IIB 

116TH CONGRESS 

2D SESSION H. R. 2477 

IN THE SENATE OF THE UNITED STATES 

DECEMBER 9, 2020 

Received; read twice and referred to the Committee on Finance 

AN ACT 

To amend title XVIII of the Social Security Act to establish 

a system to notify individuals approaching Medicare eligibility, to simplify and modernize the eligibility enrollment 

process, 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, 


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Beneficiary Enrollment 

3 Notification and Eligibility Simplification Act of 2020’’ or 

4 the ‘‘BENES Act of 2020’’. 

5 SEC. 2. BENEFICIARY ENROLLMENT NOTIFICATION AND 

6 ELIGIBILITY SIMPLIFICATION. 

7 (a) ELIGIBILITY AND ENROLLMENT NOTICES.— 

8 (1) AS PART OF SOCIAL SECURITY ACCOUNT

9 STATEMENT FOR INDIVIDUALS ATTAINING AGES 63

10 TO 65.— 

11 (A) IN GENERAL.—Section 1143(a) of the 

12 Social Security Act (42 U.S.C. 1320b–13(a)) is 

13 amended by adding at the end the following 

14 new paragraph: 

15 ‘‘(4) MEDICARE ELIGIBILITY INFORMATION.— 

16 ‘‘(A) IN GENERAL.—In the case of statements 

17 provided on or after the date that is 2 years after 

18 the date of the enactment of this paragraph to indi19 viduals who are attaining ages 63, 64, and 65, the 

20 statement shall also include a notice containing the 

21 information described in subparagraph (B). 

22 ‘‘(B) CONTENTS OF NOTICE.—The notice re23 quired under subparagraph (A) shall include a clear, 

24 simple explanation of— 

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1 ticular benefits under parts B and C of such 

2 title; 

3 ‘‘(ii) the reasons a late enrollment penalty 

4 for failure to timely enroll could be assessed 

5 and how such late enrollment penalty is cal6 culated, in particular for benefits under such 

7 part B; 

8 ‘‘(iii) the availability of relief from such 

9 late enrollment penalty and retroactive enroll10 ment under section 1837(h) (including as such 

11 section is applied under sections 1818(c) and 

12 1818A(c)(3)), with examples of circumstances 

13 under which such relief may be granted and ex14 amples of circumstances under which such relief 

15 would not be granted; 

16 ‘‘(iv) coordination of benefits (including 

17 primary and secondary coverage scenarios) pur18 suant to section 1862(b), in particular for bene19 fits under such part B; 

20 ‘‘(v) enrollment, eligibility, and coordina21 tion of benefits under title XVIII with respect 

22 to populations, for whom there are special con23 siderations, such as residents of Puerto Rico 

24 and veterans; and 


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1 ‘‘(vi) online resources and toll-free tele2 phone numbers of the Social Security Adminis3 tration and the Centers for Medicare & Med4 icaid Services (including 1–800–MEDICARE 

5 and the national toll-free number of the Social 

6 Security Administration) that provide informa7 tion on eligibility for benefits under the Medi8 care program under title XVIII, including 

9 under part C of such title. 

10 ‘‘(C) DEVELOPMENT OF NOTICE.— 

11 ‘‘(i) IN GENERAL.—The Secretary, in co12 ordination with the Commissioner of Social Se13 curity, and taking into consideration informa14 tion collected pursuant to clause (ii), shall, not 

15 later than 12 months after the last day of the 

16 period for the request of information described 

17 in clause (ii), develop the notice to be provided 

18 pursuant to subparagraph (A). 

19 ‘‘(ii) REQUEST FOR INFORMATION.—Not 

20 later than 6 months after the date of the enact21 ment of this paragraph, the Secretary shall re22 quest written information, including rec23 ommendations, from stakeholders (including the 

24 groups described in subparagraph (D)) on the 

25 information to be included in the notice. 


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1 ‘‘(iii) NOTICE IMPROVEMENT.—Beginning 

2 4 years after the date of the enactment of this 

3 paragraph, and not less than once every 2 years 

4 thereafter, the Secretary, in coordination with 

5 the Commissioner of Social Security, shall— 

6 ‘‘(I) review the content of the notice 

7 to be provided under subparagraph (A); 

8 ‘‘(II) request written information, in9 cluding recommendations, on such notice 

10 through a request for information process 

11 as described in clause (ii); and 

12 ‘‘(III) update and revise such notice 

13 as the Secretary deems appropriate. 

14 ‘‘(D) GROUPS.—For purposes of subparagraph 

15 (C)(ii), the groups described in this subparagraph 

16 include the following: 

17 ‘‘(i) Individuals who are 60 years of age or 

18 older. 

19 ‘‘(ii) Veterans. 

20 ‘‘(iii) Individuals with disabilities. 

21 ‘‘(iv) Individuals with end stage renal dis22 ease. 

23 ‘‘(v) Low-income individuals and families. 

24 ‘‘(vi) Employers (including human re25 sources professionals). 


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1 ‘‘(vii) States (including representatives of 

2 State-run Health Insurance Exchanges, Med3 icaid offices, and Departments of Insurance). 

4 ‘‘(viii) State Health Insurance Assistance 

5 Programs. 

6 ‘‘(ix) Health insurers. 

7 ‘‘(x) Health insurance agents and brokers. 

8 ‘‘(xi) Such other groups as specified by the 

9 Secretary. 

10 ‘‘(E) POSTING OF NOTICE ON WEBSITES.—The 

11 Commissioner of Social Security and the Secretary 

12 shall post the notice required under subparagraph 

13 (A) on the public Internet website of the Social Se14 curity Administration and on Medicare.gov (or a 

15 successor website), respectively. 

16 ‘‘(F) REIMBURSEMENT OF COSTS.— 

17 ‘‘(i) IN GENERAL.—Effective for fiscal 

18 years beginning in the year in which the date 

19 of enactment of this paragraph occurs, the 

20 Commissioner of Social Security and the Sec21 retary shall enter into an agreement under 

22 which the Secretary shall provide for the trans23 fer, from the Federal Hospital Insurance Trust 

24 Fund under section 1817 and the Federal Sup25 plementary Medical Insurance Trust Fund 


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1 under section 1841 (in such proportion as the 

2 Secretary determines appropriate), of such 

3 sums as necessary to cover the administrative 

4 costs of the Commissioner’s activities under this 

5 paragraph. Such agreement shall— 

6 ‘‘(I) provide funds to the Commis7 sioner for the administrative costs of the 

8 Social Security Administration’s work re9 lated to the implementation of this para10 graph, including any initial costs incurred 

11 prior to the finalization of such agreement; 

12 ‘‘(II) provide such funding quarterly 

13 in advance of the applicable quarter based 

14 on estimating methodology agreed to by 

15 the Commissioner and the Secretary; and 

16 ‘‘(III) require an annual accounting 

17 (with a detailed description of the costs 

18 and methodology used to assess such costs) 

19 and reconciliation of the actual costs in20 curred and funds provided under this para21 graph. 

