[Congressional Record Volume 166, Number 207 (Tuesday, December 8, 2020)]
[House]
[Pages H6993-H7000]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




BENEFICIARY ENROLLMENT NOTIFICATION AND ELIGIBILITY SIMPLIFICATION ACT 
                                OF 2020

  Mr. LARSON of Connecticut. Madam Speaker, I move to suspend the rules 
and pass the bill (H.R. 2477) to amend title XVIII of the Social 
Security Act to establish a system to notify individuals approaching 
Medicare eligibility, to simplify and modernize the eligibility 
enrollment process, and for other purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 2477

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

     SECTION 1. SHORT TITLE.

       This Act may be cited as the ``Beneficiary Enrollment 
     Notification and Eligibility Simplification Act of 2020'' or 
     the ``BENES Act of 2020''.

     SEC. 2. BENEFICIARY ENROLLMENT NOTIFICATION AND ELIGIBILITY 
                   SIMPLIFICATION.

       (a) Eligibility and Enrollment Notices.--
       (1) As part of social security account statement for 
     individuals attaining ages 63 to 65.--
       (A) In general.--Section 1143(a) of the Social Security Act 
     (42 U.S.C. 1320b-13(a)) is amended by adding at the end the 
     following new paragraph:
       ``(4) Medicare Eligibility Information.--
       ``(A) In general.--In the case of statements provided on or 
     after the date that is 2 years after the date of the 
     enactment of this paragraph to individuals who are attaining 
     ages 63, 64, and 65, the statement shall also include a 
     notice containing the information described in subparagraph 
     (B).
       ``(B) Contents of notice.--The notice required under 
     subparagraph (A) shall include a clear, simple explanation 
     of--
       ``(i) eligibility for benefits under the Medicare program 
     under title XVIII, and in particular benefits under parts B 
     and C of such title;
       ``(ii) the reasons a late enrollment penalty for failure to 
     timely enroll could be assessed and how such late enrollment 
     penalty is calculated, in particular for benefits under such 
     part B;
       ``(iii) the availability of relief from such late 
     enrollment penalty and retroactive enrollment under section 
     1837(h) (including as such section is applied under sections 
     1818(c) and 1818A(c)(3)), with examples of circumstances 
     under which such relief may be granted and examples of 
     circumstances under which such relief would not be granted;
       ``(iv) coordination of benefits (including primary and 
     secondary coverage scenarios) pursuant to section 1862(b), in 
     particular for benefits under such part B;
       ``(v) enrollment, eligibility, and coordination of benefits 
     under title XVIII with respect to populations, for whom there 
     are special considerations, such as residents of Puerto Rico 
     and veterans; and
       ``(vi) online resources and toll-free telephone numbers of 
     the Social Security Administration and the Centers for 
     Medicare & Medicaid Services (including 1-800-MEDICARE and 
     the national toll-free number of the Social Security 
     Administration) that provide information on eligibility for 
     benefits under the Medicare program under title XVIII, 
     including under part C of such title.
       ``(C) Development of notice.--
       ``(i) In general.--The Secretary, in coordination with the 
     Commissioner of Social Security, and taking into 
     consideration information collected pursuant to clause (ii), 
     shall, not later than 12 months after the last day of the 
     period for the request of information described in clause 
     (ii), develop the notice to be provided pursuant to 
     subparagraph (A).
       ``(ii) Request for information.--Not later than 6 months 
     after the date of the enactment of this paragraph, the 
     Secretary shall request written information, including 
     recommendations, from stakeholders (including the groups 
     described in subparagraph (D)) on the information to be 
     included in the notice.
       ``(iii) Notice improvement.--Beginning 4 years after the 
     date of the enactment of this paragraph, and not less than 
     once every 2 years thereafter, the Secretary, in coordination 
     with the Commissioner of Social Security, shall--
       ``(I) review the content of the notice to be provided under 
     subparagraph (A);
       ``(II) request written information, including 
     recommendations, on such notice through a request for 
     information process as described in clause (ii); and
       ``(III) update and revise such notice as the Secretary 
     deems appropriate.
       ``(D) Groups.--For purposes of subparagraph (C)(ii), the 
     groups described in this subparagraph include the following:
       ``(i) Individuals who are 60 years of age or older.
       ``(ii) Veterans.
       ``(iii) Individuals with disabilities.
       ``(iv) Individuals with end stage renal disease.
       ``(v) Low-income individuals and families.
       ``(vi) Employers (including human resources professionals).
       ``(vii) States (including representatives of State-run 
     Health Insurance Exchanges, Medicaid offices, and Departments 
     of Insurance).
       ``(viii) State Health Insurance Assistance Programs.
       ``(ix) Health insurers.

[[Page H6994]]

       ``(x) Health insurance agents and brokers.
       ``(xi) Such other groups as specified by the Secretary.
       ``(E) Posting of notice on websites.--The Commissioner of 
     Social Security and the Secretary shall post the notice 
     required under subparagraph (A) on the public Internet 
     website of the Social Security Administration and on 
     Medicare.gov (or a successor website), respectively.
       ``(F) Reimbursement of costs.--
       ``(i) In general.--Effective for fiscal years beginning in 
     the year in which the date of enactment of this paragraph 
     occurs, the Commissioner of Social Security and the Secretary 
     shall enter into an agreement under which the Secretary shall 
     provide for the transfer, from the Federal Hospital Insurance 
     Trust Fund under section 1817 and the Federal Supplementary 
     Medical Insurance Trust Fund under section 1841 (in such 
     proportion as the Secretary determines appropriate), of such 
     sums as necessary to cover the administrative costs of the 
     Commissioner's activities under this paragraph. Such 
     agreement shall--
       ``(I) provide funds to the Commissioner for the 
     administrative costs of the Social Security Administration's 
     work related to the implementation of this paragraph, 
     including any initial costs incurred prior to the 
     finalization of such agreement;
       ``(II) provide such funding quarterly in advance of the 
     applicable quarter based on estimating methodology agreed to 
     by the Commissioner and the Secretary; and
       ``(III) require an annual accounting (with a detailed 
     description of the costs and methodology used to assess such 
     costs) and reconciliation of the actual costs incurred and 
     funds provided under this paragraph.
       ``(ii) Limitation.--In no case shall funds from the Social 
     Security Administration's Limitation on Administrative 
     Expenses be used to carry out activities related to the 
     implementation of this paragraph, except as the Commissioner 
     determines is necessary--
       ``(I) for the development of the agreement under clause 
     (i); and
       ``(II) on a temporary basis and subject to reimbursement 
     under clause (i)(I), for the initial implementation of this 
     paragraph.
       ``(G) No effect on obligation to mail statements.--Nothing 
     in this paragraph shall be construed to relieve the 
     Commissioner of Social Security from any requirement under 
     subsection (c), including the requirement to mail a statement 
     on an annual basis to each eligible individual who is not 
     receiving benefits under title II and for whom a mailing 
     address can be determined through such methods as the 
     Commissioner determines to be appropriate.''.
       (B) Timing of statements.--Section 1143(c)(2) of such Act 
     (42 U.S.C. 1320b-13(c)(2)) is amended by adding at the end 
     the following: ``With respect to statements provided to 
     individuals who are attaining age 65, as described in 
     subsection (a)(4), such statements shall be mailed not 
     earlier than 6 months and not later than 3 months before the 
     individual attains such age.''
       (2) Social security beneficiaries.--Title XI of the Social 
     Security Act (42 U.S.C. 1301 et seq.) is amended by inserting 
     after section 1144 the following new section:


