[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3980 Introduced in House (IH)]







109th CONGRESS
  1st Session
                                H. R. 3980

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            October 6, 2005

 Mr. Dingell (for himself, Mr. Brown of Ohio, Mr. Waxman, Mrs. Capps, 
  Mr. Pallone, Mr. Boucher, and Ms. Baldwin) 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 specified 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''.
    (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 2005 and 135 percent in 2006 and years thereafter''.
    (b) Conforming Removal of QI-1 Provisions.--
            (1) Section 1902(a)(10)(E) of such Act (42 U.S.C. 
        1396a(a)(10)(E)) 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. 1396u-3) is 
        repealed.
            (3) The amendments made by this subsection shall take 
        effect as of January 1, 2006.
    (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 2006.

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--
            (1) by redesignating paragraph (6) as paragraph (11); and
            (2) 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 title XVI are deemed for purposes of this title to be 
qualified medicare beneficiaries.''.
    (b) Self-Certification of Income.--Section 1905(p) of the Social 
Security Act (42 U.S.C. 1396d(p)), as amended by subsection (a), is 
amended by inserting after paragraph (6) the following new paragraph:
    ``(7) In determining whether an individual is 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.--Section 1905(p) of the Social Security Act 
        (42 U.S.C. 1396d(p)), as amended by subsections (a) and (b), is 
        amended by inserting after paragraph (7) the following new 
        paragraph:
    ``(8) In the case of an individual who has been determined to be a 
qualified medicare beneficiary or 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.--Section 1905(p) of the 
Social Security Act (42 U.S.C. 1396d(p)), as amended by subsections 
(a), (b), and (c), is amended by inserting after paragraph (8) the 
following new paragraph:
    ``(9) A State shall permit individuals to apply to qualify as a 
qualified medicare beneficiary or for eligibility 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.--Section 1905(p) of the Social Security Act 
        (42 U.S.C. 1396d(p)), as amended by subsections (a), (b), (c), 
        and (d) is amended by inserting after paragraph (9) 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 an 
        individual who is a qualified medicare beneficiary or is 
        eligible for benefits under section 1902(a)(10)(E)(iii) through 
        utilization of the process established under section 1860D-14; 
        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),'' after ``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) in the matter preceding subparagraph (A), 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 striking ``1905(1)(2)(B)'' and 
        inserting ``1905(l)(2)(B), 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, 2006.

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 preceding 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 submitted 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 
        Commissioner 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 (such as their not 
        filing tax returns or other appropriate filters) are likely to 
        be--
                    (A) a qualified medicare beneficiary (as defined in 
                1905(p)(1) of the Social Security Act (42 U.S.C. 
                1396d(p)(1)));
                    (B) otherwise eligible for medical assistance under 
                section 1902(a)(10)(E) of the Social Security Act (42 
                U.S.C. 1396a(a)(10)(E)); or
                    (C) entitled to a premium or cost-sharing subsidy 
                under section 1860D-14 of such Act (42 U.S.C. 1395w-
                114).
            (2) Limitation on use of information.--Notwithstanding any 
        other provision of law, 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 
        (42 U.S.C. 1396 et seq.) to provide funds to States to use 
        information identified under subsection (a), and other 
        appropriate information, in order to do ex parte determinations 
        or utilize other methods for identifying and enrolling 
        individuals who are potentially--
                    (A) a qualified medicare beneficiary (as defined in 
                1905(p)(1) of the Social Security Act (42 U.S.C. 
                1396d(p)(1)));
                    (B) otherwise eligible for medical assistance 
                described in section 1902(a)(10)(E) of the Social 
                Security Act (42 U.S.C. 1396a(a)(10)(E)); or
                    (C) entitled to a premium or cost-sharing subsidy 
                under section 1860D-14 of such Act (42 U.S.C. 1395w-
                114).
            (2) Authorization of appropriations.--There are authorized 
        to be appropriated such sums as may be necessary to the 
        Secretary of Health and Human Services 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 Secretary of Health and Human Services 
through the Administrator of 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 and low-income subsidy 
programs under section 1860D-14 of such Act (42 U.S.C. 1395w-114). 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 such projects, 
as the Secretary deems appropriate.

SEC. 8. NOTICES TO CERTAIN NEW MEDICARE BENEFICIARIES.

    (a) SSA Notice.--
            (1) In general.--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 (42 U.S.C. 1395 et 
        seq., 1395j et seq.), the Commissioner shall send a notice and 
        application for benefits under title XIX of the Social Security 
        Act (42 U.S.C. 1396 et seq.) to those individuals the 
        Commissioner identifies as being likely to be--
                    (A) a qualified medicare beneficiary (as defined in 
                1905(p)(1) of the Social Security Act (42 U.S.C. 
                1396d(p)(1)));
                    (B) 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)); or
                    (C) entitled to a premium or cost-sharing subsidy 
                under section 1860D-14 of such Act (42 U.S.C. 1395w-
                114).
            (2) Additional information required.--Such notice and 
        application shall be accompanied by information on how to 
        submit such an application and 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 about the 
program.
                                 <all>