H. R. 1024
IN THE HOUSE OF REPRESENTATIVES
March 7, 2013
Mrs. McMorris Rodgers introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee 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
To amend title XVIII of the Social Security Act to provide part D eligible individuals with single chronic diseases access to services under medication therapy management programs under the Medicare part D prescription drug program.
This Act may be cited as the
Medication Therapy Management
Empowerment Act of 2013
Access to services under medication therapy management programs for Medicare part D eligible individuals with single chronic diseases
Section 1860D–4(c)(2)(A) of the Social Security Act (42 U.S.C. 1395w–104(c)(2)(A)) is amended—
in clause (ii), by striking subclause (I) and inserting the following:
multiple chronic diseases (such as diabetes, asthma, hypertension, hyperlipidemia, and congestive heart failure); or
subject to clause (iii), any single chronic disease, including diabetes, hypertension, heart failure, dyslipidemia, respiratory disease (such as asthma, chronic obstructive pulmonary disease or chronic lung disorder), bone disease-arthritis (such as osteoporosis or osteoarthritis), rheumatoid arthritis, or mental health disorder (such as depression, schizophrenia, or bipolar disorder).
by adding at the end the following:
Determinations relating to program costs for including individuals with single chronic diseases
With regard to any single chronic disease, clause (ii)(I)(bb) shall only be applied if the Chief Actuary for the Centers for Medicare Medicaid Services determines that the application of such clause with regard to such disease is not projected to increase overall costs to the Medicare program under this title over the five year period beginning on the date of determination.
Review of determinations
In the case that clause (ii)(I)(bb) is applied with respect to a single chronic disease pursuant to a determination under subclause (I), not later than five years after such date of determination, the Chief Actuary for the Centers for Medicare Medicaid Services shall review the effect of the application of such clause with respect to such disease on the actual cost of the Medicare program under this title during such five years. Based on such review, if the Chief Actuary is unable to determine that, with regard to such single chronic disease, the application of such clause did not increase costs to the Federal government under the Medicare program under this title over such period, then the Secretary shall review the findings of the Chief Actuary and determine whether such clause shall continue to be applied with regard to such single chronic disease. In conducting such review and making such determination, the Secretary shall consider the extent to which the application of such clause with regard to such single chronic disease effects the health outcomes of part D eligible individuals and any savings and costs to the Federal government under the Medicare program under this title.