I 

108TH CONGRESS 

2D SESSION H. R. 4781 

To amend titles XVIII and XIX of the Social Security Act to provide for 

equitable treatment of residents of territories with respect to transitional 

assistance and low-income subsidies under the Medicare prescription drug 

benefit program. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 8, 2004 

Ms. BORDALLO (for herself, Mrs. CHRISTENSEN, Mr. FALEOMAVAEGA, and 

Mr. ACEVEDO-VILA ́) 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 titles XVIII and XIX of the Social Security Act 

to provide for equitable treatment of residents of territories with respect to transitional assistance and lowincome subsidies under the Medicare prescription drug 

benefit 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 ‘‘MMA Territorial Eq5 uity for Low-Income Individuals Act of 2004’’. 
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1 SEC. 2. EQUITABLE TREATMENT OF RESIDENTS OF TERRI2 TORIES UNDER MEDICARE PRESCRIPTION 

3 DRUG TRANSITIONAL ASSISTANCE PROGRAM. 

4 (a) IN GENERAL.—Subsection (b)(2)(A) of section 

5 1860D–31 of the Social Security Act (42 U.S.C. 1395w– 

6 141) is amended by inserting after ‘‘or the District of Co7 lumbia’’ the following: ‘‘or in Puerto Rico, the Virgin Is8 lands, Guam, American Samoa, or the Commonwealth of 

9 the Northern Mariana Islands’’. 

10 (b) CONFORMING CHANGE IN AVAILABILITY OF

11 FUNDS.—Subsection (j)(2) of such section is amended— 

12 (1) by striking ‘‘for the entire period of the op13 eration of this section’’ and inserting ‘‘for 2004’’; 

14 and 

15 (2) by striking subparagraph (D). 

16 (c) ADDITIONAL CONFORMING AMENDMENTS.—(1) 

17 Subsection (b) of such section is amended— 

18 (A) by adding at the end of paragraph (2)(A) 

19 the following: ‘‘The poverty line to be applied under 

20 this subparagraph to an individual residing in a ter21 ritory shall be the same as the poverty line applica22 ble to individuals residing in the continental United 

23 States.’’; and 

24 (B) by adding at the end of paragraph (3) the 

25 following: ‘‘The poverty line to be applied under this 

26 paragraph to an individual residing in a territory 
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1 shall be the same as the poverty line applicable to 

2 individuals residing in the continental United 

3 States.’’. 

4 (2) Subsection (f)(3)(C)(ii) of such section is amend5 ed by striking ‘‘that is one of the 50 States or the District 

6 of Columbia’’. 

7 (d) EFFECTIVE DATE.—The amendments made by 

8 this section shall take effect on January 1, 2005. 

9 SEC. 3. EQUITABLE TREATMENT OF RESIDENTS OF TERRI10 TORIES IN PREMIUM AND COST-SHARING 

11 SUBSIDIES UNDER MEDICARE PRESCRIPTION 

12 DRUG PROGRAM. 

13 (a) IN GENERAL.—Section 1860D–14(a)(3) of the 

14 Social Security Act (42 U.S.C. 1395w–114(a)(3)) is 

15 amended by striking subparagraph (F). 

16 (b) CONFORMING AMENDMENTS.— 

17 (1) Section 1935 of such Act (42 U.S.C. 1396v) 

18 is amended— 

19 (A) in subsections (a) and (c)(1), by strik20 ing ‘‘subject to subsection (e)’’; 

21 (B) in subsection (c)(1)(A), by striking 

22 ‘‘Each of the 50 States and the District of Co23 lumbia’’ and inserting ‘‘Each State’’; 

24 (C) in subsection (c)(2)(A)(i), by striking 

25 ‘‘and’’ at the end of subclause (I), and by add-
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1 ing after subclause (II) the following new sub2 clause: 

3 ‘‘(III) in the case of a territory 

4 subject to a limitation on payments 

5 under this title under subsections (f) 

6 and (g) of section 1108, the ratio of 

7 the total amounts of the payment lim8 itations under such subsections for 

9 such territory for fiscal year 2003, to 

10 the total amounts that would be pay11 able to such territory under this title 

12 for such fiscal year but for such pay13 ment limitations; and’’; and 

14 (D) by striking subsection (e). 

15 (2) Section 1108(f) of such Act (42 U.S.C. 

16 1308(f)) is amended by striking ‘‘and section 

17 1935(e)(1)(B)’’. 

18 (3) Section 1860D–14(a)(3)(C) of such Act (42 

19 U.S.C. 1395w–114(a)(3)(C)) is amended by adding 

20 at the end the following: ‘‘The poverty line to be ap21 plied in the territories shall be the same as the pov22 erty line applied to States in the continental United 

23 States.’’. 

24 (c) EFFECTIVE DATE.—The amendments made by 

25 this section shall be effective as if included in the enact-
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1 ment of the Medicare Prescription Drug, Improvement, 

2 and Modernization Act of 2003 (Public Law 108–173). 

3 SEC. 4. INSTITUTE OF MEDICINE REPORT ON ACCESS OF 

4 MEDICARE BENEFICIARIES IN TERRITORIES 

5 TO PRESCRIPTION DRUGS. 

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

7 Human Services shall request the Institute of Medicine 

8 of the National Academy of Sciences to undertake a study 

9 that examines the access of medicare beneficiaries residing 

10 in the United States territories to prescription drugs dur11 ing each of 3 periods: 

12 (1) BEFORE MMA.—The period before the date 

13 of the enactment of the Medicare Prescription Drug, 

14 Improvement, and Modernization Act of 2003 (Pub15 lic Law 108–173). 

16 (2) DISCOUNT CARD AND TRANSITIONAL AS17 SISTANCE.—The period during the implementation 

18 of the discount card and transitional assistance pro19 gram (under section 1860D–31 of the Social Secu20 rity Act). 

21 (3) IMPLEMENTATION OF PRESCRIPTION DRUG

22 BENEFIT.—The period beginning on January 1, 

23 2006. 

24 (b) REPORT.—The study under subsection (a) shall 

25 include a report to the Secretary, the Committees on Ways 
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1 and Means and Energy and Commerce of the House of 

2 Representatives, and the Committee on Finance of the 

3 Senate, on the results of such study. Such report shall 

4 include information on— 

5 (1) the relative cost of prescription drugs to 

6 medicare beneficiaries residing in the territories, 

7 both retail and as affected through benefit changes 

8 effected under the Medicare Prescription Drug, Im9 provement, and Modernization Act of 2003 (Public 

10 Law 108–173); and 

11 (2) statistical health improvements of such 

12 beneficiaries as a result of the enactment of such 

13 law. 

Æ