II 

109TH CONGRESS 

1ST SESSION S. 566 

To continue State coverage of medicaid prescription drug coverage to medicare 

dual eligible beneficiaries for 6 months while still allowing the medicare 

part D benefit to be implemented as scheduled. 

IN THE SENATE OF THE UNITED STATES 

MARCH 8, 2005 

Mr. ROCKEFELLER (for himself, Mr. KENNEDY, Mr. CORZINE, and Mr. LAUTENBERG) introduced the following bill; which was read twice and referred to the Committee on Finance 

A BILL 

To continue State coverage of medicaid prescription drug 

coverage to medicare dual eligible beneficiaries for 6 

months while still allowing the medicare part D benefit 

to be implemented as scheduled. 

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 ‘‘Medicare Dual Eligible 

5 Prescription Drug Coverage Act of 2005’’. 

6 SEC. 2. FINDINGS. 

7 The Senate finds the following: 
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1 (1) Individuals who are dually eligible for bene2 fits under the medicare program and full benefits 

3 under the medicaid program— 

4 (A) are among the most vulnerable popu5 lations in our society; and 

6 (B) require adequate outreach, education, 

7 and timing in order to adjust to changes in our 

8 health care delivery system. 

9 (2) The transition of 6,400,000 dual eligibles 

10 from prescription drug coverage under the medicaid 

11 program to prescription drug coverage under part D 

12 of the medicare program is the largest transition 

13 ever of individuals from one insurance program to 

14 another. 

15 (3) In its June 2004 report to Congress, the 

16 Medicare Payment Advisory Commission (MedPAC) 

17 suggested that large, private employers with 75,000 

18 employees or less need at least 6 months to transi19 tion their employees’ drug coverage from one phar20 macy benefit management company to another such 

21 company. The States and the Federal Government 

22 are taking on a far more complex task with 

23 6,400,000 dual eligibles having to make the transi24 tion described in paragraph (2). 
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1 (4) Timely access to prescription drugs leads to 

2 higher quality of life and prevents avoidable emer3 gency room visits, hospitalizations, and premature 

4 nursing home placements. 

5 (5) Since even a short-term gap in prescription 

6 drug coverage could have serious health con7 sequences for dual eligibles, Congress must work to 

8 guarantee as smooth a transition as possible for dual 

9 eligibles so that no dual eligible is without prescrip10 tion drug coverage even for one day. 

11 SEC. 3. CONTINUING STATE COVERAGE OF MEDICAID PRE12 SCRIPTION DRUG COVERAGE TO MEDICARE 

13 DUAL ELIGIBLE BENEFICIARIES FOR 6 

14 MONTHS. 

15 (a) SIX-MONTH TRANSITION.—For prescriptions 

16 filled during the period beginning on January 1, 2006, 

17 and ending on June 30, 2006, section 1935(d) of the So18 cial Security Act (42 U.S.C. 1396u–5(d)) shall not apply 

19 and, notwithstanding any other provision of law, a State 

20 (as defined for purposes of title XIX of such Act) shall 

21 continue to provide (and receive Federal financial partici22 pation for) medical assistance under such title with re23 spect to prescription drugs as if such section 1935(d) had 

24 not been enacted. 

25 (b) APPLICATION.— 
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1 (1) MEDICARE AS PRIMARY PAYER.—Nothing in 

2 subsection (a) shall be construed as changing or af3 fecting the primary payer status of a prescription 

4 drug plan or an MA–PD plan under part D of title 

5 XVIII of the Social Security Act with respect to pre6 scription drugs furnished to any full-benefit dual eli7 gible individual (as defined in section 1935(c)(6) of 

8 such Act (42 U.S.C. 1396u–5(c)(6)) during the 6- 

9 month period described in such subsection. 

10 (2) THIRD PARTY LIABILITY.—Nothing in sub11 section (a) shall be construed as limiting the author12 ity or responsibility of a State under section 

13 1902(a)(25) of the Social Security Act (42 U.S.C. 

14 1396a(a)(25)) to seek reimbursement from a pre15 scription drug plan, an MA–PD plan, or any other 

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

17 providing prescription drug coverage described in 

18 such subsection. 

