[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2477 Engrossed in House (EH)]

<DOC>
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
116th CONGRESS
  2d Session
                                H. R. 2477

_______________________________________________________________________

                                 AN ACT


 
 To amend title XVIII of the Social Security Act to establish a system 
to notify individuals approaching Medicare eligibility, to simplify and 
 modernize the eligibility enrollment process, 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 2020'' or the ``BENES Act of 
2020''.

SEC. 2. BENEFICIARY ENROLLMENT NOTIFICATION AND ELIGIBILITY 
              SIMPLIFICATION.

    (a) Eligibility and Enrollment Notices.--
            (1) As part of social security account statement for 
        individuals attaining ages 63 to 65.--
                    (A) In general.--Section 1143(a) of the Social 
                Security Act (42 U.S.C. 1320b-13(a)) is amended by 
                adding at the end the following new paragraph:
    ``(4) Medicare Eligibility Information.--
            ``(A) In general.--In the case of statements provided on or 
        after the date that is 2 years after the date of the enactment 
        of this paragraph to individuals who are attaining ages 63, 64, 
        and 65, the statement shall also include a notice containing 
        the information described in subparagraph (B).
            ``(B) Contents of notice.--The notice required under 
        subparagraph (A) shall include a clear, simple explanation of--
                    ``(i) eligibility for benefits under the Medicare 
                program under title XVIII, and in particular benefits 
                under parts B and C of such title;
                    ``(ii) the reasons a late enrollment penalty for 
                failure to timely enroll could be assessed and how such 
                late enrollment penalty is calculated, in particular 
                for benefits under such part B;
                    ``(iii) the availability of relief from such late 
                enrollment penalty and retroactive enrollment under 
                section 1837(h) (including as such section is applied 
                under sections 1818(c) and 1818A(c)(3)), with examples 
                of circumstances under which such relief may be granted 
                and examples of circumstances under which such relief 
                would not be granted;
                    ``(iv) coordination of benefits (including primary 
                and secondary coverage scenarios) pursuant to section 
                1862(b), in particular for benefits under such part B;
                    ``(v) enrollment, eligibility, and coordination of 
                benefits under title XVIII with respect to populations, 
                for whom there are special considerations, such as 
                residents of Puerto Rico and veterans; and
                    ``(vi) online resources and toll-free telephone 
                numbers of the Social Security Administration and the 
                Centers for Medicare & Medicaid Services (including 1-
                800-MEDICARE and the national toll-free number of the 
                Social Security Administration) that provide 
                information on eligibility for benefits under the 
                Medicare program under title XVIII, including under 
                part C of such title.
            ``(C) Development of notice.--
                    ``(i) In general.--The Secretary, in coordination 
                with the Commissioner of Social Security, and taking 
                into consideration information collected pursuant to 
                clause (ii), shall, not later than 12 months after the 
                last day of the period for the request of information 
                described in clause (ii), develop the notice to be 
                provided pursuant to subparagraph (A).
                    ``(ii) Request for information.--Not later than 6 
                months after the date of the enactment of this 
                paragraph, the Secretary shall request written 
                information, including recommendations, from 
                stakeholders (including the groups described in 
                subparagraph (D)) on the information to be included in 
                the notice.
                    ``(iii) Notice improvement.--Beginning 4 years 
                after the date of the enactment of this paragraph, and 
                not less than once every 2 years thereafter, the 
                Secretary, in coordination with the Commissioner of 
                Social Security, shall--
                            ``(I) review the content of the notice to 
                        be provided under subparagraph (A);
                            ``(II) request written information, 
                        including recommendations, on such notice 
                        through a request for information process as 
                        described in clause (ii); and
                            ``(III) update and revise such notice as 
                        the Secretary deems appropriate.
            ``(D) Groups.--For purposes of subparagraph (C)(ii), the 
        groups described in this subparagraph include the following:
                    ``(i) Individuals who are 60 years of age or older.
                    ``(ii) Veterans.
                    ``(iii) Individuals with disabilities.
                    ``(iv) Individuals with end stage renal disease.
                    ``(v) Low-income individuals and families.
                    ``(vi) Employers (including human resources 
                professionals).
                    ``(vii) States (including representatives of State-
                run Health Insurance Exchanges, Medicaid offices, and 
                Departments of Insurance).
                    ``(viii) State Health Insurance Assistance 
                Programs.
                    ``(ix) Health insurers.
                    ``(x) Health insurance agents and brokers.
                    ``(xi) Such other groups as specified by the 
                Secretary.
            ``(E) Posting of notice on websites.--The Commissioner of 
        Social Security and the Secretary shall post the notice 
        required under subparagraph (A) on the public Internet website 
        of the Social Security Administration and on Medicare.gov (or a 
        successor website), respectively.
            ``(F) Reimbursement of costs.--
                    ``(i) In general.--Effective for fiscal years 
                beginning in the year in which the date of enactment of 
                this paragraph occurs, the Commissioner of Social 
                Security and the Secretary shall enter into an 
                agreement under which the Secretary shall provide for 
                the transfer, from the Federal Hospital Insurance Trust 
                Fund under section 1817 and the Federal Supplementary 
                Medical Insurance Trust Fund under section 1841 (in 
                such proportion as the Secretary determines 
                appropriate), of such sums as necessary to cover the 
                administrative costs of the Commissioner's activities 
                under this paragraph. Such agreement shall--
                            ``(I) provide funds to the Commissioner for 
                        the administrative costs of the Social Security 
                        Administration's work related to the 
                        implementation of this paragraph, including any 
                        initial costs incurred prior to the 
                        finalization of such agreement;
                            ``(II) provide such funding quarterly in 
                        advance of the applicable quarter based on 
                        estimating methodology agreed to by the 
                        Commissioner and the Secretary; and
                            ``(III) require an annual accounting (with 
                        a detailed description of the costs and 
                        methodology used to assess such costs) and 
                        reconciliation of the actual costs incurred and 
                        funds provided under this paragraph.
                    ``(ii) Limitation.--In no case shall funds from the 
                Social Security Administration's Limitation on 
                Administrative Expenses be used to carry out activities 
                related to the implementation of this paragraph, except 
                as the Commissioner determines is necessary--
                            ``(I) for the development of the agreement 
                        under clause (i); and
                            ``(II) on a temporary basis and subject to 
                        reimbursement under clause (i)(I), for the 
                        initial implementation of this paragraph.
            ``(G) No effect on obligation to mail statements.--Nothing 
        in this paragraph shall be construed to relieve the 
        Commissioner of Social Security from any requirement under 
        subsection (c), including the requirement to mail a statement 
        on an annual basis to each eligible individual who is not 
        receiving benefits under title II and for whom a mailing 
        address can be determined through such methods as the 
        Commissioner determines to be appropriate.''.
                    (B) Timing of statements.--Section 1143(c)(2) of 
                such Act (42 U.S.C. 1320b-13(c)(2)) is amended by 
                adding at the end the following: ``With respect to 
                statements provided to individuals who are attaining 
                age 65, as described in subsection (a)(4), such 
                statements shall be mailed not earlier than 6 months 
                and not later than 3 months before the individual 
                attains such age.''
            (2) Social security beneficiaries.--Title XI of the Social 
        Security Act (42 U.S.C. 1301 et seq.) is amended by inserting 
        after section 1144 the following new section:

