S 1185 ISCommentsClose CommentsPermalink

To amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs.CommentsClose CommentsPermalink

June 4, 2009CommentsClose CommentsPermalink

Mr. BINGAMAN introduced the following bill; which was read twice and referred to the Committee on FinanceCommentsClose CommentsPermalink

To amend titles XVIII and XIX of the Social Security Act to ensure that low-income beneficiaries have improved access to health care under the Medicare and Medicaid programs.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 ‘Medicare Financial Stability for Beneficiaries Act of 2009’.CommentsClose CommentsPermalink





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





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





Sec. 2. Eligibility for other programs.CommentsClose CommentsPermalink





Sec. 3. Cost-sharing protections for low-income subsidy-eligible individuals.CommentsClose CommentsPermalink





Sec. 4. Modification of resource standards for determination of eligibility for LIS; no consideration of pension or retirement plan in determination of resources.CommentsClose CommentsPermalink





Sec. 5. Increase in income levels for eligibility.CommentsClose CommentsPermalink





Sec. 6. Effective date of MSP benefits.CommentsClose CommentsPermalink





Sec. 7. Expanding special enrollment process to individuals eligible for an income-related subsidy.CommentsClose CommentsPermalink





Sec. 8. Enhanced cost-sharing protections for full-benefit dual eligible individuals and qualified medicare beneficiaries.CommentsClose CommentsPermalink





Sec. 9. Two-way deeming between Medicare Savings Program and Low-Income Subsidy Program.CommentsClose CommentsPermalink





Sec. 10. Improving linkages between health programs and snap.CommentsClose CommentsPermalink





Sec. 11. Expediting low-income subsidies under the Medicare prescription drug program.CommentsClose CommentsPermalink





Sec. 12. Enhanced oversight and enforcement relating to reimbursements for retroactive LIS enrollment.CommentsClose CommentsPermalink





Sec. 13. Intelligent assignment in enrollment.CommentsClose CommentsPermalink





Sec. 14. Medicare enrollment assistance.CommentsClose CommentsPermalink





Sec. 15. QMB buy-in of part A and part B premiums.CommentsClose CommentsPermalink





Sec. 16. Increasing availability of MSP applications through availability on the internet and designation of preferred language.CommentsClose CommentsPermalink





Sec. 17. State Medicaid agency consideration of low-income subsidy application and data transmittal.CommentsClose CommentsPermalink

SEC. 2. ELIGIBILITY FOR OTHER PROGRAMS.

(a) LIS- Section 1860D-14(a)(3) of the Social Security Act (42 U.S.C. 1395w-114(a)(3)), as amended by section 116 of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275), is amended--CommentsClose CommentsPermalink





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





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





‘(H) DISREGARD OF PREMIUM AND COST-SHARING SUBSIDIES FOR PURPOSES OF FEDERAL AND STATE PROGRAMS- Notwithstanding any other provision of law, any premium or cost-sharing subsidy with respect to a subsidy-eligible individual under this section shall not be considered income or resources in determining eligibility for, or the amount of assistance or benefits provided under, any other public benefit provided under Federal law or the law of any State or political subdivision thereof.’.CommentsClose CommentsPermalink





(b) MSP- Section 1905(p) of the Social Security Act (42 U.S.C. 1396d(p)) is amended--CommentsClose CommentsPermalink





(1) by redesignating paragraph (6) as paragraph (7); andCommentsClose CommentsPermalink





(2) by inserting after paragraph (5) the following new paragraph:CommentsClose CommentsPermalink





‘(6) Notwithstanding any other provision of law, any medical assistance for some or all medicare cost-sharing under this title shall not be considered income or resources in determining eligibility for, or the amount of assistance or benefits provided under, any other public benefit provided under Federal law or the law of any State or political subdivision thereof’.CommentsClose CommentsPermalink





(c) Effective Date- The amendments made by this section shall apply to eligibility for benefits on or after January 1, 2010.CommentsClose CommentsPermalink

SEC. 3. COST-SHARING PROTECTIONS FOR LOW-INCOME SUBSIDY-ELIGIBLE INDIVIDUALS.

(a) In General- 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), by adding at the end the following new clause:CommentsClose CommentsPermalink





‘(iv) OVERALL LIMITATION ON COST-SHARING- In the case of all such individuals, a limitation on aggregate cost-sharing under this part for a year not to exceed 2.5 percent of income.’; andCommentsClose CommentsPermalink





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





‘(F) OVERALL LIMITATION ON COST-SHARING- A limitation on aggregate cost-sharing under this part for a year not to exceed 2.5 percent of income.’.CommentsClose CommentsPermalink





(b) Effective Date- The amendments made by subsection (a) shall apply as of January 1, 2010.CommentsClose CommentsPermalink

SEC. 4. MODIFICATION OF RESOURCE STANDARDS FOR DETERMINATION OF ELIGIBILITY FOR LIS; NO CONSIDERATION OF PENSION OR RETIREMENT PLAN IN DETERMINATION OF RESOURCES.