19 SEC. 4. DELAY IN IMPLEMENTATION OF MEDICAID 

20 CLAWBACK PAYMENTS. 

21 Notwithstanding section 1935(c) of the Social Secu22 rity Act (42 U.S.C. 1396u–5(c)), a State or the District 

23 of Columbia shall not be required to provide for a payment 

24 under such section to the Secretary of Health and human 

25 Services for any month prior to July 1, 2006. 
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1 SEC. 5. EDUCATION AND OUTREACH TO DUAL ELIGIBLES 

2 REGARDING PRESCRIPTION DRUG COV3 ERAGE AND MONITORING OF THE TRANSI4 TION OF DUAL ELIGIBLES TO PRESCRIPTION 

5 DRUG COVERAGE UNDER MEDICARE. 

6 (a) MMA AMOUNTS.—Notwithstanding any other 

7 provision of law, of the amounts appropriated for the Cen8 ters for Medicare & Medicaid Services under section 

9 1015(a)(1) of the Medicare Prescription Drug, Improve10 ment, and Modernization Act of 2003 (Public Law 108–

11 173; 117 Stat. 2446), the following rules shall apply: 

12 (1) EDUCATION AND OUTREACH TO DUALS.—

13 $100,000,000 shall be used to provide education and 

14 outreach, including through one-on-one counseling 

15 and application assistance, to full-benefit dual eligi16 ble individuals (as defined in section 1935(c)(6) of 

17 the Social Security Act (42 U.S.C. 1396u–5(c)(6))) 

18 regarding prescription drug coverage under part D 

19 of title XVIII of such Act. Of such amount— 

20 (A) at least $20,000,000 (but in no case 

21 more than $50,000,000) shall be used to award 

22 grants to States under section 4360 of the Om23 nibus Budget Reconciliation Act of 1990 (42 

24 U.S.C. 1395b–4) to provide such education and 

25 outreach; and 
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1 (B) the remaining amount shall be used to 

2 provide funding to community-based organiza3 tions that work with full-benefit dual eligible in4 dividuals (as so defined) in order to provide 

5 such education and outreach. 

6 (2) MONITORING IMPACT ON DUALS.— 

7 (A) IN GENERAL.—$50,000,000 shall be 

8 used by the Centers for Medicare & Medicaid 

9 Services, in consultation with the Centers for 

10 Disease Control and Prevention, the Adminis11 tration on Aging, and the Social Security Ad12 ministration, to develop and implement a stand13 ardized protocol to collect data from health de14 partments and other sources in 10 representa15 tive urban and rural communities on the impact 

16 of the transition of full benefit dual eligible in17 dividuals (as so defined) from prescription drug 

18 coverage under the medicaid program to pre19 scription drug coverage under part D of the 

20 medicare program. Such protocol shall be im21 plemented by not later than July 1, 2005. 

22 (B) MONITORING.—The protocol developed 

23 under subparagraph (A) shall include for the 

24 monitoring of the following information with re-
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1 spect to such full benefit dual eligible individ2 uals: 

3 (i) Emergency room visit rates. 

4 (ii) Hospitalization rates. 

5 (iii) Nursing home placement rates. 

6 (iv) Deaths. 

7 (C) COLLECTION BY PDPS AND MA–PDS.— 

8 The protocol developed under subparagraph (A) 

9 shall require that such data be collected by the 

10 prescription drug plans and the MA–PDs in 

11 which the individuals are enrolled and include 

12 information on race and ethnicity. 

13 (D) REPORTS.—Not later than January 1, 

14 2006, and July 1, 2006, the Administrator of 

15 the Centers for Medicare & Medicaid Services, 

16 in consultation with the Centers for Disease 

17 Control and Prevention, the Administration on 

18 Aging, and the Social Security Administration, 

19 shall submit a report to Congress on the imple20 mentation of the protocol under subparagraph 

21 (A). 

