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‘‘(VI) Immunosuppresessants. 
‘‘(ii) USE OF UTILIZATION MANAGE-
MENT TOOLS.—A PDP sponsor of a pre-
scription drug plan may use prior author-
ization or step therapy for the initiation of 
medications within one of the classifica-
tions specified in clause (i) but only when 
approved by the Secretary, except that 
such prior authorization or step therapy 
may 
not 
be 
used 
in 
the 
case 
of 
antiretrovirals and in the case of individ-
uals who already are stabilized on a drug 
treatment regimen.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply for plan years beginning on or 
after January 1, 2009. 
SEC. 226. ELIMINATION OF MEDICARE PART D LATE EN-
ROLLMENT PENALTIES PAID BY LOW-INCOME 
SUBSIDY-ELIGIBLE INDIVIDUALS. 
(a) INDIVIDUALS WITH INCOME BELOW 135 PER-
CENT OF POVERTY LINE.—Paragraph (1)(A)(ii) of sec-
tion 1860D–14(a) of the Social Security Act (42 U.S.C. 
1395w–114(a)) is amended to read as follows: 
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‘‘(ii) 100 percent of any late enroll-
ment penalties imposed under section 
1860D–13(b) for such individual.’’. 
(b) INDIVIDUALS WITH INCOME BETWEEN 135 AND 
150 PERCENT OF POVERTY LINE.—Paragraph (2)(A) of 
such section is amended— 
(1) by inserting ‘‘equal to (i) an amount’’ after 
‘‘premium subsidy’’; 
(2) by striking ‘‘paragraph (1)(A)’’ and insert-
ing ‘‘clause (i) of paragraph (1)(A)’’; and 
(3) by adding at the end before the period the 
following: ‘‘, plus (ii) 100 percent of the amount de-
scribed in clause (ii) of such paragraph for such in-
dividual’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to subsidies for months beginning 
with January 2008. 
SEC. 227. SPECIAL ENROLLMENT PERIOD FOR SUBSIDY EL-
IGIBLE INDIVIDUALS. 
(a) IN GENERAL.—Section 1860D–1(b)(3) of the So-
cial Security Act (42 U.S.C. 1395w–101(b)(3)), as amend-
ed by section 222(a), is further amended by adding at the 
end the following new subparagraph: 
‘‘(G) ELIGIBILITY FOR LOW-INCOME SUB-
SIDY.— 
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‘‘(i) IN GENERAL.—In the case of an 
applicable subsidy eligible individual (as 
defined in clause (ii)), the special enroll-
ment period described in clause (iii). 
‘‘(ii) APPLICABLE SUBSIDY ELIGIBLE 
INDIVIDUAL
DEFINED.—For purposes of 
this subparagraph, the term ‘applicable 
subsidy eligible individual’ means a part D 
eligible individual who is determined under 
subparagraph (B) of section 1860D– 
14(a)(3) to be a subsidy eligible individual 
(as defined in subparagraph (A) of such 
section), and includes such an individual 
who was enrolled in a prescription drug 
plan or an MA–PD plan on the date of 
such determination. 
‘‘(iii) SPECIAL ENROLLMENT PERIOD 
DESCRIBED.—The special enrollment pe-
riod described in this clause, with respect 
to an applicable subsidy eligible individual, 
is the 90-day period beginning on the date 
the individual receives notification that 
such individual has been determined under 
section 1860D–14(a)(3)(B) to be a subsidy 
eligible individual (as so defined).’’. 
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(b) AUTOMATIC ENROLLMENT PROCESS FOR CER-
TAIN SUBSIDY ELIGIBLE INDIVIDUALS.—Section 1860D– 
1(b)(1) of the Social Security Act (42 U.S.C. 1395w– 
101(b)(1)), as amended by section 218(a)(2), is further 
amended by adding at the end the following new subpara-
graph: 
‘‘(E) SPECIAL RULE FOR SUBSIDY ELIGI-
BLE
INDIVIDUALS.—The process established 
under subparagraph (A) shall include, in the 
case of an applicable subsidy eligible individual 
(as defined in clause (ii) of paragraph (3)(F)) 
who fails to enroll in a prescription drug plan 
or an MA–PD plan during the special enroll-
ment period described in clause (iii) of such 
paragraph applicable to such individual, a proc-
ess for the facilitated enrollment of the indi-
vidual in the prescription drug plan or MA–PD 
plan that is most appropriate for such indi-
vidual (as determined by the Secretary). Noth-
ing in the previous sentence shall prevent an in-
dividual described in such sentence from declin-
ing enrollment in a plan determined appropriate 
by the Secretary (or in the program under this 
part) or from changing such enrollment.’’. 
