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[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[S. 2343 Introduced in Senate (IS)]

108th CONGRESS
  2d Session
                                S. 2343

To amend title XVIII of the Social Security Act to improve the medicare 
                    program, and for other purposes.

_______________________________________________________________________

                   IN THE SENATE OF THE UNITED STATES

                             April 22, 2004

  Mr. Conrad (for himself and Mrs. Lincoln) 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 the medicare 
                    program, and for other purposes.

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

SECTION 1. SHORT TITLE; AMENDMENTS TO THE SOCIAL SECURITY ACT; 
              REFERENCES TO MMA AND SECRETARY; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare 
Modernization Improvement Act of 2004''.
    (b) Amendments to Social Security Act.--Except as otherwise 
specifically provided, whenever an amendment is expressed in terms of 
an amendment to or repeal of a section or other provision, the 
reference shall be considered to be made to that section or other 
provision of the Social Security Act.
    (c) References to MMA and Secretary.--In this Act:
            (1) MMA.--The term ``MMA'' means the Medicare Prescription 
        Drug, Improvement, and Modernization Act of 2003 (117 Stat. 
        2066 et seq.).
            (2) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
    (d) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; amendments to the Social Security Act; references 
                            to MMA and Secretary; table of contents.
   TITLE I--PROVIDING MEDICARE BENEFICIARIES WITH LOWER, NEGOTIATED 
                        PRESCRIPTION DRUG PRICES

Sec. 101. Negotiating fair prices for medicare prescription drugs.
Sec. 102. Importation of prescription drugs.
      TITLE II--STABILIZING THE MEDICARE PRESCRIPTION DRUG BENEFIT

Sec. 201. Requiring two prescription drug plans to avoid Federal 
                            fallback.
Sec. 202. Improving the stability of the drug benefit.
TITLE III--PROVIDING MEDICARE BENEFICIARIES WITH SOURCES OF ADDITIONAL 
                       PRESCRIPTION DRUG COVERAGE

Sec. 301. Making available wraparound coverage through medigap.
 TITLE IV--IMPROVED ACCESS TO PHARMACY CARE FOR MEDICARE BENEFICIARIES

Sec. 401. Improving access to pharmacy care.
 TITLE V--REPEAL OF HEALTH SAVINGS ACCOUNTS AND OTHER EMPLOYER RELATED 
                               PROVISIONS

Sec. 501. Repeal of Health Savings Accounts.
            TITLE VI--IMPROVEMENT OF CHRONIC CARE MANAGEMENT

Sec. 601. Medicare complex clinical care management payment 
                            demonstration.
    TITLE VII--REQUIRING MORE APPROPRIATE PAYMENTS TO PRIVATE PLANS

Sec. 701. Elimination of MA regional plan stabilization fund (slush 
                            fund).
Sec. 702. Requiring private plan payments to reflect appropriate health 
                            risk adjustment.
Sec. 703. Phase-in private plan payment to 100 percent of fee-for-
                            service rate.
             TITLE VIII--REPEAL OF PREMIUM SUPPORT PROGRAM

Sec. 801. Repeal of premium support program.
    TITLE IX--PROVIDING BETTER INFORMATION TO MEDICARE BENEFICIARIES

Sec. 901. Providing accurate information to beneficiaries.
Sec. 902. Providing medicare beneficiaries with better upfront drug 
                            coverage information.
Sec. 903. Ensuring medicare beneficiaries are informed of formulary 
                            changes.
   TITLE X--FULL FUNDING AND EXPANSION FOR DEMONSTRATION PROJECT FOR 
         COVERAGE OF CERTAIN PRESCRIPTION DRUGS AND BIOLOGICALS

Sec. 1001. Full funding and expansion for demonstration project for 
                            coverage of certain prescription drugs and 
                            biologicals.

   TITLE I--PROVIDING MEDICARE BENEFICIARIES WITH LOWER, NEGOTIATED 
                        PRESCRIPTION DRUG PRICES

SEC. 101. NEGOTIATING FAIR PRICES FOR MEDICARE PRESCRIPTION DRUGS.

