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SA 2586. Mr. BINGAMAN (for himself and Mr. Kerry) submitted an amendment intended to be proposed by him to the bill H.R. 976, to amend the Internal Revenue Code of 1986 to provide tax relief for small businesses, and for other purposes; which was ordered to lie on the table; as follows:
At the appropriate place, insert the following:
SEC. __. EXPEDITING LOW-INCOME SUBSIDIES AND REVISING THE RESOURCE STANDARDS UNDER THE MEDICARE PRESCRIPTION DRUG PROGRAM.
(a) Expediting Low-Income Subsidies.--
(1) IN GENERAL.--Section 1860D-14 (42 U.S.C. 1395w-114) is amended by adding at the end the following new subsection:
``(e) Expedited Application and Eligibility Process.--
``(1) EXPEDITED PROCESS.--
``(A) IN GENERAL.--The Commissioner of Social Security shall provide for an expedited process under this subsection for the qualification for low-income assistance under this section through a request to the Secretary of the Treasury as provided in subparagraphs (B) and (C) for information described in section 6103(l)(21) of the Internal Revenue Code of 1986. Such process shall be conducted in cooperation with the Secretary.
``(B) OPT IN FOR NEWLY ELIGIBLE INDIVIDUALS.--Not later than 60 days after the date of the enactment of this subsection, the Secretary shall ensure that, as part of the Medicare enrollment process, enrolling individuals--
``(i) receive information describing the low-income subsidy provided under this section; and
``(ii) are provided the opportunity to opt-in to the expedited process described in this subsection by requesting that the Commissioner of Social Security screen the individual involved for eligibility for such subsidy through a request to the Secretary of the Treasury under section 6103(l)(21) of the Internal Revenue Code of 1986.
``(C) CURRENTLY ELIGIBLE INDIVIDUALS.--The Commissioner of Social Security shall, as soon as practicable after implementation of subparagraph (A), screen any part D eligible individual to which subparagraph (B) did not apply at the time of such individual's enrollment for eligibility for the low-income subsidy provided under this section through a request to the Secretary of the Treasury under section 6103(l)(21) of the Internal Revenue Code of 1986.
``(2) NOTIFICATION OF POTENTIALLY ELIGIBLE INDIVIDUALS.--Under such process, in the case of each individual identified under paragraph (1) who has not otherwise applied for, or been determined eligible for, benefits under this section (or who has applied for and been determined ineligible for such benefits based only on excess resources), the Commissioner of Social Security shall send a notification that the individual is likely eligible for low-income subsidies under this section. Such
notification shall include the following:
``(A) APPLICATION INFORMATION.--Information on how to apply for such low-income subsidies.
``(B) DESCRIPTION OF THE LIS BENEFIT.--A description of the low-income subsidies available under this section.
``(C) INFORMATION ON STATE HEALTH INSURANCE PROGRAMS.--Information on--
``(i) the State Health Insurance Assistance Program for the State in which the individual is located; and
``(ii) how the individual may contact such Program in order to obtain assistance regarding enrollment and benefits under this part.
``(D) ATTESTATION.--An application form that provides for a signed attestation, under penalty of law, as to the amount of income and assets of the individual and constitutes an application for the low-income subsidies under this section. Such form--
``(i) shall not require the submittal of additional documentation regarding income or assets;
``(ii) shall permit the appointment of a personal representative described in paragraph (4); and
``(iii) shall allow for the specification of a language (other than English) that is preferred by the individual for subsequent communications with respect to the individual under this part.
If a State is doing its own outreach to low-income seniors regarding enrollment and low-income subsidies under this part, such process shall be coordinated with the State's outreach effort.
``(3) HOLD-HARMLESS.--Under such process, if an individual in good faith and in the absence of fraud executes an attestation described in paragraph (2)(D) and is provided low-income subsidies under this section on the basis of such attestation, if the individual is subsequently found not eligible for such subsidies, there shall be no recovery made against the individual because of such subsidies improperly paid.
``(4) USE OF AUTHORIZED REPRESENTATIVE.--Under such process, with proper authorization (which may be part of the attestation form described in paragraph (2)(D)), an individual may authorize another individual to act as the individual's personal representative with respect to communications under this part and the enrollment of the individual under a prescription drug plan (or MA-PD plan) and for low-income subsidies under this section.
