[Congressional Record Volume 155, Number 83 (Thursday, June 4, 2009)]
[Senate]
[Pages S6193-S6201]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. BINGAMAN:
  S. 1185. A bill to amend titles XVIII and XIX of the Social Security 
Act to ensure that Low-income beneficiaries have improved access to 
health care under the Medicare and Medicaid programs; to the Committee 
on Finance.
  Mr. BINGAMAN. Mr. President, I rise today to introduce the Medicare 
Financial Stability for Beneficiaries Act of 2009.
  This legislation would ensure that low-income Medicare beneficiaries 
can access the benefits to which they are entitled through one of the 
Medicare Savings Programs, MSP, and/or the Part D Low-Income Subsidy, 
LIS.
  More than 13 million Medicare beneficiaries have incomes below 150 
percent of the Federal Poverty Level,

[[Page S6194]]

FPL, and are eligible for assistance with their Medicare costs. Another 
6 million have incomes under 200 percent FPL. These nearly 20 million 
beneficiaries are poorer than other Medicare beneficiaries. They also 
tend to be sicker, more isolated and have limited educations. These 
populations are more in need of medical and other health-related 
services, and they benefit in both access and health outcomes from 
financial assistance with their out-of-pocket costs.
  Although seniors and younger people with disabilities would benefit 
tremendously from greater access to needed health care services and 
financial savings, the Congressional Budget Office has estimated that 
about 67 percent to 87 percent of individuals eligible for various MSP 
services do not receive benefits. Additionally, the Centers for 
Medicare & Medicaid Services state that more than 13 million 
individuals are eligible for Part D LIS but only about 9 million are 
enrolled. Most of those 9 million get the subsidy automatically without 
having to apply, due to their eligibility for other programs.
  The lives of low-income beneficiaries would improve significantly 
with improved access to the financial assistance provided by these 
important programs. Barriers to enrollment in MSP and LIS include: lack 
of effective outreach, lack of knowledge of the programs, language 
issues, social and physical isolation, restrictive assets limits, 
income and asset documentation complexities, and other daunting 
application requirements. Another major barrier is the lack of 
alignment of eligibility rules and application processes between MSP 
and LIS, although both programs serve the same general population.
  The Medicare Financial Stability for Beneficiaries Act of 2009 
decreases these barriers through:
  1. Stabilizing programs by eliminating the recurring short-term re 
authorizations of one of the MSPs--the Qualified Individual, QI, 
program and the roller-coaster eligibility/loss of eligibility some 
beneficiaries face due to the effects of the subsidies on eligibility 
for other benefits.
  2. Increasing access to financial assistance for low-income 
beneficiaries. Research supports the conclusion that financial 
assistance results in greater access and better health outcomes for 
low-income beneficiaries. Currently full assistance is available only 
for those beneficiaries with incomes up to 135 percent of the Federal 
Poverty Level, 135 percent FPL is $1218/month for an individual, and 
very limited assets, about $8,000 for an individual); much more limited 
assistance is available for those with incomes up to 150 percent of 
FPL. People with low incomes but some savings may be disqualified 
altogether. Our bill increases income eligibility to 150 percent of FPL 
for full benefits and 200 percent FPL for partial benefits and uses a 
single asset standard for all programs of $27,500 for an individual. 
Increasing the asset test for both MSP and LIS and increasing income 
eligibility levels will improve health outcomes for millions more 
seniors and younger people with disabilities.
  3. Aligning the rules for MSP and LIS programs and authorizing cross-
deeming so that qualifying for one program would automatically qualify 
an individual for the other programs. Currently, income and asset 
eligibility rules for MSP and LIS are similar, but not identical. 
Individuals eligible for MSP benefits are deemed eligible for LIS, 
without having to apply or take any other action. The reverse, however, 
is not true. Greater alignment of the rules of both programs makes 
cross-deeming sensible, and ensures that individuals will receive both 
benefits regardless of where they first seek assistance. The 
legislation will also assist LIS beneficiaries in receiving 
Supplemental Nutritional Assistance Program, SNAP, food stamp, and vice 
versa.
  4. Simplifying outreach and enrollment for low-income Medicare 
programs by authorizing the Social Security Administration to have 
access to Internal Revenue Service records to identify potentially 
eligible beneficiaries; by making more materials, including 
applications, available in additional languages; and by other 
simplifications of the application process. These provisions will 
benefit the millions of Americans who desperately need assistance, and 
will cut down on unnecessary and duplicative work for the Social 
Security Administration and for State Medicaid agencies.
  There is strong support for this important legislation from many 
organizations including the American Association of Retired Persons, 
National Senior Citizens Law Center, Medicare Rights Center, Center for 
Medicare Advocacy, Inc, Families USA, National Council on Aging, 
National Patient Advocate Foundation, American Federation of Labor and 
Congress of Industrial Organizations, AFL-CIO, and the National 
Committee to Preserve Social Security and Medicare.
  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. 1185

       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 
     Financial Stability for Beneficiaries Act of 2009''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Eligibility for other programs.
Sec. 3. Cost-sharing protections for low-income subsidy-eligible 
              individuals.
Sec. 4. Modification of resource standards for determination of 
              eligibility for LIS; no consideration of pension or 
              retirement plan in determination of resources.
Sec. 5. Increase in income levels for eligibility.
Sec. 6. Effective date of MSP benefits.
Sec. 7. Expanding special enrollment process to individuals eligible 
              for an income-related subsidy.
Sec. 8. Enhanced cost-sharing protections for full-benefit dual 
              eligible individuals and qualified medicare 
              beneficiaries.
Sec. 9. Two-way deeming between Medicare Savings Program and Low-Income 
              Subsidy Program.
Sec. 10. Improving linkages between health programs and snap.
Sec. 11. Expediting low-income subsidies under the Medicare 
              prescription drug program.
Sec. 12. Enhanced oversight and enforcement relating to reimbursements 
              for retroactive LIS enrollment.
Sec. 13. Intelligent assignment in enrollment.
Sec. 14. Medicare enrollment assistance.
Sec. 15. QMB buy-in of part A and part B premiums.
Sec. 16. Increasing availability of MSP applications through 
              availability on the internet and designation of preferred 
              language.
Sec. 17. State Medicaid agency consideration of low-income subsidy 
              application and data transmittal.

     SEC. 2. ELIGIBILITY FOR OTHER PROGRAMS.

       (a) LIS.--Section 1860D-14(a)(3) of the Social Security Act 
     (42 U.S.C. 1395w-114(a)(3)), as amended by section 116 of the 
     Medicare Improvements for Patients and Providers Act of 2008 
     (Public Law 110-275), is amended--
       (1) in subparagraph (A), in the matter preceding clause 
     (i), by striking ``subparagraph (F)'' and inserting 
     ``subparagraphs (F) and (H)''; and
       (2) by adding at the end the following new subparagraph:
       ``(H) Disregard of premium and cost-sharing subsidies for 
     purposes of federal and state programs.--Notwithstanding any 
     other provision of law, any premium or cost-sharing subsidy 
     with respect to a subsidy-eligible individual under this 
     section shall not be considered income or resources in 
     determining eligibility for, or the amount of assistance or 
     benefits provided under, any other public benefit provided 
     under Federal law or the law of any State or political 
     subdivision thereof.''.
       (b) MSP.--Section 1905(p) of the Social Security Act (42 
     U.S.C. 1396d(p)) is amended--
       (1) by redesignating paragraph (6) as paragraph (7); and
       (2) by inserting after paragraph (5) the following new 
     paragraph:
       ``(6) Notwithstanding any other provision of law, any 
     medical assistance for some or all medicare cost-sharing 
     under this title shall not be considered income or resources 
     in determining eligibility for, or the amount of assistance 
     or benefits provided under, any other public benefit provided 
     under Federal law or the law of any State or political 
     subdivision thereof''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to eligibility for benefits on or after January 
     1, 2010.

