[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.
____________________