``(5) USE OF PREFERRED LANGUAGE IN SUBSEQUENT COMMUNICATIONS.--In the case where an attestation described in paragraph (2)(D) is completed and in which a language other than English is specified under clause (iii) of such paragraph, the Commissioner of Social Security shall provide that subsequent communications to the individual under this part shall be in such language.
``(6) CONSTRUCTION.--Nothing in this subsection shall be construed as precluding the Commissioner of Social Security or the Secretary from taking additional outreach efforts to enroll eligible individuals under this part and to provide low-income subsidies to eligible individuals.''.
(2) PRESCRIPTION DRUG PLANS REQUIRED TO PROVIDE EXPEDITED LOW-INCOME SUBSIDY OPT-IN AS PART OF APPLICATIONS.--
(A) IN GENERAL.--Section 1860D-1(b)(1)(B)(vi) (42 U.S.C. 1395w-101(b)(1)(B)(vi)) is amended by inserting before the period at the end the following: ``, except that any application form distributed by a sponsor of a prescription drug plan, or an organization offering an MA-PD plan, shall contain an option for a part D eligible individual to opt-in to the expedited process under section 1860D-14(e) for low-income assistance subsidies under such section by requesting that the individual
be screened for eligibility for such subsidy through a request to the Secretary of the Treasury under section 6103(l)(21) of the Internal Revenue Code of 1986''.
(B) EFFECTIVE DATE.--The amendment made by subparagraph (A) shall apply to application forms for plan years beginning with 2008.
(3) DISCLOSURE OF RETURN INFORMATION FOR PURPOSES OF DETERMINING INDIVIDUALS ELIGIBLE FOR SUBSIDIES UNDER MEDICARE PART D.--
(A) IN GENERAL.--Subsection (l) of section 6103 of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph:
``(21) DISCLOSURE OF RETURN INFORMATION TO CARRY OUT MEDICARE PART D SUBSIDIES.--
``(A) IN GENERAL.--The Secretary shall, upon written request from the Commissioner of Social Security under section 1860D-14(e)(1) of the Social Security Act, disclose to officers and employees of the Social Security Administration return information of a taxpayer who (according to the records of the Secretary) may be eligible for a subsidy under section 1860D-14 of the Social Security Act. Such return information shall be limited to--
``(i) taxpayer identity information with respect to such taxpayer,
``(ii) the filing status of such taxpayer,
``(iii) the gross income of such taxpayer,
``(iv) such other information relating to the liability of the taxpayer as is prescribed by the Secretary by regulation as might indicate the eligibility of such taxpayer for a subsidy under section 1860D-14 of the Social Security Act, and
``(v) the taxable year with respect to which the preceding information relates.
``(B) RESTRICTION ON USE OF DISCLOSED INFORMATION.--Return information disclosed under this paragraph may be used by officers and employees of the Social Security Administration only for the purposes of identifying eligible individuals for, and, if applicable, administering--
``(i) low-income subsidies under section 1860D-14 of the Social Security Act, and
``(ii) the Medicare Savings Program implemented under clauses (i), (iii), and (iv) of section 1902(a)(10)(E) of such Act.
``(C) TERMINATION.--Return information may not be disclosed under this paragraph after the date that is one year after the date of the enactment of this paragraph.''.
(B) CONFORMING AMENDMENTS.--Paragraph (4) of section 6103(p) of the Internal Revenue Code of 1986 is amended--
(i) by striking ``(14) or (17)'' in the matter preceding subparagraph (A) and inserting ``(14), (17), or (21)''; and
(ii) by striking ``(15) or (17)'' in subparagraph (F)(ii) and inserting ``(15), (17), or (21)''.
(b) Modification of Resource Standards for Determination of Eligibility for Low-Income Subsidy.--
(1) INCREASING THE RESOURCE STANDARD APPLIED TO FULL LOW-INCOME SUBSIDY.--Subparagraph (D) of section 1860D-14(a)(3) (42 U.S.C. 1395w-114(a)(3)) is amended--
(A) in the heading, by striking ``THREE TIMES'';
(B) in clause (i), by striking ``and'' at the end;
(C) in clause (ii)--
(i) by striking ``a subsequent year'' and inserting ``2007'';
(ii) by striking ``this clause for the previous year'' and inserting ``clause (i) for 2006''; and
(iii) by inserting ``(or clause (i))'' after ``this clause''; and
(iv) by striking the period at the end and inserting a semicolon;
(D) by adding at the end the following new clauses:
``(iii) for 2008, six times the maximum amount of resources that an individual may have and obtain benefits under such supplemental security income program; and
``(iv) for a subsequent year the resource limitation established under this clause (or clause (iii)) for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.''; and
(E) in the last sentence, by inserting ``or (iv)'' after ``clause (ii)''.
