,i #aahth ,,congress #ast ,session ,h4 ,r4 #cedi ,,in ,,the ,,house ,,of ,,representatives ,may #ah1 #bjbc,mr4 ,wenstrup 7for himself1 ,mr4 ,blumenauer1 and ,mrs4 ,dingell7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to ensure ,medicare-only ,,pace program enrollees have a choice of prescription drug plans under ,medicare part ,d4 #a4 ,short title ,this ,act may be cited as the ,,pace ,part ,d ,choice ,act of #bjbc4 #b4 ,ensuring ,medicare-only ,,pace program enrollees have a choice of prescription drug plans under ,medicare part ,d ,section #ahfj;,d-#ba7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aca7;f77 is amended-- 7#a7 in paragraph 7#a71 by striking and 7#c7 and inserting 7#c71 and 7#d72 and 7#b7 by adding at the end the following new paragraph3 7#d7 ,ensuring choice of prescription drug plans 7,a7 ,in general ,for plan years beginning on or after ,january #a1 #bjbe1 subject to the succeeding provisions of this paragraph1 an applicable ,,pace program enrollee may elect to enroll in a qualified standalone prescription drug plan1 in accordance with rules established by the ,secretary pursuant to this paragraph1 while enrolled under a ,,pace program4 7,b7 ,definition of applicable pace program enrollee2 qualified standalone prescription drug plan ,in this paragraph3 7i7 ,applicable pace program enrollee ,the term applicable ,,pace program enrollee means a part ,d eligible individual who-- 7,i7 is not entitled to medical assistance under title ,,xix2 and 7,,ii7 is enrolled under a ,,pace program offered by a ,,pace provider4 7ii7 ,qualified standalone prescription drug plan ,the term qualified standalone prescription drug plan means1 with respect to an applicable ,,pace program enrollee1 a prescription drug plan-- 7,i7 that is not an ,,ma-,,pd plan2 7,,ii7 that is not operated by the ,,pace program under which the individual is enrolled2 and 7,,iii7 for which the ,secretary determines1 with respect to the applicable ,,pace program enrollees enrolled in a ,,pace program offered by such ,,pace provider1 that-- 7aa7 the estimated beneficiary out-of-pocket costs 7as defined in clause 7iii77 for the plan year for qualified prescription drug coverage under the plan is equal to or less than the estimated out-of-pocket costs for such coverage under the prescription drug plan offered by the ,,pace program in which the applicable ,,pace program enrollee is enrolled2 and 7bb7 the estimated total amount of ,federal subsidies for the plan year for qualified prescription drug coverage under the plan 7which may be estimated using data from the previous plan year7 is equal to or less than the estimated subsidy amount for such coverage under the prescription drug plan offered by the ,,pace program in which the applicable ,,pace program enrollee is enrolled4 7iii7 ,out-of-pocket costs defined ,in this paragraph1 the term out-of-pocket costs includes premiums imposed under a prescription drug plan and1 in the case of coverage under a qualified standalone prescription drug plan1 deductibles1 copayments1 coinsurance1 and other cost-sharing4 7,c7 ,out-of-pocket costs ,in the case where an applicable ,,pace program enrollee elects to enroll in a qualified standalone prescription drug plan pursuant to this paragraph1 the individual shall be responsible for any out-of-pocket costs imposed under the plan 7including costs for nonformulary drugs7 after the application of any subsidies under section #ahfj;,d-#ad for an applicable ,,pace program enrollee who is a subsidy eligible individual 7as defined in section #ahfj;,d-#ad7;a77#c774 7,d7 ,requirements for pace programs 7i7 ,educating and helping enroll beneficiaries into a part d plan option ,a ,,pace program shall be required to provide-- 7,i7 information to all applicable ,,pace program enrollees who are enrolled under the ,,pace program regarding the option to enroll in a qualified standalone prescription drug plan under this paragraph2 and 7,,ii7 upon request of an applicable ,,pace program enrollee1 counseling and coordination to assist applicable ,,pace program enrollees in making decisions regarding the selection of qualified standalone prescription drug plans available to them4 7ii7 ,monitoring drug utilization1 adherence1 and spend ,a ,,pace program shall be required to monitor drug utilization1 medication adherence1 and drug spending 7through claims data shared pursuant to subparagraph 7,f7 and otherwise7 throughout the year with respect to any applicable ,,pace program enrollee who elects to enroll in a qualified standalone prescription drug plan under this paragraph in order to coordinate with the ,,pdp sponsor of such plan regarding the drug benefits offered by the plan1 including upon request of an applicable ,,pace program enrollee the filing of any grievances or appeals with the plan on behalf of the applicable ,,pace program enrollee4 7,e7 ,disenrollment ,an applicable ,,pace program enrollee may disenroll from the qualified standalone prescription drug plan elected by such applicable ,,pace program enrollee under subparagraph 7,a7 if the enrollee changes medication during the plan year or can demonstrate an unexpected increase in out-of-pocket costs post enrollment4 7,f7 ,claims sharing ,in the case where an applicable ,,pace program enrollee enrolls in a qualified standalone prescription drug plan1 the ,,pace program in which the individual is enrolled and the ,,pdp sponsor of the qualified standalone prescription drug plan shall share claims data with each other with respect to the applicable ,,pace program enrollee as needed to support care management for the applicable ,,pace program enrollee 7including for purposes of monitoring and coordination required under subparagraph 7,d77ii77 and for purposes of comprehensive risk adjustment under section #ahid7;d74 ,such data shall be shared without the need for any formal or informal request of the ,,pace program in which the individual is enrolled or the ,,pdp sponsor of the qualified standalone prescription drug plan in which the applicable ,,pace program enrollee is enrolled4 7,g7 ,rule of construction ,the authority established under this paragraph for an applicable ,,pace program enrollee to elect to enroll in a qualified standalone prescription drug plan shall not be construed as permitting an applicable ,,pace program enrollee to enroll in a prescription drug plan that is not a qualified standalone prescription drug plan4 7,h7 ,relation to ,,pace statutes 7i7 ,in general ,the authority provided under this paragraph for an applicable ,,pace program enrollee to elect to enroll in a qualified standalone prescription drug plan shall apply notwithstanding subsection 7a77#a77;,b77#a7 of section #ahid and such other provisions of sections #ahid and #aicd as the ,secretary determines may conflict with the authority provided for under this paragraph1 including subsections 7a77#b77;,b71 7b77#a77;,a77i71 7b77#a77;,c71 7f77#b77;,b77ii71 and 7f77#b77;,b77v7 of such sections4 7ii7 ,clarification on payment for part ,d drug coverage ,insofar as an applicable ,,pace program enrollee is enrolled in a qualified standalone prescription drug plan under this paragraph1 the ,,pace program shall not be entitled to payment under section #ahid7;d7 for the provision of qualified prescription drug coverage under such standalone prescription drug plan with respect to such applicable ,,pace program enrollee4 4