I 

109TH CONGRESS 

2D SESSION H. R. 4722 

To amend title XVIII of the Social Security Act to eliminate cost-sharing 

under part D of such title for certain full-benefit dual eligible individuals. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 8, 2006 

Mr. ENGEL (for himself, Mr. BROWN of Ohio, Mr. WAXMAN, Mr. BOUCHER, 

Mr. TOWNS, Mr. PALLONE, Mr. RUSH, Mr. STUPAK, Mr. STRICKLAND, 

Ms. DEGETTE, Mrs. CAPPS, Mr. ALLEN, Ms. SCHAKOWSKY, Mr. MCNULTY, Mr. JEFFERSON, Mr. EMANUEL, and Mr. KENNEDY of Rhode Island) 

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 amend title XVIII of the Social Security Act to eliminate 

cost-sharing under part D of such title for certain fullbenefit dual eligible individuals. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 
2 

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1 SECTION 1. ELIMINATION OF PART D COST-SHARING FOR 

2 CERTAIN FULL-BENEFIT DUAL ELIGIBLE IN3 DIVIDUALS. 

4 (a) IN GENERAL.—Section 1860D–14(a)(1)(D)(i) of 

5 the Social Security Act (42 U.S.C. 1395w– 

6 114(a)(1)(D)(i)) is amended— 

7 (1) in the heading, by striking ‘‘INSTITU8 TIONALIZED INDIVIDUALS.—In’’ and inserting 

9 ‘‘ELIMINATION OF COST-SHARING FOR CERTAIN

10 FULL-BENEFIT DUAL ELIGIBLE INDIVIDUALS.—’’ 

11 ‘‘(I) INSTITUTIONALIZED INDI12 VIDUALS.—In’’; and 

13 (2) by adding at the end the following new sub14 clauses: 

15 ‘‘(II) CERTAIN OTHER INDIVID16 UALS.—In the case of an individual 

17 who is a full-benefit dual eligible indi18 vidual and who receives services from 

19 a facility or program described in sub20 clause (III), the elimination of any 

21 beneficiary coinsurance described in 

22 section 1860D–2(b)(2) (for all 

23 amounts through the total amount of 

24 expenditures at which benefits are 

25 available under section 1860D– 

26 2(b)(4)). 
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1 ‘‘(III) FACILITY DESCRIBED.— 

2 For purposes of subclause (II), a fa3 cility or program described in this 

4 subclause is a board and care facility, 

5 a custodial care facility, a group 

6 home, or an assisted living facility (as 

7 such terms are defined by the Sec8 retary), or any other facility or pro9 gram that the Secretary determines 

10 provides services without which the in11 dividual would require long-term care 

12 in a medical institution or nursing fa13 cility.’’. 

14 (b) EFFECTIVE DATE.— 

15 (1) IN GENERAL.—The amendments made by 

16 subsection (a) shall take effect as if included in the 

17 enactment of section 101 of the Medicare Prescrip18 tion Drug, Improvement, and Modernization Act of 

19 2003 (Public Law 108–173). 

20 (2) REIMBURSEMENT OF COST-SHARING PAY21 MENTS.—The Secretary shall provide for reimburse22 ment of any beneficiary coinsurance described in sec23 tion 1860D–2(b)(2) of the Social Security Act (42 

24 U.S.C. 1395w–102(b)(2)) paid by or on behalf of an 

25 individual described in section 1860D– 
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•HR 4722 IH 

1 14(a)(1)(D)(i)(II) of such Act, as added by sub2 section (a), during the period beginning on January 

3 1, 2006, and ending on the date of enactment of this 

4 Act. 

Æ