II 

111TH CONGRESS 

1ST SESSION S. 1185 

To amend titles XVIII and XIX of the Social Security Act to ensure that 

low-income beneficiaries have improved access to health care under the 

Medicare and Medicaid programs. 

IN THE SENATE OF THE UNITED STATES 

JUNE 4, 2009 

Mr. BINGAMAN introduced the following bill; which was read twice and 

referred to the Committee on Finance 

A BILL 

To amend titles XVIII and XIX of the Social Security Act 

to ensure that low-income beneficiaries have improved 

access to health care under the Medicare and Medicaid 

programs. 

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; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Medicare Financial Stability for Beneficiaries Act of 

6 2009’’. 

7 (b) TABLE OF CONTENTS.—The table of contents of 

8 this Act is as follows: 


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Sec. 1. Short title; table of contents. 

Sec. 2. Eligibility for other programs. 

Sec. 3. Cost-sharing protections for low-income subsidy-eligible individuals. 

Sec. 4. Modification of resource standards for determination of eligibility for 

LIS; no consideration of pension or retirement plan in determination of resources. 

Sec. 5. Increase in income levels for eligibility. 

Sec. 6. Effective date of MSP benefits. 

Sec. 7. Expanding special enrollment process to individuals eligible for an income-related subsidy. 

Sec. 8. Enhanced cost-sharing protections for full-benefit dual eligible individuals and qualified medicare beneficiaries. 

Sec. 9. Two-way deeming between Medicare Savings Program and Low-Income 

Subsidy Program. 

Sec. 10. Improving linkages between health programs and snap. 

Sec. 11. Expediting low-income subsidies under the Medicare prescription drug 

program. 

Sec. 12. Enhanced oversight and enforcement relating to reimbursements for 

retroactive LIS enrollment. 

Sec. 13. Intelligent assignment in enrollment. 

Sec. 14. Medicare enrollment assistance. 

Sec. 15. QMB buy-in of part A and part B premiums. 

Sec. 16. Increasing availability of MSP applications through availability on the 

internet and designation of preferred language. 

Sec. 17. State Medicaid agency consideration of low-income subsidy application 

and data transmittal. 

1 SEC. 2. ELIGIBILITY FOR OTHER PROGRAMS. 

2 (a) LIS.—Section 1860D–14(a)(3) of the Social Se3 curity Act (42 U.S.C. 1395w–114(a)(3)), as amended by 

4 section 116 of the Medicare Improvements for Patients 

5 and Providers Act of 2008 (Public Law 110–275), is 

6 amended— 

7 (1) in subparagraph (A), in the matter pre8 ceding clause (i), by striking ‘‘subparagraph (F)’’ 

9 and inserting ‘‘subparagraphs (F) and (H)’’; and 

10 (2) by adding at the end the following new sub11 paragraph: 

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1 ERAL AND STATE PROGRAMS.—Notwithstanding 

2 any other provision of law, any premium or 

3 cost-sharing subsidy with respect to a subsidy4 eligible individual under this section shall not 

5 be considered income or resources in deter6 mining eligibility for, or the amount of assist7 ance or benefits provided under, any other pub8 lic benefit provided under Federal law or the 

9 law of any State or political subdivision there10 of.’’. 

11 (b) MSP.—Section 1905(p) of the Social Security 

12 Act (42 U.S.C. 1396d(p)) is amended— 

13 (1) by redesignating paragraph (6) as para14 graph (7); and 

15 (2) by inserting after paragraph (5) the fol16 lowing new paragraph: 

17 ‘‘(6) Notwithstanding any other provision of law, any 

18 medical assistance for some or all medicare cost-sharing 

19 under this title shall not be considered income or resources 

20 in determining eligibility for, or the amount of assistance 

21 or benefits provided under, any other public benefit pro22 vided under Federal law or the law of any State or polit23 ical subdivision thereof’’. 


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1 (c) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to eligibility for benefits on or after 

3 January 1, 2010. 

4 SEC. 3. COST-SHARING PROTECTIONS FOR LOW-INCOME 

5 SUBSIDY-ELIGIBLE INDIVIDUALS. 

6 (a) IN GENERAL.—Section 1860D–14(a) of the So7 cial Security Act (42 U.S.C. 1395w–114(a)) is amended— 

8 (1) in paragraph (1)(D), by adding at the end 

9 the following new clause: 

10 ‘‘(iv) OVERALL LIMITATION ON COST11 SHARING.—In the case of all such individ12 uals, a limitation on aggregate cost-sharing 

13 under this part for a year not to exceed 

14 2.5 percent of income.’’; and 

15 (2) in paragraph (2), by adding at the end the 

16 following new subparagraph: 

17 ‘‘(F) OVERALL LIMITATION ON COST-SHAR18 ING.—A limitation on aggregate cost-sharing 

19 under this part for a year not to exceed 2.5 per20 cent of income.’’. 

