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US Laws | Affordable Health Care Act (HR3950F)
TITLE III--IMPROVING THE QUALITY AND EFFICIENCY OF HEALTH CARE
Subtitle D--Medicare Part D Improvements for Prescription Drug Plans and MA-PD Plans

(2) REPORT- (5478)

(A) IN GENERAL- Not later than October 1, 2011, subject to subparagraph (B), the Inspector General shall submit to Congress a report containing the results of the study conducted under paragraph (1), together with recommendations for such legislation and administrative action as the Inspector General determines appropriate. (5479)

(B) LIMITATION ON INFORMATION CONTAINED IN REPORT- The report submitted under subparagraph (A) shall not include any information that the Inspector General determines is proprietary or is likely to negatively impact the ability of a PDP sponsor or a State plan under title XIX to negotiate prices for covered part D drugs or covered outpatient drugs, respectively. (5480)

(3) DEFINITIONS- In this section: (5481)

(A) COVERED PART D DRUG- The term "covered part D drug" has the meaning given such term in section 1860D-2(e) of the Social Security Act (42 U.S.C. 1395w-102(e)). (5482)

(B) COVERED OUTPATIENT DRUG- The term "covered outpatient drug" has the meaning given such term in section 1927(k) of such Act (42 U.S.C. 1396r(k)). (5483)

(C) MA-PD PLAN- The term "MA-PD plan" has the meaning given such term in section 1860D-41(a)(9) of such Act (42 U.S.C. 1395w-151(a)(9)). (5484)

(D) MEDICARE ADVANTAGE ORGANIZATION- The term "Medicare Advantage organization" has the meaning given such term in section 1859(a)(1) of such Act (42 U.S.C. 1395w-28)(a)(1)). (5485)

(E) PDP SPONSOR- The term "PDP sponsor" has the meaning given such term in section 1860D-41(a)(13) of such Act (42 U.S.C. 1395w-151(a)(13)). (5486)

(F) PRESCRIPTION DRUG PLAN- The term "prescription drug plan" has the meaning given such term in section 1860D-41(a)(14) of such Act (42 U.S.C. 1395w-151(a)(14)). (5487)

SEC. 3314. INCLUDING COSTS INCURRED BY AIDS DRUG ASSISTANCE PROGRAMS AND INDIAN HEALTH SERVICE IN PROVIDING PRESCRIPTION DRUGS TOWARD THE ANNUAL OUT-OF-POCKET THRESHOLD UNDER PART D. (5488)(Text)

(a) In General- Section 1860D-2(b)(4)(C) of the Social Security Act (42 U.S.C. 1395w-102(b)(4)(C)) is amended-- (5489)

(1) in clause (i), by striking "and" at the end; (5490)

(2) in clause (ii)-- (5491)

(A) by striking "such costs shall be treated as incurred only if" and inserting "subject to clause (iii), such costs shall be treated as incurred only if"; (5492)

(B) by striking ", under section 1860D-14, or under a State Pharmaceutical Assistance Program"; and (5493)

(C) by striking the period at the end and inserting "; and"; and (5494)

(3) by inserting after clause (ii) the following new clause: (5495)

"(iii) such costs shall be treated as incurred and shall not be considered to be reimbursed under clause (ii) if such costs are borne or paid-- (5496)

"(I) under section 1860D-14; (5497)

"(II) under a State Pharmaceutical Assistance Program; (5498)

"(III) by the Indian Health Service, an Indian tribe or tribal organization, or an urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act); or (5499)

"(IV) under an AIDS Drug Assistance Program under part B of title XXVI of the Public Health Service Act.". (5500)

(b) Effective Date- The amendments made by subsection (a) shall apply to costs incurred on or after January 1, 2011. (5501)

SEC. 3315. IMMEDIATE REDUCTION IN COVERAGE GAP IN 2010. (5502)(Text)

Section 1860D-2(b) of the Social Security Act (42 U.S.C. 1395w-102(b)) is amended-- (5503)

(1) in paragraph (3)(A), by striking "paragraph (4)" and inserting "paragraphs (4) and (7)"; and (5504)

(2) by adding at the end the following new paragraph: (5505)

"(7) INCREASE IN INITIAL COVERAGE LIMIT IN 2010- (5506)

"(A) IN GENERAL- For the plan year beginning on January 1, 2010, the initial coverage limit described in paragraph (3)(B) otherwise applicable shall be increased by $500. (5507)

"(B) APPLICATION- In applying subparagraph (A)-- (5508)

"(i) except as otherwise provided in this subparagraph, there shall be no change in the premiums, bids, or any other parameters under this part or part C; (5509)

"(ii) costs that would be treated as incurred costs for purposes of applying paragraph (4) but for the application of subparagraph (A) shall continue to be treated as incurred costs; (5510)

"(iii) the Secretary shall establish procedures, which may include a reconciliation process, to fully reimburse PDP sponsors with respect to prescription drug plans and MA organizations with respect to MA-PD plans for the reduction in beneficiary cost sharing associated with the application of subparagraph (A); (5511)

"(iv) the Secretary shall develop an estimate of the additional increased costs attributable to the application of this paragraph for increased drug utilization and financing and administrative costs and shall use such estimate to adjust payments to PDP sponsors with respect to prescription drug plans under this part and MA organizations with respect to MA-PD plans under part C; and (5512)

"(v) the Secretary shall establish procedures for retroactive reimbursement of part D eligible individuals who are covered under such a plan for costs which are incurred before the date of initial implementation of subparagraph (A) and which would be reimbursed under such a plan if such implementation occurred as of January 1, 2010. (5513)

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