[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2199 Introduced in House (IH)]







108th CONGRESS
  1st Session
                                H. R. 2199

   To amend title XVIII of the Social Security Act to provide for a 
 voluntary program for limiting maximum out-of-pocket expenditures for 
               beneficiaries under the Medicare Program.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 21, 2003

  Mr. Stark introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
   To amend title XVIII of the Social Security Act to provide for a 
 voluntary program for limiting maximum out-of-pocket expenditures for 
               beneficiaries under the Medicare 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 Out-of-
Pocket Spending Limit Act of 2003''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Establishment of medicare voluntary catastrophic coverage 
                            program.
            ``Part D--Voluntary Catastrophic Benefit Program

``Sec. 1860. Establishment of program.
``Sec. 1860A. Scope of benefits.
``Sec. 1860B. Eligibility and enrollment.
``Sec. 1860C. Monthly premium; collection of premiums.
``Sec. 1860E. Federal Catastrophic Insurance Account.
``Sec. 1860F. Appropriations to cover Government contributions.
Sec. 3. Medicaid buy-in of medicare catastrophic coverage for certain 
                            low-income individuals.
``Sec. 1860D. Special eligibility, enrollment, and copayment rules for 
                            low-income individuals.

SEC. 2. ESTABLISHMENT OF MEDICARE VOLUNTARY CATASTROPHIC COVERAGE 
              PROGRAM.

    (a) In General.--Title XVIII of the Social Security Act is 
amended--
            (1) by redesignating part D as part E; and
            (2) by inserting after part C the following new part:

            ``Part D--Voluntary Catastrophic Benefit Program

                       ``establishment of program

    ``Sec. 1860. There is established as a part of the medicare program 
under this title a voluntary program to cover catastrophic out-of-
pocket costs incurred under parts A and B.

                          ``scope of benefits

    ``Sec. 1860A. (a) In General.--The benefits provided to an 
individual enrolled in the insurance program under this part shall 
consist of elimination of further cost-sharing (described in subsection 
(b)) for expenses incurred during a year after the individual has 
incurred cost-sharing totaling the catastrophic limit specified in 
subsection (c).
    ``(b) Cost-Sharing Covered.--
            ``(1) In general.--For purposes of this part, the term 
        `cost-sharing' means costs incurred by an individual that are 
        attributable to the following:
                    ``(A) Inpatient hospital deductible and hospital 
                coinsurance.--Costs incurred for the deductible and 
                coinsurance described in section 1813(a)(1).
                    ``(2) Blood deductible.--The deduction described in 
                section 1813(a)(2).
                    ``(C) SNF coinsurance.--Coinsurance described in 
                section 1813(a)(3).
                    ``(D) Hospice coinsurance.--Hospice coinsurance 
                under section 1813(a)(4).
                    ``(E) Part b deductible and coinsurance.--Amounts 
                charged as the deductible or coinsurance or copayments 
                under part B, but not including any amounts owed in 
                excess of the full payment rate recognized under this 
                title with respect to the items or services involved.
            ``(2) Treatment of incurred costs.--For purposes of this 
        part, costs shall be treated as incurred only if they were 
        incurred during an individual's coverage period under this part 
        and only if they were billed and owed, regardless of whether 
        payment was or was not made by the individual or by another 
        party (including by a group health plan, by a medicare 
        supplemental health insurance policy, under title XIX, or 
        otherwise).
    ``(c) Catastrophic Limit.--
            ``(1) In general.--The catastrophic limit under this 
        subsection is equal to--
                    ``(A) for 2006, $2000; or
                    ``(B) for a subsequent year, is equal to $2,000 
                increased the percentage by which the average 
                expenditures per full-year enrollee under this part for 
                that subsequent year will exceed such average for 2006.
            ``(2) Rounding.--Any amount computed under paragraph (1)(B) 
        shall be rounded to the nearest $50.
            ``(3) Promulgation.--Not later than September 1 of each 
        year (beginning with 2006) the Secretary shall determine the 
        catastrophic limit under this subsection for the following 
        year.
    ``(d) Administration of Benefits.--The Secretary shall establish a 
method for the administration of this part through fiscal 
intermediaries and carriers under parts A and B in coordination with 
the payment of benefits under those parts. In carrying out this part--
            ``(1) to the maximum extent feasible, the Secretary shall 
        provide for timely determination of eligibility and benefits so 
        as to permit the adjustment of the amount of payments made to 
        providers under such parts to take into account the 
        catastrophic benefits provided under this part and to avoid the 
        need for payment of covered cost-sharing by beneficiaries;
            ``(2) the Secretary shall develop a method for the 
        reimbursement of individuals (or other parties) in cases in 
        which they make payment for costs for which benefits are 
        available under this part; and
            ``(3) the Secretary may enter into contracts with other 
        parties to administer and facilitate administration of this 
        part.
    ``(e) Source of Payment.--Payment of benefits under this part shall 
be made from the Federal Catastrophic Insurance Account within the 
Federal Supplementary Medical Insurance Trust Fund and shall be 
transferred (in a manner specified by the Secretary) to the Federal 
Hospital Insurance Trust Fund.