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

22 subsection (a) shall apply as of January 1, 2010. 


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1 SEC. 4. MODIFICATION OF RESOURCE STANDARDS FOR DE2 TERMINATION OF ELIGIBILITY FOR LIS; NO 

3 CONSIDERATION OF PENSION OR RETIRE4 MENT PLAN IN DETERMINATION OF RE5 SOURCES. 

6 (a) ELIMINATING THE BIFURCATION OF RESOURCE

7 STANDARDS.— 

8 (1) IN GENERAL.—Section 1860D– 

9 14(a)(3)(A)(iii) of the Social Security Act (42 

10 U.S.C. 1395w–114(a)(3)(A)(iii)) is amended by 

11 striking ‘‘meets the’’ and all that follows through the 

12 period at the end and inserting ‘‘meets— 

13 ‘‘(I) in the case of determinations 

14 made before January 1, 2011, the re15 source requirement described in sub16 paragraph (D) or (E); and 

17 ‘‘(II) in the case of determina18 tions made on or after January 1, 

19 2011, the resource requirement de20 scribed in subparagraph (E).’’. 

21 (2) CONFORMING AMENDMENT.—Section 

22 1860D–14(a)(3)(D)(ii) of the Social Security Act 

23 (42 U.S.C. 1395w–114(a)(3)(D)(ii)) is amended by 

24 inserting ‘‘(before 2011)’’ after ‘‘a subsequent year’’. 

25 (b) INCREASING THE APPLICABLE RESOURCE

26 STANDARD.—Section 1860D–14(a)(3)(E) of the Social 


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1 Security Act (42 U.S.C. 1395w–114(a)(3)(E)(i)) is 

2 amended— 

3 (1) in the heading, by striking ‘‘ALTERNATIVE’’ 

4 and inserting ‘‘APPLICABLE’’; 

5 (2) in clause (i)— 

6 (A) in subclause (I), by striking ‘‘and’’ at 

7 the end; 

8 (B) in subclause (II)— 

9 (i) by inserting ‘‘(before 2011)’’ after 

10 ‘‘a subsequent year’’; 

11 (ii) by striking the period at the end 

12 and inserting a semicolon; and 

13 (iii) by inserting before the flush sen14 tence at the end the following new sub15 clauses: 

16 ‘‘(III) for 2011, $27,500 (or 

17 $55,000 in the case of the combined 

18 value of the individual’s assets or re19 sources and the assets or resources of 

20 the individual’s spouse); and 

21 ‘‘(IV) for a subsequent year the 

22 dollar amounts specified in this sub23 clause (or subclause (III)) for the pre24 vious year increased by the annual 

25 percentage increase in the consumer 


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1 price index (all items; U.S. city aver2 age) as of September of such previous 

3 year.’’; and 

4 (C) in the flush sentence at the end, by in5 serting ‘‘or (IV)’’ after ‘‘subclause (II)’’. 

6 (c) EXCLUSION OF PENSION AND RETIREMENT BEN7 EFITS FROM RESOURCES.— 

8 (1) IN GENERAL.—Section 1860D–14(a)(3) of 

9 the Social Security Act (42 U.S.C. 1395w– 

10 114(a)(3)), as amended by section 2, is amended— 

11 (A) in subparagraph (E)(i), in the matter 

12 preceding subclause (I), by inserting ‘‘and the 

13 pension or retirement plan exclusion provided 

14 under subparagraph (I)’’ after ‘‘(G)’’; and 

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

16 subparagraph: 

17 ‘‘(I) PENSION AND RETIREMENT BENEFITS

18 EXCLUSION.—In determining the resources of 

19 an individual (and the eligible spouse of the in20 dividual, if any) under section 1613 for pur21 poses of subparagraph (E) no balance in, or 

22 benefits received under, an employee pension 

23 benefit plan (as defined in section 3 of the Em24 ployee Retirement Income Security Act of 

25 1974) shall be taken into account.’’. 


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1 (2) EFFECTIVE DATE.—The amendments made 

2 by this subsection shall apply to determinations 

3 made on or after January 1, 2011. 

