H. R. 1—248
title XVIII of the Social Security Act for such drugs and
biologicals and the acquisition costs of such facilities for
such drugs and biologicals and which are separately billed
by end stage renal disease facilities, and
(B) estimate the rates of growth of expenditures for
such drugs and biologicals billed by such facilities.
(4) REPORTS.—
(A) EXISTING ESRD DRUGS.—Not later than April 1,
2004, the Inspector General shall report to the Secretary
on the study described in paragraph (2)(A).
(B) NEW ESRD DRUGS.—Not later than April 1, 2006,
the Inspector General shall report to the Secretary on
the study described in paragraph (2)(B).
(d) BASIC CASE-MIX ADJUSTED COMPOSITE RATE FOR RENAL
DIALYSIS
FACILITY
SERVICES.—(1) Section 1881(b) (42 U.S.C.
1395rr(b)) is amended by adding at the end the following new
paragraphs:
‘‘(12)(A) In lieu of payment under paragraph (7) beginning
with services furnished on January 1, 2005, the Secretary shall
establish a basic case-mix adjusted prospective payment system
for dialysis services furnished by providers of services and renal
dialysis facilities in a year to individuals in a facility and to such
individuals at home. The case-mix under such system shall be
for a limited number of patient characteristics.
‘‘(B) The system described in subparagraph (A) shall include—
‘‘(i) the services comprising the composite rate established
under paragraph (7); and
‘‘(ii) the difference between payment amounts under this
title for separately billed drugs and biologicals (including
erythropoietin) and acquisition costs of such drugs and
biologicals, as determined by the Inspector General reports
to the Secretary as required by section 623(c) of the Medicare
Prescription Drug, Improvement, and Modernization Act of
2003—
‘‘(I) beginning with 2005, for such drugs and biologicals
for which a billing code exists prior to January 1, 2004;
and
‘‘(II) beginning with 2007, for such drugs and
biologicals for which a billing code does not exist prior
to January 1, 2004,
adjusted to 2005, or 2007, respectively, as determined to be
appropriate by the Secretary.
‘‘(C)(i) In applying subparagraph (B)(ii) for 2005, such payment
amounts under this title shall be determined using the methodology
specified in paragraph (13)(A)(i).
‘‘(ii) For 2006, the Secretary shall provide for an adjustment
to the payments under clause (i) to reflect the difference between
the payment amounts using the methodology under paragraph
(13)(A)(i) and the payment amount determined using the method-
ology applied by the Secretary under paragraph (13)(A)(iii) of such
paragraph, as estimated by the Secretary.
‘‘(D) The Secretary shall adjust the payment rates under such
system by a geographic index as the Secretary determines to be
appropriate. If the Secretary applies a geographic index under
this paragraph that differs from the index applied under paragraph
(7) the Secretary shall phase-in the application of the index under
this paragraph over a multiyear period.
H. R. 1—249
‘‘(E)(i) Such system shall be designed to result in the same
aggregate amount of expenditures for such services, as estimated
by the Secretary, as would have been made for 2005 if this para-
graph did not apply.
‘‘(ii) The adjustment made under subparagraph (B)(ii)(II) shall
be done in a manner to result in the same aggregate amount
of expenditures after such adjustment as would otherwise have
been made for such services for 2006 or 2007, respectively, as
estimated by the Secretary, if this paragraph did not apply.
‘‘(F) Beginning with 2006, the Secretary shall annually increase
the basic case-mix adjusted payment amounts established under
this paragraph, by an amount determined by—
‘‘(i) applying the estimated growth in expenditures for drugs
and biologicals (including erythropoietin) that are separately
billable to the component of the basic case-mix adjusted system
described in subparagraph (B)(ii); and
‘‘(ii) converting the amount determined in clause (i) to
an increase applicable to the basic case-mix adjusted payment
amounts established under subparagraph (B).
Nothing in this paragraph shall be construed as providing for
an update to the composite rate component of the basic case-
mix adjusted system under subparagraph (B).
‘‘(G) There shall be no administrative or judicial review under
section 1869, section 1878, or otherwise, of the case-mix system,
relative weights, payment amounts, the geographic adjustment
factor, or the update for the system established under this para-
graph, or the determination of the difference between medicare
payment amounts and acquisition costs for separately billed drugs
and biologicals (including erythropoietin) under this paragraph and
paragraph (13).