 ``medicare enrollment notification and eligibility notices for social 
          security beneficiaries prior to medicare eligibility

                               ``Notices

    ``Sec. 1144A. (a)
            ``(1) In General.--The Commissioner of Social Security 
        shall distribute the notice to be provided pursuant to section 
        1143(a)(4), as may be modified under paragraph (2), to 
        individuals entitled to monthly insurance benefits under title 
        II in accordance with subsection (b).
            ``(2) Authority to Modify Notice.--The Secretary, in 
        coordination with the Commissioner of Social Security, may 
        modify the notice to be distributed under paragraph (1) as 
        necessary to take into account the individuals described in 
        such paragraph.
            ``(3) Posting of Notice on Websites.--The Commissioner of 
        Social Security and the Secretary shall post the notice 
        required to be distributed under paragraph (1) on the public 
        Internet website of the Social Security Administration and on 
        Medicare.gov (or a successor website), respectively.

                                ``Timing

    ``(b) Beginning not later than 2 years after the date of the 
enactment of this section, a notice required under subsection (a)(1) 
shall be mailed to an individual described in such subsection--
            ``(1) in the third month before the date on which such 
        individual's initial enrollment period begins as provided under 
        section 1837; and
            ``(2) in the case of an individual with respect to whom 
        section 226(b) applies (except for an individual who will 
        attain age 65 during the 24 month period described in such 
        section), in the month before such date on which such 
        individual's initial enrollment period so begins.

