MAIL Act

I 116TH CONGRESS 2D SESSION H. R. 6557 To amend title XIX of the Social Security Act to increase the Federal medical assistance percentage under the Medicaid program for States providing certain coverage relating to covered outpatient drugs, and for other purposes. IN THE HOUSE OF REPRESENTATIVES APRIL 17, 2020 Ms. ESHOO (for herself and Ms. BLUNT ROCHESTER) introduced the following bill; which was referred to the Committee on Energy and Commerce A BILL To amend title XIX of the Social Security Act to increase the Federal medical assistance percentage under the Medicaid program for States providing certain coverage relating to covered outpatient drugs, and for other pur- poses. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Medication Access Im- 4 proves Lives Act’’ or the ‘‘MAIL Act’’. 5 VerDate Sep 11 2014 19:16 Apr 23, 2020 Jkt 099200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H6557.IH H6557 pamtmann on DSKBC07HB2PROD with BILLS 2 •HR 6557 IH SEC. 2. INCREASE IN MEDICAID FMAP FOR STATES PRO- 1 VIDING CERTAIN COVERAGE RELATING TO 2 COVERED OUTPATIENT DRUGS. 3 (a) IN GENERAL.—Section 1905(b) of the Social Se- 4 curity Act (42 U.S.C. 1396d(b)) is amended by adding 5 at the end the following new sentence: ‘‘Beginning April 6 1, 2020, in the case of a State that provides medical as- 7 sistance for covered outpatient drugs (as defined in section 8 1927(k)), including such drugs dispensed by a mail order 9 pharmacy, the Federal medical assistance percentage de- 10 termined under this subsection (and subsections (y) and 11 (ff) (as applicable)) shall be increased by 1 percentage 12 point with respect to medical assistance for such drugs, 13 but in no case may such percentage exceed 100 percent 14 for such medical assistance.’’. 15 (b) CONFORMING AMENDMENTS.—Section 1905 of 16 the Social Security Act (42 U.S.C. 1396d) is amended— 17 (1) in subsection (y)(1), by inserting after 18 ‘‘Notwithstanding subsection (b)’’ the following: 19 ‘‘(but subject to the sixth sentence of such sub- 20 section (relating to a Federal medical assistance per- 21 centage increase with respect to medical assistance 22 for covered outpatient drugs))’’; and 23 (2) in subsection (ff), by inserting after ‘‘Not- 24 withstanding subsection (b)’’ the following: ‘‘(but 25 subject to the sixth sentence of such subsection (re- 26 VerDate Sep 11 2014 19:16 Apr 23, 2020 Jkt 099200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H6557.IH H6557 pamtmann on DSKBC07HB2PROD with BILLS 3 •HR 6557 IH lating to a Federal medical assistance percentage in- 1 crease with respect to medical assistance for covered 2 outpatient drugs))’’. 3 SEC. 3. REQUIRING STATES THAT PROVIDE MEDICAL AS- 4 SISTANCE FOR COVERED OUTPATIENT 5 DRUGS TO ALLOW FOR UP TO 3-MONTH SUP- 6 PLY OF FILLS AND REFILLS OF SUCH DRUGS. 7 Section 1927(a) of the Social Security Act (42 U.S.C. 8 1396r–8(a)) is amended by adding at the end the fol- 9 lowing new paragraph: 10 ‘‘(8) REQUIREMENT TO ALLOW FOR UP TO 3- 11 MONTH SUPPLY OF FILLS AND REFILLS.— 12 ‘‘(A) IN GENERAL.—In order for payment 13 to be available under section 1903(a) for a cov- 14 ered outpatient drug that is administered on or 15 after the first day of the first full month fol- 16 lowing the date of the enactment of this para- 17 graph, the State shall permit any individual en- 18 rolled under the State plan (or a waiver of such 19 plan) to obtain in a single fill or refill, at the 20 option of such individual, the total day supply 21 (not to exceed a 90-day supply) prescribed for 22 such individual for a covered outpatient drug, 23 without regard to any cost and utilization man- 24 agement, medication therapy management, or 25 VerDate Sep 11 2014 19:16 Apr 23, 2020 Jkt 099200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H6557.IH H6557 pamtmann on DSKBC07HB2PROD with BILLS 4 •HR 6557 IH other such program that would otherwise apply 1 under such plan (or waiver). 2 ‘‘(B) SAFETY EDIT.—The State may not 3 permit an individual enrolled under the State 4 plan (or a waiver of such plan) to obtain a sin- 5 gle fill or refill of a covered outpatient drug 6 under such State plan (or waiver) if such fill or 7 refill would be inconsistent with an applicable 8 safety edit under such plan (or waiver).’’. 9 Æ VerDate Sep 11 2014 19:16 Apr 23, 2020 Jkt 099200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6301 E:\BILLS\H6557.IH H6557 pamtmann on DSKBC07HB2PROD with BILLS