[DOCID: f:publ173.108]
[[Page 2065]]
MEDICARE PRESCRIPTION DRUG, IMPROVEMENT, AND MODERNIZATION ACT OF 2003
[[Page 117 STAT. 2066]]
Public Law 108-173
108th Congress
An Act
To amend title XVIII of the Social Security Act to provide for a
voluntary program for prescription drug coverage under the Medicare
Program, to modernize the Medicare Program, to amend the Internal
Revenue Code of 1986 to allow a deduction to individuals for amounts
contributed to health savings security accounts and health savings
accounts, to provide for the disposition of unused health benefits in
cafeteria plans and flexible spending arrangements, and for other
purposes. <<NOTE: Dec. 8, 2003 - [H.R. 1]>> <<NOTE: Medicare
Prescription Drug, Improvement, and Modernization Act of
2003.>>
Be it enacted by the Senate and House of Representatives of the United States of America in Congress
assembled,
SEC. 1014. <<NOTE: 42 USC 299 note.>> HEALTH CARE THAT WORKS FOR ALL
AMERICANS: CITIZENS HEALTH CARE WORKING GROUP.
(a) Findings.--Congress finds the following:
(1) In order to improve the health care system, the American
public must engage in an informed national public debate to make
choices about the services they want covered, what health care
coverage they want, and how they are willing to pay for
coverage.
(2) More than a trillion dollars annually is spent on the
health care system, yet--
(A) 41,000,000 Americans are uninsured;
(B) insured individuals do not always have access to
essential, effective services to improve and maintain
their health; and
(C) employers, who cover over 170,000,000 Americans,
find providing coverage increasingly difficult because
of rising costs and double digit premium increases.
(3) Despite increases in medical care spending that are
greater than the rate of inflation, population growth, and Gross
Domestic Product growth, there has not been a commensurate
improvement in our health status as a nation.
[[Page 117 STAT. 2442]]
(4) Health care costs for even just 1 member of a family can
be catastrophic, resulting in medical bills potentially harming
the economic stability of the entire family.
(5) Common life occurrences can jeopardize the ability of a
family to retain private coverage or jeopardize access to public
coverage.
(6) Innovations in health care access, coverage, and quality
of care, including the use of technology, have often come from
States, local communities, and private sector organizations, but
more creative policies could tap this potential.
(7) Despite our Nation's wealth, the health care system does
not provide coverage to all Americans who want it.
(b) Purposes.--The purposes of this section are--
(1) to provide for a nationwide public debate about
improving the health care system to provide every American with
the ability to obtain quality, affordable health care coverage;
and
(2) to provide for a vote by Congress on the recommendations
that result from the debate.
(c) Establishment.--The Secretary, acting through the Agency for
Healthcare Research and Quality, shall establish an entity to be known
as the Citizens' Health Care Working Group (referred to in this section
as the ``Working Group'').
(d) Membership.--
(1) Number and appointment.--The Working Group shall be
composed of 15 members. One member shall be the Secretary. The
Comptroller General of the United States shall appoint 14
members.
(2) Qualifications.--
(A) In general.--The membership of the Working Group
shall include--
(i) consumers of health services that
represent those individuals who have not had
insurance within 2 years of appointment, that have
had chronic illnesses, including mental illness,
are disabled, and those who receive insurance
coverage through medicare and medicaid; and
(ii) individuals with expertise in financing
and paying for benefits and access to care,
business and labor perspectives, and providers of
health care.
The membership shall reflect a broad geographic
representation and a balance between urban and rural
representatives.
(B) Prohibited appointments.--Members of the Working
Group shall not include Members of Congress or other
elected government officials (Federal, State, or local).
Individuals appointed to the Working Group shall not be
paid employees or representatives of associations or
advocacy organizations involved in the health care
system.
(e) Period of Appointment.--Members of the Working Group shall be
appointed for a life of the Working Group. Any vacancies shall not
affect the power and duties of the Working Group but shall be filled in
the same manner as the original appointment.
