[Congressional Record (Bound Edition), Volume 153 (2007), Part 18]
[Senate]
[Pages 25661-25674]
[From the U.S. Government Publishing Office, www.gpo.gov]




          STATEMENTS ON INTRODUCED BILLS AND JOINT RESOLUTIONS

      By Mr. SANDERS:
  S. 2094. A bill to increase the wages and benefits of blue collar 
workers by strengthening labor provisions in the H-2B program, to 
provide for labor recruiter accountability, and for other purposes; to 
the Committee on the Judiciary.
  Mr. SANDERS. Mr. President, today I am introducing the Increasing 
American Wages and Benefits Act of 2007.
  Since 2000, key economic indicators confirm that the economic 
security of Americans is moving in the wrong direction: nearly 5 
million more Americans are living in poverty; nonelderly household 
income has declined by nearly $2,500; over 3 million manufacturing jobs 
have been lost; and 8.6 million more Americans are without health 
insurance. While the rich have gotten richer, every other income group 
over the past 7 years has lost ground economically, with the middle 
class and working families losing the most.
  The Increasing American Wages and Benefits Act would begin to reverse 
this downward economic trend for workers employed in construction, 
forestry, ski resorts, stone quarries, asphalt paving, hotels, 
restaurants, landscaping, housekeeping and many other industries by 
reforming the H-2B guest-worker program.
  Under current law and existing Federal regulations, employers 
applying for H-2B visas must first certify that capable U.S. workers 
are not available, efforts were made to recruit U.S. workers for these 
positions first, and the employment of guest workers will not adversely 
affect the wages and working conditions of similarly employed U.S. 
workers.
  As documented by the AFL-CIO, Change to Win, the Southern Poverty Law 
Center and other groups, the H-2B program is frequently used by 
employers to drive down the wages and benefits of U.S. workers, while 
cheating H-2B workers out of earned benefits. These abuses have clearly 
undermined the legislative and regulatory intent of this temporary 
guest-worker program.
  The Increasing American Wages and Benefits Act would reform the H-2B 
program to ensure that workers receive the wages and benefits they 
deserve and prevent employers from abusing the system.
  Specifically, this legislation: requires employers to do a much 
better job at recruiting American workers first at higher wages before 
being able to hire H-2B guest-workers; provides the Department of Labor 
with the explicit authority to enforce labor law violations pertaining 
to the H-2B program; allows workers who have been directly and 
adversely affected by the H-2B program to have their day in court 
against unscrupulous employers; prohibits companies that have announced 
mass lay-offs within the past year from hiring H-2B guest-workers. 
Allows the Legal Services Corporation to provide the same legal 
services to H-2B workers as it provides to H-2A workers; requires 
employers to pay for the transportation expenses for H-2B guest workers 
both to the United States and back to their country of origin once the 
employment period ends; and provides other important protections for H-
2B guest-workers.
  This legislation improves and strengthens the H-2B program so that it 
can be used by employers during emergency labor shortages, while 
increasing the wages and benefits for both American workers and guest-
workers.
  I am proud that the Increasing American Wages and Benefits Act has 
the strong support of the AFL-CIO; the Service Employees International 
Union, SEIU; the International Brotherhood of Teamsters; the Southern 
Poverty Law Center; the Building and Construction Trades Department; 
the Laborers' International Union of North America; the United Food and 
Commercial Workers; the International Brotherhood of Electrical 
Workers; the Alliance of Forest Workers and Harvesters; the United 
Farmworkers of America; and the Farmworkers Support Committee.
  I ask unanimous consent to have printed in the Record letters of 
support.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

         American Federation of Labor and Congress of Industrial 
           Organizations,
                               Washington, DC, September 19, 2007.
     Hon. Bernard Sanders,
     Dirksen Senate Office Building,
     Washington, DC.
       Dear Senator Sanders: The AFL-CIO strongly supports the 
     ``Increasing American Wages and Benefits Act of 2007,'' which 
     would strengthen necessary labor protections within the H-2B 
     seasonal non-agricultural guest worker program.
       As demonstrated by a recent report issued by the Southern 
     Poverty Law Center, ``Close to Slavery,'' employers and 
     recruiters who seek to import seasonal workers through this 
     program have all too often engaged in questionable tactics 
     and subjected workers to exploitation. This exploitation 
     often goes undetected because the investigative and 
     enforcement mechanisms of the H-2B program are largely non-
     existent.
       Adequate enforcement of labor standards within the H-2B 
     seasonal guest worker program would not only help deter the 
     abuse of an imported foreign workforce, but would also 
     protect the wages and benefits offered to American workers, 
     who are unfairly forced to compete for jobs by employers who 
     appreciate the benefits of filling vacancies with a more 
     vulnerable workforce.
       The suffering of one segment of our workforce has an 
     inevitable and damaging impact on every worker. We must stop 
     unscrupulous employers from padding their profit margins by 
     endangering workers and driving down wages and workplace 
     standards. We applaud your efforts to protect the living 
     standards of all who labor within our borders.
           Sincerely,
                                                   William Samuel,
     Director, Department of Legislation.
                                  ____

                                        Immigrant Justice Project,


                                  Southern Poverty Law Center,

                               Montgomery, AL, September 17, 2007.
     Hon. Bernie Sanders,
     U.S. Senate,
     Washington, DC.
       Dear Senator Sanders: I write on behalf of the Southern 
     Poverty Law Center in support of the legislation you recently 
     introduced to reform the H-2B guestworker program. The bill, 
     ``The Increasing American Wages and Benefits Act,'' would 
     substantially improve the legal protections available to H-2B 
     workers and to American workers laboring in industries that 
     rely heavily on guestworkers.
       Founded in 1971, the Southern Poverty Law Center is a civil 
     rights organization dedicated to advancing and protecting the 
     rights of minorities, the poor and victims of injustice in 
     significant civil rights and social justice matters. Our 
     Immigrant Justice Project represents low-income immigrant 
     workers in litigation across the Southeast.
       During my legal career, I have represented and spoken with 
     literally thousands of H-2 guestworkers in many states. 
     Currently, the Southern Poverty Law Center is representing 
     workers in seven class action lawsuits on behalf of 
     guestworkers. We have also recently published a report about 
     the H-2 guestworker program in the United States entitled 
     ``Close to Slavery,'' which can be accessed at http://
www.splcenter.org/pdf/static/SPLCguestworker.pdf.
       Our report, which discusses in detail the abuses suffered 
     by guestworkers, is based upon thousands of interviews with 
     workers as well as a review of the research on guestworker 
     programs, scores of legal cases and the experience of legal 
     experts from around the country. As the report reflects, 
     guestworkers are systematically exploited because the very 
     structure of the program places them at the mercy of a single 
     employer and provides no realistic means for workers to 
     exercise the few rights they have.
       The H-2B guestworker program permits U.S. employers to 
     import human beings on a temporary basis from other nations 
     to perform work when the employer certifies that ``qualified 
     persons in the United States are not available and . . . the 
     terms of employment will not adversely affect the wages and 
     working conditions of workers in the U.S. similarly 
     employed.'' Those workers generally cannot bring with them 
     their immediate family members, and their status provides 
     them no route to permanent residency in the United States.
       The program is rife with abuses. The abuses typically start 
     long before the worker has arrived in the United States, with 
     the recruitment process, and they continue through and even 
     after his or her employment here. Unlike U.S. citizens, guest 
     workers do not enjoy the most fundamental protection of a 
     competitive labor market--the

[[Page 25662]]

     ability to change jobs if they are mistreated. If 
     guestworkers complain about abuses, they face deportation, 
     blacklisting or other retaliation.
       Our report documents rampant wage violations, recruitment 
     abuses, seizure of identity documents and squalid living 
     conditions, among other things. H-2B workers simply have very 
     few legal protections under our current law.
       In addition, H-2B workers cannot reasonably enforce the few 
     rights they have under our current system. Providing workers 
     a way to enforce promises made to them by employers and 
     giving them access to legal services attorneys are important 
     steps in helping workers combat abuse and protect their 
     rights.
       In conclusion, current guestworker programs for low-skilled 
     workers in the United States lack adequate worker protections 
     and lack any real means to enforce the protections that do 
     exist under federal law. Vulnerable workers desperately need 
     Congress to take the lead in demanding reform of this system. 
     Passage of this bill would go a long way toward remedying the 
     abuses that vulnerable workers experience in U.S. guestworker 
     programs.
           Sincerely,
                                                       Mary Bauer,
     Director.
                                  ____

                                          United Food & Commercial


                             Workers International Union, CLC,

                               Washington, DC, September 21, 2007.
     Hon. Bernard Sanders,
     U.S. Senate,
     Washington, DC.
       Dear Senator Sanders: On behalf of the 1.3 million members 
     of the United Food and Commercial Workers International Union 
     (UFCW), I am writing to thank you for introducing the 
     ``Increasing American Wages and Benefits Act of 2007.'' UFCW 
     supports this legislation that will improve the legal 
     protections to H-2B seasonal non-agricultural workers.
       It is clear that the current temporary non-immigrant 
     programs have not worked as intended and it is long past the 
     time for reform. UFCW has long advocated for reform of 
     existing guestworker programs. Many employers and recruiters 
     who recruit and hire workers through this program have 
     engaged in questionable tactics, and many of the workers have 
     been subjected to exploitation.
       In addition, we believe that many of these jobs could and 
     would be filled by American workers, especially if the 
     employers offer appropriate wages and working conditions to 
     attract domestic workers. The ``Increasing American Wages and 
     Benefits Act'' will increase the enforcement for the program, 
     deter abuse of guestworkers, and would improve the wages, 
     benefits, and working conditions offered to these workers and 
     all American workers, who are unfairly forced to compete for 
     these jobs.
       UFCW has been a long-time proponent of reforming 
     guestworker programs because, in spite of the theory, the 
     real world impact is that they have created an underclass of 
     workers, have held down wages, discouraged reporting of 
     workplace complaints, and reduced workers' ability to 
     organize and collectively bargain. In addition, the result of 
     the existing programs is that they have engendered 
     discriminatory attitudes toward individuals who are afforded 
     neither full rights nor benefits on the job, nor 
     participation in our society. Our experience is that no 
     matter how many worker protections have been written into 
     temporary worker programs, the approach inherently provides 
     employers with the opportunity to exploit workers and turn 
     permanent jobs into low-wage, no-benefit, and no-future jobs.
       UFCW supports your reform efforts and we look forward to 
     working with you to enact this important legislation.
           Sincerely,
     Michael J. Wilson,
       International Vice President, Director, Legislative and 
     Political Action Department.
                                  ____



                                           Farmworker Justice,

                               Washington, DC, September 19, 2007.
     Re reform of the H-2B Temporary Foreign Worker Program.
     Senator Bernard Sanders,
     U.S. Senate,
     Washington, DC.
       Dear Senator Sanders: Thank you for introducing the 
     Increasing American Wages and Benefits Act to reform the H-2B 
     guestworker program for seasonal employment Farmworker 
     Justice, a national advocacy and litigation organization for 
     agricultural workers, has had substantial experience helping 
     U.S. and foreign workers affected by the H-2B program as well 
     as the H-2A agricultural guestworker program. Our research 
     and direct experience cause us to conclude that substantial 
     reforms of the program are needed. We support the legislation 
     and hope that Congress enacts it immediately.
       Currently, the H-2B law instructs the Department of Labor 
     to prevent employers that hire H-2B guestworkers based on 
     claimed labor shortages from displacing United States workers 
     and from adversely affecting their wages and working 
     conditions. The law's provisions fail to achieve these 
     objectives. The law also fails to prevent exploitation of 
     foreign citizens who, due to their poverty and the temporary, 
     nonimmigrant status of the H-2B visa, are vulnerable to 
     accepting substandard and often illegal employment 
     conditions. Further, the Department of Labor's policies and 
     actions fail to meet the statutory goals. The H-2B law must 
     be improved and your legislation would do so.
       The need for strong protections in guestworker programs has 
     been demonstrated time and time again, in the hiring of 
     Chinese workers in the 1860's to 1870's, in the employment of 
     Mexican workers in the Bracero guestworker program in the 
     1940's to 1960's, and in the H-2A and H-2B guestworker 
     programs. Many employers find guestworkers advantageous 
     because they usually come from poor countries, where wages 
     are a small fraction of those in the U.S., and often will 
     work at very high productivity rates for significantly lower 
     wages than will U.S. workers. Guestworker programs have 
     displaced U.S. workers and depressed wage rates.
       Your legislation is also important because it would begin a 
     process of regulating the international recruitment of 
     guestworkers by labor contracting firms that are hired by 
     employers in the United States. The guestworker recruitment 
     system often enables the ultimate employers to escape 
     responsibility for the mistreatment of the foreign citizens.
       While we support reform of the H-2B program, we remain 
     skeptical that any guestworker program is consistent with 
     America's economic and democratic freedoms. We are a nation 
     of immigrants, not a nation of guestworkers. In America, 
     workers should have the freedom to switch employers, demand 
     better wages and working conditions, join unions and become 
     citizens with the right to vote. Although reform is one 
     critical step to protect U.S. workers from displacement and 
     wage depression and guestworkers from exploitation, 
     ultimately Congress should consider abolishing the program 
     and replacing it with a system based on a true immigration 
     status for workers who are needed in this country.
       Thank you very much for introducing the Increasing American 
     Wages and Benefits Act.
           Sincerely,
                                                  Bruce Goldstein,
     Excecutive Director.
                                  ____