     SEC. 3. COST-SHARING PROTECTIONS FOR LOW-INCOME SUBSIDY-
                   ELIGIBLE INDIVIDUALS.

       (a) In General.--Section 1860D-14(a) of the Social Security 
     Act (42 U.S.C. 1395w-114(a)) is amended--

[[Page S6195]]

       (1) in paragraph (1)(D), by adding at the end the following 
     new clause:
       ``(iv) Overall limitation on cost-sharing.--In the case of 
     all such individuals, a limitation on aggregate cost-sharing 
     under this part for a year not to exceed 2.5 percent of 
     income.''; and
       (2) in paragraph (2), by adding at the end the following 
     new subparagraph:
       ``(F) Overall limitation on cost-sharing.--A limitation on 
     aggregate cost-sharing under this part for a year not to 
     exceed 2.5 percent of income.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply as of January 1, 2010.

     SEC. 4. MODIFICATION OF RESOURCE STANDARDS FOR DETERMINATION 
                   OF ELIGIBILITY FOR LIS; NO CONSIDERATION OF 
                   PENSION OR RETIREMENT PLAN IN DETERMINATION OF 
                   RESOURCES.

       (a) Eliminating the Bifurcation of Resource Standards.--
       (1) In general.--Section 1860D-14(a)(3)(A)(iii) of the 
     Social Security Act (42 U.S.C. 1395w-114(a)(3)(A)(iii)) is 
     amended by striking ``meets the'' and all that follows 
     through the period at the end and inserting ``meets--

       ``(I) in the case of determinations made before January 1, 
     2011, the resource requirement described in subparagraph (D) 
     or (E); and
       ``(II) in the case of determinations made on or after 
     January 1, 2011, the resource requirement described in 
     subparagraph (E).''.

       (2) Conforming amendment.--Section 1860D-14(a)(3)(D)(ii) of 
     the Social Security Act (42 U.S.C. 1395w-114(a)(3)(D)(ii)) is 
     amended by inserting ``(before 2011)'' after ``a subsequent 
     year''.
       (b) Increasing the Applicable Resource Standard.--Section 
     1860D-14(a)(3)(E) of the Social Security Act (42 U.S.C. 
     1395w-114(a)(3)(E)(i)) is amended--
       (1) in the heading, by striking ``Alternative'' and 
     inserting ``Applicable'';
       (2) in clause (i)--
       (A) in subclause (I), by striking ``and'' at the end;
       (B) in subclause (II)--
       (i) by inserting ``(before 2011)'' after ``a subsequent 
     year'';
       (ii) by striking the period at the end and inserting a 
     semicolon; and
       (iii) by inserting before the flush sentence at the end the 
     following new subclauses:

       ``(III) for 2011, $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
       ``(IV) for a subsequent year the dollar amounts specified 
     in this subclause (or subclause (III)) 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.''; and

       (C) in the flush sentence at the end, by inserting ``or 
     (IV)'' after ``subclause (II)''.
       (c) Exclusion of Pension and Retirement Benefits From 
     Resources.--
       (1) In general.--Section 1860D-14(a)(3) of the Social 
     Security Act (42 U.S.C. 1395w-114(a)(3)), as amended by 
     section 2, is amended--
       (A) in subparagraph (E)(i), in the matter preceding 
     subclause (I), by inserting ``and the pension or retirement 
     plan exclusion provided under subparagraph (I)'' after 
     ``(G)''; and
       (B) by adding at the end the following new subparagraph:
       ``(I) Pension and retirement benefits exclusion.--In 
     determining the resources of an individual (and the eligible 
     spouse of the individual, if any) under section 1613 for 
     purposes of subparagraph (E) no balance in, or benefits 
     received under, an employee pension benefit plan (as defined 
     in section 3 of the Employee Retirement Income Security Act 
     of 1974) shall be taken into account.''.
       (2) Effective date.--The amendments made by this subsection 
     shall apply to determinations made on or after January 1, 
     2011.
       (d) Application of Applicable Resource Standard Under 
     Medicare Savings Program and Exemptions From Income and 
     Resources.--
       (1) Application of applicable resource standard and 
     exemptions from resources.--Section 1905(p)(1)(C) of the 
     Social Security Act (42 U.S.C. 1396d(p)(1)(C)) is amended--
       (A) by inserting ``without taking into account any part of 
     the value of any life insurance policy or any balance in, or 
     benefits received under, an employee pension benefit plan (as 
     defined in section 3 of the Employee Retirement Income 
     Security Act of 1974)'' after ``(as so determined''; and
       (B) by striking ``subparagraph (D)'' and all that follows 
     through ``section)'' and inserting ``section 1860D-
     14(a)(3)(E)''.
       (2) Exemption of in-kind support and maintenance.--
       (A) In general.--Section 1905(p)(1)(B) of the Social 
     Security Act (42 U.S.C. 1396d(p)(1)(B)) is amended by 
     inserting ``and except that support and maintenance furnished 
     in kind shall not be counted as income'' after ``(2)(D)''.
       (B) Conforming amendment.--Section 1860D-14(a)(3)(C)(i) of 
     the Social Security Act (42 U.S.C. 1395w-114(a)(3)(C)(i)) is 
     amended by striking ``and except that support and maintenance 
     furnished in kind shall not be counted as income''.
       (3) Effective date.--The amendments made by this subsection 
     shall apply to determinations made on or after January 1, 
     2011.
       (e) Clarification Relating to Including Retirement Benefits 
     as Income.--Nothing in subparagraph (I) of section 1860D-
     14(a)(3) of the Social Security Act (42 U.S.C. 1395w-
     114(a)(3)), as added by subsection (c)(1), or section 
     1905(p)(1)(C) of such Act (42 U.S.C. 1396d(p)(1)(C)), as 
     amended by subsection (d)(1), shall be construed as affecting 
     the inclusion of retirement benefits as income under section 
     1612(a)(2)(B) of such Act (42 U.S.C. 1382a(a)(2)(B)).

     SEC. 5. INCREASE IN INCOME LEVELS FOR ELIGIBILITY.

       (a) LIS.--
       (1) In general.--Section 1860D-14(a) of the Social Security 
     Act (42 U.S.C. 1395w-114(a)) is amended--
       (A) in the subsection heading, by striking ``150'' and 
     inserting ``200'';
       (B) in paragraph (1)--
       (i) in the heading, by striking ``135'' and inserting 
     ``150''; and
       (ii) in the matter preceding subparagraph (A), by striking 
     ``135'' and inserting ``150'';
       (C) in paragraph (2)--
       (i) in the heading, by striking ``150'' and inserting 
     ``200''; and
       (ii) in subparagraph (A)--

       (I) by striking ``135'' and inserting ``150''; and
       (II) by striking ``150'' and inserting ``200''; and

       (D) in paragraph (3)(A)(ii), by striking ``150'' and 
     inserting ``200''.
       (2) Effective date.--The amendments made by this subsection 
     shall apply to determinations made on or after January 1, 
     2011.
       (b) MSP.--
       (1) Increase to 150 percent of fpl for qualified medicare 
     beneficiaries.--
       (A) In general.--Section 1905(p)(2) of the Social Security 
     Act (42 U.S.C. 1396d(p)(2)) is amended--
       (i) in subparagraph (A), by striking ``100 percent'' and 
     inserting ``150 percent'';
       (ii) 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, 2011, is 150 percent.''; and
       (iii) 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, 2011, is 150 percent.''.
       (B) Application of income test based on family size.--
     Section 1905(p)(2)(A) of such Act (42 U.S.C. 1396d(p)(2)(A)) 
     is amended by adding at the end the following: ``For purposes 
     of this subparagraph, family size means the applicant, the 
     spouse (if any) of the applicant if living in the same 
     household as the applicant, and the number of individuals who 
     are related to the applicant (or applicants), who are living 
     in the same household as the applicant (or applicants), and 
     who are dependent on the applicant (or the applicant's 
     spouse) for at least one-half of their financial support.''.
       (2) Expansion of specified low-income medicare beneficiary 
     (slmb) program.--
       (A) Eligibility of individuals with incomes below 200 
     percent of fpl.--Section 1902(a)(10)(E) of the Social 
     Security Act (42 U.S.C. 1396b(a)(10)(E)) is amended--
       (i) by adding ``and'' at the end of clause (ii);
       (ii) 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 2011, or 200 percent beginning in 
     2011''; and
       (II) by striking ``and'' at the end; and

