 

8 (c) DEFINITION OF MA–PD PLAN AND PRESCRIP9 TION DRUG PLAN.—For purposes of this section, the 

10 terms ‘‘MA–PD plan’’ and ‘‘prescription drug plan’’ have 

11 the meaning given such terms in sections 1860D– 

12 1(a)(3)(C) and 1860D–41(a)(14) of the Social Security 

13 Act (42 U.S.C. 1395w–101(a)(3)(C); 1395w–151(a)(14)), 

14 respectively. 

15 SEC. 5. PROHIBITION ON CONDITIONING MEDICAID ELIGI16 BILITY FOR INDIVIDUALS ENROLLED IN CER17 TAIN CREDITABLE PRESCRIPTION DRUG 

18 COVERAGE ON ENROLLMENT IN THE MEDI19 CARE PART D DRUG PROGRAM. 

20 (a) IN GENERAL.—Section 1935 of the Social Secu21 rity Act (42 U.S.C. 1396v) is amended by adding at the 

22 end the following: 

23 ‘‘(f) PROHIBITION ON CONDITIONING ELIGIBILITY

24 FOR MEDICAL ASSISTANCE FOR INDIVIDUALS ENROLLED

25 IN CERTAIN CREDITABLE PRESCRIPTION DRUG COV-
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1 ERAGE ON ENROLLMENT IN MEDICARE PRESCRIPTION

2 DRUG BENEFIT.— 

3 ‘‘(1) IN GENERAL.—A State shall not condition 

4 eligibility for medical assistance under the State 

5 plan for a part D eligible individual (as defined in 

6 section 1860D–1(a)(3)(A)) who is enrolled in cred7 itable prescription drug coverage described in any of 

8 subparagraphs (C) through (H) of section 1860D– 

9 13(b)(4) on the individual’s enrollment in a prescrip10 tion drug plan under part D of title XVIII or an 

11 MA–PD plan under part C of such title. 

12 ‘‘(2) COORDINATION OF BENEFITS WITH PART

13 D FOR OTHER INDIVIDUALS.—Nothing in this sub14 section shall be construed as prohibiting a State 

15 from coordinating medical assistance under the 

16 State plan with benefits under part D of title XVIII 

17 for individuals not described in paragraph (1).’’. 

18 (b) NULLIFICATION OF STATE PLAN AMENDMENTS, 

19 REDETERMINATION OF ELIGIBILITY.—In the case of a 

20 State that, as of the date of enactment of this Act, has 

21 an approved amendment to its State plan under title XIX 

22 of the Social Security Act with a provision that conflicts 

23 with section 1935(f) of such Act (as added by subsection 

24 (a)), such provision is, as of such date of enactment, null 

25 and void. The State shall redetermine any applications for 
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1 medical assistance that have been denied solely on the 

2 basis of the application of such a State plan amendment 

3 not later than 90 days after the date of enactment of this 

4 Act. 

5 SEC. 6. ENSURING THAT FULL-BENEFIT DUAL ELIGIBLE IN6 DIVIDUALS ARE NOT OVERCHARGED. 

7 (a) IN GENERAL.—Section 1860D–14 of the Social 

8 Security Act (42 U.S.C. 1395w–114) is amended— 

9 (1) by redesignating subsection (d) as sub10 section (e); and 

11 (2) by inserting after subsection (c) the fol12 lowing new subsection: 

13 ‘‘(d) ENSURING FULL-BENEFIT DUAL ELIGIBLE IN14 DIVIDUALS ARE NOT OVERCHARGED.— 

15 ‘‘(1) IN GENERAL.—The Secretary shall, as 

16 soon a possible after the date of enactment of this 

17 subsection, establish processes for the following: 

18 ‘‘(A) TRACKING INAPPROPRIATE PAY19 MENTS.—The Secretary shall track full-benefit 

20 dual eligible individuals enrolled in a prescrip21 tion drug plan or an MA–PD plan to determine 

22 whether such individuals were inappropriately 

23 subject under the plan to a deductible or cost24 sharing that is greater than is required under 

25 section 1860D–14. 
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1 ‘‘(B) REDUCTION IN PAYMENTS TO PLANS

2 AND REFUNDS TO INDIVIDUALS.—If the Sec3 retary determines under subparagraph (A) that 

4 an individual was overcharged, the Secretary 

5 shall— 

6 ‘‘(i) reduce payments to the sponsor 

7 of the prescription drug plan under section 

8 1860D–15 or to the organization offering 

9 the MA–PD plan under section 1853 that 

10 inappropriately charged the individual by 

11 an amount equal to the inappropriate 

12 charges; and 

13 ‘‘(ii) refund such amount to the indi14 vidual within 60 days of the determination 

15 that the individual was inappropriately 

16 charged. 