(2) INCREASING THE ALTERNATE RESOURCE STANDARD.--Subparagraph (E)(i) of such section is amended--
(A) by striking ``and'' at the end of subclause (I);
(B) in subclause (II)--
(i) by striking ``a subsequent year'' and inserting ``2007'';
(ii) by striking ``in this subclause (or subclause (I)) for the previous year'' and inserting ``in subclause (I) for 2006''; and
(iii) by striking the period at the end and inserting a semicolon;
(C) by inserting after subclause (II) the following new subclauses:
``(III) for 2008, $27,500 (or $55,000 in the case of the combined value of the individual's assets or resources and the assets or resources of the individual's spouse); and
``(IV) for a subsequent year the dollar amounts specified in this subclause (or subclause (III)) for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.''; and
(D) in the last sentence, by inserting ``or (IV)'' after ``subclause (II)''.
(3) EXEMPTIONS FROM RESOURCES.--Section 1860D-14(a)(3) (42 U.S.C. 1395w-114(a)(3)) is amended--
(A) in subparagraph (D), in the matter preceding clause (i), by inserting ``, subject to the additional exclusions provided under subparagraph (G)'' before ``)'';
(B) in subparagraph (E)(i), in the matter preceding subclause (I), by inserting ``,subject to the additional exclusions provided under subparagraph (G)'' before ``)''; and
(C) by adding at the end the following new subparagraph:
``(G) ADDITIONAL EXCLUSIONS.--In determining the resources of an individual (and their eligible spouse, if any) under section 1613 for purposes of subparagraphs (D) and (E) the following additional exclusions shall apply:
``(i) LIFE INSURANCE POLICY.--No part of the value of any life insurance policy shall be taken into account.
``(ii) IN-KIND CONTRIBUTIONS.--No in-kind contribution shall be taken into account.
``(iii) PENSION OR RETIREMENT PLAN.--No balance in any pension or retirement plan shall be taken into account.''.
(4) EFFECTIVE DATE.--The amendments made by this subsection shall take effect on the date of enactment of this Act.
(c) Indexing Deductible and Cost-Sharing Above Annual Out-of-Pocket Threshold for Individuals With Income Below 150 Percent of Poverty Line.--
(1) INDEXING DEDUCTIBLE.--Section 1860D-14(a)(4)(B) (42 U.S.C. 1395w-114(a)(4)(B)) is amended--
(A) in clause (i), by striking ``or'';
(B) in clause (ii)--
(i) by striking ``a subsequent year'' and inserting ``2008'';
(ii) by striking ``this clause (or clause (i)) for the previous year'' and inserting ``clause (i) for 2007''; and
(iii) by striking ``involved.'' and inserting ``involved; and'';
(C) by adding after clause (ii) the following new clause:
``(iii) for 2008 and each succeeding year, the amount determined under this subparagraph for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.''; and
(D) in the flush sentence at the end, by striking ``clause (i) or (ii)'' and inserting ``clause (i), (ii), or (iii)''.
(2) INDEXING COST-SHARING.--Section 1860D-14(a) (42 U.S.C. 1395w-114(a)) is amended-
(A) in paragraph (1)(D)(iii), by striking ``exceed the copayment amount'' and all that follows through the period at the end and inserting ``exceed--
``(I) for 2006 and 2007, the copayment amount specified under section 1860D-2(b)(4)(A)(i)(I) for the drug and year involved; and
``(II) for 2008 and each succeeding year, the amount determined under this subparagraph for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.''; and
(B) in paragraph (2)(E), by striking ``exceed the copayment or coinsurance amount'' and all that follows through the period at the end and inserting ``exceed--
``(i) for 2006 and 2007, the copayment or coinsurance amount specified under section 1860D-2(b)(4)(A)(i)(I) for the drug and year involved; and
``(ii) for 2008 and each succeeding year, the amount determined under this clause for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.''.