                      ``eligibility and enrollment

    ``Sec. 1860B. (a) Eligibility.--Every individual who, in or after 
2006, is entitled to hospital insurance benefits under part A and is 
enrolled in the medical insurance program under part B is eligible to 
enroll in the insurance program under this part, during an enrollment 
period prescribed in or under this section, in such manner and form as 
may be prescribed by regulations.
    ``(b) Enrollment.--
            ``(1) In general.--Each individual who satisfies subsection 
        (a) shall be enrolled (or eligible to enroll) in the program 
        under this part in accordance with the provisions of section 
        1837 (other than subsection (f)), as if that section applied to 
        this part, except as otherwise explicitly provided in this 
        part.
            ``(2) Penalty for late enrollment.--Except as provided in 
        subsection (d), section 1860D(b) (relating to loss of coverage 
        under the medicaid program) or as otherwise explicitly 
        provided, no individual shall be entitled to enroll in the 
        program under this part at any time after the initial 
        enrollment period without penalty, and in the case of all other 
        late enrollments, the Secretary shall develop and apply a late 
        enrollment penalty for the individual that is similar to the 
        late enrollment penalty described in section 1839(b).
            ``(3) Special enrollment period in 2005.--
                    ``(A) In general.--In the case of an individual who 
                first satisfies subsection (a) on or before October 1, 
                2005, there shall be an initial general enrollment 
                period beginning on such date and ending on March 31, 
                2006, during which the individual may enroll under this 
                part.
                    ``(B) Effective date of coverage.--An individual 
                who enrolls under the program under this part pursuant 
                to subparagraph (A) shall be entitled to benefits under 
                this part beginning on the first day of the month 
                following the month in which such enrollment occurs, 
                but in no case earlier than January 1, 2006.
    ``(c) Period of Coverage.--
            ``(1) In general.--Except as otherwise provided in this 
        part, an individual's coverage under the program under this 
        part shall be effective for the period provided in section 
        1838, as if that section applied to the program under this 
        part.
            ``(2) Part d coverage terminated by termination of coverage 
        under part a or part b.--In addition to the causes of 
        termination specified in section 1838, an individual's coverage 
        under this part shall be terminated when the individual 
        terminates coverage under either part A or part B, effective on 
        the effective date of the earlier termination of coverage under 
        either such part.
    ``(d) Enrollment for Individuals Whose Group Health Plan Coverage 
Ends.--The provisions of section 1837(i) shall apply with respect to 
enrollment under this part in the same manner as such section applies 
with respect to enrollment under part B.