       (iii) by striking clause (iv).
       (B) Revision to description.--Section 1902(a)(10)(E)(iii) 
     of the Social Security Act (42 U.S.C. 1396b(a)(10)(E)(iii)) 
     is amended by striking ``who would be qualified medicare'' 
     and all that follows through ``but is less than'' and 
     inserting ``whose income (as determined in accordance with 
     subparagraphs (B) and (C) of section 1905(p)(1)) is less 
     than''.
       (C) 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).''.
       (3) 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: ``, with respect to medical assistance for 
     medicare cost-sharing provided under clause (i) of section 
     1902(a)(10)(E) for individuals with incomes greater than 100 
     percent of the official poverty line described in subsection 
     (p)(2)(A) and less than or equal to 150 percent of such 
     official poverty line, and with respect to medical assistance 
     for medicare cost-sharing provided under clause (iii) of such 
     section''.
       (4) Effective date.--
       (A) Except as provided in subparagraph (B), the amendments 
     made by this subsection shall take effect on January 1, 2011, 
     and, with respect to title XIX of the Social Security Act, 
     shall apply to calendar quarters beginning on or after 
     January 1, 2011.
       (B) 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 
     subsection,

[[Page S6196]]

     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. EFFECTIVE DATE OF MSP BENEFITS.

       (a) In General.--
       (1) Effective date of msp benefits.--Section 1905(a) of the 
     Social Security Act (42 U.S.C. 1396d(a)) is amended, in the 
     matter preceding paragraph (1), by striking ``assistance or, 
     in the case of medicare cost-sharing'' and all that follows 
     through ``beneficiary)'' and inserting ``assistance)''.
       (2) Conforming amendments.--(A) Section 1902(e)(8) of the 
     Social Security Act (42 U.S.C. 1396a(e)(8)) is amended by 
     striking 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, 2010, but shall not result in 
     eligibility for benefits for medicare cost-sharing for months 
     before January 2010.

     SEC. 7. EXPANDING SPECIAL ENROLLMENT PROCESS TO INDIVIDUALS 
                   ELIGIBLE FOR AN INCOME-RELATED SUBSIDY.

       (a) In General.--Section 1860D-1(b)(1)(C) of the Social 
     Security Act (42 U.S.C. 1395w-101(b)(1)(C)) is amended--
       (1) by striking ``a full-benefit dual eligible individual 
     (as defined in section 1935(c)(6))'' and inserting ``a 
     subsidy-eligible individual (as defined in section 1860D-
     14(a)(3))''; and
       (2) by striking ``1860D-14(a)(1)(A)'' and inserting 
     ``subsection (a)(1)(A) or (b)(1)(A) of section 1860D-14, as 
     applicable''
       (b) Effective Date.--The amendments made by this section 
     shall apply to enrollments on or after January 1, 2010.

     SEC. 8. ENHANCED COST-SHARING PROTECTIONS FOR FULL-BENEFIT 
                   DUAL ELIGIBLE INDIVIDUALS AND QUALIFIED 
                   MEDICARE BENEFICIARIES.

       (a) Elimination of Part D Cost-Sharing for Certain Non-
     Institutionalized Full-Benefit Dual Eligible Individuals.--
     Section 1860D-14(a)(1)(D)(i) of the Social Security Act (42 
     U.S.C. 1395w-114(a)(1)(D)(i)) is amended--
       (1) in the heading, by striking ``Institutionalized 
     individuals.--In'' and inserting ``Elimination of cost-
     sharing for certain full-benefit dual eligible individuals.--

       ``(I) Institutionalized individuals.--In''; and

       (2) by adding at the end the following new subclause:

       ``(II) Certain other individuals.--In the case of an 
     individual who is a full-benefit dual eligible individual who 
     is receiving home and community based care (whether under 
     section 1915 or under a waiver under section 1115), the 
     elimination of any beneficiary coinsurance described in 
     section 1860D-2(b)(2) (for all amounts through the total 
     amount of expenditures at which benefits are available under 
     section 1860D-2(b)(4)).''.

       (b) Repeal of Authority for States to Pay Medicare Cost-
     Sharing at Medicaid Rates and Provision of Medical Assistance 
     to Dual Eligibles in MA Plans.--
       (1) Repeal of authority for states to pay medicare cost-
     sharing at medicaid rates.--Section 1902(n) of the Social 
     Security Act (42 U.S.C. 1396a(n)) is amended--
       (A) by striking paragraph (2);
       (B) by redesignating paragraph (3) as paragraph (2);
       (C) in paragraph (2), as redesignated by subparagraph (B)--
       (i) in the matter preceding subparagraph (A)--

       (I) by striking ``In the case in which a State's payment 
     for'' and inserting ``With respect to''; and
       (II) by striking ``with respect to an item or service is 
     reduced or eliminated through the application of paragraph 
     (2)'' and inserting ``for an item or service''; and

       (ii) in subparagraph (A), by striking ``(if any)''; and
       (D) by adding at the end the following new paragraph:
       ``(3) Each State shall establish procedures for receiving 
     and processing claims for payment for medicare cost-sharing 
     with respect to items or services furnished to qualified 
     medicare beneficiaries by providers of services and suppliers 
     under title XVIII who are not participating providers under 
     the State plan.''.
       (2) Provision of medical assistance to dual eligibles in ma 
     plans.--Section 1902(n) of the Social Security Act (42 U.S.C. 
     1396a(n)), as amended by paragraph (1), is amended by adding 
     at the end the following new paragraph:
       ``(4)(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 3 
     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.''.
       (3) Conforming amendments.--
       (A) Provider agreements.--Section 1866(a)(1)(A)(ii) of the 
     Social Security Act (42 U.S.C. 1395cc(a)(1)(A)(ii)) is 
     amended by striking ``1902(n)(3)'' and inserting 
     ``1902(n)(2)''.
       (B) Nonparticipating providers.--Section 1848(g)(3)(A) of 
     the Social Security Act (42 U.S.C. 1395w-4(g)(3)(A)) is 
     amended by striking ``1902(n)(3)(A)'' and inserting 
     ``1902(n)(2)(A)''.
       (4) Effective date.--
       (A) In general.--Except as provided in subparagraph (B), 
     the amendments made by this subsection shall take effect on 
     the date of enactment of this Act.
       (B) Exception.--The amendment made by paragraph (2) shall 
     be effective and apply as if included in the enactment of the 
     Medicare Prescription Drug, Improvement, and Modernization 
     Act of 2003 (Public Law 108-173).

     SEC. 9. TWO-WAY DEEMING BETWEEN MEDICARE SAVINGS PROGRAM AND 
                   LOW-INCOME SUBSIDY PROGRAM.

       (a) Low-Income Subsidy Program.--Section 1860D-14(a)(3) of 
     the Social Security Act (42 U.S.C. 1395w-104(a)(3)), as 
     amended by section 4, is amended by adding at the end the 
     following new subparagraph:
       ``(J) 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).''.
       (b) Medicare Savings Program.--Section 1905(p) of the 
     Social Security Act (42 U.S.C. 1396d(p)), as amended by 
     section 4, is amended--
       (1) by redesignating paragraph (8) as paragraph (9); and
       (2) 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)).''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to eligibility for months beginning on or after 
     January 2010.

     SEC. 10. IMPROVING LINKAGES BETWEEN HEALTH PROGRAMS AND SNAP.

