II 110th CONGRESS 1st Session S. 1108 IN THE SENATE OF THE UNITED STATES April 12, 2007 Mr. Smith (for himself, Mr. Bingaman, Ms. Snowe, Mrs. Lincoln, and Mr. Kerry) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title XVIII of the Social Security Act to provide a special enrollment period for individuals who qualify for an income-related subsidy under the Medicare prescription drug program and to provide funding for the conduct of outreach and education with respect to the premium and cost-sharing subsidies under such program, and for other purposes.

1.

Short title

This Act may be cited as the Medicare Part D Outreach and Enrollment Enhancement Act of 2007.

2.

Special enrollment period for individuals eligible for an income-related subsidy

(a)

Special enrollment period

Section 1860D–1(b)(3) of the Social Security Act (42 U.S.C. 1395w–101(b)(3)) is amended by adding at the end the following new subparagraph: (F)

Eligibility for low-income subsidy

(i)

In general

Subject to clause (iii), in the case of an applicable individual (as defined in clause (ii)). (ii)

Applicable individual defined

For purposes of this subparagraph, the term applicable individual means a part D eligible individual who is determined to be a subsidy-eligible individual (as defined in section 1860D–14(a)(3)), including such an individual who was enrolled in a prescription drug plan or an MA–PD plan on the date of such determination. (iii)

Timing of special enrollment period

The special enrollment period established under this subparagraph shall be for a 90-day period beginning on the date the applicable individual receives notification of such determination. . (b)

Enrollment process for subsidy-eligible individuals eligible for special enrollment period

Section 1860D–1(b)(1) is amended by adding at the end the following new subparagraph: (D)

Special rule for subsidy-eligible individuals eligible for special enrollment period

The process established under subparagraph (A) shall include, in the case of an applicable individual (as defined in clause (ii) of paragraph (3)(F)) the following: (i)

Facilitated enrollment

During the 90-day period described in clause (iii) of such paragraph, a process for the facilitated enrollment of the individual in the prescription drug plan or MA–PD plan that is most appropriate for such individual (as determined by the Secretary). At the end of such 90-day period, the individual shall be enrolled in such plan unless the individual declines enrollment in the plan or in the program under this part, or chooses to enroll in another plan selected by the individual prior to the end of such 90-day period. (ii)

One-time change of enrollment

The opportunity to change enrollment with a prescription drug plan or an MA–PD plan not less than once during a plan year. Nothing in the previous sentence shall limit the ability of a part D eligible individual who is a full-benefit dual eligible individual (as defined in section 1935(c)(6)) to change enrollment under subparagraph (C) . (c)

Waiver of late enrollment penalty

Section 1860D–13(b) of the Social Security Act (42 U.S.C. 1395w–113(b)) is amended by adding at the end the following new paragraph: (8)

Waiver of penalty for subsidy-eligible individuals

In no case shall a part D eligible individual who is determined to be a subsidy-eligible individual (as defined in section 1860D–14(a)(3)) be subject to an increase in the monthly beneficiary premium established under subsection (a). . (d)

Effective date

The amendments made by this section shall take effect on January 1, 2008.

3.

Outreach and education for premium and cost-sharing subsidies under part D

(a)

Additional funding for outreach and assistance

(1)

State health insurance assistance programs

There are authorized to be appropriated for each of fiscal years 2008, 2009, 2010, and 2011, an amount equal to $1 multiplied by the total number of individuals entitled to benefits, or enrolled, under part A of title XVIII of the Social Security Act, or enrolled under part B of such title during the fiscal year (as determined by the Secretary of Health and Human Services, based on the most recent available data before the beginning of the fiscal year) to be used to provide additional grants to State Health Insurance Assistance Programs (SHIPs) to conduct outreach and education related to the Medicare program under such title. (2)

National center on senior benefits outreach and enrollment

(A)

In general

There are appropriated $4,000,000 to the National Center on Senior Benefits Outreach and Enrollment established under section 202(a)(20)(B) of the Older Americans Act of 1965 (42 U.S.C. 3012(a)(20)(B)) to be used to provide outreach and enrollment assistance with respect to premium and cost-sharing subsidies under the Medicare prescription drug program under part D of title XVIII of the Social Security Act (42 U.S.C. 1395w–101 et seq.). (B)

Coordination

The National Center on Senior Benefits Outreach and Enrollment shall coordinate outreach and enrollment assistance conducted under subparagraph (A) with activities conducted by State Health Insurance Assistance Programs (SHIPs) and other appropriate entities that conduct outreach and education related to such premium and cost-sharing subsidies. (b)

Encouraging states to direct subsidy-eligible individuals to organizations providing assistance

(1)

In general

The Secretary of Health and Human Services shall encourage States to direct applicable individuals to appropriate organizations and entities that provide assistance with respect to— (A)applying for premium and cost-sharing subsidies under section 1860D–14 of the Social Security Act (42 U.S.C. 1395w–114); and (B)enrolling in a prescription drug plan or an MA–PD plan under part D of title XVIII of the Social Security Act (42 U.S.C. 1395w–101 et seq.). (2)

Applicable individuals defined

In this subsection, the term applicable individual means an individual the State believes to be, or determines to be, eligible for premium and cost-sharing subsidies under section 1860D–14 of the Social Security Act (42 U.S.C. 1395w–114).

4.

Screening by commissioner of social security for eligibility under medicare savings programs

(a)

In general

Section 1860D–14(a)(3)(B)(i) of the Social Security Act (42 U.S.C. 1395w–114(a)(3)(B)(i)) is amended by inserting after the first sentence the following: As part of making an eligibility determination under the preceding sentence for an individual, the Commissioner shall screen for the individual’s eligibility for medical assistance for any medicare cost-sharing described in section 1905(p)(3) and, if the screening indicates the individual is likely eligible for any such medicare cost-sharing, transmit the pertinent information to the appropriate State Medicaid agency for the determination of eligibility and enrollment of the individual for such medicare cost-sharing under the State plan (or under a waiver of such plan).. (b)

Effective date

The amendment made by this section shall take effect on the date of enactment of this Act.

5.

Administration on Aging study and report on screening processes used by government needs-based programs

(a)

Study

(1)

In general

The Assistant Secretary of the Administration on Aging (in this section referred to as the Assistant Secretary) shall conduct a comprehensive study of screening processes used by government needs-based programs. (2)

Matters studied

In conducting the study under paragraph (1), the Assistant Secretary shall— (A)assess any duplications of effort under existing screening processes used by government needs-based programs; (B)determine the feasibility of creating a uniform screening process for such needs-based programs; (C)determine how the Federal government, State governments, and community-based organizations can better coordinate existing screening processes in order to facilitate the enrollment of seniors into need-based programs; (D)include a cost-benefit analysis with respect to creating a uniform screening process or better streamlining existing screening processes; and (E)determine the feasibility of using the Internet to administer screening processes, as well as the costs and benefits of migrating to on online system. (b)

Report

Not later than 1 year after the date of enactment of this Act, the Assistant Secretary shall submit a report to Congress containing the results of the study conducted under subsection (a), together with recommendations— (1)to streamline and improve the effectiveness of screening processes used by government needs-based programs; and (2)for such legislation or administrative action as the Assistant Secretary determines appropriate. (c)

Authorization

There are authorized to be appropriated such sums as are necessary to carry out this section.