Summary: H.R.2473 — 108th Congress (2003-2004)All Information (Except Text)

There is one summary for H.R.2473. Bill summaries are authored by CRS.

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Introduced in House (06/16/2003)

Medicare Prescription Drug and Modernization Act of 2003 - Amends title XVIII (Medicare) of the Social Security Act (SSA) to add a new part D (Voluntary Prescription Drug Benefit Program) under which each individual who is entitled to benefits under Medicare part A (Hospital Insurance) or enrolled under Medicare part B (Supplemental Medical Insurance) is entitled to obtain qualified prescription drug coverage. Authorizes the individual to elect to enroll: (1) in a Medicare Advantage (MA) plan (replacing the current Medicare+Choice plans); (2) in an enhanced fee-for-service (EFFS) plan; or (3) in a prescription drug plan (PDP) if the individual is not enrolled in an MA-EFFS plan (a Medicare Advantage plan and an EFFS plan).

Establishes a Medicare Prescription Drug Trust Fund.

Outlines standard coverage benefit packages for FY 2006. Includes for the standard package an annual deductible of $250, and requires insurers to cover 80 percent of enrollees drug costs up to the initial coverage limit of $2,000. Requires enrollees to cover all costs between $2,001 and $3,700, and Medicare to cover the entire cost once the beneficiary has reached the $3,700 catastrophic out-of-pocket threshold. Prescribes a formula for adjustment of: (1) such deductible and annual limits for inflation; and (2) such catastrophic limit for each enrollee in a PDP or in an MA-EFFS Rx plan (an MA-EFFS plan which provides qualified prescription drug coverage) whose adjusted gross income exceeds $60,000.

Establishes a competitive bidding process for negotiating the terms and conditions of PDP sponsors.

Provides for full premium subsidy and reduction of cost-sharing for individuals with incomes below 135 percent of the Federal poverty level. Contains subsidy payments for qualifying entities to promote the participation of PDP and MA-EFFS Rx plan sponsors.

Sets out a: (1) new Medicare prescription drug discount card endorsement program under the Medicare program; and (2) requirements for combating waste, fraud, and abuse under Medicare.

Makes a number of other changes with regard to Medicare: (1) part A concerning rural health care, inpatient hospital services, skilled nursing facility services, and hospices; (2) part B concerning physicians services and other services; and (3) part A and B concerning home health services, direct graduate medical education, and voluntary chronic care improvement.

Establishes the Medicare Benefits Administration in the Department of Health and Human Services.

Amends SSA title XVIII part F (Miscellaneous) (currently part D) to include a number of regulatory, contracting, and administrative changes, such as: (1) coordination of educational funding; (2) transfer of responsibility for Medicare appeals; (3) provision of expedited access to judicial review of Medicare appeals; (4) recovery of overpayments; and (5) revision of reassignment requirements.