Short title; table of contents

(a)

Short title

This Act may be cited as the

Medicare Savings Program Improvement Act of 2007

. (b)

Table of contents

The table of contents of this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. References to Medicare Savings Program.

Sec. 3. Increase in income levels for eligibility.

Sec. 4. Elimination of application of estate recovery for Medicare Savings Program beneficiaries.

Sec. 5. Modification of asset test.

Sec. 6. Eligibility for other programs.

Sec. 7. Effective date of MSP benefits.

Sec. 8. Expediting eligibility under the Medicare Savings Program.

Sec. 9. Treatment of qualified medicare beneficiaries, specified low-income medicare beneficiaries, and other dual eligibles as Medicare beneficiaries.

Sec. 10. Medicaid treatment of certain medicare providers.

Sec. 11. Monitoring and enforcement of limitation on beneficiary liability.

Sec. 12. State provision of medical assistance to dual eligibles in MA plans.

References to Medicare Savings Program

The low-income assistance programs for Medicare beneficiaries under the Medicaid program under title XIX of the Social Security Act now popularly referred to the QMB and SLMB programs are to be known as the Medicare Savings Program.

Increase in income levels for eligibility

(a)

Increase to 135 percent of FPL for qualified Medicare beneficiaries

(1)

In general

Section 1905(p)(2) of the Social Security Act (42 U.S.C. 1396d(p)(2)) is amended— (A)in subparagraph (A), by striking 100 percent and inserting 135 percent; (B)in subparagraph (B)— (i)by striking and at the end of clause (ii); (ii)by striking the period at the end of clause (iii) and inserting , and; and (iii)by adding at the end the following:

(iv)January 1, 2008, is 135 percent.

; and

(C)in subparagraph (C)— (i)by striking and at the end of clause (iii); (ii)by striking the period at the end of clause (iv) and inserting , and; and (iii)by adding at the end the following:

(v)January 1, 2008, is 135 percent.

(2)

Application of income test based on family size

Section 1905(p)(2)(A) of such Act (42 U.S.C. 1396d(p)(2)(A)) is amended by adding at the end the following: For purposes of this subparagraph, family size means the applicant, the spouse (if any) of the applicant if living in the same household as the applicant, and the number of individuals who are related to the applicant (or applicants), who are living in the same household as the applicant (or applicants), and who are dependent on the applicant (or the applicant's spouse) for at least one-half of their financial support.. (3)

Not counting in-kind support and maintenance as income

Section 1905(p)(2)(D) of such Act (42 U.S.C. 1396d(p)(2)(D)) is amended by adding at the end the following new clause:

(iii)In determining income under this subsection, support and maintenance furnished in kind shall not be counted as income.

(b)

Expansion of specified low-income Medicare beneficiary (SLMB) program

(1)

Eligibility of individuals with incomes below 150 percent of FPL

Section 1902(a)(10)(E) of the Social Security Act (42 U.S.C. 1396b(a)(10)(E)) is amended— (A)by adding and at the end of clause (ii); (B)in clause (iii)— (i)by striking and 120 percent in 1995 and years thereafter and inserting , or 120 percent in 1995 and any succeeding year before 2008, or 150 percent beginning in 2008; and (ii)by striking and at the end; and (C)by striking clause (iv). (2)

Providing 100 percent Federal financing

The third sentence of section 1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by inserting before the period at the end the following: and with respect to medical assistance for medicare cost-sharing provided under section 1902(a)(10)(E)(iii). (3)

References

Section 1905(p)(1) of such Act (42 U.S.C. 1396d(p)(1)) is amended by adding at and below subparagraph (C) the following: The term specified low-income medicare beneficiary means an individual described in section 1902(a)(10)(E)(iii).. (c)

Effective date

(1)Except as provided in paragraph (2), the amendments made by this section shall take effect on January 1, 2008, and, with respect to title XIX of the Social Security Act, shall apply to calendar quarters beginning on or after January 1, 2008. (2)In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.