 ``MEDICARE ENROLLMENT NOTIFICATION AND ELIGIBILITY NOTICES FOR SOCIAL 
          SECURITY BENEFICIARIES PRIOR TO MEDICARE ELIGIBILITY

                               ``Notices

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

                                ``Timing

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

                        ``Reimbursement of Costs

       ``(c)
       ``(1) In General.--Effective for fiscal years beginning in 
     the year in which the date of enactment of this section 
     occurs, the Commissioner of Social Security and the Secretary 
     shall enter into an agreement under which the Secretary shall 
     provide for the transfer, from the Federal Hospital Insurance 
     Trust Fund under section 1817 and the Federal Supplementary 
     Medical Insurance Trust Fund under section 1841 (in such 
     proportion as the Secretary determines appropriate), of such 
     sums as necessary to cover the administrative costs of the 
     Commissioner's activities under this section. Such agreement 
     shall--
       ``(A) provide funds to the Commissioner for the 
     administrative costs of the Social Security Administration's 
     work related to the implementation of this section, including 
     any initial costs incurred prior to the finalization of such 
     agreement;
       ``(B) provide such funding quarterly in advance of the 
     applicable quarter based on estimating methodology agreed to 
     by the Commissioner and the Secretary; and
       ``(C) require an annual accounting (with a detailed 
     description of the costs and methodology used to assess such 
     costs) and reconciliation of the actual costs incurred and 
     funds provided under this paragraph.
       ``(2) Limitation.--In no case shall funds from the Social 
     Security Administration's Limitation on Administrative 
     Expenses be used to carry out activities related to the 
     implementation of this section, except as the Commissioner 
     determines is necessary--
       ``(A) for the development of the agreement under paragraph 
     (1); and
       ``(B) on a temporary basis and subject to reimbursement 
     under paragraph (1)(A), for the initial implementation of 
     this section.''.
       (b) Beneficiary Enrollment Simplification.--
       (1) Effective date of coverage.--Section 1838(a) of the 
     Social Security Act (42 U.S.C. 1395q(a)) is amended--
       (A) by amending paragraph (2) to read as follows:
       ``(2)(A) in the case of an individual who enrolls pursuant 
     to subsection (d) of section 1837 before the month in which 
     he first satisfies paragraph (1) or (2) of section 1836(a), 
     the first day of such month,
       ``(B) in the case of an individual who first satisfies such 
     paragraph in a month beginning before January 2023 and who 
     enrolls pursuant to such subsection (d)--
       ``(i) in such month in which he first satisfies such 
     paragraph, the first day of the month following the month in 
     which he so enrolls,
       ``(ii) in the month following such month in which he first 
     satisfies such paragraph, the first day of the second month 
     following the month in which he so enrolls, or
       ``(iii) more than one month following such month in which 
     he satisfies such paragraph, the first day of the third month 
     following the month in which he so enrolls,
       ``(C) in the case of an individual who first satisfies such 
     paragraph in a month beginning on or after January 1, 2023, 
     and who enrolls pursuant to such subsection (d) in such month 
     in which he first satisfies such paragraph or in any 
     subsequent month of his initial enrollment period, the first 
     day of the month following the month in which he so enrolls, 
     or
       ``(D) in the case of an individual who enrolls pursuant to 
     subsection (e) of section 1837 in a month beginning--
       ``(i) before January 1, 2023, the July 1 following the 
     month in which he so enrolls; or
       ``(ii) on or after January 1, 2023, the first day of the 
     month following the month in which he so enrolls; or''; and
       (B) by amending paragraph (3) to read as follows:
       ``(3) in the case of an individual who is deemed to have 
     enrolled--
       ``(A) on or before the last day of the third month of his 
     initial enrollment period, the first day of the month in 
     which he first meets the applicable requirements of section 
     1836(a) or July 1, 1973, whichever is later, or
       ``(B) on or after the first day of the fourth month of his 
     initial enrollment period, and where such month begins--
       ``(i) before January 1, 2023, as prescribed under 
     subparagraphs (B)(i), (B)(ii), (B)(iii), and (D)(i) of 
     paragraph (2), or
       ``(ii) on or after January 1, 2023, as prescribed under 
     subparagraphs (C) and (D)(ii) of paragraph (2).''.
       (2) Special enrollment periods for exceptional 
     circumstances.--
       (A) Enrollment.--Section 1837 of the Social Security Act 
     (42 U.S.C. 1395p) is amended by adding at the end the 
     following new subsection:
       ``(m) Beginning January 1, 2023, the Secretary may 
     establish special enrollment periods in the case of 
     individuals who satisfy paragraph (1) or (2) of section 
     1836(a) and meet such exceptional conditions as the Secretary 
     may provide.''.
       (B) Coverage period.--Section 1838 of the Social Security 
     Act (42 U.S.C. 1395q) is amended by adding at the end the 
     following new subsection:
       ``(g) Notwithstanding subsection (a), in the case of an 
     individual who enrolls during a special enrollment period 
     pursuant to section 1837(m), the coverage period shall begin 
     on a date the Secretary provides in a manner consistent (to 
     the extent practicable) with protecting continuity of health 
     benefit coverage.''.
       (C) Conforming amendment.--Title XVIII of the Social 
     Security Act (42 U.S.C. 1395 et seq.) is amended--
       (i) in section 1818A(c)(3), by striking ``subsections (h) 
     and (i) of section 1837'' and inserting ``subsections (h), 
     (i), and (m) of section 1837''; and
       (ii) in section 1839(b), in the first sentence, by striking 
     ``or (l)'' and inserting ``, (l), or (m)''.
       (3) Technical correction.--Section 1839(b) of the Social 
     Security Act (42 U.S.C. 1395r(b))

[[Page H6995]]

     is amended by adding at the end the following new sentence: 
     ``For purposes of determining any increase under this 
     subsection for individuals whose enrollment occurs on or 
     after January 1, 2023, the second sentence of this subsection 
     shall be applied by substituting `close of the month' for 
     `close of the enrollment period' each place it appears.''.
       (4) Report.--Not later than January 1, 2023, the Secretary 
     of Health and Human Services shall submit to the Committee on 
     Ways and Means and Committee on Energy and Commerce of the 
     House of Representatives and the Committee on Finance and 
     Special Committee on Aging of the Senate a report on how to 
     align existing Medicare enrollment periods under title XVIII 
     of the Social Security Act, including the general enrollment 
     period under part B of such title and the annual, coordinated 
     election period under the Medicare Advantage program under 
     part C of such title and under the prescription drug program 
     under part D of such title. Such report shall include 
     recommendations consistent with the goals of maximizing 
     coverage continuity and choice and easing beneficiary 
     transition.
       (5) GAO study and report.--
       (A) Study.--The Comptroller General of the United States 
     (in this section referred to as the ``Comptroller General'') 
     shall conduct a study on the activities carried out under 
     this section. Such study shall include the following:
       (i) An analysis of the Social Security Administration's use 
     of the funds provided to carry out the activities described 
     under this section and the amendments made by this section. 
     The Comptroller General shall examine the amount of funds 
     transferred from the Federal Hospital Insurance Trust Fund 
     and the Federal Supplementary Medical Insurance Trust Fund, 
     respectively, for those activities; how the funds were spent; 
     what procedures the agency had in place over the use of those 
     funds; and how the agency complied with those procedures.
       (ii) An evaluation of the notices described in sections 
     1143(a)(4)(A) and 1144A(a) of the Social Security Act, 
     including, to the extent data is available, how the mailing 
     of such notices affected enrollee behavior and the imposition 
     of late enrollment penalties under Medicare Part B.
       (iii) Any other area determined appropriate by the 
     Comptroller General.
       (B) Report.--Not later than 5 years after the date of 
     enactment of this section, the Comptroller General shall 
     submit to the Committee on Ways and Means and Committee on 
     Energy and Commerce of the House of Representatives and the 
     Committee on Finance of the Senate a report containing the 
     results of the study conducted under paragraph (1), including 
     recommendations for any legislative and administrative 
     actions as the Comptroller General determines appropriate.
       (c) Funding.--Section 1808 of the Social Security Act (42 
     U.S.C. 1395b-9) is amended by adding the end the following 
     new subsection:
       ``(e) Funding for Implementation of Beneficiary Enrollment 
     Notification and Eligibility Simplification.--For purposes of 
     carrying out the provisions of and the amendments made by 
     section 2 of the BENES Act of 2020, the Secretary shall 
     provide for the transfer, from the Federal Hospital Insurance 
     Trust Fund under section 1817 and the Federal Supplementary 
     Medical Insurance Trust Fund under section 1841 (in such 
     proportion as the Secretary determines appropriate), to the 
     Centers for Medicare & Medicaid Services Program Management 
     Account, of $2,000,000 for each fiscal year beginning with 
     fiscal year 2021, to remain available until expended.''.