22 ‘‘(ii) LIMITATION.—In no case shall funds 

23 from the Social Security Administration’s Limi24 tation on Administrative Expenses be used to 

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1 tion of this paragraph, except as the Commis2 sioner determines is necessary— 

3 ‘‘(I) for the development of the agree4 ment under clause (i); and 

5 ‘‘(II) on a temporary basis and sub6 ject to reimbursement under clause (i)(I), 

7 for the initial implementation of this para8 graph. 

9 ‘‘(G) NO EFFECT ON OBLIGATION TO MAIL

10 STATEMENTS.—Nothing in this paragraph shall be 

11 construed to relieve the Commissioner of Social Se12 curity from any requirement under subsection (c), 

13 including the requirement to mail a statement on an 

14 annual basis to each eligible individual who is not re15 ceiving benefits under title II and for whom a mail16 ing address can be determined through such meth17 ods as the Commissioner determines to be appro18 priate.’’. 

19 (B) TIMING OF STATEMENTS.—Section 

20 1143(c)(2) of such Act (42 U.S.C. 1320b21 13(c)(2)) is amended by adding at the end the 

22 following: ‘‘With respect to statements provided 

23 to individuals who are attaining age 65, as de24 scribed in subsection (a)(4), such statements 

25 shall be mailed not earlier than 6 months and 


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1 not later than 3 months before the individual 

2 attains such age.’’ 

3 (2) SOCIAL SECURITY BENEFICIARIES.—Title 

4 XI of the Social Security Act (42 U.S.C. 1301 et 

5 seq.) is amended by inserting after section 1144 the 

6 following new section: 

7 ‘‘MEDICARE ENROLLMENT NOTIFICATION AND ELIGI8 BILITY NOTICES FOR SOCIAL SECURITY BENE9 FICIARIES PRIOR TO MEDICARE ELIGIBILITY

10 ‘‘Notices 

11 ‘‘SEC. 1144A. (a) 

12 ‘‘(1) IN GENERAL.—The Commissioner of So13 cial Security shall distribute the notice to be pro14 vided pursuant to section 1143(a)(4), as may be 

15 modified under paragraph (2), to individuals entitled 

16 to monthly insurance benefits under title II in ac17 cordance with subsection (b). 

18 ‘‘(2) AUTHORITY TO MODIFY NOTICE.—The 

19 Secretary, in coordination with the Commissioner of 

20 Social Security, may modify the notice to be distrib21 uted under paragraph (1) as necessary to take into 

22 account the individuals described in such paragraph. 

23 ‘‘(3) POSTING OF NOTICE ON WEBSITES.—The 

24 Commissioner of Social Security and the Secretary 

25 shall post the notice required to be distributed under 

26 paragraph (1) on the public Internet website of the 


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1 Social Security Administration and on Medicare.gov 

2 (or a successor website), respectively. 

3 ‘‘Timing 

4 ‘‘(b) Beginning not later than 2 years after the date 

5 of the enactment of this section, a notice required under 

6 subsection (a)(1) shall be mailed to an individual described 

7 in such subsection— 

8 ‘‘(1) in the third month before the date on 

9 which such individual’s initial enrollment period be10 gins as provided under section 1837; and 

11 ‘‘(2) in the case of an individual with respect to 

12 whom section 226(b) applies (except for an indi13 vidual who will attain age 65 during the 24 month 

14 period described in such section), in the month be15 fore such date on which such individual’s initial en16 rollment period so begins. 

17 ‘‘Reimbursement of Costs 

18 ‘‘(c) 

19 ‘‘(1) IN GENERAL.—Effective for fiscal years 

20 beginning in the year in which the date of enactment 

21 of this section occurs, the Commissioner of Social 

22 Security and the Secretary shall enter into an agree23 ment under which the Secretary shall provide for the 

24 transfer, from the Federal Hospital Insurance Trust 

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1 mentary Medical Insurance Trust Fund under sec2 tion 1841 (in such proportion as the Secretary de3 termines appropriate), of such sums as necessary to 

4 cover the administrative costs of the Commissioner’s 

5 activities under this section. Such agreement shall— 

6 ‘‘(A) provide funds to the Commissioner 

7 for the administrative costs of the Social Secu8 rity Administration’s work related to the imple9 mentation of this section, including any initial 

10 costs incurred prior to the finalization of such 

11 agreement; 

12 ‘‘(B) provide such funding quarterly in ad13 vance of the applicable quarter based on esti14 mating methodology agreed to by the Commis15 sioner and the Secretary; and 

16 ‘‘(C) require an annual accounting (with a 

17 detailed description of the costs and method18 ology used to assess such costs) and reconcili19 ation of the actual costs incurred and funds 

20 provided under this paragraph. 

21 ‘‘(2) LIMITATION.—In no case shall funds from 

22 the Social Security Administration’s Limitation on 

23 Administrative Expenses be used to carry out activi24 ties related to the implementation of this section, ex25 cept as the Commissioner determines is necessary— 


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1 ‘‘(A) for the development of the agreement 

2 under paragraph (1); and 

3 ‘‘(B) on a temporary basis and subject to 

4 reimbursement under paragraph (1)(A), for the 

5 initial implementation of this section.’’. 

6 (b) BENEFICIARY ENROLLMENT SIMPLIFICATION.— 

7 (1) EFFECTIVE DATE OF COVERAGE.—Section 

8 1838(a) of the Social Security Act (42 U.S.C. 

