[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2925 Introduced in House (IH)]
106th CONGRESS
1st Session
H. R. 2925
To amend the Public Health Service Act to finance the provision of
outpatient prescription drug coverage for low-income medicare
beneficiaries and to provide stop-loss protection for outpatient
prescription drug expenses under qualified medicare prescription drug
coverage.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 23, 1999
Mr. Bilirakis (for himself, Mr. Peterson of Minnesota, and Mr.
Fletcher) introduced the following bill; which was referred to the
Committee on 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
_______________________________________________________________________
A BILL
To amend the Public Health Service Act to finance the provision of
outpatient prescription drug coverage for low-income medicare
beneficiaries and to provide stop-loss protection for outpatient
prescription drug expenses under qualified medicare prescription drug
coverage.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Medicare
Beneficiary Prescription Drug Assistance and Stop-Loss Protection Act
of 1999''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Promoting prescription drug coverage for medicare
beneficiaries.
``TITLE XXVIII--PROMOTING PRESCRIPTION DRUG COVERAGE FOR MEDICARE
BENEFICIARIES
``Part A--Prescription Drug Coverage Assistance for Low-income Medicare
Beneficiaries
``Sec. 2801. Purpose; methods of providing assistance.
``Sec. 2802. Beneficiary eligibility.
``Sec. 2803. Coverage requirements for prescription drug coverage.
``Sec. 2804. Payments to States.
``Sec. 2805. State plan, data collection, records, audits, and reports.
``Sec. 2806. Definition of prescription drug assistance and other
terms.
``Part B--Medicare Outpatient Prescription Drug Stop-Loss Protection
``Sec. 2811. Medicare outpatient prescription drug stop-loss
protection.
``Part C--Access to Prescription Drug Coverage Under Medigap Policies
``Sec. 2821. Permitting medicare beneficiaries to adjust medigap
coverage.
SEC. 2. PROMOTING PRESCRIPTION DRUG COVERAGE FOR MEDICARE
BENEFICIARIES.
The Public Health Service Act is amended by adding at the end the
following new title:
``TITLE XXVIII--PROMOTING PRESCRIPTION DRUG COVERAGE FOR MEDICARE
BENEFICIARIES
``Part A--Prescription Drug Coverage Assistance for Low-income Medicare
Beneficiaries
``SEC. 2801. PURPOSE; METHODS OF PROVIDING ASSISTANCE.
``(a) In General.--The purpose of this part is to provide funds to
States to enable them, at their option, to establish programs, separate
from their medicaid plans, that provide assistance to low-income
medicare beneficiaries in obtaining qualified prescription drug
coverage using the following methods in a manner consistent with the
provisions of this part:
``(1) Premium subsidy for individuals obtaining coverage
through enrollment in a medicare+choice plan or a group health
plan.--In the case of a low-income medicare beneficiary
enrolled in Medicare+Choice plan or a group health plan that
provides qualified prescription drug coverage, payment of the
portion of the beneficiary premium (if any) of such plan that
is attributable to the cost of furnishing such coverage to such
beneficiary.
``(2) Other methods.--Any other method for the provision
of, or payment for, qualified prescription drug coverage that
meets the requirements of this part and that is separate from
its medicaid plan.
The Secretary shall provide guidance to States in establishing
reasonable procedures to determine the portion of the premium described
in paragraph (1).
``(b) Requiring Provision of Assistance Through Medicare+Choice
Plans or Group Health Plans in Case of Individuals Enrolled in such
Plans.--If a low-income medicare beneficiary is enrolled in a
Medicare+Choice plan or in a group health plan that provides qualified
prescription drug coverage--
``(1) a State drug assistance program shall provide for
assistance under this part to be provided in the form of a
premium subsidy described in subsection (a)(1); and
``(2) the beneficiary is deemed to have assigned the right
to such subsidy to the organization or sponsor offering such
plan.
Nothing in this part shall be construed as providing for any premium
subsidy described in subsection (a)(1) to the extent such subsidy
exceeds the amount of the beneficiary premium applicable to qualified
prescription drug coverage.
``(c) State Entitlement.--This part constitutes budget authority in
advance of appropriations Acts and represents the obligation of the
Federal Government to provide for the payment to States of amounts
provided under section 2804.
``SEC. 2802. BENEFICIARY ELIGIBILITY.
``(a) In General.--In order for a State to receive payments under
section 2804 with respect to a State drug assistance program, the
program must provide prescription drug assistance to each individual
residing in the State who applies for such assistance and establishes
that the individual is a low-income medicare beneficiary (as defined in
subsection (b)). In applying the previous sentence, residency rules
similar to the residency rules applicable under medicaid plans shall
apply.