(d) No Impact on Eligibility for Benefits Under Other Programs.--
(1) IN GENERAL.--Section 1860D-14(a)(3) (42 U.S.C. 1395w-114(a)(3)), as amended by subsection b(3), is amended--
(A) in subparagraph (A), in the matter preceding clause (i), by striking ``subparagraph (F)'' and inserting ``subparagraphs (F) and (H)''; and
(B) by adding at the end the following new subparagraph:
``(H) NO IMPACT ON ELIGIBILITY FOR BENEFITS UNDER OTHER PROGRAMS.--The availability of premium and cost-sharing subsidies under this section shall not be treated as benefits or otherwise taken into account in determining an individual's eligibility for, or the amount of benefits under, any other Federal program.''.
(2) EFFECTIVE DATE.--The amendments made by this subsection shall take effect on the date of enactment of this Act.
(e) Extension of Prescription Drug Discounts to Enrollees of Medicaid Managed Care Organizations.--
(1) IN GENERAL.--Section 1903(m)(2)(A) (42 U.S.C. 1396b(m)(2)(A)) is amended--
(A) in clause (xi), by striking ``and'' at the end;
(B) in clause (xii), by striking the period at the end and inserting ``; and''; and
(C) by adding at the end the following:
``(xiii) such contract provides that (I) payment for covered outpatient drugs dispensed to individuals eligible for medical assistance who are enrolled with the entity shall be subject to the same rebate required by the agreement entered into under section 1927 as the State is subject to and that the State shall allow the entity to collect such rebates from manufacturers, and (II) capitation rates paid to the entity shall be based on actual cost experience related to rebates and subject to the
Federal regulations requiring actuarially sound rates.''.
(2) CONFORMING AMENDMENTS.--Section 1927 (42 U.S.C. 1396r-8) is amended--
(A) in subsection (d)--
(i) in paragraph (1), by adding at the end the following:
``(C) Notwithstanding subparagraphs (A) and (B)--
``(i) a medicaid managed care organization with a contract under section 1903(m) may exclude or otherwise restrict coverage of a covered outpatient drug on the basis of policies or practices of the organization, such as those affecting utilization management, formulary adherence, and cost sharing or dispute resolution, in lieu of any State policies or practices relating to the exclusion or restriction of coverage of such drugs; and
``(ii) nothing in this section or paragraph (2)(A)(xiii) of section 1903(m) shall be construed as requiring a medicaid managed care organization with a contract under such section to maintain the same such polices and practices as those established by the State for purposes of individuals who receive medical assistance for covered outpatient drugs on a fee-for service basis.''; and
(ii) in paragraph (4), by inserting after subparagraph (E) the following:
``(F) Notwithstanding the preceding subparagraphs of this paragraph, any formulary established by medicaid managed care organization with a contract under section 1903(m) may be based on positive inclusion of drugs selected by a formulary committee consisting of physicians, pharmacists, and other individuals with appropriate clinical experience as long as drugs excluded from the formulary are available through prior authorization, as described in paragraph (5).''; and
(B) in subsection (j), by striking paragraph (1) and inserting the following:
``(1) Covered outpatients drugs are not subject to the requirements of this section if such drugs are--
``(A) dispensed by a health maintenance organization other than a medicaid managed care organization with a contract under section 1903(m); and
``(B) subject to discounts under section 340B of the Public Health Service Act.''.
(3) EFFECTIVE DATE.--The amendments made by this subsection take effect on the date of enactment of this Act and apply to rebate agreements entered into or renewed under section 1927 of the Social Security Act (42 U.S.C. 1396r-8) on or after such date.
(f) Increase in Basic Rebate for Single Source Drugs and Innovator Multiple Source Drugs.--
(1) IN GENERAL.--Section 1927(c) (42 U.S.C. 1396r-8(c)) is amended--
(A) in paragraph (1)(B)(i)--
(i) in subclause (IV), by striking ``and'' after the semicolon;
(ii) in subclause (V)--
(I) by inserting ``and before January 1, 2008,'' after ``1995,''; and
(II) by striking the period and inserting ``; and''; and
(iii) by adding at the end the following:
``(VI) after December 31, 2007, is 20.1 percent.''; and
(B) in paragraph (3) (B)--
(i) in clause (i), by striking ``and'' at the end;
(ii) in clause (ii)--
(I) by inserting ``and before January 1, 2008,'' after ``1993,''; and
(II) by striking the period and inserting ``; and''; and
(III) by adding at the end the following new clause:
``(iii) after December 31, 2007, is 16 percent.''.
(2) EFFECTIVE DATE.--The amendments made by this subsection take effect on the date of enactment of this Act and apply to rebate agreements entered into or renewed under section 1927 of the Social Security Act (42 U.S.C. 1396r-8) on or after such date.
