[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5772 Introduced in House (IH)]

<DOC>






114th CONGRESS
  2d Session
                                H. R. 5772

 To amend title XVIII of the Social Security Act to establish a system 
 to educate individuals approaching Medicare eligibility, to simplify 
 and modernize the eligibility enrollment process, and to provide for 
     additional assistance for complaints and requests of Medicare 
beneficiaries that relate to their enrollment in the Medicare program, 
                        and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             July 13, 2016

 Mr. Ruiz (for himself and Mr. Meehan) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addition 
      to the Committee on Energy and Commerce, 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 establish a system 
 to educate individuals approaching Medicare eligibility, to simplify 
 and modernize the eligibility enrollment process, and to provide for 
     additional assistance for complaints and requests of Medicare 
beneficiaries that relate to their enrollment in the Medicare program, 
                        and for other purposes.

    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 ``Beneficiary Enrollment Notification 
and Eligibility Simplification Act of 2016'' or the ``BENES Act of 
2016''.

SEC. 2. ELIGIBILITY AND ENROLLMENT NOTIFICATION.

    (a) Notification Requirements.--Section 1804 of the Social Security 
Act (42 U.S.C. 1395b-2) is amended by adding at the end the following 
new subsection:
    ``(d) Eligibility Information.--
            ``(1) Coordination of notice.--The Secretary, in 
        consultation with representatives of each of the groups 
        described in paragraph (2)(A), and in coordination with the 
        Commissioner of Social Security and the Secretary of the 
        Treasury, shall prepare and distribute a notice, in accordance 
        with this subsection, to potentially eligible Medicare 
        individuals.
            ``(2) Groups for consultation.--
                    ``(A) In general.--For purposes of paragraph (1), 
                the groups described in this subparagraph include the 
                following:
                            ``(i) Individuals who are more than 60 
                        years of age.
                            ``(ii) Individuals with disabilities.
                            ``(iii) Individuals with end stage renal 
                        disease.
                            ``(iv) Low-income individuals and families.
                            ``(v) Employers (including human resources 
                        professionals).
                            ``(vi) States (including representatives of 
                        State-run Health Insurance Exchanges, Medicaid 
                        offices, and Departments of Insurance).
                            ``(vii) State Health Insurance Assistance 
                        Programs.
                            ``(viii) Health insurers.
                            ``(ix) Such other groups as specified by 
                        the Secretary.
                    ``(B) Non-application of faca.--The Federal 
                Advisory Committee Act shall not apply to consultations 
                made pursuant to paragraph (1) with groups described in 
                subparagraph (A).
            ``(3) Contents of notice.--The notice required under 
        paragraph (1) shall contain information on (including a clear, 
        simple explanation of)--
                    ``(A)(i) eligibility for benefits under this title, 
                and in particular benefits under part B;
                    ``(ii) the possibility of a late enrollment penalty 
                for failure to timely enroll (including the 
                availability of equitable relief); and
                    ``(iii) how to access the Website described in 
                paragraph (5); and
                    ``(B) the need for coordination of benefits under 
                part B (including secondary and primary coverage 
                scenarios) imposed under this title, including the 
                effects of enrollment in retiree health coverage; group 
                health coverage; coverage under a group health plan 
                provided by an employer pursuant to title XXII of the 
                Public Health Service Act, section 4980B of the 
                Internal Revenue Code of 1986, or title VI of the 
                Employee Retirement Income Security Act of 1974; 
                coverage under a qualified health plan offered through 
                an Exchange established under title I of the Patient 
                Protection and Affordable Care Act; and other widely 
                available coverage which may be available to 
                potentially eligible Medicare individuals.
            ``(4) Timing of notice to potential enrollees.--Beginning 
        one year after the date of the enactment of this subsection, a 
        notice required under paragraph (1) shall be mailed (or, 
        starting after 2025, mailed or otherwise delivered) to each 
        potentially eligible Medicare individual no less than two times 
        in accordance with the following:
                    ``(A) The notice shall be initially provided to 
                such individual no later than 6 months prior to the 
                date of such individual's initial enrollment period as 
                provided under section 1837.
