[Congressional Bills 117th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5099 Introduced in House (IH)]
<DOC>
117th CONGRESS
1st Session
H. R. 5099
To amend title XVIII of the Social Security Act to move Medicare cost-
sharing benefits from Medicaid to Medicare, and for other purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
August 24, 2021
Mr. Schneider (for himself and Ms. Schakowsky) 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
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act to move Medicare cost-
sharing benefits from Medicaid to Medicare, 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.
This Act may be cited as the ``Lowering Medicare Premiums and
Prescription Drug Costs Act''.
SEC. 2. MEDICARE COST ASSISTANCE PROGRAM.
(a) In General.--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:
``SEC. 1899B. MEDICARE COST ASSISTANCE PROGRAM.
``(a) In General.--Effective beginning January 1, 2023, in the case
of a Medicare Cost Assistance Program eligible individual (as defined
in subsection (b)(1)), the Secretary shall provide Medicare cost
assistance for the following costs incurred with respect to the
individual:
``(1)(A) premiums under section 1818; and
``(B) premiums under section 1839.
``(2) Coinsurance under this title (including coinsurance
described in section 1813).
``(3) Deductibles established under this title (including
those described in section 1813 and section 1833(b)).
``(4) The difference between the amount that is paid under
section 1833(a) and the amount that would be paid under such
section if any reference to a percent less than 100 percent
therein were deemed a reference to `100 percent'.
``(b) Determination of Eligibility.--
``(1) Medicare cost assistance program eligible individual
defined.--The term `Medicare Cost Assistance Program eligible
individual' means an individual who--
``(A) is eligible for and is receiving medical
assistance for the payment of medicare cost-sharing
under a State Medicaid program pursuant to clause (i),
(iii), or (iv) of section 1902(a)(10)(E) as of December
31, 2022; or
``(B)(i) is entitled to hospital insurance benefits
under part A (including an individual entitled to such
benefits pursuant to an enrollment under section 1818);
and
``(ii) has income at or below 200 percent of the
poverty line applicable to a family of the size
involved.
``(2) Joint determination by commissioner of social
security for lis and medicare cost assistance.--
``(A) In general.--The determination of whether an
individual is a Medicare Cost Assistance Program
eligible individual described in paragraph (1) shall be
determined by the Commissioner of Social Security
jointly with the determination of whether an individual
is a subsidy eligible individual described in section
1860D-14(a)(3). Such determination shall be made with
respect to eligibility for Medicare cost assistance
under this section and premium and cost-sharing
subsidies under section 1860D-14 upon application of an
individual for a determination with respect to
eligibility for either such assistance or such
subsidies. There are authorized to be appropriated to
the Social Security Administration such sums as may be
necessary for the determination of eligibility under
this paragraph.
``(B) Effective period.--Determinations under this
paragraph with respect to eligibility for each of such
assistance or such subsidies shall be effective
beginning with the month in which the individual
applies for a determination described in subparagraph
(A) and shall remain in effect until such time as the
Secretary determines the individual is no longer
eligible as determined under subparagraph (C)(ii).
``(C) Redeterminations.--With respect to
eligibility determinations under this paragraph--
``(i) redeterminations shall be made at the
same time with respect to eligibility for
Medicare cost assistance under this section and
cost-sharing subsidies under section 1860D-14,
but not more frequently than once every 12
months;
``(ii) a redetermination shall
automatically determine that an individual
remains eligible for such assistance or
subsidies unless--
``(I) the Commissioner has
information indicating that the
individual's circumstances have changed
such that the individual is no longer
eligible for such assistance or
subsidies;
``(II) the Commissioner sends
notice to the individual regarding such
information that requests a response
either confirming or correcting such
information; and
``(III) the individual either
confirms such information or fails to
provide documentation indicating that
such circumstances have not changed
within 60 days of receiving the notice
described in subclause (II);
``(iii) the Commissioner shall establish
procedures for appeals of such determinations
that are similar to the procedures described in
the third sentence of section 1631(c)(1)(A);
and
``(iv) judicial review of the final
decision of the Commissioner made after a
hearing shall be available to the same extent,
and with the same limitations, as provided in
subsections (g) and (h) of section 205.
``(D) Treatment of medicaid beneficiaries.--The
Secretary shall provide that individuals who are full-
benefit dual eligible individuals (as defined in
section 1935(c)(6)) or who are recipients of
supplemental security income benefits under title XVI
shall be treated as a Medicare Cost Assistance Program
eligible individual described in paragraph (1) and, in
the case of such individual who is a part D eligible
individual, a subsidy eligible individual described in
section 1860D-14(a)(3).