       (a) Low-Income Part D Subsidy Program.--Section 1144(c) of 
     the Social Security Act (42 U.S.C. 1320b-14(c)) is amended--
       (1) in paragraph (1)(C) by striking ``an application for 
     benefits under the Medicare Savings Program.'' and inserting 
     ``applications for benefits under the Medicare Savings 
     Program and the supplemental nutrition assistance program.'';
       (2) by striking paragraph (3) and inserting the following:
       ``(3) Transmittal of data to states.--
       ``(A) In general.--Beginning on January 1, 2010, with the 
     consent of an individual completing an application for 
     benefits described in paragraph (1)(B), the Commissioner 
     shall electronically transmit data from such application--
       ``(i) to the appropriate State Medicaid agency, as 
     determined by the Commissioner, which transmittal shall 
     initiate an application of the individual for benefits under 
     the

[[Page S6197]]

     Medicare Savings Program with the State Medicaid agency; and
       ``(ii) to the appropriate State agency which administers 
     benefits under the supplemental nutrition assistance program, 
     as determined by the Commissioner, which transmittal shall 
     initiate an application of the individual for benefits under 
     the supplemental nutrition assistance program with the State 
     agency that administers that program.
       ``(B) Consultation regarding content, time, form, frequency 
     and manner of transmission.--In order to ensure that such 
     data transmittal provides effective assistance for purposes 
     of State adjudication of applications for benefits under the 
     Medicare Savings Program and the supplemental nutrition 
     assistance program, the Commissioner shall consult with the 
     Secretary after the Secretary has consulted with the States, 
     regarding the content, form, frequency, and manner in which 
     data (on a uniform basis for all States) shall be transmitted 
     under this paragraph.'';
       (3) in paragraph (5), by adding at the end the following 
     new subparagraph:
       ``(D) Supplemental nutrition assistance program 
     administrative costs.--The costs of the Social Security 
     Administration's work related to the supplemental nutrition 
     assistance program under this subsection shall be eligible 
     for reimbursement under section 11(j)(2)(C) of the Food and 
     Nutrition Act of 2008 (7 U.S.C. 2020(j)(2)(C)). To the extent 
     necessary the Commissioner and the Secretary of Agriculture 
     shall revise any memoranda of understanding in effect under 
     such section.''; and
       (4) by adding at the end the following new paragraph:
       ``(8) Supplemental nutrition assistance program defined.--
     For purposes of this subsection, the term `supplemental 
     nutrition assistance program' means the program of temporary 
     benefits authorized under section 11(v) of the Food and 
     Nutrition Act of 2008 (7 U.S.C. 2020(v)).''.
       (b) Temporary Supplemental Nutrition Assistance Benefits.--
     Section 11 of the Food and Nutrition Act of 2008 (7 U.S.C. 
     2020) is amended by adding at the end the following:
       ``(v) Temporary Benefits for Medicare Part D Low Income 
     Subsidy Applicants.--
       ``(1) Definition of medicare part d low income subsidy 
     applicant.--In this subsection, the term `Medicare part D low 
     income subsidy applicant' means an individual, along with any 
     other family members, whose low income subsidy application 
     information has been electronically transmitted to the State 
     agency under section 1144(c)(3) of the Social Security Act 
     (42 U.S.C. 1320b-14(c)(3)).
       ``(2) Provision of temporary benefits.--A State agency 
     shall provide temporary supplemental nutrition assistance 
     program benefits to a Medicare part D low income subsidy 
     applicant whose--
       ``(A) income does not exceed 150 percent of the poverty 
     line (as determined in accordance with section 5(c)(1)); and
       ``(B) financial resources do not exceed the limit in effect 
     in the State for such households under section 5.
       ``(3) Determination based on medicare information.--For 
     purposes of determining eligibility under paragraph (2) and 
     the amount of temporary benefits under paragraph (5), 
     information on household members, household income, and 
     household resources from the Medicare part D low income 
     subsidy application as transmitted to the State agency under 
     section 1144(c)(3) of the Social Security Act (42 U.S.C. 
     1320b-14(c)(3)) shall satisfy the requirements of this Act 
     with regard to--
       ``(A) the members of the household under section 3(n); and
       ``(B) the gross income and financial resources of the 
     household under section 5.
       ``(4) Temporary benefit period.--A household shall receive 
     temporary supplemental nutrition assistance benefits under 
     this subsection for a period of not more than 2 months.
       ``(5) Temporary benefit amount.--
       ``(A) In general.--During the temporary benefit period 
     under paragraph (4), except as provided in subparagraph (B), 
     a household shall receive a monthly amount of supplemental 
     nutrition assistance program benefits calculated under 
     section 8(a).
       ``(B) Calculation.--In calculating benefits under 
     subparagraph (A)--
       ``(i) the benefits shall be determined based on the gross 
     income of the household rather than net income; and
       ``(ii) the minimum allotment described in the proviso in 
     section 8(a) shall be equal to 40 percent of the cost of the 
     thrifty food plan for a household containing 1 member, as 
     determined by the Secretary under section 3, rounded to the 
     nearest whole dollar increment.
       ``(6) Determination of future eligibility.--During the 
     temporary benefit period under paragraph (4), the State 
     agency shall provide to the household--
       ``(A) an application to apply for benefits under the other 
     provisions of this Act; and
       ``(B) an opportunity to complete the application process by 
     the month immediately following the temporary benefit period, 
     without a delay or suspension in the benefits of the 
     household.
       ``(7) Limitation.--This subsection shall not apply to 
     individuals who--
       ``(A) are members of households that currently receive 
     benefits under this Act; or
       ``(B) have received benefits under this subsection in the 
     preceding 12-month period.''.
       (c) Medicare Savings Program Applications.--
       (1) In general.--Section 1902(a) of the Social Security Act 
     (42 U.S.C. 1396a(a)) is amended--
       (A) in paragraph (72), by striking ``and'' at the end;
       (B) in paragraph (73), by striking the period at the end 
     and inserting ``; and''; and
       (C) by inserting after paragraph (73) the following new 
     paragraph:
       ``(74) provide that the State coordinates with the State 
     agency that administers benefits under the supplemental 
     nutrition assistance program established under the Food and 
     Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) to ensure that 
     individuals applying for medical assistance provided under 
     section 1902(a)(10)(E), as described in sections 1905(p) and 
     1933, have the opportunity to apply for, establish 
     eligibility for, and, if eligible, receive supplemental 
     nutrition assistance program benefits.''.
       (2) Effective date.--
       (A) In general.--Except as provided in subparagraph (B), 
     the amendments made by paragraph (1) take effect on the date 
     that is 1 year after the date of enactment of this Act.
       (B) Extension of effective date for state law amendment.--
     In the case of a State plan under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
     Health and Human Services determines requires State 
     legislation in order for the plan to meet the additional 
     requirements imposed by the amendments made by paragraph (1), 
     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 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 the 
     session is considered to be a separate regular session of the 
     State legislature.
       (3) Report to congress.--Not later than 2 years after the 
     date of enactment of this Act, the Secretary of Health and 
     Human Services shall submit to Congress a report on the 
     process each State uses to meet the requirements under 
     section 1902(a)(74) of the Social Security Act, as added by 
     subsection (c).

     SEC. 11. EXPEDITING LOW-INCOME SUBSIDIES UNDER THE MEDICARE 
                   PRESCRIPTION DRUG PROGRAM.