                    ``(B) The notice shall subsequently be provided to 
                such individual no later than one month prior to such 
                date.
            ``(5) Creation of a centralized enrollment website.--The 
        information contained in notices required under this subsection 
        shall be made available through a new Website to be maintained 
        by the Secretary. Such Website shall include both Social 
        Security and Medicare online tools in a coordinated and 
        organized manner, and shall also contain, or link to, such 
        other eligibility tools, services, notices (including with 
        respect to the availability of equitable relief), and other 
        information as determined by the Secretary, in consultation 
        with groups described in paragraph (2) for the purposes of 
        being available to potentially eligible Medicare individuals.
            ``(6) Interagency coordination.--Beginning not later than 2 
        months after the date of the enactment of this subsection, the 
        Secretary, along with the Secretary of the Treasury and the 
        Commissioner of the Social Security Administration, shall 
        undertake all necessary action and coordination to identify 
        potentially eligible individuals and in order to provide such 
        individuals with notifications under this subsection in 
        accordance with paragraph (4).
            ``(7) Notification improvement.--The Secretary shall, no 
        less than once every fiscal year, review the content of the 
        notices required under this subsection and the practices of 
        providing such notices to individuals, and shall update and 
        revise such notices and practices as the Secretary deems 
        appropriate.
            ``(8) Potentially eligible medicare individual defined.--
        For purposes of this subsection, the term `potentially eligible 
        Medicare individual' means an individual, with respect to a 
        month, who is expected to satisfy the description in paragraph 
        (1) or (2) of section 1836 during such month or during any of 
        the subsequent 11 months.''.
    (b) Disclosure Authority.--Section 6103(l) of the Internal Revenue 
Code of 1986 is amended by adding at the end the following new 
paragraph:
            ``(23) Disclosure of return information to carry out 
        eligibility notification requirements for certain programs.--
                    ``(A) In general.--The Secretary, upon request from 
                the Secretary of Health and Human Services, shall 
                disclose to officers, employees, and contractors of the 
                Department of Health and Human Services and the Social 
                Security Administration return information of any 
                taxpayer who is a potentially eligible Medicare 
                individual (as defined in section 1804(d)(8) of the 
                Social Security Act). Such return information shall be 
                limited to--
                            ``(i) taxpayer identity information with 
                        respect to such taxpayer, including the age and 
                        address or other location of such taxpayer;
                            ``(ii) the filing status of such taxpayer;
                            ``(iii) such other information as is 
                        prescribed by the Secretary of Health and Human 
                        Services by regulation as might indicate 
                        whether the taxpayer is eligible for coverage 
                        under such title; and
                            ``(iv) the taxable year with respect to 
                        which the preceding information relates or, if 
                        applicable, the fact that such information is 
                        not available.
                    ``(B) Restriction on use of disclosed 
                information.--Return information disclosed under 
                subparagraph (A) may be used by officers, employees, 
                and contractors of the Department of Health and Human 
                Services or the Social Security Administration only for 
                the purposes of, and to the extent necessary in, 
                establishing potential eligibility for benefits under 
                title XVIII of the Social Security Act.''.
    (c) Computer Matching Agreement.--Not later than 6 months after the 
date of the enactment of this Act, the Secretary of Health and Human 
Services, the Secretary of the Treasury, and the Commissioner of Social 
Security shall enter into a computer matching agreement pursuant to 
section 552a(o) of title 5 of the United States Code for the purposes 
of implementing section 1804(d) of the Social Security Act, as added by 
subsection (a), and section 6103(l)(23) of the Internal Revenue Code of 
1986, as added by subsection (b).
    (d) Report to Congress.--Not later than 4 years after the date of 
the enactment of this Act, the Secretary of Health and Human Services, 
the Secretary of the Treasury, and the Commissioner of Social Security 
shall submit to Congress a report on the process taken by the relevant 
agencies in implementing the notice requirement under subsection (d) of 
section 1804 of the Social Security Act (42 U.S.C. 1395b-2), as added 
by subsection (a) of this section, the status of notices created 
pursuant to such section, and an evaluation of the effect of such 
notices on enrollment under title XVIII of the Social Security Act. 
Such report shall be made publicly available.

