Medication Therapy Management Empowerment Act of 2013

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medication Therapy Management 
Empowerment Act of 2013''.

SEC. 2. IMPROVED ACCESS TO MEDICATION THERAPY MANAGEMENT UNDER PART D 
              OF THE MEDICARE PROGRAM.

    Section 1860D-4(c)(2) of the Social Security Act (42 U.S.C. 1395w-
104(c)(2)) is amended--
            (1) in subparagraph (A)(ii)(I), by striking ``have'' and 
        inserting ``subject to subparagraph (H), have''; and
            (2) by adding at the end the following new subparagraph:
                    ``(H) Expansion of definition of targeted 
                beneficiary the expansion reduces spending.--
                            ``(i) CMS actuary report.--Not later than 
                        January 1, 2014, the Chief Actuary of the 
                        Centers for Medicare & Medicaid Services (in 
                        this subparagraph referred to as the `Chief 
                        Actuary') shall submit to the Secretary and to 
                        Congress a report on whether or not the 
                        expansion described in clause (ii) would, if 
                        implemented, reduce expenditures under this 
                        title. If the Chief Actuary determines that 
                        such expansion would reduce spending under this 
                        title, such report shall include a 
                        certification of such determination.
                            ``(ii) Expansion described.--The expansion 
                        described in this clause is an expansion of the 
                        definition of targeted beneficiary under 
                        subparagraph (A)(ii) by applying subclause (I) 
                        of such subparagraph as if the following were 
                        inserted before the semicolon at the end: `or a 
                        single chronic disease that accounts for high 
                        spending under this title, including diabetes, 
                        hypertension, heart failure, dyslipidemia, 
                        respiratory disease (such as asthma, chronic 
                        obstructive pulmonary disease, or chronic lung 
                        disorders), bone disease-arthritis (such as 
                        osteoporosis or osteoarthritis), rheumatoid 
                        arthritis, and mental health (such as 
                        depression, schizophrenia, or bipolar 
                        disorder)'.
                            ``(iii) Application if the chief actuary 
                        determines that the expansion reduces 
                        spending.--If the report under clause (i) 
                        contains the certification described in such 
                        clause, the following rules shall apply:
                                    ``(I) Implementation of 
                                expansion.--Subject to subclause (III), 
                                effective with respect to plan years 
                                beginning on or after January 1, 2015, 
                                subparagraph (A)(ii)(I) shall be 
                                applied to include the expansion 
                                described in clause (ii).
                                    ``(II) Updated cms actuary report 
                                based on implementation.--Not later 
                                than March 1, 2020, the Chief Actuary 
                                shall submit to the Secretary and to 
                                Congress a report on the implementation 
                                of the expansion under subclause (I). 
                                Such report shall include an analysis 
                                of whether or not such expansion 
                                reduces spending under this title.
                                    ``(III) Authority to terminate 
                                expansion if the expansion does not 
                                reduce spending.--If the Chief Actuary 
                                determines in the report under 
                                subclause (II) that the expansion does 
                                not reduce spending under this title, 
                                the Secretary may, effective with 
                                respect to plan years beginning on or 
                                after January 1, 2021, apply 
                                subparagraph (A)(ii)(I) as if this 
                                subparagraph had never been enacted. In 
                                making the determination under the 
                                preceding sentence, the Secretary shall 
                                take into account whether such 
                                expansion improves the quality of care 
                                furnished to, and the health outcomes 
                                of, individuals eligible for services 
                                under a medication therapy management 
                                program by reason of such expansion.''.

Summary: Medication Therapy Management Empowerment Act of 2013 - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to direct the Chief Actuary of the Centers for Medicare and Medicaid Services to report to the Secretary of Health and Human Services (HHS) and to Congress on whether or not the expansion of the definition of targeted beneficiary, with respect to medication therapy management, would, if implemented, reduce spending under Medicare. Requires the report to include a certification of any determination by the Chief Actuary that such expansion would reduce such spending. Specifies such an expansion as targeted beneficiaries with a single chronic disease that accounts for high Medicare spending, including diabetes, hypertension, heart failure, dyslipidemia, respiratory disease (such as asthma, chronic obstructive pulmonary disease, or chronic lung disorders), bone disease-arthritis (such as osteoporosis or osteoarthritis), rheumatoid arthritis, and mental health (such as depression, schizophrenia, or bipolar disorder). (Currently a targeted beneficiary must have multiple chronic diseases.) Requires such an expansion to take place if the report contains the certification indicated.