[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4671 Reported in House (RH)]
<DOC>
Union Calendar No. 305
116th CONGRESS
2d Session
H. R. 4671
[Report No. 116-381, Part I]
To amend titles XVIII and XIX of the Social Security Act to reduce
cost-sharing, align income and resource eligibility tests, simplify
enrollment, and provide for other program improvements for low-income
Medicare beneficiaries.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 15, 2019
Mr. Kim (for himself, Ms. Blunt Rochester, and Mr. Evans) introduced
the following bill; which was referred to the Committee on Energy and
Commerce, and in addition to the Committee on Ways and Means, for a
period to be subsequently determined by the Speaker, in each case for
consideration of such provisions as fall within the jurisdiction of the
committee concerned
January 24, 2020
Additional sponsors: Mr. Cuellar, Ms. Matsui, Mr. Pascrell, Mr.
Malinowski, and Mr. Norcross
January 24, 2020
Reported from the Committee on Energy and Commerce
January 24, 2020
Committee on Ways and Means discharged, committed to the Committee of
the Whole House on the State of the Union, and ordered to be printed
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to reduce
cost-sharing, align income and resource eligibility tests, simplify
enrollment, and provide for other program improvements for low-income
Medicare beneficiaries.
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 ``Helping Seniors Afford Health Care
Act''.
SEC. 2. REDUCING COST-SHARING, ALIGNING INCOME AND RESOURCE ELIGIBILITY
TESTS, SIMPLIFYING ENROLLMENT, AND OTHER PROGRAM
IMPROVEMENTS FOR LOW-INCOME BENEFICIARIES.
(a) Increase in Income Eligibility to 135 Percent of FPL for
Qualified Medicare Beneficiaries.--
(1) In general.--Section 1905(p)(2)(A) of the Social
Security Act (42 U.S.C. 1396d(p)(2)(A)) is amended by striking
``shall be at least the percent provided under subparagraph (B)
(but not more than 100 percent) of the official poverty line''
and all that follows through the period at the end and
inserting the following: ``shall be--
``(i) before January 1, 2021, at least the
percent provided under subparagraph (B) (but
not more than 100 percent) of the official
poverty line (as defined by the Office of
Management and Budget, and revised annually in
accordance with section 673(2) of the Omnibus
Budget Reconciliation Act of 1981) applicable
to a family of the size involved; and
``(ii) on or after January 1, 2021, equal
to 135 percent of the official poverty line (as
so defined and revised) applicable to a family
of the size involved.''.
(2) Not counting in-kind support and maintenance as
income.--Section 1905(p)(2)(D) of the Social Security 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) Increase in Income Eligibility to 200 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. 1396a(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
2021, and 200 percent in 2021 and years
thereafter''; and
(ii) by striking ``and'' at the end; and
(C) by striking clause (iv).
(2) References.--Section 1905(p)(1) of the Social Security
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:
``(gg) 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,
2021, 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, 2018.''.
(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 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;
``(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; and
``(iv) no balance in, or benefits received
under, an employee pension benefit plan (as
defined in section 3 of the Employee Retirement
Income Security Act of 1974) shall be taken
into account.
``(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.--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 (G) 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).''.
(2) 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 (G) 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''.
(3) Application to lis.--Clause (i) of section 1860D-
14(a)(3)(D) of the Social Security Act (42 U.S.C. 1395w-
114(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 (G)) 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) Process for submitting claims during
retroactive eligibility period.--Section 1902(e)(8) of
the Social Security Act (42 U.S.C. 1396a(e)(8)) is
further amended by adding at the end the following:
``The Secretary shall provide for a process under which
claims for medical assistance under the State plan may
be submitted for services furnished to such an
individual during such 3-month period before the month
in which the individual made application for
assistance.''.
(C) 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).''.
(g) Medicaid Treatment of Certain Medicare Providers.--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. The State shall create
a mechanism through which provider or suppliers that do not otherwise
have provider agreements with the State can bill the State for medicare
cost-sharing for qualified medicare beneficiaries.''.
(h) Eligibility for Other Programs.--Section 1905(p) of the Social
Security Act (42 U.S.C. 1396d(p)) is amended by adding at the end the
following new paragraph:
``(7) Notwithstanding any other provision of law, any
medical assistance for some or all medicare cost-sharing under
this title shall not be considered income or resources in
determining eligibility for, or the amount of assistance or
benefits provided under, any other public benefit provided
under Federal law or the law of any State or political
subdivision thereof.''.
