Text: H.R.3473 — 102nd Congress (1991-1992)All Information (Except Text)

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HR 3473 IH
102d CONGRESS
1st Session
 H. R. 3473
To amend title XVIII of the Social Security Act to require the Secretary of
Health and Human Services to include a description of the medical assistance
for medicare cost-sharing available under title XIX of such Act in the annual
program notices sent to medicare beneficiaries, to amend title XIX of such
Act to require States to make applications for such assistance available
at local offices of the Social Security Administration and to accept such
applications by mail, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
October 2, 1991
Mr. MOODY (for himself, Mr. KOSTMAYER, Mr. MCDERMOTT, Mr. STUDDS, Mr. ROYBAL,
Mr. COYNE, Mr. DONNELLY, Mr. LEVIN of Michigan, Mr. BEVILL, Mr. REED, Mr. FRANK
of Massachusetts, Mr. SABO, Ms. PELOSI, Mr. FASCELL, Mr. GUARINI,  Mr. HORTON,
Mr. MANTON, Mr. BILBRAY, Mr. SYNAR, Mr. OBERSTAR, Ms.  OAKAR, Mr. JONTZ,
Mr. AUCOIN, Mr. TOWNS, Mrs. LLOYD, Mr. DIXON, Mr. EVANS, Mr. KANJORSKI,
Mr. ACKERMAN, Mr. KILDEE, Mr. OWENS of Utah, Mr. BRYANT, Mr. MCCANDLESS,
Mr. TANNER, Mr. BORSKI, Mr. MFUME, and Mr. HALL of Ohio) introduced the
following bill; which was referred jointly to the Committees on Ways and
Means and Energy and Commerce
A BILL
To amend title XVIII of the Social Security Act to require the Secretary of
Health and Human Services to include a description of the medical assistance
for medicare cost-sharing available under title XIX of such Act in the annual
program notices sent to medicare beneficiaries, to amend title XIX of such
Act to require States to make applications for such assistance available
at local offices of the Social Security Administration and to accept such
applications by mail, 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; REFERENCES IN ACT.
  (a) SHORT TITLE- This Act may be cited as the `Qualified Medicare Beneficiary
  Enrollment Improvement and Protection Act of 1991'.
  (b) REFERENCES TO SOCIAL SECURITY ACT- Whenever in this Act an amendment
  is expressed in terms of an amendment to or repeal of a section or other
  provision, the reference shall be considered to be made to that section
  or other provision of the Social Security Act.
SEC. 2. REQUIRING DESCRIPTION OF MEDICARE COST-SHARING IN ANNUAL NOTICE SENT
TO MEDICARE BENEFICIARIES.
  (a) IN GENERAL- Section 1804 (42 U.S.C. 1395b-2) is amended--
  (1) by striking `and' at the end of paragraph (2);
  (2) by striking the period at the end of paragraph (3) and inserting `, and';
  (3) by inserting after paragraph (3) the following new paragraph:
  `(4) a clear, simple explanation (in a manner designed to attract the
  reader's attention and stated in plain English) of the availability of and
  the requirements for obtaining medical assistance for medicare cost-sharing
  under State plans approved under title XIX (including a description of
  changes in such availability and requirements from the previous year)
  and the toll-free telephone number for information on such assistance
  established under section 2(b)(2) of the Qualified Medicare Beneficiary
  Enrollment Improvement and Protection Act of 1991, together with an initial
  application for such assistance that may be returned to the Secretary and
  forwarded by the Secretary to the State in which the recipient resides.'.
  (b) ADDITIONAL REQUIREMENTS FOR PUBLICIZING AVAILABILITY OF ASSISTANCE-
  (1) DISTRIBUTION OF NOTICE TO HEALTH CARE PROVIDERS- Not later than January
  1, 1992, the Secretary of Health and Human Services shall develop a poster
  containing the notice provided to medicare beneficiaries under section
  1804(4) of the Social Security Act (as added by subsection (a)) of the
  availability of and the requirements for obtaining medical assistance for
  medicare cost-sharing under State medicaid plans that is suitable for
  posting, and shall distribute the poster to physicians, hospitals, and
  other providers of services under the medicare program, and to entities
  receiving grants from the Secretary for programs designed to provide
  services to individuals age 65 or older.
  (2) ESTABLISHMENT OF TOLL-FREE HOTLINE- Not later than January 1, 1992,
  the Secretary of Health and Human Services shall establish and operate a
  toll-free telephone number to provide individuals with information on the
  availability of and the requirements for obtaining medical assistance for
  medicare cost-sharing under State medicaid plans.