Elimination of application of estate recovery for Medicare Savings Program beneficiaries

(a)

In general

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)

Effective date

The amendment made by subsection (a) shall apply to actions commencing on or after January 1, 2008.

Modification of asset test

(a)

For QMBs

Section 1905(p) of the Social Security Act (42 U.S.C. 1396d(p)) is amended— (1)in paragraph (1), by amending subparagraph (C) to read as follows:

(C)whose resources (as determined under section 1613 for purposes of the supplemental income security program, except as provided in paragraph (6)(C)) do not exceed the amount described in paragraph (6)(A).

;

(2)by redesignating paragraph (6) as paragraph (7); and (3)by inserting after paragraph (5) the following:

(6)(A)The resource level specified in this subparagraph for— (i)for 2008 is six times the maximum amount of resources that an individual may have and obtain benefits under the supplemental security income program under title XVI; or (ii)for a subsequent year is the resource level specified in this subparagraph for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.

Any dollar amount established under clause (ii) that is not a multiple of $10 shall be rounded to the nearest multiple of $10.

(C)In determining the resources of an individual (and their eligible spouse, if any) under section 1613 for purposes of paragraph (1)(C) (relating to qualified medicare beneficiaries) or section 1902(a)(10)(E)(iii) (relating to individuals popularly known as specified low-income medicare beneficiaries), the following additional exclusions shall apply— (i)No part of the value of any life insurance policy shall be taken into account. (ii)No balance in any pension or retirement plan or account shall be taken into account.

(b)

For SLMBs

(1)

Permitting greater assets

Section 1902(a)(10)(E)(iii) of such Act (42 U.S.C. 1396b(a)(10)(E)(iii)) is amended by inserting before the semicolon the following: or but for the fact that their resources exceed the resource level specified in section 1905(p)(6)(A) but does not exceed the resource level specified in section 1905(p)(6)(B). (2)

Higher resource level specified

Section 1905(p)(6) of such Act, as inserted by subsection (a)(3), is amended by inserting after subparagraph (A) the following new subparagraph:

(B)The resource level specified in this subparagraph for— (i)for 2008, is $27,500 (or $55,000 in the case of the combined value of the individual’s assets or resources and the assets or resources of the individual’s spouse); and (ii)for a subsequent year is the applicable resource level specified in this subparagraph for the previous year increased by the annual percentage increase in the consumer price index (all items; U.S. city average) as of September of such previous year.

Any dollar amount established under clause (ii) that is not a multiple of $10 shall be rounded to the nearest multiple of $10.

(c)

Effective date

(1)Except as provided in paragraph (2), the amendments made by this section shall apply to calendar quarters beginning on or after January 1, 2008. (2)In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.

Eligibility for other programs

(a)

In general

Section 1905(p) of the Social Security Act (42 U.S.C. 1396d(p)), as amended by section 4(a), is amended— (1)by redesignating paragraph (7) as paragraph (8); and (2)by inserting after paragraph (6) the following new paragraph:

(7)Medical assistance for some or all medicare cost-sharing under this title shall not be treated as benefits or otherwise taken into account in determining an individual’s eligibility for, or the amount of benefits under, any other Federal program.

(b)

Effective date

The amendments made by subsection (a) shall apply to eligibility for benefits on or after January 1, 2008.

Effective date of MSP benefits

(a)

Providing for 3 Months retroactive eligibility

(1)

In general

Section 1905(a) of the Social Security 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) or a specified low-income medicare beneficiary described in section 1902(a)(10)(E)(iii), if provided in or after the third month before the month in which the individual expresses an interest in applying to become such a beneficiary, as determined in the manner provided for assistance under section 1860D–14. (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 which are submitted for services furnished during the period of retroactive eligibility and during a month in which the individual otherwise would have been eligible for such assistance and which were not submitted in accordance with such subparagraph are resubmitted and re-processed in accordance with such subparagraph.

