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SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Drug Savings Act of 2017''.

SEC. 2. REQUIRING DRUG MANUFACTURERS TO PROVIDE DRUG REBATES FOR DRUGS
              DISPENSED TO LOW-INCOME INDIVIDUALS.

    (a) In General.--Section 1860D-2 of the Social Security Act (42
U.S.C. 1395w-102) is amended--
            (1) in subsection (e)(1), in the matter preceding
        subparagraph (A), by inserting ``and subsection (f)'' after
        ``this subsection''; and
            (2) by adding at the end the following new subsection:
    ``(f) Prescription Drug Rebate Agreement for Rebate Eligible
Individuals.--
            ``(1) Requirement.--
                    ``(A) In general.--For plan years beginning on or
                after January 1, 2019, in this part, the term `covered
                part D drug' does not include any drug or biological
                product that is manufactured by a manufacturer that has
                not entered into and have in effect a rebate agreement
                described in paragraph (2).
                    ``(B) 2018 plan year requirement.--Any drug or
                biological product manufactured by a manufacturer that
                declines to enter into a rebate agreement described in
                paragraph (2) for the period beginning on January 1,
                2018, and ending on December 31, 2018, shall not be
                included as a `covered part D drug' for the subsequent
                plan year.
            ``(2) Rebate agreement.--A rebate agreement under this
        subsection shall require the manufacturer to provide to the
        Secretary a rebate for each rebate period (as defined in
        paragraph (6)(B)) ending after December 31, 2017, in the amount
        specified in paragraph (3) for any covered part D drug of the
        manufacturer dispensed after December 31, 2017, to any rebate
        eligible individual (as defined in paragraph (6)(A)) for which
        payment was made by a PDP sponsor or MA organization under this
        part for such period, including payments passed through the
        low-income and reinsurance subsidies under sections 1860D-14
        and 1860D-15(b), respectively. Such rebate shall be paid by the
        manufacturer to the Secretary not later than 30 days after the
        date of receipt of the information described in section 1860D-
        12(b)(7), including as such section is applied under section
        1857(f)(3), or 30 days after the receipt of information under
        subparagraph (D) of paragraph (3), as determined by the
        Secretary. Insofar as not inconsistent with this subsection,
        the Secretary shall establish terms and conditions of such
        agreement relating to compliance, penalties, and program
        evaluations, investigations, and audits that are similar to the
        terms and conditions for rebate agreements under paragraphs (3)
        and (4) of section 1927(b).
            ``(3) Rebate for rebate eligible medicare drug plan
        enrollees.--
                    ``(A) In general.--The amount of the rebate
                specified under this paragraph for a manufacturer for a
                rebate period, with respect to each dosage form and
                strength of any covered part D drug provided by such
                manufacturer and dispensed to a rebate eligible
                individual, shall be equal to the product of--
                            ``(i) the total number of units of such
                        dosage form and strength of the drug so
                        provided and dispensed for which payment was
                        made by a PDP sponsor or an MA organization
                        under this part for the rebate period,
                        including payments passed through the low-
                        income and reinsurance subsidies under sections
                        1860D-14 and 1860D-15(b), respectively; and
                            ``(ii) the amount (if any) by which--
                                    ``(I) the Medicaid rebate amount
                                (as defined in subparagraph (B)) for
                                such form, strength, and period,
                                exceeds
                                    ``(II) the average Medicare drug
                                program rebate eligible rebate amount
                                (as defined in subparagraph (C)) for
                                such form, strength, and period.
                    ``(B) Medicaid rebate amount.--For purposes of this
                paragraph, the term `Medicaid rebate amount' means,
                with respect to each dosage form and strength of a
                covered part D drug provided by the manufacturer for a
                rebate period--
                            ``(i) in the case of a single source drug
                        or an innovator multiple source drug, the
                        amount specified in paragraph (1)(A)(ii)(II) or
                        (2)(C) of section 1927(c) plus the amount, if
                        any, specified in subparagraph (A)(ii) of
                        paragraph (2) of such section, for such form,
                        strength, and period; or
                            ``(ii) in the case of any other covered
                        outpatient drug, the amount specified in
                        paragraph (3)(A)(i) of such section for such
                        form, strength, and period.
                    ``(C) Average medicare drug program rebate eligible
                rebate amount.--For purposes of this subsection, the
                term `average Medicare drug program rebate eligible
                rebate amount' means, with respect to each dosage form
                and strength of a covered part D drug provided by a
                manufacturer for a rebate period, the sum, for all PDP
                sponsors under part D and MA organizations
                administering an MA-PD plan under part C, of--
                            ``(i) the product, for each such sponsor or
                        organization, of--
                                    ``(I) the sum of all rebates,
                                discounts, or other price concessions
                                (not taking into account any rebate
                                provided under paragraph (2) or any
                                discounts under the program under
                                section 1860D-14A) for such dosage form
                                and strength of the drug dispensed,
                                calculated on a per-unit basis, but
                                only to the extent that any such
                                rebate, discount, or other price
                                concession applies equally to drugs
                                dispensed to rebate eligible Medicare
                                drug plan enrollees and drugs dispensed
                                to PDP and MA-PD enrollees who are not
                                rebate eligible individuals; and
                                    ``(II) the number of the units of
                                such dosage and strength of the drug
                                dispensed during the rebate period to
                                rebate eligible individuals enrolled in
                                the prescription drug plans
                                administered by the PDP sponsor or the
                                MA-PD plans administered by the MA
                                organization; divided by
                            ``(ii) the total number of units of such
                        dosage and strength of the drug dispensed
                        during the rebate period to rebate eligible
                        individuals enrolled in all prescription drug
                        plans administered by PDP sponsors and all MA-
                        PD plans administered by MA organizations.
                    ``(D) Use of estimates.--The Secretary may
                establish a methodology for estimating the average
                Medicare drug program rebate eligible rebate amounts
                for each rebate period based on bid and utilization
                information under this part and may use these estimates
                as the basis for determining the rebates under this
                section. If the Secretary elects to estimate the
                average Medicare drug program rebate eligible rebate
                amounts, the Secretary shall establish a reconciliation
                process for adjusting manufacturer rebate payments not
                later than 3 months after the date that manufacturers
                receive the information collected under section 1860D-
                12(b)(7)(B).
            ``(4) Length of agreement.--The provisions of paragraph (4)
        of section 1927(b) (other than clauses (iv) and (v) of
        subparagraph (B)) shall apply to rebate agreements under this
        subsection in the same manner as such paragraph applies to a
        rebate agreement under such section.
            ``(5) Other terms and conditions.--The Secretary shall
        establish other terms and conditions of the rebate agreement
        under this subsection, including terms and conditions related
        to compliance, that are consistent with this subsection.
            ``(6) Definitions.--In this subsection and section 1860D-
        12(b)(7):
                    ``(A) Rebate eligible individual.--The term `rebate
                eligible individual' means--
                            ``(i) a subsidy eligible individual (as
                        defined in section 1860D-14(a)(3)(A));
                            ``(ii) a Medicaid beneficiary treated as a
                        subsidy eligible individual under clause (v) of
                        section 1860D-14(a)(3)(B); and
                            ``(iii) any part D eligible individual not
                        described in clause (i) or (ii) who is
                        determined for purposes of the State plan under
                        title XIX to be eligible for medical assistance
                        under clause (i), (iii), or (iv) of section
                        1902(a)(10)(E).
                    ``(B) Rebate period.--The term `rebate period' has
                the meaning given such term in section 1927(k)(8).''.
    (b) Reporting Requirement for the Determination and Payment of
Rebates by Manufacturers Related to Rebate for Rebate Eligible Medicare
Drug Plan Enrollees.--
            (1) Requirements for pdp sponsors.--Section 1860D-12(b) of
        the Social Security Act (42 U.S.C. 1395w-112(b)) is amended by
        adding at the end the following new paragraph:
            ``(7) Reporting requirement for the determination and
        payment of rebates by manufacturers related to rebate for
        rebate eligible medicare drug plan enrollees.--
                    ``(A) In general.--For purposes of the rebate under
                section 1860D-2(f) for contract years beginning on or
                after January 1, 2019, each contract entered into with
                a PDP sponsor under this part with respect to a
                prescription drug plan shall require that the sponsor
                comply with subparagraphs (B) and (C).
                    ``(B) Report form and contents.--Not later than a
                date specified by the Secretary, a PDP sponsor of a
                prescription drug plan under this part shall report to
                each manufacturer--
                            ``(i) information (by National Drug Code
                        number) on the total number of units of each
                        dosage, form, and strength of each drug of such
                        manufacturer dispensed to rebate eligible
                        Medicare drug plan enrollees under any
                        prescription drug plan operated by the PDP
                        sponsor during the rebate period;
                            ``(ii) information on the price discounts,
                        price concessions, and rebates for such drugs
                        for such form, strength, and period;
                            ``(iii) information on the extent to which
                        such price discounts, price concessions, and
                        rebates apply equally to rebate eligible
                        Medicare drug plan enrollees and PDP enrollees
                        who are not rebate eligible Medicare drug plan
                        enrollees; and
                            ``(iv) any additional information that the
                        Secretary determines is necessary to enable the
                        Secretary to calculate the average Medicare
                        drug program rebate eligible rebate amount (as
                        defined in paragraph (3)(C) of such section),
                        and to determine the amount of the rebate
                        required under this section, for such form,
                        strength, and period.
                Such report shall be in a form consistent with a
                standard reporting format established by the Secretary.
                    ``(C) Submission to secretary.--Each PDP sponsor
                shall promptly transmit a copy of the information
                reported under subparagraph (B) to the Secretary for
                the purpose of audit oversight and evaluation.
                    ``(D) Confidentiality of information.--The
                provisions of subparagraph (D) of section 1927(b)(3),
                relating to confidentiality of information, shall apply
                to information reported by PDP sponsors under this
                paragraph in the same manner that such provisions apply
                to information disclosed by manufacturers or
                wholesalers under such section, except--
                            ``(i) that any reference to `this section'
                        in clause (i) of such subparagraph shall be
                        treated as being a reference to this section;
                            ``(ii) the reference to the Director of the
                        Congressional Budget Office in clause (iii) of
                        such subparagraph shall be treated as including
                        a reference to the Medicare Payment Advisory
                        Commission; and
                            ``(iii) clause (iv) of such subparagraph
                        shall not apply.
                    ``(E) Oversight.--Information reported under this
                paragraph may be used by the Inspector General of the
                Department of Health and Human Services for the
                statutorily authorized purposes of audit,
                investigation, and evaluations.
                    ``(F) Penalties for failure to provide timely
                information and provision of false information.--In the
                case of a PDP sponsor--
                            ``(i) that fails to provide information
                        required under subparagraph (B) on a timely
                        basis, the sponsor is subject to a civil money
                        penalty in the amount of $10,000 for each day
                        in which such information has not been
                        provided; or
                            ``(ii) that knowingly (as defined in
                        section 1128A(i)) provides false information
                        under such subparagraph, the sponsor is subject
                        to a civil money penalty in an amount not to
                        exceed $100,000 for each item of false
                        information.
                Such civil money penalties are in addition to other
                penalties as may be prescribed by law. The provisions
                of section 1128A (other than subsections (a) and (b))
                shall apply to a civil money penalty under this
                subparagraph in the same manner as such provisions
                apply to a penalty or proceeding under section
                1128A(a).''.
            (2) Application to ma organizations.--Section 1857(f)(3) of
        the Social Security Act (42 U.S.C. 1395w-27(f)(3)) is amended
        by adding at the end the following:
                    ``(D) Reporting requirement related to rebate for
                rebate eligible medicare drug plan enrollees.--Section
                1860D-12(b)(7).''.
    (c) Deposit of Rebates Into Medicare Prescription Drug Account.--
Section 1860D-16(c) of the Social Security Act (42 U.S.C. 1395w-116(c))
is amended by adding at the end the following new paragraph:
            ``(6) Rebate for rebate eligible medicare drug plan
        enrollees.--Amounts paid under a rebate agreement under section
        1860D-2(f) shall be deposited into the Account.''.
    (d) Exclusion From Determination of Best Price and Average
Manufacturer Price Under Medicaid.--
            (1) Exclusion from best price determination.--Section
        1927(c)(1)(C)(ii)(I) of the Social Security Act (42 U.S.C.
        1396r-8(c)(1)(C)(ii)(I)) is amended by inserting ``and amounts
        paid under a rebate agreement under section 1860D-2(f)'' after
        ``this section''.
            (2) Exclusion from average manufacturer price
        determination.--Section 1927(k)(1)(B)(i) of the Social Security
        Act (42 U.S.C. 1396r-8(k)(1)(B)(i)) is amended--
                    (A) in subclause (IV), by striking ``and'' after
                the semicolon;
                    (B) in subclause (V), by striking the period at the
                end and inserting ``; and''; and
                    (C) by adding at the end the following:
                                    ``(VI) amounts paid under a rebate
                                agreement under section 1860D-2(f).''.