‘‘(13)(A) The payment amounts under this title for separately
billed drugs and biologicals furnished in a year, beginning with
2004, are as follows:
‘‘(i) For such drugs and biologicals (other than erythro-
poietin) furnished in 2004, the amount determined under sec-
tion 1842(o)(1)(A)(v) for the drug or biological.
‘‘(ii) For such drugs and biologicals (including erythro-
poietin) furnished in 2005, the acquisition cost of the drug
or biological, as determined by the Inspector General reports
to the Secretary as required by section 623(c) of the Medicare
Prescription Drug, Improvement, and Modernization Act of
2003. Insofar as the Inspector General has not determined
the acquisition cost with respect to a drug or biological, the
Secretary shall determine the payment amount for such drug
or biological.
‘‘(iii) For such drugs and biologicals (including erythro-
poietin) furnished in 2006 and subsequent years, such acquisi-
tion cost or the amount determined under section 1847A for
the drug or biological, as the Secretary may specify.
‘‘(B)(i) Drugs and biologicals (including erythropoietin) which
were separately billed under this subsection on the day before
the date of the enactment of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 shall continue to
be separately billed on and after such date.
‘‘(ii) Nothing in this paragraph, section 1842(o), section 1847A,
or section 1847B shall be construed as requiring or authorizing
H. R. 1—250
the bundling of payment for drugs and biologicals into the basic
case-mix adjusted payment system under this paragraph.’’.
(2) Paragraph (7) of such section is amended in the first sen-
tence by striking ‘‘The Secretary’’ and inserting ‘‘Subject to para-
graph (12), the Secretary’’.
(3) Paragraph (11)(B) of such section is amended by inserting
‘‘subject to paragraphs (12) and (13)’’ before ‘‘payment for such
item’’.
(e) DEMONSTRATION OF BUNDLED CASE-MIX ADJUSTED PAYMENT
SYSTEM FOR ESRD SERVICES.—
(1) IN
GENERAL.—The Secretary shall establish a dem-
onstration project of the use of a fully case-mix adjusted pay-
ment system for end stage renal disease services under section
1881 of the Social Security Act (42 U.S.C. 1395rr) for patient
characteristics identified in the report under subsection (f) that
bundles into such payment rates amounts for—
(A) drugs and biologicals (including erythropoietin) fur-
nished to end stage renal disease patients under the medi-
care program which are separately billed by end stage
renal disease facilities (as of the date of the enactment
of this Act); and
(B) clinical laboratory tests related to such drugs and
biologicals.
(2) FACILITIES INCLUDED IN THE DEMONSTRATION.—In con-
ducting the demonstration under this subsection, the Secretary
shall ensure the participation of a sufficient number of pro-
viders of dialysis services and renal dialysis facilities, but in
no case to exceed 500. In selecting such providers and facilities,
the Secretary shall ensure that the following types of providers
are included in the demonstration:
(A) Urban providers and facilities.
(B) Rural providers and facilities.
(C) Not-for-profit providers and facilities.
(D) For-profit providers and facilities.
(E) Independent providers and facilities.
(F) Specialty providers and facilities, including pedi-
atric providers and facilities and small providers and facili-
ties.
(3) TEMPORARY ADD-ON PAYMENT FOR DIALYSIS SERVICES
FURNISHED UNDER THE DEMONSTRATION.—
(A) IN GENERAL.—During the period of the demonstra-
tion project, the Secretary shall increase payment rates
that would otherwise apply under section 1881(b) of such
Act (42 U.S.C. 1395rr(b)) by 1.6 percent for dialysis services
furnished in facilities in the demonstration site.
(B) RULES OF CONSTRUCTION.—Nothing in this sub-
section shall be construed as—
(i) as an annual update under section 1881(b) of
the Social Security Act (42 U.S.C. 1395rr(b));
(ii) as increasing the baseline for payments under
such section; or
(iii) requiring the budget neutral implementation
of the demonstration project under this subsection.
(4) 3-YEAR PERIOD.—The Secretary shall conduct the dem-
onstration under this subsection for the 3-year period beginning
on January 1, 2006.
(5) USE OF ADVISORY BOARD.—
H. R. 1—251
(A) IN GENERAL.—In carrying out the demonstration
under this subsection, the Secretary shall establish an
advisory board comprised of representatives described in
subparagraph (B) to provide advice and recommendations
with respect to the establishment and operation of such
demonstration.