(a) Eliminating the Bifurcation of Resource Standards-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1860D-14(a)(3)(A)(iii) of the Social Security Act (42 U.S.C. 1395w-114(a)(3)(A)(iii)) is amended by striking ‘meets the’ and all that follows through the period at the end and inserting ‘meets--CommentsClose CommentsPermalink





‘(I) in the case of determinations made before January 1, 2011, the resource requirement described in subparagraph (D) or (E); andCommentsClose CommentsPermalink





‘(II) in the case of determinations made on or after January 1, 2011, the resource requirement described in subparagraph (E).’.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENT- Section 1860D-14(a)(3)(D)(ii) of the Social Security Act (42 U.S.C. 1395w-114(a)(3)(D)(ii)) is amended by inserting ‘(before 2011)’ after ‘a subsequent year’.CommentsClose CommentsPermalink





(b) Increasing the Applicable Resource Standard- Section 1860D-14(a)(3)(E) of the Social Security Act (42 U.S.C. 1395w-114(a)(3)(E)(i)) is amended--CommentsClose CommentsPermalink





(1) in the heading, by striking ‘ALTERNATIVE’ and inserting ‘APPLICABLE’;CommentsClose CommentsPermalink





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





(A) in subclause (I), by striking ‘and’ at the end;CommentsClose CommentsPermalink





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





(i) by inserting ‘(before 2011)’ after ‘a subsequent year’;CommentsClose CommentsPermalink





(ii) by striking the period at the end and inserting a semicolon; andCommentsClose CommentsPermalink





(iii) by inserting before the flush sentence at the end 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 subclause (or subclause (III)) 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





(C) in the flush sentence at the end, by inserting ‘or (IV)’ after ‘subclause (II)’.CommentsClose CommentsPermalink





(c) Exclusion of Pension and Retirement Benefits 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)), as amended by section 2, is amended--CommentsClose CommentsPermalink





(A) in subparagraph (E)(i), in the matter preceding subclause (I), by inserting ‘and the pension or retirement plan exclusion provided under subparagraph (I)’ after ‘(G)’; andCommentsClose CommentsPermalink





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





‘(I) PENSION AND RETIREMENT BENEFITS EXCLUSION- In determining the resources of an individual (and the eligible spouse of the individual, if any) under section 1613 for purposes of subparagraph (E) no balance in, or benefits received under, an employee pension benefit plan (as defined in section 3 of the Employee Retirement Income Security Act of 1974) shall be taken into account.’.CommentsClose CommentsPermalink





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





(d) Application of Applicable Resource Standard Under Medicare Savings Program and Exemptions From Income and Resources-CommentsClose CommentsPermalink





(1) APPLICATION OF APPLICABLE RESOURCE STANDARD AND EXEMPTIONS FROM RESOURCES- Section 1905(p)(1)(C) of the Social Security Act (42 U.S.C. 1396d(p)(1)(C)) is amended--CommentsClose CommentsPermalink





(A) by inserting ‘without taking into account any part of the value of any life insurance policy or any balance in, or benefits received under, an employee pension benefit plan (as defined in section 3 of the Employee Retirement Income Security Act of 1974)’ after ‘(as so determined’; andCommentsClose CommentsPermalink





(B) by striking ‘subparagraph (D)’ and all that follows through ‘section)’ and inserting ‘section 1860D-14(a)(3)(E)’.CommentsClose CommentsPermalink





(2) EXEMPTION OF IN-KIND SUPPORT AND MAINTENANCE-CommentsClose CommentsPermalink





(A) IN GENERAL- Section 1905(p)(1)(B) of the Social Security Act (42 U.S.C. 1396d(p)(1)(B)) is amended by inserting ‘and except that support and maintenance furnished in kind shall not be counted as income’ after ‘(2)(D)’.CommentsClose CommentsPermalink





(B) CONFORMING AMENDMENT- Section 1860D-14(a)(3)(C)(i) of the Social Security Act (42 U.S.C. 1395w-114(a)(3)(C)(i)) is amended by striking ‘and except that support and maintenance furnished in kind shall not be counted as income’.CommentsClose CommentsPermalink





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





(e) Clarification Relating to Including Retirement Benefits as Income- Nothing in subparagraph (I) of section 1860D-14(a)(3) of the Social Security Act (42 U.S.C. 1395w-114(a)(3)), as added by subsection (c)(1), or section 1905(p)(1)(C) of such Act (42 U.S.C. 1396d(p)(1)(C)), as amended by subsection (d)(1), 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

SEC. 5. INCREASE IN INCOME LEVELS FOR ELIGIBILITY.

(a) LIS-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 subsection 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) in the matter preceding subparagraph (A), 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)--CommentsClose CommentsPermalink





(I) by striking ‘135’ and inserting ‘150’; andCommentsClose CommentsPermalink





(II) by striking ‘150’ and inserting ‘200’; andCommentsClose CommentsPermalink





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





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





(b) MSP-CommentsClose CommentsPermalink





(1) INCREASE TO 150 PERCENT OF FPL FOR QUALIFIED MEDICARE BENEFICIARIES-CommentsClose CommentsPermalink





(A) IN GENERAL- Section 1905(p)(2) of the Social Security Act (42 U.S.C. 1396d(p)(2)) is amended--CommentsClose CommentsPermalink





(i) in subparagraph (A), by striking ‘100 percent’ and inserting ‘150 percent’;CommentsClose CommentsPermalink





(ii) in subparagraph (B)--CommentsClose CommentsPermalink





(I) by striking ‘and’ at the end of clause (ii);CommentsClose CommentsPermalink





(II) by striking the period at the end of clause (iii) and inserting ‘, and’; andCommentsClose CommentsPermalink





(III) by adding at the end the following:CommentsClose CommentsPermalink





‘(iv) January 1, 2011, is 150 percent.’; andCommentsClose CommentsPermalink





(iii) in subparagraph (C)--CommentsClose CommentsPermalink





(I) by striking ‘and’ at the end of clause (iii);CommentsClose CommentsPermalink





(II) by striking the period at the end of clause (iv) and inserting ‘, and’; andCommentsClose CommentsPermalink





(III) by adding at the end the following:CommentsClose CommentsPermalink





‘(v) January 1, 2011, is 150 percent.’.CommentsClose CommentsPermalink





(B) APPLICATION OF INCOME TEST BASED ON FAMILY SIZE- Section 1905(p)(2)(A) of such Act (42 U.S.C. 1396d(p)(2)(A)) is amended by adding at the end the following: ‘For purposes of this subparagraph, family size means the applicant, the spouse (if any) of the applicant if living in the same household as the applicant, and the number of individuals who are related to the applicant (or applicants), who are living in the same household as the applicant (or applicants), and who are dependent on the applicant (or the applicant’s spouse) for at least one-half of their financial support.’.CommentsClose CommentsPermalink