9 1395q(a)) is amended— 

10 (A) by amending paragraph (2) to read as 

11 follows: 

12 ‘‘(2)(A) in the case of an individual who enrolls 

13 pursuant to subsection (d) of section 1837 before 

14 the month in which he first satisfies paragraph (1) 

15 or (2) of section 1836(a), the first day of such 

16 month, 

17 ‘‘(B) in the case of an individual who first sat18 isfies such paragraph in a month beginning before 

19 January 2023 and who enrolls pursuant to such 

20 subsection (d)— 

21 ‘‘(i) in such month in which he first satis22 fies such paragraph, the first day of the month 

23 following the month in which he so enrolls, 

24 ‘‘(ii) in the month following such month in 

25 which he first satisfies such paragraph, the first 


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1 day of the second month following the month in 

2 which he so enrolls, or 

3 ‘‘(iii) more than one month following such 

4 month in which he satisfies such paragraph, the 

5 first day of the third month following the 

6 month in which he so enrolls, 

7 ‘‘(C) in the case of an individual who first satis8 fies such paragraph in a month beginning on or 

9 after January 1, 2023, and who enrolls pursuant to 

10 such subsection (d) in such month in which he first 

11 satisfies such paragraph or in any subsequent month 

12 of his initial enrollment period, the first day of the 

13 month following the month in which he so enrolls, or 

14 ‘‘(D) in the case of an individual who enrolls 

15 pursuant to subsection (e) of section 1837 in a 

16 month beginning— 

17 ‘‘(i) before January 1, 2023, the July 1 

18 following the month in which he so enrolls; or 

19 ‘‘(ii) on or after January 1, 2023, the first 

20 day of the month following the month in which 

21 he so enrolls; or’’; and 

22 (B) by amending paragraph (3) to read as 

23 follows: 

24 ‘‘(3) in the case of an individual who is deemed 

25 to have enrolled— 


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1 ‘‘(A) on or before the last day of the third 

2 month of his initial enrollment period, the first 

3 day of the month in which he first meets the 

4 applicable requirements of section 1836(a) or 

5 July 1, 1973, whichever is later, or 

6 ‘‘(B) on or after the first day of the fourth 

7 month of his initial enrollment period, and 

8 where such month begins— 

9 ‘‘(i) before January 1, 2023, as pre10 scribed under subparagraphs (B)(i), 

11 (B)(ii), (B)(iii), and (D)(i) of paragraph 

12 (2), or 

13 ‘‘(ii) on or after January 1, 2023, as 

14 prescribed under subparagraphs (C) and 

15 (D)(ii) of paragraph (2).’’. 

16 (2) SPECIAL ENROLLMENT PERIODS FOR EX17 CEPTIONAL CIRCUMSTANCES.— 

18 (A) ENROLLMENT.—Section 1837 of the 

19 Social Security Act (42 U.S.C. 1395p) is 

20 amended by adding at the end the following 

21 new subsection: 

22 ‘‘(m) Beginning January 1, 2023, the Secretary may 

23 establish special enrollment periods in the case of individ24 uals who satisfy paragraph (1) or (2) of section 1836(a) 


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1 and meet such exceptional conditions as the Secretary may 

2 provide.’’. 

3 (B) COVERAGE PERIOD.—Section 1838 of 

4 the Social Security Act (42 U.S.C. 1395q) is 

5 amended by adding at the end the following 

6 new subsection: 

7 ‘‘(g) Notwithstanding subsection (a), in the case of 

8 an individual who enrolls during a special enrollment pe9 riod pursuant to section 1837(m), the coverage period 

10 shall begin on a date the Secretary provides in a manner 

11 consistent (to the extent practicable) with protecting con12 tinuity of health benefit coverage.’’. 

13 (C) CONFORMING AMENDMENT.—Title 

14 XVIII of the Social Security Act (42 U.S.C. 

15 1395 et seq.) is amended— 

16 (i) in section 1818A(c)(3), by striking 

17 ‘‘subsections (h) and (i) of section 1837’’ 

18 and inserting ‘‘subsections (h), (i), and (m) 

19 of section 1837’’; and 

20 (ii) in section 1839(b), in the first 

21 sentence, by striking ‘‘or (l)’’ and inserting 

22 ‘‘, (l), or (m)’’. 

23 (3) TECHNICAL CORRECTION.—Section 1839(b) 

24 of the Social Security Act (42 U.S.C. 1395r(b)) is 

25 amended by adding at the end the following new 


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1 sentence: ‘‘For purposes of determining any increase 

2 under this subsection for individuals whose enroll3 ment occurs on or after January 1, 2023, the second 

4 sentence of this subsection shall be applied by sub5 stituting ‘close of the month’ for ‘close of the enroll6 ment period’ each place it appears.’’. 

7 (4) REPORT.—Not later than January 1, 2023, 

8 the Secretary of Health and Human Services shall 

9 submit to the Committee on Ways and Means and 

10 Committee on Energy and Commerce of the House 

11 of Representatives and the Committee on Finance 

12 and Special Committee on Aging of the Senate a re13 port on how to align existing Medicare enrollment 

14 periods under title XVIII of the Social Security Act, 

15 including the general enrollment period under part 

16 B of such title and the annual, coordinated election 

17 period under the Medicare Advantage program 

18 under part C of such title and under the prescription 

19 drug program under part D of such title. Such re20 port shall include recommendations consistent with 

21 the goals of maximizing coverage continuity and 

22 choice and easing beneficiary transition. 

23 (5) GAO STUDY AND REPORT.— 

24 (A) STUDY.—The Comptroller General of 

25 the United States (in this section referred to as 


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1 the ‘‘Comptroller General’’) shall conduct a 

2 study on the activities carried out under this 

3 section. Such study shall include the following: 

4 (i) An analysis of the Social Security 

5 Administration’s use of the funds provided 

6 to carry out the activities described under 

7 this section and the amendments made by 

8 this section. The Comptroller General shall 

9 examine the amount of funds transferred 

10 from the Federal Hospital Insurance Trust 

11 Fund and the Federal Supplementary 

12 Medical Insurance Trust Fund, respec13 tively, for those activities; how the funds 

14 were spent; what procedures the agency 

15 had in place over the use of those funds; 

16 and how the agency complied with those 

17 procedures. 

18 (ii) An evaluation of the notices de19 scribed in sections 1143(a)(4)(A) and 

20 1144A(a) of the Social Security Act, in21 cluding, to the extent data is available, 

22 how the mailing of such notices affected 

23 enrollee behavior and the imposition of late 

24 enrollment penalties under Medicare Part 

25 B. 


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1 (iii) Any other area determined appro2 priate by the Comptroller General. 

3 (B) REPORT.—Not later than 5 years after 

4 the date of enactment of this section, the 

5 Comptroller General shall submit to the Com6 mittee on Ways and Means and Committee on 

7 Energy and Commerce of the House of Rep8 resentatives and the Committee on Finance of 

9 the Senate a report containing the results of 

10 the study conducted under paragraph (1), in11 cluding recommendations for any legislative and 

12 administrative actions as the Comptroller Gen13 eral determines appropriate. 