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

       (a) Medicare Entitlement to Immunosuppressive Drugs for 
     Kidney Transplant Recipients.--
       (1) In general.--Section 226A(b)(2) of the Social Security 
     Act (42 U.S.C. 426-1(b)(2)) is amended by inserting ``(except 
     for eligibility for enrollment under part B solely for 
     purposes of coverage of immunosuppressive drugs described in 
     section 1861(s)(2)(J))'' before ``, with the thirty-sixth 
     month''.
       (2) Individuals eligible only for coverage of 
     immunosuppressive drugs.--
       (A) In general.--Section 1836 of the Social Security Act 
     (42 U.S.C. 1395o) is amended--
       (i) by striking ``Every'' and inserting ``(a) In General.--
     Every''; and
       (ii) by adding at the end the following new subsection:
       ``(b) Individuals Eligible for Immunosuppressive Drug 
     Coverage.--
       ``(1) In general.--Except as provided under paragraph (2), 
     every individual whose entitlement to insurance benefits 
     under part A ends (whether before, on, or after January 1, 
     2023) by reason of section 226A(b)(2) is eligible to enroll 
     or to be deemed to have enrolled in the medical insurance 
     program established by this part solely for purposes of 
     coverage of immunosuppressive drugs in accordance with 
     section 1837(n).
       ``(2) Exception if other coverage is available.--
       ``(A) In general.--An individual described in paragraph (1) 
     shall not be eligible for enrollment in the program for 
     purposes of coverage described in such paragraph with respect 
     to any period in which the individual, as determined in 
     accordance with subparagraph (B)--
       ``(i) is enrolled in a group health plan or group or 
     individual health insurance coverage, as such terms are 
     defined in section 2791 of the Public Health Service Act;
       ``(ii) is enrolled for coverage under the TRICARE for Life 
     program under section 1086(d) of title 10, United States 
     Code;
       ``(iii) is enrolled under a State plan (or waiver of such 
     plan) under title XIX and is eligible to receive benefits for 
     immunosuppressive drugs described in this subsection under 
     such plan (or such waiver);
       ``(iv) is enrolled under a State child health plan (or 
     waiver of such plan) under title XXI and is eligible to 
     receive benefits for such drugs under such plan (or such 
     waiver); or
       ``(v)(I) is enrolled in the patient enrollment system of 
     the Department of Veterans Affairs established and operated 
     under section 1705 of title 38, United States Code;
       ``(II) is not required to enroll under section 1705 of such 
     title to receive immunosuppressive drugs described in this 
     subsection; or
       ``(III) is otherwise eligible under a provision of title 
     38, United States Code, other than section 1710 of such title 
     to receive immunosuppressive drugs described in this 
     subsection.
       ``(B) Eligibility determinations.--
       ``(i) In general.--The Secretary, in coordination with the 
     Commissioner of Social Security, shall establish a process 
     for determining whether an individual described in paragraph 
     (1) who is to be enrolled or deemed to be enrolled in the 
     medical insurance program described in such paragraph meets 
     the requirements for such enrollment under this subsection, 
     including the requirement that the individual not be enrolled 
     in other coverage as described in subparagraph (A).
       ``(ii) Attestation regarding other coverage.--The process 
     established under clause (i) shall include, at a minimum, a 
     requirement that--

       ``(I) the individual provide to the Commissioner an 
     attestation that the individual is not enrolled and does not 
     expect to enroll in such other coverage; and
       ``(II) the individual notify the Commissioner within 60 
     days of enrollment in such other coverage.''.

       (B) Conforming amendment.--
       (i) In general.--Sections 1837, 1838, and 1839 of the 
     Social Security Act (42 U.S.C. 1395p, 42 U.S.C. 1395q, 42 
     U.S.C. 1395r) are each amended by striking ``1836'' and 
     inserting ``1836(a)'' each place it appears.
       (ii) Additional amendment.--Section 1837(j)(1) of such Act 
     (42 U.S.C. 1395p(j)(1)) is amended by striking ``1836(1)'' 
     and inserting ``1836(a)(1)''.
       (b) Enrollment for Individuals Only Eligible for Coverage 
     of Immunosuppressive Drugs.--Section 1837 of the Social 
     Security Act (42 U.S.C. 1395p), as amended by section 
     2(b)(2)(A), is further amended by adding at the end the 
     following new subsection:
       ``(n)(1) Any individual who is eligible for coverage of 
     immunosuppressive drugs under section 1836(b) may enroll or 
     be deemed to have enrolled only in such manner and form as 
     may be prescribed by regulations, and only during an 
     enrollment period described in this subsection.
       ``(2) An individual described in paragraph (1) whose 
     entitlement for hospital insurance benefits under part A ends 
     by reason of section 226A(b)(2) prior to January 1, 2023, may 
     enroll beginning on October 1, 2022, or the day on which the 
     individual first satisfies section 1836(b), whichever is 
     later.
       ``(3) An individual described in paragraph (1) whose 
     entitlement for hospital insurance benefits under part A ends 
     by reason of section 226A(b)(2) on or after January 1, 2023, 
     shall be deemed to have enrolled in the medical insurance 
     program established by this part for purposes of coverage of 
     immunosuppressive drugs.
       ``(4) The Secretary shall establish a process under which 
     an individual described in paragraph (1) whose other coverage 
     described in section 1836(b)(2)(A), or coverage under this 
     part (including the medical insurance program established 
     under this part for purposes of coverage of immunosuppressive 
     drugs), is terminated voluntarily or involuntary may enroll 
     or reenroll, if applicable, in the medical insurance program 
     established under this part for purposes of coverage of 
     immunosuppressive drugs.''.
       (c) Coverage Period for Individuals Only Eligible for 
     Coverage of Immunosuppressive Drugs.--
       (1) In general.--Section 1838 of the Social Security Act 
     (42 U.S.C. 1395q), as amended by section 2(b)(2)(B), is 
     further amended by adding at the end the following new 
     subsection:
       ``(h) In the case of an individual described in section 
     1836(b)(1), the following rules shall apply:
       ``(1) In the case of such an individual who is deemed to 
     have enrolled in part B for coverage of immunosuppressive 
     drugs under section 1837(n)(3), such individual's coverage 
     period shall begin on the first day of the month in which the 
     individual first satisfies section 1836(b).
       ``(2) In the case of such an individual who enrolls (or 
     reenrolls, if applicable) in part B for coverage of 
     immunosuppressive drugs under paragraph (2) or (4) of section 
     1837(n), such individual's coverage period shall begin on 
     January 1, 2023, or the month following the month in which 
     the individual so enrolls (or reenrolls), whichever is later.
       ``(3) The provisions of subsections (b) and (d) shall apply 
     with respect to an individual described in paragraph (1) or 
     (2).
       ``(4) In addition to the reasons for termination under 
     subsection (b), the coverage period of an individual 
     described in paragraph