                        ``Reimbursement of Costs

    ``(c)
            ``(1) In General.--Effective for fiscal years beginning in 
        the year in which the date of enactment of this section occurs, 
        the Commissioner of Social Security and the Secretary shall 
        enter into an agreement under which the Secretary shall provide 
        for the transfer, from the Federal Hospital Insurance Trust 
        Fund under section 1817 and the Federal Supplementary Medical 
        Insurance Trust Fund under section 1841 (in such proportion as 
        the Secretary determines appropriate), of such sums as 
        necessary to cover the administrative costs of the 
        Commissioner's activities under this section. Such agreement 
        shall--
                    ``(A) provide funds to the Commissioner for the 
                administrative costs of the Social Security 
                Administration's work related to the implementation of 
                this section, including any initial costs incurred 
                prior to the finalization of such agreement;
                    ``(B) provide such funding quarterly in advance of 
                the applicable quarter based on estimating methodology 
                agreed to by the Commissioner and the Secretary; and
                    ``(C) require an annual accounting (with a detailed 
                description of the costs and methodology used to assess 
                such costs) and reconciliation of the actual costs 
                incurred and funds provided under this paragraph.
            ``(2) Limitation.--In no case shall funds from the Social 
        Security Administration's Limitation on Administrative Expenses 
        be used to carry out activities related to the implementation 
        of this section, except as the Commissioner determines is 
        necessary--
                    ``(A) for the development of the agreement under 
                paragraph (1); and
                    ``(B) on a temporary basis and subject to 
                reimbursement under paragraph (1)(A), for the initial 
                implementation of this section.''.
    (b) Beneficiary Enrollment Simplification.--
            (1) Effective date of coverage.--Section 1838(a) of the 
        Social Security Act (42 U.S.C. 1395q(a)) is amended--
                    (A) 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(a), the 
        first day of such month,
            ``(B) in the case of an individual who first satisfies such 
        paragraph in a month beginning before January 2023 and who 
        enrolls pursuant to such subsection (d)--
                    ``(i) 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) 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) 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 who first satisfies such 
        paragraph in a month beginning on or after January 1, 2023, and 
        who enrolls pursuant to such subsection (d) in such month in 
        which he first satisfies such paragraph or in any subsequent 
        month of his initial enrollment period, the first day of the 
        month following the month in which he so enrolls, or
            ``(D) in the case of an individual who enrolls pursuant to 
        subsection (e) of section 1837 in a month beginning--
                    ``(i) before January 1, 2023, the July 1 following 
                the month in which he so enrolls; or
                    ``(ii) on or after January 1, 2023, the first day 
                of the month following the month in which he so 
                enrolls; or''; and
                    (B) by amending paragraph (3) to read as follows:
            ``(3) in the case of an individual who is deemed to have 
        enrolled--
                    ``(A) on or before the last day of the third month 
                of his initial enrollment period, the first day of the 
                month in which he first meets the applicable 
                requirements of section 1836(a) or July 1, 1973, 
                whichever is later, or
                    ``(B) on or after the first day of the fourth month 
                of his initial enrollment period, and where such month 
                begins--
                            ``(i) before January 1, 2023, as prescribed 
                        under subparagraphs (B)(i), (B)(ii), (B)(iii), 
                        and (D)(i) of paragraph (2), or
                            ``(ii) on or after January 1, 2023, as 
                        prescribed under subparagraphs (C) and (D)(ii) 
                        of paragraph (2).''.
            (2) Special enrollment periods for exceptional 
        circumstances.--
                    (A) Enrollment.--Section 1837 of the Social 
                Security Act (42 U.S.C. 1395p) is amended by adding at 
                the end the following new subsection:
    ``(m) Beginning January 1, 2023, the Secretary may establish 
special enrollment periods in the case of individuals who satisfy 
paragraph (1) or (2) of section 1836(a) and meet such exceptional 
conditions as the Secretary may provide.''.
                    (B) Coverage period.--Section 1838 of the Social 
                Security Act (42 U.S.C. 1395q) is amended by adding at 
                the end the following new subsection:
    ``(g) Notwithstanding subsection (a), in the case of an individual 
who enrolls during a special enrollment period pursuant to section 
1837(m), the coverage period shall begin on a date the Secretary 
provides in a manner consistent (to the extent practicable) with 
protecting continuity of health benefit coverage.''.
                    (C) Conforming amendment.--Title XVIII of the 
                Social Security Act (42 U.S.C. 1395 et seq.) is 
                amended--
                            (i) in section 1818A(c)(3), by striking 
                        ``subsections (h) and (i) of section 1837'' and 
                        inserting ``subsections (h), (i), and (m) of 
                        section 1837''; and
                            (ii) in section 1839(b), in the first 
                        sentence, by striking ``or (l)'' and inserting 
                        ``, (l), or (m)''.
            (3) Technical correction.--Section 1839(b) of the Social 
        Security Act (42 U.S.C. 1395r(b)) is amended by adding at the 
        end the following new sentence: ``For purposes of determining 
        any increase under this subsection for individuals whose 
        enrollment occurs on or after January 1, 2023, the second 
        sentence of this subsection shall be applied by substituting 
        `close of the month' for `close of the enrollment period' each 
        place it appears.''.
            (4) Report.--Not later than January 1, 2023, the Secretary 
        of Health and Human Services shall submit to the Committee on 
        Ways and Means and Committee on Energy and Commerce of the 
        House of Representatives and the Committee on Finance and 
        Special Committee on Aging of the Senate a report on how to 
        align existing Medicare enrollment periods under title XVIII of 
        the Social Security Act, including the general enrollment 
        period under part B of such title and the annual, coordinated 
        election period under the Medicare Advantage program under part 
        C of such title and under the prescription drug program under 
        part D of such title. Such report shall include recommendations 
        consistent with the goals of maximizing coverage continuity and 
        choice and easing beneficiary transition.
            (5) GAO study and report.--
                    (A) Study.--The Comptroller General of the United 
                States (in this section referred to as the 
                ``Comptroller General'') shall conduct a study on the 
                activities carried out under this section. Such study 
                shall include the following:
                            (i) An analysis of the Social Security 
                        Administration's use of the funds provided to 
                        carry out the activities described under this 
                        section and the amendments made by this 
                        section. The Comptroller General shall examine 
                        the amount of funds transferred from the 
                        Federal Hospital Insurance Trust Fund and the 
                        Federal Supplementary Medical Insurance Trust 
                        Fund, respectively, for those activities; how 
                        the funds were spent; what procedures the 
                        agency had in place over the use of those 
                        funds; and how the agency complied with those 
                        procedures.
                            (ii) An evaluation of the notices described 
                        in sections 1143(a)(4)(A) and 1144A(a) of the 
                        Social Security Act, including, to the extent 
                        data is available, how the mailing of such 
                        notices affected enrollee behavior and the 
                        imposition of late enrollment penalties under 
                        Medicare Part B.
                            (iii) Any other area determined appropriate 
                        by the Comptroller General.
                    (B) Report.--Not later than 5 years after the date 
                of enactment of this section, the Comptroller General 
                shall submit to the Committee on Ways and Means and 
                Committee on Energy and Commerce of the House of 
                Representatives and the Committee on Finance of the 
                Senate a report containing the results of the study 
                conducted under paragraph (1), including 
                recommendations for any legislative and administrative 
                actions as the Comptroller General determines 
                appropriate.
    (c) Funding.--Section 1808 of the Social Security Act (42 U.S.C. 
1395b-9) is amended by adding the end the following new subsection:
    ``(e) Funding for Implementation of Beneficiary Enrollment 
Notification and Eligibility Simplification.--For purposes of carrying 
out the provisions of and the amendments made by section 2 of the BENES 
Act of 2020, the Secretary shall provide for the transfer, from the 
Federal Hospital Insurance Trust Fund under section 1817 and the 
Federal Supplementary Medical Insurance Trust Fund under section 1841 
(in such proportion as the Secretary determines appropriate), to the 
Centers for Medicare & Medicaid Services Program Management Account, of 
$2,000,000 for each fiscal year beginning with fiscal year 2021, to 
remain available until expended.''.

