IN THE SENATE OF THE UNITED STATES
March 13, 2013
Mrs. Hagan(for herself,Mr. Roberts,Mr. Franken,Ms. Klobuchar,Mr. Johnson of South Dakota, andMr. Brown) introduced the following bill; which was read twice and referred to theCommittee on Finance
To amend title XVIII of the Social Security Act to improve access to medication therapy management under part D of the Medicare program.
This Act may be cited as
Medication Therapy Management
Empowerment Act of 2013
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—
(A)(ii)(I), by striking
subject tosubparagraph (H), have; and
by adding at the end the following new subparagraph:
Expansion of definition of targeted beneficiary the expansion reduces spending
CMS actuary report
Not later than January 1, 2014, theChief Actuary of the
Centers for Medicare Medicaid Services(in this subparagraph referred to
Chief Actuary) shall submit to theSecretaryand toCongressa report on whether or not the expansion described inclause (ii)would, if implemented, reduce expenditures under this title. If theChief
Actuarydetermines that such expansion would reduce spending under this title,
such report shall include a certification of such determination.
The expansion described in this clause is an expansion
of the definition of targeted beneficiary undersubparagraph (A)(ii)by
applyingsubclause (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
Application if the Chief Actuary determines that the expansion reduces spending
If the report underclause (i)contains the certification described in such clause, the following rules shall apply:
Implementation of expansion
Subject tosubclause (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 inclause (ii).
Updated CMS actuary report based on implementation
Not later than March 1, 2020, theChief Actuaryshall submit to theSecretaryand toCongressa report on the implementation of the expansion undersubclause (I). Such report shall include an analysis of whether or not such expansion reduces spending under this title.
Authority to terminate expansion if the expansion does not reduce spending
If theChief Actuarydetermines in the report undersubclause (II)that the expansion does not reduce spending under this title, theSecretarymay, effective with respect to plan years beginning on or after January 1, 2021, applysubparagraph (A)(ii)(I)as if this subparagraph had never been enacted. In making the determination under the preceding sentence, theSecretaryshall 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.