[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 649 Introduced in Senate (IS)]

103d CONGRESS
  1st Session
                                 S. 649

 To ensure proper and full implementation by the Department of Health 
and Human Services of medicaid coverage for certain low-income medicare 
                             beneficiaries.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

               March 24 (legislative day, March 3), 1993

   Mr. Riegle (for himself, Mr. Mitchell, Mr. Pryor, Mr. Cohen, Mr. 
  Kennedy, Mr. Simon, Mr. Leahy, Mr. Johnston, Mr. Sarbanes, and Mr. 
   Wofford) introduced the following bill; which was read twice and 
                  referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
 To ensure proper and full implementation by the Department of Health 
and Human Services of medicaid coverage for certain low-income medicare 
                             beneficiaries.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Enrollment Improvement and 
Protection Act of 1993''.

                     TITLE I--IMPROVING ENROLLMENT

SEC. 101. NOTIFICATION.

    (a) In General.--Section 1804 of the Social Security Act (42 U.S.C. 
1395b-2) is amended--
            (1) by striking ``and'' at the end of paragraph (2),
            (2) by striking the period at the end of paragraph (3) and 
        inserting ``, and'',
            (3) by inserting after paragraph (3) the following new 
        paragraph:
            ``(4) a clear, simple explanation (designed to attract the 
        reader's attention and stated plainly in English and any other 
        language determined by the Secretary) of the eligibility 
        requirements and application procedures for receiving payment 
        of medicare cost-sharing (as defined in section 1905(p)(3)) by 
        qualified medicare beneficiaries (as defined in section 
        1905(p)(1)), qualified disabled and working individuals (as 
        defined in section 1905(s)), and individuals described in 
        section 1902(a)(10)(E)(iii).'', and
            (4) by adding at the end thereof the following new 
        sentence: ``The portion of the notice containing the 
        explanation described in paragraph (4) shall also be prepared 
        in a manner suitable for posting and shall be distributed to 
        physicians, hospital offices, other medical facilities, and 
        entities receiving grants from the Secretary for programs 
        designed to provide services to individuals age 65 or older.''.
    (b) Toll-Free Hotline.--The Secretary of Health and Human Services 
shall establish a toll-free telephone number to provide individuals 
with information on medicare cost-sharing (as defined in section 
1905(p)(3) of the Social Security Act (42 U.S.C. 1396d(p)(3)), 
including the availability of and requirements for obtaining such 
medicare cost-sharing, where to go for applications, and documentation 
needed for applying. Such information shall be offered to every caller 
to the hotline regardless of the specific inquiry. All notices 
described in section 1804(4) of the Social Security Act (42 U.S.C. 
1395b-2(4)) shall include this toll-free telephone number.
    (c) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date of the enactment of this Act.

SEC. 102. USE OF SOCIAL SECURITY ADMINISTRATION OFFICES AND SIMPLIFIED 
              APPLICATION PROCESSES.

    (a) In General.--Title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.) is amended by adding at the end thereof the following new 
section:

   ``alternative locations for processing applications for qualified 
                         medicare beneficiaries