SEC. 3. EXTENDED MONTHS OF COVERAGE OF IMMUNOSUPPRESSIVE DRUGS FOR 
              KIDNEY TRANSPLANT PATIENTS AND OTHER RENAL DIALYSIS 
              PROVISIONS.

    (a) Medicare Entitlement to Immunosuppressive Drugs for Kidney 
Transplant Recipients.--
            (1) In general.--Section 226A(b)(2) of the Social Security 
        Act (42 U.S.C. 426-1(b)(2)) is amended by inserting ``(except 
        for eligibility for enrollment under part B solely for purposes 
        of coverage of immunosuppressive drugs described in section 
        1861(s)(2)(J))'' before ``, with the thirty-sixth month''.
            (2) Individuals eligible only for coverage of 
        immunosuppressive drugs.--
                    (A) In general.--Section 1836 of the Social 
                Security Act (42 U.S.C. 1395o) is amended--
                            (i) by striking ``Every'' and inserting 
                        ``(a) In General.--Every''; and
                            (ii) by adding at the end the following new 
                        subsection:
    ``(b) Individuals Eligible for Immunosuppressive Drug Coverage.--
            ``(1) In general.--Except as provided under paragraph (2), 
        every individual whose entitlement to insurance benefits under 
        part A ends (whether before, on, or after January 1, 2023) by 
        reason of section 226A(b)(2) is eligible to enroll or to be 
        deemed to have enrolled in the medical insurance program 
        established by this part solely for purposes of coverage of 
        immunosuppressive drugs in accordance with section 1837(n).
            ``(2) Exception if other coverage is available.--
                    ``(A) In general.--An individual described in 
                paragraph (1) shall not be eligible for enrollment in 
                the program for purposes of coverage described in such 
                paragraph with respect to any period in which the 
                individual, as determined in accordance with 
                subparagraph (B)--
                            ``(i) is enrolled in a group health plan or 
                        group or individual health insurance coverage, 
                        as such terms are defined in section 2791 of 
                        the Public Health Service Act;
                            ``(ii) is enrolled for coverage under the 
                        TRICARE for Life program under section 1086(d) 
                        of title 10, United States Code;
                            ``(iii) is enrolled under a State plan (or 
                        waiver of such plan) under title XIX and is 
                        eligible to receive benefits for 
                        immunosuppressive drugs described in this 
                        subsection under such plan (or such waiver);
                            ``(iv) is enrolled under a State child 
                        health plan (or waiver of such plan) under 
                        title XXI and is eligible to receive benefits 
                        for such drugs under such plan (or such 
                        waiver); or
                            ``(v)(I) is enrolled in the patient 
                        enrollment system of the Department of Veterans 
                        Affairs established and operated under section 
                        1705 of title 38, United States Code;
                            ``(II) is not required to enroll under 
                        section 1705 of such title to receive 
                        immunosuppressive drugs described in this 
                        subsection; or
                            ``(III) is otherwise eligible under a 
                        provision of title 38, United States Code, 
                        other than section 1710 of such title to 
                        receive immunosuppressive drugs described in 
                        this subsection.
                    ``(B) Eligibility determinations.--
                            ``(i) In general.--The Secretary, in 
                        coordination with the Commissioner of Social 
                        Security, shall establish a process for 
                        determining whether an individual described in 
                        paragraph (1) who is to be enrolled or deemed 
                        to be enrolled in the medical insurance program 
                        described in such paragraph meets the 
                        requirements for such enrollment under this 
                        subsection, including the requirement that the 
                        individual not be enrolled in other coverage as 
                        described in subparagraph (A).
                            ``(ii) Attestation regarding other 
                        coverage.--The process established under clause 
                        (i) shall include, at a minimum, a requirement 
                        that--
                                    ``(I) the individual provide to the 
                                Commissioner an attestation that the 
                                individual is not enrolled and does not 
                                expect to enroll in such other 
                                coverage; and
                                    ``(II) the individual notify the 
                                Commissioner within 60 days of 
                                enrollment in such other coverage.''.
                    (B) Conforming amendment.--
                            (i) In general.--Sections 1837, 1838, and 
                        1839 of the Social Security Act (42 U.S.C. 
                        1395p, 42 U.S.C. 1395q, 42 U.S.C. 1395r) are 
                        each amended by striking ``1836'' and inserting 
                        ``1836(a)'' each place it appears.
                            (ii) Additional amendment.--Section 
                        1837(j)(1) of such Act (42 U.S.C. 1395p(j)(1)) 
                        is amended by striking ``1836(1)'' and 
                        inserting ``1836(a)(1)''.
    (b) Enrollment for Individuals Only Eligible for Coverage of 
Immunosuppressive Drugs.--Section 1837 of the Social Security Act (42 
U.S.C. 1395p), as amended by section 2(b)(2)(A), is further amended by 
adding at the end the following new subsection:
    ``(n)(1) Any individual who is eligible for coverage of 
immunosuppressive drugs under section 1836(b) may enroll or be deemed 
to have enrolled only in such manner and form as may be prescribed by 
regulations, and only during an enrollment period described in this 
subsection.
    ``(2) An individual described in paragraph (1) whose entitlement 
for hospital insurance benefits under part A ends by reason of section 
226A(b)(2) prior to January 1, 2023, may enroll beginning on October 1, 
2022, or the day on which the individual first satisfies section 
1836(b), whichever is later.
    ``(3) An individual described in paragraph (1) whose entitlement 
for hospital insurance benefits under part A ends by reason of section 
226A(b)(2) on or after January 1, 2023, shall be deemed to have 
enrolled in the medical insurance program established by this part for 
purposes of coverage of immunosuppressive drugs.
    ``(4) The Secretary shall establish a process under which an 
individual described in paragraph (1) whose other coverage described in 
section 1836(b)(2)(A), or coverage under this part (including the 
medical insurance program established under this part for purposes of 
coverage of immunosuppressive drugs), is terminated voluntarily or 
involuntary may enroll or reenroll, if applicable, in the medical 
insurance program established under this part for purposes of coverage 
of immunosuppressive drugs.''.
    (c) Coverage Period for Individuals Only Eligible for Coverage of 
Immunosuppressive Drugs.--