``(E) Simplified application form.--
``(i) In general.--The Secretary shall
develop and distribute a simplified application
form for use by individuals in applying for
Medicare cost assistance under this section and
premium and cost-sharing subsidies under
section 1860D-14. Such form shall be easily
readable by applicants and uniform nationally.
The Secretary shall provide for the translation
of such application form into at least the 10
languages (other than English) that are most
often used by individuals applying for hospital
insurance benefits under section 226 or 226A
and shall make the translated forms available
to the Commissioner of Social Security.
``(ii) Consultation.--In developing such
form, the Secretary shall consult with
beneficiary groups.
``(3) Income determinations.--For purposes of applying this
section--
``(A) in the case of an individual who is not
treated as a Medicare Cost Assistance Program eligible
individual or a subsidy eligible individual under
paragraph (2)(D), income shall be determined in the
manner described under section 1612 for purposes of the
supplemental security income program, except that
support and maintenance furnished in kind shall not be
counted as income; and
``(B) the term `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.
``(c) Beneficiary Protections.--
``(1) In general.--In the case in which the payment for
Medicare cost assistance for a Medicare Cost Assistance Program
eligible individual with respect to an item or service is
reduced or eliminated the individual shall not have any legal
liability to make payment to a provider of services or supplier
or to an organization described in section 1903(m)(1)(A) for
the service, and any lawful sanction that may be imposed upon a
provider of services or supplier or such an organization for
excess charges under this title or title XIX shall apply to the
imposition of any charge imposed upon the individual in such
case.
``(2) Clarification.--This paragraph shall not be construed
as preventing payment of any medicare cost assistance by a
medicare supplemental policy or an employer retiree health plan
on behalf of an individual.
``(d) Administration.--
``(1) In general.--The Secretary shall establish procedures
for the administration of the program under this section.
``(2) Funding.--For purposes of carrying out this section,
the Secretary shall make payments from the Federal Hospital
Insurance Trust Fund under section 1817 and the Federal
Supplementary Medical Insurance Trust Fund under section 1841,
in such proportion as the Secretary determines appropriate, of
such amounts as the Secretary determines necessary to provide
Medicare cost assistance under this section.
``(e) References to Medicare Cost-Sharing.--Effective beginning
January 1, 2023, any reference to medicare cost-sharing described in
section 1905(p) shall be deemed a reference to Medicare cost assistance
under this section.
``(f) Outreach Efforts.--For provisions relating to outreach
efforts to increase awareness of the availability of Medicare cost
assistance, see section 1144.''.
(b) Special Enrollment Period.--
(1) No premium penalty.--Section 1839(b) of the Social
Security Act (42 U.S.C. 1395r(b)) is amended, in the last
sentence, by inserting the following before the period: ``or,
effective beginning January 1, 2023, for individuals who are
Medicare Cost Assistance Program eligible individuals (as
defined in section 1899B(b)(1)).''.
(2) Special enrollment period.--Section 1837 of the Social
Security Act (42 U.S.C. 1395p) is amended by adding at the end
the following new subsection:
``(o) Special Enrollment Period for Medicare Cost Assistance
Program Eligible Individual.--
``(1) In general.--Effective beginning January 1, 2023, the
Secretary shall establish special enrollment periods for
Medicare Cost Assistance Program eligible individuals (as
defined in section 1899B(b)(1)).
``(2) Coverage period.--In the case of an individual who
enrolls during the special enrollment period provided under
paragraph (1), the coverage period under this part shall--
``(A) begin on the first day of the first month in
which the individual applies for a determination under
section 1899B(b)(2)(A); and
``(B) remain in effect until such time as the
Secretary determines the individual no longer eligible
as determined under section 1899B(b)(2)(C)(ii).''.
(3) Conforming sunset of state agreements relating to
enrollment of qualified medicare beneficiaries.--
(A) Part a.--Section 1818(g) of the Social Security
Act (42 U.S.C. 1395i-2(g)) is amended by adding at the
end the following new paragraph:
``(3) Sunset.--This subsection shall not apply on or after
January 1, 2023.''.
(B) Part b.--Section 1843(h) of the Social Security
Act (42 U.S.C. 1395v(h)) is amended by adding at the
end the following new paragraph:
``(3) Sunset with respect to qualified medicare
beneficiaries.--This subsection shall not apply with respect to
qualified medicare beneficiaries on or after January 1,
2023.''.
(c) Public Awareness Campaign.--Section 1144 of the Social Security
Act (42 U.S.C. 1320b-14) is amended by adding at the end the following
new subsection:
``(d) Public Awareness Campaign.--
``(1) In general.--The Commissioner shall conduct a public
awareness campaign to educate Medicare beneficiaries on the
availability of Medicare cost assistance for low-income
individuals under section 1899B.