(B) REPRESENTATIVES.—Representatives referred to in
subparagraph (A) include representatives of the following:
(i) Patient organizations.
(ii) Individuals with expertise in end stage renal
dialysis services, such as clinicians, economists, and
researchers.
(iii) The Medicare Payment Advisory Commission,
established under section 1805 of the Social Security
Act (42 U.S.C. 1395b–6).
(iv) The National Institutes of Health.
(v) Network organizations under section 1881(c)
of the Social Security Act (42 U.S.C. 1395rr(c)).
(vi) Medicare contractors to monitor quality of care.
(vii) Providers of services and renal dialysis facili-
ties furnishing end stage renal disease services.
(C) TERMINATION OF ADVISORY PANEL.—The advisory
panel shall terminate on December 31, 2008.
(6) AUTHORIZATION OF APPROPRIATIONS.—There are author-
ized to be appropriated, in appropriate part from the Federal
Hospital Insurance Trust Fund and the Federal Supplementary
Medical Insurance Trust Fund, $5,000,000 in fiscal year 2006
to conduct the demonstration under this subsection.
(f) REPORT ON A BUNDLED PROSPECTIVE PAYMENT SYSTEM FOR
END STAGE RENAL DISEASE SERVICES.—
(1) REPORT.—
(A) IN GENERAL.—Not later than October 1, 2005, the
Secretary shall submit to Congress a report detailing the
elements and features for the design and implementation
of a bundled prospective payment system for services fur-
nished by end stage renal disease facilities including, to
the maximum extent feasible, bundling of drugs, clinical
laboratory tests, and other items that are separately billed
by such facilities. The report shall include a description
of the methodology to be used for the establishment of
payment rates, including components of the new system
described in paragraph (2).
(B) RECOMMENDATIONS.—The Secretary shall include
in such report recommendations on elements, features, and
methodology for a bundled prospective payment system
or other issues related to such system as the Secretary
determines to be appropriate.
(2) ELEMENTS AND FEATURES OF A BUNDLED PROSPECTIVE
PAYMENT SYSTEM.—The report required under paragraph (1)
shall include the following elements and features of a bundled
prospective payment system:
(A) BUNDLE OF ITEMS AND SERVICES.—A description
of the bundle of items and services to be included under
the prospective payment system.
(B) CASE MIX.—A description of the case-mix adjust-
ment to account for the relative resource use of different
types of patients.
H. R. 1—252
(C) WAGE INDEX.—A description of an adjustment to
account for geographic differences in wages.
(D) RURAL AREAS.—The appropriateness of establishing
a specific payment adjustment to account for additional
costs incurred by rural facilities.
(E) OTHER ADJUSTMENTS.—Such other adjustments as
may be necessary to reflect the variation in costs incurred
by facilities in caring for patients with end stage renal
disease.
(F) UPDATE FRAMEWORK.—A methodology for appro-
priate updates under the prospective payment system.
(G) ADDITIONAL RECOMMENDATIONS.—Such other mat-
ters as the Secretary determines to be appropriate.
SEC. 624. TWO-YEAR MORATORIUM ON THERAPY CAPS; PROVISIONS
RELATING TO REPORTS.
(a) ADDITIONAL MORATORIUM ON THERAPY CAPS.—
(1) 2004 AND 2005.—Section 1833(g)(4) (42 U.S.C. 1395l(g)(4))
is amended by striking ‘‘and 2002’’ and inserting ‘‘2002, 2004,
and 2005’’.
(2) REMAINDER OF 2003.—For the period beginning on the
date of the enactment of this Act and ending of December
31, 2003, the Secretary shall not apply the provisions of para-
graphs (1), (2), and (3) of section 1833(g) to expenses incurred
with respect to services described in such paragraphs during
such period. Nothing in the preceding sentence shall be con-
strued as affecting the application of such paragraphs by the
Secretary before the date of the enactment of this Act.
(b) PROMPT SUBMISSION OF OVERDUE REPORTS ON PAYMENT
AND UTILIZATION OF OUTPATIENT THERAPY SERVICES.—Not later
than March 31, 2004, the Secretary shall submit to Congress the
reports required under section 4541(d)(2) of the Balanced Budget
Act of 1997 (Public Law 105–33; 111 Stat. 457) (relating to alter-
natives to a single annual dollar cap on outpatient therapy) and
under section 221(d) of the Medicare, Medicaid, and SCHIP
Balanced Budget Refinement Act of 1999 (Appendix F, 113 Stat.
