Emergency Access to Insulin Act of 2019

I 116TH CONGRESS 1ST SESSION H. R. 4010 To amend the Public Health Service Act to establish insulin assistance programs, and for other purposes. IN THE HOUSE OF REPRESENTATIVES JULY 25, 2019 Ms. CRAIG (for herself and Mr. PHILLIPS) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provi- sions as fall within the jurisdiction of the committee concerned A BILL To amend the Public Health Service Act to establish insulin assistance programs, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Emergency Access to 4 Insulin Act of 2019’’. 5 SEC. 2. INSULIN ASSISTANCE PROGRAMS. 6 (a) IN GENERAL.—Part B of title III of the Public 7 Health Service Act (42 U.S.C. 243 et seq.) is amended 8 by adding at the end the following: 9 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H4010.IH H4010 kjohnson on DSK79L0C42 with BILLS 2 •HR 4010 IH ‘‘SEC. 320B. INSULIN ASSISTANCE PROGRAMS. 1 ‘‘(a) ESTABLISHMENT OF PROGRAM OF GRANTS TO 2 STATES, INDIAN TRIBES, AND TRIBAL ORGANIZA- 3 TIONS.— 4 ‘‘(1) IN GENERAL.—The Secretary, acting 5 through the Director of the Centers for Disease 6 Control and Prevention, shall, not later than 1 year 7 after the date of enactment of this section, make 8 grants to States, Indian tribes, and tribal organiza- 9 tions for the purpose of carrying out programs to as- 10 sist eligible individuals in obtaining insulin in ac- 11 cordance with paragraph (4). 12 ‘‘(2) GRANT AND CONTRACT AUTHORITY FOR 13 STATES, INDIAN TRIBES, AND TRIBAL ORGANIZA- 14 TIONS.— 15 ‘‘(A) IN GENERAL.—A State, Indian tribe, 16 or tribal organization receiving a grant under 17 paragraph (1) may, subject to subparagraph 18 (B), expend the grant to carry out the purpose 19 described in such paragraph through grants or 20 contracts to public or private entities, including 21 local governments. 22 ‘‘(B) CERTAIN APPLICATIONS.—If a non- 23 profit private entity and a private entity that is 24 not a nonprofit entity both submit applications 25 to a State, Indian tribe, or tribal organization 26 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H4010.IH H4010 kjohnson on DSK79L0C42 with BILLS 3 •HR 4010 IH to receive an award of a grant or contract 1 under subparagraph (A), the State, Indian 2 tribe, or tribal organization may give priority to 3 the application submitted by the nonprofit pri- 4 vate entity in any case in which the State, In- 5 dian tribe, or tribal organization determines 6 that the quality of such application is equiva- 7 lent to the quality of the application submitted 8 by the other private entity. 9 ‘‘(3) ALLOTMENT.—Each State, Indian tribe, 10 or tribal organization that applies for a grant in ac- 11 cordance with subsection (e) shall receive a grant 12 under this section in an amount that is equal to the 13 sum of— 14 ‘‘(A) a minimum amount determined by 15 the Secretary; and 16 ‘‘(B) an additional amount based on cri- 17 teria established by the Secretary, which may 18 include the ability of the State, Indian tribe, or 19 tribal organization to successfully assist individ- 20 uals in seeking eligibility for Federal or State- 21 funded programs as described in paragraph 22 (4)(A)(iv). 23 ‘‘(4) PROGRAM COMPONENTS.— 24 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H4010.IH H4010 kjohnson on DSK79L0C42 with BILLS 4 •HR 4010 IH ‘‘(A) IN GENERAL.—A State, Indian tribe, 1 or tribal organization carrying out a program 2 supported by a grant under this subsection 3 shall use the grant funds to— 4 ‘‘(i) purchase insulin; 5 ‘‘(ii) issue insulin cards to eligible in- 6 dividuals in accordance with subparagraph 7 (B); 8 ‘‘(iii) enter into agreements with phar- 9 macies— 10 ‘‘(I) for such pharmacies to fill 11 prescriptions for individuals displaying 12 valid insulin cards that are issued in 13 accordance with subparagraph (B) at 14 no cost to such individuals; and 15 ‘‘(II) for the State, Indian tribe, 16 or tribal organization to pay such 17 pharmacies for insulin filled for a pre- 18 scription described in subclause (I); 19 and 20 ‘‘(iv) assist individuals in seeking eli- 21 gibility for Federal or State-funded pro- 22 grams which may provide coverage for in- 23 sulin or otherwise assist such individuals in 24 obtaining insulin. 25 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H4010.IH H4010 kjohnson on DSK79L0C42 with BILLS 5 •HR 4010 IH ‘‘(B) INSULIN CARDS.— 1 ‘‘(i) APPLICATION.