(As printed in the Congressional Record for the Senate on Jul 31, 2007.)
At the appropriate place, insert the following:
SEC. __. EXPEDITING LOW-INCOME SUBSIDIES AND REVISING THE RESOURCE STANDARDS UNDER THE MEDICARE PRESCRIPTION DRUG PROGRAM.
(a) Expediting Low-Income Subsidies.--
(1) IN GENERAL.--Section 1860D-14 (42 U.S.C. 1395w-114) is amended by adding at the end the following new subsection:
``(e) Expedited Application and Eligibility Process.--
``(1) EXPEDITED PROCESS.--
``(A) IN GENERAL.--The Commissioner of Social Security shall provide for an expedited process under this subsection for the qualification for low-income assistance under this section through a request to the Secretary of the Treasury as provided in subparagraphs (B) and (C) for information described in section 6103(l)(21) of the Internal Revenue Code of 1986. Such process shall be conducted in cooperation with the Secretary.
``(B) OPT IN FOR NEWLY ELIGIBLE INDIVIDUALS.--Not later than 60 days after the date of the enactment of this subsection, the Secretary shall ensure that, as part of the Medicare enrollment process, enrolling individuals--
``(i) receive information describing the low-income subsidy provided under this section; and
``(ii) are provided the opportunity to opt-in to the expedited process described in this subsection by requesting that the Commissioner of Social Security screen the individual involved for eligibility for such subsidy through a request to the Secretary of the Treasury under section 6103(l)(21) of the Internal Revenue Code of 1986.
``(C) CURRENTLY ELIGIBLE INDIVIDUALS.--The Commissioner of Social Security shall, as soon as practicable after implementation of subparagraph (A), screen any part D eligible individual to which subparagraph (B) did not apply at the time of such individual's enrollment for eligibility for the low-income subsidy provided under this section through a request to the Secretary of the Treasury under section 6103(l)(21) of the Internal Revenue Code of 1986.
``(2) NOTIFICATION OF POTENTIALLY ELIGIBLE INDIVIDUALS.--Under such process, in the case of each individual identified under paragraph (1) who has not otherwise applied for, or been determined eligible for, benefits under this section (or who has applied for and been determined ineligible for such benefits based only on excess resources), the Commissioner of Social Security shall send a notification that the individual is likely eligible for low-income subsidies under this section. Such
notification shall include the following:
``(A) APPLICATION INFORMATION.--Information on how to apply for such low-income subsidies.
``(B) DESCRIPTION OF THE LIS BENEFIT.--A description of the low-income subsidies available under this section.
``(C) INFORMATION ON STATE HEALTH INSURANCE PROGRAMS.--Information on--
``(i) the State Health Insurance Assistance Program for the State in which the individual is located; and
``(ii) how the individual may contact such Program in order to obtain assistance regarding enrollment and benefits under this part.
``(D) ATTESTATION.--An application form that provides for a signed attestation, under penalty of law, as to the amount of income and assets of the individual and constitutes an application for the low-income subsidies under this section. Such form--
``(i) shall not require the submittal of additional documentation regarding income or assets;
``(ii) shall permit the appointment of a personal representative described in paragraph (4); and
``(iii) shall allow for the specification of a language (other than English) that is preferred by the individual for subsequent communications with respect to the individual under this part.
If a State is doing its own outreach to low-income seniors regarding enrollment and low-income subsidies under this part, such process shall be coordinated with the State's outreach effort.
``(3) HOLD-HARMLESS.--Under such process, if an individual in good faith and in the absence of fraud executes an attestation described in paragraph (2)(D) and is provided low-income subsidies under this section on the basis of such attestation, if the individual is subsequently found not eligible for such subsidies, there shall be no recovery made against the individual because of such subsidies improperly paid.
``(4) USE OF AUTHORIZED REPRESENTATIVE.--Under such process, with proper authorization (which may be part of the attestation form described in paragraph (2)(D)), an individual may authorize another individual to act as the individual's personal representative with respect to communications under this part and the enrollment of the individual under a prescription drug plan (or MA-PD plan) and for low-income subsidies under this section.
``(5) USE OF PREFERRED LANGUAGE IN SUBSEQUENT COMMUNICATIONS.--In the case where an attestation described in paragraph (2)(D) is completed and in which a language other than English is specified under clause (iii) of such paragraph, the Commissioner of Social Security shall provide that subsequent communications to the individual under this part shall be in such language.
