text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Guidance, Understanding, and 
  Information for Dual Eligibles (GUIDE) Act''.
  
  SEC. 2. FINDINGS; PURPOSE.
  
      (a) Findings.--The Congress finds the following:
              (1) Nearly 8,800,000 Americans were eligible for benefits 
          under the Medicare program and for medical assistance under 
          Medicaid (dual eligible beneficiaries) in fiscal year 2005. Of 
          these ``dual eligible beneficiaries'', almost 40 percent have 
          cognitive impairments, including Alzheimer's disease, dementia, 
          serious mental illnesses, and intellectual disabilities. Until 
          December 31, 2005, dual eligible beneficiaries received 
          outpatient prescription drug benefits through medical 
          assistance under Medicaid. On January 1, 2006, drug coverage 
          for dual eligibles switched from Medicaid to Medicare.
              (2) In 2008, 53 percent of dual eligible beneficiaries had 
          medication access problems and of those, 27 percent experienced 
          significant adverse clinical events.
              (3) Individuals with medication access issues experience 
          significantly more adverse clinical events. Among dual eligible 
          beneficiaries with mental illness who had medication access 
          problems, 27 percent experienced significant adverse clinical 
          events, which included emergency room visits and 
          hospitalizations.
              (4) In total, over 1,000,000 dual eligible beneficiaries 
          and low-income subsidy beneficiaries were automatically auto-
          enrolled to new benchmark prescription drug plans under part D 
          of the Medicare program between 2006 and 2007.
              (5) Community providers are at the front line of helping 
          the most vulnerable dual eligible beneficiaries obtain 
          prescription drug coverage under the Medicare program and 
          navigate complex enrollment and low-income subsidy eligibility 
          requirements under such program.
      (b) Purpose.--It is the purpose of this bill to help low-income 
  persons with cognitive impairments to enroll in and navigate the 
  prescription drug benefit under the Medicare program by providing front 
  line community providers who serve the population daily with financial 
  assistance to conduct vigorous education and outreach and direct case 
  management.
  
  SEC. 3. MEDICARE PRESCRIPTION DRUG OUTREACH DEMONSTRATION PROGRAM FOR 
                DUAL ELIGIBLE BENEFICIARIES WITH MENTAL DISABILITIES.
  
      (a) In General.--The Secretary of Health and Human Services (in 
  this section referred to as the ``Secretary'') shall establish a 3-year 
  demonstration program (in this section referred to as ``the 
  demonstration program'') under which the Secretary awards grants and 
  contracts to appropriate, qualified community programs and clinics for 
  individuals with intellectual or developmental disabilities or such 
  programs that are described in subsection (b)(1) of section 1913 of the 
  Public Health Services Act, regardless of whether such program meets 
  the criteria described in subsection (c) of such section, to employ 
  qualified social workers and case managers to provide Medicare 
  prescription drug assistance described in subsection (c) to target 
  full-benefit dual eligible individuals. As a condition of receipt of a 
  grant or contract under this subsection, a program or clinic shall 
  collect and maintain data identified by the Centers for Medicare & 
  Medicaid Services as critical for the final evaluation and report to 
  Congress described in subsection (d).
      (b) Target Full-Benefit Dual Eligible Individual Defined.--For 
  purposes of this section, the term ``target full-benefit dual eligible 
  individual'' means a part D eligible individual, as defined in section 
  1860D-1(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w-
  101(a)(3)(A)), who is a full-benefit dual eligible individual (as 
  defined in section 1935(c)(6) of the Social Security Act (42 U.S.C. 
  1396u-5(c)(6))) with one or more mental disabilities, including mental 
  retardation, dementia, mental illnesses, Alzheimer's disease, autism, 
  or any other related condition that produces serious cognitive 
  impairments.
      (c) Types of Assistance.--For purposes of subsection (a), the 
  Medicare prescription drug assistance described in this subsection is 
  one-on-one counseling with respect to one or more of the following 
  areas of assistance:
              (1) Assistance with initial enrollment in a prescription 
          drug plan under part D of title XVIII of the Social Security 
          Act or in an MA-PD plan under part C of such title.
              (2) Assistance with switching from one such prescription 
          drug plan or MA-PD plan to another such prescription drug plan 
          or MA-PD plan.
              (3) Assistance with filing for an exception to a formulary 
          used by such a plan.
              (4) Assistance with filing a grievance, reconsideration, or 
          appeal under section 1860D-4 of the Social Security Act (42 
          U.S.C. 1395w-104), including assistance with collecting 
          relevant information to file such a grievance, reconsideration, 
          or appeal.
              (5) Assistance with navigating utilization management 
          programs administered by a PDP sponsor offering a prescription 
          drug plan under part D of title XVIII of the Social Security 
          Act or a Medicare Advantage organization offering an MA-PD plan 
          under part C of such title.
              (6) Assistance with obtaining prescription drugs from 
          pharmacies participating with such a plan.
              (7) Assistance with facilitating contact with the Medicare 
          Beneficiary Ombudsman appointed under section 1808(c) of the 
          Social Security Act (42 U.S.C. 1395b-9).
      (d) Evaluation and Report.--
              (1) Evaluation.--The Secretary shall provide for an 
          evaluation of the demonstration program. Such evaluation may 
          include an analysis of--
                      (A) the utilization of the assistance provided 
                  under the program;
                      (B) the satisfaction of target full-benefit dual 
                  eligible individuals with such assistance; and
                      (C) the success of the program in--
                              (i) facilitating access by such individuals 
                          to covered part D drugs (as defined in section 
                          1860D-2(e) of the Social Security Act (42 
                          U.S.C. 1395w-102(e)); and
                              (ii) medication compliance.
              (2) Report.--Not later than 6 months after the date of the 
          completion of the demonstration program, the Secretary shall 
          submit to Congress a report on such evaluation and shall 
          include in such report recommendations regarding the 
          feasibility of permanently funding an education and outreach 
          program on the prescription drug benefit under the Medicare 
          program for target full-benefit dual eligible individuals.
      (e) Authorization of Appropriations.--There is authorized to be 
  appropriated for each of the fiscal years 2011 through 2013--
              (1) to carry out this section (other than subsection (d)), 
          $10,000,000; and
              (2) such sums as may be necessary to carry out subsection 
          (d).
target: Guidance, Understanding, and Information for Dual Eligibles (GUIDE) Act - Directs the Secretary of Health and Human Services to establish a three-year demonstration program under which the Secretary awards grants and contracts to appropriate, qualified community programs and clinics for individuals with intellectual or developmental disabilities, or certain programs under the Public Health Services Act, to employ qualified social workers and case managers to provide one-on-one counseling about benefits under part D (Voluntary Prescription Drug Benefit Program) of title XVIII (Medicare) of the Social Security Act (SSA) to a full-benefit dual eligible individual (eligible for benefits under both Medicare and SSA title XIX [Medicaid]) who has one or more mental disabilities.
feat_title: To provide for a Medicare prescription drug outreach demonstration program for individuals who are eligible for benefits under the Medicare Program and for medical assistance under Medicaid and who have mental disabilities.