S.Amdt. 2394

1. Adds CHAPTER 7--ADDITONAL REFORMS on page 256, between lines 21 and 22

   Adds a sectionPrinted page

   Inserted: CHAPTER 7--ADDITONAL REFORMS

   Inserted: SEC. 6081. ENSURING FAIR TREATMENT OF MEDICAID SERVICES FURNISHED TO INDIANS.

   Inserted: (a) Application of 100 Percent FMAP for Services Furnished to an Indian by an Urban Indian Health Program.--

   Inserted: (1) In general.--The third sentence of section 1905(b) (42 U.S.C. 1396d(b)) is amended by inserting before the period at the end the following: ", or through an urban Indian health program receiving funds under title V of the Indian Health Care Improvement Act".

   Inserted: (2) Conforming amendment.--Section 1911(c) (42 U.S.C. 1396j(c)) is amended by inserting before the period the following: ", or through an urban Indian health program receiving funds under title V of the Indian Health Care Improvement Act".

   Inserted: (b) Prohibition on Imposition of Premiums, Deductibles, Copayments, and Other Cost-Sharing on Indians.--Section 1916 (42 U.S.C. 1396o) is amended--

   Inserted: (1) in subsection (a)(3), by inserting "(other than such individuals who are Indians (as defined in section 4 of the Indian Health Care Improvement Act)" after "other such individuals";

   Inserted: (2) in subsection (b), in the matter preceding paragraph (1), by inserting "or who are Indians (as defined in section 4 of the Indian Health Care Improvement Act)" after "section 1902(a)(10)"; and

   Inserted: (3) in subsection (c)(1), by inserting "(other than such an individual who is an Indian (as defined in section 4 of the Indian Health Care Improvement Act))" after "section 1902(l)(1)".

   Inserted: (c) Prohibition on Recovery Against Estates of Indians.--Section 1917(b)(1) (42 U.S.C. 1396p(b)(1)) is amended, in the matter preceding subparagraph (A), by inserting " who is not an Indian (as defined in section 4 of the Indian Health Care Improvement Act)" after "an individual" the second place it appears.

   Inserted: (d) Requirement for Consultation With Indian Tribes Prior to Approval of Section 1115 Waivers.--Section 1115 (42 U.S.C. 1315) is amended by adding at the end the following:

   Inserted: "(g) In the case of an application for a waiver of compliance with the requirements of section 1902 (or a renewal or extension of such a waiver) that is likely to affect members of an Indian tribe (as defined in section 4 of the Indian Health Care Improvement Act) or a tribal health program (whether operated by an Indian tribe or a tribal organization (as so defined) serving such members, the Secretary shall, prior to granting such a waiver under subsection (a) or renewing or extending such a waiver under subsection (e), consult with each such Indian tribe.".

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   Inserted: (e) Effective Date.--Except as provided in section 6026(e), the amendments made by this section shall apply to items or services furnished on or after October 1, 2006.

   Inserted: SEC. 6082. INCREASED AFFORDABILITY OF INPATIENT DRUGS FOR MEDICAID AND SAFETY NET HOSPITALS.

   Inserted: (a) Extension of Discounts to Inpatient Drugs.--

   Inserted: (1) In general.--Section 340B(b) of the Public Health Service Act (42 U.S.C. 256b(b)) is amended by inserting before the period the following: ", except that, notwithstanding the limiting definition set forth in section 1927(k)(3) of the Social Security Act, the terms 'covered outpatient drug' and 'covered drug' include any inpatient or outpatient drug purchased by a hospital described in subsection (a)(4)(L)".

   Inserted: (2) Payment of medicaid rebates on inpatient drugs.--Section 340B(c) of such Act (42 U.S.C. 256b(c)) is amended to read as follows:

   Inserted: "(c) Payment of Medicaid Rebates on Inpatient Drugs.--

   Inserted: "(1) In general.--For the cost reporting period covered by the most recently filed Medicare cost report, a hospital described in subsection (a)(4)(L) shall provide to each State with an approved State plan under title XIX of such Act--

   Inserted: "(A) a rebate on the estimated annual costs of single source and innovator multiple source drugs provided to Medicaid recipients for inpatient use; and

   Inserted: "(B) a rebate on the estimated annual costs of noninnovator multiple source drugs provided to Medicaid recipients for inpatient use.