         Comite de Apoyo a los Transbajadores Agricolas--
           Farmworkers Support Committee,
                                Glassboro, NJ, September 19, 2007.
     Re endorsement for the increasing American Wages and Benefits 
         Act.
     Senator Sanders,
     U.S. Senate,
     Washington DC.
       Dear Senator Sanders: CATA--El Comite de Apoyo a los 
     Trabajadores Agricolas, The Farmworker Support Committee, is 
     a grassroots migrant and immigrant worker organization whose 
     mission is to educate and empower workers so they are able to 
     defend their rights.
       We at CATA acknowledge that the H-2B reform bill you have 
     prepared would provide greater protection to workers. Thank 
     you for your support in combating the abuse of current H-2B 
     workers.
       We believe that maintaining equivalent wages between 
     American workers and guestworkers is critical for sustaining 
     appropriate working conditions and preventing the creation of 
     an underclass. We at CATA remain adamant that enforcement of 
     any legislation is key to its effectiveness at protecting 
     workers' rights.
       We at CATA recommend further legislation to address the 
     portability of jobs to eliminate worker vulnerability under 
     the current law. We also insist on developing a mechanism for 
     H-2B workers to achieve permanent residence. Despite not 
     addressing these critical concerns that CATA has, the 
     Increasing American Wages and Benefits Act is a decisive step 
     forward for human rights.
           Sincerely,
                                              Nelson Carrasquillo,
                                               Executive Director.
                                 ______
                                 
      By Mr. DORGAN (for himself, Mr. Stevens, Mr. Schumer, Mr. Ensign, 
        Mr. Kerry, Mr. Kohl, Mr. Feingold, Mrs. Clinton, Mrs. 
        Feinstein, and Mr. Nelson of Florida):
  S. 2096. A bill to amend the Do-Not-Call Implementation Act to 
eliminate the automatic removal of telephone numbers registered on the 
Federal ``do-not-call'' registry; to the Committee on Commerce, 
Science, and Transportation.
  Mr. DORGAN. Mr. President, today I am introducing, along with 
Senators Stevens, Schumer, Ensign, Kerry, Kohl, Feingold, Clinton, 
Feinstein, and Nelson of Florida, the Do-Not-Call Improvement Act of 
2007. We seek with this bill to ensure that millions of

[[Page 25663]]

Americans who signed up for the ``Do-Not-Call'' registry do not face a 
resumption of unwanted calls from telemarketers next year when 
registrations on the registry begin to expire.
  Most Americans are unaware that their registration on the list is set 
to expire after 5 years. The expiration is unnecessary, most people who 
initially wanted to be rid of telemarketing calls likely still want to 
block these calls. The system automatically removes numbers that are 
disconnected and reassigned.
  The automatic expiration will only create a hassle for Americans as 
they start receiving calls again and have to go through the process of 
re-registering. The U.S. Government would have to spend money to let 
people know they need to sign up again.
  This bill would prevent the automatic expiration and removal of 
numbers from the registry.
  Congress established the ``Do Not Call'' registry in 2003. It quickly 
became one of the most popular consumer protection programs in history. 
Congress did not provide for automatic expiration of ``Do Not Call'' 
list registrations, but the FTC and FCC included an automatic five year 
expiration for registrations when they wrote the rules for implementing 
the program.
  That was not what Congress intended. As things stand today, 52 
million Americans will either have to re-register on October 1, 2008, 
or get ready to hear their telephones ringing during supper time again 
with unwanted, commercial solicitation calls.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
placed in the Record, as follows:

                                S. 2096

       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 ``Do-Not-Call Improvement Act 
     of 2007''.

     SEC. 2. PROHIBITION OF EXPIRATION DATE FOR REGISTERED 
                   TELEPHONE NUMBERS.

       The Do-Not-Call Implementation Act (15 U.S.C. 6101 note) is 
     amended--
       (1) by inserting ``Such rule shall not provide any date of 
     expiration for telephone numbers registered on the `do-not-
     call' registry, nor for any predetermined time limitation for 
     telephone numbers to remain on the registry.'' after the 
     first sentence in section 3; and
       (2) by adding at the end the following:

     ``SEC. 5. PROHIBITION OF EXPIRATION DATE.

       ``In issuing regulations regarding the `do-not-call' 
     registry of the Telemarketing Sales Rule (16 C. F. R. 
     310.4(b)(1)(iii)), the Federal Trade Commission shall not 
     provide for any date of expiration for telephone numbers 
     registered on the `do-not-call' registry, nor for any 
     predetermined time limitation for telephone numbers to remain 
     on the registry.''.
                                 ______
                                 
      By Mr. FEINGOLD:
  S. 2097. A bill to modify the optional method of computing net 
earnings from self-employment; to the Committee on Finance.
  Mr. FEINGOLD. Mr. President, today I am introducing legislation to 
address an injustice in the Tax Code that is threatening family farmers 
and other self-employed individuals. Some of my constituents, primarily 
Wisconsin farmers, have requested Congress's assistance to correct the 
Tax Code so they can protect their families. The legislation I 
introduce today, the Farmer Tax Fairness Act of 2007, is similar to 
legislation I introduced in the last two Congresses and will solve the 
problem for today and into the future.
  Farming is vital to Wisconsin. Wisconsin's agricultural industry 
plays a large and important role in the growth and prosperity of the 
entire State. Wisconsin's status as ``America's Dairyland'' is central 
to our State's agriculture industry. Wisconsin's dairy farmers produce 
approximately 23 billion pounds of milk and lead the Nation in cheese 
production with over 25 percent or 2.5 billion pounds of cheese a year. 
But Wisconsin's farmers produce much more than milk; they also are 
national leaders in the production of butter, potatoes, ginseng, 
cranberries, various processing vegetables, and many organic foods. So 
when the hardworking farmers of Wisconsin need help, I will do all I 
can to assist.
  One concern that I have heard from Wisconsin farmers is that the Tax 
Code can limit their eligibility for social safety net programs, 
including old age, survivors, and disability insurance, OASDI, under 
Social Security and the hospital insurance HI part of Medicare. These 
programs are paid for through payroll taxes on workers and through the 
self-employment tax on the income of self-employed individuals. To be 
eligible for OSADI and HI benefits an individual must be fully insured 
and must have earned a minimum amount of income in the years 
immediately preceding the need for coverage. Every year, the Social 
Security Administration, SSA, sets the amount of earned income that 
individuals must pay taxes on to earn quarters of coverage, QCs, and 
maintain their benefits. An individual's eligibility requirements 
depend upon the age at which death or disability occurs, but for 
workers over 31 years of age, they must have earned at least 20 QCs 
within the past 10 years.
  Self-employed individuals can have highly variable income, and, 
particularly for farmers who are at the whim of Mother Nature, not 
every year is a good year. During lean years, individuals may not earn 
enough income to maintain adequate coverage under OASDI and HI. 
Therefore, the Tax Code provides options to allow self-employed 
individuals to maintain eligibility for benefits. These options allow 
individuals to choose to pay taxes based on $1,600 of earned income, 
thus allowing self-employed entrepreneurs to maintain the same Federal 
protections even when their income varies.
  Unfortunately, both the options for farmers and nonfarmers, Social 
Security Act Sec. 211(a) and I.R.C. Sec. 1402(a), have not kept pace 
with inflation, and they no longer provide security to families across 
the country. Decades ago, self-employment income of $1,600 earned an 
individual four QCs under SSA's calculations. In 2001, the amount 
needed to earn a QC rose to $830 of earned income, so individuals 
electing the optional methods were only able to earn one QC per year; 
making it much harder for them to remain eligible for benefits because 
they must average 2 QCs per year to be eligible. With inflation, there 
is no chance of the amount needed to earn a QC dropping on its own and 
it has steadily risen since 2001, so legislation is needed to fix this 
unanticipated erosion in this option for farmers and the self-employed.
  Congress's failure to address this problem threatens the ability of 
self-employed individuals to maintain eligibility for OASDI and HI. I 
have heard from several of my constituent who want these options to be 
fixed so they can make sure their families will be taken care of in the 
event that something unforeseen occurs.
  Therefore, I am introducing the Farmer Tax Fairness Act of 2007 in 
order to provide farmers and self-employed individuals with a fair 
choice. Under this bill, they will continue to be able to elect the 
optional method if they so choose. When individuals do elect the 
option, this legislation provides an update to the Tax Code so farmers 
and self-employed individuals can retain full eligibility for OASDI and 
HI benefits. It indexes the optional income levels to SSA's QC 
calculations, allowing these farmers and self-employed individuals to 
claim enough earned income to qualify for four OCs annually. In 
addition, by linking the earned income level to SSA's requirements for 
QCs, the bill will ensure that the amount of income deemed to be earned 
under the optional methods will not need to be adjusted by Congress 
again.
  Along with providing security to self-employed individuals and 
farmers across the country, this solution is fiscally responsible. It 
could even provide a short run increase in U.S. Treasury revenues while 
having negligible impact upon the Social Security trust fund in the 
long run.
  Let me take a moment to acknowledge the efforts of the Senator from 
Iowa, Mr. Grassley, to address this problem in the 107th Congress. As 
chairman of the Senate Finance Committee, he included similar 
legislative language in the chairman's mark for

[[Page 25664]]

the Small Business and Farm Economic Recovery Act of 2002. The Senate 
Finance Committee held a markup on the legislation on September 19, 
2002, but the changes to the optional methods did not become law.
  When incomes fall, the Tax Code provides optional methods for 
calculating net earnings to ensure that farmers and self-employed 
individuals maintain eligibility for social safety net programs. When 
these provisions were developed, Congress intended self-employed 
individuals to have the ability to pay enough to earn a full 4 QCs. 
Unfortunately the Tax Code has not kept up with the times and due to 
inflation many farmers are losing eligibility for some of Social 
Security's programs. Congress needs to provide security to farm 
families and other self-employed individuals. I urge my colleagues to 
support the Farmer Tax Fairness Act of 2007.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the text of the bill was ordered to be 
placed in the Record, as follows:

                                S. 2097

       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 ``Farmer Tax Fairness Act of 
     2007''.

     SEC. 2. MODIFICATION TO OPTIONAL METHOD OF COMPUTING NET 
                   EARNINGS FROM SELF-EMPLOYMENT.

       (a) Amendments to the Internal Revenue Code of 1986.--
       (1) In general.--The matter following paragraph (15) of 
     section 1402(a) of the Internal Revenue Code of 1986 is 
     amended--
       (A) by striking ``$2,400'' each place it appears and 
     inserting ``the upper limit'', and
       (B) by striking ``$1,600'' each place it appears and 
     inserting ``the lower limit''.
       (2) Definitions.--Section 1402 of such Code is amended by 
     adding at the end the following new subsection:
       ``(l) Upper and Lower Limits.--For purposes of subsection 
     (a)--
       ``(1) Lower limit.--The lower limit for any taxable year is 
     the sum of the amounts required under section 213(d) of the 
     Social Security Act for a quarter of coverage in effect with 
     respect to each calendar quarter ending with or within such 
     taxable year.
       ``(2) Upper limit.--The upper limit for any taxable year is 
     the amount equal to 150 percent of the lower limit for such 
     taxable year.''.
       (b) Amendments to the Social Security Act.--
       (1) In general.--The matter following paragraph (15) of 
     section 211(a) of the Social Security Act is amended--
       (A) by striking ``$2,400'' each place it appears and 
     inserting ``the upper limit'', and
       (B) by striking ``$1,600'' each place it appears and 
     inserting ``the lower limit''.
       (2) Definitions.--Section 211 of such Act is amended by 
     adding at the end the following new subsection:

                        ``Upper and Lower Limits

       ``(k) For purposes of subsection (a)--
       ``(1) The lower limit for any taxable year is the sum of 
     the amounts required under section 213(d) for a quarter of 
     coverage in effect with respect to each calendar quarter 
     ending with or within such taxable year.
       ``(2) The upper limit for any taxable year is the amount 
     equal to 150 percent of the lower limit for such taxable 
     year.''.
       (3) Conforming amendment.--Section 212 of such Act is 
     amended--
       (A) in subsection (b), by striking ``For'' and inserting 
     ``Except as provided in subsection (c), for''; and
       (B) by adding at the end the following new subsection:
       ``(c) For the purpose of determining average indexed 
     monthly earnings, average monthly wage, and quarters of 
     coverage in the case of any individual who elects the option 
     described in clause (ii) or (iv) in the matter following 
     section 211(a)(15) for any taxable year that does not begin 
     with or during a particular calendar year and end with or 
     during such year, the self-employment income of such 
     individual deemed to be derived during such taxable year 
     shall be allocated to the two calendar years, portions of 
     which are included within such taxable year, in the same 
     proportion to the total of such deemed self-employment income 
     as the sum of the amounts applicable under section 213(d) for 
     the calendar quarters ending with or within each such 
     calendar year bears to the lower limit for such taxable year 
     specified in section 211(k)(1).''.
       (c) Effective Date.--The amendments made by this section 
     shall apply to taxable years beginning after the date of the 
     enactment of this Act.
                                 ______
                                 
      By Mr. DORGAN (for himself and Mr. Conrad):
  S. 2098. A bill to establish the Northern Plains Heritage Area in the 
State of North Dakota; to the Committee on Energy and Natural 
Resources.
  Mr. DORGAN. Mr. President, today I am pleased to be joined by Senator 
Conrad to introduce legislation called the Northern Plains Heritage 
Area Act. This legislation would designate a core area of historically 
significant resources in Burleigh, McLean, Mercer, Morton and Oliver 
counties in North Dakota.
  This National Heritage Area extends nearly the entire length of the 
last of the free-flowing Missouri River in North Dakota, the last place 
the river can be seen as it was seen by Lewis and Clark and the 
ancestors of today's Mandan and Hidatsa tribes.
  But what makes this area a particularly good fit for a National 
Heritage Area designation is the distinction arising from the patterns 
of human activity shaped by geography. This is the northern extremity 
of Native agriculture on the Great Plains.
  The scenic breaks of North Dakota's Missouri Valley overlook a rich 
agricultural tradition stretching back a thousand years. Along the 
length of the State's remaining free-flowing Missouri River, from Huff 
National Landmark on the south to the Knife River Indian Villages 
National Historic Site on the north, the Northern Plains Heritage Area 
would encompass the ancient homeland of the Mandan and Hidatsa nations.
  While farming methods have changed, the agricultural traditions and 
the scenic, cultural and historic values remain. The same attributes of 
geography and climate that attracted the Mandan and Hidatsa later 
appealed to homesteading farmers and ranchers and the energy industry, 
all of whom benefited from the natural resources of the land.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 2098

       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 ``Northern Plains Heritage 
     Area Act''.

