Medication Therapy Management Empowerment Act of 2013 - Amends part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act to direct the Chief Actuary of the Centers for Medicare and Medicaid Services to report to the Secretary of Health and Human Services (HHS) and to Congress on whether or not the expansion of the definition of targeted beneficiary, with respect to medication therapy management, would, if implemented, reduce spending under Medicare. Requires the report to include a certification of any determination by the Chief Actuary that such expansion would reduce such spending.
Specifies such an expansion as targeted beneficiaries with a single chronic disease that accounts for high Medicare spending, 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). (Currently a targeted beneficiary must have multiple chronic diseases.)
Requires such an expansion to take place if the report contains the certification indicated.
[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[S. 557 Introduced in Senate (IS)]
113th CONGRESS
1st Session
S. 557
To amend title XVIII of the Social Security Act to improve access to
medication therapy management under part D of the Medicare program.
_______________________________________________________________________
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, and Mr. Brown) introduced the following bill;
which was read twice and referred to the Committee 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.
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 ``Medication Therapy Management
Empowerment Act of 2013''.
SEC. 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) in subparagraph (A)(ii)(I), by striking ``have'' and
inserting ``subject to subparagraph (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, the Chief Actuary of the
Centers for Medicare & Medicaid Services (in
this subparagraph referred to as the `Chief
Actuary') shall submit to the Secretary and to
Congress a report on whether or not the
expansion described in clause (ii) would, if
implemented, reduce expenditures under this
title. If the Chief Actuary determines 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 under
subparagraph (A)(ii) by applying subclause (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 under clause (i)
contains the certification described in such
clause, the following rules shall apply:
``(I) Implementation of
expansion.--Subject to subclause (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 in clause (ii).
``(II) Updated cms actuary report
based on implementation.--Not later
than March 1, 2020, the Chief Actuary
shall submit to the Secretary and to
Congress a report on the implementation
of the expansion under subclause (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 the Chief Actuary
determines in the report under
subclause (II) that the expansion does
not reduce spending under this title,
the Secretary may, effective with
respect to plan years beginning on or
after January 1, 2021, apply
subparagraph (A)(ii)(I) as if this
subparagraph had never been enacted. In
making the determination under the
preceding sentence, the Secretary shall
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.''.
<all>
Introduced in Senate
Read twice and referred to the Committee on Finance.
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