    (a) In General.--Section 1860D-11(i) (42 U.S.C. 1395w-111(i)) is 
amended to read as follows:
    ``(i) Authority To Negotiate Prices With Manufacturers.--In order 
to ensure that beneficiaries enrolled under prescription drug plans and 
MA-PD plans pay the lowest possible price, the Secretary shall have 
authority to negotiate contracts with manufacturers of covered part D 
drugs as necessary to reduce prices and protect access to needed drugs, 
consistent with the requirements and in furtherance of the goals of 
providing quality care and containing costs under this part.''.
    (b) Effective Date.--The amendment made by this section shall take 
effect as if included in the enactment of section 101 of MMA (117 Stat. 
2071).

SEC. 102. IMPORTATION OF PRESCRIPTION DRUGS.

    (a) In General.--Section 804 of the Federal Food, Drug, and 
Cosmetic Act (21 U.S.C. 535) is amended--
            (1) by striking subsection (l); and
            (2) by redesignating subsection (m) as subsection (l).
    (b) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of section 1121 of MMA (117 
Stat. 2464).

      TITLE II--STABILIZING THE MEDICARE PRESCRIPTION DRUG BENEFIT

SEC. 201. REQUIRING TWO PRESCRIPTION DRUG PLANS TO AVOID FEDERAL 
              FALLBACK.

    Section 1860D-3(a) (42 U.S.C. 1395w-103(a)) is amended--
            (1) in paragraph (1)--
                    (A) by striking ``qualifying plans (as defined in 
                paragraph (3))'' and inserting ``prescription drug 
                plans''; and
                    (B) by striking ``, at least one of which is a 
                prescription drug plan'';
            (2) in paragraph (2), by striking ``qualifying plans'' and 
        inserting ``prescription drug plans''; and
            (3) by striking paragraph (3).

SEC. 202. IMPROVING THE STABILITY OF THE DRUG BENEFIT.

    (a) In General.--Section 1860D-3 (42 U.S.C. 1395w-103) is amended 
by adding at the end the following new subsection:
    ``(c) Fallback Prescription Drug Plans To Be Available for 2 
Years.--Notwithstanding subsection (b)(2), if the Secretary provides 
for the offering of a fallback prescription drug plan under subsection 
(a) in an area for a year, the following rules shall apply:
            ``(1) The fallback prescription drug plan shall be 
        available for not less than a 2-year period.
            ``(2) The Secretary is not required to make the 
        determination under subsection (a)(1) with respect to the 
        second year in which the fallback prescription drug plan is 
        offered in the area.
            ``(3) During the second year in which the fallback 
        prescription drug plan is offered in an area, any part D 
        eligible individual residing in the area (regardless of whether 
        such individual was enrolled in the fallback prescription drug 
        plan during the previous year) may elect to receive 
        prescription drug coverage under the fallback prescription drug 
        plan or through any other type of qualified prescription drug 
        coverage available in the area, subject to the requirements of 
        section 1860D-1.''.
    (b) Effective Date.--The amendment made by this section shall take 
effect as if included in the enactment of section 101 of MMA (117 Stat. 
2071).

TITLE III--PROVIDING MEDICARE BENEFICIARIES WITH SOURCES OF ADDITIONAL 
                       PRESCRIPTION DRUG COVERAGE

SEC. 301. MAKING AVAILABLE WRAPAROUND COVERAGE THROUGH MEDIGAP.

    (a) In General.--Section 1882(v)(1) (42 U.S.C. 1395ss(v)(1)) is 
amended--
            (1) in subparagraph (A), by inserting ``, other than such a 
        policy that provides wraparound prescription drug coverage 
        included within a range of such coverage approved under 
subparagraph (D)(ii),'' after ``paragraph (6)(A))''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Wraparound prescription drug coverage.--
                            ``(i) In general.--Notwithstanding any 
                        other provision of this subsection, a medigap 
                        Rx policy that provides wraparound prescription 
                        drug coverage included within a range of such 
                        coverage approved by the Secretary under clause 
                        (ii) may be offered to part D enrollees.
                            ``(ii) Development of standards.--The 
                        Secretary shall approve a range of wraparound 
                        prescription drug coverage that may be offered 
                        under this subparagraph to part D enrollees.''.
    (b) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of section 104 of MMA (117 Stat. 
2161).