4 (d) APPLICATION OF APPLICABLE RESOURCE

5 STANDARD UNDER MEDICARE SAVINGS PROGRAM AND

6 EXEMPTIONS FROM INCOME AND RESOURCES.— 

7 (1) APPLICATION OF APPLICABLE RESOURCE

8 STANDARD AND EXEMPTIONS FROM RESOURCES.— 

9 Section 1905(p)(1)(C) of the Social Security Act (42 

10 U.S.C. 1396d(p)(1)(C)) is amended— 

11 (A) by inserting ‘‘without taking into ac12 count any part of the value of any life insur13 ance policy or any balance in, or benefits re14 ceived under, an employee pension benefit plan 

15 (as defined in section 3 of the Employee Retire16 ment Income Security Act of 1974)’’ after ‘‘(as 

17 so determined’’; and 

18 (B) by striking ‘‘subparagraph (D)’’ and 

19 all that follows through ‘‘section)’’ and inserting 

20 ‘‘section 1860D–14(a)(3)(E)’’. 

21 (2) EXEMPTION OF IN-KIND SUPPORT AND

22 MAINTENANCE.— 

23 (A) IN GENERAL.—Section 1905(p)(1)(B) 

24 of the Social Security Act (42 U.S.C. 

25 1396d(p)(1)(B)) is amended by inserting ‘‘and 


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1 except that support and maintenance furnished 

2 in kind shall not be counted as income’’ after 

3 ‘‘(2)(D)’’. 

4 (B) CONFORMING AMENDMENT.—Section 

5 1860D–14(a)(3)(C)(i) of the Social Security 

6 Act (42 U.S.C. 1395w–114(a)(3)(C)(i)) is 

7 amended by striking ‘‘and except that support 

8 and maintenance furnished in kind shall not be 

9 counted as income’’. 

10 (3) EFFECTIVE DATE.—The amendments made 

11 by this subsection shall apply to determinations 

12 made on or after January 1, 2011. 

13 (e) CLARIFICATION RELATING TO INCLUDING RE14 TIREMENT BENEFITS AS INCOME.—Nothing in subpara15 graph (I) of section 1860D–14(a)(3) of the Social Security 

16 Act (42 U.S.C. 1395w–114(a)(3)), as added by subsection 

17 (c)(1), or section 1905(p)(1)(C) of such Act (42 U.S.C. 

18 1396d(p)(1)(C)), as amended by subsection (d)(1), shall 

19 be construed as affecting the inclusion of retirement bene20 fits as income under section 1612(a)(2)(B) of such Act 

21 (42 U.S.C. 1382a(a)(2)(B)). 

22 SEC. 5. INCREASE IN INCOME LEVELS FOR ELIGIBILITY. 

23 (a) LIS.— 


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1 (1) IN GENERAL.—Section 1860D–14(a) of the 

2 Social Security Act (42 U.S.C. 1395w–114(a)) is 

3 amended— 

4 (A) in the subsection heading, by striking 

5 ‘‘150’’ and inserting ‘‘200’’; 

6 (B) in paragraph (1)— 

7 (i) in the heading, by striking ‘‘135’’ 

8 and inserting ‘‘150’’; and 

9 (ii) in the matter preceding subpara10 graph (A), by striking ‘‘135’’ and inserting 

11 ‘‘150’’; 

12 (C) in paragraph (2)— 

13 (i) in the heading, by striking ‘‘150’’ 

14 and inserting ‘‘200’’; and 

15 (ii) in subparagraph (A)— 

16 (I) by striking ‘‘135’’ and insert17 ing ‘‘150’’; and 

18 (II) by striking ‘‘150’’ and in19 serting ‘‘200’’; and 

20 (D) in paragraph (3)(A)(ii), by striking 

21 ‘‘150’’ and inserting ‘‘200’’. 

22 (2) EFFECTIVE DATE.—The amendments made 

23 by this subsection shall apply to determinations 

24 made on or after January 1, 2011. 

25 (b) MSP.— 


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1 (1) INCREASE TO 150 PERCENT OF FPL FOR

2 QUALIFIED MEDICARE BENEFICIARIES.— 

3 (A) IN GENERAL.—Section 1905(p)(2) of 

4 the Social Security Act (42 U.S.C. 