[[Page H6996]]

     (1) or (2) shall end when the individual becomes entitled to 
     benefits under this title under subsection (a) or (b) of 
     section 226, or under section 226A, or is no longer eligible 
     for such coverage as a result of the application of section 
     1836(b)(2).
       ``(5) The Secretary may conduct public education activities 
     to raise awareness of the availability of more comprehensive, 
     individual health insurance coverage (as defined in section 
     2791 of the Public Health Service Act) for individuals 
     eligible under section 1836(b) to enroll or to be deemed 
     enrolled in the medical insurance program established under 
     this part for purposes of coverage of immunosuppressive 
     drugs.''.
       (2) Conforming amendments.--Section 1838(b) of the Social 
     Security Act (42 U.S.C. 1395q(b)) is amended, in the matter 
     following paragraph (2), by inserting ``or section 
     1837(n)(3)'' after ``section 1837(f)'' each place it appears.
       (d) Premiums for Individuals Only Eligible for Coverage of 
     Immunosuppressive Drugs.--
       (1) In general.--Section 1839 of the Social Security Act 
     (42 U.S.C. 1395r) is amended--
       (A) in subsection (b), by adding at the end the following 
     new sentence: ``No increase in the premium shall be effected 
     for individuals who are enrolled pursuant to section 1836(b) 
     for coverage only of immunosuppressive drugs.''; and
       (B) by adding at the end the following new subsection:
       ``(j) Determination of Premium for Individuals Only 
     Eligible for Coverage of Immunosuppressive Drugs.--The 
     Secretary shall, during September of each year (beginning 
     with 2022), determine and promulgate a monthly premium rate 
     for the succeeding calendar year for individuals enrolled 
     only for the purpose of coverage of immunosuppressive drugs 
     under section 1836(b). Such premium shall be equal to 15 
     percent of the monthly actuarial rate for enrollees age 65 
     and over (as would be determined in accordance with 
     subsection (a)(1) if the reference to `one-half' in such 
     subsection were a reference to `100 percent') for that 
     succeeding calendar year. The monthly premium of each 
     individual enrolled for coverage of immunosuppressive drugs 
     under section 1836(b) for each month shall be the amount 
     promulgated in this subsection. In the case of such 
     individual not otherwise enrolled under this part, such 
     premium shall be in lieu of any other monthly premium 
     applicable under this section. Such amount shall be adjusted 
     in accordance with subsections (c), (f), and (i), but shall 
     not be adjusted under subsection (b).''.
       (2) Special rule for application of hold harmless 
     provisions to transitioning individuals.--Section 1839(f) of 
     the Social Security Act (42 U.S.C. 1395r(f)) is amended by 
     adding at the end the following new sentence: ``Any increase 
     in the premium for an individual who was enrolled under 
     section 1836(b) attributable to such individual otherwise 
     enrolling under this part shall not be taken into account in 
     applying this subsection.''.
       (3) Special rule for application of premium subsidy 
     reduction provisions.--Section 1839(i)(3)(A)(ii)(II) of the 
     Social Security Act (42 U.S.C. 1395r(i)(3)(A)(ii)(II)) is 
     amended by inserting ``except in the case of an individual 
     enrolled under section 1836(b) and not otherwise enrolled 
     under this part,'' before ``4 times''.
       (e) Government Contribution.--Section 1844(a) of the Social 
     Security Act (42 U.S.C. 1395w(a)) is amended--
       (1) in paragraph (3), by striking the period at the end and 
     inserting ``; plus'';
       (2) by inserting after paragraph (3) the following new 
     paragraph:
       ``(4) a Government contribution equal to the estimated 
     aggregate reduction in premiums payable under part B that 
     results from establishing the premium at 15 percent of the 
     actuarial rate (as would be determined in accordance with 
     section 1839(a)(1) if the reference to `one-half' in such 
     section were a reference to `100 percent') under section 
     1839(j) instead of 25 percent of such rate (as so determined) 
     for individuals enrolled only for the purpose of coverage of 
     immunosuppressive drugs under section 1836(b).''; and
       (3) by adding the following sentence at the end of the 
     flush matter following paragraph (4), as added by paragraph 
     (2) of this subsection:
     ``The Government contribution under paragraph (4) shall be 
     treated as premiums payable and deposited for purposes of 
     subparagraphs (A) and (B) of paragraph (1).''.
       (f) Ensuring Coverage Under the Medicare Savings Program.--
       (1) In general.--Section 1905(p)(1)(A) of the Social 
     Security Act (42 U.S.C. 1396d(p)(1)(A)) is amended by 
     inserting ``or who is enrolled under part B for the purpose 
     of coverage of immunosuppressive drugs under section 
     1836(b)'' after ``under section 1818A)''.
       (2) Conforming amendments.--Section 1902(a)(10)(E) of the 
     Social Security Act (42 U.S.C. 1396a(a)(10)(E)) is amended in 
     each of clauses (iii) and (iv) by inserting ``(including such 
     individuals enrolled under section 1836(b))'' after ``section 
     1905(p)(1)''.
       (g) Part D.--Section 1860D-1(a)(3)(A) of the Social 
     Security Act (42 U.S.C. 1395w-101(a)(3)(A)) is amended by 
     inserting ``(but not including an individual enrolled solely 
     for coverage of immunosuppressive drugs under section 
     1836(b))'' before the period at the end.
       (h) GAO Study and Report.--
       (1) Study.--The Comptroller General of the United States 
     (in this subsection referred to as the ``Comptroller 
     General'') shall conduct a study on the implementation of 
     coverage of immunosuppressive drugs for kidney transplant 
     patients under the Medicare program pursuant to the 
     provisions of, and amendments made by, this section.
       (2) Report.--Not later than January 1, 2025, the 
     Comptroller General shall submit to Congress a report on the 
     study conducted under paragraph (1), together with 
     recommendations as the Comptroller General determines 
     appropriate.

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

       (a) In General.--Section 1862(b)(8)(G) of the Social 
     Security Act (42 U.S.C. 395y(b)(8)(G)) is amended--
       (1) by striking ``information.--The Secretary'' and 
     inserting ``information.--
       ``(i) In general.--The Secretary''; and
       (2) by adding at the end the following new clause:
       ``(ii) Specified information.--In responding to any query 
     from an applicable plan related to a determination described 
     in subparagraph (A)(i), the Secretary, notwithstanding any 
     other provision of law, shall provide to such applicable 
     plan--

       ``(I) whether a claimant subject to the query is, or during 
     the preceding 3-year period has been, entitled to benefits 
     under the program under this title on any basis; and
       ``(II) to the extent applicable, the plan name and address 
     of any Medicare Advantage plan under part C and any 
     prescription drug plan under part D in which the claimant is 
     enrolled or has been enrolled during such period.''.

       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply with respect to queries from plans made on or 
     after the date that is one year after the date of the 
     enactment of this Act.