(i) Treatment of Qualified Medicare Beneficiaries, Specified Low-
Income Medicare Beneficiaries, and Other Dual Eligibles as Medicare
Beneficiaries.--Section 1862 of the Social Security Act (42 U.S.C.
1395y) is amended by adding at the end the following new subsection:
``(p) 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.''.
(j) Additional Funding for State Health Insurance Assistance
Programs.--
(1) Grants.--
(A) In general.--The Secretary of Health and Human
Services (in this subsection referred to as the
``Secretary'') shall use amounts made available under
subparagraph (B) to make grants to States for State
health insurance assistance programs receiving
assistance under section 4360 of the Omnibus Budget
Reconciliation Act of 1990.
(B) Funding.--For purposes of making grants under
this subsection, the Secretary shall provide for the
transfer, from the Federal Hospital Insurance Trust
Fund under section 1817 of the Social Security Act (42
U.S.C. 1395i) and the Federal Supplementary Medical
Insurance Trust Fund under section 1841 of such Act (42
U.S.C. 1395t), in the same proportion as the Secretary
determines under section 1853(f) of such Act (42 U.S.C.
1395w-23(f)), of $50,000,000 to the Centers for
Medicare & Medicaid Services Program Management Account
for each of the fiscal years 2021 through 2025, to
remain available until expended.
(2) Amount of grants.--The amount of a grant to a State
under this subsection from the total amount made available
under paragraph (1) shall be equal to the sum of the amount
allocated to the State under paragraph (3)(A) and the amount
allocated to the State under subparagraph (3)(B).
(3) Allocation to states.--
(A) Allocation based on percentage of low-income
beneficiaries.--The amount allocated to a State under
this subparagraph from \2/3\ of the total amount made
available under paragraph (1) shall be based on the
number of individuals who meet the requirement under
subsection (a)(3)(A)(ii) of section 1860D-14 of the
Social Security Act (42 U.S.C. 1395w-114) but who have
not enrolled to receive a subsidy under such section
1860D-14 relative to the total number of individuals
who meet the requirement under such subsection
(a)(3)(A)(ii) in each State, as estimated by the
Secretary.
(B) Allocation based on percentage of rural
beneficiaries.--The amount allocated to a State under
this subparagraph from \1/3\ of the total amount made
available under paragraph (1) shall be based on the
number of part D eligible individuals (as defined in
section 1860D-1(a)(3)(A) of such Act (42 U.S.C. 1395w-
101(a)(3)(A))) residing in a rural area relative to the
total number of such individuals in each State, as
estimated by the Secretary.
(4) Portion of grant based on percentage of low-income
beneficiaries to be used to provide outreach to individuals who
may be subsidy eligible individuals or eligible for the
medicare savings program.--Each grant awarded under this
subsection with respect to amounts allocated under paragraph
(3)(A) shall be used to provide outreach to individuals who may
be subsidy eligible individuals (as defined in section 1860D-
14(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w-
114(a)(3)(A))) or eligible for the program of medical
assistance for payment of the cost of medicare cost-sharing
under the Medicaid program pursuant to sections 1902(a)(10)(E)
and 1933 of such Act (42 U.S.C. 1396a(a)(10)(E), 1396u-3).
(k) Effective Date.--
(1) In general.--Except as provided in paragraph (2), the
amendments and repeal made by this section take effect on
January 1, 2021, and, with respect to title XIX of the Social
Security Act, apply to calendar quarters beginning on or after
January 1, 2021.
(2) 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, 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.
Union Calendar No. 305
116th CONGRESS
2d Session
H. R. 4671
[Report No. 116-381, Part I]
_______________________________________________________________________
A BILL
To amend titles XVIII and XIX of the Social Security Act to reduce
cost-sharing, align income and resource eligibility tests, simplify
enrollment, and provide for other program improvements for low-income
Medicare beneficiaries.
_______________________________________________________________________
January 24, 2020
Reported from the Committee on Energy and Commerce
January 24, 2020
Committee on Ways and Means discharged, committed to the Committee of
the Whole House on the State of the Union, and ordered to be printed