[Congressional Bills 108th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4437 Introduced in House (IH)]







108th CONGRESS
  2d Session
                                H. R. 4437

 To amend part D of title XVIII of the Social Security Act to provide 
for low-income beneficiaries in the Medicare savings programs automatic 
enrollment and eligibility for low-income subsidies under the Medicare 
         transitional and permanent prescription drug programs.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 20, 2004

Mr. Dingell (for himself, Mr. Rangel, Mr. Waxman, Mr. Stark, Mr. Brown 
of Ohio, Ms. Pelosi, Mr. Markey, Mr. Towns, Mr. Pallone, Mr. Rush, Mr. 
Stupak, Mr. Engel, Mr. Wynn, Ms. McCarthy of Missouri, Mr. Strickland, 
Mrs. Capps, Mr. John, Mr. Allen, Mr. Davis of Florida, Mr. Becerra, Mr. 
    McNulty, Mr. Doggett, Mr. Matsui, Mr. Sandlin, and Mr. Deutsch) 
 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 part D of title XVIII of the Social Security Act to provide 
for low-income beneficiaries in the Medicare savings programs automatic 
enrollment and eligibility for low-income subsidies under the Medicare 
         transitional and permanent prescription drug programs.

    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 Prescription Drug Low-
Income Assistance Act of 2004''.

SEC. 2. ASSURANCE OF ASSISTANCE FOR LOW-INCOME BENEFICIARIES IN 
              MEDICARE SAVINGS PROGRAMS UNDER MEDICARE PRESCRIPTION 
              DRUG DISCOUNT CARD AND TRANSITIONAL ASSISTANCE PROGRAM.

    (a) Automatic Enrollment.--
            (1) In general.--Section 1860D-31(c)(1) of the Social 
        Security Act (42 U.S.C. 1395w-141(c)(1)) is amended by adding 
        at the end the following new subparagraph:
                    ``(F) Automatic enrollment of certain low-income 
                beneficiaries in medicare savings programs.--
                            ``(i) Notice of eligibility.--Not later 
                        than 45 days after the date an individual 
                        described in clause (ii) is first eligible to 
                        enroll in an endorsed discount card program 
                        under this section, each State or the Secretary 
                        (at the option of each State) shall mail to 
                        each individual described in clause (ii), a 
                        notice stating the following:
                                    ``(I) Such individual is eligible 
                                to enroll in an endorsed discount card 
                                program and to receive transitional 
                                assistance under subsection (g).
                                    ``(II) If such individual does not 
                                enroll before 30 days after the date of 
                                the notice, such individual will be 
                                automatically enrolled in an endorsed 
                                discount card program selected by the 
                                Secretary unless the individual 
                                notifies the Secretary that such 
                                individual does not wish to be so 
                                enrolled.
                                    ``(III) If such individual is 
                                automatically enrolled in an endorsed 
                                discount card program selected by the 
                                Secretary, the individual may enroll in 
                                another endorsed discount card program 
                                selected by the individual during the 
                                60-day period beginning on the date of 
                                such automatic enrollment.
                                    ``(IV) If the individual is 
                                enrolled in an endorsed discount card 
                                program during 2004, the individual 
                                will be permitted to change enrollment 
                                under subsection (c)(1)(C)(ii) for 
                                2005.
                                    ``(V) There is no obligation to use 
                                the endorsed discount card program or 
                                transitional assistance when purchasing 
                                prescription drugs.
                            ``(ii) Individuals benefiting from 
                        automatic enrollment.--An individual described 
                        in this clause is a discount card eligible 
                        individual who--
                                    ``(I) is a recipient of 
                                supplemental security income benefits 
                                under title XVI, or is determined to be 
                                eligible for medical assistance under 
                                title XIX solely by reason of clause 
                                (i), (iii), or (iv) of section 
                                1902(a)(10)(E); and
                                    ``(II) has not enrolled in an 
                                endorsed discount card program as of 
                                the date that is 30 days after the date 
                                the individual is first eligible to 
                                enroll in such a program.
                            ``(iii) Automatic enrollment.--The 
                        Secretary shall enroll each individual 
                        described in clause (ii), who has not enrolled 
                        in an endorsed discount card program or 
                        provided notice to the Secretary under clause 
                        (iv) as of the end of the 30-day period 
                        beginning on the date of the notice to the 
                        individual under clause (i), in an endorsed 
                        discount card program selected by the Secretary 
                        that serves residents of the State in which the 
                        individual resides.
                            ``(iv) Opt-out.--Clause (iii) shall not 
                        apply to an individual if the individual 
                        notifies the Secretary before the end of the 
                        30-day period described in such clause that the 
                        individual does not wish to be automatically 
                        enrolled under such clause.
                            ``(v) 60-day grace period to change card 
                        program.--The Secretary shall permit each 
                        individual who is automatically enrolled under 
                        clause (iii) to elect, during the 60-day period 
                        that begins on the date the individual is so 
                        enrolled, to enroll in a different endorsed 
                        discount card program selected by such 
                        individual. Such a change shall be treated as 
                        an exceptional case for purposes of 
                        subparagraph (C)(iii).''.
    (b) Provision of Transitional Assistance.--
            (1) In general.--Section 1860D-31(b) of such Act (42 U.S.C. 
        1395w-141(b)) is amended by adding at the end the following new 
        paragraph:
            ``(5) Special rule for certain low-income beneficiaries in 
        medicare savings programs.--
                    ``(A) In general.--Except as provided in 
                subparagraph (C), individuals described in subsection 
                (c)(1)(F)(ii) shall be treated as transitional 
                assistance eligible individuals.
                    ``(B) Special transitional assistance eligible 
                individuals.--Except as provided in subparagraph (C), 
                such individuals who are recipients of supplemental 
                security income benefits under title XVI or determined 
                to be eligible for medical assistance under title XIX 
                solely by reason of clause (i), (iii), or (iv) of 
                section 1902(a)(10)(E) shall be treated as special 
                transitional assistance eligible individuals.
                    ``(C) Application of disqualification for 
                individuals with prescription drug coverage.--The 
                Secretary shall not apply subparagraphs (A) and (B) in 
                the case of an individual if the Secretary finds that 
                there is reason to believe that the individual is 
                described in paragraph (2)(B) (relating to individuals 
                with certain prescription drug coverage).''.
            (2) Waiver of self-certification and verification.--Section 
        1860D-31(f) of such Act (42 U.S.C. 1395w-141(f)) is amended by 
        adding at the end the following new paragraph:
            ``(5) Special rule for certain low-income beneficiaries in 
        medicare savings programs.--The provisions of paragraphs (2) 
        and (3) shall not apply to individuals who are treated as 
        transitional assistance eligible individuals under subsection 
        (b)(5).''.
    (c) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of section 101 of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 (Public 
Law 108-173; 117 Stat. 2071).