 TITLE IV--IMPROVED ACCESS TO PHARMACY CARE FOR MEDICARE BENEFICIARIES

SEC. 401. IMPROVING ACCESS TO PHARMACY CARE.

    (a) Application of TriCare Pharmacy Access Standards.--Section 
1860D-4(b)(1)(C)(ii) (42 U.S.C. 1395w-104(b)(1)(C)(ii)) is amended--
            (1) by striking: ``Application of tricare standards.--The 
        Secretary shall'' and inserting the following: ``Application of 
        tricare standards.--
                                    ``(I) The Secretary shall''; and
            (2) by adding at the end the following new subclauses:
                                    ``(II) In determining whether 
                                convenient access has been provided 
                                under subclause (I), the Secretary may 
                                only consider community retail 
                                pharmacies (as defined by the 
                                Secretary) that are accessible to the 
                                general public. The Secretary may not 
                                consider pharmacies located in long-
                                term care facilities, pharmacies 
                                located in skilled nursing facilities, 
                                pharmacies operated by the Indian 
                                Health Service, Indian tribes or tribal 
                                organizations, or urban Indian 
                                organizations (as defined in section 4 
                                of the Indian Health Care Improvement 
                                Act), mail order pharmacies, or 
                                pharmacies located in community health 
                                centers receiving funds under section 
                                330 of the Public Health Service Act.
                                    ``(III) The Secretary shall make a 
                                separate determination under subclause 
                                (I) with respect to each State within 
                                the region served by the prescription 
                                drug plan or MA-PD plan.''.
    (b) Level Playing Field.--Section 1860D-4(b)(1)(D) (42 U.S.C. 
1395w-104(b)(1)(D)) is amended to read as follows:
                    ``(D) Level playing field.--Such a sponsor shall 
                permit enrollees to receive the same amount, scope, and 
                duration of drugs and biologicals (which may include a 
                90-day supply of drugs or biologicals) and medication 
                therapy management services through any pharmacy (other 
                than a mail order pharmacy) as the sponsor permits 
                enrollees to receive through a mail order pharmacy, 
                with any differential in charge paid by such 
                enrollees.''.
    (c) Provision of Coverage Information by Pharmacies.--Section 
1860D-4(a) is amended by adding at the end the following new paragraph:
            ``(5) Dissemination of information by pharmacists.--
                    ``(A) Payment to pharmacies.--Subject to 
                subparagraph (C)(ii), beginning on January 1, 2006, and 
                annually thereafter, the Secretary shall make an annual 
                payment to each pharmacy participating in a pharmacy 
                network of a PDP sponsor for providing information to 
                enrollees in prescription drug plans and MA-PD plans 
                offered by that sponsor in an amount determined by the 
                Secretary based on an estimate of the number of 
                enrollees in prescription drug plans and MA-PD plans 
                served by the pharmacy and taking into account the 
                costs of the pharmacy in distributing such information 
                and the availability of funding under subparagraph (C).
                    ``(B) Provision of information to pharmacies.--Each 
                PDP sponsor offering a prescription drug plan or an MA-
                PD plan shall furnish each pharmacy that participates 
                in its network with the information to be provided 
                under subparagraph (A).
                    ``(C) Funding.--
                            ``(i) In general.--Subject to clause (ii), 
                        the Secretary shall make payments under 
                        subparagraph (A) from the Medicare Prescription 
                        Drug Account.
                            ``(ii) Limitation.--The Secretary may not 
                        make any payments under subparagraph (A) after 
                        the date on which a total of $500,000,000 have 
                        been expended from such Account as a result of 
                        the application of this paragraph.''.
    (d) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of section 101 of MMA (117 Stat. 
2071).

 TITLE V--REPEAL OF HEALTH SAVINGS ACCOUNTS AND OTHER EMPLOYER RELATED 
                               PROVISIONS

SEC. 501. REPEAL OF HEALTH SAVINGS ACCOUNTS.

    Section 1201 of MMA (117 Stat. 2469) is repealed and any provisions 
of law amended by such section are restored as if such section had not 
been enacted.

            TITLE VI--IMPROVEMENT OF CHRONIC CARE MANAGEMENT

SEC. 601. MEDICARE COMPLEX CLINICAL CARE MANAGEMENT PAYMENT 
              DEMONSTRATION.

