[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5276 Introduced in House (IH)]







107th CONGRESS
  2d Session
                                H. R. 5276

To amend title XIX of the Social Security Act to improve the qualified 
Medicare beneficiary (QMB) and special low-income Medicare beneficiary 
              (SLMB) programs within the Medicaid Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 26, 2002

Mr. Dingell (for himself, Mr. Brown of Ohio, Mr. Waxman, and Mr. Stark) 
 introduced the following bill; which was referred to the Committee on 
                          Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
To amend title XIX of the Social Security Act to improve the qualified 
Medicare beneficiary (QMB) and special low-income Medicare beneficiary 
              (SLMB) programs within the Medicaid Program.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare 
Beneficiary Assistance Improvement Act of 2002''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Renaming program to eliminate confusion.
Sec. 3. Expanding protections by increasing SLMB eligibility income 
                            level to 135 percent of poverty.
Sec. 4. Eliminating barriers to enrollment.
Sec. 5. Elimination of asset test.
Sec. 6. Improving assistance with out-of-pocket costs.
Sec. 7. Improving program information and coordination with State, 
                            local, and other partners.
Sec. 8. Notices to certain new medicare beneficiaries.

SEC. 2. RENAMING PROGRAM TO ELIMINATE CONFUSION.

    The programs of benefits for lower income medicare beneficiaries 
provided under section 1902(a)(10)(E) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(E)) shall be known as the ``Medicare Savings 
Programs''.

SEC. 3. EXPANDING PROTECTIONS BY INCREASING SLMB ELIGIBILITY INCOME 
              LEVEL TO 135 PERCENT OF POVERTY.

    (a) In General.--Section 1902(a)(10)(E)(iii) of the Social Security 
Act (42 U.S.C. 1396a(a)(10)(E)(iii)) is amended by striking ``120 
percent in 1995 and years thereafter'' and inserting ``120 percent in 
1995 through 2002 and 135 percent in 2003 and years thereafter''.
    (b) Conforming Removal of QI-1 and QI-2 Provisions.--
            (1) Section 1902(a)(10)(E) of such Act is further amended--
                    (A) by adding ``and'' at the end of clause (ii);
                    (B) by striking ``and'' at the end of clause (iii); 
                and
                    (C) by striking clause (iv).
            (2) Section 1933 of such Act (42 U.S.C. 1396v) is repealed.
            (3) The amendments made by this subsection shall take 
        effect as of January 1, 2003.
    (c) Application of CHIP Enhanced Matching Rate for SLMB 
Assistance.--
            (1) In general.--Section 1905(b)(4) of such Act (42 U.S.C. 
        1396d(b)(4)) is amended by inserting ``or section 
        1902(a)(10)(E)(iii)'' after ``section 
        1902(a)(10)(A)(ii)(XVIII)''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall apply to medical assistance for medicare cost-sharing for 
        months beginning with January 2003.

SEC. 4. ELIMINATING BARRIERS TO ENROLLMENT.