(2) EXPANSION OF SPECIFIED LOW-INCOME MEDICARE BENEFICIARY (SLMB) PROGRAM-CommentsClose CommentsPermalink





(A) ELIGIBILITY OF INDIVIDUALS WITH INCOMES BELOW 200 PERCENT OF FPL- Section 1902(a)(10)(E) of the Social Security Act (42 U.S.C. 1396b(a)(10)(E)) is amended--CommentsClose CommentsPermalink





(i) by adding ‘and’ at the end of clause (ii);CommentsClose CommentsPermalink





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





(I) by striking ‘and 120 percent in 1995 and years thereafter’ and inserting ‘, or 120 percent in 1995 and any succeeding year before 2011, or 200 percent beginning in 2011’; andCommentsClose CommentsPermalink





(II) by striking ‘and’ at the end; andCommentsClose CommentsPermalink





(iii) by striking clause (iv).CommentsClose CommentsPermalink





(B) REVISION TO DESCRIPTION- Section 1902(a)(10)(E)(iii) of the Social Security Act (42 U.S.C. 1396b(a)(10)(E)(iii)) is amended by striking ‘who would be qualified medicare’ and all that follows through ‘but is less than’ and inserting ‘whose income (as determined in accordance with subparagraphs (B) and (C) of section 1905(p)(1)) is less than’.CommentsClose CommentsPermalink





(C) REFERENCES- Section 1905(p)(1) of such Act (42 U.S.C. 1396d(p)(1)) is amended by adding at and below subparagraph (C) the following: ‘The term ‘specified low-income medicare beneficiary’ means an individual described in section 1902(a)(10)(E)(iii).’.CommentsClose CommentsPermalink





(3) PROVIDING 100 PERCENT FEDERAL FINANCING- The third sentence of section 1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by inserting before the period at the end the following: ‘, with respect to medical assistance for medicare cost-sharing provided under clause (i) of section 1902(a)(10)(E) for individuals with incomes greater than 100 percent of the official poverty line described in subsection (p)(2)(A) and less than or equal to 150 percent of such official poverty line, and with respect to medical assistance for medicare cost-sharing provided under clause (iii) of such section’.CommentsClose CommentsPermalink





(4) EFFECTIVE DATE-CommentsClose CommentsPermalink





(A) Except as provided in subparagraph (B), the amendments made by this subsection shall take effect on January 1, 2011, and, with respect to title XIX of the Social Security Act, shall apply to calendar quarters beginning on or after January 1, 2011.CommentsClose CommentsPermalink





(B) In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by this subsection, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.CommentsClose CommentsPermalink

SEC. 6. EFFECTIVE DATE OF MSP BENEFITS.

(a) In General-CommentsClose CommentsPermalink





(1) EFFECTIVE DATE OF MSP BENEFITS- Section 1905(a) of the Social Security Act (42 U.S.C. 1396d(a)) is amended, in the matter preceding paragraph (1), by striking ‘assistance or, in the case of medicare cost-sharing’ and all that follows through ‘beneficiary)’ and inserting ‘assistance)’.CommentsClose CommentsPermalink





(2) CONFORMING AMENDMENTS- (A) Section 1902(e)(8) of the Social Security Act (42 U.S.C. 1396a(e)(8)) is amended by striking the first sentence.CommentsClose CommentsPermalink





(B) Section 1848(g)(3) of such Act (42 U.S.C. 1395w-4(g)(3)) is amended by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





‘(C) TREATMENT OF RETROACTIVE ELIGIBILITY- In the case of an individual who is determined to be eligible for medical assistance described in subparagraph (A) retroactively, the Secretary shall provide a process whereby claims which are submitted for services furnished during the period of retroactive eligibility and during a month in which the individual otherwise would have been eligible for such assistance and which were not submitted in accordance with such subparagraph are resubmitted and re-processed in accordance with such subparagraph.’.CommentsClose CommentsPermalink





(b) Effective Date- The amendments made by this section shall take effect on January 1, 2010, but shall not result in eligibility for benefits for medicare cost-sharing for months before January 2010.CommentsClose CommentsPermalink

SEC. 7. EXPANDING SPECIAL ENROLLMENT PROCESS TO INDIVIDUALS ELIGIBLE FOR AN INCOME-RELATED SUBSIDY.

(a) In General- Section 1860D-1(b)(1)(C) of the Social Security Act (42 U.S.C. 1395w-101(b)(1)(C)) is amended--CommentsClose CommentsPermalink





(1) by striking ‘a full-benefit dual eligible individual (as defined in section 1935(c)(6))’ and inserting ‘a subsidy-eligible individual (as defined in section 1860D-14(a)(3))’; andCommentsClose CommentsPermalink





(2) by striking ‘1860D-14(a)(1)(A)’ and inserting ‘subsection (a)(1)(A) or (b)(1)(A) of section 1860D-14, as applicable’CommentsClose CommentsPermalink





(b) Effective Date- The amendments made by this section shall apply to enrollments on or after January 1, 2010.CommentsClose CommentsPermalink

SEC. 8. ENHANCED COST-SHARING PROTECTIONS FOR FULL-BENEFIT DUAL ELIGIBLE INDIVIDUALS AND QUALIFIED MEDICARE BENEFICIARIES.