(b)

Effective date

The amendments made by this section shall take effect on January 1, 2008, but shall not result in eligibility for benefits for medicare cost-sharing for months before January 2008.

Expediting eligibility under the Medicare Savings Program

(a)

Increasing eligibility through the Social Security office

(1)

In general

Title XVIII of the Social Security Act is amended by inserting after section 1808 the following new section:

1809.

Expedited enrollment under the medicare savings program through social security offices

(a)

In general

The Secretary shall provide, in cooperation with the Commissioner of Social Security, for an expedited process under this section for individuals to apply and qualify for benefits under the Medicare Savings Program. For purposes of this section, the term Medicare Savings Program means medical assistance for medicare cost-sharing (as defined in section 1905(p)(3)) for qualified medicare beneficiaries and specified low-income medicare beneficiaries under title XIX. (b)

Process

The process shall be consistent with the following: (1)

Coordination with social security and medicare enrollment process

The application shall be part of the process for applying for benefits under title II and this title. (2)

Simplified application process

The application may be made over the Internet, by telephone, or by mail, without the need for an interview in person by the applicant or a representative of the applicant. (3)

Contents of application

The application shall contain a description (in English, Spanish and other languages determined appropriate by the Secretary) of the availability of and the requirements for obtaining benefits under the Medicare Savings Program. (4)

Training

Employees of the Social Security office involved shall be trained to assist individuals completing such applications. (5)

Self-certification and verification

In determining whether an individual is eligible for benefits under the Medicare Savings Program, the Secretary shall permit individuals to qualify on the basis of self certifications of income and resources meeting applicable standards without the need to provide additional documentation. The Secretary shall verify that information provided in the application is correct. (6)

Transmittal of application

(A)

Eligible applicants

In the case of an applicant determined by the Social Security office to be eligible for benefits under the Medicare Savings Program based on income and resources meeting the standards otherwise applicable, the office shall transmit to the applicable State Medicaid office the application so that the applicant can be enrolled within 30 days based on the information collected by the office. (B)

Use of electronic transfer system

Not later than two years after the date of implementation of improvements of the electronic data transfer system under section 8(c) of the Medicare Savings Program Improvement Act of 2007, the process under this paragraph shall use the such system for information transmittal. (C)

Ineligible applicants

In the case of other applicants whose income and resources do not meet such standards, the Social Security office shall transmit to the applicable State Medicaid office the application so that the application may be considered under State standards that may be more generous than the standards otherwise generally applicable.

The process under this subsection shall be established and implemented one year after the date of the enactment of this section.

(c)

Distribution of application form

The Secretary shall distribute the application form used under subsection (b) to any organization that requests them, including entities receiving grants from the Secretary for programs designed to provide services to individuals 65 years of age or older and people with disabilities. The Commissioner of Social Security shall make such forms available at local offices of the Social Security Administration. (d)

State response and application process

(1)

In general

In the case of an application transmitted under subsection (b)(6), the State agency responsible for determinations of eligibility for benefits under the State’s Medicare Savings Program— (A)shall make a determination on the application within 30 days of the date of its receipt; and (B)shall notify the applicant of the determination within 10 days after it is made. (2)

Use of simplified application process

In the case of an application other than an application transmitted under subsection (b)(6), a State plan under title XIX shall provide that an application for benefits under the Medicare Savings Program may be made over the Internet, by telephone, or by mail, without the need for an interview in person by the applicant or a representative of the applicant. (e)

Expedited application and eligibility process

(1)

Expedited process

(A)

In general

As part of the expedited process for obtaining benefits under the Medicare Savings Program, the Secretary shall through a request to the Secretary of the Treasury to obtain information sufficient to identify whether the individual involved is likely eligible for such benefits based on such information and the type of assistance under the Medicare Savings Program for which they would qualify based on such information. Such process shall be conducted in cooperation with the Commissioner of Social Security. (B)