Output: Medicare Drug Savings Act of 2017 This bill requires drug manufacturers to issue rebates to the Centers for Medicare & Medicaid Services (CMS) for prescription drugs dispensed to eligible low-income individuals under the Medicare prescription drug benefit or a Medicare Advantage (MA) prescription drug plan (PDP). Subject to civil monetary penalties, a Medicare or MA PDP sponsor must report, both to drug manufacturers and to the CMS, specified information related to the determination and payment of such rebates.


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SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Supporting Transparent Regulatory
and Environmental Actions in Mining Act of 2015'' or the ``STREAM Act
of 2015''.

SEC. 2. PUBLICATION OF SCIENTIFIC PRODUCTS FOR RULES AND RELATED
              ENVIRONMENTAL IMPACT STATEMENTS, ENVIRONMENTAL
              ASSESSMENTS, AND ECONOMIC ASSESSMENTS.

    (a) In General.--Title V of the Surface Mining Control and
Reclamation Act of 1977 (30 U.S.C. 1251 et seq.) is amended by adding
at the end the following:

``SEC. 530. PUBLICATION OF SCIENTIFIC PRODUCTS FOR RULES AND RELATED
              ENVIRONMENTAL IMPACT STATEMENTS, ENVIRONMENTAL
              ASSESSMENTS, AND ECONOMIC ASSESSMENTS.

    ``(a) Definitions.--In this section:
            ``(1) Agency action.--The term `agency action' has the
        meaning given the term in section 551 of title 5, United States
        Code.
            ``(2) Background information.--The term `background
        information' means--
                    ``(A) a biographical document, including a
                curriculum vitae or resume, that details the
                exhaustive, professional work history, education, and
                any professional memberships of a person; and
                    ``(B) the amount and date of any Federal grants or
                contracts received by that person.
            ``(3) Economic assessment.--The term `economic assessment'
        means any assessment prepared by a Federal agency in accordance
        with section 6(a)(3)(C) of Executive Order 12866 (5 U.S.C. 601
        note; relating to regulatory planning and review).
            ``(4) Environmental assessment.--The term `environmental
        assessment' has the meaning given the term in section 1508.9 of
        title 40, Code of Federal Regulations.
            ``(5) Environmental impact statement.--The term
        `environmental impact statement' means any environmental impact
        statement or similar analysis required under the National
        Environmental Policy Act of 1969 (42 U.S.C. 4321 et seq.).
            ``(6) Publicly available.--The term `publicly available'
        means published online on--
                    ``(A) a publicly accessible website that allows the
                submission of comments on proposed regulations and
                related documents published by the Federal Government;
                    ``(B) a publicly accessible website of the
                Secretary; and
                    ``(C) the website of the Federal Register.
            ``(7) Raw data.--The term `raw data' means any
        computational process or quantitative or qualitative data
        processed from a source that is relied upon in a scientific
        product to support a finding or observation.
            ``(8) Relied upon.--The term `relied upon' means explicitly
        cited or referenced in a rule, environmental impact statement,
        environmental assessment, or economic assessment.
            ``(9) Rule.--The term `rule' has the meaning given the term
        in section 551 of title 5, United States Code.
            ``(10) Scientific method.--The term `scientific method'
        means a method of research under which--
                    ``(A) a problem is identified;
                    ``(B) relevant data are gathered;
                    ``(C) a hypothesis is formulated from the data; and
                    ``(D) the hypothesis is empirically tested in a
                manner specified by documented protocols and
                procedures.
            ``(11) Scientific product.--The term `scientific product'
        means any product that--
                    ``(A) employs the scientific method for
                inventorying, monitoring, experimenting, studying,
                researching, and modeling purposes; and
                    ``(B) is relied upon by the Secretary in
                development of any rule, environmental impact
                statement, environmental assessment, or economic
                assessment.
    ``(b) Requirements.--The Secretary shall--
            ``(1) make publicly available on the date of the
        publication of any draft, final, emergency, or supplemental
        rule under this Act, or any related environmental impact
        statement, environmental assessment, or economic assessment,
        each scientific product the Secretary relied upon in developing
        the rule, environmental impact statement, environmental
        assessment, or economic assessment; and
            ``(2) for those scientific products receiving Federal
        funds, also make publicly available--
                    ``(A) the raw data used for the federally funded
                scientific product; and
                    ``(B) background information of the authors of the
                scientific study.
    ``(c) Compliance.--
            ``(1) In general.--Subject to paragraph (2), failure to
        comply with the publication requirements of subsection (b)--
                    ``(A) with respect to draft or supplemental rules,
                environmental impact statements, environmental
                assessments, or economic assessments shall extend by 1
                day the notice and comment period for each day of
                noncompliance; or
                    ``(B) with respect to final or emergency rules,
                shall delay the effective date of the final rule by 60
                days plus an additional day for each day of
                noncompliance.
            ``(2) Withdrawal.--If the Secretary fails to comply with
        the publication requirements of subsection (b) for more than
        180 days after the date of publication of any rule, or any
        related environmental impact statement, environmental
        assessment, or economic assessment, under this Act, the
        Secretary shall withdraw the rule, environmental impact
        statement, environmental assessment, or economic assessment.''.
    (b) Conforming Amendment.--The table of contents for the Surface
Mining Control and Reclamation Act of 1977 (30 U.S.C. 1201 et seq.) is
amended by inserting after the item relating to section 529 the
following:

``Sec. 530. Publication of scientific products for rules and related
                            environmental impact statements,
                            environmental assessments, and economic
                            assessments.''.