(a) Elimination of Part D Cost-Sharing for Certain Non-Institutionalized Full-Benefit Dual Eligible Individuals- Section 1860D-14(a)(1)(D)(i) of the Social Security Act (42 U.S.C. 1395w-114(a)(1)(D)(i)) is amended--CommentsClose CommentsPermalink





(1) in the heading, by striking ‘INSTITUTIONALIZED INDIVIDUALS- In’ and inserting ‘ELIMINATION OF COST-SHARING FOR CERTAIN FULL-BENEFIT DUAL ELIGIBLE INDIVIDUALS-CommentsClose CommentsPermalink





‘(I) INSTITUTIONALIZED INDIVIDUALS- In’; andCommentsClose CommentsPermalink





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





‘(II) CERTAIN OTHER INDIVIDUALS- In the case of an individual who is a full-benefit dual eligible individual who is receiving home and community based care (whether under section 1915 or under a waiver under section 1115), the elimination of any beneficiary coinsurance described in section 1860D-2(b)(2) (for all amounts through the total amount of expenditures at which benefits are available under section 1860D-2(b)(4)).’.CommentsClose CommentsPermalink





(b) Repeal of Authority for States To Pay Medicare Cost-Sharing at Medicaid Rates and Provision of Medical Assistance to Dual Eligibles in MA Plans-CommentsClose CommentsPermalink





(1) REPEAL OF AUTHORITY FOR STATES TO PAY MEDICARE COST-SHARING AT MEDICAID RATES- Section 1902(n) of the Social Security Act (42 U.S.C. 1396a(n)) is amended--CommentsClose CommentsPermalink





(A) by striking paragraph (2);CommentsClose CommentsPermalink





(B) by redesignating paragraph (3) as paragraph (2);CommentsClose CommentsPermalink





(C) in paragraph (2), as redesignated by subparagraph (B)--CommentsClose CommentsPermalink





(i) in the matter preceding subparagraph (A)--CommentsClose CommentsPermalink





(I) by striking ‘In the case in which a State’s payment for’ and inserting ‘With respect to’; andCommentsClose CommentsPermalink





(II) by striking ‘with respect to an item or service is reduced or eliminated through the application of paragraph (2)’ and inserting ‘for an item or service’; andCommentsClose CommentsPermalink





(ii) in subparagraph (A), by striking ‘(if any)’; andCommentsClose CommentsPermalink





(D) by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(3) Each State shall establish procedures for receiving and processing claims for payment for medicare cost-sharing with respect to items or services furnished to qualified medicare beneficiaries by providers of services and suppliers under title XVIII who are not participating providers under the State plan.’.CommentsClose CommentsPermalink





(2) PROVISION OF MEDICAL ASSISTANCE TO DUAL ELIGIBLES IN MA PLANS- Section 1902(n) of the Social Security Act (42 U.S.C. 1396a(n)), as amended by paragraph (1), is amended by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(4)(A) Each State shall--CommentsClose CommentsPermalink





‘(i) identify those individuals who are eligible for medical assistance for medicare cost-sharing and who are enrolled with a Medicare Advantage plan under part C of title XVIII; andCommentsClose CommentsPermalink





‘(ii) for the individuals so identified, provide for payment of medical assistance for the medicare cost-sharing (including cost-sharing under a Medicare Advantage plan) to which they are entitled.CommentsClose CommentsPermalink





‘(B)(i) The Inspector General of the Department of Health and Human Services shall examine, not later than one year after the date of the enactment of this paragraph and every 3 years thereafter, whether States are providing for medical assistance for medicare cost-sharing for individuals enrolled in Medicare Advantage plans in accordance with this title. The Inspector General shall submit to the Secretary a report on such examination and a finding as to whether States are failing to provide such medical assistance.CommentsClose CommentsPermalink





‘(ii) If a report under clause (i) includes a finding that States are failing to provide such medical assistance, not later than 60 days after the date of receiving such report the Secretary shall submit to Congress a report that includes a plan of action on how to enforce such requirement.’.CommentsClose CommentsPermalink





(3) CONFORMING AMENDMENTS-CommentsClose CommentsPermalink





(A) PROVIDER AGREEMENTS- Section 1866(a)(1)(A)(ii) of the Social Security Act (42 U.S.C. 1395cc(a)(1)(A)(ii)) is amended by striking ‘1902(n)(3)’ and inserting ‘1902(n)(2)’.CommentsClose CommentsPermalink





(B) NONPARTICIPATING PROVIDERS- Section 1848(g)(3)(A) of the Social Security Act (42 U.S.C. 1395w-4(g)(3)(A)) is amended by striking ‘1902(n)(3)(A)’ and inserting ‘1902(n)(2)(A)’.CommentsClose CommentsPermalink





(4) EFFECTIVE DATE-CommentsClose CommentsPermalink





(A) IN GENERAL- Except as provided in subparagraph (B), the amendments made by this subsection shall take effect on the date of enactment of this Act.CommentsClose CommentsPermalink





(B) EXCEPTION- The amendment made by paragraph (2) shall be effective and apply as if included in the enactment of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173).CommentsClose CommentsPermalink

SEC. 9. TWO-WAY DEEMING BETWEEN MEDICARE SAVINGS PROGRAM AND LOW-INCOME SUBSIDY PROGRAM.

(a) Low-Income Subsidy Program- Section 1860D-14(a)(3) of the Social Security Act (42 U.S.C. 1395w-104(a)(3)), as amended by section 4, is amended by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





‘(J) DEEMED TREATMENT FOR QUALIFIED MEDICARE BENEFICIARIES AND SPECIFIED LOW-INCOME MEDICARE BENEFICIARIES-CommentsClose CommentsPermalink





‘(i) QMBS ELIGIBLE FOR FULL SUBSIDY- A part D eligible individual who has been determined for purposes of title XIX to be a qualified medicare beneficiary is deemed, for purposes of this part and without the need to file any additional application, to be a subsidy eligible individual described in paragraph (1).CommentsClose CommentsPermalink





‘(ii) SLMBS ELIGIBLE FOR PARTIAL SUBSIDY- A part D eligible individual who has been determined to be a specified low-income medicare beneficiary (as defined in section 1905(p)(1)) and who is not described in paragraph (1) is deemed, for purposes of this part and without the need to file any additional application, to be a subsidy eligible individual who is not described in paragraph (1).’.CommentsClose CommentsPermalink