SEC. 3. BENEFICIARY MEDICARE PART B ENROLLMENT PERIODS AND EFFECTIVE 
              DATE OF COVERAGE.

    (a) Effective Dates.--Section 1838(a) of the Social Security Act 
(42 U.S.C. 1395q(a)) is amended--
            (1) by amending paragraph (2) to read as follows:
            ``(2)(A) in the case of an individual who enrolls pursuant 
        to subsection (d) of section 1837 before the month in which he 
        first satisfies paragraph (1) or (2) of section 1836, the first 
        day of such month,
            ``(B) in the case of an individual not described in 
        subparagraph (A) who first satisfies such paragraph in a month 
        beginning before January 2018 and who enrolls--
                    ``(i) pursuant to such subsection (d) in such month 
                in which he first satisfies such paragraph, the first 
                day of the month following the month in which he so 
                enrolls,
                    ``(ii) pursuant to such subsection (d) in the month 
                following such month in which he first satisfies such 
                paragraph, the first day of the second month following 
                the month in which he so enrolls, or
                    ``(iii) pursuant to such subsection (d) more than 
                one month following such month in which he satisfies 
                such paragraph, the first day of the third month 
                following the month in which he so enrolls,
            ``(C) in the case of an individual not described in 
        subparagraph (A) who enrolls pursuant to subsection (e) of 
        section 1837 in a month beginning before January 2018, the July 
        1 following the month in which he so enrolls,
            ``(D) in the case of an individual not described in 
        subparagraph (A) who first satisfies such paragraph in a month 
        beginning on or after January 1, 2018, and who enrolls pursuant 
        to such subsection (d) in such month in which he first 
        satisfies such paragraph or in any subsequent month, the first 
        day of the month following the month in which he so enrolls, or
            ``(E) in the case of an individual not described in 
        subparagraph (A) who enrolls pursuant to subsection (e) of 
        section 1837 in a month beginning on or after October 15, 2017, 
        the first day of the month following the month in which he so 
        enrolls.''; and
            (2) by amending paragraph (3) to read as follows:
            ``(3)(A) in the case of an individual who is deemed to have 
        enrolled on or before the last day of the third month of his 
        initial enrollment period beginning before January 1, 2018, the 
        first day of the month in which he first meets the applicable 
        requirements of section 1836 or July 1, 1973, whichever is 
        later, or
            ``(B) in the case of an individual who is deemed to have 
        enrolled on or after the first day of the fourth month of his 
        initial enrollment period beginning before January 1, 2018, as 
        prescribed under subparagraphs (B)(i), (B)(ii), (B)(iii), and 
        (C) of paragraph (2) of this subsection.''.
    (b) General and Special Enrollment Periods.--Section 1837(e) of the 
Social Security Act (42 U.S.C. 1395p(e)) is amended to read as follows:
    ``(e) Enrollment Periods.--
            ``(1) For coverage during years before 2018.--There shall 
        be a general enrollment period during the period beginning on 
        January 1 and ending on March 31 of each year before 2018.
            ``(2) For coverage during years beginning with 2018.--For 
        2018 and each subsequent year:
                    ``(A) In general.--Subject to subparagraph (B), 
                there shall be a general enrollment period beginning on 
                October 15 of the previous year through December 31 of 
                such previous year.
                    ``(B) Exceptional circumstances.--The Secretary 
                shall establish special enrollment periods in the case 
                of a potentially eligible Medicare individual (as 
                defined in section 1804(d)(8)) who meets such 
                exceptional conditions as the Secretary may provide.''.
    (c) Technical Correction.--Section 1839(b) of the Social Security 
Act (42 U.S.C. 1395r(b)) is amended striking ``close of the enrollment 
period'' each place it appears and inserting ``close of the month''.