17 If the Secretary does not provide for the refund 

18 under clause (i) within the 60 days provided for 

19 under such clause, interest at the rate estab20 lished under section 6621(a)(1) of the Internal 

21 Revenue Code of 1986 shall be payable from 

22 the end of such 60-day period until the date of 

23 the refund. 

24 ‘‘(2) REQUIREMENT.—The processes estab25 lished under paragraph (1) shall provide for the abil-
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1 ity of an individual to notify the Secretary if the in2 dividual believes that they were inappropriately sub3 ject under the plan to a deductible or cost-sharing 

4 that is greater than is required under section 

5 1860D–14.’’. 

6 (b) REPORT TO CONGRESS.—Not later than January 

7 1, 2007, the Secretary of Health and Human Services 

8 shall submit a report to Congress on the implementation 

9 of the processes established under subsection (d) of section 

10 1860D–14 of the Social Security Act (42 U.S.C. 1395w– 

11 114), as added by subsection (a). 

12 SEC. 7. REIMBURSEMENT OF STATES FOR 2006 TRANSITION 

13 COSTS. 

14 (a) REIMBURSEMENT.— 

15 (1) IN GENERAL.—Notwithstanding section 

16 1935(d) of the Social Security Act (42 U.S.C. 

17 1396u–5(d) or any other provision of law, the Sec18 retary of Health and Human Services shall reim19 burse States for 100 percent of the costs incurred by 

20 the State during 2006 for covered part D drugs (as 

21 defined in section 1860D–2(e) of such Act (42 

22 U.S.C. 1395w–102(e))) for part D eligible individ23 uals (as defined in section 1860D–1(a)(3)(A) of the 

24 Social Security Act (42 U.S.C. 1394w– 

25 101(a)(3)(A))) which the State reasonably expected 
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1 would have been covered under such part but were 

2 not because the individual was unable to access on 

3 a timely basis prescription drug benefits to which 

4 they were entitled under such part. Such payments 

5 shall be made from the Medicare Prescription Drug 

6 Account under section 1860D–16 of the Social Secu7 rity Act (42 U.S.C. 1395w–116) and shall be 

8 deemed to be payments from such Account under 

9 subsection (b) of such section. 

10 (2) RETROACTIVE APPLICATION TO BEGINNING

11 OF 2006.—The costs incurred by a State which may 

12 be reimbursed under paragraph (1) shall include 

13 costs incurred during the period beginning on Janu14 ary 1, 2006, and before the date of enactment of 

15 this Act. 

16 (b) RECOVERY OF COSTS FROM PLANS BY SEC17 RETARY NOT STATES.—The Secretary of Health and 

18 Human Services shall establish a process for recovering 

19 the costs described in subsection (a)(1) from prescription 

20 drug plans (as defined in section 1860D–1(a)(3)(C) of the 

21 Social Security Act (42 U.S.C. 1394w–101(a)(3)(C))) and 

22 MA–PD plans (as defined in section 1860D–41(a)(14) of 

23 such Act (42 U.S.C. 1395w–151(a)(14))) if the Secretary 

24 determines that such plans should have incurred such 

25 costs. Amounts recovered pursuant to the preceding sen-
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1 tence shall be deposited in the Medicare Prescription Drug 

2 Account described in subsection (a)(1). 

3 (c) STATE.—For purposes of this section, the term 

4 ‘‘State’’ includes the District of Columbia. 

5 SEC. 8. FACILITATION OF IDENTIFICATION AND ENROLL6 MENT THROUGH PHARMACIES OF FULL-BEN7 EFIT DUAL ELIGIBLE INDIVIDUALS IN THE 

8 MEDICARE PART D DRUG PROGRAM. 

9 (a) IN GENERAL.—The Secretary of Health and 

10 Human Services shall provide for outreach and education 

11 to every pharmacy that has participated in the Medicaid 

12 program under title XIX of the Social Security Act, par13 ticularly independent pharmacies, on the following: 

14 (1) The needs of full-benefit dual eligible indi15 viduals and the challenges of meeting those needs. 