14 (c) FUNDING.—Section 1808 of the Social Security 

15 Act (42 U.S.C. 1395b–9) is amended by adding the end 

16 the following new subsection: 

17 ‘‘(e) FUNDING FOR IMPLEMENTATION OF BENE18 FICIARY ENROLLMENT NOTIFICATION AND ELIGIBILITY

19 SIMPLIFICATION.—For purposes of carrying out the provi20 sions of and the amendments made by section 2 of the 

21 BENES Act of 2020, the Secretary shall provide for the 

22 transfer, from the Federal Hospital Insurance Trust Fund 

23 under section 1817 and the Federal Supplementary Med24 ical Insurance Trust Fund under section 1841 (in such 

25 proportion as the Secretary determines appropriate), to 


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1 the Centers for Medicare & Medicaid Services Program 

2 Management Account, of $2,000,000 for each fiscal year 

3 beginning with fiscal year 2021, to remain available until 

4 expended.’’. 

5 SEC. 3. EXTENDED MONTHS OF COVERAGE OF IMMUNO6 SUPPRESSIVE DRUGS FOR KIDNEY TRANS7 PLANT PATIENTS AND OTHER RENAL DIALY8 SIS PROVISIONS. 

9 (a) MEDICARE ENTITLEMENT TO IMMUNO10 SUPPRESSIVE DRUGS FOR KIDNEY TRANSPLANT RECIPI11 ENTS.— 

12 (1) IN GENERAL.—Section 226A(b)(2) of the 

13 Social Security Act (42 U.S.C. 426–1(b)(2)) is 

14 amended by inserting ‘‘(except for eligibility for en15 rollment under part B solely for purposes of cov16 erage of immunosuppressive drugs described in sec17 tion 1861(s)(2)(J))’’ before ‘‘, with the thirty-sixth 

18 month’’. 

19 (2) INDIVIDUALS ELIGIBLE ONLY FOR COV20 ERAGE OF IMMUNOSUPPRESSIVE DRUGS.— 

21 (A) IN GENERAL.—Section 1836 of the So22 cial Security Act (42 U.S.C. 1395o) is amend23 ed— 

24 (i) by striking ‘‘Every’’ and inserting 

25 ‘‘(a) IN GENERAL.—Every’’; and 


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1 (ii) by adding at the end the following 

2 new subsection: 

3 ‘‘(b) INDIVIDUALS ELIGIBLE FOR IMMUNO4 SUPPRESSIVE DRUG COVERAGE.— 

5 ‘‘(1) IN GENERAL.—Except as provided under 

6 paragraph (2), every individual whose entitlement to 

7 insurance benefits under part A ends (whether be8 fore, on, or after January 1, 2023) by reason of sec9 tion 226A(b)(2) is eligible to enroll or to be deemed 

10 to have enrolled in the medical insurance program 

11 established by this part solely for purposes of cov12 erage of immunosuppressive drugs in accordance 

13 with section 1837(n). 

14 ‘‘(2) EXCEPTION IF OTHER COVERAGE IS

15 AVAILABLE.— 

16 ‘‘(A) IN GENERAL.—An individual de17 scribed in paragraph (1) shall not be eligible for 

18 enrollment in the program for purposes of cov19 erage described in such paragraph with respect 

20 to any period in which the individual, as deter21 mined in accordance with subparagraph (B)— 

22 ‘‘(i) is enrolled in a group health plan 

23 or group or individual health insurance 

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1 tion 2791 of the Public Health Service 

2 Act; 

3 ‘‘(ii) is enrolled for coverage under the 

4 TRICARE for Life program under section 

5 1086(d) of title 10, United States Code; 

6 ‘‘(iii) is enrolled under a State plan 

7 (or waiver of such plan) under title XIX 

8 and is eligible to receive benefits for im9 munosuppressive drugs described in this 

10 subsection under such plan (or such waiv11 er); 

12 ‘‘(iv) is enrolled under a State child 

13 health plan (or waiver of such plan) under 

14 title XXI and is eligible to receive benefits 

15 for such drugs under such plan (or such 

16 waiver); or 

17 ‘‘(v)(I) is enrolled in the patient en18 rollment system of the Department of Vet19 erans Affairs established and operated 

20 under section 1705 of title 38, United 

21 States Code; 

22 ‘‘(II) is not required to enroll under 

23 section 1705 of such title to receive im24 munosuppressive drugs described in this 

25 subsection; or 


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1 ‘‘(III) is otherwise eligible under a 

2 provision of title 38, United States Code, 

3 other than section 1710 of such title to re4 ceive immunosuppressive drugs described 

5 in this subsection. 

6 ‘‘(B) ELIGIBILITY DETERMINATIONS.— 

7 ‘‘(i) IN GENERAL.—The Secretary, in 

8 coordination with the Commissioner of So9 cial Security, shall establish a process for 

10 determining whether an individual de11 scribed in paragraph (1) who is to be en12 rolled or deemed to be enrolled in the med13 ical insurance program described in such 

14 paragraph meets the requirements for such 

15 enrollment under this subsection, including 

16 the requirement that the individual not be 

17 enrolled in other coverage as described in 

18 subparagraph (A). 

19 ‘‘(ii) ATTESTATION REGARDING

20 OTHER COVERAGE.—The process estab21 lished under clause (i) shall include, at a 

22 minimum, a requirement that— 

23 ‘‘(I) the individual provide to the 

24 Commissioner an attestation that the 

25 individual is not enrolled and does not 


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1 expect to enroll in such other cov2 erage; and 

3 ‘‘(II) the individual notify the 

4 Commissioner within 60 days of en5 rollment in such other coverage.’’. 

6 (B) CONFORMING AMENDMENT.— 

7 (i) IN GENERAL.—Sections 1837, 

8 1838, and 1839 of the Social Security Act 

9 (42 U.S.C. 1395p, 42 U.S.C. 1395q, 42 

10 U.S.C. 1395r) are each amended by strik11 ing ‘‘1836’’ and inserting ‘‘1836(a)’’ each 

12 place it appears. 

13 (ii) ADDITIONAL AMENDMENT.—Sec14 tion 1837(j)(1) of such Act (42 U.S.C. 

15 1395p(j)(1)) is amended by striking 

16 ‘‘1836(1)’’ and inserting ‘‘1836(a)(1)’’. 

17 (b) ENROLLMENT FOR INDIVIDUALS ONLY ELIGIBLE

18 FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—Sec19 tion 1837 of the Social Security Act (42 U.S.C. 1395p), 

20 as amended by section 2(b)(2)(A), is further amended by 

21 adding at the end the following new subsection: 

22 ‘‘(n)(1) Any individual who is eligible for coverage of 

23 immunosuppressive drugs under section 1836(b) may en24 roll or be deemed to have enrolled only in such manner 


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1 and form as may be prescribed by regulations, and only 

2 during an enrollment period described in this subsection. 