SEC. 3. COMPLIANCE WITH OTHER FEDERAL LAWS.

    Section 702 of the Surface Mining Control and Reclamation Act of
1977 (30 U.S.C. 1292) is amended--
            (1) by redesignating subsections (c) and (d) as subsection
        (e) and (f), respectively; and
            (2) by inserting after subsection (b) the following:
    ``(c) Compliance With Other Federal Laws.--Nothing in this Act
authorizes the Secretary to take any action by rule, interpretive rule,
policy, regulation, notice, or order that duplicates any action taken
under an Act referred to in subsection (a) (including regulations and
rules).
    ``(d) Deference to Implementing Agencies and State Authorities.--In
carrying out this Act (including rules, interpretive rules, policies,
regulations, notices, or orders), the Secretary--
            ``(1) shall defer to the determinations of an agency or
        State authority implementing an Act referred to in subsection
        (a) with respect to any agency action under the jurisdiction of
        the agency or State authority, as applicable; and
            ``(2) shall not make any determination regarding any agency
        action subject to an Act referred to in subsection (a).''.

Output: Supporting Transparent Regulatory and Environmental Actions in Mining Act of 2015 or the STREAM Act of 2015 This bill amends the Surface Mining Control and Reclamation Act of 1977 to direct the Department of the Interior to make publicly available the scientific products used in developing a rule under the Act or any related environmental impact statement, environmental assessment, or economic assessment when the rule or assessment is published. If those scientific products received federal funds, Interior must also make publicly available the data used and the background information of its authors. If Interior does not comply, the notice and comment period for the rules and assessments will be extended by specified periods. A rule or an assessment must be withdrawn if Interior fails to comply for more than 180 days. In carrying out the Act, Interior: (1) may not make any determination regarding certain agency action subject to specified mining and environmental Acts, and (2) shall defer to the determinations of an agency or state authority implementing those Acts with respect to any agency action under the jurisdiction of that agency or state.


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SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Holocaust Survivors Assistance Act
of 2011''.

            TITLE I--PURPOSES; FINDINGS; DEFINITIONS; GRANTS

SEC. 101. PURPOSES.

    The purposes of this Act are--
            (1) to include ``older individuals who are Holocaust
        survivors'' to the list of groups that receive preference for
        services as defined in section 305(a)(2)(E) of the Older
        Americans Act of 1965,
            (2) to designate within the Administration on Aging an
        individual to have responsibility for older individuals who are
        Holocaust survivors, and
            (3) to create a grant program to increase and improve
        transportation services for older individuals with preference
        to those older individuals who are Holocaust survivors.

SEC. 102. FINDINGS.

    The Congress finds the following:
            (1) During the Holocaust, which took place between 1933 and
        1945, an estimated 6,000,000 Jews, as well as millions from
        other targeted groups, were murdered by the Nazis and their
        collaborators.
            (2) Approximately 127,000 Holocaust survivors remain in the
        United States, and thousands pass away each year.
            (3) Holocaust survivors are getting older and frailer, and
        will be seeking additional support and assistance from social
        service providers to enable them to age in place. Providers
        face increased levels of demand from vulnerable individuals
        without any additional revenue to cover needed services.
            (4) All Holocaust survivors are at least 65 years old with
        approximately three quarters of them older than 75 and a
        majority in their 80s and 90s.
            (5) More than half of all Holocaust survivors who emigrated
        to the United States from the former Soviet Union after 1965
        fall beneath 200 percent of the Federal poverty threshold and
        constitute an extremely vulnerable at-risk population in the
        United States.
            (6) Holocaust survivors continue to live with the mental
        and physical scars of the unconscionable trauma caused by the
        Holocaust.
            (7) While institutionalized settings are beneficial for
        some older people, long-term care facilities can have an
        adverse effect on Holocaust survivors. For many Holocaust
        survivors, institutionalized settings reintroduce sights,
        sounds, smells, emotions and routines which can induce panic,
        anxiety, and re-traumatization as a result of experiences
        resulting from the Holocaust.
            (8) Approximately two-thirds of Holocaust survivors live
        alone and living alone is a risk factor for
        institutionalization.
            (9) Low income Holocaust survivors are more reliant on
        social service programs than most other older Americans, with
        proportionally more Holocaust survivors needing services such
        as personal care, home-delivered and congregate meals,
        transportation, counseling and mental health support.

SEC. 103. DEFINITION.

    Section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002) is
amended by adding at the end the following:
            ``(55) The term `Holocaust survivor' means an individual
        who--
                    ``(A)(i) lived in a country between 1933 and 1945
                under a Nazi regime, under Nazi occupation, or under
                the control of Nazi collaborators; or
                    ``(ii) fled from a country between 1933 and 1945
                under a Nazi regime; under Nazi occupation, or under
                the control of Nazi collaborators;
                    ``(B) was persecuted between 1933 and 1945 on the
                basis of race, religion, physical or mental disability,
                sexual orientation, political affiliation, ethnicity,
                or other basis; and
                    ``(C) was a member of a group that was persecuted
                by the Nazis.''.

SEC. 104. ORGANIZATION.

    Section 305(a) of the Older Americans Act of 1965 (42 U.S.C.
3025(a)) is amended--
            (1) in paragraph (1)(E) by inserting ``older individuals
        who are Holocaust survivors,'' after ``proficiency,'' each
        place it appears, and
            (2) in paragraph (2)(E) by inserting ``older individuals
        who are Holocaust survivors,'' after ``proficiency,''.

SEC. 105. AREA PLANS.

    Section 306 of the Older Americans Act of 1965 (42 U.S.C. 3025(a))
is amended--
            (1) in subsection (a)--
                    (A) in paragraph (1) by inserting ``older
                individuals who are Holocaust survivors,'' after
                ``proficiency,'' each place it appears,
                    (B) in paragraph (4)--
                            (i) in subparagraph (A)--
                                    (I) in clause (i)(I)(bb) by
                                inserting ``older individuals who are
                                Holocaust survivors,'' after
                                ``proficiency,'' and
                                    (II) in clause (ii) by inserting
                                ``older individuals who are Holocaust
                                survivors,'' after ``proficiency,''
                                each place it appears, and
                            (ii) in subparagraph (B)--
                                    (I) in subclause (VII) by striking
                                ``and'' at the end,
                                    (II) by redesignating subclause
                                (VIII) as subclause (IX), and
                                    (III) by inserting after subclause
                                (VIII) the following:
                                    ``(VIII) older individuals who are
                                Holocaust survivors; and'', and
                    (C) in paragraph (7)(B)(iii) by inserting ``, in
                particular, older individuals who are Holocaust
                survivors,'' after ``placement'', and
            (2) by inserting ``older individuals who are Holocaust
        survivors,'' after ``areas,''.

SEC. 106. STATE PLANS.

    Section 307(a) of the Older Americans Act of 1965 (42 U.S.C.
3027(a)) is amended--
            (1) in paragraph (4) by inserting ``older individuals who
        are Holocaust survivors,'' after ``proficiency,'',
            (2) in paragraph (16)(A)--
                    (A) in clause (v) by striking ``and'' at the end,
                and
                    (B) by adding at the end the following:
                            ``(vii) older individuals who are Holocaust
                        survivors; and'', and
            (3) in paragraph (28)(A)(ii) by inserting ``older
        individuals who are Holocaust survivors,'' after
        ``proficiency,''.

SEC. 107. CONSUMER CONTRIBUTIONS.

    Section 315 of the Older Americans Act of 1965 (42 U.S.C. 3030c-2)
is amended--
            (1) in subsection (c)(2) by inserting ``older individuals
        who are Holocaust survivors,'' after ``proficiency,'' and
            (2) in subsection (d) by inserting ``older individuals who
        are Holocaust survivors,'' after ``proficiency,''.

SEC. 108. PROGRAM AUTHORIZED.

