Medicare State Reimbursement Act of 2006

Mr. President, I am pleased to join with Senator Lautenberg today to introduce urgent legislation to assist the many States which have stepped forward to provide an essential safety net to our Medicare Part D beneficiaries. Our States have acted as ``payers of last resort''--as beneficiaries faced unaffordable costs when errors in implementing their coverage denied them access to vital medications. The Medicare State Reimbursement Act will reimburse our States for their costs in assuring that millions receive their medications. So many of our colleagues have recognized the crisis which was averted-- Senators Coleman, Schumer, DeWine, Feinstein, Collins, Jeffords and many more have joined us in this bipartisan effort to support the States in the vital role they have played in countering a deficit of action by the Federal bureaucracy.

The introduction of the prescription drug benefit is a landmark step in the progress of Medicare. This benefit will save the average senior about $1,000 per year. This is the relief that millions have needed for so long. It must eliminate the terrible choices so many have had to make between vital medications and the other essentials of life--not create new dilemmas.

As we worked to ensure a prescription drug benefit, many of us worked hard to assure special help to those with the most limited resources. We enacted a benefit which provided additional help for those on limited incomes, including millions who rely on both Medicare and Medicaid--our ``dual eligibles''. It was essential that these individuals would see uninterrupted coverage of their essential medications. So we needed to ensure each would be enrolled in a drug plan. To do this, the Centers for Medicare and Medicaid Services, CMS, randomly assigned each of them to a plan. In a program based on competition--based on choices--plans are going to differ. To find the best plan, one must make an educated choice, not a random assignment.

So the result of random assignment was predictable. Many beneficiaries wound up in plans which did not cover their drugs. My State of Maine immediately stepped forward to work to assure that every beneficiary was matched with the plan which best met their needs. As plans were reviewed, my State found a third of those reviewed--15,000 beneficiaries--were not enrolled in the most appropriate drug plan. Getting each into the plan that met their medication requirements was essential to meeting their needs.

Despite these best efforts to improve the situation, some beneficiaries were not in a plan at all, while others were in plans which seemed not to understand that every beneficiary was to be allowed a refill of their existing medications. So as beneficiaries came to their local pharmacies to get prescription refills, many faced great obstacles in getting the drugs they needed. We had heard of some problems in validating enrollment eligibility, but at year end, these just became worse, and we found beneficiaries were not properly enrolled, plans were not giving the proper transition refills, and co- payments charged were often excessive. As individual faced co-payments of $100 or more--instead of the $5 or less they should have been charged--many simply couldn't afford their medications. Thankfully, our States have stepped in to make sure low income seniors received their medications. In Maine alone, approximately $5 million in assistance has been given to ensure medications are dispensed.

This drug benefit must increase access, not make it more difficult. I am appalled, that with all the technology we have, so many have faced such difficulties in the implementation of this benefit. I salute the forbearance of our pharmacies, as they strived to meet essential needs, and the efforts of my State and others which have assured that these most vulnerable Americans not suffer from the failures of either the Federal bureaucracy or the plan administrators.

So what this legislation does is simple. It authorizes CMS to reimburse the States their costs which they paid for providing medications to those who did not receive the benefits to which they were entitled. It does this by a simple mechanism: an adjustment in the ``claw back'' payments which States make as their contribution for their dual eligibles. Accordingly, CMS is authorized to collect those funds from those who were obligated to serve our beneficiaries--the drug plans and managed care plans which deliver the drug benefit.

It has been confirmed that CMS does not presently have this authority, and it simply is not acceptable to propose that CMS will simply help the States collect from the plans. It was CMS which approved the plans, and it is CMS which administers Part D. They are in the best position to assure plan compliance.

I look forward to prompt consideration of this legislation, and look forward to continuing work with my colleagues to assure that the Medicare drug benefit meets the needs of all our beneficiaries, and that none of our most vulnerable citizens should suffer from such administrative failures as we have seen here.

I call on my colleagues to join us in assuring our States are justly compensated.

Mr. President, I am pleased to join with Senator Lautenberg today to introduce urgent legislation to assist the many States which have stepped forward to provide an essential safety net to our Medicare Part D beneficiaries. Our States have acted as ``payers of last resort''--as beneficiaries faced unaffordable costs when errors in implementing their coverage denied them access to vital medications. The Medicare State Reimbursement Act will reimburse our States for their costs in assuring that millions receive their medications. So many of our colleagues have recognized the crisis which was averted-- Senators Coleman, Schumer, DeWine, Feinstein, Collins, Jeffords and many more have joined us in this bipartisan effort to support the States in the vital role they have played in countering a deficit of action by the Federal bureaucracy.