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(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to subsidy determinations made 
for months beginning with January 2008. 
Subtitle D—Reducing Health 
Disparities 
SEC. 231. MEDICARE DATA ON RACE, ETHNICITY, AND PRI-
MARY LANGUAGE. 
(a) REQUIREMENTS.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services (in this subtitle referred to as the 
‘‘Secretary’’) shall— 
(A) collect data on the race, ethnicity, and 
primary language of each applicant for and re-
cipient of benefits under title XVIII of the So-
cial Security Act— 
(i) using, at a minimum, the cat-
egories for race and ethnicity described in 
the 1997 Office of Management and Budg-
et Standards for Maintaining, Collecting, 
and Presenting Federal Data on Race and 
Ethnicity; 
(ii) using the standards developed 
under subsection (e) for the collection of 
language data; 
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(iii) where practicable, collecting data 
for additional population groups if such 
groups can be aggregated into the min-
imum race and ethnicity categories; and 
(iv) where practicable, through self-re-
porting; 
(B) with respect to the collection of the 
data described in subparagraph (A) for appli-
cants and recipients who are minors or other-
wise legally incapacitated, require that— 
(i) such data be collected from the 
parent or legal guardian of such an appli-
cant or recipient; and 
(ii) the preferred language of the par-
ent or legal guardian of such an applicant 
or recipient be collected; 
(C) systematically analyze at least annually 
such data using the smallest appropriate units 
of analysis feasible to detect racial and ethnic 
disparities in health and health care and when 
appropriate, for men and women separately; 
(D) report the results of analysis annually 
to the Director of the Office for Civil Rights, 
the Committee on Health, Education, Labor, 
and Pensions and the Committee on Finance of 
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the Senate, and the Committee on Energy and 
Commerce and the Committee on Ways and 
Means of the House of Representatives; and 
(E) ensure that the provision of assistance 
to an applicant or recipient of assistance is not 
denied or otherwise adversely affected because 
of the failure of the applicant or recipient to 
provide race, ethnicity, and primary language 
data. 
(2) RULES
OF
CONSTRUCTION.—Nothing in 
this subsection shall be construed— 
(A) to permit the use of information col-
lected under this subsection in a manner that 
would adversely affect any individual providing 
any such information; and 
(B) to require health care providers to col-
lect data. 
(b) PROTECTION OF DATA.—The Secretary shall en-
sure (through the promulgation of regulations or other-
wise) that all data collected pursuant to subsection (a) is 
protected— 
(1) under the same privacy protections as the 
Secretary applies to other health data under the reg-
ulations promulgated under section 264(c) of the 
Health Insurance Portability and Accountability Act 
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of 1996 (Public Law 104–191; 110 Stat. 2033) re-
lating to the privacy of individually identifiable 
health information and other protections; and 
(2) from all inappropriate internal use by any 
entity that collects, stores, or receives the data, in-
cluding use of such data in determinations of eligi-
bility (or continued eligibility) in health plans, and 
from other inappropriate uses, as defined by the 
Secretary. 
(c) COLLECTION PLAN.—In carrying out the duties 
specified in subsection (a), the Secretary shall develop and 
implement a plan to improve the collection, analysis, and 
reporting of racial, ethnic, and primary language data 
within the programs administered under title XVIII of the 
Social Security Act, and, in consultation with the National 
Committee on Vital Health Statistics, the Office of Minor-
ity Health, and other appropriate public and private enti-
ties, shall make recommendations on how to— 
(1) implement subsection (a) while minimizing 
the cost and administrative burdens of data collec-
tion and reporting; 
(2) expand awareness that data collection, anal-
ysis, and reporting by race, ethnicity, and primary 
language is legal and necessary to assure equity and 
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