[Congressional Bills 114th Congress]
[From the U.S. Government Publishing Office]
[S. 3371 Introduced in Senate (IS)]
<DOC>
114th CONGRESS
2d Session
S. 3371
To amend titles II, XVIII, and XIX of the Social Security Act to
improve the affordability and enrollment procedures of the Medicare
program, and for other purposes.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
September 21, 2016
Mr. Wyden (for himself, Ms. Stabenow, Mr. Bennet, Mr. Nelson, and Mr.
Brown) introduced the following bill; which was read twice and referred
to the Committee on Finance
_______________________________________________________________________
A BILL
To amend titles II, XVIII, and XIX of the Social Security Act to
improve the affordability and enrollment procedures of the Medicare
program, and for other purposes.
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
Affordability and Enrollment Act of 2016''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Protecting against high out-of-pocket expenditures for Medicare
fee-for-service benefits.
Sec. 3. Reducing cost-sharing, aligning income and resource eligibility
tests, and simplifying enrollment for low-
income beneficiaries.
Sec. 4. Reducing Medicare cost-sharing for low-income beneficiaries.
Sec. 5. Eliminating the 24-month waiting period for Medicare coverage
for individuals with disabilities.
Sec. 6. Improving Medicare beneficiary enrollment procedures and
effective dates of coverage.
Sec. 7. Eliminating exclusion of part D eligible individuals residing
in territories from eligibility for premium
and cost-sharing subsidies.
Sec. 8. Extending funding for low-income Medicare beneficiary outreach
and assistance education activities.
SEC. 2. PROTECTING AGAINST HIGH OUT-OF-POCKET EXPENDITURES FOR MEDICARE
FEE-FOR-SERVICE BENEFITS.
Title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) is
amended by adding at the end the following new section:
``protection against high out-of-pocket expenditures
``Sec. 1899C. (a) In General.--Notwithstanding any other provision
of this title, in the case of an individual entitled to, or enrolled
for, benefits under part A or enrolled in part B, if the amount of the
out-of-pocket cost-sharing of such individual for a year (beginning
with 2018) equals or exceeds the annual out-of-pocket limit under
subsection (b) for that year--
``(1) the amount otherwise payable under part A and the
total amount of expenses incurred by the individual which would
(except for this section) constitute incurred expenses for
which benefits are payable under part B, shall be 100 percent
of such amount for the remainder of that year; and
``(2) the individual shall not be responsible for out-of-
pocket cost-sharing incurred during the remainder of that year.
``(b) Annual Out-of-Pocket Limit.--
``(1) In general.--The amount of the annual out-of-pocket
limit under this subsection shall be--
``(A) for 2018, $5,500; or
``(B) for a subsequent year, the amount specified
in this subsection for the preceding year increased or
decreased by the percentage change in the Consumer
Price Index for All Urban Consumers for the 12-month
period ending with June of such preceding year.
``(2) Rounding.--If any amount determined under paragraph
(1)(B) is not a multiple of $5, such amount shall be rounded to
the nearest multiple of $5.
``(c) Out-of-Pocket Cost-Sharing Defined.--
``(1) In general.--Subject to paragraphs (2) and (3), in
this section, the term `out-of-pocket cost-sharing' means, with
respect to an individual, the amount of the expenses incurred
by the individual that are attributable to--
``(A) deductibles, coinsurance and copayments
applicable under part A or B; or
``(B) for items and services that would have
otherwise been covered under part A or B but for the
exhaustion of those benefits.
``(2) Certain costs not included.--
``(A) Non-covered items and services.--Expenses
incurred for items and services which are not covered
under part A or B shall not be considered incurred
expenses for purposes of determining out-of-pocket
cost-sharing under paragraph (1).
``(B) Items and services not furnished on an
assignment-related basis.--If an item or service is
furnished to an individual under this title and is not
furnished on an assignment-related basis, any
additional expenses the individual incurs above the
amount the individual would have incurred if the item
or service was furnished on an assignment-related basis
shall not be considered incurred expenses for purposes
of determining out-of-pocket cost-sharing under
paragraph (1).
``(3) Source of payment.--For purposes of paragraph (1),
the Secretary shall consider expenses to be incurred by the
individual without regard to whether the individual or another
person, including a State program, an employer, a medicare
supplemental policy, or other third-party coverage, has paid
for such expenses.