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

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

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

       ``(a) Surveys.--
       ``(1) Frequency.--Any entity that is certified as a hospice 
     program shall be subject to a standard survey by an 
     appropriate State or local survey agency, or an approved 
     accreditation agency, as determined by the Secretary, not 
     less frequently than once every 36 months (and not less 
     frequently than once every 24 months beginning October 1, 
     2021).
       ``(2) Public transparency of survey and certification 
     information.--
       ``(A) Submission of information to the secretary.--
       ``(i) In general.--Each State, and each national 
     accreditation body with respect to which the Secretary has 
     made a finding under section 1865(a) respecting the 
     accreditation of a hospice program by such body, shall 
     submit, in a form and manner, and at a time, specified by the 
     Secretary for purposes of this subparagraph, information 
     respecting any survey or certification made with respect to a 
     hospice program by such State or body, as applicable. Such 
     information shall include any inspection report made by such 
     State or body with respect to such survey or certification, 
     any enforcement actions taken as a result of such survey or 
     certification, and any other information determined 
     appropriate by the Secretary.
       ``(ii) Required inclusion of specified form.--With respect 
     to a survey under this subsection carried out by a national 
     accreditation body described in clause (i) on or after 
     October 1, 2021, information described in such clause shall 
     include Form 2567 (or a successor form), along with such 
     additional information determined appropriate by such body.
       ``(B) Public disclosure of information.--Beginning not 
     later than October 1, 2022, the Secretary shall publish the 
     information submitted under subparagraph (A) on the public 
     website of the Centers for Medicare & Medicaid Services in a 
     manner that is prominent, easily accessible, readily 
     understandable, and searchable. The Secretary shall provide 
     for the timely update of such information so published.
       ``(3) Consistency of surveys.--Each State and the Secretary 
     shall implement programs to measure and reduce inconsistency 
     in the application of survey results among surveyors.
       ``(4) Survey teams.--
       ``(A) In general.--In the case of a survey conducted under 
     this subsection on or after October 1, 2021, by more than 1 
     individual, such survey shall be conducted by a 
     multidisciplinary team of professionals (including a 
     registered professional nurse).
       ``(B) Prohibition of conflicts of interest.--Beginning 
     October 1, 2021, a State may not use as a member of a survey 
     team under this subsection an individual who is serving (or 
     has served within the previous 2 years) as a member of the 
     staff of, or as a consultant to, the program surveyed 
     respecting compliance with the requirements of section 
     1861(dd) or who has a personal or familial financial interest 
     in the program being surveyed.

[[Page H6997]]

       ``(C) Training.--The Secretary shall provide, not later 
     than October 1, 2021, for the comprehensive training of State 
     and Federal surveyors, and any surveyor employed by a 
     national accreditation body described in paragraph (2)(A)(i), 
     in the conduct of surveys under this subsection, including 
     training with respect to the review of written plans for 
     providing hospice care (as described in section 
     1814(a)(7)(B)). No individual shall serve as a member of a 
     survey team with respect to a survey conducted on or after 
     such date unless the individual has successfully completed a 
     training and testing program in survey and certification 
     techniques that has been approved by the Secretary.
       ``(5) Funding.--The Secretary shall provide for the 
     transfer, from the Federal Hospital Insurance Trust Fund 
     under section 1817 to the Centers for Medicare & Medicaid 
     Services Program Management Account, of $10,000,000 for each 
     fiscal year (beginning with fiscal year 2022) for purposes of 
     carrying out this subsection and subsection (b). Sums so 
     transferred shall remain available until expended. Any 
     transfer pursuant to this paragraph shall be in addition to 
     any transfer pursuant to section 3(a)(2) of the Improving 
     Medicare Post-Acute Care Transformation Act of 2014.
       ``(b) Special Focus Program.--
       ``(1) In general.--The Secretary shall conduct a special 
     focus program for enforcement of requirements for hospice 
     programs that the Secretary has identified as having 
     substantially failed to meet applicable requirements of this 
     Act.
       ``(2) Periodic surveys.--Under such special focus program, 
     the Secretary shall conduct surveys of each hospice program 
     in the special focus program not less than once every 6 
     months.
       ``(c) Enforcement.--
       ``(1) Situations involving immediate jeopardy.--If the 
     Secretary determines on the basis of a standard survey or 
     otherwise that a hospice program that is certified for 
     participation under this title is no longer in compliance 
     with the requirements specified in section 1861(dd) and 
     determines that the deficiencies involved immediately 
     jeopardize the health and safety of the individuals to whom 
     the program furnishes items and services, the Secretary shall 
     take immediate action to remove the jeopardy and correct the 
     deficiencies through the remedy described in paragraph 
     (5)(B)(iii) or terminate the certification of the program, 
     and may provide, in addition, for 1 or more of the other 
     remedies described in paragraph (5)(B).
       ``(2) Situations not involving immediate jeopardy.--If the 
     Secretary determines on the basis of a standard survey or 
     otherwise that a hospice program that is certified for 
     participation under this title is no longer in compliance 
     with the requirements specified in section 1861(dd) and 
     determines that the deficiencies involved do not immediately 
     jeopardize the health and safety of the individuals to whom 
     the program furnishes items and services, the Secretary may 
     (for a period not to exceed 6 months) impose remedies 
     developed pursuant to paragraph (5)(A), in lieu of 
     terminating the certification of the program. If, after such 
     a period of remedies, the program is still no longer in 
     compliance with such requirements, the Secretary shall 
     terminate the certification of the program.
       ``(3) Penalty for previous noncompliance.--If the Secretary 
     determines that a hospice program that is certified for 
     participation under this title is in compliance with the 
     requirements specified in section 1861(dd) but, as of a 
     previous period, did not meet such requirements, the 
     Secretary may provide for a civil monetary penalty under 
     paragraph (5)(B)(i) for the days in which the Secretary finds 
     that the program was not in compliance with such 
     requirements.
       ``(4) Option to continue payments for noncompliant hospice 
     programs.--The Secretary may continue payments under this 
     title with respect to a hospice program not in compliance 
     with the requirements specified in section 1861(dd) over a 
     period of not longer than 6 months, if--
       ``(A) the State or local survey agency finds that it is 
     more appropriate to take alternative action to assure 
     compliance of the program with such requirements than to 
     terminate the certification of the program;
       ``(B) the program has submitted a plan and timetable for 
     corrective action to the Secretary for approval and the 
     Secretary approves the plan of corrective action; and
       ``(C) the program agrees to repay to the Federal Government 
     payments received under this title during such period if the 
     corrective action is not taken in accordance with the 
     approved plan and timetable.
     The Secretary shall establish guidelines for approval of 
     corrective actions requested by hospice programs under this 
     paragraph.
       ``(5) Remedies.--
       ``(A) Development.--
       ``(i) In general.--Not later than October 1, 2021, the 
     Secretary shall develop and implement--

       ``(I) a range of remedies to apply to hospice programs 
     under the conditions described in paragraphs (1) through (4); 
     and
       ``(II) appropriate procedures for appealing determinations 
     relating to the imposition of such remedies.