3 ‘‘(2) An individual described in paragraph (1) whose 

4 entitlement for hospital insurance benefits under part A 

5 ends by reason of section 226A(b)(2) prior to January 1, 

6 2023, may enroll beginning on October 1, 2022, or the 

7 day on which the individual first satisfies section 1836(b), 

8 whichever is later. 

9 ‘‘(3) An individual described in paragraph (1) whose 

10 entitlement for hospital insurance benefits under part A 

11 ends by reason of section 226A(b)(2) on or after January 

12 1, 2023, shall be deemed to have enrolled in the medical 

13 insurance program established by this part for purposes 

14 of coverage of immunosuppressive drugs. 

15 ‘‘(4) The Secretary shall establish a process under 

16 which an individual described in paragraph (1) whose 

17 other coverage described in section 1836(b)(2)(A), or cov18 erage under this part (including the medical insurance 

19 program established under this part for purposes of cov20 erage of immunosuppressive drugs), is terminated volun21 tarily or involuntary may enroll or reenroll, if applicable, 

22 in the medical insurance program established under this 

23 part for purposes of coverage of immunosuppressive 

24 drugs.’’. 


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1 (c) COVERAGE PERIOD FOR INDIVIDUALS ONLY ELI2 GIBLE FOR COVERAGE OF IMMUNOSUPPRESSIVE

3 DRUGS.— 

4 (1) IN GENERAL.—Section 1838 of the Social 

5 Security Act (42 U.S.C. 1395q), as amended by sec6 tion 2(b)(2)(B), is further amended by adding at the 

7 end the following new subsection: 

8 ‘‘(h) In the case of an individual described in section 

9 1836(b)(1), the following rules shall apply: 

10 ‘‘(1) In the case of such an individual who is 

11 deemed to have enrolled in part B for coverage of 

12 immunosuppressive drugs under section 1837(n)(3), 

13 such individual’s coverage period shall begin on the 

14 first day of the month in which the individual first 

15 satisfies section 1836(b). 

16 ‘‘(2) In the case of such an individual who en17 rolls (or reenrolls, if applicable) in part B for cov18 erage of immunosuppressive drugs under paragraph 

19 (2) or (4) of section 1837(n), such individual’s cov20 erage period shall begin on January 1, 2023, or the 

21 month following the month in which the individual 

22 so enrolls (or reenrolls), whichever is later. 

23 ‘‘(3) The provisions of subsections (b) and (d) 

24 shall apply with respect to an individual described in 

25 paragraph (1) or (2). 


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1 ‘‘(4) In addition to the reasons for termination 

2 under subsection (b), the coverage period of an indi3 vidual described in paragraph (1) or (2) shall end 

4 when the individual becomes entitled to benefits 

5 under this title under subsection (a) or (b) of section 

6 226, or under section 226A, or is no longer eligible 

7 for such coverage as a result of the application of 

8 section 1836(b)(2). 

9 ‘‘(5) The Secretary may conduct public edu10 cation activities to raise awareness of the availability 

11 of more comprehensive, individual health insurance 

12 coverage (as defined in section 2791 of the Public 

13 Health Service Act) for individuals eligible under 

14 section 1836(b) to enroll or to be deemed enrolled in 

15 the medical insurance program established under 

16 this part for purposes of coverage of immuno17 suppressive drugs.’’. 

18 (2) CONFORMING AMENDMENTS.—Section 

19 1838(b) of the Social Security Act (42 U.S.C. 

20 1395q(b)) is amended, in the matter following para21 graph (2), by inserting ‘‘or section 1837(n)(3)’’ after 

22 ‘‘section 1837(f)’’ each place it appears. 

23 (d) PREMIUMS FOR INDIVIDUALS ONLY ELIGIBLE

24 FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.— 


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1 (1) IN GENERAL.—Section 1839 of the Social 

2 Security Act (42 U.S.C. 1395r) is amended— 

3 (A) in subsection (b), by adding at the end 

4 the following new sentence: ‘‘No increase in the 

5 premium shall be effected for individuals who 

6 are enrolled pursuant to section 1836(b) for 

7 coverage only of immunosuppressive drugs.’’; 

8 and 

9 (B) by adding at the end the following new 

10 subsection: 

11 ‘‘(j) DETERMINATION OF PREMIUM FOR INDIVID12 UALS ONLY ELIGIBLE FOR COVERAGE OF IMMUNO13 SUPPRESSIVE DRUGS.—The Secretary shall, during Sep14 tember of each year (beginning with 2022), determine and 

15 promulgate a monthly premium rate for the succeeding 

16 calendar year for individuals enrolled only for the purpose 

17 of coverage of immunosuppressive drugs under section 

18 1836(b). Such premium shall be equal to 15 percent of 

19 the monthly actuarial rate for enrollees age 65 and over 

20 (as would be determined in accordance with subsection 

21 (a)(1) if the reference to ‘one-half’ in such subsection were 

22 a reference to ‘100 percent’) for that succeeding calendar 

23 year. The monthly premium of each individual enrolled for 

24 coverage of immunosuppressive drugs under section 

25 1836(b) for each month shall be the amount promulgated 


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1 in this subsection. In the case of such individual not other2 wise enrolled under this part, such premium shall be in 

3 lieu of any other monthly premium applicable under this 

4 section. Such amount shall be adjusted in accordance with 

5 subsections (c), (f), and (i), but shall not be adjusted 

6 under subsection (b).’’. 

7 (2) SPECIAL RULE FOR APPLICATION OF HOLD

8 HARMLESS PROVISIONS TO TRANSITIONING INDIVID9 UALS.—Section 1839(f) of the Social Security Act 

10 (42 U.S.C. 1395r(f)) is amended by adding at the 

11 end the following new sentence: ‘‘Any increase in the 

12 premium for an individual who was enrolled under 

13 section 1836(b) attributable to such individual oth14 erwise enrolling under this part shall not be taken 

15 into account in applying this subsection.’’. 

16 (3) SPECIAL RULE FOR APPLICATION OF PRE17 MIUM SUBSIDY REDUCTION PROVISIONS.—Section 

18 1839(i)(3)(A)(ii)(II) of the Social Security Act (42 

19 U.S.C. 1395r(i)(3)(A)(ii)(II)) is amended by insert20 ing ‘‘except in the case of an individual enrolled 

21 under section 1836(b) and not otherwise enrolled 

22 under this part,’’ before ‘‘4 times’’. 