``(6) CONSTRUCTION.--Nothing in this subsection shall be construed as precluding the Commissioner of Social Security or the Secretary from taking additional outreach efforts to enroll eligible individuals under this part and to provide low-income subsidies to eligible individuals.''.
(2) PRESCRIPTION DRUG PLANS REQUIRED TO PROVIDE EXPEDITED LOW-INCOME SUBSIDY OPT-IN AS PART OF APPLICATIONS.--
(A) IN GENERAL.--Section 1860D-1(b)(1)(B)(vi) (42 U.S.C. 1395w-101(b)(1)(B)(vi)) is amended by inserting before the period at the end the following: ``, except that any application form distributed by a sponsor of a prescription drug plan, or an organization offering an MA-PD plan, shall contain an option for a part D eligible individual to opt-in to the expedited process under section 1860D-14(e) for low-income assistance subsidies under such section by requesting that the individual
be screened for eligibility for such subsidy through a request to the Secretary of the Treasury under section 6103(l)(21) of the Internal Revenue Code of 1986''.
(B) EFFECTIVE DATE.--The amendment made by subparagraph (A) shall apply to application forms for plan years beginning with 2008.
(3) DISCLOSURE OF RETURN INFORMATION FOR PURPOSES OF DETERMINING INDIVIDUALS ELIGIBLE FOR SUBSIDIES UNDER MEDICARE PART D.--
(A) IN GENERAL.--Subsection (l) of section 6103 of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph:
``(21) DISCLOSURE OF RETURN INFORMATION TO CARRY OUT MEDICARE PART D SUBSIDIES.--
``(A) IN GENERAL.--The Secretary shall, upon written request from the Commissioner of Social Security under section 1860D-14(e)(1) of the Social Security Act, disclose to officers and employees of the Social Security Administration return information of a taxpayer who (according to the records of the Secretary) may be eligible for a subsidy under section 1860D-14 of the Social Security Act. Such return information shall be limited to--
``(i) taxpayer identity information with respect to such taxpayer,
``(ii) the filing status of such taxpayer,
``(iii) the gross income of such taxpayer,
``(iv) such other information relating to the liability of the taxpayer as is prescribed by the Secretary by regulation as might indicate the eligibility of such taxpayer for a subsidy under section 1860D-14 of the Social Security Act, and
``(v) the taxable year with respect to which the preceding information relates.
``(B) RESTRICTION ON USE OF DISCLOSED INFORMATION.--Return information disclosed under this paragraph may be used by officers and employees of the Social Security Administration only for the purposes of identifying eligible individuals for, and, if applicable, administering--
``(i) low-income subsidies under section 1860D-14 of the Social Security Act, and
``(ii) the Medicare Savings Program implemented under clauses (i), (iii), and (iv) of section 1902(a)(10)(E) of such Act.
``(C) TERMINATION.--Return information may not be disclosed under this paragraph after the date that is one year after the date of the enactment of this paragraph.''.
(B) CONFORMING AMENDMENTS.--Paragraph (4) of section 6103(p) of the Internal Revenue Code of 1986 is amended--
(i) by striking ``(14) or (17)'' in the matter preceding subparagraph (A) and inserting ``(14), (17), or (21)''; and
(ii) by striking ``(15) or (17)'' in subparagraph (F)(ii) and inserting ``(15), (17), or (21)''.
(b) Modification of Resource Standards for Determination of Eligibility for Low-Income Subsidy.--
(1) INCREASING THE RESOURCE STANDARD APPLIED TO FULL LOW-INCOME SUBSIDY.--Subparagraph (D) of section 1860D-14(a)(3) (42 U.S.C. 1395w-114(a)(3)) is amended--
(A) in the heading, by striking ``THREE TIMES'';
(B) in clause (i), by striking ``and'' at the end;
(C) in clause (ii)--
(i) by striking ``a subsequent year'' and inserting ``2007'';
(ii) by striking ``this clause for the previous year'' and inserting ``clause (i) for 2006''; and
(iii) by inserting ``(or clause (i))'' after ``this clause''; and
(iv) by striking the period at the end and inserting a semicolon;
(D) by adding at the end the following new clauses:
``(iii) for 2008, six times the maximum amount of resources that an individual may have and obtain benefits under such supplemental security income program; and
``(iv) for a subsequent year the resource limitation established under this clause (or clause (iii)) for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.''; and
(E) in the last sentence, by inserting ``or (iv)'' after ``clause (ii)''.