5 1396d(p)(2)) is amended— 

6 (i) in subparagraph (A), by striking 

7 ‘‘100 percent’’ and inserting ‘‘150 per8 cent’’; 

9 (ii) in subparagraph (B)— 

10 (I) by striking ‘‘and’’ at the end 

11 of clause (ii); 

12 (II) by striking the period at the 

13 end of clause (iii) and inserting ‘‘, 

14 and’’; and 

15 (III) by adding at the end the 

16 following: 

17 ‘‘(iv) January 1, 2011, is 150 percent.’’; and 

18 (iii) in subparagraph (C)— 

19 (I) by striking ‘‘and’’ at the end 

20 of clause (iii); 

21 (II) by striking the period at the 

22 end of clause (iv) and inserting ‘‘, 

23 and’’; and 

24 (III) by adding at the end the 

25 following: 


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1 ‘‘(v) January 1, 2011, is 150 percent.’’. 

2 (B) APPLICATION OF INCOME TEST BASED

3 ON FAMILY SIZE.—Section 1905(p)(2)(A) of 

4 such Act (42 U.S.C. 1396d(p)(2)(A)) is amend5 ed by adding at the end the following: ‘‘For 

6 purposes of this subparagraph, family size 

7 means the applicant, the spouse (if any) of the 

8 applicant if living in the same household as the 

9 applicant, and the number of individuals who 

10 are related to the applicant (or applicants), who 

11 are living in the same household as the appli12 cant (or applicants), and who are dependent on 

13 the applicant (or the applicant’s spouse) for at 

14 least one-half of their financial support.’’. 

15 (2) EXPANSION OF SPECIFIED LOW-INCOME

16 MEDICARE BENEFICIARY (SLMB) PROGRAM.— 

17 (A) ELIGIBILITY OF INDIVIDUALS WITH

18 INCOMES BELOW 200 PERCENT OF FPL.—Sec19 tion 1902(a)(10)(E) of the Social Security Act 

20 (42 U.S.C. 1396b(a)(10)(E)) is amended— 

21 (i) by adding ‘‘and’’ at the end of 

22 clause (ii); 

23 (ii) in clause (iii)— 

24 (I) by striking ‘‘and 120 percent 

25 in 1995 and years thereafter’’ and inVerDate Nov 24 2008 06:24 Jun 05, 2009 Jkt 079200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\S1185.IS S1185

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1 serting ‘‘, or 120 percent in 1995 and 

2 any succeeding year before 2011, or 

3 200 percent beginning in 2011’’; and 

4 (II) by striking ‘‘and’’ at the end; 

5 and 

6 (iii) by striking clause (iv). 

7 (B) REVISION TO DESCRIPTION.—Section 

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

9 (42 U.S.C. 1396b(a)(10)(E)(iii)) is amended by 

10 striking ‘‘who would be qualified medicare’’ and 

11 all that follows through ‘‘but is less than’’ and 

12 inserting ‘‘whose income (as determined in ac13 cordance with subparagraphs (B) and (C) of 

14 section 1905(p)(1)) is less than’’. 

15 (C) REFERENCES.—Section 1905(p)(1) of 

16 such Act (42 U.S.C. 1396d(p)(1)) is amended 

17 by adding at and below subparagraph (C) the 

18 following: ‘‘The term ‘specified low-income 

19 medicare beneficiary’ means an individual de20 scribed in section 1902(a)(10)(E)(iii).’’. 

21 (3) PROVIDING 100 PERCENT FEDERAL FINANC22 ING.—The third sentence of section 1905(b) of such 

23 Act (42 U.S.C. 1396d(b)) is amended by inserting 

24 before the period at the end the following: ‘‘, with 

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1 ing provided under clause (i) of section 

2 1902(a)(10)(E) for individuals with incomes greater 

3 than 100 percent of the official poverty line de4 scribed in subsection (p)(2)(A) and less than or 

5 equal to 150 percent of such official poverty line, 

6 and with respect to medical assistance for medicare 

7 cost-sharing provided under clause (iii) of such sec8 tion’’. 

9 (4) EFFECTIVE DATE.— 

10 (A) Except as provided in subparagraph 

11 (B), the amendments made by this subsection 

12 shall take effect on January 1, 2011, and, with 

13 respect to title XIX of the Social Security Act, 

14 shall apply to calendar quarters beginning on or 

15 after January 1, 2011. 

