Common use of House Bill Clause in Contracts

House Bill. The provision would require the Secretary to establish a program to: 1) endorse prescription drug discount card programs meeting certain requirements; 2) provide for prescription drug accounts; and 3) make available information on such programs to beneficiaries. The Secretary would begin operation of the endorsement program within 90 days of enactment. The account part of the program would begin no later than September 2004. The Secretary would provide for an appropriate transition and termination of the program on January 1, 2006. The program would be voluntary. Eligible beneficiaries would be defined as persons eligible under Part A or enrolled in Part B, but not enrolled in an MA plan offering qualified prescription drug coverage. The Secretary would establish a process through which an Part D eligible individual could make an election to enroll under the new Section 1807 with an endorsed program. The beneficiary would have to enroll for a year in order to receive the benefits for the year. An individual would, in general have only one opportunity for enrollment. This would occur during an initial, general enrollment period as soon as possible after enactment, and annually thereafter. The annual open enrollment periods would be coordinated with those for MA. An individual who enrolled in the new Section 1807, subsequently enrolled in an MA plan with drug coverage, and then discontinued such MA enrollment would be permitted to reenroll under Section 1807. In general, eligible beneficiaries would not be permitted to enroll after their initial enrollment period (as defined under Part B). The Secretary would establish an open enrollment period for current beneficiaries. The Secretary would establish a process through which an Part D eligible individual, enrolled under the new Section 1807, would select an eligible entity to provide access to negotiated prices. The entity would be one, which had been awarded a contract and served the state in which the beneficiary resided. Eligible entities would be pharmaceutical benefit management companies, wholesale and retail pharmacy delivery systems, insurers, MA organizations, other entities, or any combination of these. The enrollment process, established by the Secretary, would use rules similar to those established for MA. Individuals could not select more than one entity at a time and, except for unusual circumstances (including changing residential setting, such as nursing home placement.) change the selection once a year. The process would provide for selecting eligible entities for individuals who enrolled in the New Section 1807, but failed to select an entity. Entities would compete for beneficiaries on the basis of discounts, formularies, pharmacy networks, and other services. The Secretary would broadly disseminate information to eligible beneficiaries regarding enrollment, selection of eligible entities, and the coverage made available by entities. The enrollment fee would be $30 with the 2004 fee including any portion of 2003 covered by the program. The fee would be collected in the same manner as Part B premiums are collected from social security payments, except the collection would be made only once a year. States could pay the fee for some or all low-income enrollees in the state. No federal matching payments would be available. The Secretary would make 2/3 of the fee collected available to the eligible entity. Each eligible entity would be required to issue a card and an enrollment number to each enrolled beneficiary and to provide for electronic methods to coordinate with prescription drug accounts established under the New Section 1807A. Beneficiary protections would be established including guaranteed issue and nondiscrimination provisions. If an eligible entity served a state, it would be required to serve the entire state. Entities would be required to disseminate, to each beneficiary who selected the entity, summary information on negotiated prices, access to such prices through pharmacy networks, and how the formulary functioned. Upon request, entities would be required to provide general coverage, utilization, and grievance information. In addition, entities would be required to have a mechanism for providing specific information upon request. The new Part D provisions relating to pharmacy access would apply to eligible entities. To the extent the Secretary determined they could be implemented on a timely basis, entities would be required to meet the new Part D provisions with respect to development and application of formularies and the requirements to have in place an effective cost and drug utilization management program, quality assurance measures and systems, and a program to control fraud, abuse and waste. Each entity would be required to have in place meaningful procedures for hearing and resolving grievances and for expedited determinations and reconsiderations of coverage determinations. Entities would be required to provide pharmaceutical support services. They would also be required to provide for confidentiality and accuracy of enrollee records and periodic reports to the Secretary. Entities would be required to provide beneficiaries with access to negotiated prices (including applicable discounts). Such discounts would not be taken into account in establishing “best price” for purposes of Medicaid calculations. If the entity used a formulary, negotiated prices would only be available for formulary drugs. Negotiated prices could not be limited to mail order drugs. Entities and contracting pharmacies could not charge beneficiaries for any required services. Entities would be required to disclose to the Secretary the extent to which discounts, or rebates or other remuneration or price concessions made available by a manufacturer were passed through to enrollees; such information would be confidential. Entities would be required to notify enrollees at the time of purchase of the differential between any prescribed drug and the cost of the lowest cost available generic drug that was therapeutically equivalent and bioequivalent. The Secretary would be required to establish a prescription drug account for each enrolled individual and deposit into the account the federal contribution amount. This amount would be $800 for an accountholder with income under 135% of poverty, $500 for an accountholder with income between 135% and 150% of poverty, and $100 for all other persons. Income would be determined under the state Medicaid program or by the Social Security Administration (SSA). Such sums as may be necessary would be authorized to be appropriated to the SSA. If the program was not in effect for all of 2004, the amounts would be prorated. Persons would not be eligible for a federal contribution if they were eligible for drug coverage under Medicaid, group health plan, Medigap, medical care for members of the uniformed services, Veterans’ medical care, Federal Employees Health Benefits program, or the Indian Health Care Improvement Act. The provision would authorize appropriations to the Part B trust fund of an amount equal to the amount by which benefits and administrative costs exceeded the portion of enrollment fees retained by the Secretary. The provision would establish a new Section 1807A, Prescription Drug Accounts, that would be established for each enrolled beneficiary. Contributions to the account would include federal contributions, any state contributions, private contributions (including employer and individual contributions) and spousal rollover contributions. If the accountholder was married at the time of death, the amount in the account attributable to public contributions would be credited to the account, if any, of the surviving spouse, or if the spouse was not an Part D eligible individual, into a reserve account to be held for when the spouse became an Part D eligible individual. Costs of the voluntary prescription drug discount card program would not be considered in calculating the Part B premium. By March 1, 2005, the Administrator would be required to submit a report to Congress on the progress made in implementing the new prescription drug benefit, including specific steps that had been taken, and need to be taken, to ensure timely start of the program on January 1, 2006. Senate Bill