    Section 372(c)(2)(A) of the Older Americans Act of 1965 (42 U.S.C.
3030s-2(c)(2)(A)) is amended by striking ``individuals)'' inserting
``individuals and older individuals who are Holocaust survivors)''.

SEC. 109. PREVENTION OF ELDER ABUSE, NEGLECT, AND EXPLOITATION.

    Section 721(b)(12) of the Older Americans Act of 1965 (42 U.S.C.
3058i(b)(12)) is amended--
            (1) in subparagraph (B) by striking ``or'' at the end,
            (2) in subparagraph (C) by striking the period at the end
        and inserting ``or'', and
            (3) by adding at the end the following:
                    ``(D) older individuals who are Holocaust
                survivors.''.

               TITLE II--FUNCTIONS OF ASSISTANT SECRETARY

SEC. 201. ESTABLISHMENT OF ADMINISTRATION ON AGING.

    Section 201 of the Older Americans Act of 1965 (42 U.S.C. 3012) is
amended by adding at the end the following:
    ``(g)(1) The Assistant Secretary is authorized to designate within
the Administration a person to have responsibility for older
individuals who are Holocaust survivors.
    ``(h) It shall be the duty of the Assistant Secretary, acting
through the person designated to have responsibility for older
individuals who are Holocaust survivors.''.

     TITLE III--ACTIVITIES FOR HEALTH, INDEPENDENCE, AND LONGEVITY

SEC. 301. INNOVATION TO IMPROVE TRANSPORTATION FOR OLDER INDIVIDUALS
              WHO ARE HOLOCAUST SURVIVORS.

    Part A of title IV of the Older Americans Act of 1965 (42 U.S.C.
3032 et seq.) is amended by adding at the end the following:

``SEC. 423. INNOVATION TO IMPROVE TRANSPORTATION FOR OLDER INDIVIDUALS
              WHO ARE HOLOCAUST SURVIVORS.

    ``(a) In General.--The Assistant Secretary shall award grants or
contracts to nonprofit organizations to improve and increase
transportation services for older individuals, with preference toward
those older individuals who are Holocaust survivors. The Assistant
Secretary shall make grants or enter into such contracts for period of
not less than 5 years.
    ``(b) Use of Funds.--
            ``(1) In general.--A nonprofit organization receiving a
        grant or contract under subsection (a) shall use the funds
        received through such grant or contract to carry out a
        demonstration project, or to provide technical assistance to
        assist local transit providers, area agencies on aging, senior
        centers, and local senior support groups, to encourage and
        facilitate coordination of Federal, State, and local
        transportation services and resources for older individuals who
        are Holocaust survivors. The organization may use the funds to
        develop and carry out an innovative transportation
        demonstration project to create transportation services for
        older individuals.
            ``(2) Specific activities.--In carrying out a demonstration
        project or providing technical assistance under paragraph (1)
        the organization may carry out activities that include--
                    ``(A) developing innovative approaches for
                improving access by older individuals to transportation
                services, including volunteer driver programs,
                economically sustainable transportation programs, and
                programs that allow older individuals to transfer their
                automobiles to a provider of transportation services in
                exchange for the services;
                    ``(B) preparing information on transportation
                options and resources for older individuals and
                organizations serving such individuals, and
                disseminating the information by establishing and
                operating a toll-free telephone number;
                    ``(C) developing models and best practices for
                providing comprehensive integrated transportation
                services for older individuals, including services
                administered by the Secretary of Transportation, by
                providing ongoing technical assistance to agencies
                providing services under title III and by assisting in
                coordination of public and community transportation
                services; and
                    ``(D) providing special services to link older
                individuals to transportation services not provided
                under title III.
    ``(c) Preference.--In awarding grants and entering into contracts
under paragraph (a), the Assistant Secretary shall give preference to
organizations and institutions that have previous extensive experience
working with and conducting assessment of the needs of Holocaust
survivors who are older individuals.
    ``(d) Consultation.--In determining the type of programs and
activities used to improve and increase transportation assistance for
Holocaust survivors, the Assistant Secretary shall consult with the
individual designated by Section 201(h)(1) of the Act and with national
organizations with special expertise in serving Holocaust survivors who
are older individuals.
    ``(e) Eligible Entities.--To be eligible to receive a grant or
enter into a contract under paragraph (a), an entity shall have
previous extensive experience working with and conducting assessment of
the needs of older individuals.
    ``(f) Report to Congress.--The Assistant Secretary with assistance
from the individual designated by Section 201 (h)(1) of the Act, shall
prepare and submit to the Speaker of the House of Representatives and
the President pro tempore of the Senate an annual report on the status
and needs, including the priority areas of concern, of older
individuals who are Holocaust survivors.''.

Output: Holocaust Survivors Assistance Act of 2011 - Amends the Older Americans Act of 1965 to: (1) include specifically within its purview older Americans who are Holocaust survivors; (2) authorize the Assistant Secretary for Aging of the Department of Health and Human Services (HHS) to designate within the Administration of Aging an individual who is to have responsibility for such individuals; and (3) create a grant program to increase and improve transportation services for older Americans, with preference for Holocaust survivors.


Input:
SECTION 1. EXCISE TAX ON GROSS RECEIPTS DERIVED FROM CRUISES.

    (a) In General.--Subchapter B of chapter 36 of the Internal Revenue
Code of 1986 is amended by inserting after section 4472 the following:

                       ``PART II--AD VALOREM TAX

``Sec. 4476. Imposition of tax.
``Sec. 4477. Definitions.

``SEC. 4476. IMPOSITION OF TAX.

    ``(a) In General.--In addition to any other tax, there is hereby
imposed a tax of 5 percent of the allocable amount with respect to any
covered passenger cruise.
    ``(b) By Whom Paid.--The tax imposed by this section shall be paid
by the person providing the covered passenger cruise.

``SEC. 4477. DEFINITIONS.

    ``For purposes of this section--
            ``(1) Covered passenger cruise.--
                    ``(A) In general.--The term `covered passenger
                cruise' means a voyage of a commercial passenger cruise
                vessel--
                            ``(i) that extends over 1 or more nights,
                        and
                            ``(ii) during which passengers embark or
                        disembark the vessel in the United States.
                    ``(B) Exceptions for certain voyages.--Such term
                shall not include any voyage--
                            ``(i) on any vessel owned or operated by
                        the United States, a State, or any subdivision
                        thereof,
                            ``(ii) which occurs exclusively on the
                        inland waterways of the United States, or
                            ``(iii) in which a vessel in the usual
                        course of employment proceeds, without an
                        intervening foreign port of call from one port
                        or place in the United States to the same port
                        or place or to another port or place in the
                        United States.
            ``(2) Passenger cruise vessel.--
                    ``(A) In general.--The term `passenger cruise
                vessel' means any passenger vessel--
                            ``(i) having berth or stateroom
                        accommodations for at least 250 passengers, and
                            ``(ii) that is used in the business of
                        carrying passengers for hire.
                    ``(B) Exceptions.--Such term shall not include any
                ferry, recreational vessel, sailing school vessel,
                small passenger vessel, offshore supply vessel, or any
                other vessel determined under regulations by the
                Secretary to be excluded from the application of this
                part.
                    ``(C) Definitions.--Any term used in this section
                which is used in chapter 21 of title 46, United States
                Code, shall have the meaning given such term under
                section 2101 of such title.
            ``(3) Allocable amount.--The term `allocable amount'
        means--
                    ``(A) in the case in which a majority of the
                passengers on any covered passenger cruise embark or
                disembark in the United States, 100 percent of the
                gross receipts attributable to such covered passenger
                cruise, and
                    ``(B) in any other case, 50 percent of the gross
                receipts attributable to such covered passenger cruise.
            ``(4) United states.--The term `United States' includes any
        possession of the United States.''.
    (b) Conforming Amendment.--Subchapter B of chapter 36 of the
Internal Revenue Code of 1986 is amended by striking all preceding
section 4471 and inserting the following:

                ``Subchapter B--Transportation by Water

                      ``Part I--Per Passenger Tax

                       ``Part II--Ad Valorem Tax

                      ``PART I--PER PASSENGER TAX

``Sec. 4471. Imposition of tax.
``Sec. 4472. Definitions.''.
    (c) Effective Date.--The amendments made by this section shall
apply to voyages made after the date of the enactment of this Act.

SEC. 2. INTERMODAL INFRASTRUCTURE TRUST FUND.

    (a) In General.--Subchapter A of Chapter 98 of the Internal Revenue
Code of 1986 is amended by adding at the end the following new section:

``SEC. 9512. INTERMODAL INFRASTRUCTURE TRUST FUND.

