HR 2700 IHCommentsClose CommentsPermalink

To amend part D of title XVIII of the Social Security Act to assist low-income individuals in obtaining subsidized prescription drug coverage under the Medicare prescription drug program by expediting the application and qualification process and by revising the resource standards used to determine eligibility for such subsidies, and for other purposes.CommentsClose CommentsPermalink

June 4, 2009CommentsClose CommentsPermalink

Mr. DOGGETT (for himself, Mr. ALTMIRE, Mr. ARCURI, Ms. BALDWIN, Mr. BECERRA, Ms. BERKLEY, Mr. BERMAN, Mr. BISHOP of New York, Mr. BLUMENAUER, Ms. BORDALLO, Mr. BOUCHER, Ms. CLARKE, Mr. CLAY, Mr. CLEAVER, Mr. CLYBURN, Mr. COHEN, Mr. CONNOLLY of Virginia, Mr. COSTELLO, Mr. CUMMINGS, Mr. DAVIS of Alabama, Mr. DAVIS of Illinois, Mr. DEFAZIO, Ms. DEGETTE, Mr. DELAHUNT, Ms. DELAURO, Mr. EDWARDS of Texas, Mr. FATTAH, Mr. FILNER, Mr. GENE GREEN of Texas, Mr. GRIJALVA, Mr. HASTINGS of Florida, Mr. HIGGINS, Mr. HINCHEY, Mr. HINOJOSA, Mr. HOLT, Mr. INSLEE, Mr. ISRAEL, Mr. JACKSON of Illinois, Ms. JACKSON-LEE of Texas, Mr. JOHNSON of Georgia, Ms. KAPTUR, Mr. KILDEE, Ms. KILPATRICK of Michigan, Mr. KUCINICH, Mr. LANGEVIN, Ms. LEE of California, Mr. LEVIN, Mr. LEWIS of Georgia, Mr. LIPINSKI, Ms. ZOE LOFGREN of California, Ms. MCCOLLUM, Mr. MCDERMOTT, Mrs. MALONEY, Mr. MEEK of Florida, Mr. MEEKS of New York, Mr. MICHAUD, Mr. MOORE of Kansas, Mr. NADLER of New York, Mrs. NAPOLITANO, Mr. NEAL of Massachusetts, Ms. NORTON, Mr. ORTIZ, Mr. PAYNE, Mr. PASCRELL, Mr. PRICE of North Carolina, Mr. RANGEL, Mr. ROTHMAN of New Jersey, Mr. RUSH, Mr. RYAN of Ohio, Ms. LINDA T. SANCHEZ of California, Mr. SARBANES, Ms. SCHAKOWSKY, Ms. SHEA-PORTER, Mr. SIRES, Mr. STARK, Ms. SUTTON, Mr. VAN HOLLEN, Ms. WASSERMAN SCHULTZ, Mr. WEINER, Mr. WELCH, Mr. WEXLER, Ms. WOOLSEY, and Mr. YARMUTH) 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 provisions as fall within the jurisdiction of the committee concernedCommentsClose CommentsPermalink

To amend part D of title XVIII of the Social Security Act to assist low-income individuals in obtaining subsidized prescription drug coverage under the Medicare prescription drug program by expediting the application and qualification process and by revising the resource standards used to determine eligibility for such subsidies, and for other purposes.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) Short Title- This Act may be cited as the ‘Prescription Coverage Now Act of 2009’.CommentsClose CommentsPermalink





(b) Table of Contents- The table of contents for this Act is as follows:CommentsClose CommentsPermalink





Sec. 1. Short title; table of contents.CommentsClose CommentsPermalink





Sec. 2. Expediting low-income subsidies under the Medicare prescription drug program.CommentsClose CommentsPermalink





Sec. 3. Enhanced oversight and enforcement relating to reimbursements for retroactive LIS enrollment.CommentsClose CommentsPermalink





Sec. 4. Modification of resource standards for determination of eligibility for low-income subsidy; simplification of income and asset rules.CommentsClose CommentsPermalink





Sec. 5. Indexing deductible and cost-sharing above annual out-of-pocket threshold for individuals with income below 150 percent of poverty line.CommentsClose CommentsPermalink





Sec. 6. No impact on eligibility for benefits under other programs.CommentsClose CommentsPermalink





Sec. 7. Requiring individuals eligible for Medicare savings programs to be deemed to be subsidy eligible individuals.CommentsClose CommentsPermalink





Sec. 8. Special enrollment period for subsidy eligible individuals.CommentsClose CommentsPermalink

SEC. 2. EXPEDITING LOW-INCOME SUBSIDIES UNDER THE MEDICARE PRESCRIPTION DRUG PROGRAM.