SEC. 3. USE OF SOCIAL SECURITY OFFICES FOR RECEIPT OF APPLICATIONS FOR
MEDICARE COST-SHARING; REQUIRING STATES TO ACCEPT APPLICATIONS BY MAIL.
  (a) RECEIPT OF APPLICATIONS BY SOCIAL SECURITY ADMINISTRATION- Title XIX
  (42 U.S.C. 1396 et seq.) is amended by adding at the end the following
  new section:
`RECEIPT BY SECRETARY OF APPLICATIONS FOR MEDICARE COST-SHARING
  `SEC. 1931. (a) IN GENERAL- The Secretary shall establish a process for
  the distribution and receipt of applications for medical assistance for
  medicare cost-sharing under section 1902(a)(10)(E) under which--
  `(1) individuals applying for such assistance may obtain applications from
  local offices of the Social Security Administration in the State and submit
  applications to such offices; and
  `(2) personnel of such offices shall be trained to assist individuals in
  completing such applications.
  `(b) TRANSMISSION OF APPLICATIONS TO STATES- The Secretary shall transmit
  applications for assistance submitted by individuals under subsection (a)
  to the agency administering the State program under this title for the
  State in which the individual resides.
  `(c) DEVELOPMENT AND DISTRIBUTION OF FORM CONTAINING REQUEST FOR APPLICATION-
  `(1) DEVELOPMENT- Under the process established under subsection (a),
  the Secretary shall develop a form that contains--
  `(A) a description (in English and other languages determined appropriate
  by the Secretary) of the availability of and the requirements for obtaining
  medical assistance for medicare cost-sharing under section 1902(a)(10)(E);
  and
  `(B) a pre-addressed reply card that an individual may mail to the agency
  administering the State program under this title for the State in which the
  individual resides to request additional information on or an application
  for such assistance.
  `(2) DISTRIBUTION- The Secretary shall distribute the form developed under
  paragraph (1) to entities receiving grants from the Secretary for programs
  designed to provide services to individuals age 65 or older and shall make
  the form available at local offices of the Social Security Administration.'.
  (b) REQUIREMENTS FOR STATE MEDICAID PLANS-
  (1) IN GENERAL- Section 1902(a) (42 U.S.C. 1396a) is amended--
  (A) in paragraph (54)(B), by striking `; and' and inserting a semicolon;
  (B) in the paragraph (55)(B) added by section 4602(a)(3) of the Omnibus
  Budget Reconciliation Act of 1990 (hereafter referred to as `OBRA-1990'),
  by striking the period at the end and inserting a semicolon;
  (C) by redesignating the paragraph (55) added by section 4604(b)(3) of
  OBRA-1990 as paragraph (56);
  (D) in the paragraph (58) added by section 4751(a)(1)(C) of OBRA-1990,
  by striking the period at the end and inserting a semicolon;
  (E) by redesignating the paragraph (58) added by section 4752(c)(1)(C)
  of OBRA-1990 as paragraph (59) and by striking the period at the end of
  such paragraph and inserting `; and'; and
  (F) by inserting after paragraph (59) (as so redesignated) the following
  new paragraph:
  `(60) provide for a process for the receipt and processing of applications
  for medical assistance for medicare cost-sharing under paragraph (10)(E)
  under which--
  `(A) the State shall receive and respond to requests for such assistance
  and shall distribute and process applications for such assistance by mail
  (except that nothing in this subparagraph shall be construed to prohibit
  a State from requiring an individual to appear before the State agency to
  confirm information provided in such an application),
  `(B) the State shall provide applications for such assistance to all local
  offices of the Social Security Administration located in the State, and
  `(C) if the State receives a request in the mail from an individual
  for information on or an application for such assistance (including
  a pre-addressed reply card developed by the Secretary under section
  1931(c)), the State shall mail the information or application requested
  to the individual not later than 30 days after receiving the request.'.
  (2) EFFECTIVE DATE- The amendments made by paragraph (1) shall apply
  to calendar quarters beginning on or after January 1, 1992, regardless
  of whether or not regulations to carry out such amendments have been
  promulgated by that date.
SEC. 4. ESTABLISHMENT OF 3-MONTH RETROACTIVE ELIGIBILITY.
  (a) IN GENERAL- The first sentence of section 1905(a) (42 U.S.C. 1396d)
  is amended in the matter preceding clause (i) by striking `assistance or,
  in the case of' and all that follows through `such a beneficiary)' and
  inserting `assistance)'.