    ``Sec. 1931. (a) In General.--The Secretary, through the Social 
Security Administration and the Health Care Financing Administration, 
shall provide, as an alternative to the procedure established by State 
agencies under State plans under this title, a procedure (including 
appropriate training of personnel by the Health Care Financing 
Administration) to assist individuals in completing the application 
form described in subsection (b) at Social Security Administration 
offices (and any other Federal office, as determined appropriate by the 
Secretary), and to accept by mail or in person such application form at 
such offices. The Secretary shall ensure that adequate resources are 
available to implement the procedure developed under this subsection.
    ``(b) Simplified Application Forms.--The Secretary shall develop a 
short, simplified application form to determine if an individual meets 
the requirements for status as a qualified medicare beneficiary under 
section 1905(p)(1), a qualified disabled and working individual (as 
defined in section 1905(s)), or an individual described in section 
1902(a)(10)(E)(iii). The form shall be developed with the consultation 
of consumer advocates and State agencies and shall be available in 
offices described in subsection (a).
    ``(c) Additional Uses of Forms.--The Secretary shall periodically 
(at such times as determined by the Secretary) mail the forms described 
in subsection (b) to individuals potentially eligible for the status 
described in such subsection, and shall provide such forms to 
counselors in organizations described in section 105 of the Medicare 
Enrollment Improvement and Protection Act of 1993 for use in 
determining an individual's eligibility for such status.
    ``(d) Submission of Forms.--Except as provided in subsection (e), 
the Secretary shall refer application forms described in subsection (b) 
which are received by the Secretary to the appropriate State agency 
designated under this title for review and decision.
    ``(e) Certification of Determination of Status.--
            ``(1) Certification to state.--If the Secretary, based upon 
        an application described in subsection (b), makes a 
        determination that an individual meets the requirements for the 
        status described in such subsection, the Secretary shall 
        certify such determination to the State in which the individual 
        resides.
            ``(2) State recognition of eligibility.--If the Secretary 
        certifies to the State that an individual meets the 
        requirements for such status, the individual shall be deemed to 
        have met the requirements for such status.
            ``(3) Continuing eligibility required.--Nothing in 
        paragraph (2) shall be construed to prohibit a State from 
        requiring an individual to continue to meet the requirements of 
        such status after the individual is deemed to have met the 
        requirements of such status under paragraph (2).''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
take effect on the date of the enactment of this Act.

SEC. 103. MANDATORY DIRECT ENROLLMENT OF PART A ELIGIBLES.

    (a) In General.--Paragraph (1) of section 1818(g) of the Social 
Security Act (42 U.S.C. 1395i-2(e)) is amended by striking ``shall, at 
the request of a State made after 1989, enter into a modification of an 
agreement entered into with the State pursuant to section 1843(a)'' and 
inserting ``shall enter into an agreement with each State under terms 
described in section 1843''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect on the date of the enactment of this Act.

SEC. 104. OPTIONAL PRESUMPTIVE ELIGIBILITY.

    (a) In General.--Title XIX of the Social Security Act (42 U.S.C. 
1396 et seq.) is amended by inserting after section 1920 the following 
new section:

     ``presumptive eligibility for qualified medicare beneficiaries

    ``Sec. 1920A. (a) In General.--A State plan approved under section 
1902 may provide that during a presumptive eligibility period, medical 
assistance may be made available for medicare cost-sharing (as 
described in clauses (i), (ii), and (iii) of section 1902(a)(10)(E)) to 
qualified medicare beneficiaries (as defined in section 1905(p)(1)), 
qualified disabled and working individuals (as defined in section 
1905(s)), and individuals described in section 1902(a)(10)(E)(iii) 
without regard to whether a final determination of eligibility for such 
assistance has been made.
    ``(b) Definitions.--For purposes of this section--
            ``(1) the term `presumptive eligibility period' means, with 
        respect to an individual described in subsection (a), the 
        period that--
                    ``(A) begins with the date on which a qualified 
                provider determines, on the basis of preliminary 
                information, that the family income of the individual 
                does not exceed the applicable income level of 
                eligibility under the State plan, and
                    ``(B) ends with (and includes) the earlier of--
                            ``(i) the day on which a determination is 
                        made with respect to the eligibility of the 
                        individual for medical assistance described in 
                        subsection (a) under the State plan, or
                            ``(ii) in the case of an individual who 
                        does not file an application by the last day of 
                        the month following the month during which the 
                        provider makes the determination referred to in 
                        subparagraph (A), such last day, and
            ``(2) the term `qualified provider' means any provider 
        that--
                    ``(A) is eligible for payments under a State plan 
                approved under this title, and
                    ``(B) is determined by the State agency to be 
                capable of making determinations of the type described 
                in paragraph (1)(A).
    ``(c) Duties of State Agency, Qualified Providers, and 
Presumptively Eligible Individuals.--
            ``(1) Duties of state agency.--The State agency shall 
        provide qualified providers with--
                    ``(A) such forms as are necessary for an individual 
                described in subsection (a) to make application for 
                medical assistance described in subsection (a) under 
                the State plan, and
                    ``(B) information on how to assist such individuals 
                in completing and filing such forms.
            ``(2) Duties of qualified providers.--A qualified provider 
        that determines under subsection (b)(1)(A) that such an 
        individual is presumptively eligible for such medical 
        assistance under a State plan shall--
                    ``(A) notify the State agency of the determination 
                within 5 working days after the date on which the 
                determination is made, and
                    ``(B) inform the individual at the time the 
                determination is made that such individual is required 
                to make application for such medical assistance under 
                the State plan by no later than the last day of the 
                month following the month during which the 
                determination is made.
            ``(3) Duties of presumptively eligible individuals.--An 
        individual who is determined by a qualified provider to be 
        presumptively eligible for medical assistance under a State 
        plan shall make application for such medical assistance under 
        such plan by no later than the last day of the month following 
        the month during which the determination is made.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to calendar quarters beginning on or after January 1, 1994, 
without regard to whether or not regulations to implement such 
amendment are promulgated by such date.