     Remedies developed pursuant to the preceding sentence shall 
     include the remedies specified in subparagraph (B).
       ``(ii) Conditions of imposition of remedies.--Not later 
     than October 1, 2021, the Secretary shall develop and 
     implement specific procedures with respect to the conditions 
     under which each of the remedies developed under clause (i) 
     is to be applied, including the amount of any fines and the 
     severity of each of these remedies. Such procedures shall be 
     designed so as to minimize the time between identification of 
     deficiencies and imposition of these remedies and shall 
     provide for the imposition of incrementally more severe fines 
     for repeated or uncorrected deficiencies.
       ``(B) Specified remedies.--The remedies specified in this 
     subparagraph are the following:
       ``(i) Civil monetary penalties in an amount not to exceed 
     $10,000 for each day of noncompliance by a hospice program 
     with the requirements specified in section 1861(dd).
       ``(ii) Suspension of all or part of the payments to which a 
     hospice program would otherwise be entitled under this title 
     with respect to items and services furnished by a hospice 
     program on or after the date on which the Secretary 
     determines that remedies should be imposed pursuant to 
     paragraph (2).
       ``(iii) The appointment of temporary management to oversee 
     the operation of the hospice program and to protect and 
     assure the health and safety of the individuals under the 
     care of the program while improvements are made in order to 
     bring the program into compliance with all such requirements.
       ``(C) Procedures.--
       ``(i) Civil monetary penalties.--

       ``(I) In general.--Subject to subclause (II), the 
     provisions of section 1128A (other than subsections (a) and 
     (b)) shall apply to a civil monetary penalty under this 
     subsection in the same manner as such provisions apply to a 
     penalty or proceeding under section 1128A(a).
       ``(II) Retention of amounts for hospice program 
     improvements.--The Secretary may provide that any portion of 
     civil monetary penalties collected under this subsection may 
     be used to support activities that benefit individuals 
     receiving hospice care, including education and training 
     programs to ensure hospice program compliance with the 
     requirements of section 1861(dd).

       ``(ii) Suspension of payment.--A finding to suspend payment 
     under subparagraph (B)(ii) shall terminate when the Secretary 
     finds that the program is in substantial compliance with all 
     such requirements.
       ``(iii) Temporary management.--The temporary management 
     under subparagraph (B)(iii) shall not be terminated until the 
     Secretary has determined that the program has the management 
     capability to ensure continued compliance with all the 
     requirements referred to in such subparagraph.
       ``(D) Relationship to other remedies.--The remedies 
     developed under subparagraph (A) are in addition to sanctions 
     otherwise available under State or Federal law and shall not 
     be construed as limiting other remedies, including any remedy 
     available to an individual at common law.''.
       (2) Availability of hospice accreditation surveys.--Section 
     1865(b) of the Social Security Act (42 U.S.C. 1395bb(b)) is 
     amended by inserting ``or, beginning on the date of the 
     enactment of the BENES Act of 2020, a hospice program'' after 
     ``home health agency''.
       (3) State provision of hospice program information.--
       (A) In general.--Section 1864(a) of the Social Security Act 
     (42 U.S.C. 1395aa(a)) is amended in the sixth sentence--
       (i) by inserting ``and hospice programs'' after 
     ``information on home health agencies'';
       (ii) by inserting ``or the hospice program'' after ``the 
     home health agency'';
       (iii) by inserting ``or the hospice program'' after ``with 
     respect to the agency''; and
       (iv) by inserting ``and hospice programs'' after ``with 
     respect to home health agencies''.
       (B) Effective date.--The amendments made by subparagraph 
     (A) shall apply with respect to agreements entered into on or 
     after, or in effect as of, the date that is 1 year after the 
     date of the enactment of this Act.
       (4) Conforming amendments.--
       (A) Definition of a hospice program.--Section 1861(dd)(4) 
     of the Social Security Act (42 U.S.C. 1395x(dd)(4)) is 
     amended by striking subparagraph (C).
       (B) Continuation of funding.--Section 3(a)(2) of the 
     Improving Medicare Post-Acute Care Transformation Act of 2014 
     is amended by inserting ``and section 1822(a)(1) of such 
     Act,'' after ``as added by paragraph (1),''.
       (b) Increasing Payment Reductions for Failure to Meet 
     Quality Data Reporting Requirements.--Section 
     1814(i)(5)(A)(i) of the Social Security Act (42 U.S.C. 
     1395f(i)(5)(A)(i)) is amended by inserting ``(or, for fiscal 
     year 2023 and each subsequent fiscal year, 4 percentage 
     points)'' before the period.
       (c) Report.--Not later than 36 months after the date of the 
     enactment of this Act, the Comptroller General of the United 
     States shall submit to the Committee on Ways and Means of the 
     House of Representatives and the Committee on Finance of the 
     Senate a report containing an analysis of the effects of the 
     amendments made by subsection (a), including the frequency of 
     application of remedies specified in section 1822(c)(5)(B) of 
     the Social Security Act (as added by such subsection), on 
     access to, and quality of, care furnished by hospice programs 
     under part A of title XVIII of the Social Security Act (42 
     U.S.C. 1395c et seq.).

  The SPEAKER pro tempore. Pursuant to the rule, the gentleman from

[[Page H6998]]

Connecticut (Mr. Larson) and the gentlewoman from Indiana (Mrs. 
Walorski) each will control 20 minutes.
  The Chair recognizes the gentleman from Connecticut.


                             General Leave

  Mr. LARSON of Connecticut. Madam Speaker, I ask unanimous consent 
that all Members have 5 legislative days to revise and extend their 
remarks and include extraneous material on the bill under 
consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentleman from Connecticut?
  There was no objection.
  Mr. LARSON of Connecticut. Madam Speaker, I yield myself such time as 
I may consume.
  Madam Speaker, H.R. 2477, the Beneficiary Enrollment Notification and 
Eligibility Simplification Act of 2020, as amended, includes four 
policies that improve Medicare enrollment, access, and quality of care.
  First, the BENES Act, as I shall continue to call it, introduced by 
my colleague, Representative Raul Ruiz, fills a longstanding gap in 
education for older adults and people with disabilities, eliminating 
needless multimonth coverage gaps in Medicare by mandating that part B 
insurance begin the first month following an individual's enrollment 
during both the later months of the beneficiary's initial enrollment 
period and during the general enrollment period.
  The BENES Act also provides increased notification to better inform 
older adults and people with disabilities about Medicare eligibility 
enrollment.
  The BENES Act also allows the Federal Government to create a part B 
special enrollment period for exceptional circumstances, like natural 
disasters.
  Complex Medicare enrollment rules and inadequate notification cause 
tens of thousands of older adults and people with disabilities to face 
lifetime fines, coverage gaps, and other harmful consequences. 
Individuals who miss their initial Medicare enrollment window may pay 
lifetime late enrollment penalties, experience lengthy gaps in 
outpatient health coverage, or face unaffordable and unexpected out-of-
pocket healthcare costs.
  The bill under consideration today also includes two provisions based 
on legislation again championed by Ron Kind from Wisconsin. The first 
will provide access to immunosuppressive therapy to individuals after a 
kidney transplant.
  I have heard from the Hartford Hospital kidney transplant group and 
National Kidney Foundation how vitally important this legislation is, 
and I am pleased that it is included.
  The second provision will make improvements to reporting regarding 
Medicare Advantage enrollees between the Centers for Medicare and 
Medicaid Services and liability and non-group health plans to improve 
financial accountability.
  Finally, H.R. 2477 includes language from H.R. 5821, the bipartisan 
Helping Our Senior Population in Comfort Environments Act, or the 
HOSPICE Act, introduced by my Ways and Means colleagues, 
Representatives   Jimmy Panetta and   Tom Reed.
  This policy addresses vital program integrity concerns identified by 
the Department of Health and Human Services' Office of the Inspector 
General in 2019 through a series of much-needed reforms that provide 
additional oversight and transparency of Medicare hospice providers.
  The changes in this bill align the HHS Secretary's oversight tools 
with those of other Medicare providers, including skilled nursing 
facilities and home health providers. These reforms are vital to 
improving the quality of care delivered to some of the most vulnerable 
patients in the healthcare system.
  Madam Speaker, I urge my colleagues to support this legislation, and 
I reserve the balance of my time.
  Mrs. WALORSKI. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, I rise today in support of H.R. 2477, the Beneficiary 
Enrollment Notification and Eligibility Simplification Act, or the 
BENES Act.
  This important bipartisan legislation will improve education and 
outreach to Americans approaching Medicare age while simplifying the 
part B enrollment process, which hasn't been updated in over 50 years.
  Currently, Medicare enrollment is often too complicated and 
confusing, and in the event of a mistake, very costly. The consequences 
of making a simple mistake in the enrollment process can be 
significant, with a lifetime late enrollment penalty of 10 percent for 
every year a beneficiary hasn't enrolled in part B.
  According to a Congressional Research Service report, last year, 
approximately 764,000 part B enrollees paid an average penalty of 
nearly 30 percent higher Medicare premiums. That is a superheavy 
financial burden these Medicare beneficiaries will carry throughout 
their retirement. That is what the BENES Act aims to help seniors 
avoid.
  This vital bill will help prevent late enrollment penalties by 
sending an advance notice about the Medicare enrollment process to 
Americans approaching Medicare eligibility. It will also prevent gaps 
in coverage by requiring that part B coverage begin during the first 
month after an individual enrolls through either the initial enrollment 
period or general enrollment period.
  These long-overdue reforms will significantly improve the health and 
well-being of Medicare beneficiaries and protect America's seniors from 
unnecessary penalties and unexpected healthcare bills.
  Madam Speaker, I reserve the balance of my time.