1501A–352), as enacted into law by section 1000(a)(6) of Public
Law 106–113 (relating to utilization patterns for outpatient
therapy).
(c) GAO REPORT IDENTIFYING CONDITIONS AND DISEASES JUSTI-
FYING WAIVER OF THERAPY CAP.—
(1) STUDY.—The Comptroller General of the United States
shall identify conditions or diseases that may justify waiving
the application of the therapy caps under section 1833(g) of
the Social Security Act (42 U.S.C. 1395l(g)) with respect to
such conditions or diseases.
(2) REPORT TO CONGRESS.—Not later than October 1, 2004,
the Comptroller General shall submit to Congress a report
on the conditions and diseases identified under paragraph (1),
and shall include a recommendation of criteria, with respect
to such conditions and disease, under which a waiver of the
therapy caps would apply.
SEC. 625. WAIVER OF PART B LATE ENROLLMENT PENALTY FOR CER-
TAIN 
MILITARY 
RETIREES; 
SPECIAL 
ENROLLMENT
PERIOD.
(a) WAIVER OF PENALTY.—
H. R. 1—253
(1) IN GENERAL.—Section 1839(b) (42 U.S.C. 1395r(b)) is
amended by adding at the end the following new sentence:
‘‘No increase in the premium shall be effected for a month
in the case of an individual who enrolls under this part during
2001, 2002, 2003, or 2004 and who demonstrates to the Sec-
retary before December 31, 2004, that the individual is a cov-
ered beneficiary (as defined in section 1072(5) of title 10, United
States Code). The Secretary of Health and Human Services
shall consult with the Secretary of Defense in identifying
individuals described in the previous sentence.’’.
(2) EFFECTIVE DATE.—The amendment made by paragraph
(1) shall apply to premiums for months beginning with January
2004. The Secretary shall establish a method for providing
rebates of premium penalties paid for months on or after
January 2004 for which a penalty does not apply under such
amendment but for which a penalty was previously collected.
(b) MEDICARE PART B SPECIAL ENROLLMENT PERIOD.—
(1) IN GENERAL.—In the case of any individual who, as
of the date of the enactment of this Act, is eligible to enroll
but is not enrolled under part B of title XVIII of the Social
Security Act and is a covered beneficiary (as defined in section
1072(5) of title 10, United States Code), the Secretary of Health
and Human Services shall provide for a special enrollment
period during which the individual may enroll under such part.
Such period shall begin as soon as possible after the date
of the enactment of this Act and shall end on December 31,
2004.
(2) COVERAGE PERIOD.—In the case of an individual who
enrolls during the special enrollment period provided under
paragraph (1), the coverage period under part B of title XVIII
of the Social Security Act shall begin on the first day of the
month following the month in which the individual enrolls.
SEC. 626. PAYMENT FOR SERVICES FURNISHED IN AMBULATORY SUR-
GICAL CENTERS.
(a) REDUCTIONS IN PAYMENT UPDATES.—Section 1833(i)(2)(C)
(42 U.S.C. 1395l(i)(2)(C)) is amended to read as follows:
‘‘(C)(i) Notwithstanding the second sentence of each of subpara-
graphs (A) and (B), except as otherwise specified in clauses (ii),
(iii), and (iv), if the Secretary has not updated amounts established
under such subparagraphs or under subparagraph (D), with respect
to facility services furnished during a fiscal year (beginning with
fiscal year 1986 or a calendar year (beginning with 2006)), such
amounts shall be increased by the percentage increase in the Con-
sumer Price Index for all urban consumers (U.S. city average)
as estimated by the Secretary for the 12-month period ending
with the midpoint of the year involved.
‘‘(ii) In each of the fiscal years 1998 through 2002, the increase
under this subparagraph shall be reduced (but not below zero)
by 2.0 percentage points.
‘‘(iii) In fiscal year 2004, beginning with April 1, 2004, the
increase under this subparagraph shall be the Consumer Price
Index for all urban consumers (U.S. city average) as estimated
by the Secretary for the 12-month period ending with March 31,
2003, minus 3.0 percentage points.
H. R. 1—254
‘‘(iv) In fiscal year 2005, the last quarter of calendar year
2005, and each of calendar years 2006 through 2009, the increase
under this subparagraph shall be 0 percent.’’.