``(d) Announcement of the Annual Out-of-Pocket Limit.--The
Secretary shall (beginning in 2017) announce (in a manner intended to
provide notice to all interested parties) the annual out-of-pocket
limit under this section that will be applicable for the succeeding
year.''.
SEC. 3. REDUCING COST-SHARING, ALIGNING INCOME AND RESOURCE ELIGIBILITY
TESTS, AND SIMPLIFYING ENROLLMENT FOR LOW-INCOME
BENEFICIARIES.
(a) Increase in Income Eligibility to 135 Percent of FPL for
Qualified Medicare Beneficiaries.--Section 1905(p)(2) of the Social
Security Act (42 U.S.C. 1396d(p)(2)) is amended--
(1) in subparagraph (A), by striking ``100 percent'' and
inserting ``135 percent'';
(2) in subparagraph (B)--
(A) by striking ``and'' at the end of clause (ii);
(B) by striking the period at the end of clause
(iii) and inserting ``, and''; and
(C) by adding at the end the following:
``(iv) January 1, 2018, is 135 percent.''; and
(3) in subparagraph (C)--
(A) by striking ``and'' at the end of clause (iii);
(B) by striking the period at the end of clause
(iv) and inserting ``, and''; and
(C) by adding at the end the following:
``(v) January 1, 2018, is 135 percent.''.
(b) Increase in Income Eligibility to 150 Percent of FPL for
Specified Low-Income Medicare Beneficiaries.--
(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 ``120
percent in 1995 and years thereafter before
2018, and 150 percent in 2018 and years
thereafter''; and
(ii) by striking ``and'' at the end; and
(C) by striking clause (iv).
(2) 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 flush sentence:
``The term `specified low-income medicare beneficiary' means an
individual described in section 1902(a)(10)(E)(iii).''.
(3) Conforming amendments.--
(A) The first sentence of section 1905(b) of such
Act (42 U.S.C. 1396d(b)) is amended by striking ``and
section 1933(d)''.
(B) Section 1933 of such Act (42 U.S.C. 1396u-3) is
repealed.
(c) 100 Percent FMAP.--Section 1905 of the Social Security Act (42
U.S.C. 1396d) is amended by adding at the end the following new
subsection:
``(ee) Increased FMAP for Expanded Medicare Cost-Sharing
Populations.--
``(1) In general.--Notwithstanding subsection (b), with
respect to expenditures described in paragraph (2) the Federal
medical assistance percentage shall be equal to 100 percent.
``(2) Expenditures described.--The expenditures described
in this paragraph are expenditures made on or after January 1,
2018, for medical assistance for medicare cost-sharing provided
to any individual under clause (i), (ii), or (iii) of section
1902(a)(10)(E) who would not have been eligible for medicare
cost-sharing under any such clause under the income or resource
eligibility standards in effect on October 1, 2016.''.
(d) Consolidation of Low-Income Subsidy Resource Eligibility
Tests.--
(1) In general.--Section 1860D-14(a)(3) of the Social
Security Act (42 U.S.C. 1395w-114(a)(3)) is amended--
(A) by striking subparagraph (D);
(B) by redesignating subparagraphs (E) through (G)
as subparagraphs (D) through (F), respectively; and
(C) in the heading of subparagraph (D), as so
redesignated, by striking ``Alternative''.
(2) Clarification of certain rules relating to income and
resource determinations.--Section 1860D-14(a)(3) of the Social
Security Act (42 U.S.C. 1395w-114(a)(3)), as amended by
paragraph (1), is amended by striking subparagraph (F) and
inserting the new following new subparagraphs:
``(F) Resource exclusions.--In determining the
resources of an individual (and the eligible spouse of
the individual, if any) under section 1613 for purposes
of subparagraph (D)--
``(i) no part of the value of any life
insurance policy shall be taken into account;
``(ii) no part of the value of any vehicle
shall be taken into account; and
``(iii) there shall be excluded an amount
equal to $1,500 each with respect to any
individual or eligible spouse of an individual
who attests that some of the resources of such
individual or spouse will be used to meet the
burial and related expenses of such individual
or spouse.
``(G) Family size.--In determining the size of the
family of an individual for purposes of determining the
income eligibility of such individual under this
section, an individual's family shall consist of--
``(i) the individual;
``(ii) the individual's spouse who lives in
the same household as the individual (if any);
and
``(iii) any other individuals who--
``(I) are related to the individual
whose income eligibility is in question
or such individual's spouse who lives
in the same household;
``(II) are living in the same
household as such individual; and
``(III) are dependent on such
individual or such individual's spouse
who is living in the same household for
at least one-half of their financial
support.''.