     SEC. 2. DEFINITIONS.

       In this Act:
       (1) Heritage area.--The term ``Heritage Area'' means the 
     Northern Plains Heritage Area established by section 3(a).
       (2) Management entity.--The term ``management entity'' 
     means the management entity for the Heritage Area designated 
     by section 3(d).
       (3) Management plan.--The term ``management plan'' means 
     the management plan for the Heritage Area required under 
     section 5.
       (4) Map.--The term ``map'' means the map entitled 
     ``Proposed Northern Plains National Heritage Area''.
       (5) Secretary.--The term ``Secretary'' means the Secretary 
     of the Interior.
       (6) State.--The term ``State'' means the State of North 
     Dakota.

     SEC. 3. ESTABLISHMENT.

       (a) In General.--There is established in the State the 
     Northern Plains National Heritage Area.
       (b) Boundaries.--The Heritage Area shall consist of--
       (1) a core area of resources in Burleigh, McLean, Mercer, 
     Morton, and Oliver Counties in the State; and
       (2) any sites, buildings, and districts within the core 
     area recommended by the management plan for inclusion in the 
     Heritage Area.
       (c) Map.--A map of the Heritage Area shall be--
       (1) included in the management plan; and
       (2) on file and available for public inspection in the 
     appropriate offices of the National Park Service.
       (d) Management Entity.--The management entity for the 
     Heritage Area shall be the Northern Plains Heritage 
     Foundation, a nonprofit corporation established under the 
     laws of the State.

     SEC. 4. ADMINISTRATION.

       (a) In General.--For purposes of carrying out the 
     management plan, the Secretary, acting through the management 
     entity, may use amounts made available under this Act to--
       (1) make grants to the State or a political subdivision of 
     the State, nonprofit organizations, and other persons;
       (2) enter into cooperative agreements with, or provide 
     technical assistance to, the State or a political subdivision 
     of the State, nonprofit organizations, and other interested 
     parties;

[[Page 25665]]

       (3) hire and compensate staff, including individuals with 
     expertise in natural, cultural, and historical resources 
     protection and heritage programming;
       (4) obtain money or services from any source, including 
     under any other Federal law or program;
       (5) contract for goods or services; and
       (6) carry out any other activity that--
       (A) furthers the purposes of the Heritage Area; and
       (B) is consistent with the approved management plan.
       (b) Duties.--The management entity shall--
       (1) in accordance with section 5, prepare and submit a 
     management plan for the Heritage Area to the Secretary;
       (2) give priority to implementing actions covered by the 
     management plan, including assisting units of local 
     government, regional planning organizations, and nonprofit 
     organizations in carrying out the approved management plan 
     by--
       (A) carrying out programs and projects that recognize, 
     protect, and enhance important resource values in the 
     Heritage Area;
       (B) establishing and maintaining interpretive exhibits and 
     programs in the Heritage Area;
       (C) developing recreational and educational opportunities 
     in the Heritage Area;
       (D) increasing public awareness of, and appreciation for, 
     natural, historical, scenic, and cultural resources of the 
     Heritage Area;
       (E) protecting and restoring historic sites and buildings 
     in the Heritage Area that are consistent with the themes of 
     the Heritage Area;
       (F) ensuring that clear, consistent, and appropriate signs 
     identifying points of public access and sites of interest are 
     posted throughout the Heritage Area; and
       (G) promoting a wide range of partnerships among 
     governments, organizations, and individuals to further the 
     Heritage Area;
       (3) consider the interests of diverse units of government, 
     businesses, organizations, nonprofit groups, and individuals 
     in the Heritage Area in the preparation and implementation of 
     the management plan;
       (4) conduct meetings open to the public at least 
     semiannually regarding the development and implementation of 
     the management plan;
       (5) for any year for which Federal funds have been received 
     under this Act--
       (A) submit an annual report to the Secretary that describes 
     the activities, expenses, and income of the management 
     entity, including any grants to any other entities;
       (B) make available to the Secretary for audit all records 
     relating to the expenditure of the Federal funds and any 
     matching funds; and
       (C) require, with respect to all agreements authorizing the 
     expenditure of Federal funds by other organizations, that the 
     organizations receiving the Federal funds make available to 
     the Secretary for audit all records concerning the 
     expenditure of the funds; and
       (6) encourage by appropriate means economic viability that 
     is consistent with the Heritage Area.
       (c) Prohibition on the Acquisition of Real Property.--The 
     management entity shall not use Federal funds made available 
     under this Act to acquire real property or any interest in 
     real property.
       (d) Cost-Sharing Requirement.--The Federal share of the 
     cost of any activity carried out using any Federal funds made 
     available under this Act shall be 50 percent.
       (e) Other Sources.--Nothing in this Act precludes the 
     management entity from using Federal funds form other sources 
     for authorized purposes.

     SEC. 5. MANAGEMENT PLAN.

       (a) In General.--Not later than 3 years after the date of 
     enactment of this Act, the management entity shall submit to 
     the Secretary for approval a proposed management plan for the 
     Heritage Area.
       (b) Requirements.--The management plan shall--
       (1) incorporate an integrated and cooperative approach for 
     the protection, enhancement, and interpretation of the 
     natural, cultural, historic, scenic, and recreational 
     resources of the Heritage Area;
       (2) take into consideration State and local plans;
       (3) include--
       (A) an inventory of--
       (i) the resources located in the core area described in 
     section 3(b)(1); and
       (ii) any other property in the core area that--

       (I) is related to the themes of the Heritage Area; and
       (II) should be preserved, restored, managed, or maintained 
     because of the significance of the property;

       (B) comprehensive policies, strategies and recommendations 
     for the conservation, funding, management, and development of 
     the Heritage Area;
       (C) a description of actions that governments, private 
     organizations, and individuals have agreed to take to protect 
     the natural, historical and cultural resources of the 
     Heritage Area;
       (D) a program of implementation for the management plan by 
     the management entity that includes a description of--
       (i) actions to facilitate ongoing collaboration among 
     partners to promote plans for resource protection, 
     restoration, and construction; and
       (ii) specific commitments for implementation that have been 
     made by the management entity or any government, 
     organization, or individual for the first 5 years of 
     operation of the Heritage Area;
       (E) the identification of sources of funding for carrying 
     out the management plan;
       (F) analysis and recommendations for means by which 
     Federal, State, and local programs may best be coordinated to 
     carry out this Act, including recommendations for the role of 
     the National Park Service in the Heritage Area; and
       (G) an interpretive plan for the Heritage Area; and
       (4) recommend policies and strategies for resource 
     management that consider and describe the application of 
     appropriate land and water management techniques, including 
     the development of intergovernmental and interagency 
     cooperative agreements to protect the natural, historical, 
     cultural, educational, scenic, and recreational resources of 
     the Heritage Area.
       (c) Deadline.--If a proposed management plan is not 
     submitted to the Secretary by the date that is 3 years after 
     the date of enactment of this Act, the management entity 
     shall be ineligible to receive additional funding under this 
     Act until the date on which the Secretary approves a 
     management plan.
       (d) Approval or Disapproval of Management Plan.--
       (1) In general.--Not later than 180 days after the date of 
     receipt of the management plan under subsection (a), the 
     Secretary, in consultation with the State, shall approve or 
     disapprove the management plan.
       (2) Criteria for approval.--In determining whether to 
     approve the management plan, the Secretary shall consider 
     whether--
       (A) the management entity is representative of the diverse 
     interests of the Heritage Area, including governments, 
     natural and historic resource protection organizations, 
     educational institutions, businesses, and recreational 
     organizations;
       (B) the management entity has afforded adequate 
     opportunity, including public hearings, for public and 
     governmental involvement in the preparation of the management 
     plan; and
       (C) the resource protection and interpretation strategies 
     contained in the management plan, if implemented, would 
     adequately protect the natural, historical, and cultural 
     resources of the Heritage Area.
       (3) Action following disapproval.--If the Secretary 
     disapproves the management plan under paragraph (1), the 
     Secretary shall--
       (A) advise the management entity in writing of the reasons 
     for the disapproval;
       (B) make recommendations for revisions to the management 
     plan; and
       (C) not later than 180 days after the receipt of any 
     proposed revision of the management plan from the management 
     entity, approve or disapprove the proposed revision.
       (4) Amendments.--
       (A) In general.--The Secretary shall approve or disapprove 
     each amendment to the management plan that the Secretary 
     determines would make a substantial change to the management 
     plan.
       (B) Use of funds.--The management entity shall not use 
     Federal funds authorized by this Act to carry out any 
     amendments to the management plan until the Secretary has 
     approved the amendments.

     SEC. 6. RELATIONSHIP TO OTHER FEDERAL AGENCIES.

       (a) In General.--Nothing in this Act affects the authority 
     of a Federal agency to provide technical or financial 
     assistance under any other law.
       (b) Technical and Financial Assistance.--
       (1) In general.--On the request of the management entity, 
     the Secretary may provide financial assistance and, on a 
     reimbursable or nonreimbursable basis, technical assistance 
     to the management entity to develop and implement the 
     management plan.
       (2) Cooperative agreements.--The Secretary may enter into 
     cooperative agreements with the management entity and other 
     public or private entities to provide technical or financial 
     assistance under paragraph (1).
       (3) Priority.--In assisting the Heritage Area, the 
     Secretary shall give priority to actions that assist in--
       (A) conserving the significant natural, historic, cultural, 
     and scenic resources of the Heritage Area; and
       (B) providing educational, interpretive, and recreational 
     opportunities consistent with the purposes of the Heritage 
     Area.
       (c) Consultation and Coordination.--To the maximum extent 
     practicable, the head of any Federal agency planning to 
     conduct activities that may have an impact on the Heritage 
     Area is encouraged to consult and coordinate the activities 
     with the Secretary and the management entity.
       (d) Other Federal Agencies.--Nothing in this Act--
       (1) modifies or alters any laws (including regulations) 
     authorizing a Federal agency to manage Federal land under the 
     jurisdiction of the Federal agency;
       (2) limits the discretion of a Federal land manager to 
     implement an approved land use

[[Page 25666]]

     plan within the boundaries of the Heritage Area; or
       (3) modifies, alters, or amends any authorized use of 
     Federal land under the jurisdiction of a Federal agency.

     SEC. 7. PRIVATE PROPERTY AND REGULATORY PROTECTIONS.

       Nothing in this Act--
       (1) abridges the rights of any owner of public or private 
     property, including the right to refrain from participating 
     in any plan, project, program, or activity conducted within 
     the Heritage Area;
       (2) requires any property owner to--
       (A) permit public access (including access by Federal, 
     State, or local agencies) to the property of the property 
     owner; or
       (B) modify public access to, or use of, the property of the 
     property owner under any other Federal, State, or local law;
       (3) alters any land use regulation, approved land use plan, 
     or other regulatory authority of any Federal, State, or local 
     agency;
       (4) conveys any land use or other regulatory authority to 
     the management entity;
       (5) authorizes or implies the reservation or appropriation 
     of water or water rights;
       (6) diminishes the authority of the State to manage fish 
     and wildlife, including the regulation of fishing and hunting 
     within the Heritage Area; or
       (7) creates any liability, or affects any liability under 
     any other law, of any private property owner with respect to 
     any person injured on the private property.

     SEC. 8. EVALUATION; REPORT.