``(b) Low-Income Medicare Beneficiary Defined.--
``(1) In general.--For purposes of this part with respect
to a State drug assistance program, the term `low-income
medicare beneficiary' means an individual who--
``(A) is entitled to benefits under part A of title
XVIII of the Social Security Act or enrolled under part
B of such title, or both, including an individual
enrolled in a Medicare+Choice plan under part C of such
title;
``(B) is not entitled to medical assistance with
respect to prescribed drugs under a medicaid plan;
``(C) is determined by the State under the program
to have family income (as determined under section
2806(6)) which does not exceed a percentage of the
applicable poverty line (as defined in section 673(2)
of the Community Services Block Grant Act, including
any revision required by such section), for a family of
the size involved, specified by the State, which
percentage may not be less 120 percent nor more than
200 percent; and
``(D) at the option of the State, is determined by
the State under the program to have resources (as
determined under section 1613 of the Social Security
Act for purposes of the supplemental security income
program) that do not exceed a level specified under the
program, which level shall not be less than the level
used by the State under section 1905(p)(1)(C) of such
Act.
``(2) Exclusion.--Such term does not include an individual
who is--
``(A) an inmate of a public institution or a
patient in an institution for mental diseases; or
``(B) a member of a family that is eligible for
health benefits coverage under a State health benefits
plan on the basis of a family member's employment with
a public agency in the State if such coverage includes
outpatient prescription drug coverage.
``SEC. 2803. COVERAGE REQUIREMENTS FOR PRESCRIPTION DRUG COVERAGE.
``(a) Qualified Prescription Drug Coverage Defined.--For purposes
of this part, the term `qualified prescription drug coverage' means
prescription drug coverage that--
``(1) provides for a scope and quality of coverage that is
not less than the scope and quality of coverage described in
subsection (b);
``(2) imposes any cost-sharing (including enrollment fees,
premiums, deductibles, copayments, coinsurance, and similar
costs) only consistent with subsection (c); and
``(3) meets the requirements of subsection (d) (relating to
miscellaneous provisions).
``(b) Minimum Scope and Quality of Coverage Required.--
``(1) In general.--The scope and quality of coverage
described in this subsection is the scope and quality of
coverage for outpatient prescription drugs and biologicals
equivalent to any of the following:
``(A) Medicaid coverage.--Coverage of outpatient
prescribed drugs under the State medicaid plan.
``(B) Comprehensive benchmark coverage.--
Comprehensive outpatient prescription drug coverage if
included in a benchmark benefit package described in
paragraph (2).
``(C) Other comprehensive coverage.--Outpatient
prescription drug coverage that the Secretary
determines, upon application by a State, provides
comprehensive outpatient prescription drug coverage,
which may be such coverage typically available in large
group health plans or in the large group market (as
such term is defined in section 2791(e)(3)).
Nothing in subparagraph (C) shall be construed as authorizing
the Secretary to require any particular type of formulary or
pricing structure.
``(2) Benchmark benefit packages.--The benchmark benefit
packages are as follows:
``(A) FEHBP-equivalent health insurance coverage.--
The standard Blue Cross/Blue Shield preferred provider
option service benefit plan, described in and offered
under section 8903(1) of title 5, United States Code.
``(B) State employee coverage.--A health benefits
coverage plan that is offered and generally available
to State employees in the State involved.
``(C) Coverage offered through hmo.--The health
insurance coverage plan that--
``(i) is offered by a health maintenance
organization (as defined in section
2791(b)(3)), and
``(ii) has the largest insured commercial,
non-medicaid enrollment of covered lives of
such coverage plans offered by such a health
maintenance organization in the State involved.
``(3) Scope and quality of coverage defined.--In this
subsection, the term `scope and quality of coverage' means the
extent of prescription drugs covered (including any exclusions
or limitations and the application of any formulary, including
exceptions to the application of such a formulary) and
provisions that assure access to, and the quality of, covered
prescription drugs, but not including terms and conditions
relating to cost-sharing or other matters described in
subsection (c) or (d).
``(4) Construction.--Nothing in this subsection shall be
construed as requiring qualified prescription drug coverage--
``(A) to provide for the same cost-sharing as that
provided under the State medicaid plan or under a
benchmark benefit package, respectively; or
``(B) to provide coverage for items or services for
which payment is prohibited under this part,
notwithstanding that any benchmark benefit or other
package includes coverage for such an item or service.
