[Congressional Record Volume 153, Number 144 (Wednesday, September 26, 2007)]
[Senate]
[Pages S12148-S12153]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN (for himself, Mr. Kerry, Mr. Salazar, and Ms. 
        Stabenow):
  S. 2101. A bill to amend title XIX of the Social Security Act to 
assist low-income Medicare beneficiaries by improving eligibility and 
services under the Medicare Savings Program, and for other purposes; to 
the Committee on Finance.
  Mr. BINGAMAN. Mr. President, I rise today with Senators Kerry, 
Salazar and Stabenow to introduce the Medicare Savings Program 
Improvement Act of 2007. This legislation would make critical 
improvements to the Medicare Savings Programs, which provide important 
cost-assistance for low-income Medicare beneficiaries through the 
Medicaid program and include the Qualified Medicare Beneficiary, QMB, 
Specified Low-income Medicare Beneficiary, SLMB, and Qualified 
Individuals-1, QI-1, programs.
  One of the most significant improvements within this legislation is 
to make permanent the QI-1 program, which expires at the end of this 
month. This program provides vital assistance to low-income Medicare 
beneficiaries in paying for Medicare Part B premiums. It was 
established as part of the Balanced Budget Act of 1997 and was 
authorized for 5 years. Unfortunately, every few years we in Congress

[[Page S12149]]

must act to reauthorize this program, providing unnecessary uncertainty 
for beneficiaries and State Medicaid programs.
  Congress should not participate in this annual last minute scramble 
to try and extend the program for a few months or a year. It is a 
disservice to the States, who must watch the Congress closely to 
constantly prepare to send out disenrollment notices and lay off staff, 
even though they are relatively certain the program will be extended. 
But, more importantly, it is a disservice to the 185,000 beneficiaries 
that need this important assistance, as many of those enrolled worry 
this benefit will be taken away and many of those never enrolled are 
not told of the benefit since States and advocates are spending their 
time trying to get the program extended rather than conducting 
outreach.
  While I remain very hopeful that the Congress will pass an extension 
of the QI-1 program for an additional period in the coming week, I am 
introducing the Medicare Savings Program Improvement Act of 2007 today 
in the hope that Congress will end this process of temporary extensions 
and permanently authorize the program, as provided for in this 
legislation.
  Furthermore, the bill proposes several improvements to the Medicare 
Savings Programs and application processes that will make these low-
income benefits both more efficient to administer and more accessible 
to the individuals who need them. It would also seek to simplify the 
process of applying for Medicare Savings Programs and make the Programs 
more understandable to low-income senior citizens and people with 
disabilities, as well as State and Federal Government officials.
  Rates of enrollment in the Medicare Savings Programs are well below 
those of other means-tested benefit programs. The Congressional Budget 
Office estimates that only 33 percent of eligible people are 
participating in the QMB program, and that the participation rate in 
the SLMB program is only 13 percent--these figures exclude people who 
are eligible for full Medicaid benefits. In comparison, participation 
rates are estimated to be 75 percent in the earned income tax credit, 
66 percent to 73 percent for Supplemental Security Income, and 66 
percent to 70 percent for Medicaid.
  In New Mexico, over 1,500 low-income Medicare beneficiaries receive 
the QI-1 benefit, which saves them almost $1,000 in Medicare Part B 
premium out-of-pocket costs annually. Unfortunately, according to 
estimates made by the Medicare Rights Center using Census Bureau data, 
over 11,000 are likely to be eligible. Many are completely unaware of 
the assistance this program offers. This is usually because many 
eligible individuals are difficult to reach or communicate with because 
they are isolated, cannot read or speak English, have difficulty seeing 
or hearing, or lack transportation.
  To briefly describe the most critical aspects of the legislation, 
Section 2 of the bill provides for one unified name for the Federal 
programs that offer cost sharing and benefit assistance for low income 
Medicare beneficiaries. Rather than separately referring to the QMB, 
SLMB, and QI-1 programs, the bill provides one common name for all of 
these programs, the ``Medicare Savings Programs.'' Aligning these 
programs under one title helps to establish greater uniformity in 
income and resource limits, simplifies the application process, makes 
more people eligible for subsidies and increases the enrollment in 
programs.
  Low enrollment in these assistance programs is in large part due to 
the lack of knowledge and understanding of the programs or benefits 
offered. For example, 79 percent of non-enrolled eligible people have 
ever heard of the Medicare Savings Programs and two thirds of enrollees 
need assistance in completing the lengthy application form. This simple 
change has been pilot tested with Medicare beneficiary groups and found 
to elicit a positive response and interest from Medicare beneficiaries.
  Section 3 of the legislation would make permanent the QI-1 category 
by incorporating these individuals into the SLMB category at 100 
percent Federal medical percentage, FMAP, matching rate. In addition to 
simplifying and making permanent the program, such a change would 
ensure funding for QI-1 cost-sharing.
  Section 5 eliminates the limit on assets, which is set at $4,000 for 
an individual and $6,000 for a couple and disqualifies millions of 
Medicare beneficiaries with very low incomes from qualifying for 
assistance. Many potential beneficiaries do not apply for benefits 
because they incorrectly assume that they have too many assets to 
qualify or fear losing their estate. Some States have waived or 
disallowed the counting of some assets for the purposes of eligibility 
determination and have seen much higher enrollment rates. The 
requirements to document one's assets also makes the application 
process burdensome and deters potential enrollees who might pass the 
asset test.
  Finally, section 8 eliminates some of the critical barriers to 
enrollment. As I noted earlier, rates of enrollment in the Medicare 
Savings Programs are well below those of other means-tested. benefit 
programs. This section provides for several important enrollment 
simplification procedures, such as allowing self-certification of 
income and continuous eligibility, and expanded outreach efforts. For 
instance, instead of requiring people to apply for benefits at the 
state Medicaid office, the Social Security Administration took 
applications and forwarded them to Medicaid offices for processing and 
increased enrollment by 10 percent. Perhaps with more outreach efforts 
provided within this bill, even more low-income Medicare beneficiaries 
will receive the health care for which they are eligible.
  I urge the Congress to pass a temporary extension of the QI-1 program 
early next week, but then to immediately begin work to permanently 
authorize the QI-1 program and to simplify and streamline all the 
Medicare Savings Programs. Our Nation's low-income Medicare 
beneficiaries and the States deserve nothing less.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 2101

       Be it enacted by the Senate and House of Representatives of 
     the United States of America in Congress assembled,

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Medicare 
     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.

     SEC. 2. 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''.

     SEC. 3. 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

[[Page S12150]]

     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.

     SEC. 4. 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.

     SEC. 5. 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.
       ``(B) 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.

     SEC. 6. 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.

     SEC. 7. 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.

     SEC. 8. 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:

[[Page S12151]]

   ``EXPEDITED ENROLLMENT UNDER THE MEDICARE SAVINGS PROGRAM THROUGH 
                        SOCIAL SECURITY OFFICES

       ``Sec. 1809.  (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).

[[Page S12152]]

       ``(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.

     SEC. 9. 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:

[[Page S12153]]

       ``(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.

     SEC. 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.

     SEC. 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.''.

     SEC. 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.
                                 ______