               ``monthly premium; collection of premiums

    ``Sec. 1860C. (a) Monthly Premium Based on Part B Methodology.--
            ``(1) Determination of monthly actuarial rate and monthly 
        premium.--The Secretary shall compute, with respect to this 
        part and the Federal Catastrophic Insurance Account, a monthly 
        actuarial rate and a monthly premium in the same manner as such 
        a rate and premium is computed under section 1839(a) with 
        respect to part B and the Federal Supplementary Medical 
        Insurance Trust Fund.
            ``(2) Application of part b late enrollment penalty and 
        related provisions.--The provisions of subsections (b), (d), 
        and (e) of section 1839 shall apply with respect to enrollment 
        under this part and the premium established under paragraph (1) 
        in the same manner as such provisions apply to enrollment under 
        part B and the premium established under section 1839(a).
            ``(3) Treatment as part of consolidated premium.--The 
        provisions of section 1839(f) shall be applied (after the first 
        year in which this part is in effect) as if the premium 
        established under this section were included as part of the 
        premium under section 1839.
    ``(b) Payment of Premiums.--
            ``(1) Generally through deduction from social security, 
        railroad retirement benefits, or benefits administered by 
        opm.--
                    ``(A) In general.--In the case of an individual who 
                is entitled to or receiving benefits as described in 
                subsection (a), (b), or (d) of section 1840, premiums 
                payable under this part shall be collected by deduction 
                from such benefits at the same time and in the same 
                manner as premiums payable under part B are collected 
pursuant to section 1840.
                    ``(B) Transfers of deduction to account.--The 
                Secretary of the Treasury shall, from time to time, but 
                not less often than quarterly, transfer premiums 
                collected pursuant to subparagraph (A) to the Federal 
                Catastrophic Insurance Account from the appropriate 
                funds and accounts described in subsections (a)(2), 
                (b)(2), and (d)(2) of section 1840, on the basis of the 
                certifications described in such subsections. The 
                amounts of such transfers shall be appropriately 
                adjusted to the extent that prior transfers were too 
                great or too small.
            ``(2) Otherwise through direct payments by enrollee to 
        secretary.--
                    ``(A) In the case of inadequate deduction.--An 
                individual to whom paragraph (1) applies (other than an 
                individual receiving benefits as described in section 
                1840(d)) and who estimates that the amount that will be 
                available for deduction under such paragraph for any 
                premium payment period will be less than the amount of 
                the monthly premiums for such period may (under 
                regulations) pay to the Secretary the estimated 
                balance, or such greater portion of the monthly premium 
                as the individual chooses.
                    ``(B) Other cases.--An individual enrolled in the 
                insurance program under this part with respect to whom 
                none of the preceding provisions of this subsection 
                applies (or to whom section 1840(c) applies) shall pay 
                premiums to the Secretary at such times and in such 
                manner as the Secretary shall by regulations prescribe.
                    ``(C) Deposit of premiums in account.--Amounts paid 
                to the Secretary under this paragraph shall be 
                deposited in the Treasury to the credit of the Federal 
                Catastrophic Insurance Account in the Federal 
                Supplementary Medical Insurance Trust Fund.

 ``special eligibility, enrollment, and copayment rules for low-income 
                              individuals

    ``Sec. 1860D. (a) State Options for Coverage: Continuation of 
Medicaid Coverage or Enrollment Under This Part.--
            ``(1) In general.--The Secretary shall, at the request of a 
        State, enter into an agreement with the State under which all 
        individuals described in paragraph (2) are enrolled in the 
        program under this part, without regard to whether any such 
        individual has previously declined the opportunity to enroll in 
        such program.
            ``(2) Eligibility groups.--The individuals described in 
        this paragraph, for purposes of paragraph (1), are individuals 
        who satisfy section 1860B(a) and who are--
                    ``(A) in a coverage group or groups permitted under 
                section 1843 (as selected by the State and specified in 
                the agreement); or
                    ``(B) qualified medicare catastrophic beneficiaries 
                (as defined in section 1905(x)(1)).
            ``(3) Coverage period.--The period of coverage under this 
        part of an individual enrolled under an agreement under this 
        subsection shall be as follows:
                    ``(A) Individuals eligible (at state option) for 
                part b buy-in.--In the case of an individual described 
                in subsection (a)(2)(A), the coverage period shall be 
                the same period that applies (or would apply) pursuant 
                to section 1843(d).
                    ``(B) Qualified medicare catastrophic 
                beneficiaries.--In the case of an individual described 
                in subsection (a)(2)(B)--
                            ``(i) the coverage period shall begin on 
                        the latest of--
                                    ``(I) January 1, 2006;
                                    ``(II) the first day of the third 
                                month following the month in which the 
                                State agreement is entered into; or
                                    ``(III) the first day of the first 
                                month following the month in which the 
                                individual satisfies section 1860B(a); 
                                and
                            ``(ii) the coverage period shall end on the 
                        last day of the month in which the individual 
                        is determined by the State to have become 
                        ineligible for medicare catastrophic coverage 
                        benefits.
            ``(4) Enrollment for low-income subsidy through other 
        means.--
                    ``(A) Flexibility in enrollment process.--With 
                respect to low-income individuals residing in a State 
                enrolling under this part on or after January 1, 2006, 
                the Secretary shall provide for determinations of 
                whether the individual is eligible for a subsidy and 
                the amount of such individual's income to be made under 
                arrangements with appropriate entities other than State 
                medicaid agencies.
                    ``(B) Use of certain information.--Arrangements 
                with entities under subparagraph (A) shall provide for 
                --
                            ``(i) the use of existing Federal 
                        government databases to identify eligibility; 
                        and
                            ``(ii) the use of information obtained 
                        under section 154 of the Social Security Act 
                        Amendments of 1994 for newly eligible medicare 
                        beneficiaries, and the application of such 
                        information with respect to other medicare 
                        beneficiaries.
    ``(b) Special Part D Enrollment Opportunity for Individuals Losing 
Medicaid Eligibility.--
            ``(1) In general.--In the case of an individual who--
                    ``(A) satisfies section 1860B(a); and
                    ``(B) loses eligibility for benefits under the 
                State plan under title XIX after having been enrolled 
                under such plan or having been determined eligible for 
                such benefits;
        the Secretary shall provide an opportunity for enrollment under 
        the program under this part during the period that begins on 
the date that such individual loses such eligibility and ends on the 
date specified by the Secretary.
            ``(2) Reference to waiver of late enrollment penalty.--For 
        provision waiving imposition of late enrollment penalty in the 
        case of an enrollment of an individual under this part by 
        reason of paragraph (1), see section 1860B(b)(2).
    ``(c) Definition.--For purposes of this section, the term `State' 
has the meaning given such term under section 1101(a) for purposes of 
title XIX.