(2) INCREASING THE ALTERNATE RESOURCE STANDARD.--Subparagraph (E)(i) of such section is amended--
(A) by striking ``and'' at the end of subclause (I);
(B) in subclause (II)--
(i) by striking ``a subsequent year'' and inserting ``2007'';
(ii) by striking ``in this subclause (or subclause (I)) for the previous year'' and inserting ``in subclause (I) for 2006''; and
(iii) by striking the period at the end and inserting a semicolon;
(C) by inserting after subclause (II) the following new subclauses:
``(III) for 2008, $27,500 (or $55,000 in the case of the combined value of the individual's assets or resources and the assets or resources of the individual's spouse); and
``(IV) for a subsequent year the dollar amounts specified in this subclause (or subclause (III)) for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.''; and
(D) in the last sentence, by inserting ``or (IV)'' after ``subclause (II)''.
(3) EXEMPTIONS FROM RESOURCES.--Section 1860D-14(a)(3) (42 U.S.C. 1395w-114(a)(3)) is amended--
(A) in subparagraph (D), in the matter preceding clause (i), by inserting ``, subject to the additional exclusions provided under subparagraph (G)'' before ``)'';
(B) in subparagraph (E)(i), in the matter preceding subclause (I), by inserting ``,subject to the additional exclusions provided under subparagraph (G)'' before ``)''; and
(C) by adding at the end the following new subparagraph:
``(G) ADDITIONAL EXCLUSIONS.--In determining the resources of an individual (and their eligible spouse, if any) under section 1613 for purposes of subparagraphs (D) and (E) the following additional exclusions shall apply:
``(i) LIFE INSURANCE POLICY.--No part of the value of any life insurance policy shall be taken into account.
``(ii) IN-KIND CONTRIBUTIONS.--No in-kind contribution shall be taken into account.
``(iii) PENSION OR RETIREMENT PLAN.--No balance in any pension or retirement plan shall be taken into account.''.
(4) EFFECTIVE DATE.--The amendments made by this subsection shall take effect on the date of enactment of this Act.
(c) Indexing Deductible and Cost-Sharing Above Annual Out-of-Pocket Threshold for Individuals With Income Below 150 Percent of Poverty Line.--
(1) INDEXING DEDUCTIBLE.--Section 1860D-14(a)(4)(B) (42 U.S.C. 1395w-114(a)(4)(B)) is amended--
(A) in clause (i), by striking ``or'';
(B) in clause (ii)--
(i) by striking ``a subsequent year'' and inserting ``2008'';
(ii) by striking ``this clause (or clause (i)) for the previous year'' and inserting ``clause (i) for 2007''; and
(iii) by striking ``involved.'' and inserting ``involved; and'';
(C) by adding after clause (ii) the following new clause:
``(iii) for 2008 and each succeeding year, the amount determined under this subparagraph for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.''; and
(D) in the flush sentence at the end, by striking ``clause (i) or (ii)'' and inserting ``clause (i), (ii), or (iii)''.
(2) INDEXING COST-SHARING.--Section 1860D-14(a) (42 U.S.C. 1395w-114(a)) is amended-
(A) in paragraph (1)(D)(iii), by striking ``exceed the copayment amount'' and all that follows through the period at the end and inserting ``exceed--
``(I) for 2006 and 2007, the copayment amount specified under section 1860D-2(b)(4)(A)(i)(I) for the drug and year involved; and
``(II) for 2008 and each succeeding year, the amount determined under this subparagraph for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.''; and
(B) in paragraph (2)(E), by striking ``exceed the copayment or coinsurance amount'' and all that follows through the period at the end and inserting ``exceed--
``(i) for 2006 and 2007, the copayment or coinsurance amount specified under section 1860D-2(b)(4)(A)(i)(I) for the drug and year involved; and
``(ii) for 2008 and each succeeding year, the amount determined under this clause for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.''.
(d) No Impact on Eligibility for Benefits Under Other Programs.--
(1) IN GENERAL.--Section 1860D-14(a)(3) (42 U.S.C. 1395w-114(a)(3)), as amended by subsection b(3), is amended--
(A) in subparagraph (A), in the matter preceding clause (i), by striking ``subparagraph (F)'' and inserting ``subparagraphs (F) and (H)''; and
(B) by adding at the end the following new subparagraph:
``(H) NO IMPACT ON ELIGIBILITY FOR BENEFITS UNDER OTHER PROGRAMS.--The availability of premium and cost-sharing subsidies under this section shall not be treated as benefits or otherwise taken into account in determining an individual's eligibility for, or the amount of benefits under, any other Federal program.''.