22 (b) NEW AMOUNTS.—There are appropriated to the 

23 Secretary of Health and Human Services, to be trans24 ferred from the Federal Hospital Insurance Trust Fund 

25 and the Federal Supplementary Medical Insurance Trust 
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1 Fund, for fiscal year 2005 and each subsequent fiscal 

2 year, an amount not to exceed $50,000,000 (or if greater, 

3 an amount equal to $1 multiplied by the number of indi4 viduals entitled to benefits under part A of title XVIII 

5 of the Social Security Act or enrolled under part B of such 

6 title for the year) in order award grants to States under 

7 section 4360 of the Omnibus Budget Reconciliation Act 

8 of 1990 (42 U.S.C. 1395b–4). 

9 (c) EXTENSION OF AVAILABILITY OF AMOUNTS AP10 PROPRIATED UNDER MMA.—Section 1015(b) of the 

11 Medicare Prescription Drug, Improvement, and Mod12 ernization Act of 2003 (Public Law 108–173; 117 Stat. 

13 2446) is amended by striking ‘‘September 30, 2005’’ and 

14 inserting ‘‘September 30, 2006’’. 

15 SEC. 6. COLLECTION AND SHARING OF DUAL ELIGIBLE 

16 DRUG UTILIZATION DATA. 

17 (a) IN GENERAL.—Section 1860D–42 of the Social 

18 Security Act (42 U.S.C. 1395w–152) is amended by add19 ing at the end the following new subsection: 

20 ‘‘(c) COLLECTION AND SHARING OF DUAL ELIGIBLE

21 DRUG UTILIZATION DATA.— 

22 ‘‘(1) PLAN REQUIREMENT.—A PDP sponsor of 

23 a prescription drug plan and an MA organization of24 fering an MA–PD plan shall submit to the Secretary 

25 such information regarding the drug utilization of 
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1 enrollees in such plans who are full-benefit dual eli2 gible individuals (as defined in section 1935(c)(6)) 

3 as the Secretary determines appropriate to carry out 

4 paragraph (2). 

5 ‘‘(2) COLLECTION AND SHARING OF DATA.— 

6 The Secretary shall collect data on the drug utiliza7 tion of full-benefit dual eligible individuals (as so de8 fined). The Secretary shall share such data with the 

9 States and the District of Columbia in as close to 

10 a real-time basis as possible.’’. 

11 (b) EFFECTIVE DATE.—The amendment made by 

12 subsection (a) shall take effect as if included in the enact13 ment of section 101(a) of the Medicare Prescription Drug, 

14 Improvement, and Modernization Act of 2003 (Public Law 

15 108–173; 117 Stat. 2071). 

16 SEC. 7. GAO STUDY ON THE CLAWBACK FORMULA. 

17 (a) STUDY.— 

18 (1) IN GENERAL.—The Comptroller General of 

19 the United States shall conduct a study on the 

20 clawback formula contained in section 1935(c) of the 

21 Social Security Act (42 U.S.C. 1396u–5(c)), as 

22 added by section 103(b) of the Medicare Prescrip23 tion Drug, Improvement, and Modernization Act of 

24 2003 (Public Law 108–173; 117 Stat. 2155). 
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1 (2) REQUIREMENTS.—The study conducted 

2 under paragraph (1) shall include a full examination 

3 of— 

4 (A) disincentives for States to enroll full5 benefit dual eligible individuals (as defined in 

6 section 1935(c)(6) of the Social Security Act 

7 (42 U.S.C. 1396u–5(c)(6))) in the medicaid 

8 program or part D of title XVIII of the Social 

9 Security Act; 

10 (B) the 6-month delay in States receiving 

11 rebate data; 

12 (C) the prescription drug cost containment 

13 measures implemented by States after 2003; 

14 and 

15 (D) issues relating to States having to pay 

16 more for prescription drug coverage for full 

17 benefit dual eligible individuals (as so defined) 

18 than they otherwise would have if the Medicare 

19 Prescription Drug, Improvement, and Mod20 ernization Act of 2003 (Public Law 108–173; 

21 117 Stat. 2066 et seq.) had not been enacted. 

22 (b) REPORT.—Not later than April 1, 2006, the 

23 Comptroller General of the United States shall submit to 

24 Congress a report on the study conducted under sub-
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1 section (a) together with such recommendations as the 

2 Comptroller General determines appropriate. 

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