16 (2) The processes for the transition from Med17 icaid prescription drug coverage to coverage under 

18 such part D for such individuals. 

19 (3) The processes established by the Secretary 

20 to facilitate, at point of sale, identification of drug 

21 plan assignment of such population or enrollment of 

22 previously unidentified or new full-benefit dual eligi23 ble individuals into Medicare part D prescription 

24 drug coverage, including how pharmacies can use 

25 such processes to help ensure that such population 
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1 makes a successful transition to Medicare part D 

2 without a lapse in prescription drug coverage. 

3 (b) HOLDING PHARMACIES HARMLESS FOR CERTAIN

4 COSTS.— 

5 (1) IN GENERAL.—The Secretary of Health and 

6 Human Services shall provide for such payments to 

7 pharmacies as may be necessary to reimburse phar8 macies fully for— 

9 (A) transaction fees associated with the 

10 point-of-sale facilitated identification and enroll11 ment processes referred to in subsection (a)(3); 

12 and 

13 (B) costs associated with technology or 

14 software upgrades necessary to make any iden15 tification and enrollment inquiries as part of 

16 the processes under subsection (a)(3). 

17 (2) TIME.—Payments under paragraph (1) 

18 shall be made with respect to fees and costs incurred 

19 during the period beginning on December 1, 2005, 

20 and ending on June 1, 2006. 

21 (3) PAYMENTS FROM ACCOUNT.—Payments 

22 under paragraph (1) shall be made from the Medi23 care Prescription Drug Account under section 

24 1860D–16 of the Social Security Act (42 U.S.C. 

25 1395w–116) and shall be deemed to be payments 
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1 from such Account under subsection (b) of such sec2 tion. 

3 SEC. 9. STATE HEALTH INSURANCE PROGRAM ASSISTANCE 

4 REGARDING THE NEW MEDICARE PRESCRIP5 TION DRUG BENEFIT. 

6 During the period beginning on the date that is 7 

7 days after the date of enactment of this Act and ending 

8 on May 15, 2006 (or a later date if determined appro9 priate by the Secretary of Health and Human Services), 

10 the Secretary shall ensure that an employee of the Centers 

11 for Medicare & Medicaid Services is stationed at each 

12 State health insurance counseling program (receiving 

13 funding under section 4360 of the Omnibus Budget Rec14 onciliation Act of 1990) in order to— 

15 (1) assist Medicare beneficiaries and counselors 

16 under such program in better understanding the 

17 Medicare prescription drug benefit under part D of 

18 title XVIII of the Social Security Act; and 

19 (2) act as a liaison to the Secretary and the Ad20 ministrator of the Centers for Medicare & Medicaid 

21 Services regarding issues related to oversight and 

22 enforcement of provisions under the Medicare pre23 scription drug benefit. 
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1 SEC. 10. ADDITIONAL MEDICARE PART D INFORMATIONAL 

2 RESOURCES. 

3 (a) 1–800–MEDICARE.—The Secretary of Health 

4 and Human Services shall increase the number of trained 

5 employees staffing the toll-free telephone number 1–800– 

6 MEDICARE in order to ensure that the average wait time 

7 for a caller does not exceed 20 minutes. 

8 (b) PHARMACY HOTLINE.—The Secretary of Health 

9 and Human Services shall— 

10 (1) establish a toll-free telephone number that 

11 is dedicated to providing information regarding the 

12 Medicare prescription drug benefit under title XVIII 

13 of the Social Security Act to pharmacists; and 

14 (2) staff such telephone number in order to en15 sure that the average wait time for a caller does not 

16 exceed 20 minutes. 

17 (c) STATE HEALTH INSURANCE PROGRAM HOT18 LINE.—The Secretary of Health and Human Services 

19 shall— 

20 (1) establish a toll-free telephone number that 

21 is dedicated to providing information regarding the 

22 Medicare prescription drug benefit under title XVIII 

23 of the Social Security Act to counselors working in 

24 State health insurance counseling programs (receiv25 ing funding under section 4360 of the Omnibus 

26 Budget Reconciliation Act of 1990); and 
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1 (2) staff such telephone number in order to en2 sure that the average wait time for a caller does not 

3 exceed 20 minutes. 

