,,ii #aaith ,,congress #ast ,session ,s4 #cefj ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,december #ah1 #bjbe,ms4 ,hassan 7for herself1 ,ms4 ,murkowski1 ,ms4 ,duckworth1 and ,ms4 ,collins7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to provide coverage of contraceptive items and services at no cost-sharing under the ,medicare program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,closing the ,contraception ,coverage ,gap ,act4 #b4 ,providing coverage of contraceptive items and services at no cost-sharing under the ,medicare program 7a7 ,part ,b coverage 7#a7 ,in general ,section #ahfa of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7 is amended-- 7,a7 in subsection 7s77#b7-- 7i7 in subparagraph 7,,jj71 by inserting and after the semicolon at the end2 and 7ii7 by adding at the end the following new subparagraph3 7,,kk7 contraceptive items and services 7as defined in subsection 7nnn77 furnished to individuals on or after ,january #a1 #bjbg2 2 and 7,b7 by adding at the end the following new subsection3 7nnn7 ,contraceptive items and services 7#a7 ,in general ,the term contraceptive items and services means items and services furnished by a physician or practitioner 7as defined in section #ahdb7;b77#ah77;,c77-- 7,a7 that-- 7i7 align with guidance as of ,january #ab1 #bjbb1 issued in accordance with in section #bgac7;a77#d7 of the ,public ,health ,service ,act 7including patient-centered counseling services72 and 7ii7 may be furnished for the purpose of contraception2 or 7,b7 that are ancillary clinical services4 7#b7 ,ancillary clinical services ,for purposes of paragraph 7#a77;,b71 the term ancillary clinical services means-- 7,a7 clinical services that are related to the items and services described in paragraph 7#a77;,a71 including consultations1 examinations1 procedures1 device insertion1 ultrasound1 pain management1 patient education1 referrals1 and counseling2 and 7,b7 follow-up services related to the provision or use of the items and services described in paragraph 7#a77;,a71 including management of side effects1 counseling for continued adherence1 and device removal4 7#c7 ,clarification ,the term contraceptive items and services includes items and services described in paragraph 7#a7 regardless of whether such items and services are actually furnished for purposes of contraception4 7#d7 ,patient-centered counseling services ,for purposes of paragraph 7#a77;,a71 the ,secretary shall issue guidance regarding the coverage of patient-centered counseling4 ,such guidance shall-- 7,a7 align with guidance as of ,january #ab1 #bjbb1 issued in accordance with section #bgac7;a77#d7 of the ,public ,health ,service ,act42 and 7,b7 include the coverage of counseling to all patients on the full range of contraceptive items and services described in paragraph 7#a74 4 7#b7 ,payment ,section #ahcc of the ,social ,security ,act 7#db ,u4,s4,c4 #aciel7 is amended-- 7,a7 in subsection 7a77#a7-- 7i7 by striking and before 7,,hh72 and 7ii7 by inserting the following before the semicolon3 and 7,,ii7 with respect to contraceptive items and services 7as defined in section #ahfa7nnn771 the amount paid shall be an amount equal to #ajj percent of the lesser of the actual charge for the items and services or the amount determined under a payment basis determined appropriate by the ,secretary2 and 7,b7 in subsection 7b71 in the first sentence-- 7i7 by striking 1 and 7#ac7 and inserting 7#ac72 and 7ii7 by striking #ahfa7n744 and inserting #ahfa7n71 and 7#ad7 such deductible shall not apply with respect to contraceptive items and services 7as defined in section #ahfa7nnn7744 7#c7 ,exclusion modification ,section #ahfb7;a77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7a77#a77 is amended-- 7,a7 in subparagraph 7,o71 by striking and at the end2 7,b7 in subparagraph 7,p71 by striking the semicolon and inserting 1 and2 and 7,c7 by adding at the end the following new subparagraph3 7,q7 in the case of contraceptive items and services 7as defined in section #ahfa7nnn771 which are not furnished or ordered by a physician or practitioner 7as defined in section #ahdb7;b77#ah77;,c772 4 7#d7 ,quality measures ,the ,secretary of ,health and ,human ,services may1 for the purposes of ensuring quality in services1 develop measures of contraceptive counseling1 care1 and access1 including but not limited to validated survey instruments4 7b7 ,part ,c cost-,sharing for contraceptive items and services 7#a7 ,in general ,section #aheb7;a77#a77;,b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bb7;a77#a77;,b77 is amended-- 7,a7 in clause 7iv7-- 7i7 by redesignating subclause 7,,viii7 as subclause 7,,ix72 and 7ii7 by inserting after subclause 7,,vii7 the following new subclause3 7,,viii7 ,contraceptive items and services 7as defined in section #ahfa7nnn774 2 and 7,b7 in clause 7v71 by striking and 7,,vi7 and inserting 7,,vi71 and 7,,viii74 7#b7 ,effective date ,the amendments made by this subsection shall apply with respect to plan years beginning on or after ,january #a1 #bjbg4 7c7 ,part ,d coverage and cost-,sharing for contraceptive drugs 7#a7 ,coverage ,section #ahfj;,d-#d7;b77#c77;,g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajd7;b77#c77;,g77 is amended-- 7,a7 in clause 7ii77,i71 by adding at the end the following new sentence3 ,such identification shall include the drugs described in clause 7iv77,,vii742 and 7,b7 in clause 7iv71 by adding at the end the following new subclause3 7,,vii7 ,covered part ,d drugs described in guidelines issued pursuant to section #bgac7;a77#d7 of the ,public ,health ,service ,act and that may be furnished for purposes