    (a) Establishment.--
            (1) In general.--The Secretary shall establish a 
        demonstration program to make the medicare program more 
        responsive to needs of eligible beneficiaries by promoting 
        continuity of care, helping stabilize medical conditions, 
        preventing or minimizing acute exacerbations of chronic 
        conditions, and reducing adverse health outcomes, such as 
        adverse drug interactions related to polypharmacy.
            (2) Sites.--The Secretary shall designate 10 sites at which 
        to conduct the demonstration program under this section, of 
        which at least 4 shall be in a rural area. One of the sites 
        shall be located in the State of Arkansas and 1 of the sites 
        shall be in the State of North Dakota.
            (3) Duration.--The Secretary shall conduct the 
        demonstration program under this section for a 3-year period.
            (4) Implementation.--The Secretary shall not implement the 
        demonstration program before October 1, 2004.
    (b) Participants.--Any eligible beneficiary who resides in an area 
designated by the Secretary as a demonstration site under subsection 
(a)(2) may participate in the demonstration program under this section 
if such beneficiary identifies a care coordinator who agrees to manage 
the complex clinical care of the eligible beneficiary under the 
demonstration program.
    (c) Care Coordinator Responsibilities.--The Secretary shall enter 
into an agreement with each care coordinator who agrees to manage the 
complex clinical care of an eligible beneficiary under subsection (b) 
under which the care coordinator shall--
            (1) serve as the primary contact of the eligible 
        beneficiary in accessing items and services for which payment 
        may be made under the medicare program;
            (2) maintain medical information related to care provided 
        by other health care providers who provide health care items 
        and services to the eligible beneficiary, including clinical 
        reports, medication and treatments prescribed by other care 
        coordinators, hospital and hospital outpatient services, 
        skilled nursing home care, home health care, and medical 
        equipment services;
            (3) monitor and advocate for the continuity of care of the 
        eligible beneficiary and the use of evidence-based guidelines;
            (4) promote self-care and family caregiver involvement 
        where appropriate;
            (5) have appropriate staffing arrangements to conduct 
        patient self-management and other care coordination activities 
        as specified by the Secretary;
            (6) refer the eligible beneficiary to community services 
        organizations and coordinate the services of such organizations 
        with the care provided by health care providers; and
            (7) meet such other complex care management requirements as 
        the Secretary may specify.
    (d) Complex Clinical Care Management Fee.--
            (1) Payment.--Under an agreement entered into under 
        subsection (c), the Secretary shall pay to each care 
        coordinator, on behalf of each eligible beneficiary under the 
        care of that care coordinator, the complex clinical care 
        management fee developed by the Secretary under paragraph (2).
            (2) Development of fee.--The Secretary shall develop a 
        complex care management fee under this paragraph that is paid 
        on a monthly basis and which shall be payment in full for all 
        the functions performed by the care coordinator under the 
        demonstration program, including any functions performed by 
        other qualified practitioners acting on behalf of the care 
        coordinator, appropriate staff under the supervision of the 
        care coordinator, and any other person under a contract with 
        the care coordinator, including any person who conducts patient 
        self-management and caregiver education under subsection 
        (c)(4).
    (e) Funding.--The Secretary shall provide for the transfer from the 
Federal Supplementary Insurance Trust Fund established under section 
1841 of the Social Security Act (42 U.S.C. 1395t) of $1,000,000,000 for 
the costs of carrying out the demonstration program under this section.
    (f) Waiver Authority.--The Secretary may waive such requirements of 
titles XI and XVIII of the Social Security Act (42 U.S.C. 1301 et seq.; 
1395 et seq.) as may be necessary for the purpose of carrying out the 
demonstration program under this section.
    (g) Report.--Not later than 6 months after the completion of the 
demonstration program under this section, the Secretary shall submit to 
Congress a report on such program, together with recommendations for 
such legislation and administrative action as the Secretary determines 
to be appropriate.
    (h) Definitions.--In this section:
            (1) Care coordinator.--The term ``care coordinator'' means 
        a physician (as defined in subsection (r)(1)) or an entity that 
        meets such conditions as the Secretary may specify (which may 
        include physicians, physician group practices, or other health 
        care professionals or entities the Secretary may find 
        appropriate) working in collaboration with a physician that--
                    (A) has entered into a care coordination agreement 
                with the Secretary; and
                    (B) meets such other criteria as the Secretary may 
                establish (which may include experience in the 
                provision of care coordination).
            (2) Chronic condition.--The term ``chronic condition'' 
        means an illness, functional limitation, or cognitive 
        impairment that is expected to last at least one year, limits 
        the activities of an individual, and requires ongoing care.
            (3) Eligible individual.--For purposes of this subsection, 
        the term ``eligible individual'' means an individual who has--
                    (A) multiple chronic conditions, including 
                dementia;
                    (B) a high rate of use of covered part D drugs (as 
                defined in section 1860D-2(e)(1)); and
                    (C) a high rate of use of services for which 
                payment is made under this title.
            (4) Medicare program.--The term ``medicare program'' means 
        the health care program under title XVIII of the Social 
        Security Act (42 U.S.C. 1395 et seq.).
    (i) Conforming Repeal.--
            (1) Repeal.--Section 649 of MMA (42 U.S.C. 1395b-1 note) is 
        repealed.
            (2) Effective date.--The amendment made by this subsection 
        shall take effect as if such section 649 was not included in 
        the enactment of MMA (117 Stat. 2066 et seq.).