(f) <<NOTE: Deadline.>> Designation of the Chairperson.--Not later
than 15 days after the date on which all members of the Working Group
have
[[Page 117 STAT. 2443]]
been appointed under subsection (d)(1), the Comptroller General shall
designate the chairperson of the Working Group.
(g) Subcommittees.--The Working Group may establish subcommittees if
doing so increases the efficiency of the Working Group in completing its
tasks.
(h) Duties.--
(1) Hearings.--Not later than 90 days after the date of the
designation of the chairperson under subsection (f), the Working
Group shall hold hearings to examine--
(A) the capacity of the public and private health
care systems to expand coverage options;
(B) the cost of health care and the effectiveness of
care provided at all stages of disease;
(C) innovative State strategies used to expand
health care coverage and lower health care costs;
(D) local community solutions to accessing health
care coverage;
(E) efforts to enroll individuals currently eligible
for public or private health care coverage;
(F) the role of evidence-based medical practices
that can be documented as restoring, maintaining, or
improving a patient's health, and the use of technology
in supporting providers in improving quality of care and
lowering costs; and
(G) strategies to assist purchasers of health care,
including consumers, to become more aware of the impact
of costs, and to lower the costs of health care.
(2) Additional hearings.--The Working Group may hold
additional hearings on subjects other than those listed in
paragraph (1) so long as such hearings are determined to be
necessary by the Working Group in carrying out the purposes of
this section. Such additional hearings do not have to be
completed within the time period specified in paragraph (1) but
shall not delay the other activities of the Working Group under
this section.
(3) The health report to the american people.--Not later
than 90 days after the hearings described in paragraphs (1) and
(2) are completed, the Working Group shall prepare and make
available to health care consumers through the Internet and
other appropriate public channels, a report to be entitled,
``The Health Report to the American People''. Such report shall
be understandable to the general public and include--
(A) a summary of--
(i) health care and related services that may
be used by individuals throughout their life span;
(ii) the cost of health care services and
their medical effectiveness in providing better
quality of care for different age groups;
(iii) the source of coverage and payment,
including reimbursement, for health care services;
(iv) the reasons people are uninsured or
underinsured and the cost to taxpayers, purchasers
of health services, and communities when Americans
are uninsured or underinsured;
(v) the impact on health care outcomes and
costs when individuals are treated in all stages
of disease;
(vi) health care cost containment strategies;
and
[[Page 117 STAT. 2444]]
(vii) information on health care needs that
need to be addressed;
(B) examples of community strategies to provide
health care coverage or access;
(C) information on geographic-specific issues
relating to health care;
(D) information concerning the cost of care in
different settings, including institutional-based care
and home and community-based care;
(E) a summary of ways to finance health care
coverage; and
(F) the role of technology in providing future
health care including ways to support the information
needs of patients and providers.
(4) Community meetings.--
(A) In general.--Not later than 1 year after the
date on which all the members of the Working Group have
been appointed under subsection (d)(1) and
appropriations are first made available to carry out
this section, the Working Group shall initiate health
care community meetings throughout the United States (in
this paragraph referred to as ``community meetings'').
Such community meetings may be geographically or
regionally based and shall be completed within 180 days
after the initiation of the first meeting.
(B) Number of meetings.--The Working Group shall
hold a sufficient number of community meetings in order
to receive information that reflects--
(i) the geographic differences throughout the
United States;
(ii) diverse populations; and
(iii) a balance among urban and rural
populations.
(C) Meeting requirements.--
(i) Facilitator.--A State health officer may
be the facilitator at the community meetings.
(ii) Attendance.--At least 1 member of the
Working Group shall attend and serve as chair of
each community meeting. Other members may
participate through interactive technology.
(iii) Topics.--The community meetings shall,
at a minimum, address the following questions:
(I) What health care benefits and
services should be provided?
(II) How does the American public
want health care delivered?
(III) How should health care
coverage be financed?
(IV) What trade-offs are the
American public willing to make in
either benefits or financing to ensure
access to affordable, high quality
health care coverage and services?