(a) Targeted Outreach for Low-Income Subsidies-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1860D-14 of the Social Security Act (42 U.S.C. 1395w-114) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(e) Targeted Outreach for Low-Income Subsidies-CommentsClose CommentsPermalink





‘(1) TARGETED IDENTIFICATION OF SUBSIDY-ELIGIBLE INDIVIDUALS-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The Commissioner of Social Security shall provide for the identification of individuals who are potentially eligible for low-income assistance under this section through requests to the Secretary of the Treasury in accordance with the criterion established under section 6103(l)(21) of the Internal Revenue Code of 1986 for information indicating whether the individual involved is likely eligible for such assistance.CommentsClose CommentsPermalink





‘(B) INITIATION OF IDENTIFICATIONS- Not later than 90 days after the date of the enactment of this subsection, the Commissioner of Social Security shall begin the identification of individuals through the process described in subparagraph (A) and shall, by such date and through such process, submit to the Secretary of the Treasury requests for part D eligible individuals who the Commissioner has identified as potentially eligible for low-income subsidies under this section before such date of enactment.CommentsClose CommentsPermalink





‘(2) NOTIFICATION OF POTENTIALLY ELIGIBLE INDIVIDUALS- In the case of each individual identified under paragraph (1) who has not otherwise applied for, or been determined eligible for, benefits under this section (or who has applied for and been determined ineligible for such benefits based on excess income, resources, or both), the Commissioner shall transmit by mail to the individual a letter including the information and application required to be provided under subparagraphs (A), (B), and (D) of section 1144(c)(1).CommentsClose CommentsPermalink





‘(3) FOLLOW-UP COMMUNICATIONS- If an individual to whom a letter is transmitted under paragraph (2) does not affirmatively respond to such letter either by making an enrollment, completing an application, or declining either or both, the Commissioner shall make additional attempts to contact the individual to obtain such an affirmative response.CommentsClose CommentsPermalink





‘(4) USE OF PREFERRED LANGUAGE IN SUBSEQUENT COMMUNICATIONS- In the case an application is completed by an individual pursuant to this subsection in which a language other than English is specified, the Commissioner shall provide that subsequent communications under this part to the individual shall be in such language as needed.CommentsClose CommentsPermalink





‘(5) CONSTRUCTION- Nothing in this subsection shall be construed as precluding the Commissioner from taking additional outreach efforts to enroll eligible individuals under this part and to provide low-income subsidies to eligible individuals.CommentsClose CommentsPermalink





‘(6) MAINTENANCE OF EFFORT WITH RESPECT TO OUTREACH- In no case shall the level of effort with respect to outreach to and enrollment of individuals who are potentially eligible for low-income assistance under this section after the date of the enactment of this subsection be less than such level of effort before such date of enactment until at least 90 percent of such potentially eligible individuals have affirmatively responded.CommentsClose CommentsPermalink





‘(7) GAO REPORT TO CONGRESS- Not later than 2 years after the date of the first submission to the Secretary of the Treasury described in paragraph (1)(B), the Comptroller General of the United States shall submit to Congress a report, with respect to the 18-month period following the establishment of the process described in paragraph (1)(A), on--CommentsClose CommentsPermalink





‘(A) the extent to which the percentage of individuals who are eligible for low-income assistance under this section but not enrolled under this part has decreased during such period;CommentsClose CommentsPermalink





‘(B) how the Commissioner of Social Security has used any savings resulting from the implementation of this section and section 6103(l)(21) of the Internal Revenue Code of 1986 to improve outreach to individual described in subparagraph (A) to increase enrollment of such individuals under this part;CommentsClose CommentsPermalink





‘(C) the effectiveness of using information from the Secretary of the Treasury in accordance with section 6103(l)(21) of the Internal Revenue Code of 1986 for purposes of indicating whether individuals are eligible for low-income assistance under this section; andCommentsClose CommentsPermalink





‘(D) the effectiveness of the outreach conducted by the Commissioner of Social Security based on the data described in subparagraph (C).’.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENT- Section 1144(c)(1) of the Social Security Act (42 U.S.C. 1320b-14(c)(1)) is amended by inserting ‘(including through request to the Secretary of the Treasury pursuant to section 1860D-14(e))’ before ‘, the Commissioner shall’.CommentsClose CommentsPermalink