       (a) In General.--Not later than 3 years before the date on 
     which authority for Federal funding terminates for the 
     Heritage Area under section 10, the Secretary shall--
       (1) conduct an evaluation of the accomplishments of the 
     Heritage Area; and
       (2) prepare a report in accordance with subsection (c).
       (b) Evaluation.--An evaluation conducted under subsection 
     (a)(1) shall--
       (1) assess the progress of the management entity with 
     respect to--
       (A) accomplishing the purposes of this Act for the Heritage 
     Area; and
       (B) achieving the goals and objectives of the approved 
     management plan for the Heritage Area;
       (2) analyze the Federal, State, local, and private 
     investments in the Heritage Area to determine the leverage 
     and impact of the investments; and
       (3) review the management structure, partnership 
     relationships, and funding of the Heritage Area for purposes 
     of identifying the critical components for sustainability of 
     the Heritage Area.
       (c) Report.--
       (1) In general.--Based on the evaluation conducted under 
     subsection (a)(1), the Secretary shall prepare a report that 
     includes recommendations for the future role of the National 
     Park Service, if any, with respect to the Heritage Area.
       (2) Required analysis.--If the report prepared under 
     paragraph (1) recommends that Federal funding for the 
     Heritage Area be reauthorized, the report shall include an 
     analysis of--
       (A) ways in which Federal funding for the Heritage Area may 
     be reduced or eliminated; and
       (B) the appropriate time period necessary to achieve the 
     recommended reduction or elimination.
       (3) Submission to congress.--On completion of the report, 
     the Secretary shall submit the report to--
       (A) the Committee on Energy and Natural Resources of the 
     Senate; and
       (B) the Committee on Natural Resources of the House of 
     Representatives.

     SEC. 9. AUTHORIZATION OF APPROPRIATIONS.

       There is authorized to be appropriated to carry out this 
     Act $10,000,000, of which not more than $1,000,000 may be 
     made available for any fiscal year.

     SEC. 10. TERMINATION OF AUTHORITY.

       The authority of the Secretary to provide assistance under 
     this Act terminates on the date that is 15 years after the 
     date of enactment of this Act.
                                 ______
                                 
      By Mr. BINGAMAN (for himself, Mr. Kerry, Mr. Salazar, and Ms. 
        Stabenow):
  S. 2101. A bill to amend title XIX of the Social Security Act to 
assist low-income Medicare beneficiaries by improving eligibility and 
services under the Medicare Savings Program, and for other purposes; to 
the Committee on Finance.
  Mr. BINGAMAN. Mr. President, I rise today with Senators Kerry, 
Salazar and Stabenow to introduce the Medicare Savings Program 
Improvement Act of 2007. This legislation would make critical 
improvements to the Medicare Savings Programs, which provide important 
cost-assistance for low-income Medicare beneficiaries through the 
Medicaid program and include the Qualified Medicare Beneficiary, QMB, 
Specified Low-income Medicare Beneficiary, SLMB, and Qualified 
Individuals-1, QI-1, programs.
  One of the most significant improvements within this legislation is 
to make permanent the QI-1 program, which expires at the end of this 
month. This program provides vital assistance to low-income Medicare 
beneficiaries in paying for Medicare Part B premiums. It was 
established as part of the Balanced Budget Act of 1997 and was 
authorized for 5 years. Unfortunately, every few years we in Congress 
must act to reauthorize this program, providing unnecessary uncertainty 
for beneficiaries and State Medicaid programs.
  Congress should not participate in this annual last minute scramble 
to try and extend the program for a few months or a year. It is a 
disservice to the States, who must watch the Congress closely to 
constantly prepare to send out disenrollment notices and lay off staff, 
even though they are relatively certain the program will be extended. 
But, more importantly, it is a disservice to the 185,000 beneficiaries 
that need this important assistance, as many of those enrolled worry 
this benefit will be taken away and many of those never enrolled are 
not told of the benefit since States and advocates are spending their 
time trying to get the program extended rather than conducting 
outreach.
  While I remain very hopeful that the Congress will pass an extension 
of the QI-1 program for an additional period in the coming week, I am 
introducing the Medicare Savings Program Improvement Act of 2007 today 
in the hope that Congress will end this process of temporary extensions 
and permanently authorize the program, as provided for in this 
legislation.
  Furthermore, the bill proposes several improvements to the Medicare 
Savings Programs and application processes that will make these low-
income benefits both more efficient to administer and more accessible 
to the individuals who need them. It would also seek to simplify the 
process of applying for Medicare Savings Programs and make the Programs 
more understandable to low-income senior citizens and people with 
disabilities, as well as State and Federal Government officials.
  Rates of enrollment in the Medicare Savings Programs are well below 
those of other means-tested benefit programs. The Congressional Budget 
Office estimates that only 33 percent of eligible people are 
participating in the QMB program, and that the participation rate in 
the SLMB program is only 13 percent--these figures exclude people who 
are eligible for full Medicaid benefits. In comparison, participation 
rates are estimated to be 75 percent in the earned income tax credit, 
66 percent to 73 percent for Supplemental Security Income, and 66 
percent to 70 percent for Medicaid.
  In New Mexico, over 1,500 low-income Medicare beneficiaries receive 
the QI-1 benefit, which saves them almost $1,000 in Medicare Part B 
premium out-of-pocket costs annually. Unfortunately, according to 
estimates made by the Medicare Rights Center using Census Bureau data, 
over 11,000 are likely to be eligible. Many are completely unaware of 
the assistance this program offers. This is usually because many 
eligible individuals are difficult to reach or communicate with because 
they are isolated, cannot read or speak English, have difficulty seeing 
or hearing, or lack transportation.
  To briefly describe the most critical aspects of the legislation, 
Section 2 of the bill provides for one unified name for the Federal 
programs that offer cost sharing and benefit assistance for low income 
Medicare beneficiaries. Rather than separately referring to the QMB, 
SLMB, and QI-1 programs, the bill provides one common name for all of 
these programs, the ``Medicare Savings Programs.'' Aligning these 
programs under one title helps to establish greater uniformity in 
income and resource limits, simplifies the application process, makes 
more people eligible for subsidies and increases the enrollment in 
programs.
  Low enrollment in these assistance programs is in large part due to 
the lack of knowledge and understanding of the programs or benefits 
offered. For example, 79 percent of non-enrolled eligible people have 
ever heard of the Medicare Savings Programs and two

[[Page 25667]]

thirds of enrollees need assistance in completing the lengthy 
application form. This simple change has been pilot tested with 
Medicare beneficiary groups and found to elicit a positive response and 
interest from Medicare beneficiaries.
  Section 3 of the legislation would make permanent the QI-1 category 
by incorporating these individuals into the SLMB category at 100 
percent Federal medical percentage, FMAP, matching rate. In addition to 
simplifying and making permanent the program, such a change would 
ensure funding for QI-1 cost-sharing.
  Section 5 eliminates the limit on assets, which is set at $4,000 for 
an individual and $6,000 for a couple and disqualifies millions of 
Medicare beneficiaries with very low incomes from qualifying for 
assistance. Many potential beneficiaries do not apply for benefits 
because they incorrectly assume that they have too many assets to 
qualify or fear losing their estate. Some States have waived or 
disallowed the counting of some assets for the purposes of eligibility 
determination and have seen much higher enrollment rates. The 
requirements to document one's assets also makes the application 
process burdensome and deters potential enrollees who might pass the 
asset test.
  Finally, section 8 eliminates some of the critical barriers to 
enrollment. As I noted earlier, rates of enrollment in the Medicare 
Savings Programs are well below those of other means-tested. benefit 
programs. This section provides for several important enrollment 
simplification procedures, such as allowing self-certification of 
income and continuous eligibility, and expanded outreach efforts. For 
instance, instead of requiring people to apply for benefits at the 
state Medicaid office, the Social Security Administration took 
applications and forwarded them to Medicaid offices for processing and 
increased enrollment by 10 percent. Perhaps with more outreach efforts 
provided within this bill, even more low-income Medicare beneficiaries 
will receive the health care for which they are eligible.
  I urge the Congress to pass a temporary extension of the QI-1 program 
early next week, but then to immediately begin work to permanently 
authorize the QI-1 program and to simplify and streamline all the 
Medicare Savings Programs. Our Nation's low-income Medicare 
beneficiaries and the States deserve nothing less.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 2101

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Medicare 
     Savings Program Improvement Act of 2007''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. References to Medicare Savings Program.
Sec. 3. Increase in income levels for eligibility.
Sec. 4. Elimination of application of estate recovery for Medicare 
              Savings Program beneficiaries.
Sec. 5. Modification of asset test.
Sec. 6. Eligibility for other programs.
Sec. 7. Effective date of MSP benefits.
Sec. 8. Expediting eligibility under the Medicare Savings Program.
Sec. 9. Treatment of qualified medicare beneficiaries, specified low-
              income medicare beneficiaries, and other dual eligibles 
              as Medicare beneficiaries.
Sec. 10. Medicaid treatment of certain medicare providers.
Sec. 11. Monitoring and enforcement of limitation on beneficiary 
              liability.
Sec. 12. State provision of medical assistance to dual eligibles in MA 
              plans.

     SEC. 2. REFERENCES TO MEDICARE SAVINGS PROGRAM.

       The low-income assistance programs for Medicare 
     beneficiaries under the Medicaid program under title XIX of 
     the Social Security Act now popularly referred to the ``QMB'' 
     and ``SLMB'' programs are to be known as the ``Medicare 
     Savings Program''.

     SEC. 3. INCREASE IN INCOME LEVELS FOR ELIGIBILITY.

       (a) Increase to 135 Percent of FPL for Qualified Medicare 
     Beneficiaries.--
       (1) In general.--Section 1905(p)(2) of the Social Security 
     Act (42 U.S.C. 1396d(p)(2)) is amended--
       (A) in subparagraph (A), by striking ``100 percent'' and 
     inserting ``135 percent'';
       (B) in subparagraph (B)--
       (i) by striking ``and'' at the end of clause (ii);
       (ii) by striking the period at the end of clause (iii) and 
     inserting ``, and''; and
       (iii) by adding at the end the following:
       ``(iv) January 1, 2008, is 135 percent.''; and
       (C) in subparagraph (C)--
       (i) by striking ``and'' at the end of clause (iii);
       (ii) by striking the period at the end of clause (iv) and 
     inserting ``, and''; and
       (iii) by adding at the end the following:
       ``(v) January 1, 2008, is 135 percent.''.
       (2) Application of income test based on family size.--
     Section 1905(p)(2)(A) of such Act (42 U.S.C. 1396d(p)(2)(A)) 
     is amended by adding at the end the following: ``For purposes 
     of this subparagraph, family size means the applicant, the 
     spouse (if any) of the applicant if living in the same 
     household as the applicant, and the number of individuals who 
     are related to the applicant (or applicants), who are living 
     in the same household as the applicant (or applicants), and 
     who are dependent on the applicant (or the applicant's 
     spouse) for at least one-half of their financial support.''.
       (3) Not counting in-kind support and maintenance as 
     income.--Section 1905(p)(2)(D) of such Act (42 U.S.C. 
     1396d(p)(2)(D)) is amended by adding at the end the following 
     new clause:
       ``(iii) In determining income under this subsection, 
     support and maintenance furnished in kind shall not be 
     counted as income.''.
       (b) Expansion of Specified Low-Income Medicare Beneficiary 
     (SLMB) Program.--
       (1) Eligibility of individuals with incomes below 150 
     percent of fpl.--Section 1902(a)(10)(E) of the Social 
     Security Act (42 U.S.C. 1396b(a)(10)(E)) is amended--
       (A) by adding ``and'' at the end of clause (ii);
       (B) in clause (iii)--
       (i) by striking ``and 120 percent in 1995 and years 
     thereafter'' and inserting ``, or 120 percent in 1995 and any 
     succeeding year before 2008, or 150 percent beginning in 
     2008''; and
       (ii) by striking ``and'' at the end; and
       (C) by striking clause (iv).
       (2) Providing 100 percent federal financing.--The third 
     sentence of section 1905(b) of such Act (42 U.S.C. 1396d(b)) 
     is amended by inserting before the period at the end the 
     following: ``and with respect to medical assistance for 
     medicare cost-sharing provided under section 
     1902(a)(10)(E)(iii)''.
       (3) References.--Section 1905(p)(1) of such Act (42 U.S.C. 
     1396d(p)(1)) is amended by adding at and below subparagraph 
     (C) the following: ``The term `specified low-income medicare 
     beneficiary' means an individual described in section 
     1902(a)(10)(E)(iii).''.
       (c) Effective Date.--
       (1) Except as provided in paragraph (2), the amendments 
     made by this section shall take effect on January 1, 2008, 
     and, with respect to title XIX of the Social Security Act, 
     shall apply to calendar quarters beginning on or after 
     January 1, 2008.
       (2) In the case of a State plan for medical assistance 
     under title XIX of the Social Security Act which the 
     Secretary of Health and Human Services determines requires 
     State legislation (other than legislation appropriating 
     funds) in order for the plan to meet the additional 
     requirements imposed by the amendments made by this section, 
     the State plan shall not be regarded as failing to comply 
     with the requirements of such title solely on the basis of 
     its failure to meet these additional requirements before the 
     first day of the first calendar quarter beginning after the 
     close of the first regular session of the State legislature 
     that begins after the date of the enactment of this Act. For 
     purposes of the previous sentence, in the case of a State 
     that has a 2-year legislative session, each year of such 
     session shall be deemed to be a separate regular session of 
     the State legislature.