    TITLE VII--REQUIRING MORE APPROPRIATE PAYMENTS TO PRIVATE PLANS

SEC. 701. ELIMINATION OF MA REGIONAL PLAN STABILIZATION FUND (SLUSH 
              FUND).

    (a) In General.--Subsection (e) of section 1858 (42 U.S.C. 1395w-
27a) is repealed.
    (b) Effective Date.--The amendment made by this section shall take 
effect as if such subsection had not been included in the enactment of 
section 221(c) of MMA (117 Stat. 2181).

SEC. 702. REQUIRING PRIVATE PLAN PAYMENTS TO REFLECT APPROPRIATE HEALTH 
              RISK ADJUSTMENT.

    Effective January 1, 2005, in applying risk adjustment factors to 
payments to organizations under section 1853 of the Social Security Act 
(42 U.S.C. 1395w-23) in a budget neutral manner--
            (1) the Secretary shall ensure that such factors, in the 
        aggregate, take into account the actuarial characteristics of 
        the entire medicare population, and not merely the population 
        of individuals enrolled under a plan under part C of title 
        XVIII of such Act; and
            (2) the Secretary shall not make any adjustments in the 
        aggregate amount of payments under this part solely for the 
        purpose of ensuring that such aggregate payments are not 
        affected in whole or in part by the application of such risk 
        adjustment factors.

SEC. 703. PHASE-IN PRIVATE PLAN PAYMENT TO 100 PERCENT OF FEE-FOR-
              SERVICE RATE.

    Notwithstanding any other provision of law, the Secretary shall 
provide, in a phased-in manner over a 5-year period beginning with 
2005, for adjustment of payment rates to organizations under section 
1853 of the Social Security Act (42 U.S.C. 1395w-23) so that, at the 
end of such phase-in period, such payment rates reflect only the 
payment rate described in subsection (c)(1)(D) of such section 
(relating to 100 percent fee-for-service payment).

             TITLE VIII--REPEAL OF PREMIUM SUPPORT PROGRAM

SEC. 801. REPEAL OF PREMIUM SUPPORT PROGRAM.

    Subtitle E of title II of MMA (117 Stat. 2214) is repealed and any 
provisions of law amended by such section are restored as if such 
subtitle had not been enacted.

    TITLE IX--PROVIDING BETTER INFORMATION TO MEDICARE BENEFICIARIES

SEC. 901. PROVIDING ACCURATE INFORMATION TO BENEFICIARIES.

    (a) In General.--Section 1860D-1(c)(1) (42 U.S.C. 1395w-101(c)(1)) 
is amended by striking ``Such activities shall ensure that such 
information is first made available'' and inserting ``Such activities 
shall ensure that such information is not misleading, false, or 
deceptive and appropriately targets part D eligible individuals (and 
prospective eligible individuals). Funding expended for these 
activities shall give priority to activities that directly target part 
D eligible individuals (and prospective eligible individuals), 
including face-to-face educational sessions with such individuals. This 
information shall be made available''.
    (b) Effective Date.--The amendment made by this section shall take 
effect as if included in the enactment of section 101 of MMA (117 Stat. 
2071).