(3) Conforming amendments.--Section 1860D-14(a) of the
Social Security Act (42 U.S.C. 1395w-114(a)) is amended--
(A) in paragraph (1), in the matter preceding
subparagraph (A), by inserting ``(as determined under
paragraph (3)(G))'' after ``family of the size
involved''; and
(B) in paragraph (3), as amended by paragraphs (1)
and (2)--
(i) in subparagraph (A), in the matter
preceding clause (i), by striking
``subparagraph (F)'' and inserting
``subparagraph (E)'';
(ii) in subparagraph (A)(ii), by inserting
``(as determined under subparagraph (G))''
after ``family of the size involved'';
(iii) in subparagraph (A)(iii), by striking
``or (E)'';
(iv) in subparagraph (B)(v), in the matter
preceding subclause (I), by striking
``subparagraph (F)'' and inserting
``subparagraph (E)''; and
(v) in subparagraph (D)(i), in the matter
preceding subclause (I), by striking ``subject
to the life insurance policy exclusion provided
under subparagraph (G)'' and inserting
``subject to the resource exclusions provided
under subparagraph (F)''.
(e) Alignment of Low-Income Subsidy and Medicare Savings Program
Income and Resource Eligibility Tests.--
(1) Application of medicaid spousal impoverishment resource
allowance to msp and lis resource eligibility.--
(A) In general.--Section 1905(p)(1)(C) of the
Social Security Act (42 U.S.C. 1396d(p)(1)(C)) is
amended to read as follows:
``(C) whose resources (as determined under section 1613 for
purposes of the supplemental security income program subject to
the resource exclusions under subparagraph (F) of section
1860D-14(a)(3)) do not exceed--
``(i) in the case of an individual with a spouse,
an amount equal to the sum of the first amount
specified in subsection (f)(2)(A)(i) of section 1924
(as adjusted under subsection (g) of such section) and
the amount specified in subsection (f)(2)(A)(ii)(II) of
such section (as so adjusted); or
``(ii) in the case of an individual who does not
have a spouse, an amount equal to \1/2\ of the amount
described in clause (i).''.
(B) Application to qdwis.--Section 1905(s)(3) of
the Social Security Act (42 U.S.C. 1396d(s)(3)) is
amended to read as follows:
``(3) whose resources (as determined under section 1613 for
purposes of the supplemental security income program subject to
the resource exclusions under subparagraph (F) of section
1860D-14(a)(3)) do not exceed--
``(A) in the case of an individual with a spouse,
the amount in effect for the year under clause (i) of
subsection (p)(1)(C); and
``(B) in the case of an individual who does not
have a spouse, the amount in effect for the year under
clause (ii) of subsection (p)(1)(C); and''.
(C) Application to lis.--Clause (i) of section
1860D-14(a)(3)(D), as redesignated and amended by
subsection (d)(1), is amended to read as follows:
``(i) In general.--The resources
requirement of this subparagraph is that an
individual's resources (as determined under
section 1613 for purposes of the supplemental
security income program subject to the resource
exclusions provided under subparagraph (F)) do
not exceed the amount in effect for the year
under section 1905(p)(1)(C)(ii).''.
(f) Enrollment Simplifications.--
(1) Application of 3-month retroactive eligibility to
qmbs.--
(A) In general.--Section 1902(e)(8) of the Social
Security Act (42 U.S.C. 1396a(e)(8)) is amended by
striking ``after the end of the month in which the
determination first occurs'' and inserting ``in or
after the third month before the month in which the
individual makes application for assistance''.
(B) Conforming amendment.--Section 1905(a) of the
Social Security Act (42 U.S.C. 1396d(a)) is amended, in
the matter preceding paragraph (1), by striking ``or,
in the case of medicare cost-sharing with respect to a
qualified medicare beneficiary described in subsection
(p)(1), if provided after the month in which the
individual becomes such a beneficiary''.