    (a) Automatic Eligibility for SSI Recipients in 209(b) States and 
SSI Criteria States.--Section 1905(p) of the Social Security Act (42 
U.S.C. 1396d(p)) is amended by adding at the end the following new 
paragraph:
    ``(6) In the case of a State which has elected treatment under 
section 1902(f) for aged, blind, and disabled individuals, individuals 
with respect to whom supplemental security income payments are being 
paid under such title are deemed for purposes of this title to be 
qualified medicare beneficiaries.''.
    (b) Self-Certification of Income.--Such section 1905(p) is further 
amended by adding at the end the following new paragraph:
    ``(7) In determining whether an individual qualifies as a qualified 
medicare beneficiary or is eligible for benefits under section 
1902(a)(10)(E)(iii), the State shall permit individuals to qualify on 
the basis of self-certifications of income without the need to provide 
additional documentation.''.
    (c) Automatic Reenrollment Without Need To Reapply.--
            (1) In general.--Such section 1905(p) is further amended by 
        adding at the end the following new paragraph:
    ``(8) In the case of an individual who has been determined to 
qualify as a qualified medicare beneficiary or to be eligible for 
benefits under section 1902(a)(10)(E)(iii), the individual shall be 
deemed to continue to be so qualified or eligible without the need for 
any annual or periodic application unless and until the individual 
notifies the State that the individual's eligibility conditions have 
changed so that the individual is no longer so qualified or 
eligible.''.
            (2) Conforming amendment.--Section 1902(e)(8) of the Social 
        Security Act (42 U.S.C. 1396a(e)(8)) is amended by striking the 
        second sentence.
    (d) Use of Simplified Application Process.--Such section 1905(p) is 
further amended by adding at the end the following new paragraph:
    ``(9) A State shall permit individuals to apply to qualify as a 
qualified medicare beneficiary or for benefits under section 
1902(a)(10)(E)(iii) through the use of the simplified application form 
developed under section 1905(p)(5)(A) and shall permit such an 
application to be made over the telephone or by mail, without the need 
for an interview in person by the applicant or a representative of the 
applicant.''.
    (e) Role of Social Security Offices.--
            (1) Enrollment and provision of information at social 
        security offices.--Such section is further amended by adding at 
        the end the following new paragraph:
    ``(10) The Commissioner of Social Security shall provide, through 
local offices of the Social Security Administration--
            ``(A) for the enrollment under State plans under this title 
        for appropriate medicare cost-sharing benefits for individuals 
        who qualify as a qualified medicare beneficiary or for benefits 
        under section 1902(a)(10)(E)(iii); and
            ``(B) for providing oral and written notice of the 
        availability of such benefits.''.
            (2) Clarifying amendment.--Section 1902(a)(5) of such Act 
        (42 U.S.C. 1396a(a)(5)) is amended by inserting ``as provided 
        in section 1905(p)(10)'' before ``except''.
    (f) Outstationing of State Eligibility Workers at SSA Field 
Offices.--Section 1902(a)(55) of such Act (42 U.S.C. 1396a(a)(55)) is 
amended--
            (1) by striking ``subsection (a)(10)(A)(i)(IV), 
        (a)(10)(A)(i)(VI), (a)(10)(A)(i)(VII), or (a)(10)(A)(ii)(IX)'' 
        and inserting ``paragraph (10)(A)(i)(IV), (10)(A)(i)(VI), 
        (10)(A)(i)(VII), (10)(A)(ii)(IX), or (10)(E)''; and
            (2) in subparagraph (A), by inserting ``and in the case of 
        applications of individuals for medical assistance under 
        paragraph (10)(E), at locations that include field offices of 
        the Social Security Administration''.

SEC. 5. ELIMINATION OF ASSET TEST.

    (a) In General.--Section 1905(p)(1) of the Social Security Act (42 
U.S.C. 1396d(p)(1)) is amended--
            (1) by adding ``and'' at the end of subparagraph (A);
            (2) by striking ``, and'' at the end of subparagraph (B) 
        and inserting a period; and
            (3) by striking subparagraph (C).
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to eligibility determinations for medicare cost-sharing furnished 
for periods beginning on or after January 1, 2003.

SEC. 6. IMPROVING ASSISTANCE WITH OUT-OF-POCKET COSTS.

    (a) Eliminating Application of Estate Recovery Provisions.--Section 
1917(b)(1)(B)(ii) of the Social Security Act (42 U.S.C. 
1396p(b)(1)(B)(ii)) is amended by inserting ``(but not including 
medical assistance for medicare cost-sharing or for benefits described 
in section 1902(a)(10)(E))'' before the period at the end.
    (b) Providing for 3-Months Retroactive Eligibility.--
            (1) In general.--Section 1905(a) of such Act (42 U.S.C. 
        1396d(a)) is amended, in the matter before paragraph (1), by 
        striking ``described in subsection (p)(1), if provided after 
        the month'' and inserting ``described in subsection (p)(1), if 
        provided in or after the third month before the month''.
            (2) Conforming amendments.--(A) The first sentence of 
        section 1902(e)(8) of such Act (42 U.S.C. 1396a(e)(8)), as 
        amended by section 4(c)(2), is amended by striking ``(8)'' and 
        the first sentence.
            (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:
                    ``(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 previously for services furnished during 
                the period of retroactive eligibility which were not 
                submitted in accordance with such subparagraph are 
                resubmitted and re-processed in accordance with such 
                subparagraph.''.

