I 
110TH CONGRESS 
1ST SESSION H. R. 4541 
To amend title XVIII of the Social Security Act to provide for patient 
protections under the Medicare prescription drug program for residents 
of long term care facilities. 
IN THE HOUSE OF REPRESENTATIVES 
DECEMBER 13, 2007 
Mr. DAVIS of Kentucky introduced the following bill; which was referred to 
the Committee on Energy and Commerce, and in addition to the Com-
mittee 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 amend title XVIII of the Social Security Act to provide 
for patient protections under the Medicare prescription 
drug program for residents of long term care facilities. 
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 Part D Long- 
Term Care Patient Protection Act of 2007’’. 
SEC. 2. FINDINGS. 
Congress finds as follows: 
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(1) Medicare beneficiaries who are enrolled in 
the Medicare prescription drug program and who re-
side in long-term care facilities are among the most 
senior and frail of Medicare beneficiaries, and often 
are in need of the specialized pharmacy services such 
as those provided by long-term care pharmacies. 
(2) Since January 1, 2006, many of the ap-
proximately 65 percent of residents of long-term 
care facilities who are dually eligible for Medicaid 
and Medicare have been ‘‘auto-enrolled’’ as ‘‘dual 
eligibles’’ in prescription drug plans under Medicare 
part D. 
(3) For long-term care facility residents in par-
ticular, enrollment in a prescription drug plan under 
Medicare part D can be complex and confusing, and 
ensuring access to medically necessary medication is 
vital to maintaining their health, avoiding hos-
pitalizations, and otherwise containing health care 
costs. 
(4) Part D enrollees residing in long-term care 
facilities may have been auto-enrolled in one of as 
few as 5 and as many as 20 different prescription 
drug plans, which may not be properly tailored to 
meet the specialized prescription drug needs of resi-
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dents of nursing homes and other long-term care fa-
cilities. 
(5) Prescription drug plans under Medicare 
part D vary in terms of their formulary coverage of 
the prescription drugs most frequently prescribed for 
long-term care residents, their prior authorization 
and other drug utilization management controls, and 
their procedures for processing exceptions requests 
and prior authorization requests. 
(6) The Medicare prescription drug program 
should be strengthened to ensure that residents of 
long-term care facilities enjoy access to a prescrip-
tion drug plan that meets their needs and the 
unique nature of the long-term care facility setting 
in which they reside. 
(7) Robust oversight of the Medicare prescrip-
tion drug program is important to prevent fraud, 
protect beneficiaries, and maintain the program’s 
fiscal integrity, and the Federal anti-kickback stat-
ute and False Claims Act provide critical safeguards 
against potential abuse. 
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