SEC. 2. ENSURING MEDICARE-ONLY PACE PROGRAM EN-
ROLLEES HAVE A CHOICE OF PRESCRIPTION 
DRUG PLANS UNDER MEDICARE PART D. 
Section 1860D–21(f) of the Social Security Act (42 
U.S.C. 1395w–131(f)) is amended— 
(1) in paragraph (1), by striking ‘‘and (3)’’ and 
inserting ‘‘(3), and (4)’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(4) ENSURING
CHOICE
OF
PRESCRIPTION 
DRUG PLANS.— 
‘‘(A) IN GENERAL.—For plan years begin-
ning on or after January 1, 2023, subject to 
the succeeding provisions of this paragraph, an 
applicable PACE program enrollee may elect to 
enroll in a qualified standalone prescription 
drug plan, in accordance with rules established 
by the Secretary pursuant to this paragraph, 
while enrolled under a PACE program. 
‘‘(B) DEFINITION
OF
APPLICABLE
PACE 
PROGRAM ENROLLEE; QUALIFIED STANDALONE 
PRESCRIPTION DRUG PLAN.—In this paragraph: 
‘‘(i) APPLICABLE PACE PROGRAM EN-
ROLLEE.—The term ‘applicable PACE pro-
gram enrollee’ means a part D eligible in-
dividual who— 
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‘‘(I) is not entitled to medical as-
sistance under title XIX; and 
‘‘(II) is enrolled under a PACE 
program offered by a PACE provider. 
‘‘(ii) QUALIFIED
STANDALONE
PRE-
SCRIPTION DRUG PLAN.—The term ‘quali-
fied standalone prescription drug plan’ 
means, with respect to an applicable PACE 
program enrollee, a prescription drug 
plan— 
‘‘(I) that is not an MA–PD plan; 
‘‘(II) that is not operated by the 
PACE program under which the indi-
vidual is enrolled; and 
‘‘(III) for which the Secretary de-
termines, with respect to the applica-
ble PACE program enrollees enrolled 
in a PACE program offered by such 
PACE provider, that— 
‘‘(aa) the estimated bene-
ficiary out-of-pocket costs (as de-
fined in clause (iii)) for the plan 
year for qualified prescription 
drug coverage under the plan is 
equal to or less than the esti-
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mated out-of-pocket costs for 
such coverage under the prescrip-
tion drug plan offered by the 
PACE program in which the ap-
plicable PACE program enrollee 
is enrolled; and 
‘‘(bb) the estimated total 
amount of Federal subsidies for 
the plan year for qualified pre-
scription drug coverage under the 
plan (which may be estimated 
using data from the previous 
plan year) is equal to or less than 
the estimated subsidy amount for 
such coverage under the prescrip-
tion drug plan offered by the 
PACE program in which the ap-
plicable PACE program enrollee 
is enrolled. 
‘‘(iii) 
OUT-OF-POCKET
COSTS
DE-
FINED.—In this paragraph, the term ‘out- 
of-pocket costs’ includes premiums imposed 
under a prescription drug plan and, in the 
case of coverage under a qualified stand-
alone prescription drug plan, deductibles, 
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copayments, coinsurance, and other cost- 
sharing. 
‘‘(C) OUT-OF-POCKET COSTS.—In the case 
where an applicable PACE program enrollee 
elects to enroll in a qualified standalone pre-
scription drug plan pursuant to this paragraph, 
the individual shall be responsible for any out- 
of-pocket costs imposed under the plan (includ-
ing costs for nonformulary drugs) after the ap-
plication of any subsidies under section 1860D– 
14 for an applicable PACE program enrollee 
who is a subsidy eligible individual (as defined 
in section 1860D–14(a)(3)). 