(b) REPEAL
OF SURVEY REQUIREMENT
AND IMPLEMENTATION
OF NEW SYSTEM.—Section 1833(i)(2) (42 U.S.C. 1395l(i)(2)) is
amended—
(1) in subparagraph (A)—
(A) in the matter preceding clause (i), by striking ‘‘The’’
and inserting ‘‘For services furnished prior to the
implementation of the system described in subparagraph
(D), the’’; and
(B) in clause (i), by striking ‘‘taken not later than
January 1, 1995, and every 5 years thereafter,’’; and
(2) by adding at the end the following new subparagraph:
‘‘(D)(i) Taking into account the recommendations in the report
under section 626(d) of Medicare Prescription Drug, Improvement,
and Modernization Act of 2003, the Secretary shall implement
a revised payment system for payment of surgical services furnished
in ambulatory surgical centers.
‘‘(ii) In the year the system described in clause (i) is imple-
mented, such system shall be designed to result in the same aggre-
gate amount of expenditures for such services as would be made
if this subparagraph did not apply, as estimated by the Secretary.
‘‘(iii) The Secretary shall implement the system described in
clause (i) for periods in a manner so that it is first effective begin-
ning on or after January 1, 2006, and not later than January
1, 2008.
‘‘(iv) There shall be no administrative or judicial review under
section 1869, 1878, or otherwise, of the classification system, the
relative weights, payment amounts, and the geographic adjustment
factor, if any, under this subparagraph.’’.
(c) CONFORMING AMENDMENT.—Section 1833(a)(1) (42 U.S.C.
1395l(a)(1)) is amended by adding the following new subparagraph:
‘‘(G) with respect to facility services furnished in
connection with a surgical procedure specified pursuant
to subsection (i)(1)(A) and furnished to an individual in
an ambulatory surgical center described in such subsection,
for services furnished beginning with the implementation
date of a revised payment system for such services in
such facilities specified in subsection (i)(2)(D), the amounts
paid shall be 80 percent of the lesser of the actual charge
for the services or the amount determined by the Secretary
under such revised payment system,’’.
(d) GAO STUDY
OF
AMBULATORY
SURGICAL
CENTER
PAY-
MENTS.—
(1) STUDY.—
(A) IN
GENERAL.—The Comptroller General of the
United States shall conduct a study that compares the
relative costs of procedures furnished in ambulatory sur-
gical centers to the relative costs of procedures furnished
in hospital outpatient departments under section 1833(t)
of the Social Security Act (42 U.S.C. 1395l(t)). The study
shall also examine how accurately ambulatory payment
categories reflect procedures furnished in ambulatory sur-
gical centers.
(B) CONSIDERATION OF ASC DATA.—In conducting the
study under paragraph (1), the Comptroller General shall
H. R. 1—255
consider data submitted by ambulatory surgical centers
regarding the matters described in clauses (i) through (iii)
of paragraph (2)(B).
(2) REPORT AND RECOMMENDATIONS.—
(A) REPORT.—Not later than January 1, 2005, the
Comptroller General shall submit to Congress a report
on the study conducted under paragraph (1).
(B) RECOMMENDATIONS.—The report submitted under
subparagraph (A) shall include recommendations on the
following matters:
(i) The appropriateness of using the groups of cov-
ered services and relative weights established under
the outpatient prospective payment system as the basis
of payment for ambulatory surgical centers.
(ii) If the relative weights under such hospital
outpatient prospective payment system are appropriate
for such purpose—
(I) whether the payment rates for ambulatory
surgical centers should be based on a uniform
percentage of the payment rates or weights under
such outpatient system; or
(II) whether the payment rates for ambulatory
surgical centers should vary, or the weights should
be revised, based on specific procedures or types
of services (such as ophthalmology and pain
management services).
(iii) Whether a geographic adjustment should be
used for payment of services furnished in ambulatory
surgical centers, and if so, the labor and nonlabor
shares of such payment.
SEC. 627. PAYMENT FOR CERTAIN SHOES AND INSERTS UNDER THE
FEE SCHEDULE FOR ORTHOTICS AND PROSTHETICS.