(2) State option for 12-month continuous eligibility for
slmbs and qwdis.--Section 1902(e)(12) of the Social Security
Act (42 U.S.C. 1396a(e)(12)) is amended--
(A) by redesignating subparagraphs (A) and (B) as
clauses (i) and (ii), respectively;
(B) by inserting ``(A)'' after ``(12)''; and
(C) by adding at the end the following:
``(B) At the option of the State, the plan may provide that an
individual who is determined to be eligible for benefits under a State
plan approved under this title under any of the following eligibility
categories, or who is redetermined to be eligible for such benefits
under any of such categories, shall be considered to meet the
eligibility requirements met on the date of application and shall
remain eligible for those benefits until the end of the 12-month period
following the date of the determination or redetermination of
eligibility, except that a State may provide for such determinations
more frequently, but not more frequently than once every 6 months for
an individual:
``(i) A specified low-income medicare beneficiary described
in subsection (a)(10)(E)(iii) of this section who is determined
eligible for medicare cost sharing described in section
1905(p)(3)(A)(ii).
``(ii) A qualified disabled and working individual
described in section 1905(s) who is determined eligible for
medicare cost-sharing described in section 1905(p)(3)(A)(i).''.
(3) State option to use express lane eligibility for the
medicare savings program.--Section 1902(e)(13)(A) of the Social
Security Act (42 U.S.C. 1396a(e)(13)(A)) is amended by adding
at the end the following new clause:
``(iii) State option to extend express lane
eligibility to other populations.--
``(I) In general.--At the option of
the State, the State may apply the
provisions of this paragraph with
respect to determining eligibility
under this title for an eligible
individual (as defined in subclause
(II)). In applying this paragraph in
the case of a State making such an
option, any reference in this paragraph
to a child with respect to this title
(other than a reference to child health
assistance) shall be deemed to be a
reference to an eligible individual.
``(II) Eligible individual
defined.--In this clause, the term
`eligible individual' means any of the
following:
``(aa) A qualified medicare
beneficiary described in
section 1905(p)(1) for purposes
of determining eligibility for
medicare cost-sharing (as
defined in section 1905(p)(3)).
``(bb) A specified low-
income medicare beneficiary
described in subsection
(a)(10)(E)(iii) of this section
for purposes of determining
eligibility for medicare cost-
sharing described in section
1905(p)(3)(A)(ii).
``(cc) A qualified disabled
and working individual
described in section 1905(s)
for purposes of determining
eligibility for medicare cost-
sharing described in section
1905(p)(3)(A)(i).
``(dd) During the period
that begins on the date of
enactment of this clause and
ends on December 31, 2017, a
qualifying individual described
in subsection (a)(10)(E)(iv)
for purposes of determining
eligibility for medicare cost-
sharing described in section
1905(p)(3)(A)(ii).''.
(g) Effective Date.--
(1) In general.--Except as provided in paragraphs (2) and
(3), the amendments and repeal made by this section take effect
on January 1, 2018, and, with respect to title XIX of the
Social Security Act, apply to calendar quarters beginning on or
after January 1, 2018.
(2) Express lane eligibility for msp.--The amendments made
by subsection (f)(3) take effect on the date of enactment of
this Act.
(3) Exception for state legislation.--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 and repeal
made by this section (other than the amendments made by
subsection (f)(3)), 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. REDUCING MEDICARE COST-SHARING FOR LOW-INCOME BENEFICIARIES.
(a) In General.--Title XVIII of the Social Security Act (42 U.S.C.
1395 et seq.), as amended by section 2, is amended by adding at the end
the following new section:
``reduction in medicare cost-sharing for low-income beneficiaries
``Sec. 1899D. (a) In General.--Notwithstanding any other provision
of this title, in the case of items and services furnished on or after
January 1, 2018, to an applicable low-income individual, the amount of
any coinsurance or copayment otherwise applicable to the item or
service under part A or B shall be reduced by 50 percent.
``(b) Applicable Low-Income Individual Defined.--
``(1) In general.--In this section, the term `applicable
low-income individual' means an individual--
``(A) entitled to, or enrolled for, benefits under
part A or enrolled in part B;
``(B) who is determined to have income that is
greater than 135 percent and less than or equal to 200
percent of the poverty line applicable to a family of
the size involved; and
``(C) whose resources (as determined under section
1613 for purposes of the supplemental security income
program subject to the resource exclusions provided
under section 1860D-14(a)(3)(F)) do not exceed the
amount in effect for the year under section
1905(p)(1)(C)(ii).
``(2) Income determinations.--For purposes of applying this
section--
``(A) income shall be determined in the manner
described in section 1905(p)(1)(B), without regard to
the application of section 1902(r)(2); and
``(B) `poverty line' has the meaning given such
term in section 673(2) of the Community Services Block
Grant Act (42 U.S.C. 9902(2)), including any revision
required by such section.
Nothing in subparagraph (A) shall be construed to affect the
application of section 1902(r)(2) for the determination of
eligibility for medical assistance under title XIX.