SEC. 105. OUTREACH GRANTS.

    (a) Grants.--
            (1) In general.--The Secretary of Health and Human Services 
        (in this section referred to as the ``Secretary'') shall make 
        grants, one-half to State agencies and one-half to 
        organizations approved under paragraph (2), that submit 
        applications to the Secretary that meet the requirements of 
        this section for the purpose of providing information, 
        counseling, and assistance to older individuals who may be 
        eligible for, but who are not receiving, benefits as qualified 
        medicare beneficiaries (as defined in section 1905(p)(1) of the 
        Social Security Act (42 U.S.C. 1396d(p)(1)), qualified disabled 
        and working individuals (as defined in section 1905(s) of such 
        Act (42 U.S.C. 1396d(s)), and individuals described in section 
        1902(a)(10)(E)(iii) of such Act (42 U.S.C. 1396a(a)(10)(E)) (in 
        this section referred to as ``eligible individuals''). The 
        Secretary shall prescribe regulations to establish a minimum 
        level of funding for a grant issued under this section.
            (2) Approved organizations.--For purposes of paragraph (1), 
        an organization shall be approved by the Secretary to submit an 
        application for grant funding (as described in subsection (b)) 
        if, as determined by the Secretary, such organization has local 
        entities that can assist older individuals with information and 
        applications to determine if such individuals are eligible 
        individuals.
    (b) Grant Applications.--
            (1) Submissions.--In submitting an application under this 
        section, a State agency or approved organization may 
        consolidate and coordinate an application that consists of 
        parts prepared by more than one department of such State agency 
        or organization.
            (2) Program requirements.--As part of an application for a 
        grant under this section, a State agency or approved 
        organization shall submit a plan for an information, 
        counseling, and assistance program. Such program shall--
                    (A) establish or improve upon an information, 
                counseling, and assistance program that provides 
                counseling and assistance to eligible individuals in 
                need of information that may assist such individuals in 
                applying for medicare cost-sharing (as defined in 
                section 1905(p)(3) of the Social Security Act (42 
                U.S.C. 1396d(p)(3));
                    (B) establish a system of referrals to appropriate 
                Federal, State, or local departments or agencies for 
                assistance with problems related to enrollment in and 
                full implementation of such medicare cost-sharing 
                program, as determined by the Secretary;
                    (C) provide for a sufficient number of staff 
                positions (including volunteer positions) necessary to 
                provide the services of the information, counseling, 
                and assistance program;
                    (D) provide for the collection and dissemination of 
                timely and accurate enrollment information to staff 
                members;
                    (E) provide for training programs for staff members 
                (including volunteer staff members);
                    (F) provide for the coordination of the exchange of 
                enrollment information between the staff of departments 
                and agencies of the State government and the staff of 
                the information, counseling, and assistance program;
                    (G) make recommendations concerning consumer issues 
                and complaints related to such enrollment to agencies 
                and departments of the State government and the Federal 
                Government responsible for providing such medicare 
                cost-sharing;
                    (H) establish an outreach program to provide the 
                enrollment information and counseling described in 
                subparagraph (A) and the assistance described in 
                subparagraph (B) to eligible individuals; and
                    (I) demonstrate, to the satisfaction of the 
                Secretary, an ability to provide the counseling and 
                assistance required under this section.
    (c) Administration.--The State agency or approved organization 
shall operate the information, counseling, and assistance program in 
locations other than State welfare offices, including facilities 
operated by any area agency on aging (as defined in section 102(a)(17) 
of the Older Americans Act of 1965), meals on wheels program, senior 
center, and other location determined by the Secretary in consultation 
with such agency or organization.
    (d) Maintenance of Effort.--Any funds appropriated for the 
activities under this section shall supplement, and shall not supplant, 
funds that are expended for similar purposes under any Federal, State, 
or local program.
    (e) Annual Applicant Report.--A State agency or approved 
organization that receives a grant under subsection (a) shall, not 
later than 180 days after receiving such grant, and annually 
thereafter, issue an annual report to the Secretary that includes 
information concerning--
            (1) the number of individuals served by the information, 
        counseling, and assistance program of such State agency or 
        organization; and
            (2) the problems that eligible individuals encounter in 
        enrolling for medicare cost-sharing.
    (f) Report to Congress.--Not later than 180 days after the date of 
enactment of this section, and annually thereafter, the Secretary shall 
issue a report to the Committee on Finance of the Senate, the Special 
Committee on Aging of the Senate, the Committee on Ways and Means of 
the House of Representatives, the Committee on Energy and Commerce of 
the House of Representatives, and the Select Committee on Aging of the 
House of Representatives that--
            (1) summarizes the allocation of funds authorized for 
        grants under this section and the expenditure of such funds;
            (2) outlines the problems that eligible individuals 
        encounter in enrolling for medicare cost-sharing;
            (3) makes recommendations that the Secretary determines to 
        be appropriate to address the problems described in paragraph 
        (2); and
            (4) in the case of the first report issued 2 years after 
        the date of enactment of this section, evaluates the 
        effectiveness of counseling programs established under this 
        program, and makes recommendations regarding continued 
        authorization of funds for these purposes.
    (g) Authorization of Appropriations for Grants.--There are 
authorized to be appropriated, in equal parts from the Federal Hospital 
Insurance Trust Fund and from the Federal Supplementary Medical 
Insurance Trust Fund, $30,000,000 for each of the fiscal years 1994, 
1995, and 1996, and $10,000,000 for each of the fiscal years beginning 
after fiscal year 1996, to fund the grant programs described in this 
section.