                              {time}  1545

  Mr. LARSON of Connecticut. Madam Speaker, I yield 2 minutes to the 
gentleman from California (Mr. Panetta), a distinguished member of the 
Committee on Ways and Means.
  Mr. PANETTA. Madam Speaker, I thank Chairman Larson, and I appreciate 
all of his work and, of course, his support and friendship.
  Madam Speaker, I rise today to urge my colleagues to support H.R. 
2477, the BENES Act, which includes my bill and   Tom Reed's bill, the 
bipartisan HOSPICE Act.
  Now, I think we can all agree that every family wants to ensure that 
their loved one in hospice receives the end-of-life care that is 
compassionate, that is cautious, and, of course, that is circumspect so 
that they can pass with dignity and all of us are at peace.
  Now, we know while most of our Nation's Medicare hospice care 
providers work tirelessly to ensure their patients receive high quality 
care, there are, unfortunately, bad actors. That is why we introduced 
the bipartisan HOSPICE Act, so that through education, outreach, and 
even liability we can safeguard care for Medicare hospice enrollees, 
increase transparency and safety, and penalize those who fail to 
provide the necessary care for their patients.
  Madam Speaker, I encourage my colleagues to support this bipartisan 
legislation to ensure that hospice care is not just about death, but it 
is about death with dignity, integrity, and accountability.
  Mrs. WALORSKI. Madam Speaker, I yield 2 minutes to the gentleman from 
Missouri (Mr. Smith).
  Mr. SMITH of Missouri. Madam Speaker, I thank the gentlewoman for 
yielding.
  Madam Speaker, I rise today in support of H.R. 2477, which includes 
some legislation to improve Medicare coverage for kidney transplant 
recipients.
  The Trump administration has made increasing rates of kidney 
transplantation a priority. It is more cost-effective than dialysis and 
results in a dramatic increase in the quality of life for ESRD 
patients. However, these patients must continue taking medication for 
the remainder of their life so that they don't reject their organs.
  Currently, Medicare will only cover the cost of these drugs for 36 
months after a kidney transplant. Patients who do not have health 
insurance or lose their insurance coverage have to choose between 
paying thousands of dollars a month out of pocket or risk the chance of 
rejection of their organs.
  If organ rejection does occur, these patients must once again endure 
the painful, time-consuming, and expensive dialysis treatments paid for 
by the Medicare program. By simply paying for the cost of these drugs 
and preventing patients from crashing back into dialysis, the Federal 
Government

[[Page H6999]]

can save hundreds of millions of dollars and improve thousands of 
lives.
  We should not allow such unnecessary waste and suffering to occur. 
These Americans should not have to worry about how they will afford the 
cost of the medications that allow them to live a completely normal 
life.
  Madam Speaker, I thank Representatives Kind and Burgess for their 
leadership and for working together on this commonsense bipartisan 
bill.
  Madam Speaker, I urge the House to pass H.R. 2477.
  Mr. LARSON of Connecticut. Madam Speaker, I reserve the balance of my 
time.
  Mrs. WALORSKI. Madam Speaker, I yield 2 minutes to the gentleman from 
New York (Mr. Reed).
  Mr. REED. Madam Speaker, I rise today in support of the HOSPICE bill, 
which is a part of the overall BENES Act we are debating today. And I 
am proud to support the HOSPICE bill that I introduced and authored 
with my good friend,   Jimmy Panetta, from California.
  Madam Speaker, I can tell you, when loved ones, like my mother, 
became sick, it is common to be left feeling helpless and for families 
not having the resources to deal with that terrible situation. But I 
thank God every day we were able to support my mother with a wonderful 
team, not only of our family but of our hospice care providers. They 
gave her, and they gave us, the needed companionship and resources to 
have some sense of normalcy at the end of her illness. That experience 
reaffirmed the critical importance of the quality-of-life care that 
hospice care represents.
  Madam Speaker, that is why I am a hospice volunteer in my personal 
time here in Washington, D.C. I am a strong advocate for hospice care 
across America.
  However, while most hospice employees and volunteers and 
compassionate caregivers are good, hardworking individuals, there are 
some who neglect and potentially even abuse patients in that situation. 
We must hold those bad actors accountable. We must demand additional 
oversight of hospice providers. We must educate providers with 
additional training to ensure patients receive the best and most proper 
level of care they deserve.
  We are confident this legislation would do just that by giving HHS 
the tools it needs to penalize those that provide poor quality care. 
Our legislation would also improve provider transparency by requiring 
States to maintain a toll-free hotline where abuse and neglect can be 
reported.
  Madam Speaker, I am proud to stand in support of this legislation. 
More importantly, I am proud to be a hospice volunteer myself, and I am 
proud to stand with the hospice community that is giving so much great 
quality care to those that need it most in their most precious time 
that they have left.
  Madam Speaker, I urge all my colleagues to support this bill and the 
underlying legislation upon which it rides.
  Mr. LARSON of Connecticut. Madam Speaker, I continue to reserve the 
balance of my time.
  Mrs. WALORSKI. Madam Speaker, I yield 3 minutes to the gentleman from 
Florida (Mr. Bilirakis).
  Mr. BILIRAKIS. Madam Speaker, I rise today in support of H.R. 2477, 
the Beneficiary Enrollment Notification and Eligibility Simplification 
Act, the BENES Act.
  Unfortunately, complex and confusing Medicare enrollment rules 
combined with a lack of notification cause tens of thousands of older 
adults and people with disabilities to incur lifetime fines, coverage 
gaps, and other harmful consequences. This is not fair to our seniors. 
With fewer people automatically enrolled in Medicare and 10,000 baby 
boomers aging into Medicare each day, more people new to Medicare must 
actively enroll in the program.

