To provide for coverage for self-injected biologicals under part B of the medicare program until Medicare Prescription Drug plans are available.

1. 1

   Change 1: Adds SEC. ____. MEDICARE COVERAGE OF SELF-INJECTED BIOLOGICALS at the end of subtitle B of title IV

   Adds a section

   In S. 1 · Reported to Senate

   (b) Report.--Not later than 1 year after the date of enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the study conducted under subsection (a). The report shall include recommendations regarding the use of more current data in computing geographic cost of practice indices as well as the use of data directly representative of physicians' costs (rather than proxy measures of such costs).

   Inserted: SEC. ____. MEDICARE COVERAGE OF SELF-INJECTED BIOLOGICALS.

   Inserted: (a) Coverage.--

   Inserted: (1) In general.--Section 1861(s)(2) (42 U.S.C. 1395x(s)(2)) is amended--

   Inserted: (A) in subparagraph (U), by striking "and" at the end;

   Inserted: (B) in subparagraph (V), by inserting "and" at the end; and

   Inserted: (C) by adding at the end the following new subparagraph:

   Inserted: "(W)(i) a self-injected biological (which is approved by the Food and Drug Administration) that is prescribed as a complete replacement for a drug or biological (including the same biological for which payment is made under this title when it is furnished incident to a physicians' service) that would otherwise be described in subparagraph (A) or (B) and that is furnished during 2004 or 2005; and

   Inserted: "(ii) a self-injected drug that is used to treat multiple sclerosis;".

   Inserted: (2) Conforming amendment.--Subparagraphs (A) and (B) of section 1861(s)(2) of the Social Security Act (42 U.S.C. 1395x(s)(2)) are each amended by inserting ", except for any drug or biological described in subparagraph (W)," after "which".

   Inserted: (b) Effective Date.--The amendments made by subsection (a) shall apply to drugs and biologicals furnished on or after January 1, 2004 and before January 1, 2006.

   Original wording

   At the end of subtitle B of title IV, insert the following:

2. 2

   Change 2: Adds SEC. ____. MEDICARE SECONDARY PAYOR (MSP) PROVISIONS at the end of title VI

   Adds a section

   In S. 1 · Reported to Senate

   Section 13031(j)(3) of the Consolidated Omnibus Budget Reconciliation Act of 1985 (19 U.S.C. 58c(j)(3)) is amended by striking "September 30, 2003" and inserting "September 30, 2013". Amend the title so as to read: "A bill to amend title XVIII of the Social Security Act to provide for a voluntary prescription drug benefit under the medicare program and to strengthen and improve the medicare program, and for other purposes.".

   Inserted: SEC. ____. MEDICARE SECONDARY PAYOR (MSP) PROVISIONS.

   Inserted: (a) Technical Amendment Concerning Secretary's Authority To Make Conditional Payment When Certain Primary Plans Do Not Pay Promptly.--

   Inserted: (1) In general.--Section 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is amended--

   Inserted: (A) in subparagraph (A)(ii), by striking "promptly (as determined in accordance with regulations)"; and

   Inserted: (B) in subparagraph (B)--

   Inserted: (i) by redesignating clauses (i) through (iii) as clauses (ii) through (iv), respectively; and

   Inserted: (ii) by inserting before clause (ii), as so redesignated, the following new clause:

   Inserted: "(i) Authority to make conditional payment.--The Secretary may make payment under this title with respect to an item or service if a primary plan described in subparagraph (A)(ii) has not made or cannot reasonably be expected to make payment with respect to such item or service promptly (as determined in accordance with regulations). Any such payment by the Secretary shall be conditioned on reimbursement to the appropriate Trust Fund in accordance with the succeeding provisions of this subsection.".

   Inserted: (2) Effective date.--The amendments made by paragraph (1) shall be effective as if included in the enactment of title III of the Medicare and Medicaid Budget Reconciliation Amendments of 1984 (Public Law 98-369).

   Inserted: (b) Clarifying Amendments to Conditional Payment Provisions.--Section 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is further amended--

   Inserted: (1) in subparagraph (A), in the matter following clause (ii), by inserting the following sentence at the end: "An entity that engages in a business, trade, or profession shall be deemed to have a self-insured plan if it carries its own risk (whether by a failure to obtain insurance, or otherwise) in whole or in part.";

   Inserted: (2) in subparagraph (B)(ii), as redesignated by subsection (a)(2)(B)--

   Show 6 more inserted paragraphsShow less

   Inserted: (A) by striking the first sentence and inserting the following: "A primary plan, and an entity that receives payment from a primary plan, shall reimburse the appropriate Trust Fund for any payment made by the Secretary under this title with respect to an item or service if it is demonstrated that such primary plan has or had a responsibility to make payment with respect to such item or service. A primary plan's responsibility for such payment may be demonstrated by a judgment, a payment conditioned upon the recipient's compromise, waiver, or release (whether or not there is a determination or admission of liability) of payment for items or services included in a claim against the primary plan or the primary plan's insured, or by other means."; and

   Inserted: (B) in the final sentence, by striking "on the date such notice or other information is received" and inserting "on the date notice of, or information related to, a primary plan's responsibility for such payment or other information is received"; and

   Inserted: (3) in subparagraph (B)(iii), as redesignated by subsection (a)(2)(B), by striking the first sentence and inserting the following: "In order to recover payment made under this title for an item or service, the United States may bring an action against any or all entities that are or were required or responsible (directly, as an insurer or self-insurer, as a third-party administrator, as an employer that sponsors or contributes to a group health plan, or large group health plan, or otherwise) to make payment with respect to the same item or service (or any portion thereof) under a primary plan. The United States may, in accordance with paragraph (3)(A) collect double damages against any such entity. In addition, the United States may recover under this clause from any entity that has received payment from a primary plan or from the proceeds of a primary plan's payment to any entity.".

   Inserted: (c) Clerical Amendments.--Section 1862(b) (42 U.S.C. 1395y(b)) is amended--

   Inserted: (1) in paragraph (1)(A), by moving the indentation of clauses (ii) through (v) 2 ems to the left; and

   Inserted: (2) in paragraph (3)(A), by striking "such" before "paragraphs".

   Original wording

   At the end of title VI, add the following:

Read automatically from the Congressional Record. Check the original before relying on it.

As printed