The introduction of the prescription drug benefit is a landmark step in the progress of Medicare. This benefit will save the average senior about $1,000 per year. This is the relief that millions have needed for so long. It must eliminate the terrible choices so many have had to make between vital medications and the other essentials of life--not create new dilemmas.

As we worked to ensure a prescription drug benefit, many of us worked hard to assure special help to those with the most limited resources. We enacted a benefit which provided additional help for those on limited incomes, including millions who rely on both Medicare and Medicaid--our ``dual eligibles''. It was essential that these individuals would see uninterrupted coverage of their essential medications. So we needed to ensure each would be enrolled in a drug plan. To do this, the Centers for Medicare and Medicaid Services, CMS, randomly assigned each of them to a plan. In a program based on competition--based on choices--plans are going to differ. To find the best plan, one must make an educated choice, not a random assignment.

So the result of random assignment was predictable. Many beneficiaries wound up in plans which did not cover their drugs. My State of Maine immediately stepped forward to work to assure that every beneficiary was matched with the plan which best met their needs. As plans were reviewed, my State found a third of those reviewed--15,000 beneficiaries--were not enrolled in the most appropriate drug plan. Getting each into the plan that met their medication requirements was essential to meeting their needs.

Despite these best efforts to improve the situation, some beneficiaries were not in a plan at all, while others were in plans which seemed not to understand that every beneficiary was to be allowed a refill of their existing medications. So as beneficiaries came to their local pharmacies to get prescription refills, many faced great obstacles in getting the drugs they needed. We had heard of some problems in validating enrollment eligibility, but at year end, these just became worse, and we found beneficiaries were not properly enrolled, plans were not giving the proper transition refills, and co- payments charged were often excessive. As individual faced co-payments of $100 or more--instead of the $5 or less they should have been charged--many simply couldn't afford their medications. Thankfully, our States have stepped in to make sure low income seniors received their medications. In Maine alone, approximately $5 million in assistance has been given to ensure medications are dispensed.

This drug benefit must increase access, not make it more difficult. I am appalled, that with all the technology we have, so many have faced such difficulties in the implementation of this benefit. I salute the forbearance of our pharmacies, as they strived to meet essential needs, and the efforts of my State and others which have assured that these most vulnerable Americans not suffer from the failures of either the Federal bureaucracy or the plan administrators.

So what this legislation does is simple. It authorizes CMS to reimburse the States their costs which they paid for providing medications to those who did not receive the benefits to which they were entitled. It does this by a simple mechanism: an adjustment in the ``claw back'' payments which States make as their contribution for their dual eligibles. Accordingly, CMS is authorized to collect those funds from those who were obligated to serve our beneficiaries--the drug plans and managed care plans which deliver the drug benefit.

It has been confirmed that CMS does not presently have this authority, and it simply is not acceptable to propose that CMS will simply help the States collect from the plans. It was CMS which approved the plans, and it is CMS which administers Part D. They are in the best position to assure plan compliance.

I look forward to prompt consideration of this legislation, and look forward to continuing work with my colleagues to assure that the Medicare drug benefit meets the needs of all our beneficiaries, and that none of our most vulnerable citizens should suffer from such administrative failures as we have seen here.

I call on my colleagues to join us in assuring our States are justly compensated.

Mr. President, I am pleased to join with Senator Lautenberg today to introduce urgent legislation to assist the many States which have stepped forward to provide an essential safety net to our Medicare Part D beneficiaries. Our States have acted as ``payers of last resort''--as beneficiaries faced unaffordable costs when errors in implementing their coverage

denied them access to vital medications. The Medicare State Reimbursement Act will reimburse our States for their costs in assuring that millions receive their medications. So many of our colleagues have recognized the crisis which was averted--Senators Coleman, Schumer, DeWine, Feinstein, Collins, Jeffords and many more have joined us in this bipartisan effort to support the States in the vital role they have played in countering a deficit of action by the Federal bureaucracy.

The introduction of the prescription drug benefit is a landmark step in the progress of Medicare. This benefit will save the average senior about $1,000 per year. This is the relief that millions have needed for so long. It must eliminate the terrible choices so many have had to make between vital medications and the other essentials of life--not create new dilemmas.

As we worked to ensure a prescription drug benefit, many of us worked hard to assure special help to those with the most limited resources. We enacted a benefit which provided additional help for those on limited incomes, including millions who rely on both Medicare and Medicaid--our ``dual eligibles''. It was essential that these individuals would see uninterrupted coverage of their essential medications. So we needed to ensure each would be enrolled in a drug plan. To do this, the Centers for Medicare and Medicaid Services, CMS, randomly assigned each of them to a plan. In a program based on competition--based on choices--plans are going to differ. To find the best plan, one must make an educated choice, not a random assignment.