    ``(a) Creation of Trust Fund.--There is hereby established in the
Treasury of the United States a trust fund to be known as the
`Intermodal Infrastructure Trust Fund', consisting of such amounts as
may be appropriated or credited to the Intermodal Infrastructure Trust
Fund in this section or section 9602(b).
    ``(b) Transfers to Intermodal Infrastructure Trust Fund.--There are
hereby appropriated to the Intermodal Infrastructure Trust Fund amounts
equivalent to the taxes received in the Treasury under section 4471.
    ``(c) Expenditures From Intermodal Infrastructure Trust Fund.--
Amounts in the Intermodal Infrastructure Trust Fund shall be available,
as provided in appropriations Acts, for transportation improvement,
including--
            ``(1) the construction or improvement of--
                    ``(A) passenger or freight rail lines,
                    ``(B) highways,
                    ``(C) bridges,
                    ``(D) airports,
                    ``(E) air traffic control systems,
                    ``(F) port or marine facilities,
                    ``(G) inland waterways,
                    ``(H) transmission or distribution pipelines,
                    ``(I) public transportation facilities or systems,
                    ``(J) intercity passenger bus or passenger rail
                facilities or equipment, and
                    ``(K) freight rail facilities or equipment, and
            ``(2) planning, preparation, or design of any project
        described in paragraph (1).''.
    (b) Clerical Amendment.--The table of sections for subchapter A of
Chapter 98 of such Code is amended by adding at the end the following
new item:

``Sec. 9512. Intermodal Infrastructure Trust Fund.''.

Output: Amends the Internal Revenue Code to impose a 5% excise tax on persons providing a covered passenger cruise. Defines "covered passenger cruise" as a voyage of a commercial passenger cruise vessel that extends over one or more nights and during which passengers embark and disembark the vessel in the United States. Defines "passenger cruise vessel" as any passenger vessel having berth or stateroom accommodations for at least 250 passengers and that is used in the business of carrying passengers for hire.  Establishes in the Treasury the Intermodal Infrastructure Trust Fund to be funded by the per passenger excise tax. Allows expenditures from such Fund for specified transportation improvements.


Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Veterans Mental Health Treatment
First Act of 2013''.

SEC. 2. MENTAL HEATH CARE AND REHABILITATION FOR VETERANS FOR SERVICE-
              RELATED POST-TRAUMATIC STRESS DISORDER, DEPRESSION,
              ANXIETY DISORDER, OR RELATED SUBSTANCE USE DISORDER.

    (a) In General.--Subchapter II of chapter 17 of title 38, United
States Code, is amended by inserting after section 1712B the following
new section:
``Sec. 1712C. Mental health care and rehabilitation for service-related
              post-traumatic stress disorder, depression, anxiety
              disorder, or related substance use disorder
    ``(a) In General.--The Secretary shall carry out a program of
mental health care and rehabilitation for veterans who--
            ``(1) have been discharged or released from service in the
        active military, naval, or air service under conditions other
        than dishonorable for a period of not more than two years;
            ``(2) are enrolled in the system of annual patient
        enrollment established and operated by the Secretary under
        section 1705 of this title and have been so enrolled since
        before the date of the enactment of the Veterans Mental Health
        Treatment First Act of 2013;
            ``(3) are diagnosed by a physician of the Department with
        post-traumatic stress disorder, depression, anxiety disorder,
        or substance use disorder related to post-traumatic stress
        disorder, depression, or anxiety disorder that is service-
        related (as determined in accordance with subsection (b)); and
            ``(4) agree to the conditions of participation applicable
        to such veterans set forth in subsection (c).
    ``(b) Treatment of Conditions as Service-Related.--(1) A condition
of a veteran described in subsection (a)(3) shall be treated as
service-related for purposes of this section if--
            ``(A) the condition has previously been adjudicated by the
        Secretary to be service-connected; or
            ``(B) the condition is judged by the physician of the
        Department making the diagnosis for the veteran as described in
        subsection (a)(3) to be plausibly related to the service of the
        veteran in the active military, naval, or air service.
    ``(2) The Secretary shall prescribe in regulations the standards to
be utilized by physicians of the Department in judging under paragraph
(1)(B) whether or not a condition of a veteran described in subsection
(a)(3) is plausibly related to the service of the veteran in the active
military, naval, or air service.
    ``(c) Conditions of Participation.--(1) As conditions for
participation in the program under this section, a veteran seeking
mental health care and rehabilitation under the program for a condition
described in subsection (a)(3) who has not yet filed a claim for
disability under this title for such condition shall agree as follows:
            ``(A) To comply substantially with the treatment regimen
        and rehabilitation plan prescribed under subsection (d) for the
        veteran.
            ``(B) Not to submit a claim for disability compensation
        under chapter 11 of this title for post-traumatic stress
        disorder, depression, anxiety disorder, or a related substance
        use disorder until the earlier of--
                    ``(i) the end of the one-year period beginning on
                the date of the commencement of the program by the
                veteran; or
                    ``(ii) the conclusion of the treatment regimen and
                rehabilitation plan prescribed under subsection (d) for
                the veteran.
    ``(2) As conditions for participation in the program under this
section, a veteran seeking mental health care and rehabilitation under
the program for a condition described in subsection (a)(3) who has
filed a claim for disability under this title for such condition that
has not been adjudicated by the Secretary at the time of the diagnosis
of the veteran described in subsection (a)(3)--
            ``(A) shall agree to comply substantially with the
        treatment regimen and rehabilitation plan prescribed under
        subsection (d) for the veteran; and
            ``(B) may agree, at the election of the veteran, to the
        suspension by the Secretary of adjudication of such claim until
        completion by the veteran of the treatment regimen and
        rehabilitation plan.
    ``(3) As conditions for participation in the program under this
section, a veteran seeking mental health care and rehabilitation under
the program for one or more conditions described in subsection (a)(3)
that have been determined by the Secretary to be service-connected
shall agree as follows:
            ``(A) To comply substantially with the treatment regimen
        and rehabilitation plan prescribed under subsection (d) for the
        veteran.
            ``(B) Not to submit a claim for an increase in disability
        compensation under chapter 11 of this title for or based on
        such condition or conditions until the earlier of--
                    ``(i) the end of the one-year period beginning on
                the date of the commencement of the program by the
                veteran; or
                    ``(ii) the completion of the treatment regimen and
                rehabilitation plan prescribed under subsection (d) for
                the veteran.
    ``(d) Treatment Regimen and Rehabilitation Plan.--(1) The Secretary
shall provide for each veteran who participates in the program under
this section a treatment regimen and rehabilitation plan for the post-
traumatic stress disorder, depression, anxiety disorder, or related
substance use disorder of such veteran as described in subsection
(a)(3). The treatment regimen and rehabilitation plan shall be devised
by appropriate clinicians and other appropriate personnel of the
Department assigned for that purpose.
    ``(2) The treatment regimen and rehabilitation plan for a veteran
under this subsection shall include such mental health care and
rehabilitation as the clinicians and other personnel concerned consider
appropriate for the remediation of the condition or conditions of the
veteran covered by the plan.
    ``(3) The duration of each treatment regimen and rehabilitation
plan under this subsection shall be such period as the clinician
concerned considers appropriate.
    ``(e) Wellness Stipends.--(1) Subject to paragraph (4), each
veteran covered by subsection (c)(1) who participates in the program
under this section shall be paid a stipend as follows:
            ``(A) $2,000 payable upon commencement of the treatment
        regimen and rehabilitation plan provided under subsection (d)
        for such veteran.
            ``(B) $1,500 payable every 90 days thereafter upon
        certification by the clinician treating such veteran under the
        program that such veteran is in substantial compliance with
        such treatment regimen and rehabilitation plan, except that the
        total amount payable to such veteran under this subparagraph
        may not exceed $6,000.
            ``(C) $3,000 payable at the earlier of--
                    ``(i) the date of the conclusion of such treatment
                regimen and rehabilitation plan; or
                    ``(ii) one year after the date of the commencement
                of such treatment regimen and rehabilitation plan by
                such veteran.
    ``(2) Subject to paragraph (4), each veteran covered by subsection
(c)(2) who participates in the program under this section shall be paid
a stipend as follows:
            ``(A) If such veteran agrees as provided in subparagraph
        (B) of subsection (c)(2), the stipend payable under paragraph
        (1).
            ``(B) If such veteran does not agree as provided in
        subparagraph (B) of subsection (c)(2), the stipend payable
        under paragraph (3).
    ``(3) Subject to paragraph (4), each veteran covered by subsection
(c)(3) who participates in the program under this section shall be paid
a stipend as follows:
            ``(A) $667 payable upon commencement of the treatment
        regimen and rehabilitation plan provided under subsection (d)
        for such veteran.
            ``(B) $500 payable every 90 days thereafter upon
        certification by the clinician treating such veteran under the
        program that such veteran is in substantial compliance with
        such treatment regimen and rehabilitation plan, except that the
        total amount payable to such veteran under this subparagraph
        may not exceed $2,000.
            ``(C) $1,000 payable at the earlier of--
                    ``(i) the date of the conclusion of such treatment
                regimen and rehabilitation plan; or
                    ``(ii) one year after the date of the commencement
                of such treatment regimen and rehabilitation plan by
                such veteran.
    ``(4) In the event a veteran is determined by the Secretary to have
failed to comply with any condition agreed to by the veteran under
subsection (c), payment to the veteran of any stipend otherwise
authorized to be payable under this subsection shall cease.
    ``(f) Limitation on Participation.--(1) Except as provided in
paragraph (2), a veteran may participate only once in the program under
this section.
    ``(2) A veteran may participate more than once in the program under
this section if the Secretary determines that such additional
participation in the program will assist the veteran in achieving the
remediation of the condition or conditions addressed by participation
in the program.
    ``(3) The total amount of stipend payable under subsection (e) to a
veteran covered by paragraph (2) may not exceed $11,000.''.
    (b) Clerical Amendment.--The table of sections at the beginning of
chapter 17 of such title is amended by inserting after the item
relating to section 1712B the following new item:

``1712C. Mental health care and rehabilitation for service-related
                            post-traumatic stress disorder, depression,
                            anxiety disorder, or related substance use
                            disorder.''.