       (a) Targeted Outreach for Low-Income Subsidies.--
       (1) In general.--Section 1860D-14 of the Social Security 
     Act (42 U.S.C. 1395w-114) is amended by adding at the end the 
     following new subsection:
       ``(e) Targeted Outreach for Low-Income Subsidies.--
       ``(1) Targeted identification of subsidy-eligible 
     individuals.--
       ``(A) In general.--The Commissioner of Social Security 
     shall provide for the identification of individuals who are 
     potentially eligible for low-income assistance under this 
     section through requests to the Secretary of the Treasury in 
     accordance with the criterion established under section 
     6103(l)(21) of the Internal Revenue Code of 1986 for 
     information indicating whether the individual involved is 
     likely eligible for such assistance.
       ``(B) Initiation of identifications.--Not later than 90 
     days after the date of the enactment of this subsection, the 
     Commissioner of Social Security shall begin the 
     identification of individuals through the process described 
     in subparagraph (A) and shall, by such date and through such 
     process, submit to the Secretary of the Treasury requests for 
     part D eligible individuals who the Commissioner has 
     identified as potentially eligible for low-income subsidies 
     under this section before such date of enactment.
       ``(2) Notification of potentially eligible individuals.--In 
     the case of each individual identified under paragraph (1) 
     who has not otherwise applied for, or been determined 
     eligible for, benefits under this section (or who has applied 
     for and been determined ineligible for such benefits based on 
     excess income, resources, or both), the Commissioner shall 
     transmit by mail to the individual a letter including the 
     information and application required to be provided under 
     subparagraphs (A), (B), and (D) of section 1144(c)(1).
       ``(3) Follow-up communications.--If an individual to whom a 
     letter is transmitted under paragraph (2) does not 
     affirmatively respond to such letter either by making an 
     enrollment, completing an application, or declining either or 
     both, the Commissioner shall make additional attempts to 
     contact the individual to obtain such an affirmative 
     response.
       ``(4) Use of preferred language in subsequent 
     communications.--In the case an application is completed by 
     an individual pursuant to this subsection in which a language 
     other than English is specified, the Commissioner shall 
     provide that subsequent communications under this part to the 
     individual shall be in such language as needed.
       ``(5) Construction.--Nothing in this subsection shall be 
     construed as precluding the Commissioner from taking 
     additional outreach efforts to enroll eligible individuals 
     under this part and to provide low-income subsidies to 
     eligible individuals.
       ``(6) Maintenance of effort with respect to outreach.--In 
     no case shall the level of effort with respect to outreach to 
     and enrollment of individuals who are potentially eligible 
     for low-income assistance under this

[[Page S6198]]

     section after the date of the enactment of this subsection be 
     less than such level of effort before such date of enactment 
     until at least 90 percent of such potentially eligible 
     individuals have affirmatively responded.
       ``(7) GAO report to congress.--Not later than 2 years after 
     the date of the first submission to the Secretary of the 
     Treasury described in paragraph (1)(B), the Comptroller 
     General of the United States shall submit to Congress a 
     report, with respect to the 18-month period following the 
     establishment of the process described in paragraph (1)(A), 
     on--
       ``(A) the extent to which the percentage of individuals who 
     are eligible for low-income assistance under this section but 
     not enrolled under this part has decreased during such 
     period;
       ``(B) how the Commissioner of Social Security has used any 
     savings resulting from the implementation of this section and 
     section 6103(l)(21) of the Internal Revenue Code of 1986 to 
     improve outreach to individual described in subparagraph (A) 
     to increase enrollment of such individuals under this part;
       ``(C) the effectiveness of using information from the 
     Secretary of the Treasury in accordance with section 
     6103(l)(21) of the Internal Revenue Code of 1986 for purposes 
     of indicating whether individuals are eligible for low-income 
     assistance under this section; and
       ``(D) the effectiveness of the outreach conducted by the 
     Commissioner of Social Security based on the data described 
     in subparagraph (C).''.
       (2) Conforming amendment.--Section 1144(c)(1) of the Social 
     Security Act (42 U.S.C. 1320b-14(c)(1)) is amended by 
     inserting ``(including through request to the Secretary of 
     the Treasury pursuant to section 1860D-14(e))'' before ``, 
     the Commissioner shall''.
       (b) Improvements to the Low-Income Subsidy Applications.--
     Section 1860D-14(a)(3) of the Social Security Act (42 U.S.C. 
     1395w-114(a)(3)) is amended--
       (1) in subparagraph (E), by striking clauses (ii) and (iii) 
     and redesignating clause (iv) as clause (ii);
       (2) by redesignating subparagraphs (F) and (G) as 
     subparagraphs (G) and (H), respectively; and
       (3) by inserting after subparagraph (E) the following new 
     subparagraph:
       ``(F) Simplified low-income subsidy application and 
     process.--
       ``(i) In general.--The Secretary, jointly with the 
     Commissioner of Social Security, shall--

       ``(I) develop a model, simplified application form and 
     process consistent with clause (ii) for the determination and 
     verification of a part D eligible individual's assets or 
     resources under this paragraph; and
       ``(II) provide such form to States.

       ``(ii) Documentation and safeguards.--Under such process--

       ``(I) the application form shall consist of an attestation 
     under penalty of perjury regarding the level of assets or 
     resources (or combined assets and resources in the case of a 
     married part D eligible individual) and valuations of general 
     classes of assets or resources;
       ``(II) such form shall not require the submittal of 
     additional documentation regarding income or assets;
       ``(III) matters attested to in the application shall be 
     subject to appropriate methods of administrative 
     verification;
       ``(IV) the applicant shall be permitted to authorize 
     another individual to act as the applicant's personal 
     representative with respect to communications under this part 
     and the enrollment of the applicant into a prescription drug 
     plan (or MA-PD plan) and for low-income subsidies under this 
     section; and
       ``(V) the application form 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 part.

       ``(iii) No recovery for certain subsidies improperly 
     paid.--If an individual in good faith and in the absence of 
     fraud is provided low-income subsidies under this section, 
     and if the individual is subsequently found not eligible for 
     such subsidies, there shall be no recovery made against the 
     individual because of such subsidies improperly paid.''.
       (c) Disclosures to Facilitate Identification of Individuals 
     Likely to Be Eligible for the Low-Income Assistance Under the 
     Medicare Prescription Drug Program.--
       (1) 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 to facilitate 
     identification of individuals likely to be eligible for low-
     income subsidies under medicare prescription drug program.--
       ``(A) In general.--The Secretary, upon written request from 
     the Commissioner of Social Security, shall disclose to 
     officers and employees of the Social Security Administration, 
     with respect to any individual identified by the 
     Commissioner--
       ``(i) whether, based on the criterion determined under 
     subparagraph (B), such individual is likely to be eligible 
     for low-income assistance under section 1860D-14 of the 
     Social Security Act, or
       ``(ii) that, based on such criterion, there is insufficient 
     information available to the Secretary to make the 
     determination described in clause (i).
       ``(B) Criterion.--Not later than 90 days after the date of 
     the enactment of this paragraph, the Secretary, in 
     consultation with the Commissioner of Social Security, shall 
     develop the criterion by which the determination under 
     subparagraph (A)(i) shall be made (and the criterion for 
     determining that insufficient information is available to 
     make such determination). Such criterion may include analysis 
     of information available on such individual's return, the 
     return of such individual's spouse, and any information 
     related to such individual or such individual's spouse which 
     is available on any information return.''.
       (2) Procedures and recordkeeping related to disclosures.--
     Paragraph (4) of section 6103(p) of such Code is amended by 
     striking ``or (17)'' each place it appears and inserting 
     ``(17), or (21)''.
       (3) Effective date.--The amendments made by this subsection 
     shall apply to disclosures made after the date of the 
     enactment of this Act.

     SEC. 12. ENHANCED OVERSIGHT AND ENFORCEMENT RELATING TO 
                   REIMBURSEMENTS FOR RETROACTIVE LIS ENROLLMENT.