     SEC. 4. ELIMINATION OF APPLICATION OF ESTATE RECOVERY FOR 
                   MEDICARE SAVINGS PROGRAM BENEFICIARIES.

       (a) In General.--Section 1917(b)(1)(B)(ii) of the Social 
     Security Act (42 U.S.C. 1396p(b)(1)(B)(ii)) is amended by 
     inserting ``(but not including medical assistance for 
     medicare cost-sharing or for benefits described in section 
     1902(a)(10)(E))'' before the period at the end.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to actions commencing on or after January 1, 
     2008.

     SEC. 5. MODIFICATION OF ASSET TEST.

       (a) For QMBs.--Section 1905(p) of the Social Security Act 
     (42 U.S.C. 1396d(p)) is amended--
       (1) in paragraph (1), by amending subparagraph (C) to read 
     as follows:
       ``(C) whose resources (as determined under section 1613 for 
     purposes of the supplemental income security program, except 
     as provided in paragraph (6)(C)) do not exceed the amount 
     described in paragraph (6)(A).'';
       (2) by redesignating paragraph (6) as paragraph (7); and
       (3) by inserting after paragraph (5) the following:

[[Page 25668]]

       ``(6)(A) The resource level specified in this subparagraph 
     for--
       ``(i) for 2008 is six times the maximum amount of resources 
     that an individual may have and obtain benefits under the 
     supplemental security income program under title XVI; or
       ``(ii) for a subsequent year is the resource level 
     specified in this subparagraph for the previous year 
     increased by the annual percentage increase in the consumer 
     price index (all items; U.S. city average) as of September of 
     such previous year.

     Any dollar amount established under clause (ii) that is not a 
     multiple of $10 shall be rounded to the nearest multiple of 
     $10.
       ``(B) In determining the resources of an individual (and 
     their eligible spouse, if any) under section 1613 for 
     purposes of paragraph (1)(C) (relating to qualified medicare 
     beneficiaries) or section 1902(a)(10)(E)(iii) (relating to 
     individuals popularly known as specified low-income medicare 
     beneficiaries), the following additional exclusions shall 
     apply--
       ``(i) No part of the value of any life insurance policy 
     shall be taken into account.
       ``(ii) No balance in any pension or retirement plan or 
     account shall be taken into account.''.
       (b) For SLMBs.--
       (1) Permitting greater assets.--Section 1902(a)(10)(E)(iii) 
     of such Act (42 U.S.C. 1396b(a)(10)(E)(iii)) is amended by 
     inserting before the semicolon the following: ``or but for 
     the fact that their resources exceed the resource level 
     specified in section 1905(p)(6)(A) but does not exceed the 
     resource level specified in section 1905(p)(6)(B)''.
       (2) Higher resource level specified.--Section 1905(p)(6) of 
     such Act, as inserted by subsection (a)(3), is amended by 
     inserting after subparagraph (A) the following new 
     subparagraph:
       ``(B) The resource level specified in this subparagraph 
     for--
       ``(i) for 2008, is $27,500 (or $55,000 in the case of the 
     combined value of the individual's assets or resources and 
     the assets or resources of the individual's spouse); and
       ``(ii) for a subsequent year is the applicable resource 
     level specified in this subparagraph for the previous year 
     increased by the annual percentage increase in the consumer 
     price index (all items; U.S. city average) as of September of 
     such previous year.

     Any dollar amount established under clause (ii) that is not a 
     multiple of $10 shall be rounded to the nearest multiple of 
     $10.''.
       (c) Effective Date.--
       (1) Except as provided in paragraph (2), the amendments 
     made by this section shall apply to calendar quarters 
     beginning on or after January 1, 2008.
       (2) In the case of a State plan for medical assistance 
     under title XIX of the Social Security Act which the 
     Secretary of Health and Human Services determines requires 
     State legislation (other than legislation appropriating 
     funds) in order for the plan to meet the additional 
     requirements imposed by the amendments made by this section, 
     the State plan shall not be regarded as failing to comply 
     with the requirements of such title solely on the basis of 
     its failure to meet these additional requirements before the 
     first day of the first calendar quarter beginning after the 
     close of the first regular session of the State legislature 
     that begins after the date of the enactment of this Act. For 
     purposes of the previous sentence, in the case of a State 
     that has a 2-year legislative session, each year of such 
     session shall be deemed to be a separate regular session of 
     the State legislature.

     SEC. 6. ELIGIBILITY FOR OTHER PROGRAMS.

       (a) In General.--Section 1905(p) of the Social Security Act 
     (42 U.S.C. 1396d(p)), as amended by section 4(a), is 
     amended--
       (1) by redesignating paragraph (7) as paragraph (8); and
       (2) by inserting after paragraph (6) the following new 
     paragraph:
       ``(7) Medical assistance for some or all medicare cost-
     sharing under this title shall not be treated as benefits or 
     otherwise taken into account in determining an individual's 
     eligibility for, or the amount of benefits under, any other 
     Federal program.''.
       (b) Effective Date.--The amendments made by subsection (a) 
     shall apply to eligibility for benefits on or after January 
     1, 2008.

     SEC. 7. EFFECTIVE DATE OF MSP BENEFITS.

       (a) Providing for 3 Months Retroactive Eligibility.--
       (1) In general.--Section 1905(a) of the Social Security Act 
     (42 U.S.C. 1396d(a)) is amended, in the matter preceding 
     paragraph (1), by striking ``described in subsection (p)(1), 
     if provided after the month'' and inserting ``described in 
     subsection (p)(1) or a specified low-income medicare 
     beneficiary described in section 1902(a)(10)(E)(iii), if 
     provided in or after the third month before the month in 
     which the individual expresses an interest in applying to 
     become such a beneficiary, as determined in the manner 
     provided for assistance under section 1860D-14''.
       (2) Conforming amendments.--(A) The first sentence of 
     section 1902(e)(8) of such Act (42 U.S.C. 1396a(e)(8)), as 
     amended by section 4(c)(2), is amended by striking ``(8)'' 
     and the first sentence.
       (B) Section 1848(g)(3) of such Act (42 U.S.C. 1395w-
     4(g)(3)) is amended by adding at the end the following new 
     subparagraph:
       ``(C) Treatment of retroactive eligibility.--In the case of 
     an individual who is determined to be eligible for medical 
     assistance described in subparagraph (A) retroactively, the 
     Secretary shall provide a process whereby claims which are 
     submitted for services furnished during the period of 
     retroactive eligibility and during a month in which the 
     individual otherwise would have been eligible for such 
     assistance and which were not submitted in accordance with 
     such subparagraph are resubmitted and re-processed in 
     accordance with such subparagraph.''.
       (b) Effective Date.--The amendments made by this section 
     shall take effect on January 1, 2008, but shall not result in 
     eligibility for benefits for medicare cost-sharing for months 
     before January 2008.

     SEC. 8. EXPEDITING ELIGIBILITY UNDER THE MEDICARE SAVINGS 
                   PROGRAM.

       (a) Increasing Eligibility Through the Social Security 
     Office.--
       (1) In general.--Title XVIII of the Social Security Act is 
     amended by inserting after section 1808 the following new 
     section:


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

       ``Sec. 1809.  (a) In General.--The Secretary shall provide, 
     in cooperation with the Commissioner of Social Security, for 
     an expedited process under this section for individuals to 
     apply and qualify for benefits under the Medicare Savings 
     Program. For purposes of this section, the term `Medicare 
     Savings Program' means medical assistance for medicare cost-
     sharing (as defined in section 1905(p)(3)) for qualified 
     medicare beneficiaries and specified low-income medicare 
     beneficiaries under title XIX.
       ``(b) Process.--The process shall be consistent with the 
     following:
       ``(1) Coordination with social security and medicare 
     enrollment process.--The application shall be part of the 
     process for applying for benefits under title II and this 
     title.
       ``(2) Simplified application process.--The application may 
     be made over the Internet, by telephone, or by mail, without 
     the need for an interview in person by the applicant or a 
     representative of the applicant.
       ``(3) Contents of application.--The application shall 
     contain a description (in English, Spanish and other 
     languages determined appropriate by the Secretary) of the 
     availability of and the requirements for obtaining benefits 
     under the Medicare Savings Program.
       ``(4) Training.--Employees of the Social Security office 
     involved shall be trained to assist individuals completing 
     such applications.
       ``(5) Self-certification and verification.--In determining 
     whether an individual is eligible for benefits under the 
     Medicare Savings Program, the Secretary shall permit 
     individuals to qualify on the basis of self certifications of 
     income and resources meeting applicable standards without the 
     need to provide additional documentation. The Secretary shall 
     verify that information provided in the application is 
     correct.
       ``(6) Transmittal of application.--
       ``(A) Eligible applicants.--In the case of an applicant 
     determined by the Social Security office to be eligible for 
     benefits under the Medicare Savings Program based on income 
     and resources meeting the standards otherwise applicable, the 
     office shall transmit to the applicable State Medicaid office 
     the application so that the applicant can be enrolled within 
     30 days based on the information collected by the office.
       ``(B) Use of electronic transfer system.--Not later than 
     two years after the date of implementation of improvements of 
     the electronic data transfer system under section 8(c) of the 
     Medicare Savings Program Improvement Act of 2007, the process 
     under this paragraph shall use the such system for 
     information transmittal.
       ``(C) Ineligible applicants.--In the case of other 
     applicants whose income and resources do not meet such 
     standards, the Social Security office shall transmit to the 
     applicable State Medicaid office the application so that the 
     application may be considered under State standards that may 
     be more generous than the standards otherwise generally 
     applicable.

     The process under this subsection shall be established and 
     implemented one year after the date of the enactment of this 
     section.
       ``(c) Distribution of Application Form.--The Secretary 
     shall distribute the application form used under subsection 
     (b) to any organization that requests them, including 
     entities receiving grants from the Secretary for programs 
     designed to provide services to individuals 65 years of age 
     or older and people with disabilities. The Commissioner of 
     Social Security shall make such forms available at local 
     offices of the Social Security Administration.
       ``(d) State Response and Application Process.--
       ``(1) In general.--In the case of an application 
     transmitted under subsection (b)(6), the State agency 
     responsible for determinations of eligibility for benefits 
     under the State's Medicare Savings Program--
       ``(A) shall make a determination on the application within 
     30 days of the date of its receipt; and

[[Page 25669]]