16 (B) In the case of a State plan for medical 

17 assistance under title XIX of the Social Secu18 rity Act which the Secretary of Health and 

19 Human Services determines requires State leg20 islation (other than legislation appropriating 

21 funds) in order for the plan to meet the addi22 tional requirements imposed by the amend23 ments made by this subsection, the State plan 

24 shall not be regarded as failing to comply with 

25 the requirements of such title solely on the 


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1 basis of its failure to meet these additional re2 quirements before the first day of the first cal3 endar quarter beginning after the close of the 

4 first regular session of the State legislature that 

5 begins after the date of the enactment of this 

6 Act. For purposes of the previous sentence, in 

7 the case of a State that has a 2-year legislative 

8 session, each year of such session shall be 

9 deemed to be a separate regular session of the 

10 State legislature. 

11 SEC. 6. EFFECTIVE DATE OF MSP BENEFITS. 

12 (a) IN GENERAL.— 

13 (1) EFFECTIVE DATE OF MSP BENEFITS.—Sec14 tion 1905(a) of the Social Security Act (42 U.S.C. 

15 1396d(a)) is amended, in the matter preceding para16 graph (1), by striking ‘‘assistance or, in the case of 

17 medicare cost-sharing’’ and all that follows through 

18 ‘‘beneficiary)’’ and inserting ‘‘assistance)’’. 

19 (2) CONFORMING AMENDMENTS.—(A) Section 

20 1902(e)(8) of the Social Security Act (42 U.S.C. 

21 1396a(e)(8)) is amended by striking the first sen22 tence. 

23 (B) Section 1848(g)(3) of such Act (42 U.S.C. 

24 1395w–4(g)(3)) is amended by adding at the end 

25 the following new subparagraph: 


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1 ‘‘(C) TREATMENT OF RETROACTIVE ELIGI2 BILITY.—In the case of an individual who is de3 termined to be eligible for medical assistance 

4 described in subparagraph (A) retroactively, the 

5 Secretary shall provide a process whereby 

6 claims which are submitted for services fur7 nished during the period of retroactive eligi8 bility and during a month in which the indi9 vidual otherwise would have been eligible for 

10 such assistance and which were not submitted 

11 in accordance with such subparagraph are re12 submitted and re-processed in accordance with 

13 such subparagraph.’’. 

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

15 this section shall take effect on January 1, 2010, but shall 

16 not result in eligibility for benefits for medicare cost-shar17 ing for months before January 2010. 

18 SEC. 7. EXPANDING SPECIAL ENROLLMENT PROCESS TO 

19 INDIVIDUALS ELIGIBLE FOR AN INCOME-RE20 LATED SUBSIDY. 

21 (a) IN GENERAL.—Section 1860D–1(b)(1)(C) of the 

22 Social Security Act (42 U.S.C. 1395w–101(b)(1)(C)) is 

23 amended— 

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1 serting ‘‘a subsidy-eligible individual (as defined in 

2 section 1860D–14(a)(3))’’; and 

3 (2) by striking ‘‘1860D–14(a)(1)(A)’’ and in4 serting ‘‘subsection (a)(1)(A) or (b)(1)(A) of section 

5 1860D–14, as applicable’’ 

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

7 this section shall apply to enrollments on or after January 

8 1, 2010. 

9 SEC. 8. ENHANCED COST-SHARING PROTECTIONS FOR 

10 FULL-BENEFIT DUAL ELIGIBLE INDIVIDUALS 

11 AND QUALIFIED MEDICARE BENEFICIARIES. 

12 (a) ELIMINATION OF PART D COST-SHARING FOR

13 CERTAIN NON-INSTITUTIONALIZED FULL-BENEFIT DUAL

14 ELIGIBLE INDIVIDUALS.—Section 1860D–14(a)(1)(D)(i) 

15 of the Social Security Act (42 U.S.C. 1395w– 

16 114(a)(1)(D)(i)) is amended— 

17 (1) in the heading, by striking ‘‘INSTITU18 TIONALIZED INDIVIDUALS.—In’’ and inserting 

19 ‘‘ELIMINATION OF COST-SHARING FOR CERTAIN

20 FULL-BENEFIT DUAL ELIGIBLE INDIVIDUALS.— 

21 ‘‘(I) INSTITUTIONALIZED INDI22 VIDUALS.—In’’; and 

23 (2) by adding at the end the following new sub24 clause: 


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1 ‘‘(II) CERTAIN OTHER INDIVID2 UALS.—In the case of an individual 

3 who is a full-benefit dual eligible indi4 vidual who is receiving home and com5 munity based care (whether under 

6 section 1915 or under a waiver under 

7 section 1115), the elimination of any 

8 beneficiary coinsurance described in 

9 section 1860D–2(b)(2) (for all 

10 amounts through the total amount of 

11 expenditures at which benefits are 

12 available under section 1860D– 

13 2(b)(4)).’’. 