``(c) Establishment of Procedures for Identification of Applicable
Low-Income Individuals and Notification of Providers of Services and
Suppliers.--
``(1) In general.--The Secretary, in consultation with the
Commissioner of Social Security and the Secretary of the
Treasury, shall establish procedures for--
``(A) the determination of whether an individual is
an applicable low-income individual; and
``(B) the notification of providers of services and
suppliers in the case where an individual is an
applicable low-income individual so that the reduction
in any coinsurance or copayment under subsection (a) is
applied at the time the item or service is provided to
the applicable low-income individual.
``(2) Determinations.--
``(A) In general.--The provisions of section 1860D-
14(a)(3)(B)(i) shall apply to the determination of
whether an individual is an applicable low-income
individual under this section in the same manner as
such provisions apply to the determination of whether a
part D eligible is a subsidy eligible individual under
section 1860D-14(a)(3)(B)(i).
``(B) Effective period.--Determinations under this
subsection shall be effective for a period determined
appropriate by the Secretary.
``(d) No Effect on Payment to Providers of Services or Suppliers.--
Notwithstanding any other provision of this title, in the case of an
item or service for which the reduction in coinsurance or copayment
under subsection (a) applies, the amount of payment otherwise
applicable for the item or service under part A or B shall be increased
by the amount of the reduction in coinsurance or copayment under such
subsection.''.
(b) Disclosure.--Section 6103(l)(7)(D)(ii) of the Internal Revenue
Code of 1986 is amended--
(1) by striking ``or subsidies'' and inserting ``,
subsidies''; and
(2) by inserting ``, or reduced cost-sharing provided under
section 1899D'' before the period at the end.
SEC. 5. ELIMINATING THE 24-MONTH WAITING PERIOD FOR MEDICARE COVERAGE
FOR INDIVIDUALS WITH DISABILITIES.
(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,'';
(2) in paragraph (2)(B), by striking ``, and has been for
not less than 24 months,'';
(3) in paragraph (2)(C)(ii), by striking ``, including the
requirement that he has been entitled to the specified benefits
for 24 months,'';
(4) 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 for which the individual
meets the requirements of paragraph (2), beginning with the
month following the month in which the individual meets the
requirements of such paragraph, and''; and
(5) in the second sentence, by striking ``the `twenty-fifth
month of his entitlement''' and all that follows through
``paragraph (2)(C) and''.
(b) Conforming Amendments.--
(1) Section 226.--Section 226 of the Social Security Act
(42 U.S.C. 426) is amended by--
(A) striking subsections (e)(1)(B), (f), and (h);
and
(B) redesignating subsections (g) and (i) as
subsections (f) and (g), respectively.
(2) Medicare description.--Section 1811(2) of the Social
Security Act (42 U.S.C. 1395c(2)) is amended by striking ``have
been entitled for not less than 24 months'' and inserting ``are
entitled''.
(3) Medicare coverage.--Section 1837(g)(1) of the Social
Security Act (42 U.S.C. 1395p(g)(1)) is amended by striking
``25th month of'' and inserting ``month following the first
month of''.
(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 ``has been entitled to an annuity''
and inserting ``is entitled to an annuity'';
(B) by striking ``, for not less than 24 months'';
and
(C) by striking ``could have been entitled for 24
calendar months, and''.
(c) 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
after December 2017.
SEC. 6. IMPROVING MEDICARE BENEFICIARY ENROLLMENT PROCEDURES AND
EFFECTIVE DATES OF COVERAGE.
(a) General Enrollment Period.--Section 1837(e) of the Social
Security Act (42 U.S.C. 1395p(e)) is amended to read as follows:
``(e) General and Special Enrollment Periods.--
``(1) General enrollment.--
``(A) For coverage during years before 2018.--There
shall be a general enrollment period during the period
beginning on January 1 and ending on March 31 of each
year before 2018.
``(B) For coverage during years beginning with
2018.--Subject to subparagraph (B), there shall be a
general enrollment period beginning on October 15 and
ending on December 31 of 2017 and each subsequent year.
``(2) Special enrollment.--Beginning January 1, 2018, the
Secretary shall establish special enrollment periods in the
case of an individual who meets such exceptional conditions as
the Secretary may provide.''.