‘‘(D) REQUIREMENTS
FOR
PACE
PRO-
GRAMS.— 
‘‘(i) EDUCATING
AND
HELPING
EN-
ROLL BENEFICIARIES INTO A PART D PLAN 
OPTION.—A PACE program shall be re-
quired to provide— 
‘‘(I) information to all applicable 
PACE program enrollees who are en-
rolled under the PACE program re-
garding the option to enroll in a quali-
fied standalone prescription drug plan 
under this paragraph; and 
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‘‘(II) upon request of an applica-
ble PACE program enrollee, coun-
seling and coordination to assist appli-
cable PACE program enrollees in 
making decisions regarding the selec-
tion of qualified standalone prescrip-
tion drug plans available to them. 
‘‘(ii) MONITORING DRUG UTILIZATION, 
ADHERENCE, AND SPEND.—A PACE pro-
gram shall be required to monitor drug 
utilization, medication adherence, and drug 
spending (through claims data shared pur-
suant to subparagraph (F) and otherwise) 
throughout the year with respect to any 
applicable PACE program enrollee who 
elects to enroll in a qualified standalone 
prescription drug plan under this para-
graph in order to coordinate with the PDP 
sponsor of such plan regarding the drug 
benefits offered by the plan, including 
upon request of an applicable PACE pro-
gram enrollee the filing of any grievances 
or appeals with the plan on behalf of the 
applicable PACE program enrollee. 
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‘‘(E) 
DISENROLLMENT.—An 
applicable 
PACE program enrollee may disenroll from the 
qualified standalone prescription drug plan 
elected by such applicable PACE program en-
rollee under subparagraph (A) if the enrollee 
changes medication during the plan year or can 
demonstrate an unexpected increase in out-of- 
pocket costs post enrollment. 
‘‘(F) CLAIMS SHARING.—In the case where 
an applicable PACE program enrollee enrolls in 
a qualified standalone prescription drug plan, 
the PACE program in which the individual is 
enrolled and the PDP sponsor of the qualified 
standalone prescription drug plan shall share 
claims data with each other with respect to the 
applicable PACE program enrollee as needed to 
support care management for the applicable 
PACE program enrollee (including for purposes 
of monitoring and coordination required under 
subparagraph (D)(ii)) and for purposes of com-
prehensive 
risk 
adjustment 
under 
section 
1894(d). Such data shall be shared without the 
need for any formal or informal request of the 
PACE program in which the individual is en-
rolled or the PDP sponsor of the qualified 
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standalone prescription drug plan in which the 
applicable PACE program enrollee is enrolled. 
‘‘(G) RULE OF CONSTRUCTION.—The au-
thority established under this paragraph for an 
applicable PACE program enrollee to elect to 
enroll in a qualified standalone prescription 
drug plan shall not be construed as permitting 
an applicable PACE program enrollee to enroll 
in a prescription drug plan that is not a quali-
fied standalone prescription drug plan. 
‘‘(H) RELATION TO PACE STATUTES.— 
‘‘(i) IN GENERAL.—The authority pro-
vided under this paragraph for an applica-
ble PACE program enrollee to elect to en-
roll in a qualified standalone prescription 
drug plan shall apply notwithstanding sub-
section (a)(1)(B)(1) of section 1894 and 
such other provisions of sections 1894 and 
1934 as the Secretary determines may con-
flict with the authority provided for under 
this 
paragraph, 
including 
subsections 
(a)(2)(B), 
(b)(1)(A)(i), 
(b)(1)(C), 
(f)(2)(B)(ii), and (f)(2)(B)(v) of such sec-
tions. 
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‘‘(ii) CLARIFICATION
ON
PAYMENT 
FOR PART D DRUG COVERAGE.—Insofar as 
an applicable PACE program enrollee is 
enrolled in a qualified standalone prescrip-
tion drug plan under this paragraph, the 
PACE program shall not be entitled to 
payment under section 1894(d) for the 
provision of qualified prescription drug 
coverage under such standalone prescrip-
tion drug plan with respect to such appli-
cable PACE program enrollee.’’. 
Æ 
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