            (1) In general.--Section 1838 of the Social Security Act 
        (42 U.S.C. 1395q), as amended by section 2(b)(2)(B), is further 
        amended by adding at the end the following new subsection:
    ``(h) In the case of an individual described in section 1836(b)(1), 
the following rules shall apply:
            ``(1) In the case of such an individual who is deemed to 
        have enrolled in part B for coverage of immunosuppressive drugs 
        under section 1837(n)(3), such individual's coverage period 
        shall begin on the first day of the month in which the 
        individual first satisfies section 1836(b).
            ``(2) In the case of such an individual who enrolls (or 
        reenrolls, if applicable) in part B for coverage of 
        immunosuppressive drugs under paragraph (2) or (4) of section 
        1837(n), such individual's coverage period shall begin on 
        January 1, 2023, or the month following the month in which the 
        individual so enrolls (or reenrolls), whichever is later.
            ``(3) The provisions of subsections (b) and (d) shall apply 
        with respect to an individual described in paragraph (1) or 
        (2).
            ``(4) In addition to the reasons for termination under 
        subsection (b), the coverage period of an individual described 
        in paragraph (1) or (2) shall end when the individual becomes 
        entitled to benefits under this title under subsection (a) or 
        (b) of section 226, or under section 226A, or is no longer 
        eligible for such coverage as a result of the application of 
        section 1836(b)(2).
            ``(5) The Secretary may conduct public education activities 
        to raise awareness of the availability of more comprehensive, 
        individual health insurance coverage (as defined in section 
        2791 of the Public Health Service Act) for individuals eligible 
        under section 1836(b) to enroll or to be deemed enrolled in the 
        medical insurance program established under this part for 
        purposes of coverage of immunosuppressive drugs.''.
            (2) Conforming amendments.--Section 1838(b) of the Social 
        Security Act (42 U.S.C. 1395q(b)) is amended, in the matter 
        following paragraph (2), by inserting ``or section 1837(n)(3)'' 
        after ``section 1837(f)'' each place it appears.
    (d) Premiums for Individuals Only Eligible for Coverage of 
Immunosuppressive Drugs.--
            (1) In general.--Section 1839 of the Social Security Act 
        (42 U.S.C. 1395r) is amended--
                    (A) in subsection (b), by adding at the end the 
                following new sentence: ``No increase in the premium 
                shall be effected for individuals who are enrolled 
                pursuant to section 1836(b) for coverage only of 
                immunosuppressive drugs.''; and
                    (B) by adding at the end the following new 
                subsection:
    ``(j) Determination of Premium for Individuals Only Eligible for 
Coverage of Immunosuppressive Drugs.--The Secretary shall, during 
September of each year (beginning with 2022), determine and promulgate 
a monthly premium rate for the succeeding calendar year for individuals 
enrolled only for the purpose of coverage of immunosuppressive drugs 
under section 1836(b). Such premium shall be equal to 15 percent of the 
monthly actuarial rate for enrollees age 65 and over (as would be 
determined in accordance with subsection (a)(1) if the reference to 
`one-half' in such subsection were a reference to `100 percent') for 
that succeeding calendar year. The monthly premium of each individual 
enrolled for coverage of immunosuppressive drugs under section 1836(b) 
for each month shall be the amount promulgated in this subsection. In 
the case of such individual not otherwise enrolled under this part, 
such premium shall be in lieu of any other monthly premium applicable 
under this section. Such amount shall be adjusted in accordance with 
subsections (c), (f), and (i), but shall not be adjusted under 
subsection (b).''.
            (2) Special rule for application of hold harmless 
        provisions to transitioning individuals.--Section 1839(f) of 
        the Social Security Act (42 U.S.C. 1395r(f)) is amended by 
        adding at the end the following new sentence: ``Any increase in 
        the premium for an individual who was enrolled under section 
        1836(b) attributable to such individual otherwise enrolling 
        under this part shall not be taken into account in applying 
        this subsection.''.
            (3) Special rule for application of premium subsidy 
        reduction provisions.--Section 1839(i)(3)(A)(ii)(II) of the 
        Social Security Act (42 U.S.C. 1395r(i)(3)(A)(ii)(II)) is 
        amended by inserting ``except in the case of an individual 
        enrolled under section 1836(b) and not otherwise enrolled under 
        this part,'' before ``4 times''.
    (e) Government Contribution.--Section 1844(a) of the Social 
Security Act (42 U.S.C. 1395w(a)) is amended--
            (1) in paragraph (3), by striking the period at the end and 
        inserting ``; plus'';
            (2) by inserting after paragraph (3) the following new 
        paragraph:
            ``(4) a Government contribution equal to the estimated 
        aggregate reduction in premiums payable under part B that 
        results from establishing the premium at 15 percent of the 
        actuarial rate (as would be determined in accordance with 
        section 1839(a)(1) if the reference to `one-half' in such 
        section were a reference to `100 percent') under section 
        1839(j) instead of 25 percent of such rate (as so determined) 
        for individuals enrolled only for the purpose of coverage of 
        immunosuppressive drugs under section 1836(b).''; and
            (3) by adding the following sentence at the end of the 
        flush matter following paragraph (4), as added by paragraph (2) 
        of this subsection:
        ``The Government contribution under paragraph (4) shall be 
        treated as premiums payable and deposited for purposes of 
        subparagraphs (A) and (B) of paragraph (1).''.
    (f) Ensuring Coverage Under the Medicare Savings Program.--
            (1) In general.--Section 1905(p)(1)(A) of the Social 
        Security Act (42 U.S.C. 1396d(p)(1)(A)) is amended by inserting 
        ``or who is enrolled under part B for the purpose of coverage 
        of immunosuppressive drugs under section 1836(b)'' after 
        ``under section 1818A)''.
            (2) Conforming amendments.--Section 1902(a)(10)(E) of the 
        Social Security Act (42 U.S.C. 1396a(a)(10)(E)) is amended in 
        each of clauses (iii) and (iv) by inserting ``(including such 
        individuals enrolled under section 1836(b))'' after ``section 
        1905(p)(1)''.
    (g) Part D.--Section 1860D-1(a)(3)(A) of the Social Security Act 
(42 U.S.C. 1395w-101(a)(3)(A)) is amended by inserting ``(but not 
including an individual enrolled solely for coverage of 
immunosuppressive drugs under section 1836(b))'' before the period at 
the end.
    (h) GAO Study and Report.--
            (1) Study.--The Comptroller General of the United States 
        (in this subsection referred to as the ``Comptroller General'') 
        shall conduct a study on the implementation of coverage of 
        immunosuppressive drugs for kidney transplant patients under 
        the Medicare program pursuant to the provisions of, and 
        amendments made by, this section.
            (2) Report.--Not later than January 1, 2025, the 
        Comptroller General shall submit to Congress a report on the 
        study conducted under paragraph (1), together with 
        recommendations as the Comptroller General determines 
        appropriate.