``(c) Limitations on Cost-Sharing.--
``(1) No premium and no deductible.--
``(A) In general.--There shall be no premium or
enrollment fee and no deductible imposed under the
program.
``(B) Construction.--Nothing in subparagraph (A)
shall be construed as preventing the imposition of a
premium, enrollment fee, or similar charge or the
application of a deductible for coverage of benefits
other than outpatient prescription drugs under a
Medicare+Choice plan or group health plan to the extent
otherwise permitted under law.
``(2) Limitations on copayments and coinsurance.--
``(A) No copayments and coinsurance for lowest
income beneficiaries.--There shall be no copayments or
coinsurance in the case of a low-income medicare
beneficiary whose family income does not exceed 120
percent of the applicable poverty line described in
section 2802(b)(1)(C).
``(B) Other beneficiaries.--
``(i) In general.--In the case of a low-
income medicare beneficiary whose family income
exceeds 120 percent of such poverty line, any
cost-sharing in the form of a copayment or
coinsurance imposed with respect to coverage
under the program does not exceed--
``(I) a copayment of $5 per
prescription unit (such a unit being
determined consistent with reasonable
rules established under the program
that reflect common industry practice),
or
``(II) coinsurance of 20 percent,
whichever is greater. Any such cost-sharing may
not exceed, in the aggregate in any year,
$1,500 with respect to a low-income medicare
beneficiary.
``(ii) Sliding scale permitted.--In the
case of such beneficiaries, a program may vary
the cost-sharing based on family income, but
only in a manner, consistent with clause (i),
so that the cost sharing increases as family
income increases.
``(iii) Publication.--Any cost-sharing
imposed under this subparagraph shall be
imposed pursuant to a public schedule.
``(iv) Indexing limitation on cost-
sharing.--For a year after 2000, the dollar
amount specified in the last sentence of clause
(i) shall be increased by the same percentage
as the percentage increase (if any) in per
capita expenditures for prescription drugs (as
estimated by the Secretary based on the best
data available from the Bureau of Labor
Statistics) between July 1999 and July of the
previous year, except that any such increase
which is not a multiple of $10 shall be rounded
to the nearest multiple of $10.
``(3) No balance billing.--The coverage does not permit the
imposition of any cost-sharing or balance billing except as
permitted under paragraph (2).
``(d) Additional Conditions.--The conditions specified in this
subsection with respect to outpatient prescription drug coverage are as
follows:
``(1) No durational limitation on benefit.--
``(A) In general.--Subject to subparagraph (B), the
coverage does not impose any maximum annual, lifetime,
or other durational limit on benefits that may be paid
with respect to covered prescription drugs.
``(B) Construction.--Subparagraph (A) shall not be
construed from preventing the imposition of limits so
long as such limits are no lower than the limits
imposed under the State's medicaid plan.
``(2) Restriction on application of preexisting condition
exclusions.--The coverage shall not impose any preexisting
condition exclusion (as defined in section 2701(b)(1)(A)) for
covered benefits.
``(e) No Application of Medicaid or Other Federal Prescription Drug
Rebate System.--Federal rebate systems (including that under section
1927 of the Social Security Act) applicable to the purchase of
prescription drugs shall not apply to the prescription drugs furnished
under this part.
``SEC. 2804. PAYMENTS TO STATES.
``(a) In General.--Subject to the succeeding provisions of this
section, the Secretary shall pay to each State which has submitted a
plan pursuant to section 2805(a) an amount for each quarter (beginning
on or after October 1, 1999) equal to the sum of--
``(1) the enhanced FMAP (as defined in section 2105(b) of
the Social Security Act) of expenditures in the quarter for
prescription drug assistance under the program for low-income
medicare beneficiaries whose family income is below 150 percent
of the poverty line;
``(2) the Federal medical assistance percentage (as defined
in section 1905(b) of the Social Security Act) of expenditures
in the quarter for prescription drug assistance under the
program for low-income medicare beneficiaries not described in
paragraph (1); plus
``(3) only to the extent permitted consistent with
subsection (b)(1), the enhanced FMAP (as defined in section
2105(b) of the Social Security Act) of expenditures--
``(A) for outreach activities described in section
2805(a)(2) under the program; and
``(B) for other reasonable costs incurred by the
State to administer the program.