Output: Veterans Mental Health Treatment First Act of 2013 - Directs the Secretary of Veterans Affairs (VA) to carry out a program of mental health care and rehabilitation for veterans who: (1) have been discharged or released from active-duty service under conditions other than dishonorable for no more than two years; (2) are enrolled in the VA system of annual patient enrollment and were so enrolled before the date of enactment of this Act; (3) are diagnosed by a VA physician with post-traumatic stress disorder, depression, anxiety disorder, or substance use disorder that is service-related (as determined by the Secretary or a VA physician); and (4) agree to certain participation conditions, including not submitting a claim for veterans' disability compensation for any such condition until either one year after program commencement or the conclusion of the prescribed treatment regimen. Requires the Secretary to provide for each participant a treatment regimen and rehabilitation plan for the determined condition. Provides a stipend for participants, commencing upon program commencement, continuing through successful treatment and plan compliance, and ending either upon the conclusion of such treatment or one year after treatment and plan commencement. Allows a veteran to participate more than once in the program if the Secretary determines that the additional participation will assist the veteran in achieving the remediation of the condition.


Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Quality Cancer Care Preservation
Act''.

SEC. 2. MEDICARE PAYMENT FOR DRUGS AND BIOLOGICALS.

    (a) In General.--Section 1842(o)(1) of the Social Security Act (42
U.S.C. 1395u(o)(1)) is amended by striking ``95 percent of the average
wholesale price'' and inserting ``the payment amount specified in
section 1834(n)(2)''.
    (b) Determination of Payment Amount.--Section 1834 of such Act (42
U.S.C. 1395m) is amended by adding at the end the following new
subsection:
    ``(n) Payment for Drugs and Biologicals.--
            ``(1) Reports by manufacturers.--
                    ``(A) In general.--Every drug manufacturer shall
                report to the Secretary, in the manner prescribed in
                this paragraph, its average sales price (as defined in
                subparagraph (B)) in the United States during each
                calendar quarter for drugs and biologicals covered
                under this part.
                    ``(B) Definitions.--For purposes of this
                subsection--
                            ``(i) the term `manufacturer' means, with
                        respect to a drug or biological, the entity
                        identified by the Labeler Code portion of the
                        National Drug Code of such drug or biological;
                        and
                            ``(ii) the term `average sales price' means
                        the weighted average of all final sales prices
                        to all purchasers, excluding sales specified in
                        subparagraph (C).
                In determining such average sales prices, such prices
                shall be net of volume discounts, chargebacks, short-
                dated product discounts, free goods contingent on
                purchases, rebates (other than those made or authorized
                under section 1927), and all other price concessions
                that result in a reduction of the ultimate cost to the
                purchaser.
                    ``(C) Consideration in calculation of average sales
                prices.--The calculation of average sales price under
                this subsection shall not include--
                            ``(i) prices that are excluded from the
                        calculation of `best price' under section
                        1927(c)(1)(C);
                            ``(ii) prices offered to entities that are
                        considered under subparagraph (B)(i) to be the
                        manufacturers of the drugs or biologicals
                        involved;
                            ``(iii) prices offered by a manufacturer to
                        a hospital, nursing facility, hospice, or
                        health maintenance organization;
                            ``(iv) prices to governmental entities; and
                            ``(v) nominal prices offered to bona fide
                        charitable organizations.
                    ``(D) Quarterly reports.--Each manufacturer shall
                submit the report required by subparagraph (A) to the
                Secretary by electronic means no later than 30 days
                after the end of a calendar quarter with respect to
                sales that occurred during such quarter. The Secretary
                shall prescribe the format and other requirements for
                the report.
                    ``(E) Enforcement.--
                            ``(i) Failure to timely report.--The
                        Secretary may impose a civil monetary penalty
                        in an amount not to exceed $100,000 on a
                        manufacturer that fails to provide the
                        information required under this paragraph on a
                        timely basis and in the manner required.
                            ``(ii) False information.--For each item of
                        false information, the Secretary may impose a
                        civil money penalty in an amount not to exceed
                        $100,000 on a manufacturer that knowingly
                        provides false information under this
                        paragraph.
                            ``(iii) Manner of imposition of civil
                        monetary penalties.--The provisions in section
                        1128A (other than subsections (a) and (b))
                        shall apply to a civil monetary penalty under
                        this subparagraph in the same manner as such
                        provisions apply to a penalty or proceeding
                        under section 1128A(a).
                    ``(F) Confidentiality of information.--
                Notwithstanding any other provision of law, information
                disclosed by manufacturers under this paragraph is
                confidential and shall not be disclosed by the
                Secretary in any form other than as specifically
                authorized by this subsection.
            ``(2) Calculation of payment amount.--
                    ``(A) In general.--Except as otherwise provided in
                this paragraph, the payment amount for a drug or
                biological furnished during a calendar quarter shall be
                120 percent of the average sales price of the drug or
                biological for the second preceding calendar quarter as
determined under paragraph (1).
                    ``(B) Methodology.--In determining payment amounts
                under subparagraph (A), the Secretary may, in the
                Secretary's discretion, use either the average sales
                price for each drug or biological by specific drug or
                biological, or a cumulative average sales price based
                on sales data for all versions of a multiple-source
                drug that the Secretary, acting through the Food and
                Drug Administration, has determined are therapeutically
                equivalent (as evidenced by `A' ratings in the
                publication Approved Drug Products with Therapeutic
                Equivalence Evaluations).
                    ``(C) Increase to reflect additional costs
                attributable to state and local taxes.--In the case of
                a drug or biological that was subject to a State or
                local sales tax or gross receipts tax when administered
                or dispensed, the payment amount determined under
                subparagraph (A) shall be increased by the amount of
                such tax paid with respect to such drug or biological.
                    ``(D) Substitution of higher payment amount.--If a
                physician's, supplier's, or any other person's claim
                for payment for services under this Act documents that
                the price paid for a drug or biological was greater
                than the payment amount determined under subparagraph
                (A), the actual amount paid shall be substituted for
                the payment amount determined under subparagraph (A),
                unless the Secretary determines that the actual amount
                paid was unreasonable under the circumstances.
                    ``(E) Increase for bad debt and certain other
                costs.--Upon the submission of supporting information,
                the Secretary shall make an additional payment to a
                physician or supplier to cover--
                            ``(i) uncollectible deductibles and
                        coinsurance due from Medicare beneficiaries
                        with respect to drugs and biologicals furnished
                        to such beneficiaries; and
                            ``(ii) costs incurred in procuring and
                        billing for drugs and biologicals furnished to
                        Medicare beneficiaries.''.

SEC. 3. MEDICARE PAYMENT FOR DRUG ADMINISTRATION SERVICES.

