219 
(2) PREMIUM RATE FOR CERTAIN TERMINATED 
SINGLE-EMPLOYER PLANS.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), the amendment made by 
subsection (d) shall apply with respect to termi-
nations for which the termination date occurs 
on or after the date of the enactment of this 
Act. 
(B) TREATMENT
OF
CASES
IN
BANK-
RUPTCY.—In any case in which the require-
ments 
of 
subparagraph 
(B) 
of 
section 
4007(a)(7) of the Employee Retirement Income 
Security Act of 1974 (as added by subsection 
(d)) are met in connection with the termination 
of the plan with respect to 1 or more persons 
described in such subparagraph, the amend-
ment made by subsection (d) shall apply with 
respect to any such termination described in 
such subparagraph (B), notwithstanding sub-
paragraph (A) of this paragraph, if the case 
under title 11, United States Code, or under 
any similar law of a State or political subdivi-
sion of a State (referred to in such subpara-
graph (B)) commenced after October 26, 2005.
220 
(3) SPECIAL
RULE
IF
SUBSEQUENT
SAVINGS 
ENACTED.—The amendments made by this section 
shall not take effect if, after the date of enactment 
of this Act and before January 1, 2006, a Federal 
law is enacted which— 
(A) provides for decreases in Federal out-
lays which in the aggregate are less than the 
decreases in Federal outlays by reason of the 
amendments made by this section; and 
(B) specifically provides that such de-
creases are to be in lieu of the decreases in 
Federal outlays by reason of the amendments 
made by this section. 
TITLE III—COMMITTEE ON 
ENERGY AND COMMERCE 
Subtitle A—Medicaid 
Sec. 3100. Short title of subtitle; rule of construction with regard to Katrina 
evacuees. 
CHAPTER 1—PAYMENT FOR PRESCRIPTION DRUGS 
Sec. 3101. Federal upper limit (FUL). 
Sec. 3102. Collection and submission of utilization data for certain physician 
administered drugs. 
Sec. 3103. Improved regulation of drugs sold under a new drug application ap-
proved under section 505(c) of the Federal Food, Drug, and 
Cosmetic Act. 
Sec. 3104. Children’s hospital participation in section 340B drug discount pro-
gram. 
Sec. 3105. Improving patient outcomes through greater reliance on science and 
best practices. 
CHAPTER 2—REFORM OF ASSET TRANSFER RULES 
Sec. 3111. Lengthening look-back period; change in beginning date for period 
of ineligibility. 
Sec. 3112. Disclosure and treatment of annuities and of large transactions.
221 
Sec. 3113. Application of ‘‘income-first’’ rule in applying community spouse’s 
income before assets in providing support of community 
spouse. 
Sec. 3114. Disqualification for long-term care assistance for individuals with 
substantial home equity. 
Sec. 3115. Enforceability of continuing care retirement communities (CCRC) 
and life care community admission contracts. 
CHAPTER 3—FLEXIBILITY IN COST SHARING AND BENEFITS 
Sec. 3121. State option for alternative medicaid premiums and cost sharing. 
Sec. 3122. Special rules for cost sharing for prescription drugs. 
Sec. 3123. Emergency room copayments for non-emergency care. 
Sec. 3124. Use of benchmark benefit packages. 
Sec. 3125. State option to establish non-emergency medical transportation pro-
gram. 
Sec. 3126. Exempting women covered under breast or cervical cancer program. 
CHAPTER 4—EXPANDED ACCESS TO CERTAIN BENEFITS 
Sec. 3131. Expanded access to home and community-based services for the el-
derly and disabled. 
Sec. 3132. Optional choice of self-directed personal assistance services (cash 
and counseling). 
Sec. 3133. Expansion of State long-term care partnership program. 
Sec. 3134. Health opportunity accounts. 
CHAPTER 5—OTHER PROVISIONS 
Sec. 3141. Increase in medicaid payments to insular areas. 
Sec. 3142. Managed care organization provider tax reform. 
Sec. 3143. Medicaid transformation grants. 
Sec. 3144. Enhancing third party identification and payment. 
Sec. 3145. Improved enforcement of documentation requirements. 
Sec. 3146. Reforms of targeted case management. 
Sec. 3147. Emergency services furnished by non-contract providers for med-
icaid managed care enrollees. 
Sec. 3148. Adjustment in computation of medicaid FMAP to disregard an ex-
traordinary employer pension contribution. 
Subtitle B—Katrina Health Care Relief 
Sec. 3201. Targeted medicaid relief for States affected by Hurricane Katrina. 
Sec. 3202. State high risk health insurance pool funding. 
Sec. 3203. Recomputation of HPSA, MUA, and MUP designations within Hur-
ricane Katrina affected areas. 
Sec. 3204. Waiver of certain requirements applicable to the provision of health 
care in areas impacted by Hurricane Katrina. 
Sec. 3205. FMAP hold harmless for Katrina impact. 
Subtitle C—Katrina and Rita Energy Relief 
Sec. 3301. Hurricanes Katrina and Rita energy relief. 
Subtitle D—Digital Television Transition 
Sec. 3401. Short title. 