                ``federal catastrophic insurance account

    ``Sec. 1860E. (a) Establishment.--There is created within the 
Federal Supplementary Medical Insurance Trust Fund established by 
section 1841 an account to be known as the `Federal Catastrophic 
Insurance Account' (in this section referred to as the `Account').
    ``(b) Amounts in Account.--
            ``(1) In general.--The Account shall consist of--
                    ``(A) such amounts as may be deposited in, or 
                appropriated to, such fund as provided in this part; 
                and
                    ``(B) such gifts and bequests as may be made as 
                provided in section 201(i)(1).
            ``(2) Separation of funds.--Funds provided under this part 
        to the Account shall be kept separate from all other funds 
        within the Federal Supplementary Medical Insurance Trust Fund.
    ``(c) Payments From Account.--
            ``(1) In general.--The Managing Trustee shall pay from time 
        to time from the Account such amounts as the Secretary 
        certifies are necessary to make the payments provided for by 
        this part, and the payments with respect to administrative 
        expenses in accordance with section 201(g).
            ``(2) Treatment in relation to part b premium.--Amounts 
        payable from the Account shall not be taken into account in 
        computing actuarial rates or premium amounts under section 
        1839.

           ``appropriations to cover government contributions

    ``Sec. 1860F. There are authorized to be appropriated from time to 
time, out of any moneys in the Treasury not otherwise appropriated, to 
the Federal Catastrophic Insurance Account, a Government contribution 
computed in the same manner as the Government contributions are 
computed under section 1844(a)(1), except that any reference to part B 
or a provision in section 1839(a) is deemed to be a reference to this 
part and the corresponding provision in section 1860C.''.
    (b) Catastrophic Coverage Option Under Medicare+Choice Plans.--
            (1) Eligibility, election, and enrollment.--Section 1851 of 
        the Social Security Act (42 U.S.C. 1395w-21) is amended--
                    (A) in subsection (a)(1)(A), by striking ``parts A 
                and B'' inserting ``parts A, B, and D''; and
                    (B) in subsection (i)(1), by striking ``parts A and 
                B'' and inserting ``parts A, B, and D''.
            (2) Voluntary beneficiary enrollment for catastrophic 
        coverage.--Section 1852(a)(1)(A) of such Act (42 U.S.C. 1395w-
        22(a)(1)(A)) is amended by inserting ``(and under part D to 
        individuals also enrolled under that part)'' after ``parts A 
        and B''.
            (3) Payments to organizations.--Section 1853(a)(1)(A) of 
        such Act (42 U.S.C. 1395w-23(a)(1)(A)) is amended--
                    (A) by inserting ``determined separately for 
                benefits under parts A and B and under part D (for 
                individuals enrolled under that part)'' after ``as 
                calculated under subsection (c)'';
                    (B) by striking ``that area, adjusted for such risk 
                factors'' and inserting ``that area. In the case of 
                payment for benefits under parts A and B, such payment 
                shall be adjusted for such risk factors as''; and
                    (C) by inserting before the last sentence the 
                following: ``In the case of the payments for benefits 
                under part D, such payment shall be adjusted for the 
                risk factors of each enrollee as the Secretary 
                determines to be feasible and appropriate.''.
            (4) Calculation of annual medicare+choice capitation 
        rates.--Section 1853(c) of such Act (42 U.S.C. 1395w-23(c)) is 
        amended--
                    (A) in paragraph (1), in the matter preceding 
                subparagraph (A), by inserting ``for benefits under 
                parts A and B'' after ``capitation rate'';
                    (B) in paragraph (6)(A), by striking ``rate of 