``(2) Coordination.--In carrying out such public awareness
campaign, the Commissioner shall coordinate with State health
insurance assistance programs described in subsection (a)(1)(A)
of section 119 of the Medicare Improvements for Patients and
Providers Act of 2008 (42 U.S.C. 1395b-3 note)), the
Administrator of the Administration for Community Living, and
the Administrator of the Centers for Medicare & Medicaid
Services.
``(3) Funding.--There are hereby appropriated to the
Commissioner, out of any funds in the Treasury not otherwise
appropriated, $10,000,000 for each of fiscal years 2023 through
2025, to provide grants to State health insurance assistance
programs to carry out outreach and education activities under
the public awareness campaign pursuant to this subsection.''.
SEC. 3. MOVING MEDICARE COST-SHARING BENEFITS FROM MEDICAID TO
MEDICARE.
(a) Ending Most Medicare Cost-Sharing Benefits Under Medicaid.--
Section 1902(a)(10) of the Social Security Act (42 U.S.C. 1396a(a)(10))
is amended--
(1) by inserting ``for calendar quarters beginning before
January 1, 2023,'' before ``for making'' each place it appears
in clauses (i), (iii), and (iv) of subparagraph (E); and
(2) in the matter following subparagraph (G)--
(A) by inserting ``furnished during calendar
quarters beginning before January 1, 2023'' after
``(described in section 1905(p)(3))'';
(B) by striking ``(XV)'' and inserting ``, (XV)'';
(C) by striking ``and (XVIII)'' and inserting ``,
(XVIII)''; and
(D) by inserting ``, and (XIX) no medical
assistance for medicare cost-sharing, other than
medical assistance for medicare cost-sharing for
qualified disabled and working individuals described in
section 1905(s), shall be made available after January
1, 2023'' before the semicolon at the end.
(b) Conforming Amendments.--
(1) Title xix.--
(A) Section 1903(i) of such Act (42 U.S.C.
1396b(i)) is amended--
(i) in paragraph (26), by striking ``;
and'' and inserting a semicolon;
(ii) in paragraph (27), by striking the
period at the end and inserting ``; and''; and
(iii) by inserting after paragraph (27) the
following new paragraph:
``(28) with respect to any amount expended for medical
assistance for medicare cost-sharing (other than medical
assistance for medicare cost-sharing for qualified disabled and
working individuals described in section 1905(s)) furnished
during calendar quarters beginning on or after January 1,
2023.''.
(B) Section 1905(a) of such Act (42 U.S.C.
1396d(a)) is amended, in the first sentence, by
inserting ``furnished during calendar quarters
beginning before January 1, 2023'' after ``medicare
cost-sharing''.
(C) Section 1933(g) of such Act (42 U.S.C. 1396u-
3(g)) is amended--
(i) in paragraph (2)(Q), by striking
``paragraph (4), for each subsequent year'' and
inserting ``paragraphs (4) and (5), for each
subsequent year before 2023''; and
(ii) by adding at the end the following:
``(5) Sunset.--No individual shall be selected to be a
qualifying individual for any calendar year or period under
this section beginning on or after January 1, 2023, and no
State allocation shall be made for any fiscal year or period
under this section beginning on or after January 1, 2023.''.
(D) Section 1935(a) of such Act (42 U.S.C. 1396u-
5(a)) is amended--
(i) in paragraph (2), by striking ``make
determinations'' and inserting ``prior to
January 1, 2023, make determinations''; and
(ii) in paragraph (3), by inserting ``prior
to January 1, 2023,'' before ``the State
shall''.
(2) Title xi.--Section 1144 of the Social Security Act (42
U.S.C. 1320b-14) is amended--
(A) in subsection (a)--
(i) in paragraph (1)(A)--
(I) by striking ``sections
1902(a)(10)(E) and 1933'' and inserting
``section 1902(a)(10)(E) and (prior to
January 1, 2023) section 1933'';
(II) by striking ``for the
transitional assistance under section
1860D-31(f), or'' and inserting a
comma; and
(III) by inserting ``, or for
Medicare premium and cost-sharing
assistance under section 1899B (in the
case of months beginning on or after
January 1, 2023)'' before the
semicolon; and
(ii) by striking paragraph (2) and
inserting the following:
``(2) Content of notice.--Any notice furnished under
paragraph (1) shall state that eligibility for such medical
assistance, subsidies, or program is conditioned upon meeting
the applicable eligibility criteria.'';
(B) in subsection (b)(1)(A)--
(i) by striking ``sections 1902(a)(10)(E)
and 1933'' and inserting ``section
1902(a)(10)(E) and (prior to January 1, 2023)
section 1933'';
(ii) by striking ``for transitional
assistance under section 1860D-31(f), or''; and
(iii) by inserting ``, or for Medicare
premium and cost-sharing assistance under
section 1899B'' before the semicolon; and
(C) in subsection (c)--
(i) in paragraph (1)(B), by inserting ``,
and (beginning January 1, 2023,) provide an
application for enrollment under the Medicare
Savings Program'' before the period;
(ii) in paragraph (2), in the paragraph
header, by inserting ``medicare savings program
application and'' before ``lis application'';
and
(iii) in paragraph (7), by striking ``means
the program of medical assistance'' and all
that follows through the period and inserting
``means--
``(A) prior to January 1, 2023, 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; and
``(B) beginning January 1, 2023, the program for
medical assistance for payment of the cost of medicare
cost-sharing for qualified disabled and working
individuals described in section 1905(s) pursuant to
section 1902(a)(10)(E)(ii) and medicare premium and
cost-sharing assistance provided under section
1899B.''.