    (a) General.--The Secretary of Health and Human Services (hereafter
in this Act referred to as ``the Secretary'') shall revise the practice
expense relative value units for drug administration services for years
beginning with the year 2005 in accordance with this section. For
purposes of this section, ``drug administration services'' includes
chemotherapy administration services, therapeutic and diagnostic
infusions and injections, and such other services as the Secretary
specifies.
    (b) Direct Costs Equal to 100 Percent of CPEP Estimates.--Using the
information, including estimates of clinical staff time, developed in
the clinical practice expert panel process, including refinements by
American Medical Association committees, the Secretary shall estimate
the costs of the nursing and other clinical staff, supplies, and
procedure-specific equipment (exceeding a cost specified by the
Secretary) used in furnishing each type of drug administration service.
The Secretary shall utilize without revision the minutes of clinical
staff time determined in such process. The Secretary shall convert the
information from such process to estimated costs by applying the most
current available data on staff salary, supply, and equipment costs,
and such costs shall be updated to 2005 based on estimated changes in
prices since the date of such data.
    (c) Total Practice Expenses.--The Secretary shall estimate the
total practice expenses of each drug administration service by assuming
that the direct costs for the service determined under subsection (b)
are 33.2 percent of such total practice expenses.
    (d) Conversion to Relative Value Units.--The Secretary shall
convert the total practice expenses determined under subsection (c) to
practice expense relative value units for each drug administration
service by dividing such expenses by the conversion factor that will be
in effect for the physician fee schedule for 2005. The relative value
units as so determined shall be used in determining the fee schedule
amounts paid for drug administration services under section 1848 of the
Social Security Act (42 U.S.C. 1395w-4).
    (e) Updates.--For years after 2005, the relative values determined
under subsection (d) shall continue in effect except that the Secretary
shall revise them as necessary to maintain their accuracy, provided
that such revisions are consistent with the methodology set forth in
this section.
    (f) Multiple Pushes.--In establishing the payment amounts under
this section, the Secretary shall establish the payment amount for
intravenous chemotherapy administration by push technique based on the
administration of a single drug. The Secretary shall make the same
payment for each additional drug administered by push technique during
the same encounter, except to the extent that the Secretary finds that
the cost of administering additional drugs is less than the cost of
administering the first drug.

SEC. 4. PAYMENTS FOR CHEMOTHERAPY SUPPORT SERVICES.

    (a) General.--Beginning in the year 2005, the Secretary shall
recognize and make payments under section 1848 of the Social Security
Act (42 U.S.C. 1395w-4) for chemotherapy support services furnished
incident to physicians' services. For the purposes of this section,
``chemotherapy support services'' are services furnished by the staff
of physicians to patients undergoing treatment for cancer that were not
included in the computation of clinical staff costs under section 3(b).
Such services include social worker services, nutrition counseling,
psychosocial services, and similar services.
    (b) Direct Costs.--The Secretary shall estimate the cost of the
salary and benefits of staff furnishing chemotherapy support services
as they are provided in oncology practices that furnish these services
to cancer patients in a manner that is considered to be high quality
care. The estimate shall be based on the weekly cost of such services
per patient receiving chemotherapy.
    (c) Total Costs.--The Secretary shall estimate the total practice
expenses of chemotherapy support services by assuming that the direct
costs for the service determined under subsection (b) are 33.2 percent
of such total practice expenses.
    (d) Conversion to Relative Value Units.--The Secretary shall
convert the total practice expenses determined under subsection (c) to
practice expense relative value units for chemotherapy support services
by dividing such expenses by the conversion factor that will be in
effect for the physician fee schedule for 2005. The relative value
units as so determined shall be used in determining the fee schedule
amounts paid for chemotherapy support services under such section 1848.
    (e) Updates.--For the years after 2005, the relative values
determined under subsection (d) shall continue in effect except that
the Secretary shall revise them as necessary to maintain their
accuracy, provided that such revisions are consistent with the
methodology set forth in this section.

SEC. 5. CANCER THERAPY MANAGEMENT SERVICES.

    The Secretary shall recognize and establish a payment amount for
the service of cancer therapy management to account for the greater
pre-service and post-service work associated with visits and
consultations conducted by physicians treating cancer patients compared
to typical visits and consultations. The payment amount may vary by the
level and type of the related visit or consultation.

SEC. 6. OTHER SERVICES WITHOUT PHYSICIAN WORK RELATIVE VALUE UNITS.

    The Secretary shall develop a revised methodology for determining
the payment amounts for services that are paid under the fee schedule
established by section 1848 of the Social Security Act (42 U.S.C.
1395w-4) and that do not have physician work relative value units,
including radiation oncology services. Such methodology shall result in
payment amounts that fully cover the costs of furnishing such services.
Until such time as the methodology for such services is revised and
implemented, all such services shall be protected from further payment
cuts due to factors such as shifts in utilization or removal of any one
specialty's services that are paid under the fee schedule established
by such section 1848 and that do not have physician work relative value
units.

SEC. 7. PHYSICIAN SUPERVISION OF SERVICES.

    Section 1834 of the Social Security Act (42 U.S.C. 1395m), as
amended by section 2, is further amended by adding at the end the
following new subsection:
    ``(o) Supervision Requirements.--If the Secretary requires direct
supervision of a service by a physician, that supervision requirement
may be fulfilled by one or more physicians other than the physician who
ordered the service. If the supervising physician is different from the
ordering physician for a particular service, the ordering physician may
nevertheless bill for such service provided that the medical records
for the service involved identify the supervising physician or
physicians.''.

SEC. 8. REPORT TO CONGRESS.

    No later than April 1, 2004, the Secretary shall submit to Congress
a report on the payment amounts that are projected to be adopted under
sections 2, 3, 4, and 5 of this Act.

SEC. 9. INSTITUTE OF MEDICINE STUDY.

    (a) General.--The Secretary of Health and Human Services shall
request the Institute of Medicine to conduct the study described in
this section.
    (b) Baseline Study.--The first phase of the study shall include the
following objectives:
            (1) An assessment of the extent to which the current
        Medicare payment system, prior to implementation of the
        amendments made by this Act, facilitates appropriate access to
        care by cancer patients in the various treatment settings.
            (2) The identification of the comprehensive range of
        services furnished to cancer patients in the outpatient
        setting, including support services such as psychosocial
        services and counseling, and recommendations regarding the
        types of services that ought to be furnished to Medicare
        patients with cancer.
            (3) A discussion of the practice standards necessary to
        assure the safe provision of services to cancer patients.
            (4) An analysis of the extent to which the current Medicare
        payment system supports the role of nurses in the provision of
        oncology services and recommendations for any necessary
        improvements in the payment system in that respect.
            (5) The development of a framework for assessing how the
        amendments made by this act affect the provision of care to
        Medicare patients with cancer in the various treatment
        settings.
    (c) Second Phase of Study.--After the implementation of the
amendments made by this Act, the study shall determine whether and how
those amendments affected the provision of care to Medicare patients
with cancer.
    (d) Consultation.--The Institute of Medicine shall consult with the
National Cancer Policy Board and organizations representing cancer
patients and survivors, oncologists, oncology nurses, social workers,
cancer centers, and other healthcare professionals who treat cancer
patients in planning and carrying out this study.
    (e) Due Dates.--
            (1) The study required by subsection (b) shall be submitted
        to the Congress and the Secretary of Health and Human Services
        no later than June 30, 2004.
            (2) The study required by subsection (c) shall be submitted
        to the Congress and the Secretary of Health and Human Services
        no later than December 31, 2006.

SEC. 10. EFFECTIVE DATES.

    (a) General.--Except as provided in this section, the provisions of
this Act shall apply to drugs, biologicals, and services furnished on
or after January 1, 2005.
    (b) Reports From Manufacturers.--The first report by manufacturers
required by the provisions of section 2 shall be submitted no later
than October 30, 2004, with respect to sales that occurred in the
quarter ending September 30, 2004.
    (c) Supervision of Services.--The amendment made by section 7 shall
be effective upon enactment.
    (d) Services Other Than Drug Administration.--The Secretary shall
implement the requirements of section 6 no later than January 1, 2005.

Output: Quality Cancer Care Preservation Act - Amends part B (Supplementary Medical Insurance) of title XVIII (Medicare) of the Social Security Act (SSA) to revise the payment amount for covered drugs and biologicals furnished during a calendar quarter that are not paid on a cost or prospective payment basis. Changes such amount from 95 percent of the average wholesale price to 120 percent of the average sales price of the drug or biological for the second preceding calendar quarter. Requires drug manufacturers to report average sales prices each calendar quarter for covered drugs and biologicals.Directs the Secretary of Health and Human Services to: (1) revise the practice expense relative value units for drug administration services (including chemotherapy administration services) in accordance with this Act to determine the units to be used in determining the fee schedule amounts paid for drug administration services under the Medicare program; (2) recognize and make payments under Medicare for chemotherapy support services furnished incident to physicians' services; (3) recognize and establish a payment amount for the service of cancer therapy management to account for the greater pre-service and post-service work associated with visits and consultations conducted by physicians treating cancer patients compared to typical visits and consultations; and (4) develop a revised methodology for determining the payment amounts for services that are paid under the Medicare fee schedule and that do not have physician work relative value units, including radiation oncology services.Amends SSA title XVIII to provide that if the Secretary requires direct supervision of a service by a physician, that supervision requirement may be fulfilled by one or more physicians other than the physician who ordered the service.


Input:
SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Small Business Lawsuit Abuse
Protection Act of 1997''.

SEC. 2. FINDINGS.