                growth in expenditures under this title'' and inserting 
                ``rate of growth in expenditures for benefits available 
                under parts A and B''; and
                    (C) by adding at the end the following new 
                paragraph:
            ``(8) Payment for catastrophic coverage.--The Secretary 
        shall determine a capitation rate for catastrophic coverage 
        described in part D--
                    ``(A) for 2006, which is based on the projected 
                national per capita costs for coverage under part D and 
                associated claims processing costs for beneficiaries 
                under the original medicare fee-for-service program; 
                and
                    ``(B) for each subsequent year, which shall be 
                equal to the rate for the previous year updated by the 
                Secretary's estimate of the projected per capita rate 
                of growth in expenditures under this title for such 
                coverage for an individual enrolled under part D.
        The Secretary shall provide for an appropriate geographic 
        adjustment in such capitation rate to reflect differences 
        (other than those reflected in the health status adjustments) 
        in the average per capita expenditures under part D in the 
        different geographic areas.''.
            (5) Requirement for additional benefits.--Section 
        1854(f)(1) of such Act (42 U.S.C. 1395w-24(f)(1)) is amended by 
        adding at the end the following new sentence: ``Such 
        determination shall be made separately for benefits under parts 
        A and B and for catastrophic coverage benefits under part D.''.
    (c) Conforming Revision of Medigap Standards.--The provisions of 
section 1882(p)(1)(E) of the Social Security Act (42 U.S.C. 
1395ss(p)(1)(E)) shall apply to the benefit changes effected by this 
section and the standards for benefit packages previously established 
under section 1882(p) of such Act shall be revised to avoid duplication 
with the benefits provided under part D of title XVIII of such Act (as 
inserted by subsection (a)).
    (d) Conforming Amendments to Federal Supplementary Health Insurance 
Trust Fund.--Section 1841 of the Social Security Act (42 U.S.C. 1395t) 
is amended--
            (1) in the last sentence of subsection (a)--
                    (A) by striking ``and'' after ``section 
                201(i)(1)''; and
                    (B) by inserting before the period the following: 
                ``, and such amounts as may be deposited in, or 
                appropriated to, the Federal Catastrophic Insurance 
                Account established by section 1860E'';
            (2) in subsection (g), by inserting after ``by this part,'' 
        the following: ``the payments provided for under part D (in 
        which case the payments shall come from the Federal 
        Catastrophic Insurance Account in the Federal Supplementary 
        Medical Insurance Trust Fund),'';
            (3) in the first sentence of subsection (h), by inserting 
        before the period the following: ``and section 1860C(b)(1)(A) 
        (in which case the payments shall come from the Federal 
        Catastrophic Insurance Account in the Federal Supplementary 
        Medical Insurance Trust Fund)''; and
            (4) in the first sentence of subsection (i)--
                    (A) by striking ``and'' after ``section 
                1840(b)(1)''; and
                    (B) by inserting before the period the following: 
                ``, section 1860D(b)(1)(A) (in which case the payments 
                shall come from the Federal Catastrophic Insurance 
                Account in the Federal Supplementary Medical Insurance 
                Trust Fund)''.
    (e) Applying Exclusions From Coverage.--Section 1862(a) of such Act 
(42 U.S.C. 1395y(a)) is amended in the matter preceding paragraph (1) 
by striking ``part A or part B'' and inserting ``part A, B, or D''.

SEC. 3. MEDICAID BUY-IN OF MEDICARE CATASTROPHIC COVERAGE FOR CERTAIN 
              LOW-INCOME INDIVIDUALS.