23 (e) GOVERNMENT CONTRIBUTION.—Section 1844(a) 

24 of the Social Security Act (42 U.S.C. 1395w(a)) is amend25 ed— 


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1 (1) in paragraph (3), by striking the period at 

2 the end and inserting ‘‘; plus’’; 

3 (2) by inserting after paragraph (3) the fol4 lowing new paragraph: 

5 ‘‘(4) a Government contribution equal to the es6 timated aggregate reduction in premiums payable 

7 under part B that results from establishing the pre8 mium at 15 percent of the actuarial rate (as would 

9 be determined in accordance with section 1839(a)(1) 

10 if the reference to ‘one-half’ in such section were a 

11 reference to ‘100 percent’) under section 1839(j) in12 stead of 25 percent of such rate (as so determined) 

13 for individuals enrolled only for the purpose of cov14 erage of immunosuppressive drugs under section 

15 1836(b).’’; and 

16 (3) by adding the following sentence at the end 

17 of the flush matter following paragraph (4), as 

18 added by paragraph (2) of this subsection: 

19 ‘‘The Government contribution under paragraph (4) 

20 shall be treated as premiums payable and deposited 

21 for purposes of subparagraphs (A) and (B) of para22 graph (1).’’. 

23 (f) ENSURING COVERAGE UNDER THE MEDICARE

24 SAVINGS PROGRAM.— 


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1 (1) IN GENERAL.—Section 1905(p)(1)(A) of the 

2 Social Security Act (42 U.S.C. 1396d(p)(1)(A)) is 

3 amended by inserting ‘‘or who is enrolled under part 

4 B for the purpose of coverage of immunosuppressive 

5 drugs under section 1836(b)’’ after ‘‘under section 

6 1818A)’’. 

7 (2) CONFORMING AMENDMENTS.—Section 

8 1902(a)(10)(E) of the Social Security Act (42 

9 U.S.C. 1396a(a)(10)(E)) is amended in each of 

10 clauses (iii) and (iv) by inserting ‘‘(including such 

11 individuals enrolled under section 1836(b))’’ after 

12 ‘‘section 1905(p)(1)’’. 

13 (g) PART D.—Section 1860D–1(a)(3)(A) of the So14 cial Security Act (42 U.S.C. 1395w–101(a)(3)(A)) is 

15 amended by inserting ‘‘(but not including an individual en16 rolled solely for coverage of immunosuppressive drugs 

17 under section 1836(b))’’ before the period at the end. 

18 (h) GAO STUDY AND REPORT.— 

19 (1) STUDY.—The Comptroller General of the 

20 United States (in this subsection referred to as the 

21 ‘‘Comptroller General’’) shall conduct a study on the 

22 implementation of coverage of immunosuppressive 

23 drugs for kidney transplant patients under the Medi24 care program pursuant to the provisions of, and 

25 amendments made by, this section. 


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1 (2) REPORT.—Not later than January 1, 2025, 

2 the Comptroller General shall submit to Congress a 

3 report on the study conducted under paragraph (1), 

4 together with recommendations as the Comptroller 

5 General determines appropriate. 

6 SEC. 4. TRANSPARENCY OF MEDICARE SECONDARY PAYER 

7 REPORTING INFORMATION. 

8 (a) IN GENERAL.—Section 1862(b)(8)(G) of the So9 cial Security Act (42 U.S.C. 395y(b)(8)(G)) is amended— 

10 (1) by striking ‘‘INFORMATION.—The Sec11 retary’’ and inserting ‘‘INFORMATION.— 

12 ‘‘(i) IN GENERAL.—The Secretary’’; 

13 and 

14 (2) by adding at the end the following new 

15 clause: 

16 ‘‘(ii) SPECIFIED INFORMATION.—In 

17 responding to any query from an applica18 ble plan related to a determination de19 scribed in subparagraph (A)(i), the Sec20 retary, notwithstanding any other provision 

21 of law, shall provide to such applicable 

22 plan— 

23 ‘‘(I) whether a claimant subject 

24 to the query is, or during the pre25 ceding 3-year period has been, entitled 


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1 to benefits under the program under 

2 this title on any basis; and 

3 ‘‘(II) to the extent applicable, the 

4 plan name and address of any Medi5 care Advantage plan under part C 

6 and any prescription drug plan under 

7 part D in which the claimant is en8 rolled or has been enrolled during 

9 such period.’’. 

10 (b) EFFECTIVE DATE.—The amendments made by 

11 subsection (a) shall apply with respect to queries from 

12 plans made on or after the date that is one year after 

13 the date of the enactment of this Act. 

14 SEC. 5. ESTABLISHING HOSPICE PROGRAM SURVEY AND 

15 ENFORCEMENT PROCEDURES UNDER THE 

16 MEDICARE PROGRAM. 

17 (a) SURVEY AND ENFORCEMENT PROCEDURES.— 

18 (1) IN GENERAL.—Part A of title XVIII of the 

19 Social Security Act (42 U.S.C. 1395c et seq.) is 

20 amended by adding at the end the following new sec21 tion: 

22 ‘‘SEC. 1822. HOSPICE PROGRAM SURVEY AND ENFORCE23 MENT PROCEDURES. 

24 ‘‘(a) SURVEYS.— 


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1 ‘‘(1) FREQUENCY.—Any entity that is certified 

2 as a hospice program shall be subject to a standard 

3 survey by an appropriate State or local survey agen4 cy, or an approved accreditation agency, as deter5 mined by the Secretary, not less frequently than 

6 once every 36 months (and not less frequently than 

7 once every 24 months beginning October 1, 2021). 

8 ‘‘(2) PUBLIC TRANSPARENCY OF SURVEY AND

9 CERTIFICATION INFORMATION.— 

10 ‘‘(A) SUBMISSION OF INFORMATION TO

11 THE SECRETARY.— 

12 ‘‘(i) IN GENERAL.—Each State, and 

13 each national accreditation body with re14 spect to which the Secretary has made a 

15 finding under section 1865(a) respecting 

16 the accreditation of a hospice program by 

17 such body, shall submit, in a form and 

18 manner, and at a time, specified by the 

19 Secretary for purposes of this subpara20 graph, information respecting any survey 

21 or certification made with respect to a hos22 pice program by such State or body, as ap23 plicable. Such information shall include 

24 any inspection report made by such State 

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1 tification, any enforcement actions taken 

2 as a result of such survey or certification, 

3 and any other information determined ap4 propriate by the Secretary. 

5 ‘‘(ii) REQUIRED INCLUSION OF SPECI6 FIED FORM.—With respect to a survey 

7 under this subsection carried out by a na8 tional accreditation body described in 

9 clause (i) on or after October 1, 2021, in10 formation described in such clause shall in11 clude Form 2567 (or a successor form), 

12 along with such additional information de13 termined appropriate by such body. 