``(b) Limitation on Certain Payments for Certain Expenditures.--
``(1) Limitation on administrative expenditures.--Payment
shall not be made under subsection (a) for expenditures for
items described in subsection (a)(3) for a fiscal year to the
extent the payment for expenditures under subsection (a)(3)
exceeds 10 percent of the total of all payments made to the
State under subsection (a) for such fiscal year (or 20 percent
of such total for the first such fiscal year).
``(2) Use of non-federal funds for state matching
requirement.--Amounts provided by the Federal Government, or
services assisted or subsidized to any significant extent by
the Federal Government, may not be included in determining the
amount of non-Federal contributions required under subsection
(a).
``(3) Offset of receipts attributable to cost-sharing.--For
purposes of subsection (a), the amount of the expenditures
under the program shall be reduced by the amount of any cost-
sharing received by the State.
``(4) Prevention of duplicative payments and limitation on
payment for abortions.--The provisions of paragraphs (6) and
(7) of section 2105(c) of the Social Security Act apply to
payments under this section for low-income medicare
beneficiaries and prescription drug assistance in the same
manner as they apply to payments under section 2105 of such Act
for targeted low-income children and child health assistance,
and any reference in such paragraph (6) to a private insurer is
deemed a reference to the issuer of a medicare supplemental
policy (as defined in section 1882(g) of the Social Security
Act) or an organization offering a Medicare+Choice plan.
``(5) Application of rules relating to provider taxes and
donations.--Section 1902(w) of the Social Security Act shall
apply to States under this part in the same manner as it
applies to a State under title XIX of such Act.
``(c) Advance Payment; Retrospective Adjustment.--The Secretary may
make payments under this section for each quarter on the basis of
advance estimates of expenditures submitted by the State and such other
investigation as the Secretary may find necessary, and may reduce or
increase the payments as necessary to adjust for any overpayment or
underpayment for prior quarters.
``SEC. 2805. STATE PLAN, DATA COLLECTION, RECORDS, AUDITS, AND REPORTS.
``(a) Submission of Plan.--
``(1) In general.--A State is eligible for payment under
this part if--
``(A) the State has submitted to the Secretary a
plan that includes--
``(i) a written document that outlines--
``(I) how the State intends to use
the funds provided under this part to
provide prescription drug assistance
consistent with the provisions of this
part; and
``(II) the procedures to be used by
the State to provide for outreach to
low-income medicare beneficiaries; and
``(ii) a certification by the chief
executive officer of the States that the State
drug assistance program operated under such
plan is operated consistent with the specific
requirements of this part; and
``(B) the State is not otherwise ineligible to
receive such payment under a specific provision of this
part.
``(2) Limitation on secretarial authority.--The Secretary
may not impose conditions, in addition to those specified in
this part, for State plans or State drugs assistance programs
under this part.
``(b) Data Collection, Records, Audits, and Reports.--As a
condition for the receipt of funds under this part, a State, in its
plan under subsection (a), shall provide assurances satisfactory to the
Secretary that--
``(1) the State will collect the data, maintain the
records, and furnish the reports to the Secretary, at the times
and in the standardized format the Secretary may require, in
order to enable the Secretary to monitor State program
administration and compliance and to evaluate and compare the
effectiveness of State programs under this part;
``(2) the State will afford the Secretary access to any
records or information relating to the State program under this
part for the purposes of review or audit; and
``(3) the State will--
``(A) assess the operation of the State program in
each fiscal year, including the progress made in
covering low-income medicare beneficiaries; and
``(B) report to the Secretary, by January 1
following the end of the fiscal year, on the result of
the assessment.
``SEC. 2806. DEFINITION OF PRESCRIPTION DRUG ASSISTANCE AND OTHER
TERMS.
``For purposes of this part:
``(1) Prescription drug assistance.--
``(A) In general.--The term `prescription drug
assistance' means, subject to subparagraph (B), payment
for part or all of the cost of coverage of self-
administered outpatient prescription drugs and
biologicals (including insulin and insulin supplies)
for low-income medicare beneficiaries.
``(B) Exclusions.--Such term does not include
payment or coverage with respect to--
``(i) items covered under title XVIII of
the Social Security Act;
``(ii) items for which coverage is not
available under a State medicaid plan; or
``(iii) drugs and biologicals furnished for
the purpose of causing, or assisting in
causing, the death, suicide, euthanasia, or
mercy killing of a person.
``(2) State drug assistance program; program.--The terms
`State drug assistance program' and `program' mean a State drug
assistance program receiving funds under this part.
``(3) Group health plan.--The term `group health plan' has
the meaning given such term in section 2791(a)(1).