—An eligible indi- 2 vidual seeking an insulin card through a 3 program supported by a grant under this 4 subsection shall submit an application to 5 the State, Indian tribe, or tribal organiza- 6 tion receiving the grant, at such time, in 7 such manner, and containing such infor- 8 mation as the State, Indian tribe, or tribal 9 organization may reasonably require for 10 purposes of this subsection, including— 11 ‘‘(I) documentation indicating 12 proof of— 13 ‘‘(aa) in the case of a grant 14 awarded to a State, residency in 15 the State; 16 ‘‘(bb) in the case of a grant 17 awarded to an Indian tribe, mem- 18 bership in the Indian tribe; or 19 ‘‘(cc) in the case of a grant 20 awarded to a tribal organization, 21 membership in the Indian tribe 22 or Indian community served by 23 the tribal organization; 24 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H4010.IH H4010 kjohnson on DSK79L0C42 with BILLS 6 •HR 4010 IH ‘‘(II) a prescription for insulin 1 that is prescribed to the individual; 2 ‘‘(III) a statement that, to the 3 best of the individual’s knowledge, the 4 individual is an uninsured individual 5 or an underinsured individual; and 6 ‘‘(IV) if the individual is an 7 underinsured individual, the name of 8 the high-deductible health plan in 9 which the individual is enrolled and 10 any unique identifier of the plan, such 11 as a policy number. 12 ‘‘(ii) INITIAL CARD.— 13 ‘‘(I) IN GENERAL.—A State, In- 14 dian tribe, or tribal organization car- 15 rying out a program supported by a 16 grant under this subsection shall issue 17 an initial insulin card to each indi- 18 vidual that submits an application to 19 the State, Indian tribe, or tribal orga- 20 nization meeting the requirements 21 under clause (i). 22 ‘‘(II) TIMING.—A State, Indian 23 tribe, or tribal organization that re- 24 ceives an application under clause (i) 25 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H4010.IH H4010 kjohnson on DSK79L0C42 with BILLS 7 •HR 4010 IH from an individual shall issue an ini- 1 tial insulin card to such individual not 2 later than 5 business days after re- 3 ceiving such application. 4 ‘‘(III) SUPPLY.—An initial insu- 5 lin card issued to an individual under 6 this clause shall be valid for an ap- 7 proximate 7-day supply of insulin that 8 is appropriate for the individual based 9 on the prescription for the individual 10 provided in the application under 11 clause (i) and packaging and proc- 12 essing practices for insulin. 13 ‘‘(iii) 3-MONTH CARDS.—Not later 14 than 12 business days after an individual 15 submits an application under clause (i) to 16 a State, Indian tribe, or tribal organiza- 17 tion, the State, Indian tribe, or tribal orga- 18 nization shall— 19 ‘‘(I) determine whether the indi- 20 vidual is an eligible individual; and 21 ‘‘(II) if the individual is an eligi- 22 ble individual, issue the individual an 23 insulin card that is valid for an ap- 24 proximate 90-day supply of insulin 25 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H4010.IH H4010 kjohnson on DSK79L0C42 with BILLS 8 •HR 4010 IH that is appropriate for the individual 1 based on the prescription provided in 2 the application under clause (i) and 3 packaging and processing practices 4 for insulin. 5 ‘‘(iv) RENEWAL OF CARDS.— 6 ‘‘(I) 3-MONTH CARDS.—An eligi- 7 ble individual that is issued an insulin 8 card under clause (iii) may apply to 9 renew such card in accordance with a 10 process established by the State, In- 11 dian tribe, or tribal organization. 12 ‘‘(II) LIMITATION.—An indi- 13 vidual that submits an application 14 under clause (i) and is denied an insu- 15 lin card under clause (ii) or (iii) may 16 not submit another application under 17 clause (i) for the 1-year period begin- 18 ning on the date on which the indi- 19 vidual is denied such card. 20 ‘‘(b) REQUIREMENT OF MATCHING FUNDS.— 21 ‘‘(1) IN GENERAL.—The Secretary may not 22 make a grant under subsection (a) unless the State, 23 Indian tribe, or tribal organization involved agrees, 24 with respect to the costs to be incurred by the State, 25 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H4010.IH H4010 kjohnson on DSK79L0C42 with BILLS 9 •HR 4010 IH Indian tribe, or tribal organization in carrying out 1 the purpose described in subsection (a)(1), to make 2 available non-Federal contributions (in cash or in- 3 kind under paragraph (2)) toward such costs in an 4 amount equal to not less than $1 for each $3 of 5 Federal funds provided in the grant. Such contribu- 6 tions may be made directly or through donations 7 from public or private entities. 8 ‘‘(2) DETERMINATION OF AMOUNT OF NON- 9 FEDERAL CONTRIBUTION.— 10 ‘‘(A) IN GENERAL.—Non-Federal contribu- 11 tions required in paragraph (1) may be in cash 12 or in-kind, fairly evaluated, including equipment 13 or services (and excluding indirect or overhead 14 costs). Amounts provided by the Federal Gov- 15 ernment, or services assisted or subsidized to 16 any significant extent by the Federal Govern- 17 ment, may not be included in determining the 18 amount of such non-Federal contributions. 