SEC. 4. TRANSPARENCY OF MEDICARE SECONDARY PAYER REPORTING INFORMATION.

    (a) In General.--Section 1862(b)(8)(G) of the Social Security Act 
(42 U.S.C. 395y(b)(8)(G)) is amended--
            (1) by striking ``information.--The Secretary'' and 
        inserting ``information.--
                            ``(i) In general.--The Secretary''; and
            (2) by adding at the end the following new clause:
                            ``(ii) Specified information.--In 
                        responding to any query from an applicable plan 
                        related to a determination described in 
                        subparagraph (A)(i), the Secretary, 
                        notwithstanding any other provision of law, 
                        shall provide to such applicable plan--
                                    ``(I) whether a claimant subject to 
                                the query is, or during the preceding 
                                3-year period has been, entitled to 
                                benefits under the program under this 
                                title on any basis; and
                                    ``(II) to the extent applicable, 
                                the plan name and address of any 
                                Medicare Advantage plan under part C 
                                and any prescription drug plan under 
                                part D in which the claimant is 
                                enrolled or has been enrolled during 
                                such period.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply with respect to queries from plans made on or after the date that 
is one year after the date of the enactment of this Act.

SEC. 5. ESTABLISHING HOSPICE PROGRAM SURVEY AND ENFORCEMENT PROCEDURES 
              UNDER THE MEDICARE PROGRAM.

    (a) Survey and Enforcement Procedures.--
            (1) In general.--Part A of title XVIII of the Social 
        Security Act (42 U.S.C. 1395c et seq.) is amended by adding at 
        the end the following new section:

``SEC. 1822. HOSPICE PROGRAM SURVEY AND ENFORCEMENT PROCEDURES.