(b) Medicare Savings Program- Section 1905(p) of the Social Security Act (42 U.S.C. 1396d(p)), as amended by section 4, is amended--CommentsClose CommentsPermalink





(1) by redesignating paragraph (8) as paragraph (9); andCommentsClose CommentsPermalink





(2) by inserting after paragraph (7) the following new paragraph:CommentsClose CommentsPermalink





‘(8) An individual who has been determined eligible for premium and cost-sharing subsidies under--CommentsClose CommentsPermalink





‘(A) section 1860D-14(a)(1) is deemed, for purposes of this title and without the need to file any additional application, to be a qualified medicare beneficiary for purposes of this title; orCommentsClose CommentsPermalink





‘(B) section 1860D-14(a)(2) is deemed, for purposes of this title and without the need to file any additional application, to qualify for medical assistance as a specified low-income medicare beneficiary (described in section 1902(a)(10)(E)(iii)).’.CommentsClose CommentsPermalink





(c) Effective Date- The amendments made by this section shall apply to eligibility for months beginning on or after January 2010.CommentsClose CommentsPermalink

SEC. 10. IMPROVING LINKAGES BETWEEN HEALTH PROGRAMS AND SNAP.

(a) Low-Income Part D Subsidy Program- Section 1144(c) of the Social Security Act (42 U.S.C. 1320b-14(c)) is amended--CommentsClose CommentsPermalink





(1) in paragraph (1)(C) by striking ‘an application for benefits under the Medicare Savings Program.’ and inserting ‘applications for benefits under the Medicare Savings Program and the supplemental nutrition assistance program.’;CommentsClose CommentsPermalink





(2) by striking paragraph (3) and inserting the following:CommentsClose CommentsPermalink





‘(3) TRANSMITTAL OF DATA TO STATES-CommentsClose CommentsPermalink





‘(A) IN GENERAL- Beginning on January 1, 2010, with the consent of an individual completing an application for benefits described in paragraph (1)(B), the Commissioner shall electronically transmit data from such application--CommentsClose CommentsPermalink





‘(i) to the appropriate State Medicaid agency, as determined by the Commissioner, which transmittal shall initiate an application of the individual for benefits under the Medicare Savings Program with the State Medicaid agency; andCommentsClose CommentsPermalink





‘(ii) to the appropriate State agency which administers benefits under the supplemental nutrition assistance program, as determined by the Commissioner, which transmittal shall initiate an application of the individual for benefits under the supplemental nutrition assistance program with the State agency that administers that program.CommentsClose CommentsPermalink





‘(B) CONSULTATION REGARDING CONTENT, TIME, FORM, FREQUENCY AND MANNER OF TRANSMISSION- In order to ensure that such data transmittal provides effective assistance for purposes of State adjudication of applications for benefits under the Medicare Savings Program and the supplemental nutrition assistance program, the Commissioner shall consult with the Secretary after the Secretary has consulted with the States, regarding the content, form, frequency, and manner in which data (on a uniform basis for all States) shall be transmitted under this paragraph.’;CommentsClose CommentsPermalink





(3) in paragraph (5), by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





‘(D) SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM ADMINISTRATIVE COSTS- The costs of the Social Security Administration’s work related to the supplemental nutrition assistance program under this subsection shall be eligible for reimbursement under section 11(j)(2)(C) of the Food and Nutrition Act of 2008 (7 U.S.C. 2020(j)(2)(C)). To the extent necessary the Commissioner and the Secretary of Agriculture shall revise any memoranda of understanding in effect under such section.’; andCommentsClose CommentsPermalink





(4) by adding at the end the following new paragraph:CommentsClose CommentsPermalink





‘(8) SUPPLEMENTAL NUTRITION ASSISTANCE PROGRAM DEFINED- For purposes of this subsection, the term ‘supplemental nutrition assistance program’ means the program of temporary benefits authorized under section 11(v) of the Food and Nutrition Act of 2008 (7 U.S.C. 2020(v)).’.CommentsClose CommentsPermalink





(b) Temporary Supplemental Nutrition Assistance Benefits- Section 11 of the Food and Nutrition Act of 2008 (7 U.S.C. 2020) is amended by adding at the end the following:CommentsClose CommentsPermalink





‘(v) Temporary Benefits for Medicare Part D Low Income Subsidy Applicants-CommentsClose CommentsPermalink





‘(1) DEFINITION OF MEDICARE PART D LOW INCOME SUBSIDY APPLICANT- In this subsection, the term ‘Medicare part D low income subsidy applicant’ means an individual, along with any other family members, whose low income subsidy application information has been electronically transmitted to the State agency under section 1144(c)(3) of the Social Security Act (42 U.S.C. 1320b-14(c)(3)).CommentsClose CommentsPermalink





‘(2) PROVISION OF TEMPORARY BENEFITS- A State agency shall provide temporary supplemental nutrition assistance program benefits to a Medicare part D low income subsidy applicant whose--CommentsClose CommentsPermalink





‘(A) income does not exceed 150 percent of the poverty line (as determined in accordance with section 5(c)(1)); andCommentsClose CommentsPermalink





‘(B) financial resources do not exceed the limit in effect in the State for such households under section 5.CommentsClose CommentsPermalink





‘(3) DETERMINATION BASED ON MEDICARE INFORMATION- For purposes of determining eligibility under paragraph (2) and the amount of temporary benefits under paragraph (5), information on household members, household income, and household resources from the Medicare part D low income subsidy application as transmitted to the State agency under section 1144(c)(3) of the Social Security Act (42 U.S.C. 1320b-14(c)(3)) shall satisfy the requirements of this Act with regard to--CommentsClose CommentsPermalink





‘(A) the members of the household under section 3(n); andCommentsClose CommentsPermalink





‘(B) the gross income and financial resources of the household under section 5.CommentsClose CommentsPermalink