(b) Effective Dates of Coverage.--
(1) In general.--Section 1838(a) of the Social Security Act
(42 U.S.C. 1395q(a)) is amended--
(A) by amending paragraph (2) to read as follows:
``(2)(A) in the case of an individual who enrolls pursuant
to subsection (d) of section 1837 before the month in which he
first satisfies paragraph (1) or (2) of section 1836, the first
day of such month, or
``(B) in the case of an individual not described in
subparagraph (A) who first satisfies such paragraph in a month
beginning before January 1, 2018, and who enrolls--
``(i) pursuant to such subsection (d) in such month
in which he first satisfies such paragraph, the first
day of the month following the month in which he so
enrolls, or
``(ii) pursuant to such subsection (d) in the month
following such month in which he first satisfies such
paragraph, the first day of the second month following
the month in which he so enrolls, or
``(iii) pursuant to such subsection (d) more than
one month following such month in which he satisfies
such paragraph, the first day of the third month
following the month in which he so enrolls, or
``(C) in the case of an individual not described in
subparagraph (A) who enrolls pursuant to subsection (e) of
section 1837 in a month beginning--
``(i) before April 1, 2017, the July 1 following
the month in which he so enrolls, or
``(ii) on or after October 1, 2017, the first day
of the month following the month in which he so
enrolls, or
``(D) in the case of an individual not described in
subparagraph (A) who first satisfies such paragraph in a month
beginning on or after January 1, 2018, and who enrolls pursuant
to such subsection (d) in such month in which he first
satisfies such paragraph or in any subsequent month in the
initial enrollment period, the first day of the month following
the month in which he so enrolls; or''; and
(B) in paragraph (3), by striking ``subparagraphs
(B), (C), (D), and (E) of paragraph (2) of this
subsection'' and inserting ``subparagraphs (B) and (C)
of paragraph (2), as applicable''.
(2) Technical correction.--Section 1839(b) of the Social
Security Act (42 U.S.C. 1395r(b)) is amended, in the second
sentence, by striking ``close of the enrollment period'' each
place it appears and inserting ``close of the month''.
(c) Application of the Part A Late Enrollment Penalty Time
Limitation Provision to the Part B Late Enrollment Penalty.--
(1) In general.--Section 1839(b) of the Social Security Act
(42 U.S.C. 1395r(b)) is amended by adding at the end the
following new sentence: ``Any percent increase in an
individual's monthly premium under the first sentence shall
only apply to premiums paid during a period equal to twice the
number of months in the full 12-month periods described in the
first sentence.''.
(2) Conforming amendment to the part a late enrollment
penalty.--Section 1818(c)(6) of the Social Security Act (42
U.S.C. 1395i-2(c)(6)) is amended by striking ``and shall only
apply to premiums paid during a period equal to twice the
number of months in the full 12-month periods described in that
section''.
(3) Effective date.--
(A) In general.--The amendments made by this
section shall take effect on the date of the enactment
of this Act and shall apply to premiums for months
beginning on or after January 1, 2018.
(B) Counting of months.--In applying the amendment
made by paragraph (1), months (occurring before,
during, or after the month that includes the date of
the enactment of this Act) in which an individual's
monthly premium is increased under subsection (b) of
section 1839 of the Social Security Act (42 U.S.C.
1395r) shall be taken into account in determining
whether the limitation under the last sentence of such
subsection (b), as added by paragraph (1), is
applicable.
(d) Application of Part B Deemed Enrollment Process to Residents of
Puerto Rico; Special Enrollment Period and Limit on Late Enrollment
Penalties.--
(1) Application of part b deemed enrollment process to
residents of puerto rico.--Section 1837(f)(3) of the Social
Security Act (42 U.S.C. 1395p(f)(3)) is amended by striking ``,
exclusive of Puerto Rico''.
(2) Effective date.--The amendment made by paragraph (1)
shall apply to individuals whose initial enrollment period
under section 1837(d) of the Social Security Act begins on or
after the first day of the effective month, specified by the
Secretary of Health and Human Services under section
1839(j)(1)(C) of such Act, as added by subsection (c)(2).
(3) Transition providing special enrollment period and
limit on late enrollment penalties for certain medicare
beneficiaries.--Section 1839 of the Social Security Act (42
U.S.C. 1395r) is amended--
(A) in the first sentence of subsection (b), by
inserting ``subject to section 1839(j)(2),'' after
``subsection (i)(4) or (l) of section 1837,''; and
(B) by adding at the end the following new
subsection:
``(j) Special Rules for Certain Residents of Puerto Rico.--
``(1) Special enrollment period, coverage period for
residents who are eligible but not enrolled.--
``(A) In general.--In the case of a transition
individual (as defined in paragraph (3)) who is not
enrolled under this part as of the day before the first
day of the effective month (as defined in subparagraph
(C)), the Secretary shall provide for a special
enrollment period under section 1837 of 7 months
beginning with such effective month during which the
individual may be enrolled under this part.