(b) Improvements to the Low-Income Subsidy Applications- Section 1860D-14(a)(3) of the Social Security Act (42 U.S.C. 1395w-114(a)(3)) is amended--CommentsClose CommentsPermalink





(1) in subparagraph (E), by striking clauses (ii) and (iii) and redesignating clause (iv) as clause (ii);CommentsClose CommentsPermalink





(2) by redesignating subparagraphs (F) and (G) as subparagraphs (G) and (H), respectively; andCommentsClose CommentsPermalink





(3) by inserting after subparagraph (E) the following new subparagraph:CommentsClose CommentsPermalink





‘(F) SIMPLIFIED LOW-INCOME SUBSIDY APPLICATION AND PROCESS-CommentsClose CommentsPermalink





‘(i) IN GENERAL- The Secretary, jointly with the Commissioner of Social Security, shall--CommentsClose CommentsPermalink





‘(I) develop a model, simplified application form and process consistent with clause (ii) for the determination and verification of a part D eligible individual’s assets or resources under this paragraph; andCommentsClose CommentsPermalink





‘(II) provide such form to States.CommentsClose CommentsPermalink





‘(ii) DOCUMENTATION AND SAFEGUARDS- Under such process--CommentsClose CommentsPermalink





‘(I) the application form shall consist of an attestation under penalty of perjury regarding the level of assets or resources (or combined assets and resources in the case of a married part D eligible individual) and valuations of general classes of assets or resources;CommentsClose CommentsPermalink





‘(II) such form shall not require the submittal of additional documentation regarding income or assets;CommentsClose CommentsPermalink





‘(III) matters attested to in the application shall be subject to appropriate methods of administrative verification;CommentsClose CommentsPermalink





‘(IV) the applicant shall be permitted to authorize another individual to act as the applicant’s personal representative with respect to communications under this part and the enrollment of the applicant into a prescription drug plan (or MA-PD plan) and for low-income subsidies under this section; andCommentsClose CommentsPermalink





‘(V) the application form shall allow for the specification of a language (other than English) that is preferred by the individual for subsequent communications with respect to the individual under this part.CommentsClose CommentsPermalink





‘(iii) NO RECOVERY FOR CERTAIN SUBSIDIES IMPROPERLY PAID- If an individual in good faith and in the absence of fraud is provided low-income subsidies under this section, and if the individual is subsequently found not eligible for such subsidies, there shall be no recovery made against the individual because of such subsidies improperly paid.’.CommentsClose CommentsPermalink





(c) Disclosures To Facilitate Identification of Individuals Likely To Be Eligible for the Low-Income Assistance Under the Medicare Prescription Drug Program-CommentsClose CommentsPermalink





(1) IN GENERAL-CommentsClose CommentsPermalink





Subsection (l) of section 6103 of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(21) DISCLOSURE OF RETURN INFORMATION TO FACILITATE IDENTIFICATION OF INDIVIDUALS LIKELY TO BE ELIGIBLE FOR LOW-INCOME SUBSIDIES UNDER MEDICARE PRESCRIPTION DRUG PROGRAM-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The Secretary, upon written request from the Commissioner of Social Security, shall disclose to officers and employees of the Social Security Administration, with respect to any individual identified by the Commissioner--CommentsClose CommentsPermalink





‘(i) whether, based on the criterion determined under subparagraph (B), such individual is likely to be eligible for low-income assistance under section 1860D-14 of the Social Security Act, orCommentsClose CommentsPermalink





‘(ii) that, based on such criterion, there is insufficient information available to the Secretary to make the determination described in clause (i).CommentsClose CommentsPermalink





‘(B) CRITERION- Not later than 90 days after the date of the enactment of this paragraph, the Secretary, in consultation with the Commissioner of Social Security, shall develop the criterion by which the determination under subparagraph (A)(i) shall be made (and the criterion for determining that insufficient information is available to make such determination). Such criterion may include analysis of information available on such individual’s return, the return of such individual’s spouse, and any information related to such individual or such individual’s spouse which is available on any information return.’.CommentsClose CommentsPermalink





(2) PROCEDURES AND RECORDKEEPING RELATED TO DISCLOSURES- Paragraph (4) of section 6103(p) of such Code is amended by striking ‘or (17)’ each place it appears and inserting ‘(17), or (21)’.CommentsClose CommentsPermalink





(3) EFFECTIVE DATE- The amendments made by this subsection shall apply to disclosures made after the date of the enactment of this Act.CommentsClose CommentsPermalink

SEC. 3. ENHANCED OVERSIGHT AND ENFORCEMENT RELATING TO REIMBURSEMENTS FOR RETROACTIVE LIS ENROLLMENT.