  (b) CONFORMING AMENDMENT- Section 1902(e)(8) (42 U.S.C. 1396a(e)(8))
  is amended to read as follows:
  `(8) For purposes of payment to a State under section 1903(a), a
  determination that an individual is eligible to receive medical assistance
  for medicare cost-sharing under subsection (a)(10)(E) shall be considered
  to be valid for the 12-month period beginning on the date the individual
  applies to receive such assistance, except that a State may provide for
  such determinations more frequently (but not more frequently than once
  every 6 months for an individual).'.
  (c) EFFECTIVE DATE- The amendments made by this section shall apply with
  respect to applications for medical assistance for medicare cost-sharing
  under title XIX of the Social Security Act filed after December 31, 1991.
SEC. 5. RETROACTIVE PAYMENT OF MEDICARE COST-SHARING INCURRED BUT NOT RECEIVED.
  (a) IN GENERAL- Subject to subsections (b) and (c), if an individual is
  eligible to receive medical assistance for medicare cost-sharing under a
  State plan for medical assistance under title XIX of the Social Security
  Act pursuant to section 1902(a)(10)(E) during the year preceding the first
  year for which section 1931 of such Act (as added by section 3(a)) is in
  effect, the Secretary of Health and Human Services shall make payments to
  the individual for any medicare cost-sharing incurred by the individual
  during the year for which payment was not made under the applicable State
  plan for medical assistance under title XIX of such Act.
  (b) REQUIREMENT FOR APPLICATION- No payment may be made to an individual
  under subsection (a) unless the individual applies for medical assistance
  for medicare cost-sharing under a State plan for medical assistance under
  title XIX of the Social Security Act during the first year for which
  section 1931 of such Act (as added by section 3(a)) is in effect.
  (c) LIMITATION ON COST-SHARING COVERED- Subsection (a) shall not apply
  to any medicare cost-sharing incurred by an individual if the State plan
  for medical assistance under title XIX of the Social Security Act is
  not required to provide for making medical assistance available for such
  medicare cost-sharing under section 1902(a)(10)(E) of such Act.
SEC. 6. PERMITTING SPENDDOWN FOR QUALIFIED MEDICARE BENEFICIARIES.
  (a) IN GENERAL- Section 1905(p) (42 U.S.C. 1396d(p)) is amended--
  (1) in paragraph (1)(B), by striking `paragraph (2)(D)' and inserting
  `paragraph (2)(D) or paragraph (2)(E)'; and
  (2) in paragraph (2), by adding at the end the following new paragraph:
  `(E) In determining the income of an individual under this subsection,
  a State may exclude expenses for medical care incurred by the individual
  that are not reimbursed under a public program of the State or political
  subdivision thereof, a health benefit plan, or title XVIII.'.
  (b) CONFORMING AMENDMENT- Section 1902(f)(1) (42 U.S.C. 1396a(f)(1)) is
  amended in the first sentence, by striking `and except with respect to
  qualified medicare beneficiaries,'.
  (c) EFFECTIVE DATE- The amendments made by subsections (a) and (b)
  shall apply to calendar quarters beginning on or after January 1, 1992,
  regardless of whether or not regulations to carry out such amendments have
  been promulgated by that date.
SEC. 7. OUTREACH GRANTS FOR INFORMATION, COUNSELING, AND ASSISTANCE.
  (a) ESTABLISHMENT OF GRANT PROGRAM-
  (1) IN GENERAL- Not later than 1 year after the date of the enactment
  of this Act, the Secretary of Health and Human Services (in this section
  referred to as the `Secretary') shall make grants to eligible entities to
  establish and operate an information, counseling, and assistance program
  meeting the requirements of subsection (b)(2) to enable individuals who
  are entitled to receive medical assistance for medicare cost-sharing under
  State plans for medical assistance under title XIX of the Social Security
  Act to receive such assistance.
  (2) DISTRIBUTION AMONG STATE AND PRIVATE RECIPIENTS- Of the grants made
  under this section, 50 percent shall be made to States and 50 percent
  shall be made to non-governmental entities.
  (3) AMOUNT OF GRANTS- The Secretary shall prescribe regulations to establish
  a minimum level of funding for a grant issued under this section.
  (b) ELIGIBILITY FOR GRANTS-
  (1) IN GENERAL- An entity is eligible to receive a grant under this
  section if--
  (A) the entity submits to the Secretary, at such time and in such form
  as the Secretary may require, an application containing the information
  described in paragraph (2); and
  (B) in the case of a non-governmental entity, the entity provides the
  Secretary with information on its ability to operate benefits information,
  counseling, and assistance programs for individuals age 65 and older
  (including information on its prior experience in operating programs
  providing services to such individuals), together with such other information
  as the Secretary may require.
