I
106TH CONGRESS
2D SESSION
H. R. 4235
To establish a voluntary program for low-income Medicare beneficiaries to
obtain assistance in paying for outpatient prescription drugs.
IN THE HOUSE OF REPRESENTATIVES
APRIL 11, 2000
Mr. FOLEY introduced the following bill; which was referred to the Committee
on 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 establish a voluntary program for low-income Medicare
beneficiaries to obtain assistance in paying for outpatient
prescription drugs.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Medicare Low-Income
Prescription Drug Assistance Act of 2000’’.
SEC. 2. ESTABLISHMENT OF PROGRAM.
(a) IN GENERAL.—The Secretary of Health and
Human Services shall establish a program under which
low-income medicare beneficiaries may voluntarily enroll
and receive benefits for covered outpatient prescription
drugs in return for payment of monthly premiums.
(b) VOLUNTARY ENROLLMENT.—
(1) The Secretary shall establish one or more
enrollment periods for voluntary enrollment under
this section consistent with the following:
(A) There shall be an initial enrollment pe-
riod for individuals who are low-income medi-
care beneficiaries at the time the program is es-
tablished.
(B) There shall be an initial enrollment pe-
riod for individuals who at the time the indi-
vidual first becomes a low-income medicare ben-
eficiary after the time the program is estab-
lished.
(C) The Secretary may establish special
enrollment periods that take into account the
loss of other prescription drug coverage.
(D) Individuals may disenroll from the
program only on an annual basis (with such ex-
ceptions as the Secretary may provide).
(E) Enrollment and disenrollment periods
shall be designed in a manner to avoid adverse
selection but take into account changes in eligi-
bility status.
(2) INFORMATION
DISSEMINATION.—The Sec-
retary shall provide for such widespread dissemina-
tion of information as may be appropriate to assure
that low-income medicare beneficiaries are able to
enroll in the program on a timely basis.
(c) MONTHLY PREMIUM.—
(1) AMOUNT.—Enrollment under the program
is conditioned upon payment of a monthly premium
of $20.
(2) COLLECTION.—To the extent practicable,
the Secretary shall provide for the collection of such
premiums in the same manner as part B medicare
premiums are collected under section 1839 of the
Social Security Act, except that any amounts so col-
lected shall not be deposited into the Federal Sup-
plementary Medical Insurance Trust Fund but shall
be available to the Secretary to make payments of
benefits under this section.
(d) BENEFITS.—
(1) IN GENERAL.—Subject to paragraph (2),
the benefits under the program shall consist of pay-
ment to the pharmacy providing covered outpatient
prescription drugs furnished to the enrollee and for
which coverage is not provided under the medicare
program. Such payments are subject to a copayment
of $20 per prescription (as determined by the Sec-
retary) or $10 per prescription for a generic drug
(as determined by the Secretary). The Secretary
may adjust the dollar amounts under the previous
sentence to reflect changes in the cost of benefits
under this section over time.
(2) ANNUAL LIMITATION.—The total amount of
benefits that may be paid under this section for
costs incurred by an enrollee in a year shall not ex-
ceed $1,500.
(3) ADMINISTRATION.—The Secretary may
enter into such agreements, under such terms and
conditions, with States, carriers, and other private
and public entities as the Secretary determines to be
appropriate to operate the program under this sec-
tion, including making determinations of eligibility,
enrollment of individuals, and the payment of
claims.
(e) ENTITLEMENT.—This section constitutes budget
authority in advance of appropriations Acts and rep-
resents the obligation of the Federal Government to pro-
vide for the payment of benefits under the program estab-
lished under this section.
(f) DEFINITIONS.—For purposes of this section:
(1) 
COVERED
OUTPATIENT
PRESCRIPTION
DRUGS.—The term ‘‘covered outpatient prescription
drugs’’ has the meaning given such term by the Sec-
retary and shall include drugs, biologicals, and insu-
lin of the type described in section 1927(k)(2) of the
Social Security Act, but does not include any items
for which payment may be made under the medicare
program.
(2) LOW-INCOME
MEDICARE
BENEFICIARY.—
The term ‘‘low-income medicare beneficiary’’ means
a medicare beneficiary whose annual income (as de-
fined by the Secretary) does not exceed $30,000 (in
the case of a single individual) or $60,000 (in the
case of a married individual, including the income of
the individual’s spouse). The Secretary shall provide
for an appropriate annual adjustment in the dollar
amounts under the previous sentence to reflect
changes in average income for medicare bene-
ficiaries.
(3) 
MEDICARE
BENEFICIARY.—The 
term
‘‘medicare beneficiary’’ means an individual enrolled
for benefits under part B of title XVIII of the Social
Security Act.
(4) MEDICARE PROGRAM.—The term ‘‘medicare
program’’ means the health insurance programs
under title XVIII of the Social Security Act.
(5) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services.
(g) EFFECTIVE DATE.—The Secretary shall establish
the program in a manner so that individuals are first en-
rolled (and entitled to benefits) for expenses incurred dur-
ing months beginning with January 2002.
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