Choice for America's Seniors Act of 2006 - Amends part C (Medicare+Choice) of title XVIII (Medicare) the Social Security Act (SSA) to provide for a six-month extension of the 2006 initial enrollment period for Medicare prescription drug plans and Medicare Advantage (MA) plans.
Amends SSA title XVIII part D (Voluntary Prescription Drug Benefit Program) to suspend the Medicare prescription drug late enrollment penalty during 2006.
Amends SSA title XVIII part C to allow changes of enrollment in Medicare prescription drug plans and MA plans twice during the year.
Amends title XVIII (Medicare) of the Social Security Act to prohibit removal of covered part D (Voluntary Prescription Drug Benefit Program) drugs from a prescription drug plan formulary, or imposition of a restriction or limitation on the coverage of such a drug, during the plan year: (1) except at the beginning; or (2) for an individual enrollee, from the date of enrollment until December 31 of the immediately succeeding plan year. Specifies exceptions to such prohibition.
Requires an advance notice before the time of each annual coordinated election period for a plan year of any changes in the formulary or other restrictions or limitations on coverage of a covered part D drug that will take effect for that plan year.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5116 Introduced in House (IH)]
109th CONGRESS
2d Session
H. R. 5116
To amend title XVIII of the Social Security Act to extend the 2006
initial enrollment period for the Medicare prescription drug benefit by
six months, to suspend the late enrollment penalty for such benefit
during 2006, to permit Medicare beneficiaries to change enrollment in a
prescription drug plan once a year, and to prevent changes in
formularies other than at the time of open enrollment periods and only
with advance notice.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
April 6, 2006
Mrs. Tauscher (for herself, Mr. Smith of Washington, Mr. Davis of
Alabama, Mr. Kind, Mrs. McCarthy, Mr. Inslee, Ms. Herseth, Mr. Crowley,
Mr. Meeks of New York, Mr. Emanuel, Ms. Millender-McDonald, Mr.
Higgins, Ms. Harman, Mr. Price of North Carolina, Mr. Baird, Ms.
Schwartz of Pennsylvania, Mr. McIntyre, Mr. Engel, Mr. Israel, Mr.
Chandler, Mr. Boswell, Ms. Loretta Sanchez of California, Mr. Larson of
Connecticut, Mr. Davis of Florida, Mr. Moore of Kansas, and Ms. Hooley)
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
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to extend the 2006
initial enrollment period for the Medicare prescription drug benefit by
six months, to suspend the late enrollment penalty for such benefit
during 2006, to permit Medicare beneficiaries to change enrollment in a
prescription drug plan once a year, and to prevent changes in
formularies other than at the time of open enrollment periods and only
with advance notice.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Choice for America's Seniors Act of
2006''.
SEC. 2. SIX-MONTH EXTENSION OF 2006 INITIAL ENROLLMENT PERIOD FOR
MEDICARE PRESCRIPTION DRUG PLANS AND MA PLANS.
(a) In General.--Section 1851(e)(3)(B)(iii) of the Social Security
Act (42 U.S.C. 1395w-21(e)(3)(B)(iii)) is amended by striking ``May 15,
2006'' and inserting ``November 14, 2006''.
(b) Effective Date.--The amendments made by this section shall take
effect as if included in the enactment of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173).
SEC. 3. SUSPENSION OF MEDICARE PRESCRIPTION DRUG LATE ENROLLMENT
PENALTY DURING 2006.
(a) In General.--Section 1860D-13(b)(3)(B) of the Social Security
Act (42 U.S.C. 1395w-113(b)(3)(B)) is amended by inserting ``(after
December 2006)'' after ``any month''.
(b) Effective Date.--The amendments made by this section shall take
effect as if included in the enactment of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173).
SEC. 4. CHANGES OF ENROLLMENT IN PRESCRIPTION DRUG PLANS AND MA PLANS
ALLOWED TWICE DURING YEAR.
(a) Additional Election Permitted Once Each Year Outside of Annual
Coordinated Election Period.--Section 1851(e)(4) of the Social Security
Act (42 U.S.C. 1395w-21(e)(4)) is amended by inserting ``once every
year, and in addition,'' after ``make a new election under this
section''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect as of the date of the enactment of this Act.