       TITLE II--APPLICATION OF OTHER MEDICAID ELIGIBILITY RULES

SEC. 201. OTHER MEDICAID ELIGIBILITY RULES.

    (a) In General.--Subsection (a) of section 1905 of the Social 
Security Act (42 U.S.C. 1396d) is amended by striking ``or, in the case 
of medicare cost-sharing with respect to a qualified medicare 
beneficiary described in subsection (p)(1), if provided after the month 
in which the individual becomes such a beneficiary)'' and inserting 
``or, in the case of medicare cost-sharing with respect to a qualified 
medicare beneficiary (as defined in subsection (p)(1)), a qualified 
disabled and working individual (as defined in subsection (s)), or an 
individual described in section 1902(a)(10)(E)(iii), if provided in or 
after the third month before the month in which the individual makes 
application to become such a beneficiary or individual)''.
    (b) Conforming Amendment.--Paragraph (8) of section 1902(e) of the 
Social Security Act (42 U.S.C. 1396a(e)) is amended to read as follows:
    ``(8) For purposes of payment to a State under section 1903(a), if 
an individual is determined to be a qualified medicare beneficiary (as 
defined in section 1905(p)(1)), a qualified disabled and working 
individual (as defined in section 1905(s)), or an individual described 
in subsection (a)(10)(E)(iii), such determination shall be considered 
to be valid for an individual for a period of 12 months from the date 
of application, except that a State may provide for such determinations 
more frequently, but not more frequently than once every 6 months for 
an individual.''.
    (c) Effective Date.--The amendments made by this section shall 
apply with respect to applications filed after December 31, 1993.

                           TITLE III--REPORT

SEC. 301. REPORT BY SECRETARY.

    The Secretary of Health and Human Services shall report to the 
Congress not later than 12 months after the date of enactment of this 
Act on the activities of the Department of Health and Human Services to 
ensure enrollment and full implementation of the benefits described in 
section 1902(a)(10)(E) of the Social Security Act (42 U.S.C. 
1396a(a)(10)(E)) and the effectiveness of each such activity. Such 
report shall also include any recommendations regarding any proposed 
legislation necessary to further improve such enrollment and 
implementation.

                                 <all>

S 649 IS----2