(a) In General- In the case of a retroactive LIS enrollment beneficiary (as defined in subsection (e)(4)) who is enrolled under a prescription drug plan under part D of title XVIII of the Social Security Act (or an MA-PD plan under part C of such title)--CommentsClose CommentsPermalink





(1) the beneficiary (or any eligible third party) is entitled to reimbursement by the plan for covered drug costs (as defined in subsection (e)(1)) incurred by the beneficiary during the retroactive coverage period of the beneficiary in accordance with subsection (b) and in the case of such a beneficiary described in subsection (e)(4)(A)(i), such reimbursement shall be made automatically by the plan upon receipt of appropriate notice the beneficiary is eligible for assistance described in such subsection (e)(4)(A)(i) without further information required to be filed with the plan by the beneficiary;CommentsClose CommentsPermalink





(2) the Secretary of Health and Human Services (in this section referred to as the ‘Secretary’) shall not make payment to the plan--CommentsClose CommentsPermalink





(A) in the case that the beneficiary is described in subsection (e)(4)(A)(i), for premium subsidies and cost sharing subsidies under section 1860D-14 of the Social Security Act (42 U.S.C. 1395w-114) with respect to the provision of prescription drug coverage to the beneficiary during such retroactive period; andCommentsClose CommentsPermalink





(B) in the case that the beneficiary is described in subsection (e)(4)(A)(ii), for direct subsidies under section 1860D-15(a)(1) of such Act and premium subsidies and cost-sharing subsidies under section 1860D-14 of such Act with respect to the provision of prescription drug coverage to the beneficiary during such retroactive period;CommentsClose CommentsPermalink





unless the plan demonstrates to the Secretary that the plan has provided timely and accurate reimbursement to the beneficiary (or eligible third party) in accordance with paragraph (1);CommentsClose CommentsPermalink





(3) the Secretary shall not make any payment described in paragraph (2) to the plan with respect to such beneficiary for any month of the retroactive enrollment period during which no expenses for covered part D drugs (as defined in section 1860D-2(e) of the Social Security Act (42 U.S.C. 1395w-102(e)) were incurred by such beneficiary (or eligible third party on behalf of such beneficiary); andCommentsClose CommentsPermalink





(4) any payment owed the plan pursuant to this section, taking into account paragraphs (2) and (3), shall be made at the time the Centers for Medicare & Medicaid Services reconciles payments for the entire plan year following the end of the plan year, and not before such time.CommentsClose CommentsPermalink





(b) Administrative Requirements Relating to Reimbursements-CommentsClose CommentsPermalink





(1) LINE-ITEM DESCRIPTION- Each reimbursement made by a prescription drug plan or MA-PD plan under subsection (a)(1) shall include a line-item description of the items for which the reimbursement is made.CommentsClose CommentsPermalink





(2) TIMING OF REIMBURSEMENTS- A prescription drug plan or MA-PD plan must make a reimbursement under subsection (a)(1) to a retroactive LIS enrollment beneficiary, with respect to a claim, not later than 30 days after--CommentsClose CommentsPermalink





(A) in the case of a beneficiary described in subsection (e)(4)(A)(i), the date on which the plan receives notice from the Secretary that the beneficiary is eligible for assistance described in such subsection; orCommentsClose CommentsPermalink





(B) in the case of a beneficiary described in subsection (e)(4)(A)(ii), the date on which the beneficiary files the claim with the plan.CommentsClose CommentsPermalink





(c) Notice Requirements-CommentsClose CommentsPermalink





(1) BY SECRETARY OF HHS AND COMMISSION OF THE SOCIAL SECURITY ADMINISTRATION- The Secretary, jointly with the Commissioner of the Social Security Administration, shall ensure that each retroactive LIS enrollment beneficiary receives, with any letter or notification of eligibility for a low-income subsidy under section 1860D-14 of the Social Security Act, a notice of their right to reimbursement described in subsection (a)(1) for covered drug costs incurred during the retroactive coverage period of the beneficiary. Such notice shall--CommentsClose CommentsPermalink





(A) with respect to a beneficiary described in subsection (e)(4)(A)(i), inform the beneficiary of the beneficiary’s right to automatic reimbursement as described in subsection (a)(1); andCommentsClose CommentsPermalink





(B) with respect to a beneficiary described in subsection (e)(4)(A)(ii), include a description of a clear process that the beneficiary should follow to seek such reimbursement.CommentsClose CommentsPermalink