SEC. 5. LIMITATION ON REMOVAL OR CHANGE OF COVERED PART D DRUGS FROM
THE PRESCRIPTION DRUG PLAN FORMULARY; NOTICE OF CHANGES
IN COVERAGE.
(a) Limitation on Removal or Change of Covered Part D Drugs From
the Prescription Drug Plan Formulary.--Section 1860D-4(b)(3)(E) of the
Social Security Act (42 U.S.C. 1395w-104(b)(3)(E)) is amended to read
as follows:
``(E) Removing a drug from formulary or imposing a
restriction or limitation on coverage.--
``(i) Limitation on removal, limitation, or
restriction.--
``(I) In general.--Subject to
subclause (II) and clause (ii),
beginning with 2006, the PDP sponsor of
a prescription drug plan may not remove
a covered part D drug from the plan
formulary or impose a restriction or
limitation on the coverage of such a
drug (such as through the application
of a preferred status, usage
restriction, step therapy, prior
authorization, or quantity limitation)
other than at the beginning of each
plan year except as the Secretary may
permit to take into account new
therapeutic uses and newly covered part
D drugs.
``(II) Special rule for newly
enrolled individuals.--Subject to
clause (ii), in the case of an
individual who enrolls in a
prescription drug plan on or after the
date of enactment of this subparagraph,
the PDP sponsor of such plan may not
remove a covered part D drug from the
plan formulary or impose a restriction
or limitation on the coverage of such a
drug (such as through the application
of a preferred status, usage
restriction, step therapy, prior
authorization, or quantity limitation)
during the period beginning on the date
of such enrollment and ending on
December 31 of the immediately
succeeding plan year except as the
Secretary may permit to take into
account new therapeutic uses and newly
covered part D drugs.
``(ii) Exceptions to limitation on
removal.--Clause (i) shall not apply with
respect to a covered part D drug that--
``(I) is a brand name drug for
which there is a generic drug approved
under section 505(j) of the Food and
Drug Cosmetic Act (21 U.S.C. 355(j))
that is placed on the market during the
period in which there are limitations
on removal or change in the formulary
under subclause (I) or (II) of clause
(i) if such generic drug is included in
the formulary without any restriction
or limitation placed on the coverage of
such generic drug other than a
restriction or limitation that would be
placed on the coverage of the brand
name drug during such period without
the application of this clause;
``(II) is a brand name drug that
goes off-patent during such period;
``(III) is a drug for which the
Commissioner of Food and Drugs issues a
clinical warning that imposes a
restriction or limitation on the drug
during such period;
``(IV) is a drug that the
appropriate pharmacy and therapeutic
committee determines, based on evidence
from peer-reviewed medical research, to
be unsafe or ineffective during such
period; or
``(V) is any other drug that
satisfies any other requirement
determined appropriate by the
Secretary.
``(iii) Notice of removal under application
of exception to limitation.--Not later than 90
days before a PDP sponsor of a prescription
drug plan removes a covered part D drug from
the plan formulary (or restricts or limits such
coverage) under clause (ii), the sponsor shall
provide appropriate notice (such as under
subsection (a)(3)) of such removal (or
restriction or limitation) to the Secretary,
affected enrollees, physicians, pharmacies, and
pharmacists.''.
(a) Advance Notice Required for Change in Formulary and Other
Restrictions or Limitations on Coverage.--
(1) In general.--Section 1860D-4(a) of the Social Security
Act (42 U.S.C. 1395w-104(a)) is amended by adding at the end
the following new paragraph:
``(5) Annual notice of changes in formulary and other
restrictions or limitations on coverage.--Each PDP sponsor
offering a prescription drug plan shall furnish to each
enrollee 90 days before the time of each annual coordinated
election period (referred to in section 1860D-1(b)(1)(B)(iii))
for a plan year a notice of any changes in the formulary or
other restrictions or limitations on coverage of a covered part
D drug under the plan that will take effect for the plan
year.''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to annual coordinated election periods beginning
after the date of the enactment of this Act, except that if
this Act is enacted after September 15, 2006, and before
January 1, 2007, the notice required under such section shall
apply with respect to the annual coordinated election period
that begins on November 15, 2006, as of such date (as soon as
possible after such date of enactment) as the Secretary of
Health and Human Services shall specify.
<all>
Introduced in House
Introduced in House
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.
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.
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.
Referred to the Subcommittee on Health.
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