S. 557: Medication Therapy Management Empowerment Act of 2013

113th Congress, 2013–2015. Text as of Mar 13, 2013 (Introduced).

Status & Summary | PDF | Source: GPO and Cato Institute Deepbills

II

113th CONGRESS

1st Session

S. 557

IN THE SENATE OF THE UNITED STATES

March 13, 2013

(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

A BILL

To amend title XVIII of the Social Security Act to improve access to medication therapy management under part D of the Medicare program.

1.

Short title

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

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)

insubparagraph (A)(ii)(I), by strikinghaveand insertingsubject tosubparagraph (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, theChief Actuary of the Centers for Medicare Medicaid Services(in this subparagraph referred to as theChief 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.

(ii)

Expansion described

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 disorder).

(iii)

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:

(I)

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).

(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.

(III)

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.

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