  To address this issue, the BENES Act is here for us. It directs the 
Federal Government to provide advance notice to individuals approaching 
Medicare eligibility about basic Medicare and Medicare Advantage 
enrollment rules.
  It directs Part B to begin the first of the month following one's 
enrollment during both the later months of their initial enrollment 
period and during the general enrollment period, closing coverage gaps.
  It also requires HHS to submit a report to Congress on how best to 
align the annual general enrollment period with the annual enrollment 
period for private Medicare Advantage and Medicare Part D prescription 
drug plans to reduce confusion.
  And it enables HHS to create a Part B special enrollment period for 
exceptional circumstances; a provision currently used in Medicare 
Advantage and Medicare Part D when people are unable to sign up for 
Medicare due to occurrences, like living in an area impacted by a 
disaster or emergency.
  I thank my colleague, Dr. Ruiz, for his leadership and partnership on 
this particular bill.
  Madam Speaker, all of these bills are so vital to our seniors, very 
important bills, and I am glad we are passing them in a bipartisan 
fashion.
  Madam Speaker, I urge my colleagues, again, to support this 
commonsense protective measure for seniors, veterans, and those living 
with disabilities.
  Mr. LARSON of Connecticut. Madam Speaker, I continue to reserve the 
balance of my time.
  Mrs. WALORSKI. Madam Speaker, I yield 2 minutes to the gentlewoman 
from Puerto Rico (Miss Gonzalez-Colon).
  Miss GONZALEZ-COLON of Puerto Rico. Madam Speaker, I rise in support 
of H.R. 2477, the Beneficiary Enrollment Notification and Eligibility 
Simplification Act.
  The notification system created in this bill for individuals 
approaching the age of eligibility for Social Security will soon 
provide a notice explaining: First, enrollment; second, eligibility; 
and coordination of Medicare benefits.
  And why is that so important in the case of Puerto Rico?
  Puerto Rico has a participation rate of 70 percent in Medicare 
Advantage. That will tell you how important it is for us. This will be 
especially beneficial where Medicare recipients must make the 
affirmative step of signing up for Medicare Part B, rather than be 
automatically enrolled upon turning 65, unlike anywhere else in the 
Nation. This is something that we have been fighting for many years.
  The lack of adequate notice of this difference has resulted in a 
substantially higher percentage of Medicare Part B enrollees in Puerto 
Rico paying lifetime late enrollment penalties of 10 percent of the 
premium for every year they failed to enroll.
  Currently, almost 40,000 Medicare beneficiaries who live in Puerto 
Rico are paying lifetime penalties of $20.3 million a year. These 
penalties are particularly difficult when you take into account that 
43.5 percent of my constituents live in poverty and they are not 
eligible for SSI or Medicare subsidies.
  Madam Speaker, I introduced H.R. 2310 to address this disparity and 
encourage my colleagues to also support this legislation.
  I urge my colleagues to support H.R. 2477 and support our seniors.
  Mr. LARSON of Connecticut. Madam Speaker, I reserve the balance of my 
time.
  Mrs. WALORSKI. Madam Speaker, I yield 3 minutes to the gentleman from 
Texas (Mr. Burgess).
  Mr. BURGESS. Madam Speaker, I thank the gentlewoman from Indiana for 
the recognition.
  Madam Speaker, I rise in support of a bill that includes coverage for 
immunosuppressive drugs after a kidney transplant. This is something we 
have worked on for a decade but, more importantly, for kidney patients 
and their families, this has been a priority for much, much longer.
  Madam Speaker, today's bill is monumental in the life of the 
transplant patient. In 1972, Congress voted to allow Medicare coverage 
for end-stage renal disease patients under 65 years of age. The policy 
opened the doors for patients to have Medicare pay for dialysis and 
kidney transplants, but it wasn't quite enough.
  A new kidney gives the hope of a better quality of life to patients, 
but only if they take those immunosuppressive drugs. Otherwise, their 
own immune system is going to recognize the renal graft as a foreign 
object and reject it, but that is their new kidney. So without these 
drugs, patients risk rejection of a kidney and a return to dialysis.
  Now, Medicare, to be sure, will pay for that return to dialysis and 
another renal transplant--if they are lucky

[[Page H7000]]

enough to get one--but it will not pay for more than 36 months of 
immunosuppressive drug coverage. This is incredibly expensive for the 
Medicare system, but think of the toll on the lives of kidney patients 
and their families.
  So the bill before us today will address the immunosuppressive drug 
issue directly by requiring Medicare to cover these drugs past 36 
months for kidney patients who do not obtain other health coverage.
  Look, a kidney transplant is a gift from one human to another. From 
the government's perspective, the transaction is an investment that 
allows the government to make that investment into a patient's future, 
and this policy allows us to protect that investment, so it is a policy 
that is good for the patient, to be sure. As a side benefit, it is a 
benefit to the taxpayer.
  Madam Speaker, both the CMS Office of the Actuary and the Office of 
the Assistant Secretary for Planning and Evaluation at HHS have 
published reports on the benefits of extending Medicare coverage of 
immunosuppressive drugs, which include financial savings for the 
Medicare program.

  So after years, literally a decade, of wrestling with the policy, a 
light finally shone over the Congressional Budget Office and they 
confirmed what others have known all along, that this delivers savings 
to Medicare. The policy also aligns and builds on what the Trump 
administration has done with the kidney health initiatives, including 
the Advancing American Kidney Health executive order, which the 
President signed in July of 2019.
  So this immunosuppressive drug policy has support from everyone--from 
the patients, to transplant surgeons, to patients' families, and it is 
something behind which the kidney coalition has coalesced for years. We 
would not be here today if it were not for the tireless work of that 
community and other cosponsors.
  The SPEAKER pro tempore. The time of the gentleman has expired.
  Mrs. WALORSKI. Madam Speaker, I yield an additional 30 seconds to the 
gentleman from Texas.
  Mr. BURGESS. Madam Speaker, I thank all of the many people, including 
the staffers on both of our committees, who have worked over the past 
decade, they have tuned and fine-tuned this policy to get it where it 
is today.

                              {time}  1600

  Mr. LARSON of Connecticut. Madam Speaker, I reserve the balance of my 
time.
  Mrs. WALORSKI. Madam Speaker, I have no other speakers, and I reserve 
the balance of my time.
  Mr. LARSON of Connecticut. Madam Speaker, I yield myself such time as 
I may consume.
  Madam Speaker, before I close, throughout the day, I am sure people 
observing have viewed us taking off and putting on our masks, et 
cetera. I would like to acknowledge a very special person from Mayberry 
Village in East Hartford, Connecticut, who made this mask and several 
like these and has distributed them out of the kindness of her heart 
and concern and care. Her name is Margaret Grady Ramsey from Mayberry 
Village in East Hartford, Connecticut. I thank Peg for all her hard 
work.
  Madam Speaker, in closing, I know that Dr. Ruiz has worked tirelessly 
on the BENES Act for many years. I thank him for his efforts. I also 
thank the Medicare beneficiary advocates, including the Medicare Rights 
Center and the Center for Medicare Advocacy, for their tireless work 
and support to find a solution to this longstanding problem.
  The gentlewoman from Indiana has also played a key role in this as 
well, and I want to make sure we acknowledge her as well.
  H.R. 2477, the BENES Act, provides significant long-term improvements 
to Medicare for millions of beneficiaries. I urge my colleagues to 
support this legislation, and I yield back the balance of my time.
  Mrs. WALORSKI. Madam Speaker, I yield myself such time as I may 
consume.
  Madam Speaker, as more and more Americans reach Medicare age, we need 
to simplify the part B enrollment process and improve education and 
outreach to seniors. The commonsense reforms in this bipartisan BENES 
Act will protect seniors from unnecessary late enrollment penalties, 
gaps in coverage, and unexpected healthcare bills.
  I urge my colleagues to support this vital piece of legislation that 
will simplify complicated Medicare enrollment rules.
  Madam Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentleman from Connecticut (Mr. Larson) that the House suspend the 
rules and pass the bill, H.R. 2477, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

                          ____________________