So the result of random assignment was predictable. Many beneficiaries wound up in plans which did not cover their drugs. My State of Maine immediately stepped forward to work to assure that every beneficiary was matched with the plan which best met their needs. As plans were reviewed, my State found a third of those reviewed--15,000 beneficiaries--were not enrolled in the most appropriate drug plan. Getting each into the plan that met their medication requirements was essential to meeting their needs.

Despite these best efforts to improve the situation, some beneficiaries were not in a plan at all, while others were in plans which seemed not to understand that every beneficiary was to be allowed a refill of their existing medications. So as beneficiaries came to their local pharmacies to get prescription refills, many faced great obstacles in getting the drugs they needed. We had heard of some problems in validating enrollment eligibility, but at year end, these just became worse, and we found beneficiaries were not properly enrolled, plans were not giving the proper transition refills, and co- payments charged were often excessive. As individual faced co-payments of $100 or more--instead of the $5 or less they should have been charged--many simply couldn't afford their medications. Thankfully, our States have stepped in to make sure low income seniors received their medications. In Maine alone, approximately $5 million in assistance has been given to ensure medications are dispensed.

This drug benefit must increase access, not make it more difficult. I am appalled, that with all the technology we have, so many have faced such difficulties in the implementation of this benefit. I salute the forbearance of our pharmacies, as they strived to meet essential needs, and the efforts of my State and others which have assured that these most vulnerable Americans not suffer from the failures of either the Federal bureaucracy or the plan administrators.

So what this legislation does is simple. It authorizes CMS to reimburse the States their costs which they paid for providing medications to those who did not receive the benefits to which they were entitled. It does this by a simple mechanism: an adjustment in the ``claw back'' payments which States make as their contribution for their dual eligibles. Accordingly, CMS is authorized to collect those funds from those who were obligated to serve our beneficiaries--the drug plans and managed care plans which deliver the drug benefit.

It has been confirmed that CMS does not presently have this authority, and it simply is not acceptable to propose that CMS will simply help the States collect from the plans. It was CMS which approved the plans, and it is CMS which administers Part D. They are in the best position to assure plan compliance.

I look forward to prompt consideration of this legislation, and look forward to continuing work with my colleagues to assure that the Medicare drug benefit meets the needs of all our beneficiaries, and that none of our most vulnerable citizens should suffer from such administrative failures as we have seen here.

I call on my colleagues to join us in assuring our States are justly compensated.

Mr. President, I am pleased to join with Senator Lautenberg today to introduce urgent legislation to assist the many States which have stepped forward to provide an essential safety net to our Medicare Part D beneficiaries. Our States have acted as ``payers of last resort''--as beneficiaries faced unaffordable costs when errors in implementing their coverage

denied them access to vital medications. The Medicare State Reimbursement Act will reimburse our States for their costs in assuring that millions receive their medications. So many of our colleagues have recognized the crisis which was averted--Senators Coleman, Schumer, DeWine, Feinstein, Collins, Jeffords and many more have joined us in this bipartisan effort to support the States in the vital role they have played in countering a deficit of action by the Federal bureaucracy.

The introduction of the prescription drug benefit is a landmark step in the progress of Medicare. This benefit will save the average senior about $1,000 per year. This is the relief that millions have needed for so long. It must eliminate the terrible choices so many have had to make between vital medications and the other essentials of life--not create new dilemmas.

As we worked to ensure a prescription drug benefit, many of us worked hard to assure special help to those with the most limited resources. We enacted a benefit which provided additional help for those on limited incomes, including millions who rely on both Medicare and Medicaid--our ``dual eligibles''. It was essential that these individuals would see uninterrupted coverage of their essential medications. So we needed to ensure each would be enrolled in a drug plan. To do this, the Centers for Medicare and Medicaid Services, CMS, randomly assigned each of them to a plan. In a program based on competition--based on choices--plans are going to differ. To find the best plan, one must make an educated choice, not a random assignment.

So the result of random assignment was predictable. Many beneficiaries wound up in plans which did not cover their drugs. My State of Maine immediately stepped forward to work to assure that every beneficiary was matched with the plan which best met their needs. As plans were reviewed, my State found a third of those reviewed--15,000 beneficiaries--were not enrolled in the most appropriate drug plan. Getting each into the plan that met their medication requirements was essential to meeting their needs.