14 (b) REPEAL OF AUTHORITY FOR STATES TO PAY

15 MEDICARE COST-SHARING AT MEDICAID RATES AND

16 PROVISION OF MEDICAL ASSISTANCE TO DUAL ELIGI17 BLES IN MA PLANS.— 

18 (1) REPEAL OF AUTHORITY FOR STATES TO

19 PAY MEDICARE COST-SHARING AT MEDICAID

20 RATES.—Section 1902(n) of the Social Security Act 

21 (42 U.S.C. 1396a(n)) is amended— 

22 (A) by striking paragraph (2); 

23 (B) by redesignating paragraph (3) as 

24 paragraph (2); 


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1 (C) in paragraph (2), as redesignated by 

2 subparagraph (B)— 

3 (i) in the matter preceding subpara4 graph (A)— 

5 (I) by striking ‘‘In the case in 

6 which a State’s payment for’’ and in7 serting ‘‘With respect to’’; and 

8 (II) by striking ‘‘with respect to 

9 an item or service is reduced or elimi10 nated through the application of para11 graph (2)’’ and inserting ‘‘for an item 

12 or service’’; and 

13 (ii) in subparagraph (A), by striking 

14 ‘‘(if any)’’; and 

15 (D) by adding at the end the following new 

16 paragraph: 

17 ‘‘(3) Each State shall establish procedures for 

18 receiving and processing claims for payment for 

19 medicare cost-sharing with respect to items or serv20 ices furnished to qualified medicare beneficiaries by 

21 providers of services and suppliers under title XVIII 

22 who are not participating providers under the State 

23 plan.’’. 

24 (2) PROVISION OF MEDICAL ASSISTANCE TO

25 DUAL ELIGIBLES IN MA PLANS.—Section 1902(n) of 


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1 the Social Security Act (42 U.S.C. 1396a(n)), as 

2 amended by paragraph (1), is amended by adding at 

3 the end the following new paragraph: 

4 ‘‘(4)(A) Each State shall— 

5 ‘‘(i) identify those individuals who are eli6 gible for medical assistance for medicare cost7 sharing and who are enrolled with a Medicare 

8 Advantage plan under part C of title XVIII; 

9 and 

10 ‘‘(ii) for the individuals so identified, pro11 vide for payment of medical assistance for the 

12 medicare cost-sharing (including cost-sharing 

13 under a Medicare Advantage plan) to which 

14 they are entitled. 

15 ‘‘(B)(i) The Inspector General of the Depart16 ment of Health and Human Services shall examine, 

17 not later than one year after the date of the enact18 ment of this paragraph and every 3 years thereafter, 

19 whether States are providing for medical assistance 

20 for medicare cost-sharing for individuals enrolled in 

21 Medicare Advantage plans in accordance with this 

22 title. The Inspector General shall submit to the Sec23 retary a report on such examination and a finding 

24 as to whether States are failing to provide such med25 ical assistance. 


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1 ‘‘(ii) If a report under clause (i) includes a find2 ing that States are failing to provide such medical 

3 assistance, not later than 60 days after the date of 

4 receiving such report the Secretary shall submit to 

5 Congress a report that includes a plan of action on 

6 how to enforce such requirement.’’. 

7 (3) CONFORMING AMENDMENTS.— 

8 (A) PROVIDER AGREEMENTS.—Section 

9 1866(a)(1)(A)(ii) of the Social Security Act (42 

10 U.S.C. 1395cc(a)(1)(A)(ii)) is amended by 

11 striking ‘‘1902(n)(3)’’ and inserting 

12 ‘‘1902(n)(2)’’. 

13 (B) NONPARTICIPATING PROVIDERS.—Sec14 tion 1848(g)(3)(A) of the Social Security Act 

15 (42 U.S.C. 1395w–4(g)(3)(A)) is amended by 

16 striking ‘‘1902(n)(3)(A)’’ and inserting 

17 ‘‘1902(n)(2)(A)’’. 

18 (4) EFFECTIVE DATE.— 

19 (A) IN GENERAL.—Except as provided in 

20 subparagraph (B), the amendments made by 

21 this subsection shall take effect on the date of 

22 enactment of this Act. 

23 (B) EXCEPTION.—The amendment made 

24 by paragraph (2) shall be effective and apply as 

25 if included in the enactment of the Medicare 


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1 Prescription Drug, Improvement, and Mod2 ernization Act of 2003 (Public Law 108–173). 