SEC. 902. PROVIDING MEDICARE BENEFICIARIES WITH BETTER UPFRONT DRUG 
              COVERAGE INFORMATION.

    (a) In General.--Section 1860D-1(c) (42 U.S.C. 1395w-101(c)) is 
amended by adding at the end the following new paragraph:
            ``(5) Disclosure by plan sponsors of drug-specific coverage 
        information prior to enrollment.--
                    ``(A) In general.--Upon the request of any part D 
                eligible individual, a PDP sponsor offering a 
                prescription drug plan or an MA organization offering 
                an MA-PD plan shall disclose to the individual the 
                information described in subparagraph (B) during the 
                period in which the individual is eligible to elect 
                coverage under the plan so that such individual may 
                take such information into account in determining 
                whether to enroll under the plan.
                    ``(B) Information described.--The information 
                described in this subparagraph is as follows:
                            ``(i) Access to specific covered part D 
                        drugs, including access through pharmacy 
                        networks.
                            ``(ii) How any formulary (including any 
                        tiered formulary structure) used by the sponsor 
                        functions, including a description of how a 
                        part D eligible individual may obtain 
                        information on the formulary consistent with 
                        section 1860D-4(a)(3).
                            ``(iii) Beneficiary cost-sharing 
                        requirements and how a part D eligible 
                        individual may obtain information on such 
                        requirements, including tiered or other 
                        copayment level applicable to each drug (or 
                        class of drugs), consistent with section 1860D-
                        4(a)(3).
                            ``(iv) The medication therapy management 
                        program required under section 1860D-4(c). The 
                        provisions of section 1927(b)(3)(D) shall apply 
                        to information disclosed to the Secretary under 
                        this paragraph.''.
    (b) Effective Date.--The amendment made by this section shall take 
effect as if included in the enactment of section 101 of MMA (117 Stat. 
2071).

SEC. 903. ENSURING MEDICARE BENEFICIARIES ARE INFORMED OF FORMULARY 
              CHANGES.

    (a) In General.--Section 1860D-4(a)(3)(B) (42 U.S.C. 1395w-
104(a)(3)(B)) is amended to read as follows:
                    ``(B) Notification of changes in formulary through 
                the internet, mail, and telephone.--A PDP sponsor 
                offering a prescription drug plan shall make available 
                information on specific changes in the formulary under 
                the plan (including changes to tiered or preferred 
                status of covered part D drugs) on a timely basis--
                            ``(i) through an Internet website;
                            ``(ii) by mailing a notice of the specific 
                        changes to each enrollee who may be affected by 
                        such changes; and
                            ``(iii) through the toll-free telephone 
                        number established under subparagraph (A).''.
    (b) Effective Date.--The amendment made by this section shall take 
effect as if included in the enactment of section 101 of MMA (117 Stat. 
2071).

   TITLE X--FULL FUNDING AND EXPANSION FOR DEMONSTRATION PROJECT FOR 
         COVERAGE OF CERTAIN PRESCRIPTION DRUGS AND BIOLOGICALS

SEC. 1001. FULL FUNDING AND EXPANSION FOR DEMONSTRATION PROJECT FOR 
              COVERAGE OF CERTAIN PRESCRIPTION DRUGS AND BIOLOGICALS.

    (a) In General.--Section 641 of MMA (42 U.S.C. 1395l note) is 
amended--
            (1) by striking subsection (b) and inserting the following 
        new subsection:
    ``(b) Nationwide Coverage.--The project established under this 
section shall be conducted throughout the entire United States.''; and
            (2) in subsection (d)--
                    (A) in the matter preceding paragraph (1), by 
                striking ``may not'' and inserting ``shall'';
                    (B) by striking paragraph (1) and inserting the 
                following new paragraph:
            ``(1) coverage for each medicare beneficiary for whom a 
        drug or biological described in subsection (a) is prescribed; 
        and''; and
                    (C) in paragraph (2), by striking ``more than 
                $500,000,000 in funding'' and inserting ``for not more 
                than $2,100,000,000 in funding''.
    (b) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of section 641 of MMA (177 Stat. 
2321).
                                 <all>
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