``(B) Coverage period.--In the case of such an
individual who enrolls during such special enrollment
period, the coverage period under section 1838 shall
begin on the first day of the second month after the
month in which the individual enrolls.
``(C) Effective month defined.--In this section,
the term `effective month' means a month, not earlier
than October 2017 and not later than January 2018,
specified by the Secretary.
``(2) Reduction in late enrollment penalties for current
enrollees and individuals enrolling during transition.--
``(A) In general.--In the case of a transition
individual who is enrolled under this part as of the
day before the first day of the effective month or who
enrolls under this part on or after the date of the
enactment of this subsection but before the end of the
special enrollment period under paragraph (1)(A), the
amount of the late enrollment penalty imposed under
section 1839(b) shall be recalculated by reducing the
penalty to 15 percent of the penalty otherwise
established.
``(B) Application.--Subparagraph (A) shall be
applied in the case of a transition individual who--
``(i) is enrolled under this part as of the
month before the effective month, for premiums
for months beginning with such effective month;
or
``(ii) enrolls under this part on or after
the date of the enactment of this Act and
before the end of the special enrollment period
under paragraph (1)(A), for premiums for months
during the coverage period under this part
which occur during or after the effective
month.
``(C) Loss of reduction if individual terminates
enrollment.--Subparagraph (A) shall not apply to a
transition individual if the individual terminates
enrollment under this part after the end of the special
enrollment period under paragraph (1).
``(3) Transition individual defined.--In this section, the
term `transition individual' means an individual who resides in
Puerto Rico and who would have been deemed enrolled under this
part pursuant to section 1837(f) before the first day of the
effective month but for the fact that the individual was a
resident of Puerto Rico, regardless of whether the individual
is enrolled under this part as of such first day.''.
SEC. 7. ELIMINATING EXCLUSION OF PART D ELIGIBLE INDIVIDUALS RESIDING
IN TERRITORIES FROM ELIGIBILITY FOR PREMIUM AND COST-
SHARING SUBSIDIES.
(a) In General.--Section 1860D-14(a)(3) of the Social Security Act
(42 U.S.C. 1395w-114(a)(3)), as amended by section 3(d), is amended--
(1) in subparagraph (A), in the matter preceding clause
(i), by striking ``subject to subparagraph (E),'';
(2) in subparagraph (B)(v), in the matter preceding
subclause (I), by striking ``Subject to subparagraph (E), the
Secretary'' and inserting ``The Secretary'';
(3) in subparagraph (C), by adding at the end the following
new sentence: ``In the case of an individual who is not a
resident of the 50 States or the District of Columbia, the
poverty line (as such term is defined in clause (ii)) that
shall apply to such individual shall be the poverty line for
the 48 contiguous States and the District of Columbia.'';
(4) by striking subparagraph (E), as redesignated by
section 3(d)(1); and
(5) by redesignating subparagraphs (F) and (G), as added by
section 3(d)(2), as subparagraphs (E) and (F), respectively.
(b) Application of Medicaid Provisions.--Section 1935 of the Social
Security Act (42 U.S.C. 1396u-5) is amended--
(1) in subsection (a), by striking ``subject to subsection
(e)'' in the matter preceding paragraph (1); and
(2) by striking subsection (e).
(c) Conforming Amendments.--
(1) Section 1108(f) of the Social Security Act (42 U.S.C.
1308(f)) is amended by striking ``and section 1935(e)(1)(B)''
in the matter preceding clause (i).
(2) Section 1860D-14(a) of the Social Security Act (42
U.S.C. 1395w-114(a)), as amended by section 3(d), is amended--
(A) in paragraph (1), in the matter preceding
subparagraph (A), by striking ``subparagraph (3)(G)''
and inserting ``subparagraph (3)(F)''; and
(B) in paragraph (3)--
(i) in subparagraph (A)(ii), by striking
``subparagraph (G)'' and inserting
``subparagraph (F)''; and
(ii) in subparagraph (D)(i), by striking
``subparagraph (F)'' and inserting
``subparagraph (E)''.
(3) Section 1905 of the Social Security Act (42 U.S.C.
