text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Medicare Dual Eligible Prescription 
  Drug Coverage Act of 2005''.
  
  SEC. 2. FINDINGS.
  
      The Senate finds the following:
              (1) Individuals who are dually eligible for benefits under 
          the medicare program and full benefits under the medicaid 
          program--
                      (A) are among the most vulnerable populations in 
                  our society; and
                      (B) require adequate outreach, education, and 
                  timing in order to adjust to changes in our health care 
                  delivery system.
              (2) The transition of 6,400,000 dual eligibles from 
          prescription drug coverage under the medicaid program to 
          prescription drug coverage under part D of the medicare program 
          is the largest transition ever of individuals from one 
          insurance program to another.
              (3) In its June 2004 report to Congress, the Medicare 
          Payment Advisory Commission (MedPAC) suggested that large, 
          private employers with 75,000 employees or less need at least 6 
          months to transition their employees' drug coverage from one 
          pharmacy benefit management company to another such company. 
          The States and the Federal Government are taking on a far more 
          complex task with 6,400,000 dual eligibles having to make the 
          transition described in paragraph (2).
              (4) Timely access to prescription drugs leads to higher 
          quality of life and prevents avoidable emergency room visits, 
          hospitalizations, and premature nursing home placements.
              (5) Since even a short-term gap in prescription drug 
          coverage could have serious health consequences for dual 
          eligibles, Congress must work to guarantee as smooth a 
          transition as possible for dual eligibles so that no dual 
          eligible is without prescription drug coverage even for one 
          day.
  
  SEC. 3. CONTINUING STATE COVERAGE OF MEDICAID PRESCRIPTION DRUG 
                COVERAGE TO MEDICARE DUAL ELIGIBLE BENEFICIARIES FOR 6 
                MONTHS.
  
      (a) Six-Month Transition.--For prescriptions filled during the 
  period beginning on January 1, 2006, and ending on June 30, 2006, 
  section 1935(d) of the Social Security Act (42 U.S.C. 1396u-5(d)) shall 
  not apply and, notwithstanding any other provision of law, a State (as 
  defined for purposes of title XIX of such Act) shall continue to 
  provide (and receive Federal financial participation for) medical 
  assistance under such title with respect to prescription drugs as if 
  such section 1935(d) had not been enacted.
      (b) Application.--
              (1) Medicare as primary payer.--Nothing in subsection (a) 
          shall be construed as changing or affecting the primary payer 
          status of a prescription drug plan or an MA-PD plan under part 
          D of title XVIII of the Social Security Act with respect to 
          prescription drugs furnished to any full-benefit dual eligible 
          individual (as defined in section 1935(c)(6) of such Act (42 
          U.S.C. 1396u-5(c)(6)) during the 6-month period described in 
          such subsection.
              (2) Third party liability.--Nothing in subsection (a) shall 
          be construed as limiting the authority or responsibility of a 
          State under section 1902(a)(25) of the Social Security Act (42 
          U.S.C. 1396a(a)(25)) to seek reimbursement from a prescription 
          drug plan, an MA-PD plan, or any other third party, of the 
          costs incurred by the State in providing prescription drug 
          coverage described in such subsection.
  
  SEC. 4. DELAY IN IMPLEMENTATION OF MEDICAID CLAWBACK PAYMENTS.
  
      Notwithstanding section 1935(c) of the Social Security Act (42 
  U.S.C. 1396u-5(c)), a State or the District of Columbia shall not be 
  required to provide for a payment under such section to the Secretary 
  of Health and Human Services for any month prior to July 1, 2006.
  
  SEC. 5. EDUCATION AND OUTREACH TO DUAL ELIGIBLES REGARDING PRESCRIPTION 
                DRUG COVERAGE AND MONITORING OF THE TRANSITION OF DUAL 
                ELIGIBLES TO PRESCRIPTION DRUG COVERAGE UNDER MEDICARE.
  