Sec. 3402. Findings.
222 
Sec. 3403. Analog spectrum recovery: hard deadline. 
Sec. 3404. Auction of recovered spectrum. 
Sec. 3405. Digital Television Conversion Fund. 
Sec. 3406. Public Safety Interoperable Communications Fund. 
Sec. 3407. NYC 9/11 Digital Transition Fund. 
Sec. 3408. Low-power television transition provisions. 
Sec. 3409. Consumer education regarding analog televisions. 
Sec. 3410. Additional provisions. 
Sec. 3411. Deployment of broadband wireless technologies. 
Sec. 3412. Sense of Congress. 
Sec. 3413. Band plan revision required. 
Subtitle A—Medicaid 
SEC. 3100. SHORT TITLE OF SUBTITLE; RULE OF CON-
STRUCTION 
WITH 
REGARD 
TO 
KATRINA 
EVACUEES. 
(a) SHORT TITLE.—This subtitle may be cited as the 
‘‘Medicaid Reconciliation Act of 2005’’. 
(b) RULE
OF CONSTRUCTION WITH REGARD
TO 
KATRINA EVACUEES.—None of the provisions of the fol-
lowing chapters of this subtitle shall apply during the 11- 
month period beginning September 1, 2005, to individuals 
entitled to medical assistance under title XIX of the Social 
Security Act by reason of their residence in a parish in 
the State of Louisiana, or a county in the State of Mis-
sissippi or Alabama, for which a major disaster has been 
declared in accordance with section 401 of the Robert T. 
Stafford Disaster Relief and Emergency Assistance Act 
(42 U.S.C. 5170) as a result of Hurricane Katrina and 
which the President has determined, before September 14, 
2005, warrants individual and public assistance from the 
Federal Government under such Act.
223 
CHAPTER 1—PAYMENT FOR 
PRESCRIPTION DRUGS 
SEC. 3101. FEDERAL UPPER LIMIT (FUL). 
(a) IN GENERAL.—Subsection (e) of section 1927 of 
the Social Security Act (42 U.S.C. 1396r–8) is amended 
to read as follows: 
‘‘(e) PHARMACY REIMBURSEMENT LIMITS.— 
‘‘(1) FEDERAL UPPER LIMIT FOR INGREDIENT 
COST OF COVERED OUTPATIENT DRUGS.— 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), no Federal financial participation 
shall be available for payment for the ingredient 
cost of a covered outpatient drug in excess of 
the Federal upper limit for that drug estab-
lished under paragraph (2). 
‘‘(B) OPTIONAL CARVE OUT.—A State may 
elect not to apply subparagraph (A) to payment 
for either or both of the following: 
‘‘(i) Drugs dispensed by specialty 
pharmacies (such as those dispensing only 
immunosuppressive drugs), as defined by 
the Secretary. 
‘‘(ii) Drugs administered by a physi-
cian in a physician’s office. 
‘‘(2) FEDERAL UPPER LIMIT.—
224 
‘‘(A) IN GENERAL.—Except as provided in 
subparagraph (D) and subject to paragraph 
(5), the Federal upper limit established under 
this paragraph for the ingredient cost of a— 
‘‘(i) single source drug, is 106 percent 
of the RAMP (as defined in subparagraph 
(B)(i)) for that drug; and 
‘‘(ii) multiple source drug, is 120 per-
cent of the volume weighted average 
RAMP (as determined under subparagraph 
(C)) for that drug. 
A drug product that is a single source drug and 
that becomes a multiple source drug shall con-
tinue to be treated under this subsection as a 
single source drug until the Secretary deter-
mines that there are sufficient data to compile 
the volume weighted average RAMP for that 
drug. 
‘‘(B) RAMP AND RELATED PROVISIONS.— 
For purposes of this subsection: 
‘‘(i) RAMP 
DEFINED.—The term 
‘RAMP’ means, with respect to a covered 
outpatient drug by a manufacturer for a 
calendar quarter and subject to clauses (ii) 
and (iii), the average price paid to a manu-
225 
facturer for the drug in the United States 
in the quarter by wholesalers for drugs dis-
tributed to retail pharmacies, excluding 
service fees that are paid by the manufac-
turer to an entity and that represent fair 
market value for a bona-fide service pro-
vided by the entity. 
‘‘(ii) SALES
EXEMPTED
FROM
COM-
PUTATION.—The RAMP under clause (i) 
shall exclude any of the following: 
‘‘(I) Sales exempt from inclusion 
in the determination of best price 
under subsection (c)(1)(C)(i). 
‘‘(II) Such other sales as the Sec-
retary identifies as sales to an entity 
that are merely nominal in amount 
under subsection (c)(1)(C)(ii)(III). 
‘‘(iii) SALE
PRICE
NET
OF
DIS-
COUNTS.—In calculating the RAMP under 
clause (i), such RAMP shall include any of 
the following: 
‘‘(I) Cash discounts and volume 
discounts. 
‘‘(II) Free goods that are contin-
gent upon any purchase requirement.
226 
‘‘(III) Sales at a nominal price 
that are contingent upon any pur-
chase requirement or agreement. 