3 SEC. 9. TWO-WAY DEEMING BETWEEN MEDICARE SAVINGS 

4 PROGRAM AND LOW-INCOME SUBSIDY PRO5 GRAM. 

6 (a) LOW-INCOME SUBSIDY PROGRAM.—Section 

7 1860D–14(a)(3) of the Social Security Act (42 U.S.C. 

8 1395w–104(a)(3)), as amended by section 4, is amended 

9 by adding at the end the following new subparagraph: 

10 ‘‘(J) DEEMED TREATMENT FOR QUALIFIED

11 MEDICARE BENEFICIARIES AND SPECIFIED

12 LOW-INCOME MEDICARE BENEFICIARIES.— 

13 ‘‘(i) QMBS ELIGIBLE FOR FULL SUB14 SIDY.—A part D eligible individual who 

15 has been determined for purposes of title 

16 XIX to be a qualified medicare beneficiary 

17 is deemed, for purposes of this part and 

18 without the need to file any additional ap19 plication, to be a subsidy eligible individual 

20 described in paragraph (1). 

21 ‘‘(ii) SLMBS ELIGIBLE FOR PARTIAL

22 SUBSIDY.—A part D eligible individual 

23 who has been determined to be a specified 

24 low-income medicare beneficiary (as de25 fined in section 1905(p)(1)) and who is not 


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1 described in paragraph (1) is deemed, for 

2 purposes of this part and without the need 

3 to file any additional application, to be a 

4 subsidy eligible individual who is not de5 scribed in paragraph (1).’’. 

6 (b) MEDICARE SAVINGS PROGRAM.—Section 1905(p) 

7 of the Social Security Act (42 U.S.C. 1396d(p)), as 

8 amended by section 4, is amended— 

9 (1) by redesignating paragraph (8) as para10 graph (9); and 

11 (2) by inserting after paragraph (7) the fol12 lowing new paragraph: 

13 ‘‘(8) An individual who has been determined eligible 

14 for premium and cost-sharing subsidies under— 

15 ‘‘(A) section 1860D–14(a)(1) is deemed, for 

16 purposes of this title and without the need to file 

17 any additional application, to be a qualified medicare 

18 beneficiary for purposes of this title; or 

19 ‘‘(B) section 1860D–14(a)(2) is deemed, for 

20 purposes of this title and without the need to file 

21 any additional application, to qualify for medical as22 sistance as a specified low-income medicare bene23 ficiary (described in section 1902(a)(10)(E)(iii)).’’. 


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1 (c) EFFECTIVE DATE.—The amendments made by 

2 this section shall apply to eligibility for months beginning 

3 on or after January 2010. 

4 SEC. 10. IMPROVING LINKAGES BETWEEN HEALTH PRO5 GRAMS AND SNAP. 

6 (a) LOW-INCOME PART D SUBSIDY PROGRAM.—Sec7 tion 1144(c) of the Social Security Act (42 U.S.C. 1320b– 

8 14(c)) is amended— 

9 (1) in paragraph (1)(C) by striking ‘‘an appli10 cation for benefits under the Medicare Savings Pro11 gram.’’ and inserting ‘‘applications for benefits 

12 under the Medicare Savings Program and the sup13 plemental nutrition assistance program.’’; 

14 (2) by striking paragraph (3) and inserting the 

15 following: 

16 ‘‘(3) TRANSMITTAL OF DATA TO STATES.— 

17 ‘‘(A) IN GENERAL.—Beginning on January 

18 1, 2010, with the consent of an individual com19 pleting an application for benefits described in 

20 paragraph (1)(B), the Commissioner shall elec21 tronically transmit data from such applica22 tion— 

23 ‘‘(i) to the appropriate State Medicaid 

24 agency, as determined by the Commis25 sioner, which transmittal shall initiate an 


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1 application of the individual for benefits 

2 under the Medicare Savings Program with 

3 the State Medicaid agency; and 

4 ‘‘(ii) to the appropriate State agency 

5 which administers benefits under the sup6 plemental nutrition assistance program, as 

7 determined by the Commissioner, which 

8 transmittal shall initiate an application of 

9 the individual for benefits under the sup10 plemental nutrition assistance program 

11 with the State agency that administers 

12 that program. 

