I

106TH CONGRESS

1ST SESSION H. R. 854

To amend title XIX of the Social Security Act to provide for the presumptive

eligibility of Medicare beneficiaries for the qualified Medicare beneficiary

and special low-income Medicare beneficiary programs, and for other

purposes.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 25, 1999

Mr. BENTSEN introduced the following bill; which was referred to the

Committee on Commerce

A BILL

To amend title XIX of the Social Security Act to provide

for the presumptive eligibility of Medicare beneficiaries

for the qualified Medicare beneficiary and special lowincome Medicare beneficiary programs, and for other

purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘Low-Income Medicare

5 Beneficiary Assistance Act of 1999’’.
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1 SEC. 2. PRESUMPTIVE ELIGIBILITY OF CERTAIN LOW-IN2 COME INDIVIDUALS FOR MEDICARE COST3 SHARING UNDER THE QMB OR SLMB PRO4 GRAM.

5 Title XIX of the Social Security Act is amended by

6 inserting after section 1920A the following new section:

7 ‘‘PRESUMPTIVE ELIGIBILITY OF CERTAIN LOW-INCOME

8 INDIVIDUALS

9 ‘‘SEC. 1920B. (a) A State plan approved under sec10 tion 1902 shall provide for making medical assistance with

11 respect to medicare cost-sharing covered under the State

12 plan available to a low-income individual on the date the

13 low-income individual becomes entitled to benefits under

14 part A of title XVIII during a presumptive eligibility pe15 riod.

16 ‘‘(b) For purposes of this section:

17 ‘‘(1) The term ‘low-income individual’ means an

18 individual who at the age of 65 years is described—

19 ‘‘(A) in section 1902(a)(10)(E)(i), or

20 ‘‘(B) in section 1902(a)(10)(E)(iii).

21 ‘‘(2) The term ‘medicare cost-sharing’—

22 ‘‘(A) with respect to an individual de23 scribed in paragraph (1)(A), has the meaning

24 given such term in section 1905(p)(3).
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1 ‘‘(B) with respect to an individual de2 scribed in paragraph (1)(B), has the meaning

3 given such term in section 1905(p)(3)(A).

4 ‘‘(3) The term ‘presumptive eligibility period’

5 means, with respect to a low-income individual, the

6 period that—

7 ‘‘(A) begins with the date on which a

8 qualified entity determines, on the basis of pre9 liminary information, that the income and re10 sources of the individual do not exceed the ap11 plicable income and resource level of eligibility

12 under the State plan, and

13 ‘‘(B) ends with (and includes) the earlier

14 of—

15 ‘‘(i) the day on which a determination

16 is made with respect to the eligibility of

17 the low-income individual for medical as18 sistance for medical cost-sharing under the

19 State plan, or

20 ‘‘(ii) in the case of a low-income indi21 vidual on whose behalf an application is

22 not filed by the last day of the month fol23 lowing the month during which the entity

24 makes the determination referred to in

25 subparagraph (A), such last day.
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1 ‘‘(4)(A) Subject to subparagraph (B), the term

2 ‘qualified entity’ means any of the following:

3 ‘‘(i) Qualified individuals within the Social

4 Security Administration.

5 ‘‘(ii) An entity determined by the State

6 agency to be capable of making determinations

7 of the type described in paragraph (3).

8 ‘‘(B) The Secretary may issue regulations fur9 ther limiting those entities that may become quali10 fied entities in order to prevent fraud and abuse and

11 for other reasons.

12 ‘‘(c)(1) The State agency, after consultation with the

13 Secretary, shall provide qualified entities with—

14 ‘‘(A) such forms as are necessary for an appli15 cation to be made on behalf of a low-income individ16 ual for medical assistance for medical cost-sharing

17 under the State plan, and

18 ‘‘(B) information on how to assist low-income

19 individuals and other persons in completing and fil20 ing such forms.

21 ‘‘(2) A qualified entity that determines under sub22 section (b)(2)(A) that a low-income individual is presump23 tively eligible for medical assistance for medical cost-shar24 ing under a State plan shall—
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1 ‘‘(A) notify the State agency of the determina2 tion within 5 working days after the date on which

3 the determination is made, and

4 ‘‘(B) inform the low-income individual at the

5 time the determination is made that an application

6 for medical assistance for medical cost-sharing under

7 the State plan is required to be made by not later

8 than the last day of the month following the month

9 during which the determination is made.

10 ‘‘(3) In the case of a low-income individual who is

11 determined by a qualified entity to be presumptively eligi12 ble for medical assistance for medical cost-sharing under

13 a State plan, the low-income individual shall make applica14 tion for medical assistance for medical cost-sharing under

15 such plan by not later than the last day of the month fol16 lowing the month during which the determination is made.

17 ‘‘(d) Notwithstanding any other provision of this title,

18 medical assistance for medicare cost-sharing that—

19 ‘‘(1) is furnished to a low-income individual

20 during a presumptive eligibility period under the

21 State plan; and

22 ‘‘(2) is included in the services covered by a

23 State plan;

24 shall be treated as medical assistance provided by such

25 plan for purposes of section 1903.’’.
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1 SEC. 3. AUTHORIZATION OF APPROPRIATIONS FOR OUT2 REACH EFFORTS.

3 There is authorized to be appropriated to the Sec4 retary of Health and Human Services $12,000,000 for the

5 purpose of conducting outreach efforts to increase aware6 ness of the availability of medical assistance for medicare

7 cost-sharing under a State plan under title XIX of the

8 Social Security Act to eligible low-income medicare bene9 ficiaries described in clauses (i) and (iii), respectively, of

10 section 1902(a)(10)(E) of such Act (42 U.S.C.

11 1396a(a)(10)(E)).

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