       ``(B) shall notify the applicant of the determination 
     within 10 days after it is made.
       ``(2) Use of simplified application process.--In the case 
     of an application other than an application transmitted under 
     subsection (b)(6), a State plan under title XIX shall provide 
     that an application for benefits under the Medicare Savings 
     Program may be made over the Internet, by telephone, or by 
     mail, without the need for an interview in person by the 
     applicant or a representative of the applicant.
       ``(e) Expedited Application and Eligibility Process.--
       ``(1) Expedited process.--
       ``(A) In general.--As part of the expedited process for 
     obtaining benefits under the Medicare Savings Program, the 
     Secretary shall through a request to the Secretary of the 
     Treasury to obtain information sufficient to identify whether 
     the individual involved is likely eligible for such benefits 
     based on such information and the type of assistance under 
     the Medicare Savings Program for which they would qualify 
     based on such information. Such process shall be conducted in 
     cooperation with the Commissioner of Social Security.
       ``(B) Opt in for newly eligible individuals.--Not later 
     than 60 days after the date of the enactment of this 
     subsection, the Secretary shall ensure that, as part of the 
     Medicare enrollment process, enrolling individuals--
       ``(i) receive information describing the Medicare Savings 
     Program provided under this section; and
       ``(ii) are provided the opportunity to opt-in to the 
     expedited process described in this subsection by requesting 
     that the Commissioner of Social Security screen the 
     individual involved for eligibility for the Medicare Savings 
     Program through a request to the Secretary of the Treasury 
     under section 6103(l)(21) of the Internal Revenue Code of 
     1986.
       ``(C) Transition for currently eligible individuals.--In 
     the case of any Medicare Savings Program eligible individual 
     to which subparagraph (B) did not apply at the time of such 
     individual's enrollment, the Secretary shall, not later than 
     60 days after the date of the implementation of subparagraph 
     (B), request that the Commissioner of Social Security screen 
     such individual for eligibility for the Medicare Savings 
     Program provided under this section through a request to the 
     Secretary of the Treasury under section 6103(l)(21) of the 
     Internal Revenue Code of 1986.
       ``(2) Notification of potentially eligible individuals.--
     Under such process, in the case of each individual identified 
     under paragraph (1) who has not otherwise applied for, or 
     been determined eligible for, benefits under the Medicare 
     Savings Program (or who has applied for and been determined 
     ineligible for such benefits based only on standards in 
     effect before January 1, 2008), the Secretary shall send them 
     a letter (using basic, uncomplicated language) containing the 
     following:
       ``(A) Eligibility.--A statement that, based on the 
     information obtained under process under this section, the 
     individual is likely eligible for benefits under the Medicare 
     Savings Program.
       ``(B) Amount of assistance.--A description of the amount of 
     assistance under such program for which the individual would 
     likely be eligible based on such information.
       ``(C) Attestation.--A one-page application form that 
     provides for a signed attestation, under penalty of law, as 
     to the amount of income and assets of the individual and 
     constitutes an application for the benefits under the 
     Medicare Savings Program. Such form--
       ``(i) shall not require the submittal of additional 
     documentation regarding income or assets; and
       ``(ii) shall allow for the specification of a language 
     (other than English) that is preferred by the individual for 
     subsequent communications with respect to the individual 
     under this title and title XIX.
       ``(D) Information on outreach groups.--Information on how 
     the individual may contact the a State outreach effort or 
     other groups that receive grants from the Secretary to 
     conduct outreach to individuals to receive benefits under the 
     Medicare Savings Program.
       ``(3) Follow-up communications.--If the individual does not 
     respond to the letter described in paragraph (2) by 
     completing an attestation described in paragraph (2)(C) or 
     declining to do so, the Secretary shall make additional 
     attempts to contact the individual to obtain such an 
     affirmative response.
       ``(4) Hold-harmless.--Under such process, if an individual 
     in good faith and in the absence of fraud executes an 
     attestation described in paragraph (2)(C) and is provided 
     benefits under the Medicare Savings Program on the basis of 
     such attestation, if the individual is subsequently found not 
     eligible for such benefits, there shall be no recovery made 
     against the individual because of such benefits improperly 
     paid.
       ``(5) Use of preferred language in subsequent 
     communications.--In the case an attestation described in 
     paragraph (2)(C) is completed and in which a language other 
     than English is specified under clause (ii) of such 
     paragraph, the Secretary shall provide that subsequent 
     communications to the individual under this subsection shall 
     be in such language.
       ``(6) Construction.--Nothing in this subsection shall be 
     construed as precluding the Secretary from taking additional 
     outreach efforts to enroll eligible individuals under the 
     Medicare Savings Program.
       ``(f) Electronic Communication Between Social Security and 
     State Medicaid Agencies and the Secretary.--
       ``(1) Notice by social security to secretary and state 
     medicaid agencies.--In the case of a determination of 
     eligibility of an individual under section 1860D-
     14(a)(3)(B)(i) by the Commissioner of Social Security, the 
     Commissioner shall provide for notice, preferably in 
     electronic form, to the Secretary and to State medicaid 
     agency under title XIX of such determination for purposes of 
     enabling the individual to automatically qualify for benefits 
     under the Medicare Savings Program under such title through 
     the operation of section 1905(p)(8).
       ``(2) Notice by states to secretary.--In the case that the 
     State determines that an individual is a qualified medicare 
     beneficiary or a specified low-income medicare beneficiary 
     under title XIX, the State shall provide for notice, 
     preferably in electronic form, to the Secretary of such 
     determination for purposes of enabling the individual to 
     automatically qualify for low-income subsidies under section 
     1860D-14 through the operation of section 1905(a)(3)(G).
       ``(3) Deadline.--Each State (as defined for purposes of 
     title XIX) and the Secretary shall establish the notification 
     process described in this subsection not later than 1 year 
     after the date of the enactment of this section.''.
       (2) Disclosure of return information for purposes of 
     screening individuals for eligibility for benefits under the 
     medicare savings program.--
       (A) In general.--Subsection (l) of section 6103 of the 
     Internal Revenue Code of 1986 is amended by adding at the end 
     the following new paragraph:
       ``(21) Disclosure of return information for purposes of 
     providing benefits under the medicare savings program.--
       ``(A) Return information from internal revenue service to 
     social security administration.--The Secretary, upon written 
     request from the Commissioner of Social Security under 
     section 1809(e)(1)(A) of the Social Security Act, shall 
     disclose to the Commissioner with respect to any taxpayer 
     identified by the Commissioner--
       ``(i)(I) whether the adjusted gross income, as modified in 
     accordance with specifications of the Secretary of Health and 
     Human Services for purposes of carrying out such section, of 
     such taxpayer and, if applicable, such taxpayer's spouse, for 
     the applicable year, exceeds the amounts specified by the 
     Secretary of Health and Human Services in order to apply the 
     135 and 150 percent poverty lines under section 1905(p) and 
     section 1902(a)(10)(E)(ii) of such Act;
       ``(II) the adjusted gross income (as determined under 
     subclause (I)), in the case of a taxpayer with respect to 
     which such adjusted gross income exceeds the amount so 
     specified for applying the 135 percent poverty line and does 
     not exceed the amount so specified for applying the 150 
     percent poverty line;
       ``(III) whether the return was a joint return for the 
     applicable year; and
       ``(IV) the applicable year; or
       ``(ii) if applicable, the fact that there is no return 
     filed for such taxpayer for the applicable year.
       ``(B) Definition of applicable year.--For the purposes of 
     this paragraph, the term `applicable year' means the most 
     recent taxable year for which information is available in the 
     Internal Revenue Service's taxpayer data information systems, 
     or, if there is no return filed for such taxpayer for such 
     year, the prior taxable year.
       ``(C) Restriction on individuals for whom disclosure is 
     requested.--The Commissioner of Social Security shall only 
     request information under this paragraph with respect to 
     individuals who have requested that such request be made 
     under section 1809(e) of the Social Security Act.
       ``(D) Return information from social security 
     administration to department of health and human services.--
     The Commissioner of Social Security shall, upon written 
     request from the Secretary of Health and Human Services, 
     disclose to the Secretary of Health and Human Services the 
     information described in clauses (i) and (ii) of subparagraph 
     (A).
       ``(E) Permissive disclosure to officers, employees, and 
     contractors.--The information described in clauses (i) and 
     (ii) of subparagraph (A) may be disclosed among officers, 
     employees, and contractors of the Social Security 
     Administration and the Department of Health and Human 
     Services for the purposes described in subparagraph (F).
       ``(F) Restriction on use of disclosed information.--Return 
     information disclosed under this paragraph may be used only 
     for the purposes of identifying eligible individuals for, and 
     administering--
       ``(i) low-income subsidies under section 1860D-14 of the 
     Social Security Act; and
       ``(ii) the Medicare Savings Program implemented under 
     clauses (i) and (ii) of section 1902(a)(10)(E) of such 
     Act.''.

[[Page 25670]]

       (B) Confidentiality.--Paragraph (3) of section 6103(a) of 
     such Code is amended by striking ``or (20)'' and inserting 
     ``(20), or (21)''.
       (C) Procedures and record keeping related to disclosures.--
     Paragraph (4) of section 6103(p) of such Code is amended by 
     striking ``or (20)'' each place it appears and inserting 
     ``(20), or (21)''.
       (D) Unauthorized disclosure or inspection.--Paragraph (2) 
     of section 7213(a) of such Code is amended by striking ``or 
     (20)'' and inserting ``(20), or (21)''.
       (b) Two-Way Deeming Between Medicare Savings Program and 
     Low-Income Subsidy Program.--
       (1) Medicare savings program.--Section 1905(p) of the 
     Social Security Act (42 U.S.C. 1396d(p)), as amended by 
     sections 4(a) and 5(a), is amended--
       (A) by redesignating paragraph (8) as paragraph (9); and
       (B) by inserting after paragraph (7) the following new 
     paragraph:
       ``(8) An individual who has been determined eligible for 
     premium and cost-sharing subsidies under--
       ``(A) section 1860D-14(a)(1) is deemed, for purposes of 
     this title and without the need to file any additional 
     application, to be a qualified medicare beneficiary for 
     purposes of this title; or
       ``(B) section 1860D-14(a)(2) is deemed, for purposes of 
     this title and without the need to file any additional 
     application, to qualify for medical assistance as a specified 
     low-income medicare beneficiary (described in section 
     1902(a)(10)(E)(iii)).''.
       (2) Low-income subsidy program.--Section 1860D-14(a)(3) of 
     such Act (42 U.S.C. 1395w-104(a)(3)) is amended by adding at 
     the end the following new subparagraph:
       ``(G) Deemed treatment for qualified medicare beneficiaries 
     and specified low-income medicare beneficiaries.--
       ``(i) Qmbs eligible for full subsidy.--A part D eligible 
     individual who has been determined for purposes of title XIX 
     to be a qualified medicare beneficiary is deemed, for 
     purposes of this part and without the need to file any 
     additional application, to be a subsidy eligible individual 
     described in paragraph (1).
       ``(ii) Slmbs eligible for partial subsidy.--A part D 
     eligible individual who has been determined to be a specified 
     low-income medicare beneficiary (as defined in section 
     1905(p)(1)) and who is not described in paragraph (1) is 
     deemed, for purposes of this part and without the need to 
     file any additional application, to be a subsidy eligible 
     individual who is not described in paragraph (1).''.
       (3) Effective date.--The amendments made by this subsection 
     shall apply to eligibility for months beginning on or after 
     January 2008.
       (c) Improvements in Electronic Communication Between Social 
     Security, State Medicaid Agencies, and the Secretary of 
     Health and Human Services.--
       (1) In general.--Not later than two years after the date of 
     the enactment of this Act, the Commissioner of Social 
     Security, the Secretary of Health and Human Services, and the 
     directors of State Medicaid agencies shall implement 
     improvements to the electronic data transfer system by which 
     they communicate directly and electronically with each other 
     with respect to individuals who have enrolled for benefits 
     under any part of the Medicare Savings Program in order to 
     ensure that each of them has exactly the same list of 
     beneficiaries who are signed up for the Medicare Savings 
     Program.
       (2) Increased administrative match.--In order to implement 
     paragraph (1)--
       (A) the Medicaid administrative match under section 
     1903(a)(7) of the Social Security Act shall be increased to 
     75 percent with respect to expenditures made in carrying out 
     such paragraph; and
       (B) there is appropriated to the Commissioner of Social 
     Security and the Secretary of Health and Human Services, from 
     any amounts in the Treasury not otherwise appropriated, 
     $2,000,000 each for each of fiscal years 2008 and 2009 to 
     implement paragraph (1).
       (3) Use of system.--After the implementation of the 
     improvements to the electronic data transfer system under 
     paragraph (1), the Commissioner of Social Security, State 
     Medicaid agencies, and the Secretary of Health and Human 
     Services shall primarily use this system for the Commissioner 
     and the Secretary to inform the State Medicaid agencies to 
     enroll a beneficiary for the Medicare Savings Program.
       (d) Improved Coordination With State, Local, and Other 
     Partners.--
       (1) State grants.--
       (A) In general.--The Secretary of Health and Human Services 
     shall enter into contracts with States (as defined for 
     purposes of title XIX of the Social Security Act (42 U.S.C. 
     1396 et seq.) to provide funds to States to use information 
     identified under subsection (c), and other appropriate 
     information, in order to do ex parte determinations or 
     utilize other methods for identifying and enrolling 
     individuals who are potentially--
       (i) eligible for benefits under the Medicare Savings 
     Program (under sections 1905(p) of the Social Security Act, 
     42 U.S.C. 1396d(p)); or
       (ii) entitled to a premium or cost-sharing subsidy under 
     section 1860D-14 of such Act (42 U.S.C. 1395w-114).
       (B) Authorization of appropriations.--There are authorized 
     to be appropriated such sums as may be necessary to the 
     Secretary of Health and Human Services for the purpose of 
     making contracts under this paragraph.
       (2) Funding of state health insurance counseling and 
     similar programs.--
       (A) Authorization of appropriations.--In addition to any 
     other funds authorized to be appropriated, there are 
     authorized to be appropriated $3,000,000 for each of calendar 
     years 2008 through 2012 to carry out activities described in 
     subparagraph (B).
       (B) Activities described.--The activities described in this 
     subparagraph are the following:
       (i) Activities under section 4360 of the Omnibus Budget 
     Reconciliation Act of 1990 for the purpose of outreach to 
     low-income Medicare beneficiaries to assist in applying for 
     and obtaining benefits under the Medicare Savings Program 
     (under title XIX of the Social Security Act) and the low-
     income subsidy program under section 1860D-14 of such Act.
       (ii) Activities of the National Center on Senior Benefits 
     Outreach and Enrollment (as described in section 
     202(a)(20)(B) of the Older Americans Act of 1965 (42 U.S.C. 
     3012(a)(20)(B)).
       (iii) Similar activities carried out by other qualified 
     agencies designated by the Secretary of Health and Human 
     Services.

     SEC. 9. TREATMENT OF QUALIFIED MEDICARE BENEFICIARIES, 
                   SPECIFIED LOW-INCOME MEDICARE BENEFICIARIES, 
                   AND OTHER DUAL ELIGIBLES AS MEDICARE 
                   BENEFICIARIES.

       (a) In General.--Section 1862 of the Social Security Act 
     (42 U.S.C. 1395y) is amended by adding at the end the 
     following new subsection:
       ``(n) Treatment of Qualified Medicare Beneficiaries (QMBs), 
     Specified Low-Income Medicare Beneficiaries (SLMBs), and 
     Other Dual Eligibles.--Nothing in this title shall be 
     construed as authorizing a provider of services or supplier 
     to discriminate (through a private contractual arrangement or 
     otherwise) against an individual who is otherwise entitled to 
     services under this title on the basis that the individual is 
     a qualified medicare beneficiary (as defined in section 
     1905(p)(1)), a specified low-income medicare beneficiary, or 
     is otherwise eligible for medical assistance for medicare 
     cost-sharing or other benefits under title XIX.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to items and services furnished on or after the 
     date of the enactment of this Act.