(c) Ensuring That Medicare Cost-Sharing Beneficiaries Under
Medicaid Receive Medicare Cost Assistance.--Not later than June 1,
2022, the Secretary of Health and Human Services and the Commissioner
of Social Security shall jointly develop and implement a transition
plan to ensure that all individuals who are eligible for and are
receiving medical assistance for the payment of medicare cost-sharing
under a State Medicaid program pursuant to clauses (i), (iii), and (iv)
of section 1902(a)(10)(E) of the Social Security Act (42 U.S.C.
1396a(a)(10)(E)) as of December 31, 2022, receive Medicare cost
assistance under section 1899B of such Act, as added by section 2, as
of January 1, 2023.
SEC. 4. ENHANCING PRESCRIPTION DRUG AFFORDABILITY BY EXPANDING ACCESS
TO ASSISTANCE WITH OUT-OF-POCKET COSTS UNDER MEDICARE
PART D FOR LOW-INCOME SENIORS AND INDIVIDUALS WITH
DISABILITIES.
(a) Expanding Access.--Section 1860D-14 of the Social Security Act
(42 U.S.C. 1395w-114) is amended--
(1) in subsection (a)--
(A) in the heading, by striking ``150 Percent'' and
inserting ``200 Percent'';
(B) in paragraph (1)--
(i) in the heading, by striking ``135
percent'' and inserting ``200 percent''; and
(ii) in the matter preceding subparagraph
(A)--
(I) by striking ``135 percent'' and
inserting ``200 percent''; and
(II) by striking ``and who meets
the resources requirement described in
paragraph (3)(D) or who is covered
under this paragraph under paragraph
(3)(B)(i)'' and inserting ``or who is
covered under this paragraph under
paragraph (3)(B)(v)'';
(C) by striking paragraph (2);
(D) in paragraph (3)--
(i) in subparagraph (A)--
(I) in clause (i), by adding
``and'' at the end;
(II) in clause (ii)--
(aa) by striking ``150
percent'' and inserting ``200
percent''; and
(bb) by striking ``; and''
at the end and inserting a
period; and
(III) by striking clause (iii);
(ii) by striking subparagraphs (B) and (C)
and inserting the following:
``(B) Determinations.--For provisions relating to
joint determinations with respect to eligibility for
Medicare cost assistance under section 1899B and
premium and cost-sharing subsidies under this section,
see section 1899B(b)(2).
``(C) Income determinations.--For purposes of
applying this section--
``(i) in the case of an individual who is
not treated as a Medicare cost-sharing
assistance eligible individual and a subsidy
eligible individual under section
1899B(b)(2)(D), income shall be determined in
the manner described under section 1612 for
purposes of the supplemental security income
program, except that support and maintenance
furnished in kind shall not be counted as
income; and
``(ii) the term `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.''.
(iii) by striking subparagraphs (D), (E),
and (G); and
(E) in paragraph (4), by striking subparagraph (B);
and
(2) in subsection (c)(1), in the second sentence, by
striking ``subsections (a)(1)(D) and (a)(2)(E)'' and inserting
``subsection (a)(1)(D)''.
(b) Treatment of Reduction of Cost-Sharing for Individuals
Receiving Home and Community Based Services.--Section 1860D-14(a)(1)(D)
of the Social Security Act (42 U.S.C. 1395w-114(a)(1)(D)) is amended--
(1) by striking ``who would be such an institutionalized
individual or couple, if the full-benefit dual eligible
individual were not''; and
(2) by striking ``or subsection (c) or (d) of section 1915
or under a State plan amendment under subsection (i) of such
section'' and inserting ``, section 1115A, section 1915, or
under a State plan amendment''.
(c) Effective Date.--The amendments made by this section shall
apply to plan year 2023 and subsequent plan years.
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