(a) IN
GENERAL.—Section 1833(o) (42 U.S.C. 1395l(o)) is
amended—
(1) in paragraph (1)(B), by striking ‘‘no more than the
limits established under paragraph (2)’’ and inserting ‘‘no more
than the amount of payment applicable under paragraph (2)’’;
and
(2) in paragraph (2), to read as follows:
‘‘(2)(A) Except as provided by the Secretary under subpara-
graphs (B) and (C), the amount of payment under this paragraph
for custom molded shoes, extra-depth shoes, and inserts shall be
the amount determined for such items by the Secretary under
section 1834(h).
‘‘(B) The Secretary may establish payment amounts for shoes
and inserts that are lower than the amount established under
section 1834(h) if the Secretary finds that shoes and inserts of
an appropriate quality are readily available at or below the amount
established under such section.
‘‘(C) In accordance with procedures established by the Secretary,
an individual entitled to benefits with respect to shoes described
in section 1861(s)(12) may substitute modification of such shoes
instead of obtaining one (or more, as specified by the Secretary)
pair of inserts (other than the original pair of inserts with respect
to such shoes). In such case, the Secretary shall substitute, for
the payment amount established under section 1834(h), a payment
H. R. 1—256
amount that the Secretary estimates will assure that there is no
net increase in expenditures under this subsection as a result
of this subparagraph.’’.
(b) CONFORMING AMENDMENTS.—(1) Section 1834(h)(4)(C) (42
U.S.C. 1395m(h)(4)(C)) is amended by inserting ‘‘(and includes shoes
described in section 1861(s)(12))’’ after ‘‘in section 1861(s)(9)’’.
(2) Section 1842(s)(2) (42 U.S.C. 1395u(s)(2)) is amended by
striking subparagraph (C).
(c) EFFECTIVE DATE.—The amendments made by this section
shall apply to items furnished on or after January 1, 2005.
SEC. 628. PAYMENT FOR CLINICAL DIAGNOSTIC LABORATORY TESTS.
Section 1833(h)(2)(A)(ii)(IV) (42 U.S.C. 1395l(h)(2)(A)(ii)(IV)) is
amended by striking ‘‘and 1998 through 2002’’ and inserting ‘‘,
1998 through 2002, and 2004 through 2008’’.
SEC. 629. INDEXING PART B DEDUCTIBLE TO INFLATION.
The first sentence of section 1833(b) (42 U.S.C. 1395l(b)) is
amended by striking ‘‘and $100 for 1991 and subsequent years’’
and inserting the following: ‘‘, $100 for 1991 through 2004, $110
for 2005, and for a subsequent year the amount of such deductible
for the previous year increased by the annual percentage increase
in the monthly actuarial rate under section 1839(a)(1) ending with
such subsequent year (rounded to the nearest $1)’’.
SEC. 630. FIVE-YEAR AUTHORIZATION OF REIMBURSEMENT FOR ALL
MEDICARE PART B SERVICES FURNISHED BY CERTAIN
INDIAN HOSPITALS AND CLINICS.
Section 1880(e)(1)(A) (42 U.S.C. 1395qq(e)(1)(A)) is amended
by inserting ‘‘(and for items and services furnished during the
5-year period beginning on January 1, 2005, all items and services
for which payment may be made under part B)’’ after ‘‘for services
described in paragraph (2)’’.
Subtitle D—Additional Demonstrations,
Studies, and Other Provisions
SEC. 641. DEMONSTRATION PROJECT FOR COVERAGE OF CERTAIN
PRESCRIPTION DRUGS AND BIOLOGICALS.
(a) DEMONSTRATION PROJECT.—The Secretary shall conduct a
demonstration project under part B of title XVIII of the Social
Security Act under which payment is made for drugs or biologicals
that are prescribed as replacements for drugs and biologicals
described in section 1861(s)(2)(A) or 1861(s)(2)(Q) of such Act (42
U.S.C. 1395x(s)(2)(A), 1395x(s)(2)(Q)), or both, for which payment
is made under such part. Such project shall provide for cost-sharing
applicable with respect to such drugs or biologicals in the same
manner as cost-sharing applies with respect to part D drugs under
standard prescription drug coverage (as defined in section 1860D–
2(b) of the Social Security Act, as added by section 101(a)).
(b) DEMONSTRATION PROJECT SITES.—The project established
under this section shall be conducted in sites selected by the Sec-
retary.
(c) DURATION.—The Secretary shall conduct the demonstration
project for the 2-year period beginning on the date that is 90