(2) EFFECTIVE DATE.--The amendments made by this subsection shall take effect on the date of enactment of this Act.
(e) Extension of Prescription Drug Discounts to Enrollees of Medicaid Managed Care Organizations.--
(1) IN GENERAL.--Section 1903(m)(2)(A) (42 U.S.C. 1396b(m)(2)(A)) is amended--
(A) in clause (xi), by striking ``and'' at the end;
(B) in clause (xii), by striking the period at the end and inserting ``; and''; and
(C) by adding at the end the following:
``(xiii) such contract provides that (I) payment for covered outpatient drugs dispensed to individuals eligible for medical assistance who are enrolled with the entity shall be subject to the same rebate required by the agreement entered into under section 1927 as the State is subject to and that the State shall allow the entity to collect such rebates from manufacturers, and (II) capitation rates paid to the entity shall be based on actual cost experience related to rebates and subject to the
Federal regulations requiring actuarially sound rates.''.
(2) CONFORMING AMENDMENTS.--Section 1927 (42 U.S.C. 1396r-8) is amended--
(A) in subsection (d)--
(i) in paragraph (1), by adding at the end the following:
``(C) Notwithstanding subparagraphs (A) and (B)--
``(i) a medicaid managed care organization with a contract under section 1903(m) may exclude or otherwise restrict coverage of a covered outpatient drug on the basis of policies or practices of the organization, such as those affecting utilization management, formulary adherence, and cost sharing or dispute resolution, in lieu of any State policies or practices relating to the exclusion or restriction of coverage of such drugs; and
``(ii) nothing in this section or paragraph (2)(A)(xiii) of section 1903(m) shall be construed as requiring a medicaid managed care organization with a contract under such section to maintain the same such polices and practices as those established by the State for purposes of individuals who receive medical assistance for covered outpatient drugs on a fee-for service basis.''; and
(ii) in paragraph (4), by inserting after subparagraph (E) the following:
``(F) Notwithstanding the preceding subparagraphs of this paragraph, any formulary established by medicaid managed care organization with a contract under section 1903(m) may be based on positive inclusion of drugs selected by a formulary committee consisting of physicians, pharmacists, and other individuals with appropriate clinical experience as long as drugs excluded from the formulary are available through prior authorization, as described in paragraph (5).''; and
(B) in subsection (j), by striking paragraph (1) and inserting the following:
``(1) Covered outpatients drugs are not subject to the requirements of this section if such drugs are--
``(A) dispensed by a health maintenance organization other than a medicaid managed care organization with a contract under section 1903(m); and
``(B) subject to discounts under section 340B of the Public Health Service Act.''.
(3) EFFECTIVE DATE.--The amendments made by this subsection take effect on the date of enactment of this Act and apply to rebate agreements entered into or renewed under section 1927 of the Social Security Act (42 U.S.C. 1396r-8) on or after such date.
(f) Increase in Basic Rebate for Single Source Drugs and Innovator Multiple Source Drugs.--
(1) IN GENERAL.--Section 1927(c) (42 U.S.C. 1396r-8(c)) is amended--
(A) in paragraph (1)(B)(i)--
(i) in subclause (IV), by striking ``and'' after the semicolon;
(ii) in subclause (V)--
(I) by inserting ``and before January 1, 2008,'' after ``1995,''; and
(II) by striking the period and inserting ``; and''; and
(iii) by adding at the end the following:
``(VI) after December 31, 2007, is 20.1 percent.''; and
(B) in paragraph (3) (B)--
(i) in clause (i), by striking ``and'' at the end;
(ii) in clause (ii)--
(I) by inserting ``and before January 1, 2008,'' after ``1993,''; and
(II) by striking the period and inserting ``; and''; and
(III) by adding at the end the following new clause:
``(iii) after December 31, 2007, is 16 percent.''.
(2) EFFECTIVE DATE.--The amendments made by this subsection take effect on the date of enactment of this Act and apply to rebate agreements entered into or renewed under section 1927 of the Social Security Act (42 U.S.C. 1396r-8) on or after such date.
(As printed in the Congressional Record for the Senate on Jul 31, 2007.)