(2) BY PRESCRIPTION DRUG PLANS-CommentsClose CommentsPermalink





(A) IN GENERAL- Each prescription drug plan under part D of title XVIII of the Social Security Act (and MA-PD plan under part C of such title) shall include in a notice from the plan to a retroactive LIS enrollment beneficiary described in subsection (e)(4)(A)(ii) a model notice developed under subparagraph (B) describing the process the beneficiary must follow to seek retroactive reimbursement. Such notice shall include any form required by the plan to complete such reimbursement and shall indicate the period of retroactive coverage for which the beneficiary is eligible for such reimbursement.CommentsClose CommentsPermalink





(B) MODEL NOTICE- The Secretary, jointly with the Commissioner of Social Security, shall develop a model notice for purposes of subparagraph (A) and shall make such model notice available to all prescription drug plans under part D of title XVIII of the Social Security Act (and MA-PD plans under part C of such title).CommentsClose CommentsPermalink





(d) Public Posting To Track Payments-CommentsClose CommentsPermalink





(1) IN GENERAL- Not later than one year after the date of the enactment of this Act, the Secretary shall post (and annually update) on the public Internet website of the Department of Health and Human Services information on the total amount of payments made by the Secretary under subsection (a)(2) to prescription drug plans during the most recent plan year for which plan data is available.CommentsClose CommentsPermalink





(2) SPECIFIC INFORMATION- Such information posted--CommentsClose CommentsPermalink





(A) in 2010 or in a subsequent year before 2016, shall include information on payments made for years beginning with 2006 and ending with the year for which the most current information is available; andCommentsClose CommentsPermalink





(B) in 2016 or a subsequent year, shall include information on payments made for at least the 10 previous years.CommentsClose CommentsPermalink





(e) Definitions- In this section:CommentsClose CommentsPermalink





(1) COVERED DRUG COSTS- The term ‘covered drug costs’ means, with respect to a retroactive LIS enrollment beneficiary enrolled under a prescription drug plan under part D of title XVIII of the Social Security Act (or an MA-PD plan under part C of such title), the amount by which--CommentsClose CommentsPermalink





(A) the costs incurred by such beneficiary during the retroactive coverage period of the beneficiary for covered part D drugs, premiums, and cost-sharing under such title; exceedsCommentsClose CommentsPermalink





(B) such costs that would have been incurred by such beneficiary during such period if the beneficiary had been both enrolled in the plan and recognized by such plan as qualified during such period for the low income subsidy under section 1860D-14 of the Social Security Act to which the individual is entitled.CommentsClose CommentsPermalink





(2) ELIGIBLE THIRD PARTY- The term ‘eligible third party’ means, with respect to a retroactive LIS enrollment beneficiary, an organization or other third party that paid on behalf of such beneficiary for covered drug costs incurred by such beneficiary during the retroactive coverage period of such beneficiary.CommentsClose CommentsPermalink





(3) RETROACTIVE COVERAGE PERIOD- The term ‘retroactive coverage period’ means--CommentsClose CommentsPermalink





(A) with respect to a retroactive LIS enrollment beneficiary described in paragraph (4)(A)(i), the period--CommentsClose CommentsPermalink





(i) beginning on the effective date of the assistance described in such paragraph for which the individual is eligible; andCommentsClose CommentsPermalink





(ii) ending on the date the plan effectuates the status of such individual as so eligible; andCommentsClose CommentsPermalink





(B) with respect to a retroactive LIS enrollment beneficiary described in paragraph (4)(A)(ii), the period--CommentsClose CommentsPermalink





(i) beginning on the date the individual is both entitled to benefits under part A, or enrolled under part B, of title XVIII of the Social Security Act and eligible for medical assistance under a State plan under title XIX of such Act; andCommentsClose CommentsPermalink





(ii) ending on the date the plan effectuates the status of such individual as a full-benefit dual eligible individual (as defined in section 1935(c)(6) of such Act).CommentsClose CommentsPermalink





(4) RETROACTIVE LIS ENROLLMENT BENEFICIARY-CommentsClose CommentsPermalink





(A) IN GENERAL- The term ‘retroactive LIS enrollment beneficiary’ means an individual who--CommentsClose CommentsPermalink