  (2) PROGRAM REQUIREMENTS- As part of an application for a grant under this
  section, an entity shall submit a plan for an information, counseling,
  and assistance program. Such program shall--
  (A) establish or improve upon an information, counseling, and assistance
  program that provides counseling and assistance to individuals in need
  of information that may assist them in applying for medical assistance
  for medicare cost-sharing under a State plan for medical assistance under
  title XIX of the Social Security Act;
  (B) establish a system of referral to appropriate Federal or State
  departments or agencies for assistance with problems related to receiving
  such medical assistance;
  (C) provide for a sufficient number of staff positions (including volunteer
  positions) necessary to provide the services of the program;
  (D) provide for the collection and dissemination of timely and accurate
  information on eligibility and enrollment requirements for such medical
  assistance to staff members;
  (E) provide for training programs for staff members (including volunteer
  staff members);
  (F) provide for the coordination of the exchange of information on
  eligibility and enrollment requirements for such medical assistance between
  the staff of departments and agencies of the State government and the
  staff of the program;
  (G) make recommendations concerning consumer issues and complaints related
  to eligibility and enrollment procedures for such medical assistance
  to appropriate agencies and departments of the State government and the
  Federal Government; and
  (H) establish an outreach program to provide the information and counseling
  described in subparagraph (A) and the assistance described in subparagraph
  (B) to eligible individuals.
  (c) LOCATIONS FOR ADMINISTRATION OF PROGRAM- An entity receiving a grant
  under this section shall operate the information, counseling, and assistance
  program funded with such grant at locations which are other than those used
  for the receipt and processing of applications for aid under part A of title
  IV of the Social Security Act, including Area Agencies on Aging, meals on
  wheels programs, senior centers, and other locations determined appropriate
  by the Secretary in consultation with such agency or organization.
  (d) MAINTENANCE OF EFFORT- An entity receiving a grant under this section
  shall use funds provided under the grant to supplement, and not to supplant,
  any funds expended by the recipient under any other program providing
  services similar to those provided under the information, counseling,
  and assistance program funded with the grant.
  (e) ANNUAL REPORTS BY RECIPIENTS- Each entity receiving a grant under
  subsection (a) shall, not later than 180 days after receiving the grant
  and annually thereafter, issue a report to the Secretary that includes
  information concerning--
  (1) the number of individuals served by the information, counseling,
  and assistance program funded with such grant; and
  (2) the problems that individuals encounter in applying for medical
  assistance for medicare cost-sharing under title XIX of the Social
  Security Act.
  (f) REPORT TO CONGRESS- Not later than 2 years after the date of the
  enactment of this section, and annually thereafter, the Secretary shall
  issue a report to the Committee on Finance of the Senate, the Special
  Committee on Aging of the Senate, the Committee on Ways and Means of the
  House of Representatives, the Committee on Energy and Commerce of the
  House of Representatives, and the Select Committee on Aging of the House
  of Representatives that--
  (1) summarizes the allocation of funds authorized for grants under this
  section and the expenditure of such funds;
  (2) outlines the problems that individuals encounter in applying for
  medical assistance for medicare cost-sharing under title XIX of the Social
  Security Act;
  (3) makes recommendations that the Secretary determines to be appropriate
  to address the problems described in paragraph (2); and
  (4) in the case of the report issued 2 years after the date of enactment
  of this section, evaluates the effectiveness of counseling programs
  established under this program, and makes recommendations regarding
  continued authorization of funds for these purposes.
  (g) AUTHORIZATION OF APPROPRIATIONS- There are authorized to be appropriated,
  in equal parts from the Federal Hospital Insurance Trust Fund and from
  the Federal Supplementary Medical Insurance Trust Fund, $30,000,000 for
  each of the fiscal years 1992, 1993, and 1994, and $10,000,000 for each
  fiscal year beginning after fiscal year 1994, for grants under this section.
SEC. 8. REPORT TO CONGRESS.
  Not later than 1 year after the date of the enactment of this Act, the
  Secretary of Health and Human Services shall submit a report to Congress
  describing the steps taken by the Secretary to carry out this Act,
  together with any recommendations for additional legislation to ensure
  that individuals entitled to receive medical assistance for medicare
  cost-sharing under State plans for medical assistance under title XIX of
  the Social Security Act receive such assistance.