14 ‘‘(B) PUBLIC DISCLOSURE OF INFORMA15 TION.—Beginning not later than October 1, 

16 2022, the Secretary shall publish the informa17 tion submitted under subparagraph (A) on the 

18 public website of the Centers for Medicare & 

19 Medicaid Services in a manner that is promi20 nent, easily accessible, readily understandable, 

21 and searchable. The Secretary shall provide for 

22 the timely update of such information so pub23 lished. 

24 ‘‘(3) CONSISTENCY OF SURVEYS.—Each State 

25 and the Secretary shall implement programs to 


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1 measure and reduce inconsistency in the application 

2 of survey results among surveyors. 

3 ‘‘(4) SURVEY TEAMS.— 

4 ‘‘(A) IN GENERAL.—In the case of a sur5 vey conducted under this subsection on or after 

6 October 1, 2021, by more than 1 individual, 

7 such survey shall be conducted by a multidisci8 plinary team of professionals (including a reg9 istered professional nurse). 

10 ‘‘(B) PROHIBITION OF CONFLICTS OF IN11 TEREST.—Beginning October 1, 2021, a State 

12 may not use as a member of a survey team 

13 under this subsection an individual who is serv14 ing (or has served within the previous 2 years) 

15 as a member of the staff of, or as a consultant 

16 to, the program surveyed respecting compliance 

17 with the requirements of section 1861(dd) or 

18 who has a personal or familial financial interest 

19 in the program being surveyed. 

20 ‘‘(C) TRAINING.—The Secretary shall pro21 vide, not later than October 1, 2021, for the 

22 comprehensive training of State and Federal 

23 surveyors, and any surveyor employed by a na24 tional accreditation body described in paragraph 

25 (2)(A)(i), in the conduct of surveys under this 


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1 subsection, including training with respect to 

2 the review of written plans for providing hospice 

3 care (as described in section 1814(a)(7)(B)). 

4 No individual shall serve as a member of a sur5 vey team with respect to a survey conducted on 

6 or after such date unless the individual has suc7 cessfully completed a training and testing pro8 gram in survey and certification techniques that 

9 has been approved by the Secretary. 

10 ‘‘(5) FUNDING.—The Secretary shall provide 

11 for the transfer, from the Federal Hospital Insur12 ance Trust Fund under section 1817 to the Centers 

13 for Medicare & Medicaid Services Program Manage14 ment Account, of $10,000,000 for each fiscal year 

15 (beginning with fiscal year 2022) for purposes of 

16 carrying out this subsection and subsection (b). 

17 Sums so transferred shall remain available until ex18 pended. Any transfer pursuant to this paragraph 

19 shall be in addition to any transfer pursuant to sec20 tion 3(a)(2) of the Improving Medicare Post-Acute 

21 Care Transformation Act of 2014. 

22 ‘‘(b) SPECIAL FOCUS PROGRAM.— 

23 ‘‘(1) IN GENERAL.—The Secretary shall con24 duct a special focus program for enforcement of re25 quirements for hospice programs that the Secretary 


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1 has identified as having substantially failed to meet 

2 applicable requirements of this Act. 

3 ‘‘(2) PERIODIC SURVEYS.—Under such special 

4 focus program, the Secretary shall conduct surveys 

5 of each hospice program in the special focus pro6 gram not less than once every 6 months. 

7 ‘‘(c) ENFORCEMENT.— 

8 ‘‘(1) SITUATIONS INVOLVING IMMEDIATE JEOP9 ARDY.—If the Secretary determines on the basis of 

10 a standard survey or otherwise that a hospice pro11 gram that is certified for participation under this 

12 title is no longer in compliance with the require13 ments specified in section 1861(dd) and determines 

14 that the deficiencies involved immediately jeopardize 

15 the health and safety of the individuals to whom the 

16 program furnishes items and services, the Secretary 

17 shall take immediate action to remove the jeopardy 

18 and correct the deficiencies through the remedy de19 scribed in paragraph (5)(B)(iii) or terminate the cer20 tification of the program, and may provide, in addi21 tion, for 1 or more of the other remedies described 

22 in paragraph (5)(B). 

23 ‘‘(2) SITUATIONS NOT INVOLVING IMMEDIATE

24 JEOPARDY.—If the Secretary determines on the 

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1 pice program that is certified for participation under 

2 this title is no longer in compliance with the require3 ments specified in section 1861(dd) and determines 

4 that the deficiencies involved do not immediately 

5 jeopardize the health and safety of the individuals to 

6 whom the program furnishes items and services, the 

7 Secretary may (for a period not to exceed 6 months) 

8 impose remedies developed pursuant to paragraph 

9 (5)(A), in lieu of terminating the certification of the 

10 program. If, after such a period of remedies, the 

11 program is still no longer in compliance with such 

12 requirements, the Secretary shall terminate the cer13 tification of the program. 

14 ‘‘(3) PENALTY FOR PREVIOUS NONCOMPLI15 ANCE.—If the Secretary determines that a hospice 

16 program that is certified for participation under this 

17 title is in compliance with the requirements specified 

18 in section 1861(dd) but, as of a previous period, did 

19 not meet such requirements, the Secretary may pro20 vide for a civil monetary penalty under paragraph 

21 (5)(B)(i) for the days in which the Secretary finds 

22 that the program was not in compliance with such 

23 requirements. 

24 ‘‘(4) OPTION TO CONTINUE PAYMENTS FOR

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1 retary may continue payments under this title with 

2 respect to a hospice program not in compliance with 

3 the requirements specified in section 1861(dd) over 

4 a period of not longer than 6 months, if— 

5 ‘‘(A) the State or local survey agency finds 

6 that it is more appropriate to take alternative 

7 action to assure compliance of the program with 

8 such requirements than to terminate the certifi9 cation of the program; 

10 ‘‘(B) the program has submitted a plan 

11 and timetable for corrective action to the Sec12 retary for approval and the Secretary approves 

13 the plan of corrective action; and 

14 ‘‘(C) the program agrees to repay to the 

15 Federal Government payments received under 

16 this title during such period if the corrective ac17 tion is not taken in accordance with the ap18 proved plan and timetable. 

19 The Secretary shall establish guidelines for approval 

20 of corrective actions requested by hospice programs 

21 under this paragraph. 

22 ‘‘(5) REMEDIES.— 

23 ‘‘(A) DEVELOPMENT.— 


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1 ‘‘(i) IN GENERAL.—Not later than Oc2 tober 1, 2021, the Secretary shall develop 

3 and implement— 

4 ‘‘(I) a range of remedies to apply 

5 to hospice programs under the condi6 tions described in paragraphs (1) 

7 through (4); and 

8 ‘‘(II) appropriate procedures for 

9 appealing determinations relating to 

10 the imposition of such remedies. 