    (a) State Option To Buy-In Low-Income Individuals.--
            (1) In general.--Section 1902(a)(10)(E) of the Social 
        Security Act (42 U.S.C. 1396a(a)(10)(E)) is amended--
                    (A) by striking ``and'' at the end of clause (iii);
                    (B) by adding ``and'' at the end of clause (iv); 
                and
                    (C) by adding at the end the following new clause:
                            ``(v) at the option of a State, for making 
                        medical assistance available for medicare 
                        catastrophic cost-sharing for qualified 
                        medicare catastrophic beneficiaries (as defined 
                        in subsection (x)(1)), regardless of whether or 
                        not such beneficiaries are otherwise eligible 
                        for medical assistance under this title;''.
            (2) Construction.--Nothing in this section shall be 
        construed as reducing the amount of medical assistance 
        otherwise available to medicare beneficiaries under the 
        medicaid program.
    (b) Additional Funds for Territories.--Section 1108 of the Social 
Security Act (42 U.S.C. 1308) is amended--
            (1) in subsection (f), by striking ``subsection (g),'' and 
        inserting ``subsections (g) and (h)''; and
            (2) by adding at the end the following new subsection:
    ``(h) Additional Medicaid Payments to Territories for Medicare 
Catastrophic Coverage.--.
            ``(1) In general.--In the case of a territory that develops 
        and implements a plan described in paragraph (2) (for providing 
        medical assistance with respect to the provision of 
        catastrophic coverage to medicare beneficiaries), the amount 
        otherwise determined under subsection (f) (as increased under 
        subsection (g)) for the State shall be increased by the amount 
        specified in paragraph (3).
            ``(2) Plan.--The plan described in this paragraph is a plan 
        that--
                    ``(A) provides medical assistance with respect to 
                the provision of some or all medicare catastrophic 
                coverage described in part D of title XVIII to low-
                income medicare beneficiaries; and
                    ``(B) assures that additional amounts received by 
                the State that are attributable to the operation of 
                this subsection are used only for such assistance.
            ``(3) Increased amount.--
                    ``(A) In general.--The amount specified in this 
                paragraph for a State for a year is equal to the 
                product of--
                            ``(i) the aggregate amount specified in 
                        subparagraph (B); and
                            ``(ii) the amount specified in subsection 
                        (g)(1) for that State, divided by the sum of 
                        the amounts specified in such section for all 
                        such States.
                    ``(B) Aggregate amount.--The aggregate amount 
                specified in this subparagraph for--
                            ``(i) 2006, is equal to $15,000,000; or
                            ``(ii) a subsequent year, is equal to 
                        $15,000,000 multiplied by the percentage 
                        described in section 1860A(c)(1)(B) for that 
                        subsequent year.''.
    (c) Definitions of Eligible Beneficiaries and Coverage.--Section 
1905 of the Social Security Act (42 U.S.C. 1396d) is amended by adding 
at the end the following new subsection:
    ``(x)(1) The term `qualified medicare catastrophic beneficiary' 
means an individual--
            ``(A) who is enrolled or enrolling under part D of title 
        XVIII; and
            ``(B) whose income (as determined under section 1612 for 
        purposes of the supplemental security income program, except as 
        provided in subsection (p)(2)(D)) is below 175 percent of the 
        official poverty line (as referred to in subsection (p)(2)) 
        applicable to a family of the size involved.
    ``(2) The term `medicare catastrophic cost-sharing' means the 
following:
            ``(A) In the case of a qualified medicare catastrophic 
        beneficiary whose income (as determined under paragraph (1)) is 
        less than 150 percent of the official poverty line, premiums 
        under section 1860D.
            ``(B) In the case of a qualified medicare catastrophic 
        beneficiary whose income (as determined under paragraph (1)) is 
        at least 150 percent but less than 175 percent of the official 
        poverty line, a percentage of premiums under section 1860D, 
        determined on a linear sliding scale ranging from 100 percent 
        for individuals with incomes at 150 percent of such line to 0 
        percent for individuals with incomes at 175 percent of such 
        line.
    ``(3) In the case of any State which is providing medical 
assistance to its residents under a waiver granted under section 1115, 
the Secretary shall require the State to meet the requirement of 
section 1902(a)(10)(E) in the same manner as the State would be 
required to meet such requirement if the State had in effect a plan 
approved under this title.''.
    (d) 100 Percent FMAP for Cost-Sharing.--The first sentence of 
section 1905(b) of such Act (42 U.S.C. 1396d(b)) is amended--
            (1) by striking ``and'' before ``(4)''; and
            (2) by inserting before the period at the end the 
        following: ``, and (5) with respect to the 50 States and the 
        District of Columbia the Federal medical assistance percentage 
        shall be 100 percent with respect to medicare catastrophic 
        cost-sharing (as defined in subsection (x)(2))''.
    (e) Conforming Amendment.--Section 1905(a) of the Social Security 
Act (42 U.S.C. 1396d) is amended in the second sentence of the flush 
matter at the end by striking ``premiums under part B'' the first place 
it appears and inserting ``premiums under parts B and D''.
                                 <all>