(iv) Interactive technology.--The Working
Group may encourage public participation in
community meetings through interactive technology
and other means as determined appropriate by the
Working Group.
[[Page 117 STAT. 2445]]
(D) Interim requirements.--Not later than 180 days
after the date of completion of the community meetings,
the Working Group shall prepare and make available to
the public through the Internet and other appropriate
public channels, an interim set of recommendations on
health care coverage and ways to improve and strengthen
the health care system based on the information and
preferences expressed at the community meetings. There
shall be a 90-day public comment period on such
recommendations.
(i) Recommendations.--Not later than 120 days after the expiration
of the public comment period described in subsection (h)(4)(D), the
Working Group shall submit to Congress and the President a final set of
recommendations.
(j) Administration.--
(1) Executive director.--There shall be an Executive
Director of the Working Group who shall be appointed by the
chairperson of the Working Group in consultation with the
members of the Working Group.
(2) Compensation.--While serving on the business of the
Working Group (including travel time), a member of the Working
Group shall be entitled to compensation at the per diem
equivalent of the rate provided for level IV of the Executive
Schedule under section 5315 of title 5, United States Code, and
while so serving away from home and the member's regular place
of business, a member may be allowed travel expenses, as
authorized by the chairperson of the Working Group. For purposes
of pay and employment benefits, rights, and privileges, all
personnel of the Working Group shall be treated as if they were
employees of the Senate.
(3) Information from federal agencies.--The Working Group
may secure directly from any Federal department or agency such
information as the Working Group considers necessary to carry
out this section. Upon request of the Working Group, the head of
such department or agency shall furnish such information.
(4) Postal services.--The Working Group may use the United
States mails in the same manner and under the same conditions as
other departments and agencies of the Federal Government.
(k) Detail.--Not more than 10 Federal Government employees employed
by the Department of Labor and 10 Federal Government employees employed
by the Department of Health and Human Services may be detailed to the
Working Group under this section without further reimbursement. Any
detail of an employee shall be without interruption or loss of civil
service status or privilege.
(l) Temporary and Intermittent Services.--The chairperson of the
Working Group may procure temporary and intermittent services under
section 3109(b) of title 5, United States Code, at rates for individuals
which do not exceed the daily equivalent of the annual rate of basic pay
prescribed for level V of the Executive Schedule under section 5316 of
such title.
(m) Annual Report.--Not later than 1 year after the date of
enactment of this Act, and annually thereafter during the existence of
the Working Group, the Working Group shall report to Congress and make
public a detailed description of the expenditures
[[Page 117 STAT. 2446]]
of the Working Group used to carry out its duties under this section.
(n) Sunset of Working Group.--The Working Group shall terminate on
the date that is 2 years after the date on which all the members of the
Working Group have been appointed under subsection (d)(1) and
appropriations are first made available to carry out this section.
(o) Administration <<NOTE: Reports. Deadline.>> Review and
Comments.--Not later than 45 days after receiving the final
recommendations of the Working Group under subsection (i), the President
shall submit a report to Congress which shall contain--
(1) additional views and comments on such recommendations;
and
(2) recommendations for such legislation and administrative
actions as the President considers appropriate.
(p) Required Congressional Action.--Not later than 45 days after
receiving the report submitted by the President under subsection (o),
each committee of jurisdiction of Congress, the Committee on Finance of
the Senate, the Committee on Health, Education, Labor, and Pensions of
the Senate, the Committee on Ways and Means of the House of
Representatives, the Committee on Energy and Commerce of the House of
Representatives, Committee on Education and the Workforce of the House
of Representatives, shall hold at least 1 hearing on such report and on
the final recommendations of the Working Group submitted under
subsection (i).
(q) Authorization of Appropriations.--
(1) In general.--There are authorized to be appropriated to
carry out this section, other than subsection (h)(3), $3,000,000
for each of fiscal years 2005 and 2006.
(2) Health report to the american people.--There are
authorized to be appropriated for the preparation and
dissemination of the Health Report to the American People
described in subsection (h)(3), such sums as may be necessary
for the fiscal year in which the report is required to be
submitted.
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