‘(4) TEMPORARY BENEFIT PERIOD- A household shall receive temporary supplemental nutrition assistance benefits under this subsection for a period of not more than 2 months.CommentsClose CommentsPermalink





‘(5) TEMPORARY BENEFIT AMOUNT-CommentsClose CommentsPermalink





‘(A) IN GENERAL- During the temporary benefit period under paragraph (4), except as provided in subparagraph (B), a household shall receive a monthly amount of supplemental nutrition assistance program benefits calculated under section 8(a).CommentsClose CommentsPermalink





‘(B) CALCULATION- In calculating benefits under subparagraph (A)--CommentsClose CommentsPermalink





‘(i) the benefits shall be determined based on the gross income of the household rather than net income; andCommentsClose CommentsPermalink





‘(ii) the minimum allotment described in the proviso in section 8(a) shall be equal to 40 percent of the cost of the thrifty food plan for a household containing 1 member, as determined by the Secretary under section 3, rounded to the nearest whole dollar increment.CommentsClose CommentsPermalink





‘(6) DETERMINATION OF FUTURE ELIGIBILITY- During the temporary benefit period under paragraph (4), the State agency shall provide to the household--CommentsClose CommentsPermalink





‘(A) an application to apply for benefits under the other provisions of this Act; andCommentsClose CommentsPermalink





‘(B) an opportunity to complete the application process by the month immediately following the temporary benefit period, without a delay or suspension in the benefits of the household.CommentsClose CommentsPermalink





‘(7) LIMITATION- This subsection shall not apply to individuals who--CommentsClose CommentsPermalink





‘(A) are members of households that currently receive benefits under this Act; orCommentsClose CommentsPermalink





‘(B) have received benefits under this subsection in the preceding 12-month period.’.CommentsClose CommentsPermalink





(c) Medicare Savings Program Applications-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)) is amended--CommentsClose CommentsPermalink





(A) in paragraph (72), by striking ‘and’ at the end;CommentsClose CommentsPermalink





(B) in paragraph (73), by striking the period at the end and inserting ‘; and’; andCommentsClose CommentsPermalink





(C) by inserting after paragraph (73) the following new paragraph:CommentsClose CommentsPermalink





‘(74) provide that the State coordinates with the State agency that administers benefits under the supplemental nutrition assistance program established under the Food and Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) to ensure that individuals applying for medical assistance provided under section 1902(a)(10)(E), as described in sections 1905(p) and 1933, have the opportunity to apply for, establish eligibility for, and, if eligible, receive supplemental nutrition assistance program benefits.’.CommentsClose CommentsPermalink





(2) EFFECTIVE DATE-CommentsClose CommentsPermalink





(A) IN GENERAL- Except as provided in subparagraph (B), the amendments made by paragraph (1) take effect on the date that is 1 year after the date of enactment of this Act.CommentsClose CommentsPermalink





(B) EXTENSION OF EFFECTIVE DATE FOR STATE LAW AMENDMENT- In the case of a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which the Secretary of Health and Human Services determines requires State legislation in order for the plan to meet the additional requirements imposed by the amendments made by paragraph (1), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session is considered to be a separate regular session of the State legislature.CommentsClose CommentsPermalink





(3) REPORT TO CONGRESS- Not later than 2 years after the date of enactment of this Act, the Secretary of Health and Human Services shall submit to Congress a report on the process each State uses to meet the requirements under section 1902(a)(74) of the Social Security Act, as added by subsection (c).CommentsClose CommentsPermalink

SEC. 11. 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. 12. 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. 13. INTELLIGENT ASSIGNMENT IN ENROLLMENT.

(a) In General- Section 1860D-1(b)(1) of the Social Security Act (42 U.S.C. 1395w-101(b)(1), as amended by section 7(b), is amended--CommentsClose CommentsPermalink





(1) in the second sentence of subparagraph (C), by striking ‘on a random basis among all such plans’ and inserting ‘, subject to subparagraph (E), in the most appropriate plan for such individual’; andCommentsClose CommentsPermalink





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





‘(E) INTELLIGENT ASSIGNMENT- In the case of any auto-enrollment under subparagraph (C), no part D eligible individual described in such subparagraph shall be enrolled in a prescription drug plan which does not meet requirements established by the Secretary.’.CommentsClose CommentsPermalink





(b) Effective Date- The amendment made by subsection (a) shall apply to enrollments effected on or after November 15, 2010.CommentsClose CommentsPermalink

SEC. 14. MEDICARE ENROLLMENT ASSISTANCE.

(a) Additional Funding for State Health Insurance Assistance Programs-CommentsClose CommentsPermalink





(1) GRANTS-CommentsClose CommentsPermalink





(A) IN GENERAL- The Secretary of Health and Human Services (in this section referred to as the ‘Secretary’) shall use amounts made available under subparagraph (B) to make grants to States for State health insurance assistance programs receiving assistance under section 4360 of the Omnibus Budget Reconciliation Act of 1990.CommentsClose CommentsPermalink





(B) FUNDING- For purposes of making grants under this subsection, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in the same proportion as the Secretary determines under section 1853(f) of such Act (42 U.S.C. 1395w-23(f)), of $14,000,000 to the Centers for Medicare & Medicaid Services Program Management Account for fiscal year 2011, to remain available until expended.CommentsClose CommentsPermalink





(2) AMOUNT OF GRANTS- The amount of a grant to a State under this subsection from the total amount made available under paragraph (1) shall be equal to the sum of the amount allocated to the State under paragraph (3)(A) and the amount allocated to the State under subparagraph (3)(B).CommentsClose CommentsPermalink