       (a) In General.--In the case of a retroactive LIS 
     enrollment beneficiary (as defined in subsection (e)(4)) who 
     is enrolled under a prescription drug plan under part D of 
     title XVIII of the Social Security Act (or an MA-PD plan 
     under part C of such title)--
       (1) the beneficiary (or any eligible third party) is 
     entitled to reimbursement by the plan for covered drug costs 
     (as defined in subsection (e)(1)) incurred by the beneficiary 
     during the retroactive coverage period of the beneficiary in 
     accordance with subsection (b) and in the case of such a 
     beneficiary described in subsection (e)(4)(A)(i), such 
     reimbursement shall be made automatically by the plan upon 
     receipt of appropriate notice the beneficiary is eligible for 
     assistance described in such subsection (e)(4)(A)(i) without 
     further information required to be filed with the plan by the 
     beneficiary;
       (2) the Secretary of Health and Human Services (in this 
     section referred to as the ``Secretary'') shall not make 
     payment to the plan--
       (A) in the case that the beneficiary is described in 
     subsection (e)(4)(A)(i), for premium subsidies and cost 
     sharing subsidies under section 1860D-14 of the Social 
     Security Act (42 U.S.C. 1395w-114) with respect to the 
     provision of prescription drug coverage to the beneficiary 
     during such retroactive period; and
       (B) in the case that the beneficiary is described in 
     subsection (e)(4)(A)(ii), for direct subsidies under section 
     1860D-15(a)(1) of such Act and premium subsidies and cost-
     sharing subsidies under section 1860D-14 of such Act with 
     respect to the provision of prescription drug coverage to the 
     beneficiary during such retroactive period;

     unless the plan demonstrates to the Secretary that the plan 
     has provided timely and accurate reimbursement to the 
     beneficiary (or eligible third party) in accordance with 
     paragraph (1);
       (3) the Secretary shall not make any payment described in 
     paragraph (2) to the plan with respect to such beneficiary 
     for any month of the retroactive enrollment period during 
     which no expenses for covered part D drugs (as defined in 
     section 1860D-2(e) of the Social Security Act (42 U.S.C. 
     1395w-102(e)) were incurred by such beneficiary (or eligible 
     third party on behalf of such beneficiary); and
       (4) any payment owed the plan pursuant to this section, 
     taking into account paragraphs (2) and (3), shall be made at 
     the time the Centers for Medicare & Medicaid Services 
     reconciles payments for the entire plan year following the 
     end of the plan year, and not before such time.
       (b) Administrative Requirements Relating to 
     Reimbursements.--
       (1) Line-item description.--Each reimbursement made by a 
     prescription drug plan or MA-PD plan under subsection (a)(1) 
     shall include a line-item description of the items for which 
     the reimbursement is made.
       (2) Timing of reimbursements.--A prescription drug plan or 
     MA-PD plan must make a reimbursement under subsection (a)(1) 
     to a retroactive LIS enrollment beneficiary, with respect to 
     a claim, not later than 30 days after--
       (A) in the case of a beneficiary described in subsection 
     (e)(4)(A)(i), the date on which the plan receives notice from 
     the Secretary that the beneficiary is eligible for assistance 
     described in such subsection; or
       (B) in the case of a beneficiary described in subsection 
     (e)(4)(A)(ii), the date on which the beneficiary files the 
     claim with the plan.
       (c) Notice Requirements.--
       (1) By secretary of hhs and commission of the social 
     security administration.--The Secretary, jointly with the 
     Commissioner of the Social Security Administration, shall 
     ensure that each retroactive LIS enrollment beneficiary 
     receives, with any letter or notification of eligibility for 
     a low-income subsidy under section 1860D-14 of the Social 
     Security Act, a notice of their right to reimbursement 
     described in subsection (a)(1) for covered drug costs 
     incurred during the retroactive coverage period of the 
     beneficiary. Such notice shall--
       (A) with respect to a beneficiary described in subsection 
     (e)(4)(A)(i), inform the beneficiary of the beneficiary's 
     right to automatic reimbursement as described in subsection 
     (a)(1); and
       (B) with respect to a beneficiary described in subsection 
     (e)(4)(A)(ii), include a description of a clear process that 
     the beneficiary should follow to seek such reimbursement.

[[Page S6199]]

       (2) By prescription drug plans.--
       (A) In general.--Each prescription drug plan under part D 
     of title XVIII of the Social Security Act (and MA-PD plan 
     under part C of such title) shall include in a notice from 
     the plan to a retroactive LIS enrollment beneficiary 
     described in subsection (e)(4)(A)(ii) a model notice 
     developed under subparagraph (B) describing the process the 
     beneficiary must follow to seek retroactive reimbursement. 
     Such notice shall include any form required by the plan to 
     complete such reimbursement and shall indicate the period of 
     retroactive coverage for which the beneficiary is eligible 
     for such reimbursement.
       (B) Model notice.--The Secretary, jointly with the 
     Commissioner of Social Security, shall develop a model notice 
     for purposes of subparagraph (A) and shall make such model 
     notice available to all prescription drug plans under part D 
     of title XVIII of the Social Security Act (and MA-PD plans 
     under part C of such title).
       (d) Public Posting to Track Payments.--
       (1) In general.--Not later than one year after the date of 
     the enactment of this Act, the Secretary shall post (and 
     annually update) on the public Internet website of the 
     Department of Health and Human Services information on the 
     total amount of payments made by the Secretary under 
     subsection (a)(2) to prescription drug plans during the most 
     recent plan year for which plan data is available.
       (2) Specific information.--Such information posted--
       (A) in 2010 or in a subsequent year before 2016, shall 
     include information on payments made for years beginning with 
     2006 and ending with the year for which the most current 
     information is available; and
       (B) in 2016 or a subsequent year, shall include information 
     on payments made for at least the 10 previous years.
       (e) Definitions.--In this section:
       (1) Covered drug costs.--The term ``covered drug costs'' 
     means, with respect to a retroactive LIS enrollment 
     beneficiary enrolled under a prescription drug plan under 
     part D of title XVIII of the Social Security Act (or an MA-PD 
     plan under part C of such title), the amount by which--
       (A) the costs incurred by such beneficiary during the 
     retroactive coverage period of the beneficiary for covered 
     part D drugs, premiums, and cost-sharing under such title; 
     exceeds
       (B) such costs that would have been incurred by such 
     beneficiary during such period if the beneficiary had been 
     both enrolled in the plan and recognized by such plan as 
     qualified during such period for the low income subsidy under 
     section 1860D-14 of the Social Security Act to which the 
     individual is entitled.
       (2) Eligible third party.--The term ``eligible third 
     party'' means, with respect to a retroactive LIS enrollment 
     beneficiary, an organization or other third party that paid 
     on behalf of such beneficiary for covered drug costs incurred 
     by such beneficiary during the retroactive coverage period of 
     such beneficiary.
       (3) Retroactive coverage period.--The term ``retroactive 
     coverage period'' means--
       (A) with respect to a retroactive LIS enrollment 
     beneficiary described in paragraph (4)(A)(i), the period--
       (i) beginning on the effective date of the assistance 
     described in such paragraph for which the individual is 
     eligible; and
       (ii) ending on the date the plan effectuates the status of 
     such individual as so eligible; and
       (B) with respect to a retroactive LIS enrollment 
     beneficiary described in paragraph (4)(A)(ii), the period--
       (i) beginning on the date the individual is both entitled 
     to benefits under part A, or enrolled under part B, of title 
     XVIII of the Social Security Act and eligible for medical 
     assistance under a State plan under title XIX of such Act; 
     and
       (ii) ending on the date the plan effectuates the status of 
     such individual as a full-benefit dual eligible individual 
     (as defined in section 1935(c)(6) of such Act).
       (4) Retroactive lis enrollment beneficiary.--
       (A) In general.--The term ``retroactive LIS enrollment 
     beneficiary'' means an individual who--
       (i) is enrolled in a prescription drug plan under part D of 
     title XVIII of the Social Security Act (or an MA-PD plan 
     under part C of such title) and subsequently becomes eligible 
     as a full-benefit dual eligible individual (as defined in 
     section 1935(c)(6) of such Act), an individual receiving a 
     low-income subsidy under section 1860D-14 of such Act, an 
     individual receiving assistance under the Medicare Savings 
     Program implemented under clauses (i), (ii), (iii), and (iv) 
     of section 1902(a)(10)(E) of such Act, or an individual 
     receiving assistance under the supplemental security income 
     program under section 1611 of such Act; or
       (ii) subject to subparagraph (B)(i), is a full-benefit dual 
     eligible individual (as defined in section 1935(c)(6) of such 
     Act) who is automatically enrolled in such a plan under 
     section 1860D-1(b)(1)(C) of such Act.
       (B) Exception for beneficiaries enrolled in rfp plan.--
       (i) In general.--In no case shall an individual described 
     in subparagraph (A)(ii) include an individual who is 
     enrolled, pursuant to a RFP contract described in clause 
     (ii), in a prescription drug plan offered by the sponsor of 
     such plan awarded such contract.
       (ii) RFP contract described.--The RFP contract described in 
     this section is a contract entered into between the Secretary 
     and a sponsor of a prescription drug plan pursuant to the 
     Centers for Medicare & Medicaid Services' request for 
     proposals issued on February 17, 2009, relating to Medicare 
     part D retroactive coverage for certain low income 
     beneficiaries, or a similar subsequent request for proposals.
       (f) GAO Report.--Not later than 24 months after the date of 
     the enactment of this Act, the Comptroller General of the 
     United States shall submit to Congress a report on the extent 
     to which the provisions of this section improve reimbursement 
     for covered drug costs to retroactive LIS enrollment 
     beneficiaries and lower the amounts of payments made by the 
     Secretary, with respect to such beneficiaries, to 
     prescription drug plans under part D of title XVIII of the 
     Social Security Act (and MA-PD plans under part C of such 
     title).
       (g) Report to Congress.--In the case that an RFP contract 
     described in subsection (e)(4)(B)(ii) is awarded, not later 
     than two years after the effective date of such contract, the 
     Secretary of Health and Human Services shall submit to 
     Congress a report evaluating the program carried out through 
     such contract.
       (h) Effective Date.--Paragraphs (2) and (3) of subsection 
     (a) and subsections (b) and (c) shall apply to subsidy 
     determinations made on or after the date that is 3 months 
     after the date of the enactment of this Act.