1396d) is amended--
(A) in subsection (p)--
(i) in paragraph (1)(C), by striking
``subparagraph (F)'' and inserting
``subparagraph (E)''; and
(ii) in clause (iii) of paragraph (2)(D),
as added by section 3(e)(2)(A)(ii), by striking
``section 1860D-14(a)(3)(G)'' and inserting
``section 1860D-14(a)(3)(F)''; and
(B) in subsection (s)--
(i) in paragraph (2), by striking ``section
1860D-14(a)(3)(G)'' and inserting ``section
1860D-14(a)(3)(F)''; and
(ii) in paragraph (3), by striking
``subparagraph (F)'' and inserting
``subparagraph (E)''.
(d) Effective Date.--The amendments made by this section shall take
effect on January 1, 2017.
SEC. 8. EXTENDING FUNDING FOR LOW-INCOME MEDICARE BENEFICIARY OUTREACH
AND ASSISTANCE EDUCATION ACTIVITIES.
(a) Additional Funding for State Health Insurance Programs.--
Section 119 of the Medicare Improvements for Patients and Providers Act
of 2008 (42 U.S.C. 1395b-3 note), as amended by section 3306 of the
Patient Protection and Affordable Care Act (Public Law 111-148),
section 610 of the American Taxpayer Relief Act of 2012 (Public Law
112-240), section 1110 of the Pathway for SGR Reform Act of 2013
(Public Law 113-67), section 110 of the Protecting Access to Medicare
Act of 2014 (Public Law 113-93), and section 208 of the Medicare Access
and CHIP Reauthorization Act of 2015 (Public Law 114-10) is amended--
(1) in subsection (a)(1)(B)--
(A) in clause (vi), by striking ``and'' at the end;
(B) in clause (vii), by striking the period at the
end and inserting ``; and''; and
(C) by inserting after clause (vii) at the end the
following new clause:
``(viii) for fiscal year 2018 and each
subsequent year, of the amount transferred
under this subparagraph for the preceding
fiscal year, increased by the percentage
increase determined under subsection (h) for
the fiscal year.''; and
(2) by adding at the end the following new subsection:
``(h) For purposes of subsections (a)(1)(B)(viii), (b)(1)(B)(viii),
(c)(1)(B)(viii), and (d)(2)(viii), the percentage increase determined
under this subsection for a fiscal year is equal to the sum of the--
``(1) the percentage increase in the consumer price index
for all urban consumers (all items; United States city average)
for the 12-month period ending with July preceding the
beginning of the fiscal year; and
``(2) the percentage increase in the average number of
individuals enrolled in part B of title XVIII of the Social
Security Act, from the preceding fiscal year to such fiscal
year, as estimated by the Chief Actuary of the Centers for
Medicare & Medicaid Services.''.
(b) Additional Funding for Area Agencies on Aging.--Subsection
(b)(1)(B) of such section 119, as so amended, is amended--
(1) in clause (vi), by striking ``and'' at the end;
(2) in clause (vii), by striking the period at the end and
inserting ``; and''; and
(3) by inserting after clause (vii) the following new
clause:
``(viii) for fiscal year 2018 and each
subsequent year, of the amount transferred
under this subparagraph for the preceding
fiscal year, increased by the percentage
increase determined under subsection (h) for
the fiscal year.''.
(c) Additional Funding for Aging and Disability Resource Centers.--
Subsection (c)(1)(B) of such section 119, as so amended, is amended--
(1) in clause (vi), by striking ``and'' at the end;
(2) in clause (vii), by striking the period at the end and
inserting ``; and''; and
(3) by inserting after clause (vii) the following new
clauses:
``(viii) for fiscal year 2018 and each
subsequent year, of the amount transferred
under this subparagraph for the preceding
fiscal year, increased by the percentage
increase determined under subsection (h) for
the fiscal year.''.
(d) Additional Funding for Contract With the National Center for
Benefits and Outreach Enrollment.--Subsection (d)(2) of such section
119, as so amended, is amended--
(1) in clause (vi), by striking ``and'' at the end;
(2) in clause (vii), by striking the period at the end and
inserting ``; and'';
(3) by inserting after clause (vii) the following new
clause:
``(viii) for fiscal year 2018 and each
subsequent year, of the amount transferred
under this paragraph for the preceding fiscal
year, increased by the percentage increase
determined under subsection (h) for the fiscal
year.''; and
(4) in the flush sentence at the end, by striking
``subparagraph'' and inserting ``paragraph''.
<all>