   Inserted: "(2) Calculations of rebates.--

   Inserted: "(A) Single source and innovator multiple source drugs.--For purposes of paragraph (1)(A)--

   Inserted: "(i) the rebate under such paragraph shall be calculated by multiplying the estimated annual costs of single source and innovator multiple source drugs provided to Medicaid recipients for inpatient use by the minimum rebate percentage described in section 1927(c)(1)(B) of the Social Security Act;

   Inserted: "(ii) the estimated annual costs of single source drugs and innovator multiple source drugs provided to Medicaid recipients for inpatient use under clause (i) shall be equal to the product of--

   Inserted: "(I) the hospital's actual acquisition costs of all drugs purchased during the cost reporting period for inpatient use;

   Inserted: "(II) the Medicaid inpatient drug charges as reported on the hospital's most recently filed Medicare cost report divided by total inpatient drug charges reported on the cost report; and

   Inserted: "(III) the percent of the hospital's annual inpatient drug costs described in subclause (I) arising out of the purchase of single source and innovator multiple source drugs; and

   Inserted: "(iii) the terms 'single source drug' and 'innovator multiple source drug' have the meanings given such terms in section 1927(k)(7) of the Social Security Act.

   Inserted: "(B) Noninnovator multiple source drugs.--For purposes of subparagraph (1) (B)--

   Inserted: "(i) the rebate under such paragraph shall be calculated by multiplying the estimated annual costs of noninnovator multiple source drugs provided to Medicaid recipients for inpatient use by the applicable percentage as defined in section 1927(c)(3)(B) of the Social Security Act;

   Inserted: "(ii) the estimated annual costs of noninnovator multiple source drugs provided to Medicaid recipients for inpatient use shall be equal to the product of--

   Inserted: "(I) the hospital's actual acquisition cost of all drugs purchased during the cost reporting period for inpatient use;

   Inserted: "(II) the Medicaid inpatient drug charges as reported on the hospital's most recently filed Medicare cost report divided by total inpatient drug charges reported on the cost report; and

   Inserted: "(III) the percent of the hospital's annual inpatient drug costs described in subclause (I) arising out of the purchase of noninnovator multiple source drugs; and

   Inserted: "(iii) the term 'noninnovator multiple source drug' has the meaning given such term in section 1927(k)(7) of the Social Security Act.

   Inserted: "(3) Payment deadline.--The rebates provided by a hospital under paragraph (1) shall be paid within 90 days of the filing of the hospital's most recently filed Medicare cost report.

   Inserted: "(4) Offset against medical assistance.--Amounts received by a State under this subsection in any quarter shall be considered to be a reduction in the amount expended under the State plan in the quarter for medical assistance for purposes of section 1903(a)(1) of the Social Security Act.".

   Inserted: (3) Clarification that group purchasing prohibition for certain hospitals is not applicable to inpatient drugs.--Section 340B(a)(4)(L)(iii) of such Act (42 U.S.C. 256b(a)(4)(L)(iii)) is amended by inserting "(not including such drugs purchased for inpatient use)" after "covered outpatient drugs".

   Inserted: (b) Providing Access to Discounted Drug Prices for Critical Access Hospitals.--

   Inserted: (1) In general.--Section 340B of the Public Health Service Act (42 U.S.C. 256b) is amended--

   Inserted: (A) in subsection (a)(4), by adding at the end the following:

   Inserted: "(M) An entity that--

   Inserted: "(i) is a critical access hospital (as determined under section 1820(c)(2) of the Social Security Act); and

   Inserted: "(ii) does not obtain covered outpatient drugs though a group purchasing organization or other group purchasing arrangement (not including such drugs purchased for inpatient use).";

   Inserted: (B) in subsection (b), as amended by section 2(a), by inserting "or subsection (a)(4)(M)" after "subsection (a)(4)(L)"; and

   Inserted: (C) in subsection (c)(1), as added by inserting "or subsection (a)(4)(M)" after "subsection (a)(4)(L)".

   Inserted: (2) Exclusion from medicaid best price calculations.--Section 1927(c)(1)(C)(i)(I) (42 U.S.C. 1396r-8(c)(1)(C)(i)(I)) is amended by inserting "and to critical access hospitals described in section 340B(a)(4)(M) of such Act" after "Public Health Service Act".

   Inserted: (3) Effective date.--The amendments made by this section shall apply to drugs purchased on or after January 1, 2006.

   Inserted: (c) Allowing Qualifying Children's Hospitals To Participate in the 340B Drug Discount Program.--

   Inserted: (1) In general.--Section 340B(a)(4)(L) of the Public Health Service Act (42 U.S.C. 256b(a)(4)(L)) is amended--

   Inserted: (A) by inserting after "A subsection (d) hospital (as defined in section 1886(d)(1)(B) of the Social Security Act)" the following: "or a children's hospital described in section 1886(d)(1)(B)(iii) of such Act"; and

   Inserted: (B) in clause (ii), by inserting "or, in the case of such a children's hospital, as would be determined under such section if the hospital were such a subsection (d) hospital" after "section 1886(d)(5)(F) of the Social Security Act".

   Inserted: (2) Effective date.--The amendments made by subsection (a) shall apply to drugs purchased on or after the date of the enactment of this Act.

   Original wording

   On page 256, between lines 21 and 22, insert the following:

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As printed