     SEC. 13. INTELLIGENT ASSIGNMENT IN ENROLLMENT.

       (a) In General.--Section 1860D-1(b)(1) of the Social 
     Security Act (42 U.S.C. 1395w-101(b)(1), as amended by 
     section 7(b), is amended--
       (1) in the second sentence of subparagraph (C), by striking 
     ``on a random basis among all such plans'' and inserting ``, 
     subject to subparagraph (E), in the most appropriate plan for 
     such individual''; and
       (2) by adding at the end the following new subparagraph:
       ``(E) Intelligent assignment.--In the case of any auto-
     enrollment under subparagraph (C), no part D eligible 
     individual described in such subparagraph shall be enrolled 
     in a prescription drug plan which does not meet requirements 
     established by the Secretary.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to enrollments effected on or after November 15, 
     2010.

     SEC. 14. MEDICARE ENROLLMENT ASSISTANCE.

       (a) Additional Funding for State Health Insurance 
     Assistance Programs.--
       (1) Grants.--
       (A) In general.--The Secretary of Health and Human Services 
     (in this section referred to as the ``Secretary'') shall use 
     amounts made available under subparagraph (B) to make grants 
     to States for State health insurance assistance programs 
     receiving assistance under section 4360 of the Omnibus Budget 
     Reconciliation Act of 1990.
       (B) Funding.--For purposes of making grants under this 
     subsection, the Secretary shall provide for the transfer, 
     from the Federal Hospital Insurance Trust Fund under section 
     1817 of the Social Security Act (42 U.S.C. 1395i) and the 
     Federal Supplementary Medical Insurance Trust Fund under 
     section 1841 of such Act (42 U.S.C. 1395t), in the same 
     proportion as the Secretary determines under section 1853(f) 
     of such Act (42 U.S.C. 1395w-23(f)), of $14,000,000 to the 
     Centers for Medicare & Medicaid Services Program Management 
     Account for fiscal year 2011, to remain available until 
     expended.
       (2) Amount of grants.--The amount of a grant to a State 
     under this subsection from the total amount made available 
     under paragraph (1) shall be equal to the sum of the amount 
     allocated to the State under paragraph (3)(A) and the amount 
     allocated to the State under subparagraph (3)(B).
       (3) Allocation to states.--
       (A) Allocation based on percentage of low-income 
     beneficiaries.--The amount allocated to a State under this 
     subparagraph from \2/3\ of the total amount made available 
     under paragraph (1) shall be based on the number of 
     individuals who meet the requirement under subsection 
     (a)(3)(A)(ii) of section 1860D-14 of the Social Security Act 
     (42 U.S.C. 1395w-114) but who have not enrolled to receive a 
     subsidy under such section 1860D-14 relative to the total 
     number of individuals who meet the requirement under such 
     subsection (a)(3)(A)(ii) in each State, as estimated by the 
     Secretary.
       (B) Allocation based on percentage of rural 
     beneficiaries.--The amount allocated to a State under this 
     subparagraph from \1/3\ of the total amount made available 
     under paragraph (1) shall be based on the number of part D 
     eligible individuals (as defined in section 1860D-1(a)(3)(A) 
     of such Act (42 U.S.C. 1395w-101(a)(3)(A))) residing in a 
     rural area relative to the total number of such individuals 
     in each State, as estimated by the Secretary.
       (4) Portion of grant based on percentage of low-income 
     beneficiaries to be used to provide outreach to individuals 
     who may be subsidy eligible individuals or eligible for the 
     medicare savings program.--Each grant awarded under this 
     subsection with respect to amounts allocated under paragraph 
     (3)(A) shall be used to provide outreach to individuals who 
     may be subsidy eligible individuals (as defined in section 
     1860D-14(a)(3)(A) of the Social Security Act (42 U.S.C. 
     1395w-114(a)(3)(A)) or eligible for the Medicare Savings 
     Program (as defined in subsection (f)).
       (b) Additional Funding for Area Agencies on Aging.--

[[Page S6200]]