11 Remedies developed pursuant to the pre12 ceding sentence shall include the remedies 

13 specified in subparagraph (B). 

14 ‘‘(ii) CONDITIONS OF IMPOSITION OF

15 REMEDIES.—Not later than October 1, 

16 2021, the Secretary shall develop and im17 plement specific procedures with respect to 

18 the conditions under which each of the 

19 remedies developed under clause (i) is to 

20 be applied, including the amount of any 

21 fines and the severity of each of these rem22 edies. Such procedures shall be designed so 

23 as to minimize the time between identifica24 tion of deficiencies and imposition of these 

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1 tion of incrementally more severe fines for 

2 repeated or uncorrected deficiencies. 

3 ‘‘(B) SPECIFIED REMEDIES.—The rem4 edies specified in this subparagraph are the fol5 lowing: 

6 ‘‘(i) Civil monetary penalties in an 

7 amount not to exceed $10,000 for each day 

8 of noncompliance by a hospice program 

9 with the requirements specified in section 

10 1861(dd). 

11 ‘‘(ii) Suspension of all or part of the 

12 payments to which a hospice program 

13 would otherwise be entitled under this title 

14 with respect to items and services fur15 nished by a hospice program on or after 

16 the date on which the Secretary determines 

17 that remedies should be imposed pursuant 

18 to paragraph (2). 

19 ‘‘(iii) The appointment of temporary 

20 management to oversee the operation of 

21 the hospice program and to protect and as22 sure the health and safety of the individ23 uals under the care of the program while 

24 improvements are made in order to bring 


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1 the program into compliance with all such 

2 requirements. 

3 ‘‘(C) PROCEDURES.— 

4 ‘‘(i) CIVIL MONETARY PENALTIES.— 

5 ‘‘(I) IN GENERAL.—Subject to 

6 subclause (II), the provisions of sec7 tion 1128A (other than subsections 

8 (a) and (b)) shall apply to a civil mon9 etary penalty under this subsection in 

10 the same manner as such provisions 

11 apply to a penalty or proceeding 

12 under section 1128A(a). 

13 ‘‘(II) RETENTION OF AMOUNTS

14 FOR HOSPICE PROGRAM IMPROVE15 MENTS.—The Secretary may provide 

16 that any portion of civil monetary 

17 penalties collected under this sub18 section may be used to support activi19 ties that benefit individuals receiving 

20 hospice care, including education and 

21 training programs to ensure hospice 

22 program compliance with the require23 ments of section 1861(dd). 

24 ‘‘(ii) SUSPENSION OF PAYMENT.—A 

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1 paragraph (B)(ii) shall terminate when the 

2 Secretary finds that the program is in sub3 stantial compliance with all such require4 ments. 

5 ‘‘(iii) TEMPORARY MANAGEMENT.— 

6 The temporary management under sub7 paragraph (B)(iii) shall not be terminated 

8 until the Secretary has determined that the 

9 program has the management capability to 

10 ensure continued compliance with all the 

11 requirements referred to in such subpara12 graph. 

13 ‘‘(D) RELATIONSHIP TO OTHER REM14 EDIES.—The remedies developed under sub15 paragraph (A) are in addition to sanctions oth16 erwise available under State or Federal law and 

17 shall not be construed as limiting other rem18 edies, including any remedy available to an indi19 vidual at common law.’’. 

20 (2) AVAILABILITY OF HOSPICE ACCREDITATION

21 SURVEYS.—Section 1865(b) of the Social Security 

22 Act (42 U.S.C. 1395bb(b)) is amended by inserting 

23 ‘‘or, beginning on the date of the enactment of the 

24 BENES Act of 2020, a hospice program’’ after 

25 ‘‘home health agency’’. 


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1 (3) STATE PROVISION OF HOSPICE PROGRAM

2 INFORMATION.— 

3 (A) IN GENERAL.—Section 1864(a) of the 

4 Social Security Act (42 U.S.C. 1395aa(a)) is 

5 amended in the sixth sentence— 

6 (i) by inserting ‘‘and hospice pro7 grams’’ after ‘‘information on home health 

8 agencies’’; 

9 (ii) by inserting ‘‘or the hospice pro10 gram’’ after ‘‘the home health agency’’; 

11 (iii) by inserting ‘‘or the hospice pro12 gram’’ after ‘‘with respect to the agency’’; 

13 and 

14 (iv) by inserting ‘‘and hospice pro15 grams’’ after ‘‘with respect to home health 

16 agencies’’. 

17 (B) EFFECTIVE DATE.—The amendments 

18 made by subparagraph (A) shall apply with re19 spect to agreements entered into on or after, or 

20 in effect as of, the date that is 1 year after the 

21 date of the enactment of this Act. 

22 (4) CONFORMING AMENDMENTS.— 

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1 rity Act (42 U.S.C. 1395x(dd)(4)) is amended 

2 by striking subparagraph (C). 

3 (B) CONTINUATION OF FUNDING.—Section 

4 3(a)(2) of the Improving Medicare Post-Acute 

5 Care Transformation Act of 2014 is amended 

6 by inserting ‘‘and section 1822(a)(1) of such 

7 Act,’’ after ‘‘as added by paragraph (1),’’. 

8 (b) INCREASING PAYMENT REDUCTIONS FOR FAIL9 URE TO MEET QUALITY DATA REPORTING REQUIRE10 MENTS.—Section 1814(i)(5)(A)(i) of the Social Security 

11 Act (42 U.S.C. 1395f(i)(5)(A)(i)) is amended by inserting 

12 ‘‘(or, for fiscal year 2023 and each subsequent fiscal year, 

13 4 percentage points)’’ before the period. 

14 (c) REPORT.—Not later than 36 months after the 

15 date of the enactment of this Act, the Comptroller General 

16 of the United States shall submit to the Committee on 

17 Ways and Means of the House of Representatives and the 

18 Committee on Finance of the Senate a report containing 

19 an analysis of the effects of the amendments made by sub20 section (a), including the frequency of application of rem21 edies specified in section 1822(c)(5)(B) of the Social Secu22 rity Act (as added by such subsection), on access to, and 

23 quality of, care furnished by hospice programs under part 


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1 A of title XVIII of the Social Security Act (42 U.S.C. 

2 1395c et seq.). 

Passed the House of Representatives December 8, 

2020. 

Attest: CHERYL L. JOHNSON, 

Clerk. 


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