SEC. 3. ASSURANCE OF ASSISTANCE FOR LOW-INCOME BENEFICIARIES IN 
              MEDICARE SAVINGS PROGRAMS UNDER QUALIFIED PRESCRIPTION 
              DRUG COVERAGE.

    (a) Automatic Enrollment.--Section 1860D-1(b)(1)(C) of the Social 
Security Act (42 U.S.C. 1395w-101(b)(1)(C)) is amended--
            (1) by designating the matter beginning with ``The process 
        established'' as a clause (i) with the heading ``In general.--
        '' and an appropriate indentation;
            (2) by striking ``a full-benefit dual eligible individual 
        (as defined in section 1935(c)(6)) who has failed to enroll in 
        a prescription drug plan or an MA-PD plan'' and inserting 
        ``described in clause (ii)''; and
            (3) by adding at the end the following new clauses:
                            ``(ii) Individuals covered.--An individual 
                        described in this clause is an individual who--
                                    ``(I) is a full-benefit dual 
                                eligible individual (as defined in 
                                section 1935(c)(6)), is a recipient of 
                                supplemental security income benefits 
                                under title XVI, or is determined to be 
                                eligible for medical assistance under 
                                title XIX solely by reason of clause 
                                (i), (iii), or (iv) of section 
                                1902(a)(10)(E); and
                                    ``(II) has failed to enroll in a 
                                prescription drug plan or an MA-PD 
                                plan.
                            ``(iii) Application of notice, opt-out, and 
                        grace period in change in enrollment 
                        provisions.--In carrying out this subparagraph, 
                        the Secretary shall provide for the application 
                        of notice and change in enrollment provisions 
                        with respect to enrollment in prescription drug 
                        plans and MA-PD plans similar to those provided 
                        under clauses (i), (iv), and (v) of section 
                        1860D-31(c)(1)(F) with respect to enrollment in 
                        endorsed discount card programs.''.
    (b) Provision of Premium and Cost-Sharing Subsidies.--Section 
1860D-14(a)(3)(B)(v) of such Act (42 U.S.C. 1395w-114(a)(3)(B)(v)) is 
amended to read as follows:
                            ``(v) Treatment of medicaid beneficiaries 
                        and low-income beneficiaries in medicare 
                        savings programs.--Subject to subparagraph (F), 
                        the Secretary shall provide that the following 
                        individuals who are part D eligible individuals 
                        shall be treated as being determined to be 
                        subsidy eligible individuals described in 
                        paragraph (1):
                                    ``(I) Full-benefit dual eligible 
                                individuals (as defined in section 
                                1935(c)(6)).
                                    ``(II) Individuals who are 
                                recipients of supplemental security 
                                income benefits under title XVI.
                                    ``(III) Individuals who are 
                                determined to be eligible for medical 
                                assistance under title XIX solely by 
                                reason of clause (i), (iii), or (iv) of 
                                section 1902(a)(10)(E).''.
    (c) Effective Date.--The amendments made by this section shall take 
effect as if included in the enactment of section 101 of the Medicare 
Prescription Drug, Improvement, and Modernization Act of 2003 (Public 
Law 108-173; 117 Stat. 2071).
                                 <all>