of contraception 7regardless of whether such drugs are actually furnished for purposes of contraception74 4 7#b7 ,cost-sharing ,section #ahfj;,d-#b of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ajb7 is amended-- 7,a7 in subsection 7b7-- 7i7 in paragraph 7#a77;,a71 in the matter preceding clause 7i71 by striking and 7#i7 and inserting 1 7#i71 and 7#aj72 7ii7 in paragraph 7#b77;,a71 in the matter preceding clause 7i71 by striking and 7#i7 and inserting 1 7#i71 and 7#aj72 and 7iii7 by adding at the end the following new paragraph3 7#aj7 ,treatment of cost-sharing for contraceptive drugs ,for plan years beginning on or after ,january #a1 #bjbg1 with respect to a covered part ,d drug that is described in guidelines issued pursuant to section #bgac7;a77#d7 of the ,public ,health ,service ,act and that may be furnished for purposes of contraception 7regardless of whether such drug is actually furnished for purposes of contraception7-- 7,a7 the deductible under paragraph 7#a7 shall not apply2 and 7,b7 there shall be no coinsurance or other cost-sharing under this part with respect to such drug4 2 and 7,b7 in subsection 7c71 by adding at the end the following new paragraph3 7#g7 ,treatment of cost-sharing for contraceptive drugs ,the coverage is provided in accordance with subsection 7b77#aj74 4 7#c7 ,conforming amendments to cost-sharing for low-income individuals ,section #ahfj;,d-#ad7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77 is amended-- 7,a7 in paragraph 7#a77;,d71 in each of clauses 7ii7 and 7iii71 by striking paragraph 7#f7 and inserting paragraphs 7#f7 and 7#g72 and 7,b7 by adding at the end the following new paragraph3 7#g7 ,no application of cost-sharing or deductible for contraceptive drugs ,for plan years beginning on or after ,january #a1 #bjbg1 with respect to a covered part ,d drug that is described in guidelines issued pursuant to section #bgac7;a77#d7 of the ,public ,health ,service ,act and that is furnished for purposes of contraception-- 7,a7 the deductible under section #ahfj;,d-#b7;b77#a7 shall not apply2 and 7,b7 there shall be no cost-sharing under this section with respect to such drug4 4 7#d7 ,effective date ,the amendments made by this subsection shall apply with respect to plan years beginning on or after ,january #a1 #bjbg4 7d7 ,ensuring comparable coverage for dual eligible individuals ,in implementing the amendments made by this section1 the ,secretary of ,health and ,human ,services shall ensure that the coverage of contraceptive items and services 7as defined in section #ahfa7nnn77 of the ,social ,security ,act 7as added by subsection 7a77 and covered part ,d drugs described in section #ahfj;,d-#d7;b77#c77;,g77,,vii7 of such ,act 7as added by subsection 7c77#a77 with respect to individuals who are dually eligible for benefits under the ,medicare program under title ,,xviii of such ,act and for medical assistance under a ,state plan under title ,,xix of such ,act 7or a waiver of such plan7 is at least as comprehensive as the coverage of such items and services and drugs for such individuals under such ,state plans 7or waivers of such plans71 as determined by the ,secretary based on an annual review of such ,state plans 7and waivers of such plans74 #c4 ,,hhs study and report on prescription drug coverage for ,medicare beneficiaries living with disabilities 7a7 ,study ,the ,secretary of ,health and ,human ,services 7in this section referred to as the ,secretary7 shall conduct a study on-- 7#a7 the adequacy of access to prescription drug coverage1 including oral contraceptives1 among ,medicare beneficiaries living with disabilities who are enrolled under the original ,medicare fee-for-service program under parts ,a and ,b of title ,,xviii of the ,social ,security ,act 7but not enrolled under part ,c or ,d of such title ,,xviii72 and 7#b7 providing coverage of over-the-counter contraceptive drugs under the ,medicare program under such title ,,xviii with no cost-sharing4 7b7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,secretary shall submit to ,congress a report on the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate4 #d4 ,,gao study and report on contraceptive coverage requirements under commercial and public health plans 7a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this section referred to as the ,comptroller ,general7 shall conduct a study on the forms of health insurance 7including commercial plans and public health programs 7including ,medicaid1 ,medicare1 and ,,tricare771 that are not required by ,state or ,federal law to do one or both of the following3 7#a7 ,cover all forms of contraception approved by the ,food and ,drug ,administration4 7#b7 ,waive cost-sharing for such contraception4 7b7 ,report ,not later than #a year after the date of enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report on the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,comptroller ,general determines appropriate4 #e4 ,,gao study and report on difference in coverage of contraceptive items and services for dual eligibles 7a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this section referred to as the ,comptroller ,general7 shall conduct a study on the difference in coverage of contraceptive items and services for individuals who are dually eligible for ,medicare and ,medicaid benefits4 7b7 ,report ,not later than #b years after the date of enactment of this ,act1 the ,comptroller ,general shall submit to ,congress a report on the study conducted under subsection 7a71 together with recommendations for such legislation and administrative action as the ,secretary determines appropriate4