4 SEC. 11. GAO STUDY AND REPORT ON THE IMPOSITION OF 

5 CO-PAYMENTS UNDER PART D FOR FULL6 BENEFIT DUAL ELIGIBLE INDIVIDUALS RE7 SIDING IN A LONG-TERM CARE FACILITY. 

8 (a) STUDY.—The Comptroller General of the United 

9 States shall conduct a study on how mental health pa10 tients who are full-benefit dual eligible individuals (as de11 fined in section 1935(c)(6) of the Social Security Act (42 

12 U.S.C. 1396u–5(c)(6))) and who reside in long-term care 

13 facilities, including licensed assisted living facilities, will 

14 be affected by the imposition of co-payments for covered 

15 part D drugs under part D of title XVIII of such Act. 

16 Such study shall include a review of issues that relate to 

17 the potential harm of displacement due to an inability to 

18 access needed medications because of such co-payments. 

19 (b) REPORT.—Not later than 6 months after the date 

20 of enactment of this Act, the Comptroller General of the 

21 United States shall submit a report to Congress on the 

22 study conducted under subsection (a), including rec23 ommendations for such legislation as the Comptroller Gen24 eral determines is appropriate. 
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1 SEC. 12. STATE COVERAGE OF NON-FORMULARY PRESCRIP2 TION DRUGS FOR FULL-BENEFIT DUAL ELIGI3 BLE INDIVIDUALS DURING 2006. 

4 (a) STATE COVERAGE OF NON-FORMULARY PRE5 SCRIPTION DRUGS FOR FULL-BENEFIT DUAL ELIGIBLE

6 INDIVIDUALS DURING 2006.—For prescriptions filled 

7 during 2006, notwithstanding section 1935(d) of the So8 cial Security Act (42 U.S.C. 1396v(d)), a State (as de9 fined for purposes of title XIX of such Act) may provide 

10 (and receive Federal financial participation for) medical 

11 assistance under such title with respect to prescription 

12 drugs provided to a full-benefit dual eligible individual (as 

13 defined in section 1935(c)(6) of such Act (42 U.S.C. 

14 1396v(c)(6)) that are not on the formulary of the prescrip15 tion drug plan under part D or the MA–PD plan under 

16 part C of title XVIII of such Act in which such individual 

17 is enrolled. 

18 (b) APPLICATION.— 

19 (1) MEDICARE AS PRIMARY PAYER.—Nothing in 

20 subsection (a) shall be construed as changing or af21 fecting the primary payer status of a prescription 

22 drug plan under part D or an MA–PD plan under 

23 part C of title XVIII of the Social Security Act with 

24 respect to prescription drugs furnished to any full25 benefit dual eligible individual (as defined in section 
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1 1935(c)(6) of such Act (42 U.S.C. 1396v(c)(6)) dur2 ing 2006. 

3 (2) THIRD PARTY LIABILITY.—Nothing in sub4 section (a) shall be construed as limiting the author5 ity or responsibility of a State under section 

6 1902(a)(25) of the Social Security Act (42 U.S.C. 

7 1396a(a)(25)) to seek reimbursement from a pre8 scription drug plan, an MA–PD plan, or any other 

9 third party, of the costs incurred by the State in 

10 providing prescription drug coverage during 2006. 

11 SEC. 13. PROTECTION FOR FULL-BENEFIT DUAL ELIGIBLE 

12 INDIVIDUALS FROM PLAN TERMINATION 

13 PRIOR TO RECEIVING FUNCTIONING ACCESS 

14 IN A NEW PART D PLAN. 

15 (a) IN GENERAL.—Notwithstanding any other provi16 sion of law, the Secretary of Health and Human Services 

17 shall not terminate coverage of a full-benefit dual eligible 

18 individual (as defined in section 1935(c)(6) of the Social 

19 Security Act (42 U.S.C. 1396v(c)(6)) unless such indi20 vidual has functioning access to a prescription drug plan 

21 under part D or an MA–PD plan under part C of title 

22 XVIII of such Act. Such access shall include entry of the 

23 individual into the computer system of such plan and an 

24 acknowledgment by the plan that the individual is eligible 
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1 for a full premium subsidy under section 1860D–14 of 

2 such Act (42 U.S.C. 1395w–114). 

3 (b) EFFECTIVE DATE.—This section shall take effect 

4 on the date of the enactment of this Act. 

Æ