    ``(a) Surveys.--
            ``(1) Frequency.--Any entity that is certified as a hospice 
        program shall be subject to a standard survey by an appropriate 
        State or local survey agency, or an approved accreditation 
        agency, as determined by the Secretary, not less frequently 
        than once every 36 months (and not less frequently than once 
        every 24 months beginning October 1, 2021).
            ``(2) Public transparency of survey and certification 
        information.--
                    ``(A) Submission of information to the secretary.--
                            ``(i) In general.--Each State, and each 
                        national accreditation body with respect to 
                        which the Secretary has made a finding under 
                        section 1865(a) respecting the accreditation of 
                        a hospice program by such body, shall submit, 
                        in a form and manner, and at a time, specified 
                        by the Secretary for purposes of this 
                        subparagraph, information respecting any survey 
                        or certification made with respect to a hospice 
                        program by such State or body, as applicable. 
                        Such information shall include any inspection 
                        report made by such State or body with respect 
                        to such survey or certification, any 
                        enforcement actions taken as a result of such 
                        survey or certification, and any other 
                        information determined appropriate by the 
                        Secretary.
                            ``(ii) Required inclusion of specified 
                        form.--With respect to a survey under this 
                        subsection carried out by a national 
                        accreditation body described in clause (i) on 
                        or after October 1, 2021, information described 
                        in such clause shall include Form 2567 (or a 
                        successor form), along with such additional 
                        information determined appropriate by such 
                        body.
                    ``(B) Public disclosure of information.--Beginning 
                not later than October 1, 2022, the Secretary shall 
                publish the information submitted under subparagraph 
                (A) on the public website of the Centers for Medicare & 
                Medicaid Services in a manner that is prominent, easily 
                accessible, readily understandable, and searchable. The 
                Secretary shall provide for the timely update of such 
                information so published.
            ``(3) Consistency of surveys.--Each State and the Secretary 
        shall implement programs to measure and reduce inconsistency in 
        the application of survey results among surveyors.
            ``(4) Survey teams.--
                    ``(A) In general.--In the case of a survey 
                conducted under this subsection on or after October 1, 
                2021, by more than 1 individual, such survey shall be 
                conducted by a multidisciplinary team of professionals 
                (including a registered professional nurse).
                    ``(B) Prohibition of conflicts of interest.--
                Beginning October 1, 2021, a State may not use as a 
                member of a survey team under this subsection an 
                individual who is serving (or has served within the 
                previous 2 years) as a member of the staff of, or as a 
                consultant to, the program surveyed respecting 
                compliance with the requirements of section 1861(dd) or 
                who has a personal or familial financial interest in 
                the program being surveyed.
                    ``(C) Training.--The Secretary shall provide, not 
                later than October 1, 2021, for the comprehensive 
                training of State and Federal surveyors, and any 
                surveyor employed by a national accreditation body 
                described in paragraph (2)(A)(i), in the conduct of 
                surveys under this subsection, including training with 
                respect to the review of written plans for providing 
                hospice care (as described in section 1814(a)(7)(B)). 
                No individual shall serve as a member of a survey team 
                with respect to a survey conducted on or after such 
                date unless the individual has successfully completed a 
                training and testing program in survey and 
                certification techniques that has been approved by the 
                Secretary.
            ``(5) Funding.--The Secretary shall provide for the 
        transfer, from the Federal Hospital Insurance Trust Fund under 
        section 1817 to the Centers for Medicare & Medicaid Services 
        Program Management Account, of $10,000,000 for each fiscal year 
        (beginning with fiscal year 2022) for purposes of carrying out 
        this subsection and subsection (b). Sums so transferred shall 
        remain available until expended. Any transfer pursuant to this 
        paragraph shall be in addition to any transfer pursuant to 
        section 3(a)(2) of the Improving Medicare Post-Acute Care 
        Transformation Act of 2014.
    ``(b) Special Focus Program.--
            ``(1) In general.--The Secretary shall conduct a special 
        focus program for enforcement of requirements for hospice 
        programs that the Secretary has identified as having 
        substantially failed to meet applicable requirements of this 
        Act.
            ``(2) Periodic surveys.--Under such special focus program, 
        the Secretary shall conduct surveys of each hospice program in 
        the special focus program not less than once every 6 months.
    ``(c) Enforcement.--
            ``(1) Situations involving immediate jeopardy.--If the 
        Secretary determines on the basis of a standard survey or 
        otherwise that a hospice program that is certified for 
        participation under this title is no longer in compliance with 
        the requirements specified in section 1861(dd) and determines 
        that the deficiencies involved immediately jeopardize the 
        health and safety of the individuals to whom the program 
        furnishes items and services, the Secretary shall take 
        immediate action to remove the jeopardy and correct the 
        deficiencies through the remedy described in paragraph 
        (5)(B)(iii) or terminate the certification of the program, and 
        may provide, in addition, for 1 or more of the other remedies 
        described in paragraph (5)(B).
            ``(2) Situations not involving immediate jeopardy.--If the 
        Secretary determines on the basis of a standard survey or 
        otherwise that a hospice program that is certified for 
        participation under this title is no longer in compliance with 
        the requirements specified in section 1861(dd) and determines 
        that the deficiencies involved do not immediately jeopardize 
        the health and safety of the individuals to whom the program 
        furnishes items and services, the Secretary may (for a period 
        not to exceed 6 months) impose remedies developed pursuant to 
        paragraph (5)(A), in lieu of terminating the certification of 
        the program. If, after such a period of remedies, the program 
        is still no longer in compliance with such requirements, the 
        Secretary shall terminate the certification of the program.
            ``(3) Penalty for previous noncompliance.--If the Secretary 
        determines that a hospice program that is certified for 
        participation under this title is in compliance with the 
        requirements specified in section 1861(dd) but, as of a 
        previous period, did not meet such requirements, the Secretary 
        may provide for a civil monetary penalty under paragraph 
        (5)(B)(i) for the days in which the Secretary finds that the 
        program was not in compliance with such requirements.
            ``(4) Option to continue payments for noncompliant hospice 
        programs.--The Secretary may continue payments under this title 
        with respect to a hospice program not in compliance with the 
        requirements specified in section 1861(dd) over a period of not 
        longer than 6 months, if--
                    ``(A) the State or local survey agency finds that 
                it is more appropriate to take alternative action to 
                assure compliance of the program with such requirements 
                than to terminate the certification of the program;
                    ``(B) the program has submitted a plan and 
                timetable for corrective action to the Secretary for 
                approval and the Secretary approves the plan of 
                corrective action; and
                    ``(C) the program agrees to repay to the Federal 
                Government payments received under this title during 