Opt in for newly eligible individuals

Not later than 60 days after the date of the enactment of this subsection, the Secretary shall ensure that, as part of the Medicare enrollment process, enrolling individuals— (i)receive information describing the Medicare Savings Program provided under this section; and (ii)are provided the opportunity to opt-in to the expedited process described in this subsection by requesting that the Commissioner of Social Security screen the individual involved for eligibility for the Medicare Savings Program through a request to the Secretary of the Treasury under section 6103(l)(21) of the Internal Revenue Code of 1986. (C)

Transition for currently eligible individuals

In the case of any Medicare Savings Program eligible individual to which subparagraph (B) did not apply at the time of such individual's enrollment, the Secretary shall, not later than 60 days after the date of the implementation of subparagraph (B), request that the Commissioner of Social Security screen such individual for eligibility for the Medicare Savings Program provided under this section through a request to the Secretary of the Treasury under section 6103(l)(21) of the Internal Revenue Code of 1986. (2)

Notification of potentially eligible individuals

Under such process, in the case of each individual identified under paragraph (1) who has not otherwise applied for, or been determined eligible for, benefits under the Medicare Savings Program (or who has applied for and been determined ineligible for such benefits based only on standards in effect before January 1, 2008), the Secretary shall send them a letter (using basic, uncomplicated language) containing the following: (A)

Eligibility

A statement that, based on the information obtained under process under this section, the individual is likely eligible for benefits under the Medicare Savings Program. (B)

Amount of assistance

A description of the amount of assistance under such program for which the individual would likely be eligible based on such information. (C)

Attestation

A one-page application form that provides for a signed attestation, under penalty of law, as to the amount of income and assets of the individual and constitutes an application for the benefits under the Medicare Savings Program. Such form— (i)shall not require the submittal of additional documentation regarding income or assets; and (ii)shall allow for the specification of a language (other than English) that is preferred by the individual for subsequent communications with respect to the individual under this title and title XIX. (D)

Information on Outreach groups

Information on how the individual may contact the a State outreach effort or other groups that receive grants from the Secretary to conduct outreach to individuals to receive benefits under the Medicare Savings Program. (3)

Follow-up communications

If the individual does not respond to the letter described in paragraph (2) by completing an attestation described in paragraph (2)(C) or declining to do so, the Secretary shall make additional attempts to contact the individual to obtain such an affirmative response. (4)

Hold-harmless

Under such process, if an individual in good faith and in the absence of fraud executes an attestation described in paragraph (2)(C) and is provided benefits under the Medicare Savings Program on the basis of such attestation, if the individual is subsequently found not eligible for such benefits, there shall be no recovery made against the individual because of such benefits improperly paid. (5)

Use of preferred language in subsequent communications

In the case an attestation described in paragraph (2)(C) is completed and in which a language other than English is specified under clause (ii) of such paragraph, the Secretary shall provide that subsequent communications to the individual under this subsection shall be in such language. (6)

Construction

Nothing in this subsection shall be construed as precluding the Secretary from taking additional outreach efforts to enroll eligible individuals under the Medicare Savings Program. (f)

Electronic communication between social security and State medicaid agencies and the Secretary

(1)

Notice by Social Security to Secretary and State medicaid agencies

In the case of a determination of eligibility of an individual under section 1860D–14(a)(3)(B)(i) by the Commissioner of Social Security, the Commissioner shall provide for notice, preferably in electronic form, to the Secretary and to State medicaid agency under title XIX of such determination for purposes of enabling the individual to automatically qualify for benefits under the Medicare Savings Program under such title through the operation of section 1905(p)(8). (2)

Notice by States to Secretary

In the case that the State determines that an individual is a qualified medicare beneficiary or a specified low-income medicare beneficiary under title XIX, the State shall provide for notice, preferably in electronic form, to the Secretary of such determination for purposes of enabling the individual to automatically qualify for low-income subsidies under section 1860D–14 through the operation of section 1905(a)(3)(G). (3)

Deadline

Each State (as defined for purposes of title XIX) and the Secretary shall establish the notification process described in this subsection not later than 1 year after the date of the enactment of this section.