``(4) Medicaid plan.--The term `medicaid plan' means a plan
of a State under title XIX of the Social Security Act and
includes such a plan operating under a waiver under such Act.
``(5) Medicare+choice plan.--The term `Medicare+Choice
plan' means such a plan offered under part C of title XVIII of
the Social Security Act.
``(6) Family income.--Family income shall be determined in
the same manner as it is determined for purposes of section
1905(p) of the Social Security Act, except that such
determinations shall be made only on an annual basis.
``Part B--Medicare Outpatient Prescription Drug Stop-Loss Protection
``SEC. 2811. MEDICARE OUTPATIENT PRESCRIPTION DRUG STOP-LOSS
PROTECTION.
``(a) In General.--This section establishes a program under which,
in the case of medicare beneficiaries who are covered under qualified
medicare prescription drug coverage (as defined in subsection (b)(1)),
the program provides for payment through carriers or other qualified
entities to the organization, issuer, or sponsor offering the coverage
of the cost of providing benefits (provided on or after January 1,
2000) under the coverage in a year after the beneficiary has incurred
out-of-pocket costs for outpatient prescription drugs covered under
such coverage equal to $1,500. For purposes of this section, the term
`medicare beneficiary' means an individual entitled to benefits under
part A, B, or C of title XVIII of the Social Security Act.
``(b) Qualified Medicare Prescription Drug Coverage Defined.--
``(1) In general.--For purposes of this section, the term
`qualified medicare prescription drug coverage' means
outpatient prescription drug coverage under a plan or policy
described in paragraph (2) with respect to a medicare
beneficiary if the following requirements are met:
``(A) The amount of any deductible imposed with
respect to such coverage for such a beneficiary does
not exceed $500 in any year.
``(B) The cost-sharing (in the form of copayment or
coinsurance or both) imposed (after the imposition of
any such deductible) with respect to such coverage for
such a beneficiary does not exceed 50 percent of the
payment amount to purchase the covered outpatient
prescription drug involved.
``(C) There is a annual limit of not more than
$1,500 on the out-of-pocket expenses for covered
outpatient prescription drugs under the coverage of
such a beneficiary.
``(D) The organization, issuer, or sponsor offering
the coverage has entered into an agreement with the
carrier or other qualified entity operating the program
under subsection (c) under which it agrees to provide
for the exchange of such information, in such
electronic or other form as the agreement specifies, as
the carrier or entity may require in order to verify
the eligibility for payment described in subsection
(a).
``(2) Plans and policies covered.--A plan or policy
described in this paragraph is any of the following:
``(A) Medicare+choice plan.--A Medicare+Choice plan
under part C of title XVIII of the Social Security Act.
``(B) Medigap policy.--A medicare supplemental
policy, as defined in section 1882(g) of the Social
Security Act (42 U.S.C. 1395ss(g)).
``(C) Group health plan.--A group health plan, as
defined in section 607(1) of Employee Retirement Income
Security Act of 1974 (29 U.S.C. 1167(1)), but only with
respect to a participant or beneficiary who is a
medicare beneficiary.
``(c) Operation of Program Through Private Entities.--
``(1) In general.--The Secretary shall enter into contracts
with one or more carriers or other qualified entities to
operate the stop-loss program provided under this section.
``(2) Limitation on authority.--Nothing in this section
shall be construed as authorizing the Secretary, a carrier, or
other qualified entity acting under paragraph (1) to deny or
limit payment to an entity that is offering qualified medicare
prescription drug coverage and has made payments for the cost
of providing benefits under such coverage based on the drugs so
covered or the amount so paid. The previous sentence shall not
be construed as preventing the Secretary, a carrier, or entity
from computing costs taking into account discounts or other
rebates related to the provision of qualified prescription drug
coverage.
``(d) Entitlement.--This section constitutes budget authority in
advance of appropriations Acts and represents the obligation of the
Federal Government to provide for the payment under this section of
stop-loss benefits described in subsection (a).
``(e) Indexing Dollar Amounts.--For a year after 2000, each of the
dollar amounts specified in this section shall be increased by the same
percentage as the percentage increase (if any) in per capita
expenditures for prescription drugs (as estimated by the Secretary
based on the best data available from the Bureau of Labor Statistics)
between July 1999 and July of the previous year, except that any such
increase which is not a multiple of $10 shall be rounded to the nearest
multiple of $10.
``Part C--Access to Prescription Drug Coverage Under Medigap Policies
``SEC. 2821. PERMITTING MEDICARE BENEFICIARIES TO ADJUST MEDIGAP
COVERAGE.