                such period if the corrective action is not taken in 
                accordance with the approved plan and timetable.
        The Secretary shall establish guidelines for approval of 
        corrective actions requested by hospice programs under this 
        paragraph.
            ``(5) Remedies.--
                    ``(A) Development.--
                            ``(i) In general.--Not later than October 
                        1, 2021, the Secretary shall develop and 
                        implement--
                                    ``(I) a range of remedies to apply 
                                to hospice programs under the 
                                conditions described in paragraphs (1) 
                                through (4); and
                                    ``(II) appropriate procedures for 
                                appealing determinations relating to 
                                the imposition of such remedies.
                        Remedies developed pursuant to the preceding 
                        sentence shall include the remedies specified 
                        in subparagraph (B).
                            ``(ii) Conditions of imposition of 
                        remedies.--Not later than October 1, 2021, the 
                        Secretary shall develop and implement specific 
                        procedures with respect to the conditions under 
                        which each of the remedies developed under 
                        clause (i) is to be applied, including the 
                        amount of any fines and the severity of each of 
                        these remedies. Such procedures shall be 
                        designed so as to minimize the time between 
                        identification of deficiencies and imposition 
                        of these remedies and shall provide for the 
                        imposition of incrementally more severe fines 
                        for repeated or uncorrected deficiencies.
                    ``(B) Specified remedies.--The remedies specified 
                in this subparagraph are the following:
                            ``(i) Civil monetary penalties in an amount 
                        not to exceed $10,000 for each day of 
                        noncompliance by a hospice program with the 
                        requirements specified in section 1861(dd).
                            ``(ii) Suspension of all or part of the 
                        payments to which a hospice program would 
                        otherwise be entitled under this title with 
                        respect to items and services furnished by a 
                        hospice program on or after the date on which 
                        the Secretary determines that remedies should 
                        be imposed pursuant to paragraph (2).
                            ``(iii) The appointment of temporary 
                        management to oversee the operation of the 
                        hospice program and to protect and assure the 
                        health and safety of the individuals under the 
                        care of the program while improvements are made 
                        in order to bring the program into compliance 
                        with all such requirements.
                    ``(C) Procedures.--
                            ``(i) Civil monetary penalties.--
                                    ``(I) In general.--Subject to 
                                subclause (II), the provisions of 
                                section 1128A (other than subsections 
                                (a) and (b)) shall apply to a civil 
                                monetary penalty under this subsection 
                                in the same manner as such provisions 
                                apply to a penalty or proceeding under 
                                section 1128A(a).
                                    ``(II) Retention of amounts for 
                                hospice program improvements.--The 
                                Secretary may provide that any portion 
                                of civil monetary penalties collected 
                                under this subsection may be used to 
                                support activities that benefit 
                                individuals receiving hospice care, 
                                including education and training 
                                programs to ensure hospice program 
                                compliance with the requirements of 
                                section 1861(dd).
                            ``(ii) Suspension of payment.--A finding to 
                        suspend payment under subparagraph (B)(ii) 
                        shall terminate when the Secretary finds that 
                        the program is in substantial compliance with 
                        all such requirements.
                            ``(iii) Temporary management.--The 
                        temporary management under subparagraph 
                        (B)(iii) shall not be terminated until the 
                        Secretary has determined that the program has 
                        the management capability to ensure continued 
                        compliance with all the requirements referred 
                        to in such subparagraph.
                    ``(D) Relationship to other remedies.--The remedies 
                developed under subparagraph (A) are in addition to 
                sanctions otherwise available under State or Federal 
                law and shall not be construed as limiting other 
                remedies, including any remedy available to an 
                individual at common law.''.
            (2) Availability of hospice accreditation surveys.--Section 
        1865(b) of the Social Security Act (42 U.S.C. 1395bb(b)) is 
        amended by inserting ``or, beginning on the date of the 
        enactment of the BENES Act of 2020, a hospice program'' after 
        ``home health agency''.
            (3) State provision of hospice program information.--
                    (A) In general.--Section 1864(a) of the Social 
                Security Act (42 U.S.C. 1395aa(a)) is amended in the 
                sixth sentence--
                            (i) by inserting ``and hospice programs'' 
                        after ``information on home health agencies'';
                            (ii) by inserting ``or the hospice 
                        program'' after ``the home health agency'';
                            (iii) by inserting ``or the hospice 
                        program'' after ``with respect to the agency''; 
                        and
                            (iv) by inserting ``and hospice programs'' 
                        after ``with respect to home health agencies''.
                    (B) Effective date.--The amendments made by 
                subparagraph (A) shall apply with respect to agreements 
                entered into on or after, or in effect as of, the date 
                that is 1 year after the date of the enactment of this 
                Act.
            (4) Conforming amendments.--
                    (A) Definition of a hospice program.--Section 
                1861(dd)(4) of the Social Security Act (42 U.S.C. 
                1395x(dd)(4)) is amended by striking subparagraph (C).
                    (B) Continuation of funding.--Section 3(a)(2) of 
                the Improving Medicare Post-Acute Care Transformation 
                Act of 2014 is amended by inserting ``and section 
                1822(a)(1) of such Act,'' after ``as added by paragraph 
                (1),''.
    (b) Increasing Payment Reductions for Failure to Meet Quality Data 
Reporting Requirements.--Section 1814(i)(5)(A)(i) of the Social 
Security Act (42 U.S.C. 1395f(i)(5)(A)(i)) is amended by inserting 
``(or, for fiscal year 2023 and each subsequent fiscal year, 4 
percentage points)'' before the period.
    (c) Report.--Not later than 36 months after the date of the 
enactment of this Act, the Comptroller General of the United States 
shall submit to the Committee on Ways and Means of the House of 
Representatives and the Committee on Finance of the Senate a report 
containing an analysis of the effects of the amendments made by 
subsection (a), including the frequency of application of remedies 
specified in section 1822(c)(5)(B) of the Social Security Act (as added 
by such subsection), on access to, and quality of, care furnished by 
hospice programs under part A of title XVIII of the Social Security Act 
(42 U.S.C. 1395c et seq.).

            Passed the House of Representatives December 8, 2020.

            Attest:

                                                                 Clerk.
116th CONGRESS

  2d Session

                               H. R. 2477

_______________________________________________________________________

                                 AN ACT

 To amend title XVIII of the Social Security Act to establish a system 
to notify individuals approaching Medicare eligibility, to simplify and 
 modernize the eligibility enrollment process, and for other purposes.