Despite these best efforts to improve the situation, some beneficiaries were not in a plan at all, while others were in plans which seemed not to understand that every beneficiary was to be allowed a refill of their existing medications. So as beneficiaries came to their local pharmacies to get prescription refills, many faced great obstacles in getting the drugs they needed. We had heard of some problems in validating enrollment eligibility, but at year end, these just became worse, and we found beneficiaries were not properly enrolled, plans were not giving the proper transition refills, and co- payments charged were often excessive. As individual faced co-payments of $100 or more--instead of the $5 or less they should have been charged--many simply couldn't afford their medications. Thankfully, our States have stepped in to make sure low income seniors received their medications. In Maine alone, approximately $5 million in assistance has been given to ensure medications are dispensed.

This drug benefit must increase access, not make it more difficult. I am appalled, that with all the technology we have, so many have faced such difficulties in the implementation of this benefit. I salute the forbearance of our pharmacies, as they strived to meet essential needs, and the efforts of my State and others which have assured that these most vulnerable Americans not suffer from the failures of either the Federal bureaucracy or the plan administrators.

So what this legislation does is simple. It authorizes CMS to reimburse the States their costs which they paid for providing medications to those who did not receive the benefits to which they were entitled. It does this by a simple mechanism: an adjustment in the ``claw back'' payments which States make as their contribution for their dual eligibles. Accordingly, CMS is authorized to collect those funds from those who were obligated to serve our beneficiaries--the drug plans and managed care plans which deliver the drug benefit.

It has been confirmed that CMS does not presently have this authority, and it simply is not acceptable to propose that CMS will simply help the States collect from the plans. It was CMS which approved the plans, and it is CMS which administers Part D. They are in the best position to assure plan compliance.

I look forward to prompt consideration of this legislation, and look forward to continuing work with my colleagues to assure that the Medicare drug benefit meets the needs of all our beneficiaries, and that none of our most vulnerable citizens should suffer from such administrative failures as we have seen here.

I call on my colleagues to join us in assuring our States are justly compensated.

Mr. President, I am pleased to join with Senators Lautenberg, Snowe, Schumer, Coleman and many others to introduce legislation to reimburse States for prescription drug expenses they have incurred for their residents who are dually eligible for Medicare and Medicaid. States have had no other option but to step in and ensure seniors can still get their drugs because the implementation of the new Medicare drug benefit has been so poorly handled by the Bush administration.

The faulty implementation of the new drug benefit has caused a major

health emergency in California and States across the country, particularly for seniors with chronic and debilitating diseases who rely on multiple medications every day to keep them alive.

It is incomprehensible to me that with all the money and time given to the Centers for Medicare and Medicaid Services, CMS, to implement this new drug benefit, stories emerge every day of seniors and disabled individuals being hospitalized because they are being told they have to pay hundreds of dollars for their medications which they cannot afford and thus don't take.

Because of severe glitches in the database run by CMS, these individuals are leaving pharmacies without their medications or are making undue sacrifices to pay for costs they should not have incurred in the first place.

So far, more than 24 States and the District of Columbia have stepped in to say they will cover the cost of prescription drugs for their residents who are dually eligible for Medicare and Medicaid and who cannot access lifesaving and life sustaining drugs as a result of Federal incompetence.

Earlier this week, the Governor of California and California's State legislative leaders announced a plan to make $150 million available for 30 days to cover drug costs for dual eligible individuals who have fallen through the system. In California, these individuals account for more than 1 million of the State's 4 million total Medicare recipients.

Problems with the Bush administration's implementation of the drug benefit have cost California $5.5 million to fill 63,000 prescriptions, as of January 18. I have no doubt these costs are just the beginning.

Unless these significant implementation errors are fixed immediately, the new drug benefit amounts to a massive unfunded mandate. The Bush administration must reimburse States, in full, for the drug costs they have absorbed as a result of major implementation errors that occurred on their watch.

The legislation I am introducing today with Senators Lautenberg, Snowe, Schumer and Coleman will ensure that States are repaid in full by the Federal Government for all costs associated with prescription drugs for dual eligible individuals. The States did not create the crisis felt by our Nation's poorest and most vulnerable seniors and disabled and the States should not be responsible for costs associated with a Federal program that was intended to provide these individuals with comprehensive prescription drug coverage at little or no cost.

It is simply unacceptable for the Bush administration to tell States and the Congress not to worry because the private health insurance plans will reimburse States for the costs they've incurred. States should not be made to wait to be reimbursed because of implementation foul-ups caused by CMS.

I urge my colleagues to support this legislation.