       (1) Grants.--
       (A) In general.--The Secretary, acting through the 
     Assistant Secretary for Aging, shall make grants to States 
     for area agencies on aging (as defined in section 102 of the 
     Older Americans Act of 1965 (42 U.S.C. 3002)) and Native 
     American programs carried out under the Older Americans Act 
     of 1965 (42 U.S.C. 3001 et seq.).
       (B) Funding.--For purposes of making grants under this 
     subsection, the Secretary shall provide for the transfer, 
     from the Federal Hospital Insurance Trust Fund under section 
     1817 of the Social Security Act (42 U.S.C. 1395i) and the 
     Federal Supplementary Medical Insurance Trust Fund under 
     section 1841 of such Act (42 U.S.C. 1395t), in the same 
     proportion as the Secretary determines under section 1853(f) 
     of such Act (42 U.S.C. 1395w-23(f)), of $10,000,000 to the 
     Administration on Aging for fiscal year 2011, to remain 
     available until expended.
       (2) Amount of grant and allocation to states based on 
     percentage of low-income and rural beneficiaries.--The amount 
     of a grant to a State under this subsection from the total 
     amount made available under paragraph (1) shall be determined 
     in the same manner as the amount of a grant to a State under 
     subsection (a), from the total amount made available under 
     paragraph (1) of such subsection, is determined under 
     paragraph (2) and subparagraphs (A) and (B) of paragraph (3) 
     of such subsection.
       (3) Required use of funds.--
       (A) All funds.--Subject to subparagraph (B), each grant 
     awarded under this subsection shall be used to provide 
     outreach to eligible Medicare beneficiaries regarding the 
     benefits available under title XVIII of the Social Security 
     Act.
       (B) Outreach to individuals who may be subsidy eligible 
     individuals or eligible for the medicare savings program.--
     Subsection (a)(4) shall apply to each grant awarded under 
     this subsection in the same manner as it applies to a grant 
     under subsection (a).
       (c) Additional Funding for Aging and Disability Resource 
     Centers.--
       (1) Grants.--
       (A) In general.--The Secretary shall make grants to Aging 
     and Disability Resource Centers under the Aging and 
     Disability Resource Center grant program that are established 
     centers under such program on the date of the enactment of 
     this Act.
       (B) Funding.--For purposes of making grants under this 
     subsection, the Secretary shall provide for the transfer, 
     from the Federal Hospital Insurance Trust Fund under section 
     1817 of the Social Security Act (42 U.S.C. 1395i) and the 
     Federal Supplementary Medical Insurance Trust Fund under 
     section 1841 of such Act (42 U.S.C. 1395t), in the same 
     proportion as the Secretary determines under section 1853(f) 
     of such Act (42 U.S.C. 1395w-23(f)), of $10,000,000 to the 
     Administration on Aging for fiscal year 2011, to remain 
     available until expended.
       (2) Required use of funds.--Each grant awarded under this 
     subsection shall be used to provide outreach to individuals 
     regarding the benefits available under the Medicare 
     prescription drug benefit under part D of title XVIII of the 
     Social Security Act and under the Medicare Savings Program.
       (d) Coordination of Efforts To Inform Older Americans About 
     Benefits Available Under Federal and State Programs.--
       (1) In general.--The Secretary, acting through the 
     Assistant Secretary for Aging, in cooperation with related 
     Federal agency partners, shall make a grant to, or enter into 
     a contract with, a qualified, experienced entity under which 
     the entity shall--
       (A) maintain and update web-based decision support tools, 
     and integrated, person-centered systems, designed to inform 
     older individuals (as defined in section 102 of the Older 
     Americans Act of 1965 (42 U.S.C. 3002)) about the full range 
     of benefits for which the individuals may be eligible under 
     Federal and State programs;
       (B) utilize cost-effective strategies to find older 
     individuals with the greatest economic need (as defined in 
     such section 102) and inform the individuals of the programs;
       (C) develop and maintain an information clearinghouse on 
     best practices and the most cost-effective methods for 
     finding older individuals with greatest economic need and 
     informing the individuals of the programs; and
       (D) provide, in collaboration with related Federal agency 
     partners administering the Federal programs, training and 
     technical assistance on the most effective outreach, 
     screening, and follow-up strategies for the Federal and State 
     programs.
       (2) Funding.--For purposes of making a grant or entering 
     into a contract under paragraph (1), the Secretary shall 
     provide for the transfer, from the Federal Hospital Insurance 
     Trust Fund under section 1817 of the Social Security Act (42 
     U.S.C. 1395i) and the Federal Supplementary Medical Insurance 
     Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), 
     in the same proportion as the Secretary determines under 
     section 1853(f) of such Act (42 U.S.C. 1395w-23(f)), of 
     $10,000,000 to the Administration on Aging for fiscal year 
     2011, to remain available until expended.
       (e) Medicare Savings Program Defined.--For purposes of this 
     section, the term ``Medicare Savings Program'' means the 
     program of medical assistance for payment of the cost of 
     medicare cost-sharing under the Medicaid program pursuant to 
     sections 1902(a)(10)(E) and 1933 of the Social Security Act 
     (42 U.S.C. 1396a(a)(10)(E), 1396u-3).

     SEC. 15. QMB BUY-IN OF PART A AND PART B PREMIUMS.

       (a) Requirement.--Section 1902(a) of the Social Security 
     Act (42 U.S.C. 1396a(a)), as amended by section 10, is 
     amended--
       (1) in paragraph (73), by striking ``and'' at the end;
       (2) in paragraph (74), by striking the period at the end 
     and inserting ``; and''; and
       (3) by inserting after paragraph (74) the following new 
     paragraph:
       ``(75) provide that the State enters into a modification of 
     an agreement under section 1818(g).''.
       (b) Effective Date.--
       (1) In general.--Except as provided in paragraph (2), the 
     amendments made by this section take effect on the date that 
     is 6 months after the date of enactment of this Act.
       (2) Extension of effective date for state law amendment.--
     In the case of a State plan under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
     Health and Human Services determines requires State 
     legislation 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 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 the 
     session is considered to be a separate regular session of the 
     State legislature.

     SEC. 16. INCREASING AVAILABILITY OF MSP APPLICATIONS THROUGH 
                   AVAILABILITY ON THE INTERNET AND DESIGNATION OF 
                   PREFERRED LANGUAGE.

       (a) Requirement for States.--
       (1) In general.--Section 1902(a) of the Social Security Act 
     (42 U.S.C. 1396a(a)), as amended by section 15, is amended--
       (A) in paragraph (74), by striking ``and'' at the end;
       (B) in paragraph (75), by striking the period at the end 
     and inserting ``; and''; and
       (C) by inserting after paragraph (75) the following new 
     paragraph:
       ``(76) provide--
       ``(A) that the application for medical assistance for 
     medicare cost-sharing under this title used by the State 
     allows an individual to specify a preferred language for 
     subsequent communication and, in the case in which a language 
     other than English is specified, provide that subsequent 
     communications under this title to the individual shall be in 
     such language; and
       ``(B) that the State makes such application available 
     through an Internet website and provides for such application 
     to be completed on such website.''.
       (2) Effective date.--
       (A) In general.--Except as provided in subparagraph (B), 
     the amendments made by this subsection take effect on the 
     date that is 2 years after the date of enactment of this Act.
       (B) Extension of effective date for state law amendment.--
     In the case of a State plan under title XIX of the Social 
     Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
     Health and Human Services determines requires State 
     legislation in order for the plan to meet the additional 
     requirements imposed by the amendments made by this 
     subsection, 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 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 the 
     session is considered to be a separate regular session of the 
     State legislature.
       (b) Requirement for the Secretary.--Section 1905(p)(5) of 
     the Social Security Act (42 U.S.C. 1396d(p)(5)) is amended by 
     adding at the end the following new sentence: ``Such form 
     shall allow an individual to specify a preferred language for 
     subsequent communication.''.

     SEC. 17. STATE MEDICAID AGENCY CONSIDERATION OF LOW-INCOME 
                   SUBSIDY APPLICATION AND DATA TRANSMITTAL.

       (a) Technical Amendments.--
       (1) In general.--Section 1144(c)(3)(A)(i) of the Social 
     Security Act (42 U.S.C. 1320b-14(c)(3)(A)(i)), as amended by 
     section 10, is amended--
       (A) by striking ``transmittal''; and
       (B) by inserting ``(as specified in section 1935(a)(4))'' 
     before the semicolon at the end.
       (2) Effective date.--The amendments made by this subsection 
     shall take effect as if included in the enactment of section 
     113(a) of the Medicare Improvements for Patients and 
     Providers Act of 2008 (Public Law 110-275).
       (b) Clarification of State Medicaid Agency Consideration of 
     Low-Income Subsidy Application.--Section 1935(a)(4) of the 
     Social Security Act (42 U.S.C. 1396u-5(a)(4)), as added by 
     section 113(b) of the Medicare Improvements for Patients and 
     Providers Act of 2008 (Public Law 110-275), is amended--

[[Page S6201]]

       (1) by striking ``Program.--The State'' and inserting 
     ``Program.--
       ``(A) In general.--The State'';
       (2) in subparagraph (A), as inserting by paragraph (1), by 
     striking the second sentence; and
       (3) by adding at the end the following new subparagraphs:
       ``(B) For purposes of a State's obligation under section 
     1902(a)(8) to furnish medical assistance with reasonable 
     promptness, the date of the electronic transmission by the 
     Commissioner of Social Security to the State Medicaid agency 
     of data under section 1144(c)(3) shall be the date of the 
     filing of such application for benefits under the Medicare 
     Savings Program.
       ``(C) For the purpose of determining when medical 
     assistance shall be made available for medicare cost-sharing 
     under this title, the State shall consider the date of the 
     application for low-income subsidies under section 1860D-14 
     to be the date of the filing of an application for benefits 
     under the Medicare Savings Program.''.
                                 ______