‘‘(IV) Chargebacks, rebates (not 
including rebates provided under an 
agreement under this section), or any 
other direct or indirect discounts. 
‘‘(V) Any other price concessions, 
which may be based on recommenda-
tions of the Inspector General of the 
Department of Health and Human 
Services, that would result in a reduc-
tion of the cost to the purchaser. 
‘‘(iv) RETAIL
PHARMACY.—For pur-
poses of this subsection, the term ‘retail 
pharmacy’ does not include mail-order only 
pharmacies or any pharmacy at a nursing 
facility or home. 
‘‘(C) VOLUME WEIGHTED AVERAGE RAMP 
DEFINED.—For purposes of this subsection, for 
all drug products included within the same mul-
tiple source drug billing and payment code (or 
such other methodology as may be specified by 
the Secretary), the volume weighted average 
RAMP is the volume weighted average of the
227 
RAMPs reported under subsection (b)(3)(A)(iv) 
determined by— 
‘‘(i) computing the sum of the prod-
ucts (for each National Drug Code as-
signed to such drug products) of— 
‘‘(I) the manufacturer’s RAMP 
(as defined in subparagraph (B)); and 
‘‘(II) the total number of units 
specified under section 1847A(b)(2) 
sold; and 
‘‘(ii) dividing the sum determined 
under clause (i) by the sum of the total 
number of units under clause (i)(II) for all 
National Drug Codes assigned to such 
drug products. 
‘‘(D) EXCEPTION FOR INITIAL SALES PE-
RIODS.— 
‘‘(i) IN GENERAL.—In the case of a 
single source drug during an initial sales 
period (not to exceed 2 calendar quarters) 
in which data on sales for the drug are not 
sufficiently available from the manufac-
turer to compute the RAMP or the volume 
weighted average RAMP under subpara-
graph (C), the Federal upper limit for the
228 
ingredient cost of such drug during such 
period shall be the wholesale acquisition 
cost (as defined in clause (ii)) for the drug. 
‘‘(ii) 
WHOLESALE
ACQUISITION 
COST.—For purposes of clause (i), the 
term ‘wholesale acquisition cost’ means, 
with respect to a single source drug, the 
manufacturer’s list price for the drug to 
wholesalers or direct purchasers in the 
United States, not including prompt pay or 
other discounts, rebates or reductions in 
price, for the most recent month for which 
the information is available, as reported in 
wholesale price guides or other publications 
of drug or biological pricing data. 
‘‘(E) UPDATES; DATA COLLECTION.— 
‘‘(i) FREQUENCY
OF
DETERMINA-
TION.—The Secretary shall update the 
Federal upper limits applicable under this 
paragraph on at least a quarterly basis, 
taking into account the most recent data 
collected for purposes of determining such 
limits and the Food and Drug Administra-
tion’s most recent publication of ‘Approved
229 
Drug Products with Therapeutic Equiva-
lence Evaluations’. 
‘‘(ii) COLLECTION OF DATA.—Data on 
RAMP 
is 
collected 
under 
subsection 
(b)(3)(A)(iv). 
‘‘(F) 
AUTHORITY
TO
ENTER
CON-
TRACTS.—The Secretary may enter into con-
tracts with appropriate entities to determine 
RAMPs and other data necessary to calculate 
the Federal upper limit for a covered outpatient 
drug established under this subsection and to 
calculate that payment limit. 
‘‘(3) DISPENSING FEES.— 
‘‘(A) IN
GENERAL.—A State which pro-
vides medical assistance for covered outpatient 
drugs shall pay a dispensing fee for each cov-
ered outpatient drug in accordance with this 
paragraph. A State may vary the amount of 
such dispensing fees, including taking into ac-
count the special circumstances of pharmacies 
that are serving rural or underserved areas or 
that are sole community pharmacies, so long as 
such variation is consistent with subparagraph 
(B).
230 
‘‘(B) DISPENSING
FEE
PAYMENT
FOR 
MULTIPLE SOURCE DRUGS.—A State shall es-
tablish a dispensing fee under this title for a 
covered outpatient drug that is treated as a 
multiple source drug under paragraph (2)(A) 
(whether or not it may be an innovator multiple 
source drug) in an amount that is not less than 
$8 per prescription unit. The Secretary shall 
define what constitutes a prescription unit for 
purposes of the previous sentence. 
‘‘(4) EFFECT ON STATE MAXIMUM ALLOWABLE 
COST LIMITATIONS.—This section shall not super-
sede or affect provisions in effect prior to January 
1, 1991, or after December 31, 1994, relating to 
any maximum allowable cost limitation established 
by a State for payment by the State for covered out-
patient drugs, and rebates shall be made under this 
section without regard to whether or not payment by 
the State for such drugs is subject to such a limita-
tion or the amount of such a limitation. 
‘‘(5) EVALUATION OF USE OF RETAIL SURVEY 
PRICE METHODOLOGY.— 
‘‘(A) IN
GENERAL.—The Secretary may 
develop a methodology to set the Federal upper 
limit based on the reported retail survey price,