      (a) MMA Amounts.--Notwithstanding any other provision of law, of 
  the amounts appropriated for the Centers for Medicare & Medicaid 
  Services under section 1015(a)(1) of the Medicare Prescription Drug, 
  Improvement, and Modernization Act of 2003 (Public Law 108-173; 117 
  Stat. 2446), the following rules shall apply:
              (1) Education and outreach to duals.--$100,000,000 shall be 
          used to provide education and outreach, including through one-
          on-one counseling and application assistance, to full-benefit 
          dual eligible individuals (as defined in section 1935(c)(6) of 
          the Social Security Act (42 U.S.C. 1396u-5(c)(6))) regarding 
          prescription drug coverage under part D of title XVIII of such 
          Act. Of such amount--
                      (A) at least $20,000,000 (but in no case more than 
                  $50,000,000) shall be used to award grants to States 
                  under section 4360 of the Omnibus Budget Reconciliation 
                  Act of 1990 (42 U.S.C. 1395b-4) to provide such 
                  education and outreach; and
                      (B) the remaining amount shall be used to provide 
                  funding to community-based organizations that work with 
                  full-benefit dual eligible individuals (as so defined) 
                  in order to provide such education and outreach.
              (2) Monitoring impact on duals.--
                      (A) In general.--$50,000,000 shall be used by the 
                  Centers for Medicare & Medicaid Services, in 
                  consultation with the Centers for Disease Control and 
                  Prevention, the Administration on Aging, and the Social 
                  Security Administration, to develop and implement a 
                  standardized protocol to collect data from health 
                  departments and other sources in 10 representative 
                  urban and rural communities on the impact of the 
                  transition of full benefit dual eligible individuals 
                  (as so defined) from prescription drug coverage under 
                  the medicaid program to prescription drug coverage 
                  under part D of the medicare program. Such protocol 
                  shall be implemented by not later than July 1, 2005.
                      (B) Monitoring.--The protocol developed under 
                  subparagraph (A) shall include for the monitoring of 
                  the following information with respect to such full 
                  benefit dual eligible individuals:
                              (i) Emergency room visit rates.
                              (ii) Hospitalization rates.
                              (iii) Nursing home placement rates.
                              (iv) Deaths.
                      (C) Collection by pdps and ma-pds.--The protocol 
                  developed under subparagraph (A) shall require that 
                  such data be collected by the prescription drug plans 
                  and the MA-PDs in which the individuals are enrolled 
                  and include information on race and ethnicity.
                      (D) Reports.--Not later than January 1, 2006, and 
                  July 1, 2006, the Administrator of the Centers for 
                  Medicare & Medicaid Services, in consultation with the 
                  Centers for Disease Control and Prevention, the 
                  Administration on Aging, and the Social Security 
                  Administration, shall submit a report to Congress on 
                  the implementation of the protocol under subparagraph 
                  (A).
      (b) New Amounts.--There are appropriated to the Secretary of Health 
  and Human Services, to be transferred from the Federal Hospital 
  Insurance Trust Fund and the Federal Supplementary Medical Insurance 
  Trust Fund, for fiscal year 2005 and each subsequent fiscal year, an 
  amount not to exceed $50,000,000 (or if greater, an amount equal to $1 
  multiplied by the number of individuals entitled to benefits under part 
  A of title XVIII of the Social Security Act or enrolled under part B of 
  such title for the year) in order to award grants to States under 
  section 4360 of the Omnibus Budget Reconciliation Act of 1990 (42 
  U.S.C. 1395b-4).
      (c) Extension of Availability of Amounts Appropriated Under MMA.--
  Section 1015(b) of the Medicare Prescription Drug, Improvement, and 
  Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2446) is 
  amended by striking ``September 30, 2005'' and inserting ``September 
  30, 2006''.
  
  SEC. 6. COLLECTION AND SHARING OF DUAL ELIGIBLE DRUG UTILIZATION DATA.
  