(i) is enrolled in a prescription drug plan under part D of title XVIII of the Social Security Act (or an MA-PD plan under part C of such title) and subsequently becomes eligible as a full-benefit dual eligible individual (as defined in section 1935(c)(6) of such Act), an individual receiving a low-income subsidy under section 1860D-14 of such Act, an individual receiving assistance under the Medicare Savings Program implemented under clauses (i), (ii), (iii), and (iv) of section 1902(a)(10)(E) of such Act, or an individual receiving assistance under the supplemental security income program under section 1611 of such Act; orCommentsClose CommentsPermalink





(ii) subject to subparagraph (B)(i), is a full-benefit dual eligible individual (as defined in section 1935(c)(6) of such Act) who is automatically enrolled in such a plan under section 1860D-1(b)(1)(C) of such Act.CommentsClose CommentsPermalink





(B) EXCEPTION FOR BENEFICIARIES ENROLLED IN RFP PLAN-CommentsClose CommentsPermalink





(i) IN GENERAL- In no case shall an individual described in subparagraph (A)(ii) include an individual who is enrolled, pursuant to a RFP contract described in clause (ii), in a prescription drug plan offered by the sponsor of such plan awarded such contract.CommentsClose CommentsPermalink





(ii) RFP CONTRACT DESCRIBED- The RFP contract described in this section is a contract entered into between the Secretary and a sponsor of a prescription drug plan pursuant to the Centers for Medicare & Medicaid Services’ request for proposals issued on February 17, 2009, relating to Medicare part D retroactive coverage for certain low income beneficiaries, or a similar subsequent request for proposals.CommentsClose CommentsPermalink





(f) GAO Report- Not later than 24 months after the date of the enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the extent to which the provisions of this section improve reimbursement for covered drug costs to retroactive LIS enrollment beneficiaries and lower the amounts of payments made by the Secretary, with respect to such beneficiaries, to prescription drug plans under part D of title XVIII of the Social Security Act (and MA-PD plans under part C of such title).CommentsClose CommentsPermalink





(g) Report to Congress- In the case that an RFP contract described in subsection (e)(4)(B)(ii) is awarded, not later than two years after the effective date of such contract, the Secretary of Health and Human Services shall submit to Congress a report evaluating the program carried out through such contract.CommentsClose CommentsPermalink





(h) Effective Date- Paragraphs (2) and (3) of subsection (a) and subsections (b) and (c) shall apply to subsidy determinations made on or after the date that is 3 months after the date of the enactment of this Act.CommentsClose CommentsPermalink

SEC. 4. MODIFICATION OF RESOURCE STANDARDS FOR DETERMINATION OF ELIGIBILITY FOR LOW-INCOME SUBSIDY; SIMPLIFICATION OF INCOME AND ASSET RULES.

(a) Single and Increased Resource Standard for Low-Income Subsidies- Section 1860D-14(a) of the Social Security Act (42 U.S.C. 1395w-114(a)) is amended--CommentsClose CommentsPermalink





(1) in paragraph (1), by inserting ‘(or, for years after 2010, paragraph (3)(E))’ after ‘paragraph (3)(D)’;CommentsClose CommentsPermalink





(2) in paragraph (3)--CommentsClose CommentsPermalink





(A) in subparagraph (A)(iii), by inserting ‘(or for a year after 2010, subparagraph (E))’ before the period;CommentsClose CommentsPermalink





(B) in subparagraph (D)(ii), by inserting ‘before 2011’ after ‘subsequent year’; andCommentsClose CommentsPermalink





(C) in subparagraph (E)(i)--CommentsClose CommentsPermalink





(i) by striking ‘and’ at the end of subclause (I);CommentsClose CommentsPermalink





(ii) in subclause (II)--CommentsClose CommentsPermalink





(I) by striking ‘a subsequent year’ and inserting ‘each of 2007 through 2010’;CommentsClose CommentsPermalink





(II) by striking the period at the end and inserting a semicolon;CommentsClose CommentsPermalink





(iii) by inserting after subclause (II) the following new subclauses:CommentsClose CommentsPermalink





‘(III) for 2011, $27,500 (or $55,000 in the case of the combined value of the individual’s assets or resources and the assets or resources of the individual’s spouse); andCommentsClose CommentsPermalink





‘(IV) for a subsequent year the dollar amounts specified in this clause for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.’; andCommentsClose CommentsPermalink





(iv) in the last sentence, by inserting ‘or (IV)’ after ‘subclause (II)’.CommentsClose CommentsPermalink





(b) Exemptions From Resources-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1860D-14(a)(3) of the Social Security Act (42 U.S.C. 1395w-114(a)(3) is further amended--CommentsClose CommentsPermalink