(2)

Disclosure of return information for purposes of screening individuals for eligibility for benefits under the Medicare Savings Program

(A)

In general

Subsection (l) of section 6103 of the Internal Revenue Code of 1986 is amended by adding at the end the following new paragraph:

(21)

Disclosure of return information for purposes of providing benefits under the Medicare Savings Program

(A)

Return information from Internal Revenue Service to Social Security Administration

The Secretary, upon written request from the Commissioner of Social Security under section 1809(e)(1)(A) of the Social Security Act, shall disclose to the Commissioner with respect to any taxpayer identified by the Commissioner— (i)(I)whether the adjusted gross income, as modified in accordance with specifications of the Secretary of Health and Human Services for purposes of carrying out such section, of such taxpayer and, if applicable, such taxpayer’s spouse, for the applicable year, exceeds the amounts specified by the Secretary of Health and Human Services in order to apply the 135 and 150 percent poverty lines under section 1905(p) and section 1902(a)(10)(E)(ii) of such Act; (II)the adjusted gross income (as determined under subclause (I)), in the case of a taxpayer with respect to which such adjusted gross income exceeds the amount so specified for applying the 135 percent poverty line and does not exceed the amount so specified for applying the 150 percent poverty line; (III)whether the return was a joint return for the applicable year; and (IV)the applicable year; or (ii)if applicable, the fact that there is no return filed for such taxpayer for the applicable year. (B)

Definition of applicable year

For the purposes of this paragraph, the term applicable year means the most recent taxable year for which information is available in the Internal Revenue Service’s taxpayer data information systems, or, if there is no return filed for such taxpayer for such year, the prior taxable year. (C)

Restriction on individuals for whom disclosure is requested

The Commissioner of Social Security shall only request information under this paragraph with respect to individuals who have requested that such request be made under section 1809(e) of the Social Security Act. (D)

Return information from Social Security Administration to Department of Health and Human Services

The Commissioner of Social Security shall, upon written request from the Secretary of Health and Human Services, disclose to the Secretary of Health and Human Services the information described in clauses (i) and (ii) of subparagraph (A). (E)

Permissive disclosure to officers, employees, and contractors

The information described in clauses (i) and (ii) of subparagraph (A) may be disclosed among officers, employees, and contractors of the Social Security Administration and the Department of Health and Human Services for the purposes described in subparagraph (F). (F)

Restriction on use of disclosed information

Return information disclosed under this paragraph may be used only for the purposes of identifying eligible individuals for, and administering— (i)low-income subsidies under section 1860D–14 of the Social Security Act; and (ii)the Medicare Savings Program implemented under clauses (i) and (ii) of section 1902(a)(10)(E) of such Act.

(B)

Confidentiality

Paragraph (3) of section 6103(a) of such Code is amended by striking or (20) and inserting (20), or (21). (C)

Procedures and record keeping related to disclosures

Paragraph (4) of section 6103(p) of such Code is amended by striking or (20) each place it appears and inserting (20), or (21). (D)

Unauthorized disclosure or inspection

Paragraph (2) of section 7213(a) of such Code is amended by striking or (20) and inserting (20), or (21). (b)

Two-way deeming between Medicare Savings Program and Low-Income Subsidy Program

(1)

Medicare Savings Program

Section 1905(p) of the Social Security Act (42 U.S.C. 1396d(p)), as amended by sections 4(a) and 5(a), is amended— (A)by redesignating paragraph (8) as paragraph (9); and (B)by inserting after paragraph (7) the following new paragraph:

(8)An individual who has been determined eligible for premium and cost-sharing subsidies under— (A)section 1860D–14(a)(1) is deemed, for purposes of this title and without the need to file any additional application, to be a qualified medicare beneficiary for purposes of this title; or (B)section 1860D–14(a)(2) is deemed, for purposes of this title and without the need to file any additional application, to qualify for medical assistance as a specified low-income medicare beneficiary (described in section 1902(a)(10)(E)(iii)).