      (a) In General.--Section 1860D-42 of the Social Security Act (42 
  U.S.C. 1395w-152) is amended by adding at the end the following new 
  subsection:
      ``(c) Collection and Sharing of Dual Eligible Drug Utilization 
  Data.--
              ``(1) Plan requirement.--A PDP sponsor of a prescription 
          drug plan and an MA organization offering an MA-PD plan shall 
          submit to the Secretary such information regarding the drug 
          utilization of enrollees in such plans who are full-benefit 
          dual eligible individuals (as defined in section 1935(c)(6)) as 
          the Secretary determines appropriate to carry out paragraph 
          (2).
              ``(2) Collection and sharing of data.--The Secretary shall 
          collect data on the drug utilization of full-benefit dual 
          eligible individuals (as so defined). The Secretary shall share 
          such data with the States and the District of Columbia in as 
          close to a real-time basis as possible.''.
      (b) Effective Date.--The amendment made by subsection (a) shall 
  take effect as if included in the enactment of section 101(a) of the 
  Medicare Prescription Drug, Improvement, and Modernization Act of 2003 
  (Public Law 108-173; 117 Stat. 2071).
  
  SEC. 7. GAO STUDY ON THE CLAWBACK FORMULA.
  
      (a) Study.--
              (1) In general.--The Comptroller General of the United 
          States shall conduct a study on the clawback formula contained 
          in section 1935(c) of the Social Security Act (42 U.S.C. 1396u-
          5(c)), as added by section 103(b) of the Medicare Prescription 
          Drug, Improvement, and Modernization Act of 2003 (Public Law 
          108-173; 117 Stat. 2155).
              (2) Requirements.--The study conducted under paragraph (1) 
          shall include a full examination of--
                      (A) disincentives for States to enroll full-benefit 
                  dual eligible individuals (as defined in section 
                  1935(c)(6) of the Social Security Act (42 U.S.C. 1396u-
                  5(c)(6))) in the medicaid program or part D of title 
                  XVIII of the Social Security Act;
                      (B) the 6-month delay in States receiving rebate 
                  data;
                      (C) the prescription drug cost containment measures 
                  implemented by States after 2003; and
                      (D) issues relating to States having to pay more 
                  for prescription drug coverage for full benefit dual 
                  eligible individuals (as so defined) than they 
                  otherwise would have if the Medicare Prescription Drug, 
                  Improvement, and Modernization Act of 2003 (Public Law 
                  108-173; 117 Stat. 2066 et seq.) had not been enacted.
      (b) Report.--Not later than April 1, 2006, the Comptroller General 
  of the United States shall submit to Congress a report on the study 
  conducted under subsection (a) together with such recommendations as 
  the Comptroller General determines appropriate.
target: Medicare Dual Eligible Prescription Drug Coverage Act of 2005 - Provides that, for prescriptions filled between January 1 and June 30, 2006, requirements for the coordination of prescription drug benefits with Medicare as primary payor for dual eligible individuals under the new prescription drug benefit program (PDP) under Medicare part E (Voluntary Prescription Drug Benefit Program) shall not apply. Requires a State to continue to provide Medicaid medical assistance with respect to prescription drugs as if such coordination requirements had not been enacted.
  
  Declares that no State or the District of Columbia shall be required to pay (reimburse) the Secretary of Health and Human Services for Medicaid prescription drug costs for dual eligible individuals (Medicaid clawback payments) for any month before July 1, 2006.
  
  Earmarks specified amounts for education and outreach to dual eligibles regarding prescription drug coverage and monitoring of their transition to prescription drug coverage under Medicare.
  
  Requires a PDP sponsor and an MA organization offering an MA-PD plan to submit to the Secretary appropriate information regarding the drug utilization of enrollees in such plans who are full-benefit dual eligible individuals. Directs the Secretary to collect data on the drug utilization of full-benefit dual eligible individuals and share it with the States and District of Columbia in as close to a real-time basis as possible.
  
  Directs the Comptroller General of the United States to study and report to Congress on the clawback formula.
feat_title: To continue State coverage of Medicaid prescription drug coverage to Medicare dual eligible beneficiaries for 6 months while still allowing the Medicare part D benefit to be implemented as scheduled.