     SEC. 10. MEDICAID TREATMENT OF CERTAIN MEDICARE PROVIDERS.

       (a) In General.--Section 1902(n) of the Social Security Act 
     (42 U.S.C. 1396a(n)) is amended by adding at the end the 
     following new paragraph:
       ``(4) A State plan shall not deny a claim from a provider 
     or supplier with respect to medicare cost-sharing described 
     in subparagraph (B), (C), or (D) of section 1905(p)(3) for an 
     item or service which is eligible for payment under title 
     XVIII on the basis that the provider or supplier does not 
     have a provider agreement in effect under this title or does 
     not otherwise serve all individuals entitled to medical 
     assistance under this title.''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to items and services furnished on or after the 
     date of the enactment of this Act.

     SEC. 11. MONITORING AND ENFORCEMENT OF LIMITATION ON 
                   BENEFICIARY LIABILITY.

       Section 1902(n) of the Social Security Act (42 U.S.C. 
     1396b(n)), as amended by section 9(a), is further amended by 
     adding at the end the following new paragraph:
       ``(5)(A) The Inspector General of the Department of Health 
     and Human Services shall examine, not later than one year 
     after the date of the enactment of this paragraph and every 
     three years thereafter, whether providers have attempted to 
     make qualified medicare beneficiaries liable for deductibles, 
     coinsurance, and co-payments in violation of paragraph 
     (3)(B). The Inspector General shall submit to the Secretary a 
     report on such examination and a finding as to whether 
     qualified medicare beneficiaries have been held liable in 
     violation of such paragraph.
       ``(B) If a report under subparagraph (A) includes a finding 
     that qualified medicare beneficiaries have been held liable 
     in violation of such paragraph, not later than 60 days after 
     the date of receiving such report the Secretary shall submit 
     to Congress a report that includes a plan of action on how to 
     enforce provisions of such paragraph.''.

     SEC. 12. STATE PROVISION OF MEDICAL ASSISTANCE TO DUAL 
                   ELIGIBLES IN MA PLANS.

       (a) In General.--Section 1902(n) of the Social Security Act 
     (42 U.S.C. 1396b(n)), as amended by section 10, is further 
     amended by adding at the end the following new paragraph:
       ``(6)(A) Each State shall--
       ``(i) identify those individuals who are eligible for 
     medical assistance for medicare cost-sharing and who are 
     enrolled with a Medicare Advantage plan under part C of title 
     XVIII; and
       ``(ii) for the individuals so identified, provide for 
     payment of medical assistance for

[[Page 25671]]

     the medicare cost-sharing (including cost-sharing under a 
     Medicare Advantage plan) to which they are entitled.
       ``(B)(i) The Inspector General of the Department of Health 
     and Human Services shall examine, not later than one year 
     after the date of the enactment of this paragraph and every 
     three years thereafter, whether States are providing for 
     medical assistance for medicare cost-sharing for individuals 
     enrolled in Medicare Advantage plans in accordance with this 
     title. The Inspector General shall submit to the Secretary a 
     report on such examination and a finding as to whether States 
     are failing to provide such medical assistance.
       ``(ii) If a report under clause (i) includes a finding that 
     States are failing to provide such medical assistance, not 
     later than 60 days after the date of receiving such report 
     the Secretary shall submit to Congress a report that includes 
     a plan of action on how to enforce such requirement.''.
       (b) Effective Date.--
       (1) Except as provided in paragraph (2), the amendment made 
     by subsection (a) shall apply to calendar quarters beginning 
     on or after the date of the enactment of this Act.
       (2) In the case of a State plan for medical assistance 
     under title XIX of the Social Security Act which the 
     Secretary of Health and Human Services determines requires 
     State legislation (other than legislation appropriating 
     funds) in order for the plan to meet the additional 
     requirements imposed by the amendment made by subsection (a), 
     the State plan shall not be regarded as failing to comply 
     with the requirements of such title solely on the basis of 
     its failure to meet these additional requirements before the 
     first day of the first calendar quarter beginning after the 
     close of the first regular session of the State legislature 
     that begins after the date of the enactment of this Act. For 
     purposes of the previous sentence, in the case of a State 
     that has a 2-year legislative session, each year of such 
     session shall be deemed to be a separate regular session of 
     the State legislature.
                                 ______
                                 
      By Mr. BINGAMAN (for himself, Mr. Obama, Mr. Salazar, Mr. Brown, 
        Mr. Kerry, Ms. Stabenow, Ms. Cantwell, and Mrs. Clinton):
  S. 2102. A bill to amend title II of the Social Security Act to phase 
out the 24-month waiting period for disabled individuals to become 
eligible for Medicare benefits, to eliminate the waiting period for 
individuals with life-threatening conditions, and for other purposes; 
to the Committee on Finance.
  Mr. BINGAMAN. Mr. President, I rise today to introduce bipartisan 
legislation entitled ``Ending the Medicare Disability Waiting Period 
Act of 2007 with Senators Obama, Salazar, Brown, Kerry, Stabenow, 
Cantwell, and Clinton. This legislation would phase-out the current 2 
year waiting period that people with disabilities must endure after 
qualifying for Social Security Disability Insurance SSDI. In the 
interim or as the waiting period is being phased out, the bill would 
also create a process by which the secretary can immediately waive the 
waiting period for people with life threatening illnesses.
  When Medicare was expanded in 1972 to include people with significant 
disabilities, lawmakers created the 24-month waiting period. According 
to a April 2007 report from the Commonwealth Fund, it is estimated that 
over 1.5 million SSDI beneficiaries are in the Medicare waiting period 
at any given time, ``all of whom are unable to work because of their 
disability and most of whom have serious health problems, low incomes, 
and limited access to health insurance.'' Nearly 39 percent of these 
individuals do not have health insurance coverage for some point during 
the waiting period and 26 percent have no health insurance during this 
period.
  The stated reason at the time was to limit the fiscal cost of the 
provision. However, Mr. President, I would assert that there is no 
reason, be it fiscal or moral, to tell people that they must wait 
longer than two years after becoming severely disabled before we give 
provide them access to much needed health care.
  In fact, it is important to note that there really are actually three 
waiting periods that are imposed upon people seeking to qualify for 
SSDI. First, there is the disability determination process through the 
Social Security Administration, which often takes many months or even 
longer than a year in some cases. Second, once a worker has been 
certified as having a severe or permanent disability, they must wait an 
additional five months before receiving their first SSDI check. And 
third, after receiving that first SSDI check, there is the 2-year 
period that people must wait before their Medicare coverage begins.
  What happens to the health and well-being of people waiting more than 
2\1/2\ years before they finally receive critically needed Medicare 
coverage? According to Karen Davis, president of the Commonwealth Fund, 
which has conducted several important studies on the issue, 
``Individuals in the waiting period for Medicare suffer from a broad 
range of debilitating diseases and are in urgent need of appropriate 
medical care to manage their conditions. Eliminating the 2-year wait 
would ensure access to care for those already on the way to Medicare.''
  Again, we are talking about individuals that have been determined to 
be unable to engage in any ``substantial, gainful activity'' because of 
either a physical or mental impairment that is expected to result in 
death or to continue for at least 12 months. These are people that, by 
definition, are in more need of health coverage than anybody else in 
our society. The consequences are unacceptable and are, in fact, dire.
  The majority of people who become disabled were, before their 
disability, working full-time jobs and paying into Medicare like all 
other employed Americans. At the moment these men and women need 
coverage the most, just when they have lost their health, their jobs, 
their income, and their health insurance, Federal law requires them to 
wait two full years to become eligible for Medicare. Many of these 
individuals are needlessly forced to accumulate tens-of-thousands of 
dollars in healthcare debt or compromise their health due to forgone 
medical treatment. Many individuals are forced to sell their homes or 
go bankrupt. Even more tragically, more than 16,000 disabled 
beneficiaries annually, about 4 percent of beneficiaries, do not make 
it through the waiting period. They die before their Medicare coverage 
ever begins.
  Removing the waiting period is well worth the expense. According to 
the Commonwealth Fund, analyses have shown providing men and women with 
Medicare at the time that Social Security certifies them as disabled 
would cost $8.7 billion annually. This cost would be partially offset 
by $4.3 billion in reduced Medicaid spending by Medicaid, which many 
individuals require during the waiting period. In addition, untold 
expenses borne by the individuals involved could be avoided, as well as 
the costs of charity care on which many depend. Moreover, there may be 
additional savings to the Medicare program itself, which often has to 
bear the expense of addressing the damage done during the waiting 
period. During this time, deferred health care can worsen conditions, 
creating additional health problems and higher costs.
  Further exacerbating the situation, some beneficiaries have had the 
unfortunate fate of having received SSI and Medicaid coverage, applied 
for SSDI, and then lost their Medicaid coverage because they were not 
aware the change in income when they received SSDI would push them over 
the financial limits for Medicaid. In such a case, and let me emphasize 
this point, the government is effectively taking their health care 
coverage away because they are so severely disabled.
  Therefore, for some in the waiting period, their battle is often as 
much with the Government as it is with their medical condition, 
disease, or disability.
  Nobody could possible think this makes any sense.
  As the Medicare Rights Center has said, ``By forcing Americans with 
disabilities to wait 24 months for Medicare coverage, the current law 
effectively sentences these people to inadequate health care, poverty, 
or death. . . . Since disability can strike anyone, at any point in 
life, the 24-month waiting period. should be of concern to everyone, 
not just the millions of Americans with disabilities today.''
  Although elimination of the Medicare waiting period will certainly 
increase Medicare costs, it is important to note that there will be 
some corresponding decrease in Medicaid costs.

[[Page 25672]]

Medicaid, which is financed by both Federal and State governments, 
often provides coverage for a subset of disabled Americans in the 
waiting period, as long as they meet certain income and asset limits. 
Income limits are typically at or below the poverty level, including at 
just 74 percent of the poverty line in New Mexico, with assets 
generally limited to just $2,000 for individuals and $3,000 for 
couples.
  Furthermore, from a continuity of care point of view, it makes little 
sense that somebody with disabilities must leave their job and their 
health providers associated with that plan, move on to Medicaid, often 
have a different set of providers, then switch to Medicare and yet 
another set of providers. The cost, both financial and personal, of not 
providing access to care or poorly coordinated care services for these 
seriously ill people during the waiting period may be greater in many 
cases than providing health coverage.
  Finally, private-sector employers and employees in those risk-pools 
would also benefit from the passage of the bill. As the Commonwealth 
Fund has noted, ``. . . to the extent that disabled adults rely on 
coverage through their prior employer or their spouse's employer, 
eliminating the waiting period would also produce savings to employers 
who provide this coverage.''
  To address concerns about costs and immediate impact on the Medicare 
program, the legislation phases out the waiting period over a 10-year 
period. In the interim, the legislation would create a process by which 
others with life-threatening illnesses could also get an exception to 
the waiting period. Congress has previously extended such an exception 
to the waiting period individuals with amyothrophic lateral sclerosis, 
ALS, also known as Lou Gehrig's disease, and for hospice services. The 
ALS exception passed the Congress in December 2000 and went into effect 
July 1, 2001. Thus, the legislation would extend the exception to all 
people with life-threatening illnesses in the waiting period.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                S. 2102

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

     SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

       (a) Short Title.--This Act may be cited as the ``Ending the 
     Medicare Disability Waiting Period Act of 2007''.
       (b) Table of Contents.--The table of contents of this Act 
     is as follows:

Sec. 1. Short title; table of contents.
Sec. 2. Phase-out of waiting period for medicare disability benefits.
Sec. 3. Elimination of waiting period for individuals with life-
              threatening conditions.
Sec. 4. Institute of Medicine study and report on delay and prevention 
              of disability conditions.

     SEC. 2. PHASE-OUT OF WAITING PERIOD FOR MEDICARE DISABILITY 
                   BENEFITS.