SEC. 4. REVISING BENEFICIARY APPEAL RIGHTS FOR GOOD FAITH ENROLLMENT 
              MISTAKES.

    (a) In General.--Subsection (h) of section 1837 of the Social 
Security Act (42 U.S.C. 1395p) is amended to read as follows:
    ``(h)(1) In any case in which the Secretary finds that an 
individual's enrollment or nonenrollment in the insurance program 
established by this part or part A pursuant to section 1818 is 
unintentional, inadvertent, or erroneous, whether the result of the 
error, misrepresentation, or inaction of an officer, employee, or agent 
of the Federal Government or its instrumentalities, an employer, a 
representative of a group health plan, a State, or for any other good 
faith reason on the part of such individual, the Secretary shall take 
such action (including the designation for such individual of a special 
initial or subsequent enrollment period, including retroactive 
enrollment, with a coverage period determined on the basis thereof and 
with appropriate adjustments of premiums) as may be necessary to 
correct or eliminate the effects of such error, misrepresentation, or 
inaction. The failure of an individual to enroll in the insurance 
program established by this part or part A pursuant to section 1818 due 
to enrollment under a group health plan; coverage pursuant to title 
XXII of the Public Health Service Act, section 4980B of the Internal 
Revenue Code of 1986, title VI of the Employee Retirement Income 
Security Act of 1974, or title XIX; or enrollment under a qualified 
health plan offered through an Exchange established under title I of 
the Patient Protection and Affordable Care Act shall under this 
subsection absent exceptional circumstances, as determined by the 
Secretary.
    ``(2) The Secretary, in consultation with the Commissioner of 
Social Security, shall develop and publish a formal application for 
requesting an action of the Secretary under paragraph (1) to correct or 
eliminate the effects of an error, misrepresentation, or inaction 
described in such paragraph and determine and publish specific 
timelines for timely resolution of such a request.
    ``(3) The Secretary shall also require that all such determinations 
with respect to such requests shall be reached within 15 business days 
of the submission of such application. All determinations shall be in 
writing through a standard decision notice with shall include an 
explanation of the reasons for the determination.
    ``(4)(A) The Commissioner of Social Security shall enter into 
contracts with independent review organizations in accordance with this 
subsection for the purpose of reviewing and determining individual 
appeals of determinations under paragraph (3) with respect to an 
application submitted pursuant to paragraph (2) relating to enrollment 
under part A or part B.
    ``(B) An individual who receives an adverse determination under 
paragraph (3) with respect to an application submitted pursuant to 
paragraph (2) may appeal to an independent review organization 
designated by the Commission. Any such appeal must be sent to the 
independent review organization within 90 days of the date the 
individual received the determination to be eligible for review. The 
independent review organization shall review and reach a determination 
of the review in writing within 45 days of the receipt of any such 
appeal.
    ``(C) The Secretary of the Treasury may not enter into a contract 
under subparagraph (A) with an independent review organization--
            ``(i) unless the organization has staff that has the 
        appropriate knowledge of, and experience with, the eligibility 
        and coordination of benefits rules and regulations under this 
        title; and
            ``(ii) to the extent the organization is a fiscal 
        intermediary under section 1816, a carrier under section 1842, 
        or a Medicare administrative contractor under section 1874A.
    ``(D) The Secretary of Health and Human Services shall provide for 
access by independent review organizations conducting appeal 
determinations under this subsection, to the database of the 
Coordination of Benefits Contractor of the Centers for Medicare & 
Medicaid Services as necessary in order to conduct the duties of such 
organizations to determine appeals pursuant to this subsection.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
take effect beginning on the date that is 6 months after the date of 
the enactment of this Act.
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