(3) ALLOCATION TO STATES-CommentsClose CommentsPermalink





(A) ALLOCATION BASED ON PERCENTAGE OF LOW-INCOME BENEFICIARIES- The amount allocated to a State under this subparagraph from 2/3 of the total amount made available under paragraph (1) shall be based on the number of individuals who meet the requirement under subsection (a)(3)(A)(ii) of section 1860D-14 of the Social Security Act (42 U.S.C. 1395w-114) but who have not enrolled to receive a subsidy under such section 1860D-14 relative to the total number of individuals who meet the requirement under such subsection (a)(3)(A)(ii) in each State, as estimated by the Secretary.CommentsClose CommentsPermalink





(B) ALLOCATION BASED ON PERCENTAGE OF RURAL BENEFICIARIES- The amount allocated to a State under this subparagraph from 1/3 of the total amount made available under paragraph (1) shall be based on the number of part D eligible individuals (as defined in section 1860D-1(a)(3)(A) of such Act (42 U.S.C. 1395w-101(a)(3)(A))) residing in a rural area relative to the total number of such individuals in each State, as estimated by the Secretary.CommentsClose CommentsPermalink





(4) PORTION OF GRANT BASED ON PERCENTAGE OF LOW-INCOME BENEFICIARIES TO BE USED TO PROVIDE OUTREACH TO INDIVIDUALS WHO MAY BE SUBSIDY ELIGIBLE INDIVIDUALS OR ELIGIBLE FOR THE MEDICARE SAVINGS PROGRAM- Each grant awarded under this subsection with respect to amounts allocated under paragraph (3)(A) shall be used to provide outreach to individuals who may be subsidy eligible individuals (as defined in section 1860D-14(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w-114(a)(3)(A)) or eligible for the Medicare Savings Program (as defined in subsection (f)).CommentsClose CommentsPermalink





(b) Additional Funding for Area Agencies on Aging-CommentsClose CommentsPermalink





(1) GRANTS-CommentsClose CommentsPermalink





(A) IN GENERAL- The Secretary, acting through the Assistant Secretary for Aging, shall make grants to States for area agencies on aging (as defined in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002)) and Native American programs carried out under the Older Americans Act of 1965 (42 U.S.C. 3001 et seq.).CommentsClose CommentsPermalink





(B) FUNDING- For purposes of making grants under this subsection, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in the same proportion as the Secretary determines under section 1853(f) of such Act (42 U.S.C. 1395w-23(f)), of $10,000,000 to the Administration on Aging for fiscal year 2011, to remain available until expended.CommentsClose CommentsPermalink





(2) AMOUNT OF GRANT AND ALLOCATION TO STATES BASED ON PERCENTAGE OF LOW-INCOME AND RURAL BENEFICIARIES- The amount of a grant to a State under this subsection from the total amount made available under paragraph (1) shall be determined in the same manner as the amount of a grant to a State under subsection (a), from the total amount made available under paragraph (1) of such subsection, is determined under paragraph (2) and subparagraphs (A) and (B) of paragraph (3) of such subsection.CommentsClose CommentsPermalink





(3) REQUIRED USE OF FUNDS-CommentsClose CommentsPermalink





(A) ALL FUNDS- Subject to subparagraph (B), each grant awarded under this subsection shall be used to provide outreach to eligible Medicare beneficiaries regarding the benefits available under title XVIII of the Social Security Act.CommentsClose CommentsPermalink





(B) OUTREACH TO INDIVIDUALS WHO MAY BE SUBSIDY ELIGIBLE INDIVIDUALS OR ELIGIBLE FOR THE MEDICARE SAVINGS PROGRAM- Subsection (a)(4) shall apply to each grant awarded under this subsection in the same manner as it applies to a grant under subsection (a).CommentsClose CommentsPermalink





(c) Additional Funding for Aging and Disability Resource Centers-CommentsClose CommentsPermalink





(1) GRANTS-CommentsClose CommentsPermalink





(A) IN GENERAL- The Secretary shall make grants to Aging and Disability Resource Centers under the Aging and Disability Resource Center grant program that are established centers under such program on the date of the enactment of this Act.CommentsClose CommentsPermalink





(B) FUNDING- For purposes of making grants under this subsection, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in the same proportion as the Secretary determines under section 1853(f) of such Act (42 U.S.C. 1395w-23(f)), of $10,000,000 to the Administration on Aging for fiscal year 2011, to remain available until expended.CommentsClose CommentsPermalink





(2) REQUIRED USE OF FUNDS- Each grant awarded under this subsection shall be used to provide outreach to individuals regarding the benefits available under the Medicare prescription drug benefit under part D of title XVIII of the Social Security Act and under the Medicare Savings Program.CommentsClose CommentsPermalink





(d) Coordination of Efforts To Inform Older Americans About Benefits Available Under Federal and State Programs-CommentsClose CommentsPermalink





(1) IN GENERAL- The Secretary, acting through the Assistant Secretary for Aging, in cooperation with related Federal agency partners, shall make a grant to, or enter into a contract with, a qualified, experienced entity under which the entity shall--CommentsClose CommentsPermalink





(A) maintain and update web-based decision support tools, and integrated, person-centered systems, designed to inform older individuals (as defined in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002)) about the full range of benefits for which the individuals may be eligible under Federal and State programs;CommentsClose CommentsPermalink





(B) utilize cost-effective strategies to find older individuals with the greatest economic need (as defined in such section 102) and inform the individuals of the programs;CommentsClose CommentsPermalink





(C) develop and maintain an information clearinghouse on best practices and the most cost-effective methods for finding older individuals with greatest economic need and informing the individuals of the programs; andCommentsClose CommentsPermalink





(D) provide, in collaboration with related Federal agency partners administering the Federal programs, training and technical assistance on the most effective outreach, screening, and follow-up strategies for the Federal and State programs.CommentsClose CommentsPermalink





(2) FUNDING- For purposes of making a grant or entering into a contract under paragraph (1), the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 of the Social Security Act (42 U.S.C. 1395i) and the Federal Supplementary Medical Insurance Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in the same proportion as the Secretary determines under section 1853(f) of such Act (42 U.S.C. 1395w-23(f)), of $10,000,000 to the Administration on Aging for fiscal year 2011, to remain available until expended.CommentsClose CommentsPermalink





(e) Medicare Savings Program Defined- For purposes of this section, the term ‘Medicare Savings Program’ means the program of medical assistance for payment of the cost of medicare cost-sharing under the Medicaid program pursuant to sections 1902(a)(10)(E) and 1933 of the Social Security Act (42 U.S.C. 1396a(a)(10)(E), 1396u-3).CommentsClose CommentsPermalink

SEC. 15. QMB BUY-IN OF PART A AND PART B PREMIUMS.