    Congress finds that--
            (1) the United States civil justice system is inefficient,
        unpredictable, unfair, costly, and impedes competitiveness in
        the marketplace for goods, services, business, and employees;
            (2) the defects in the civil justice system have a direct
        and undesirable effect on interstate commerce by decreasing the
        availability of goods and services in commerce;
            (3) there is a need to restore rationality, certainty, and
        fairness to the legal system;
            (4) the spiralling costs of litigation and the magnitude
        and unpredictability of punitive damage awards and noneconomic
        damage awards have continued unabated for at least the past 30
        years;
            (5) the Supreme Court of the United States has recognized
        that a punitive damage award can be unconstitutional if the
        award is grossly excessive in relation to the legitimate
        interest of the government in the punishment and deterrence of
        unlawful conduct;
            (6) just as punitive damage awards can be grossly
        excessive, so can it be grossly excessive in some circumstances
        for a party to be held responsible under the doctrine of joint
        and several liability for damages that party did not cause;
            (7) as a result of joint and several liability, entities
        including small businesses are often brought into litigation
        despite the fact that their conduct may have little or nothing
        to do with the accident or transaction giving rise to the
        lawsuit, and may therefore face increased and unjust costs due
        to the possibility or result of unfair and disproportionate
        damage awards;
            (8) the costs imposed by the civil justice system on small
        businesses are particularly acute, since small businesses often
        lack the resources to bear those costs and to challenge
        unwarranted lawsuits;
            (9) due to high liability costs and unwarranted litigation
        costs, small businesses face higher costs in purchasing
        insurance through interstate insurance markets to cover their
        activities;
            (10) liability reform for small businesses will promote the
        free flow of goods and services, lessen burdens on interstate
        commerce, and decrease litigiousness; and
            (11) legislation to address these concerns is an
        appropriate exercise of Congress' powers under Article I,
        section 8, clauses 3, 9, and 18 of the Constitution, and the
        fourteenth amendment to the Constitution.

SEC. 3. DEFINITIONS.

    In this Act:
            (1) Act of international terrorism.--The term ``act of
        international terrorism'' has the same meaning as in section
        2331 of title 18, United States Code).
            (2) Crime of violence.--The term ``crime of violence'' has
        the same meaning as in section 16 of title 18, United States
        Code.
            (3) Drug.--The term ``drug'' means any controlled substance
        (as that term is defined in section 102 of the Controlled
        Substances Act (21 U.S.C. 802(b)) that was not legally
        prescribed for use by the defendant or that was taken by the
        defendant other than in accordance with the terms of a lawfully
        issued prescription.
            (4) Economic loss.--The term ``economic loss'' means any
        pecuniary loss resulting from harm (including the loss of
        earnings or other benefits related to employment, medical
        expense loss, replacement services loss, loss due to death,
        burial costs, and loss of business or employment opportunities)
        to the extent recovery for such loss is allowed under
        applicable State law.
            (5) Harm.--The term ``harm'' includes physical,
        nonphysical, economic, and noneconomic losses.
            (6) Hate crime.--The term ``hate crime'' means a crime
        described in section 1(b) of the Hate Crime Statistics Act (28
        U.S.C. 534 note)).
            (7) Noneconomic losses.--The term ``noneconomic losses''
        means losses for physical and emotional pain, suffering,
        inconvenience, physical impairment, mental anguish,
        disfigurement, loss of enjoyment of life, loss of society and
        companionship, loss of consortium (other than loss of domestic
        service), injury to reputation, and all other nonpecuniary
        losses of any kind or nature.
            (8) Small business.--
                    (A) In general.--The term ``small business'' means
                any unincorporated business, or any partnership,
                corporation, association, unit of local government, or
                organization that has less than 25 full-time employees.
                    (B) Calculation of number of employees.--For
                purposes of subparagraph (A), the number of employees
                of a subsidiary of a wholly-owned corporation includes
                the employees of--
                            (i) a parent corporation; and
                            (ii) any other subsidiary corporation of
                        that parent corporation.
            (10) State.--The term ``State'' means each of the several
        States, the District of Columbia, the Commonwealth of Puerto
        Rico, the Virgin Islands, Guam, American Samoa, the Northern
        Mariana Islands, any other territory or possession of the
        United States, or any political subdivision of any such State,
        territory, or possession.

SEC. 4. LIMITATION ON PUNITIVE DAMAGES FOR SMALL BUSINESSES.

    (a) General Rule.--Except as provided in section 6, in any civil
action against a small business, punitive damages may, to the extent
permitted by applicable State law, be awarded against the small
business only if the claimant establishes by clear and convincing
evidence that conduct carried out by that defendant through willful
misconduct or with a conscious, flagrant indifference to the rights or
safety of others was the proximate cause of the harm that is the
subject of the action.
    (b) Limitation on Amount.--In any civil action against a small
business, punitive damages shall not exceed the lesser of--
            (1) two times the total amount awarded to the claimant for
        economic and noneconomic losses; or
            (2) $250,000.
    (c) Application by Court.--This section shall be applied by the
court and shall not be disclosed to the jury.

SEC. 5. LIMITATION ON SEVERAL LIABILITY FOR NONECONOMIC LOSS FOR SMALL
              BUSINESSES.

    (a) General Rule.--Except as provided in section 6, in any civil
action against a small business, the liability of each defendant that
is a small business, or the agent of a small business, for noneconomic
loss shall be determined in accordance with subsection (b).
    (b) Amount of Liability.--
            (1) In general.--In any civil action described in
        subsection (a)--
                    (A) each defendant described in that subsection
                shall be liable only for the amount of noneconomic loss
                allocated to that defendant in direct proportion to the
                percentage of responsibility of that defendant
                (determined in accordance with paragraph (2)) for the
                harm to the claimant with respect to which the
                defendant is liable; and
                    (B) the court shall render a separate judgment
                against each defendant described in that subsection in
                an amount determined pursuant to subparagraph (A).
            (2) Percentage of responsibility.--For purposes of
        determining the amount of noneconomic loss allocated to a
        defendant under this section, the trier of fact shall determine
        the percentage of responsibility of each person responsible for
        the harm to the claimant, regardless of whether or not the
        person is a party to the action.

SEC. 6. EXCEPTIONS TO LIMITATIONS ON LIABILITY.

    The limitations on liability under sections 4 and 5 do not apply to
any misconduct of a defendant--
            (1) that constitutes--
                    (A) a crime of violence;
                    (B) an act of international terrorism; or
                    (C) a hate crime;
            (2) that involves--
                    (A) a sexual offense, as defined by applicable
                State law; or
                    (B) a violation of a Federal or State civil rights
                law; or
            (3) if the defendant was under the influence (as determined
        pursuant to applicable State law) of intoxicating alcohol or a
        drug at the time of the misconduct, and the fact that the
        defendant was under the influence was the cause of any harm
        alleged by the plaintiff in the subject action.

SEC. 7. PREEMPTION AND ELECTION OF STATE NONAPPLICABILITY.

    (a) Preemption.--Subject to subsection (b), this Act preempts the
laws of any State to the extent that State laws are inconsistent with
this Act, except that this Act shall not preempt any State law that
provides additional protections from liability for small businesses.
    (b) Election of State Regarding Nonapplicability.--This Act does
not apply to any action in a State court against a small business in
which all parties are citizens of the State, if the State enacts a
statute--
            (1) citing the authority of this subsection;
            (2) declaring the election of such State that this Act does
        not apply as of a date certain to such actions in the State;
        and
            (3) containing no other provision.

SEC. 8. EFFECTIVE DATE.

    (a) In General.--This Act shall take effect 90 days after the date
of enactment of this Act.
    (b) Application.--This Act applies to any claim for harm caused by
an act or omission of a small business, if the claim is filed on or
after the effective date of this Act, without regard to whether the
harm that is the subject of the claim or the conduct that caused the
harm occurred before such effective date.

Output:
Small Business Lawsuit Abuse Protection Act of 1997 - Provides that, in any civil action against a small business (fewer than 25 full-time employees), punitive damages may be awarded against such business only if the claimant establishes by clear and convincing evidence that conduct carried out by the defendant through willful misconduct or with a conscious, flagrant indifference to the rights or safety of others was the proximate cause of the harm that is the subject of the action.  Prohibits, in any action against a small business, punitive damages from exceeding the lesser of:  (1) twice the amount awarded for economic and noneconomic losses; or (2) $250,000.
Provides that, in such an action, the liability of each defendant small business shall be limited to the amount of noneconomic loss allocated to that defendant in direct proportion to its percentage of responsibility for the harm that is the subject of the action. Requires the court to render a separate judgment against each such defendant.
Provides as exceptions to the small business liability limitations under this Act any misconduct:  (1) that constitutes a crime of violence, international terrorism, or a hate crime; (2) that involves a sexual offense or a violation of a Federal or State civil rights law; or (3) if the defendant was under the influence of intoxicating alcohol or a drug at the time of the misconduct and that fact causes any of the harm alleged.