       (a) In General.--Section 226(b) of the Social Security Act 
     (42 U.S.C. 426(b)) is amended--
       (1) in paragraph (2)(A), by striking ``, and has for 24 
     calendar months been entitled to,'' and inserting ``, and for 
     the waiting period (as defined in subsection (k)) has been 
     entitled to,'';
       (2) in paragraph (2)(B), by striking ``, and has been for 
     not less than 24 months,'' and inserting ``, and has been for 
     the waiting period (as defined in subsection (k)),'';
       (3) in paragraph (2)(C)(ii), by striking ``, including the 
     requirement that he has been entitled to the specified 
     benefits for 24 months,'' and inserting ``, including the 
     requirement that the individual has been entitled to the 
     specified benefits for the waiting period (as defined in 
     subsection (k)),''; and
       (4) in the flush matter following paragraph 
     (2)(C)(ii)(II)--
       (A) in the first sentence, by striking ``for each month 
     beginning with the later of (I) July 1973 or (II) the twenty-
     fifth month of his entitlement or status as a qualified 
     railroad retirement beneficiary described in paragraph (2), 
     and'' and inserting ``for each month beginning after the 
     waiting period (as so defined) for which the individual 
     satisfies paragraph (2) and'';
       (B) in the second sentence, by striking ``the `twenty-fifth 
     month of his entitlement' refers to the first month after the 
     twenty-fourth month of entitlement to specified benefits 
     referred to in paragraph (2)(C) and''; and
       (C) in the third sentence, by striking ``, but not in 
     excess of 78 such months''.
       (b) Schedule for Phase-Out of Waiting Period.--Section 226 
     of the Social Security Act (42 U.S.C. 426) is amended by 
     adding at the end the following new subsection:
       ``(k) For purposes of subsection (b) (and for purposes of 
     section 1837(g)(1) of this Act and section 7(d)(2)(ii) of the 
     Railroad Retirement Act of 1974), the term `waiting period' 
     means--
       ``(1) for 2008, 18 months;
       ``(2) for 2009, 16 months;
       ``(3) for 2010, 14 months;
       ``(4) for 2011, 12 months;
       ``(5) for 2012, 10 months;
       ``(6) for 2013, 8 months;
       ``(7) for 2014, 6 months;
       ``(8) for 2015, 4 months;
       ``(9) for 2016, 2 months; and
       ``(10) for 2017 and each subsequent year, 0 months.''.
       (c) Conforming Amendments.--
       (1) Sunset.--Effective January 1, 2017, subsection (f) of 
     section 226 of the Social Security Act (42 U.S.C. 426) is 
     repealed.
       (2) Medicare description.--Section 1811(2) of such Act (42 
     U.S.C. 1395c(2)) is amended by striking ``entitled for not 
     less than 24 months'' and inserting ``entitled for the 
     waiting period (as defined in section 226(k))''.
       (3) Medicare coverage.--Section 1837(g)(1) of such Act (42 
     U.S.C. 1395p(g)(1)) is amended by striking ``of the later of 
     (A) April 1973 or (B) the third month before the 25th month 
     of such entitlement'' and inserting ``of the third month 
     before the first month following the waiting period (as 
     defined in section 226(k)) applicable under section 226(b)''.
       (4) Railroad retirement system.--Section 7(d)(2)(ii) of the 
     Railroad Retirement Act of 1974 (45 U.S.C. 231f(d)(2)(ii)) is 
     amended--
       (A) by striking ``, for not less than 24 months'' and 
     inserting ``, for the waiting period (as defined in section 
     226(k) of the Social Security Act); and
       (B) by striking ``could have been entitled for 24 calendar 
     months, and'' and inserting ``could have been entitled for 
     the waiting period (as defined is section 226(k) of the 
     Social Security Act), and''.
       (d) Effective Date.--Except as provided in subsection 
     (c)(1), the amendments made by this section shall apply to 
     insurance benefits under title XVIII of the Social Security 
     Act with respect to items and services furnished in months 
     beginning at least 90 days after the date of the enactment of 
     this Act (but in no case earlier than January 1, 2008).

     SEC. 3. ELIMINATION OF WAITING PERIOD FOR INDIVIDUALS WITH 
                   LIFE-THREATENING CONDITIONS.

       (a) In General.--Section 226(h) of the Social Security Act 
     (42 U.S.C. 426(h)) is amended--
       (1) by redesignating paragraphs (1), (2), and (3) as 
     subparagraphs (A), (B), and (C), respectively;
       (2) in the matter preceding subparagraph (A) (as 
     redesignated by paragraph (1)), by inserting ``(1)'' after 
     ``(h)'';
       (3) in paragraph (1) (as designated by paragraph (2))--
       (A) in the matter preceding subparagraph (A) (as 
     redesignated by paragraph (1)), by inserting ``or any other 
     life-threatening condition identified by the Secretary'' 
     after ``amyotrophic lateral sclerosis (ALS)''; and
       (B) in subparagraph (B) (as redesignated by paragraph (1)), 
     by striking ``(rather than twenty-fifth month)''; and
       (4) by adding at the end the following new paragraph:
       ``(2) For purposes of identifying life-threatening 
     conditions under paragraph (1), the Secretary shall compile a 
     list of conditions that are fatal without medical treatment. 
     In compiling such list, the Secretary shall consult with the 
     Director of the National Institutes of Health (including the 
     Office of Rare Diseases), the Director of the Centers for 
     Disease Control and Prevention, the Director of the National 
     Science Foundation, and the Institute of Medicine of the 
     National Academy of Sciences.''.
       (b) Effective Date.--The amendments made by this section 
     shall apply to insurance benefits under title XVIII of the 
     Social Security Act with respect to items and services 
     furnished in months beginning at least 90 days after the date 
     of the enactment of this Act (but in no case earlier than 
     January 1, 2008).

     SEC. 4. INSTITUTE OF MEDICINE STUDY AND REPORT ON DELAY AND 
                   PREVENTION OF DISABILITY CONDITIONS.

       (a) Study.--The Secretary of Health and Human Services (in 
     this section referred to as the ``Secretary'') shall request 
     that the Institute of Medicine of the National Academy of 
     Sciences conduct a study on the range of disability 
     conditions that can be delayed or prevented if individuals 
     receive access to health care services and coverage before 
     the condition reaches disability levels.
       (b) Report.--Not later than the date that is 2 years after 
     the date of enactment of this Act, the Secretary shall submit 
     to Congress a report containing the results of the Institute 
     of Medicine study authorized under this section.
       (c) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section $750,000 for the 
     period of fiscal years 2008 and 2009.
                                 ______
                                 
      By Mr. BINGAMAN (for himself, Mr. Obama, Mr. Salazar, Ms. 
        Collins, and Mr. Lieberman):

[[Page 25673]]

  S. 2103. A bill to amend title XVIII of the Social Security Act to 
eliminate the in the home restriction for Medicare coverage of mobility 
devices for individuals with expected long-term needs; to the Committee 
on Finance.
  Mr. BINGAMAN. Mr. President, I rise today with Senators Obama, 
Salazar, Collins, and Lieberman to introduce the Medicare Independent 
Living Act of 2007. This legislation would eliminate Medicare's ``in 
the home'' restriction for the coverage of mobility devices, including 
wheelchairs and scooters, for those with disabilities and expected 
long-term needs. This includes people with multiple sclerosis, 
paraplegia, osteoarthritis, and cerebrovascular disease that includes 
acute stroke and conditions like aneurysms.
  As currently interpreted by the Centers for Medicare and Medicaid 
Services, CMS, the ``in the home'' restriction only permits 
beneficiaries to obtain wheelchairs that are necessary for use inside 
the home. As a result, seriously disabled beneficiaries who would 
primarily utilize a wheelchair outside the home are prevented from 
receiving this critical and basic equipment through Medicare. For 
example, this restriction prevents beneficiaries from receiving 
wheelchairs to access their work, the community-at-large, place of 
worship, school, physician's offices, or pharmacies.
  On July 13, 2005, 34 senators wrote Secretary Leavitt asking the 
Department of Health and Human Services, or HHS, to modify the ``in the 
home'' requirement so as to ``improve community access for Medicare 
beneficiaries with mobility impairments.'' Unfortunately, CMS continues 
to impose the ``in the home'' restriction on Medicare beneficiaries in 
need of mobility devices.
  As the Medicare Rights Center in a report entitled ``Forced 
Isolation: Medicare's `In The home' Coverage Standards for 
Wheelchairs'' in March 2004 notes, ``This effectively disqualifies you 
from leaving your home without the assistance of others.''
  Furthermore, in a Kansas City Star article dated July 3, 2005, Mike 
Oxford with the National Council on Independent Living noted, ``You 
look at mobility assistance as a way to liberate yourself.'' He added 
that the restriction ``is just backward.''
  In fact, policies such as these are not only backward but directly 
contradict numerous initiatives aimed at increasing community 
integration of people with disabilities, including the Americans with 
Disabilities Act, the Ticket-to-Work Program, the New Freedom 
Initiative, and the Olmstead Supreme Court decision.
  According to the Medicare Rights Center update dated March 23, 2006, 
``This results in arbitrary denials. People with apartments too small 
for a power wheelchair are denied a device that could also get them 
down the street. Those in more spacious quarters get coverage, allowing 
them to scoot from room to room and to the grocery store. People who 
summon all their willpower and strength to hobble around a small 
apartment get no help for tasks that are beyond them and their front 
door.''
  In New Mexico, I have heard this complaint about the law repeatedly 
from our State's most vulnerable disabled and senior citizens. People 
argue the provision is being misinterpreted by the administration and 
results in Medicare beneficiaries being trapped in their home.
  The ITEM Coalition adds in a letter to CMS on this issue in November 
25, 2005, ``There continues to be no clinical basis for the `in the 
home' restriction and by asking treating practioners to document 
medical need only within the home setting, CMS is severely restricting 
patients from receiving the most appropriate devices to meet their 
mobility needs.''
  My legislation would clarify that this restriction does not apply to 
mobility devices, including wheelchairs, for people with disabilities 
in the Medicare Program. The language change is fairly simple and 
simply clarifies that the ``in the home'' restriction for durable 
medical equipment does not apply in the case of mobility devices needed 
by Medicare beneficiaries with expected long-term needs for use ``in 
customary settings such as normal domestic, vocational, and community 
activities.''
  This legislation is certainly not intended to discourage CMS from 
dedicating its resources to reducing waste, fraud, and abuse in the 
Medicare system, as those efforts are critical to ensuring that 
Medicare remains financially viable and strong in the future. However, 
it should be noted that neither Medicaid nor the Department of Veterans 
Affairs impose such ``in the home'' restrictions on mobility devices.
  Mr. President, I ask unanimous consent that the text of the bill and 
a letter sent to Secretary Leavitt be printed in the Record.
  There being no objection, the material was ordered to be printed in 
the Record, as follows:

                                S. 2103

       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 ``Medicare Independent Living 
     Act of 2007''.

     SEC. 2. ELIMINATION OF IN THE HOME RESTRICTION FOR MEDICARE 
                   COVERAGE OF MOBILITY DEVICES FOR INDIVIDUALS 
                   WITH EXPECTED LONG-TERM NEEDS.

       (a) In General.--Section 1861(n) of the Social Security Act 
     (42 U.S.C. 1395x(n) is amended by inserting ``or, in the case 
     of a mobility device required by an individual with expected 
     long-term need, used in customary settings for the purpose of 
     normal domestic, vocational, or community activities'' after 
     ``1819(a)(1))''.
       (b) Effective Date.--The amendment made by subsection (a) 
     shall apply to items furnished on or after the date of 
     enactment of this Act.
                                  ____

                                                    July 13, 2005.

               Senate Letter Opposing In Home Restriction

     Hon. Michael O. Leavitt,
     Secretary, Department of Health and Human Services, 
         Washington, DC.
       Dear Secretary Leavitt: The undersigned members write to 
     request that you modify the ``in the home'' requirement in 
     Medicare's wheeled mobility benefit to improve community 
     access for Medicare beneficiaries with mobility impairments.
       We commend CMS for its dedication to reducing waste, fraud 
     and abuse in the Medicare system, particularly under the 
     mobility device benefit, and fully support your intention to 
     protect precious Medicare funds and resources. Additionally, 
     we commend the agency for recently taking on the task of 
     creating a new and, hopefully, more appropriate Medicare 
     coverage criteria for mobility devices. However, we are 
     concerned that CMS' current interpretation of the ``in the 
     home'' requirement may continue to act as an inappropriate 
     restriction in meeting the real-life mobility needs of 
     Medicare beneficiaries with physical disabilities and 
     mobility impairments.
       Recently CMS announced a final National Coverage 
     Determination (NCD) for mobility assistance equipment (MAE) 
     that fails to adequately address the concerns of 
     beneficiaries and other parties with the ``in the home'' 
     restriction.
       In order to ensure that the ``in the home'' requirement 
     does not act as a barrier to community participation for 
     Medicare beneficiaries with disabilities and mobility 
     impairments; we ask that you modify this requirement through 
     the regulatory process. Additionally, if your agency 
     concludes that the ``in the home'' requirement cannot be 
     addressed through the regulatory process, we request that you 
     respond with such information as quickly as possible, so that 
     Congress may begin examining legislative alternatives.
       We thank you for your consideration of this matter.
           Sincerely,
         Jeff Bingaman; Rick Santorum; John Kerry; Joseph I. 
           Lieberman; Barbara Mikulski; Maria Cantwell; Edward M. 
           Kennedy; Patty Murray; Evan Bayh; Mark Dayton; Jack 
           Reed; Johnny Isakson; Sam Brownback; Jon S. Corzine; 
           James M. Talent; Pat Roberts; Frank Lautenberg; James 
           M. Jeffords; Christopher S. Bond; Mike DeWine; Daniel 
           K. Akaka; Mary L. Landrieu; Debbie Stabenow; Charles E. 
           Schumer; Ron Wyden; Herb Kohl; Patrick J. Leahy; Arlen 
           Specter; Hillary Rodham Clinton; Christopher J. Dodd; 
           John McCain; Carl Levin; Tom Harkin; Olympia J. Snowe.

[[Page 25674]]



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