SEC. 7. IMPROVING PROGRAM INFORMATION AND COORDINATION WITH STATE, 
              LOCAL, AND OTHER PARTNERS.

    (a) Data Match Demonstration Project.--
            (1) In general.--The Secretary of Health and Human Services 
        (acting through the Administrator of the Centers for Medicare & 
        Medicaid Services), the Secretary of the Treasury, and the 
        Administrator of Social Security shall enter into an 
        arrangement under which a demonstration is conducted, 
        consistent with this subsection, for the exchange between the 
        Centers for Medicare & Medicaid Services, the Internal Revenue 
        Service, and the Social Security Administration of information 
        in order to identity individuals who are medicare beneficiaries 
        and who, based on data from the Internal Revenue Service that 
        (such as their not filing tax returns or other appropriate 
        filters) are likely to be qualified medicare beneficiaries or 
        individuals otherwise eligible for medical assistance under 
        section 1902(a)(10)(E) of the Social Security Act (42 U.S.C. 
        1396a(a)(10)(E)).
            (2) Limitation on use of information.--Specific information 
        on income or related matters exchanged under paragraph (1) may 
        be disclosed only as required to carry out subsection (b) and 
        for related Federal and State outreach efforts.
            (3) Period.--The project under this subsection shall be for 
        an initial period of 3 years and may be extended for additional 
        periods (not to exceed 3 years each) after such an extension is 
        recommended in a report under subsection (d).
    (b) State Demonstration Grants.--
            (1) In general.--The Secretary of Health and Human Services 
        shall enter into a demonstration project with States (as 
        defined for purposes of title XIX of the Social Security Act) 
        in order to provide funds to States in order to use information 
        identified under subsection (a), and other appropriate 
        information, in order to do ex parte determinations or other 
        methods for identifying and enrolling potentially eligible 
        individuals.
            (2) Authorization of appropriations.--There are authorized 
        to be appropriated such sums as may be necessary to the 
        Secretary for the purpose of making grants under this 
        subsection.
    (c) Additional CMS Funding for Outreach and Enrollment Projects.--
There are hereby appropriated, out of any funds in the Treasury not 
otherwise appropriated, to the Centers for Medicare & Medicaid 
Services. $100,000,000 which shall be used only for the purpose of 
providing grants to States to fund projects to improve outreach and 
increase enrollment in Medicare Savings Programs. Such projects may 
include cooperative grants and contracts with community groups and 
other groups (such as the Department of Veterans' Affairs and the 
Indian Health Service) to assist in the enrollment of eligible 
individuals.
    (d) Reports.--The Secretary of Health and Human Services shall 
submit to Congress periodic reports on the projects conducted under 
this section. Such reports shall include such recommendations for 
extension of such projects, and changes in laws based on based 
projects, as the Secretary deems appropriate.

SEC. 8. NOTICES TO CERTAIN NEW MEDICARE BENEFICIARIES.

    (a) SSA Notice.--At the time that the Commissioner of Social 
Security sends a notice to individuals that they have been determined 
to be eligible for benefits under part A or B of title XVIII of the 
Social Security Act, the Commissioner shall send a notice and 
application for benefits under title XIX of the Social Security Act to 
those individuals the Commissioner identifies as being likely to be 
eligible for benefits under clause (i), (ii), or (iii) of section 
1902(a)(10)(E) of such Act (42 U.S.C. 1396a(a)(10)(E)). Such notice and 
application shall be accompanied by information on how to submit such 
an application and on where to obtain more information (including 
answers to questions) on the application process.
    (b) Including Information in Medicare & You Handbook.--The 
Secretary of Health and Human Services shall include in the annual 
handbook distributed under section 1804(a) of the Social Security Act 
(42 U.S.C. 1395b-2(a)) information on the availability of Medicare 
Savings Programs and a toll-free telephone number that medicare 
beneficiaries may use to obtain additional information.
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