(2)

Low-Income subsidy program

Section 1860D–14(a)(3) of such Act (42 U.S.C. 1395w–104(a)(3)) is amended by adding at the end the following new subparagraph:

(G)

Deemed treatment for qualified medicare beneficiaries and specified low-income medicare beneficiaries

(i)

QMBs eligible for full subsidy

A part D eligible individual who has been determined for purposes of title XIX to be a qualified medicare beneficiary is deemed, for purposes of this part and without the need to file any additional application, to be a subsidy eligible individual described in paragraph (1). (ii)

SLMBs eligible for partial subsidy

A part D eligible individual who has been determined to be a specified low-income medicare beneficiary (as defined in section 1905(p)(1)) and who is not described in paragraph (1) is deemed, for purposes of this part and without the need to file any additional application, to be a subsidy eligible individual who is not described in paragraph (1).

(3)

Effective date

The amendments made by this subsection shall apply to eligibility for months beginning on or after January 2008. (c)

Improvements in electronic communication between Social Security, State Medicaid agencies, and the Secretary of Health and Human Services

(1)

In general

Not later than two years after the date of the enactment of this Act, the Commissioner of Social Security, the Secretary of Health and Human Services, and the directors of State Medicaid agencies shall implement improvements to the electronic data transfer system by which they communicate directly and electronically with each other with respect to individuals who have enrolled for benefits under any part of the Medicare Savings Program in order to ensure that each of them has exactly the same list of beneficiaries who are signed up for the Medicare Savings Program. (2)

Increased administrative match

In order to implement paragraph (1)— (A)the Medicaid administrative match under section 1903(a)(7) of the Social Security Act shall be increased to 75 percent with respect to expenditures made in carrying out such paragraph; and (B)there is appropriated to the Commissioner of Social Security and the Secretary of Health and Human Services, from any amounts in the Treasury not otherwise appropriated, $2,000,000 each for each of fiscal years 2008 and 2009 to implement paragraph (1). (3)

Use of system

After the implementation of the improvements to the electronic data transfer system under paragraph (1), the Commissioner of Social Security, State Medicaid agencies, and the Secretary of Health and Human Services shall primarily use this system for the Commissioner and the Secretary to inform the State Medicaid agencies to enroll a beneficiary for the Medicare Savings Program. (d)

Improved coordination with State, local, and other partners

(1)

State Grants

(A)

In general

The Secretary of Health and Human Services shall enter into contracts 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 (c), and other appropriate information, in order to do ex parte determinations or utilize other methods for identifying and enrolling individuals who are potentially— (i)eligible for benefits under the Medicare Savings Program (under sections 1905(p) of the Social Security Act, 42 U.S.C. 1396d(p)); or (ii)entitled to a premium or cost-sharing subsidy under section 1860D–14 of such Act (42 U.S.C. 1395w–114). (B)

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 contracts under this paragraph. (2)

Funding of State health insurance counseling and similar programs

(A)

Authorization of appropriations

In addition to any other funds authorized to be appropriated, there are authorized to be appropriated $3,000,000 for each of calendar years 2008 through 2012 to carry out activities described in subparagraph (B). (B)

Activities described

The activities described in this subparagraph are the following: (i)Activities under section 4360 of the Omnibus Budget Reconciliation Act of 1990 for the purpose of outreach to low-income Medicare beneficiaries to assist in applying for and obtaining benefits under the Medicare Savings Program (under title XIX of the Social Security Act) and the low-income subsidy program under section 1860D–14 of such Act. (ii)Activities of the National Center on Senior Benefits Outreach and Enrollment (as described in section 202(a)(20)(B) of the Older Americans Act of 1965 (42 U.S.C. 3012(a)(20)(B)). (iii)Similar activities carried out by other qualified agencies designated by the Secretary of Health and Human Services.