19 ‘‘(B) MAINTENANCE OF EFFORT.—In 20 making a determination of the amount of non- 21 Federal contributions for purposes of paragraph 22 (1), the Secretary may include only non-Federal 23 contributions in excess of the average amount 24 of non-Federal contributions made by the State, 25 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H4010.IH H4010 kjohnson on DSK79L0C42 with BILLS 10 •HR 4010 IH Indian tribe, or tribal organization involved to- 1 ward the purpose described in subsection (a)(1) 2 for the 2-year period preceding the first fiscal 3 year for which the State, Indian tribe, or tribal 4 organization is applying to receive a grant 5 under subsection (a). 6 ‘‘(C) INCLUSION OF RELEVANT NON-FED- 7 ERAL CONTRIBUTIONS FOR MEDICAID.—In 8 making a determination of the amount of non- 9 Federal contributions for purposes of paragraph 10 (1), the Secretary shall, subject to subpara- 11 graphs (A) and (B) of this paragraph, include 12 any non-Federal amounts expended pursuant to 13 title XIX of the Social Security Act by the 14 State, Indian tribe, or tribal organization re- 15 lated to insulin dispensed to individuals eligible 16 for medical assistance under such title. 17 ‘‘(c) ADDITIONAL REQUIRED AGREEMENTS.— 18 ‘‘(1) STATEWIDE PROVISION OF SERVICES.— 19 ‘‘(A) IN GENERAL.—The Secretary may 20 not make a grant under subsection (a) unless 21 the State, Indian tribe, or tribal organization 22 involved agrees that services and activities 23 under the grant will be made available through- 24 out the State (including availability to members 25 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H4010.IH H4010 kjohnson on DSK79L0C42 with BILLS 11 •HR 4010 IH of any Indian tribe or tribal organization in the 1 State), Indian tribe, or tribal organization. 2 ‘‘(B) WAIVER.— 3 ‘‘(i) IN GENERAL.—The Secretary 4 may waive the requirement established in 5 subparagraph (A) for a State, Indian tribe, 6 or tribal organization if the Secretary de- 7 termines that compliance by the State, In- 8 dian tribe, or tribal organization with the 9 requirement would result in an inefficient 10 allocation of resources with respect to car- 11 rying out the purpose described in sub- 12 section (a)(1). 13 ‘‘(ii) INDIAN TRIBES AND TRIBAL OR- 14 GANIZATIONS.—If an Indian tribe or tribal 15 organization is receiving a grant under 16 subsection (a) and the State in which the 17 tribe or organization is located is receiving 18 a grant under subsection (a), the require- 19 ment under subparagraph (A) for the 20 State regarding availability to the tribe or 21 organization is deemed to have been 22 waived under this subparagraph. 23 ‘‘(2) RELATIONSHIP TO ITEMS AND SERVICES 24 UNDER OTHER PROGRAMS.— 25 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H4010.IH H4010 kjohnson on DSK79L0C42 with BILLS 12 •HR 4010 IH ‘‘(A) IN GENERAL.—The Secretary may 1 not make a grant under subsection (a) unless 2 the State, Indian tribe, or tribal organization 3 involved agrees that the grant will not be ex- 4 pended to make payment for any item or serv- 5 ice to the extent that payment has been made, 6 or can reasonably be expected to be made, with 7 respect to such item or service— 8 ‘‘(i) except as provided in subpara- 9 graph (B), under any State compensation 10 program, under an insurance policy, or 11 under any Federal or State health benefits 12 program; or 13 ‘‘(ii) by an entity that provides health 14 services on a prepaid basis. 15 ‘‘(B) EXCEPTION.—The requirement under 16 subparagraph (A)(i) shall not apply with re- 17 spect to coverage under a high-deductible health 18 plan. 19 ‘‘(3) LIMITATION ON ADMINISTRATIVE EX- 20 PENSES.—The Secretary may not make a grant 21 under subsection (a) unless the State, Indian tribe, 22 or tribal organization involved agrees that not more 23 than 10 percent of the grant will be expended for 24 administrative expenses with respect to the grant. 25 VerDate Sep 11 2014 01:10 Aug 14, 2019 Jkt 089200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H4010.IH H4010 kjohnson on DSK79L0C42 with BILLS 13 •HR 4010 IH ‘‘(4) RECORDS AND AUDITS.—The Secretary 1 may not make a grant under subsection (a) unless 2 the State, Indian tribe, or tribal organization in- 3 volved agrees that— 4 ‘‘(A) the State, Indian tribe, or tribal orga- 5 nization will establish such fiscal control and 6 fund accounting procedures as may be nec- 7 essary to ensure the proper disbursal of, and 8 accounting for, [Text truncated for display. 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