(A) in subparagraphs (D) and (E), by inserting ‘and the retirement plan exclusion under subparagraph (H)’ after ‘subparagraph (G)’ each place it appears; andCommentsClose CommentsPermalink





(B) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





‘(H) RETIREMENT BENEFIT EXCLUSION- In determining the resources of an individual (and their eligible spouse, if any) under section 1613 for purposes of subparagraphs (D) and (E), no retirement benefit, such as an individual retirement account or plan under section 401(k) of the Internal Revenue Code of 1986, shall be taken into account.’.CommentsClose CommentsPermalink





(2) EFFECTIVE DATE- The amendments made by paragraph (1) shall apply for months beginning after 2011.CommentsClose CommentsPermalink





(c) Clarification Relating to Including Retirement Benefits as Income- Nothing in subparagraph (H) of section 1860D-14(a)(3) of the Social Security Act (42 U.S.C. 1395w-114(a)(3)), as added by subsection (b), shall be construed as affecting the inclusion of retirement benefits as income under section 1612(a)(2)(B) of such Act (42 U.S.C. 1382a(a)(2)(B)).CommentsClose CommentsPermalink





(d) Clarification Relating to MIPPA Effective Date for in Kind Exclusions From Income- Section 116(b) of the Medicare Improvements for Patients and Providers Act of 2008 is amended--CommentsClose CommentsPermalink





(1) by inserting ‘(other than subsection (a)(1))’ after ‘this section’; andCommentsClose CommentsPermalink





(2) by adding at the end the following new sentence: ‘The amendment made by subsection (a)(1) shall take effect with respect to benefits provided after such date.’.CommentsClose CommentsPermalink





(e) Increasing Income Limits for Partial LIS Eligibility to 200 Percent FPL and for Full LIS to 150 Percent FPL-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1860D-14(a) of the Social Security Act (42 U.S.C. 1395w-114(a)) is amended--CommentsClose CommentsPermalink





(A) in the heading, by striking ‘150’ and inserting ‘200’;CommentsClose CommentsPermalink





(B) in paragraph (1)--CommentsClose CommentsPermalink





(i) in the heading, by striking ‘135’ and inserting ‘150’; andCommentsClose CommentsPermalink





(ii) by striking ‘135’ and inserting ‘150’;CommentsClose CommentsPermalink





(C) in paragraph (2)--CommentsClose CommentsPermalink





(i) in the heading, by striking ‘150’ and inserting ‘200’; andCommentsClose CommentsPermalink





(ii) in subparagraph (A), by striking ‘135’ and ‘150’ and inserting ‘150’ and ‘200’, respectively; andCommentsClose CommentsPermalink





(D) in paragraph (3)(A)(ii), by striking ‘150’ and inserting ‘200’.CommentsClose CommentsPermalink





(2) EFFECTIVE DATE- The amendments made by paragraph (1) shall apply to determinations made on or after January 1, 2011.CommentsClose CommentsPermalink

SEC. 5. INDEXING DEDUCTIBLE AND COST-SHARING ABOVE ANNUAL OUT-OF-POCKET THRESHOLD FOR INDIVIDUALS WITH INCOME BELOW 200 PERCENT OF POVERTY LINE.

(a) Indexing Deductible- Section 1860D-14(a)(4)(B) of the Social Security Act (42 U.S.C. 1395w-114(a)(4)(B)) is amended--CommentsClose CommentsPermalink





(1) in clause (i), by striking ‘or’;CommentsClose CommentsPermalink





(2) in clause (ii)--CommentsClose CommentsPermalink





(A) by striking ‘a subsequent year’ and inserting ‘2008, 2009, and 2010’; andCommentsClose CommentsPermalink





(B) by striking the period at the end and inserting ‘; and’;CommentsClose CommentsPermalink





(3) by inserting after clause (ii) the following new clause:CommentsClose CommentsPermalink





‘(iii) for 2011 and each succeeding year, the amount determined under this clause (or clause (ii)) for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.’; andCommentsClose CommentsPermalink





(4) in the last sentence, by striking ‘clause (i) or (ii)’ and inserting ‘clause (i), (ii), or (iii)’.CommentsClose CommentsPermalink





(b) Indexing Cost-Sharing- Section 1860D-14(a) of the Social Security Act (42 U.S.C. 1395w-114(a)) is amended--CommentsClose CommentsPermalink





(1) in paragraph (1)(D)(iii), by striking ‘exceed the copayment amount’ and all that follows through the period at the end and inserting ‘exceed--CommentsClose CommentsPermalink