``(a) Allowing Medicare Beneficiaries Provided Low-Income
Assistance To Drop Prescription Drug Medigap Coverage.--
``(1) In general.--The issuer of a medicare supplemental
policy--
``(A) may not deny or condition the issuance or
effectiveness of a medicare supplemental policy that
has a benefit package classified as `A', `B', `C', `D',
`E', `F', or `G' (under the standards established under
subsection (p)(2) of section 1882 of the Social
Security Act) and that is offered and is available for
issuance to new enrollees by such issuer;
``(B) may not discriminate in the pricing of such
policy, because of health status, claims experience,
receipt of health care, or medical condition; and
``(C) may not impose an exclusion of benefits based
on a pre-existing condition under such policy,
in the case of an individual described in paragraph (2) who
seeks to enroll under the policy not later than 63 days after
the date of the termination of enrollment described in such
paragraph and who submits evidence of the date of termination
or disenrollment along with the application for such medicare
supplemental policy.
``(2) Individual covered.--An individual described in this
paragraph is an individual who--
``(A) is a low-income medicare beneficiary (as
defined in section 2802(b)) who is being provided
prescription drug assistance under part A; and
``(B) at the time the individual is first provided
such assistance, was enrolled and terminates enrollment
in a medicare supplemental policy which has a benefit
package classified as--
``(I) `H',
``(II) `I', or
``(III) `J',
under the standards referred to in paragraph (1)(A).
``(b) Allowing Medicare Beneficiaries Who Lose Low-Income
Prescription Drug Assistance To Restore Medigap Coverage That Included
Prescription Drug Coverage.--
``(1) In general.--The issuer of a medicare supplemental
policy--
``(A) may not deny or condition the issuance or
effectiveness of a medicare supplemental policy
described in paragraph (3) that is offered and is
available for issuance to new enrollees by such issuer;
``(B) may not discriminate in the pricing of such
policy, because of health status, claims experience,
receipt of health care, or medical condition; and
``(C) may not impose an exclusion of benefits based
on a pre-existing condition under such policy,
in the case of an individual described in paragraph (2) who
seeks to enroll under the policy not later than 63 days after
the date of the termination of prescription drug assistance
described in such paragraph and who submits evidence of the
date of termination along with the application for such
medicare supplemental policy.
``(2) Individual covered.--An individual described in this
paragraph is an individual--
``(A) who was described in paragraph (4)(B) of
section 1882(s) of the Social Security Act and changed
enrollment under paragraph (4)(A); and
``(B) whose prescription drug assistance under part
A of this title is terminated.
``(3) Policy described.--A medicare supplemental policy
described in this paragraph is the medicare supplemental policy
described in paragraph (4)(B) of section 1882(s) of the Social
Security Act from which the individual discontinued enrollment
under paragraph (4)(A) of such section.
``(c) Guaranteed Issue in Another Case.--
``(1) In general.--The issuer of a medicare supplemental
policy--
``(A) may not deny or condition the issuance or
effectiveness of a medicare supplemental policy which
has a benefit package classified as--
``(i) `H',
``(ii) `I', or
``(iii) `J',
under the standards referred to in subsection (a)(1)(A)
that is offered and is available for issuance to new
enrollees by such issuer;
``(B) may not discriminate in the pricing of such
policy, because of health status, claims experience,
receipt of health care, or medical condition; and
``(C) subject to paragraph (2), may not impose an
exclusion of benefits based on a pre-existing condition
under such policy;
in the case of an individual who is 65 years of age or older
and who seeks to enroll under the policy during a 6-month open
enrollment period specified by the Secretary.
``(2) The provisions of subparagraphs (B) and (C) of
paragraph (1) of section 1882(s) of the Social Security Act
shall apply with respect to paragraph (1) in the same manner as
they apply with respect to paragraph (1)(A) of such section.
``(d) Enforcement.--The provisions of subsections (a) through (c)
shall be enforced as though they were included in section 1882(s) of
the Social Security Act.
``(e) Definitions.--For purposes of this section, the term
`medicare supplemental policy' has the meaning given such term in
section 1882(g) of the Social Security Act.''.
<all>
Introduced in House
Introduced in House
Referred to the Committee on 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.
Referred to the Committee on 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.
Referred to the Committee on 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.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health and Environment.
Llama 3.2 · runs locally in your browser
Ask anything about this bill. The AI reads the full text to answer.
Enter to send · Shift+Enter for new line