(a) Requirement- Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as amended by section 10, is amended--CommentsClose CommentsPermalink





(1) in paragraph (73), by striking ‘and’ at the end;CommentsClose CommentsPermalink





(2) in paragraph (74), by striking the period at the end and inserting ‘; and’; andCommentsClose CommentsPermalink





(3) by inserting after paragraph (74) the following new paragraph:CommentsClose CommentsPermalink





‘(75) provide that the State enters into a modification of an agreement under section 1818(g).’.CommentsClose CommentsPermalink





(b) Effective Date-CommentsClose CommentsPermalink





(1) IN GENERAL- Except as provided in paragraph (2), the amendments made by this section take effect on the date that is 6 months after the date of enactment of this Act.CommentsClose CommentsPermalink





(2) EXTENSION OF EFFECTIVE DATE FOR STATE LAW AMENDMENT- In the case of a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which the Secretary of Health and Human Services determines requires State legislation in order for the plan to meet the additional requirements imposed by the amendments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session is considered to be a separate regular session of the State legislature.CommentsClose CommentsPermalink

SEC. 16. INCREASING AVAILABILITY OF MSP APPLICATIONS THROUGH AVAILABILITY ON THE INTERNET AND DESIGNATION OF PREFERRED LANGUAGE.

(a) Requirement for States-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1902(a) of the Social Security Act (42 U.S.C. 1396a(a)), as amended by section 15, is amended--CommentsClose CommentsPermalink





(A) in paragraph (74), by striking ‘and’ at the end;CommentsClose CommentsPermalink





(B) in paragraph (75), by striking the period at the end and inserting ‘; and’; andCommentsClose CommentsPermalink





(C) by inserting after paragraph (75) the following new paragraph:CommentsClose CommentsPermalink





‘(76) provide--CommentsClose CommentsPermalink





‘(A) that the application for medical assistance for medicare cost-sharing under this title used by the State allows an individual to specify a preferred language for subsequent communication and, in the case in which a language other than English is specified, provide that subsequent communications under this title to the individual shall be in such language; andCommentsClose CommentsPermalink





‘(B) that the State makes such application available through an Internet website and provides for such application to be completed on such website.’.CommentsClose CommentsPermalink





(2) EFFECTIVE DATE-CommentsClose CommentsPermalink





(A) IN GENERAL- Except as provided in subparagraph (B), the amendments made by this subsection take effect on the date that is 2 years after the date of enactment of this Act.CommentsClose CommentsPermalink





(B) EXTENSION OF EFFECTIVE DATE FOR STATE LAW AMENDMENT- In the case of a State plan under title XIX of the Social Security Act (42 U.S.C. 1396 et seq.) which the Secretary of Health and Human Services determines requires State legislation in order for the plan to meet the additional requirements imposed by the amendments made by this subsection, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of the session is considered to be a separate regular session of the State legislature.CommentsClose CommentsPermalink





(b) Requirement for the Secretary- Section 1905(p)(5) of the Social Security Act (42 U.S.C. 1396d(p)(5)) is amended by adding at the end the following new sentence: ‘Such form shall allow an individual to specify a preferred language for subsequent communication.’.CommentsClose CommentsPermalink

SEC. 17. STATE MEDICAID AGENCY CONSIDERATION OF LOW-INCOME SUBSIDY APPLICATION AND DATA TRANSMITTAL.

(a) Technical Amendments-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1144(c)(3)(A)(i) of the Social Security Act (42 U.S.C. 1320b-14(c)(3)(A)(i)), as amended by section 10, is amended--CommentsClose CommentsPermalink





(A) by striking ‘transmittal’; andCommentsClose CommentsPermalink





(B) by inserting ‘(as specified in section 1935(a)(4))’ before the semicolon at the end.CommentsClose CommentsPermalink





(2) EFFECTIVE DATE- The amendments made by this subsection shall take effect as if included in the enactment of section 113(a) of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275).CommentsClose CommentsPermalink





(b) Clarification of State Medicaid Agency Consideration of Low-Income Subsidy Application- Section 1935(a)(4) of the Social Security Act (42 U.S.C. 1396u-5(a)(4)), as added by section 113(b) of the Medicare Improvements for Patients and Providers Act of 2008 (Public Law 110-275), is amended--CommentsClose CommentsPermalink





(1) by striking ‘PROGRAM- The State’ and inserting ‘PROGRAM-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The State’;CommentsClose CommentsPermalink





(2) in subparagraph (A), as inserting by paragraph (1), by striking the second sentence; andCommentsClose CommentsPermalink





(3) by adding at the end the following new subparagraphs:CommentsClose CommentsPermalink





‘(B) For purposes of a State’s obligation under section 1902(a)(8) to furnish medical assistance with reasonable promptness, the date of the electronic transmission by the Commissioner of Social Security to the State Medicaid agency of data under section 1144(c)(3) shall be the date of the filing of such application for benefits under the Medicare Savings Program.CommentsClose CommentsPermalink





‘(C) For the purpose of determining when medical assistance shall be made available for medicare cost-sharing under this title, the State shall consider the date of the application for low-income subsidies under section 1860D-14 to be the date of the filing of an application for benefits under the Medicare Savings Program.’.CommentsClose CommentsPermalink