‘(I) for each of 2006 through 2010, the copayment amount specified under section 1860D-2(b)(4)(A)(i)(I) for the drug and year involved; andCommentsClose CommentsPermalink





‘(II) for 2011 and each succeeding year, the amount determined under this subparagraph for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.’; andCommentsClose CommentsPermalink





(2) in paragraph (2)(E), by striking ‘exceed the copayment or coinsurance amount’ and all that follows through the period at the end and inserting ‘exceed--CommentsClose CommentsPermalink





‘(i) for each of 2006 through 2010, the copayment or coinsurance amount specified under section 1860D-2(b)(4)(A)(i)(I) for the drug and year involved; andCommentsClose CommentsPermalink





‘(ii) for 2011 and each succeeding year, the amount determined under this clause for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.’.CommentsClose CommentsPermalink

SEC. 6. NO IMPACT ON ELIGIBILITY FOR BENEFITS UNDER OTHER PROGRAMS.

(a) In General- Section 1860D-14(a)(3) of the Social Security Act (42 U.S.C. 1395w-114(a)(3)), as amended by section 4(b)(1)(B), is further amended--CommentsClose CommentsPermalink





(1) in subparagraph (A), in the matter preceding clause (i), by striking ‘subparagraph (F)’ and inserting ‘subparagraphs (F) and (I)’; andCommentsClose CommentsPermalink





(2) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





‘(I) NO IMPACT ON ELIGIBILITY FOR BENEFITS UNDER OTHER PROGRAMS- The availability of premium and cost-sharing subsidies under this section shall not be treated as benefits or otherwise taken into account in determining an individual’s eligibility for, or the amount of benefits under, any other Federal program.’.CommentsClose CommentsPermalink





(b) Effective Date- The amendments made by subsection (a) shall apply to premium and cost-sharing subsidies for months beginning after the date of the enactment of this Act.CommentsClose CommentsPermalink

SEC. 7. REQUIRING INDIVIDUALS ELIGIBLE FOR MEDICARE SAVINGS PROGRAMS TO BE DEEMED TO BE SUBSIDY ELIGIBLE INDIVIDUALS.

(a) In General- Section 1860D-14(a)(3)(B)(v) of the Social Security Act (42 U.S.C. 1395w-114(a)(3)(B)(v)) is amended--CommentsClose CommentsPermalink





(1) in subclause (II)--CommentsClose CommentsPermalink





(A) by striking ‘may’ and inserting ‘shall’; andCommentsClose CommentsPermalink





(B) by inserting ‘(ii),’ after ‘clause (i),’; andCommentsClose CommentsPermalink





(2) by striking the second sentence.CommentsClose CommentsPermalink





(b) Effective Date- The amendment made by subsection (a) shall take effect as of the date of the enactment of this Act and apply to determinations made for purposes of title XIX on or after the first date of the first plan year beginning after the date of the enactment of this Act.CommentsClose CommentsPermalink

SEC. 8. SPECIAL ENROLLMENT PERIOD FOR SUBSIDY ELIGIBLE INDIVIDUALS.

(a) In General- Section 1860D-1(b)(3) of the Social Security Act (42 U.S.C. 1395w-101(b)(3)) is amended by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





‘(F) ELIGIBILITY FOR LOW-INCOME SUBSIDY-CommentsClose CommentsPermalink





‘(i) IN GENERAL- In the case of an applicable subsidy eligible individual (as defined in clause (ii)), the special enrollment period described in clause (iii).CommentsClose CommentsPermalink





‘(ii) APPLICABLE SUBSIDY ELIGIBLE INDIVIDUAL DEFINED- For purposes of this subparagraph, the term ‘applicable subsidy eligible individual’ means a part D eligible individual who is not described in subparagraph (D) and who is determined under subparagraph (B) of section 1860D-14(a)(3) to be a subsidy eligible individual (as defined in subparagraph (A) of such section), including such an individual who was enrolled in a prescription drug plan or an MA-PD plan on the date of such determination.CommentsClose CommentsPermalink





‘(iii) SPECIAL ENROLLMENT PERIOD DESCRIBED- The special enrollment period described in this clause, with respect to an applicable subsidy eligible individual, is the period beginning on the date the individual receives notification that such individual has been determined under section 1860D-14(a)(3)(B) to be a subsidy eligible individual (as so defined) and ending on the date the individual is no longer so eligible.’.CommentsClose CommentsPermalink





(b) Effective Date- The amendments made by this section shall apply to subsidy determinations made for months beginning with January 2010.CommentsClose CommentsPermalink