117 STAT. 2128
PUBLIC LAW 108–173—DEC. 8, 2003 to which the employer is the primary source of financing, such term means such employer. ‘‘(3) GROUP HEALTH PLAN.—The term ‘group health plan’ includes such a plan as defined in section 607(1) of the Employee Retirement Income Security Act of 1974 and also includes the following: ‘‘(A) FEDERAL AND STATE GOVERNMENTAL PLANS.—Such a plan established or maintained for its employees by the Government of the United States, by the government of any State or political subdivision thereof, or by any agency or instrumentality of any of the foregoing, including a health benefits plan offered under chapter 89 of title 5, United States Code. ‘‘(B) COLLECTIVELY BARGAINED PLANS.—Such a plan established or maintained under or pursuant to one or more collective bargaining agreements. ‘‘(C) CHURCH PLANS.—Such a plan established and maintained for its employees (or their beneficiaries) by a church or by a convention or association of churches which is exempt from tax under section 501 of the Internal Revenue Code of 1986. ‘‘STATE
42 USC 1395w–133.
VerDate 11-MAY-2000
13:59 Aug 30, 2004
PHARMACEUTICAL ASSISTANCE PROGRAMS
‘‘SEC. 1860D–23. (a) REQUIREMENTS FOR BENEFIT COORDINATION.— ‘‘(1) IN GENERAL.—Before July 1, 2005, the Secretary shall establish consistent with this section requirements for prescription drug plans to ensure the effective coordination between a part D plan (as defined in paragraph (5)) and a State Pharmaceutical Assistance Program (as defined in subsection (b)) with respect to— ‘‘(A) payment of premiums and coverage; and ‘‘(B) payment for supplemental prescription drug benefits, for part D eligible individuals enrolled under both types of plans. ‘‘(2) COORDINATION ELEMENTS.—The requirements under paragraph (1) shall include requirements relating to coordination of each of the following: ‘‘(A) Enrollment file sharing. ‘‘(B) The processing of claims, including electronic processing. ‘‘(C) Claims payment. ‘‘(D) Claims reconciliation reports. ‘‘(E) Application of the protection against high outof-pocket expenditures under section 1860D–2(b)(4). ‘‘(F) Other administrative processes specified by the Secretary. Such requirements shall be consistent with applicable law to safeguard the privacy of any individually identifiable beneficiary information. ‘‘(3) USE OF LUMP SUM PER CAPITA METHOD.—Such requirements shall include a method for the application by a part D plan of specified funding amounts from a State Pharmaceutical Assistance Program for enrolled individuals for supplemental prescription drug benefits.
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