Treatment of qualified medicare beneficiaries, specified low-income medicare beneficiaries, and other dual eligibles as Medicare beneficiaries

(a)

In general

Section 1862 of the Social Security Act (42 U.S.C. 1395y) is amended by adding at the end the following new subsection:

(n)

Treatment of qualified medicare beneficiaries (QMBs), specified low-income medicare beneficiaries (SLMBs), and other dual eligibles

Nothing in this title shall be construed as authorizing a provider of services or supplier to discriminate (through a private contractual arrangement or otherwise) against an individual who is otherwise entitled to services under this title on the basis that the individual is a qualified medicare beneficiary (as defined in section 1905(p)(1)), a specified low-income medicare beneficiary, or is otherwise eligible for medical assistance for medicare cost-sharing or other benefits under title XIX.

(b)

Effective date

The amendment made by subsection (a) shall apply to items and services furnished on or after the date of the enactment of this Act.

10.

Medicaid treatment of certain medicare providers

(a)

In general

Section 1902(n) of the Social Security Act (42 U.S.C. 1396a(n)) is amended by adding at the end the following new paragraph:

(4)A State plan shall not deny a claim from a provider or supplier with respect to medicare cost-sharing described in subparagraph (B), (C), or (D) of section 1905(p)(3) for an item or service which is eligible for payment under title XVIII on the basis that the provider or supplier does not have a provider agreement in effect under this title or does not otherwise serve all individuals entitled to medical assistance under this title.

(b)

Effective date

The amendment made by subsection (a) shall apply to items and services furnished on or after the date of the enactment of this Act.

11.

Monitoring and enforcement of limitation on beneficiary liability

Section 1902(n) of the Social Security Act (42 U.S.C. 1396b(n)), as amended by section 9(a), is further amended by adding at the end the following new paragraph:

(5)(A)The Inspector General of the Department of Health and Human Services shall examine, not later than one year after the date of the enactment of this paragraph and every three years thereafter, whether providers have attempted to make qualified medicare beneficiaries liable for deductibles, coinsurance, and co-payments in violation of paragraph (3)(B). The Inspector General shall submit to the Secretary a report on such examination and a finding as to whether qualified medicare beneficiaries have been held liable in violation of such paragraph. (B)If a report under subparagraph (A) includes a finding that qualified medicare beneficiaries have been held liable in violation of such paragraph, not later than 60 days after the date of receiving such report the Secretary shall submit to Congress a report that includes a plan of action on how to enforce provisions of such paragraph.

12.

State provision of medical assistance to dual eligibles in MA plans

(a)

In general

Section 1902(n) of the Social Security Act (42 U.S.C. 1396b(n)), as amended by section 10, is further amended by adding at the end the following new paragraph:

(6)(A)Each State shall— (i)identify those individuals who are eligible for medical assistance for medicare cost-sharing and who are enrolled with a Medicare Advantage plan under part C of title XVIII; and (ii)for the individuals so identified, provide for payment of medical assistance for the medicare cost-sharing (including cost-sharing under a Medicare Advantage plan) to which they are entitled. (B)(i)The Inspector General of the Department of Health and Human Services shall examine, not later than one year after the date of the enactment of this paragraph and every three years thereafter, whether States are providing for medical assistance for medicare cost-sharing for individuals enrolled in Medicare Advantage plans in accordance with this title. The Inspector General shall submit to the Secretary a report on such examination and a finding as to whether States are failing to provide such medical assistance. (ii)If a report under clause (i) includes a finding that States are failing to provide such medical assistance, not later than 60 days after the date of receiving such report the Secretary shall submit to Congress a report that includes a plan of action on how to enforce such requirement.

(b)

Effective date

(1)Except as provided in paragraph (2), the amendment made by subsection (a) shall apply to calendar quarters beginning on or after the date of the enactment of this Act. (2)In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendment made by subsection (a), the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.