13 ‘‘(B) CONSULTATION REGARDING CON14 TENT, TIME, FORM, FREQUENCY AND MANNER

15 OF TRANSMISSION.—In order to ensure that 

16 such data transmittal provides effective assist17 ance for purposes of State adjudication of ap18 plications for benefits under the Medicare Sav19 ings Program and the supplemental nutrition 

20 assistance program, the Commissioner shall 

21 consult with the Secretary after the Secretary 

22 has consulted with the States, regarding the 

23 content, form, frequency, and manner in which 

24 data (on a uniform basis for all States) shall be 

25 transmitted under this paragraph.’’; 


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1 (3) in paragraph (5), by adding at the end the 

2 following new subparagraph: 

3 ‘‘(D) SUPPLEMENTAL NUTRITION ASSIST4 ANCE PROGRAM ADMINISTRATIVE COSTS.—The 

5 costs of the Social Security Administration’s 

6 work related to the supplemental nutrition as7 sistance program under this subsection shall be 

8 eligible for reimbursement under section 

9 11(j)(2)(C) of the Food and Nutrition Act of 

10 2008 (7 U.S.C. 2020(j)(2)(C)). To the extent 

11 necessary the Commissioner and the Secretary 

12 of Agriculture shall revise any memoranda of 

13 understanding in effect under such section.’’; 

14 and 

15 (4) by adding at the end the following new 

16 paragraph: 

17 ‘‘(8) SUPPLEMENTAL NUTRITION ASSISTANCE

18 PROGRAM DEFINED.—For purposes of this sub19 section, the term ‘supplemental nutrition assistance 

20 program’ means the program of temporary benefits 

21 authorized under section 11(v) of the Food and Nu22 trition Act of 2008 (7 U.S.C. 2020(v)).’’. 

23 (b) TEMPORARY SUPPLEMENTAL NUTRITION AS24 SISTANCE BENEFITS.—Section 11 of the Food and NutriVerDate Nov 24 2008 06:24 Jun 05, 2009 Jkt 079200 PO 00000 Frm 00026 Fmt 6652 Sfmt 6201 E:\BILLS\S1185.IS S1185

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1 tion Act of 2008 (7 U.S.C. 2020) is amended by adding 

2 at the end the following: 

3 ‘‘(v) TEMPORARY BENEFITS FOR MEDICARE PART D 

4 LOW INCOME SUBSIDY APPLICANTS.— 

5 ‘‘(1) DEFINITION OF MEDICARE PART D LOW

6 INCOME SUBSIDY APPLICANT.—In this subsection, 

7 the term ‘Medicare part D low income subsidy appli8 cant’ means an individual, along with any other fam9 ily members, whose low income subsidy application 

10 information has been electronically transmitted to 

11 the State agency under section 1144(c)(3) of the So12 cial Security Act (42 U.S.C. 1320b–14(c)(3)). 

13 ‘‘(2) PROVISION OF TEMPORARY BENEFITS.—A 

14 State agency shall provide temporary supplemental 

15 nutrition assistance program benefits to a Medicare 

16 part D low income subsidy applicant whose— 

17 ‘‘(A) income does not exceed 150 percent 

18 of the poverty line (as determined in accordance 

19 with section 5(c)(1)); and 

20 ‘‘(B) financial resources do not exceed the 

21 limit in effect in the State for such households 

22 under section 5. 

23 ‘‘(3) DETERMINATION BASED ON MEDICARE IN24 FORMATION.—For purposes of determining eligibility 

25 under paragraph (2) and the amount of temporary 


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1 benefits under paragraph (5), information on house2 hold members, household income, and household re3 sources from the Medicare part D low income sub4 sidy application as transmitted to the State agency 

5 under section 1144(c)(3) of the Social Security Act 

6 (42 U.S.C. 1320b–14(c)(3)) shall satisfy the require7 ments of this Act with regard to— 

8 ‘‘(A) the members of the household under 

9 section 3(n); and 

10 ‘‘(B) the gross income and financial re11 sources of the household under section 5. 

12 ‘‘(4) TEMPORARY BENEFIT PERIOD.—A house13 hold shall receive temporary supplemental nutrition 

14 assistance benefits under this subsection for a period 

15 of not more than 2 months. 

16 ‘‘(5) TEMPORARY BENEFIT AMOUNT.— 

17 ‘‘(A) IN GENERAL.—During the temporary 

18 benefit period under paragraph (4), except as 

19 provided in subparagraph (B), a household shall 

20 receive a monthly amount of supplemental nu21 trition assistance program benefits calculated 

22 under section 8(a). 

23 ‘‘(B) CALCULATION.—In calculating bene24 fits under subparagraph (A)— 


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1 ‘‘(i) the benefits shall be determined 

2 based on the gross income of the household 

3 rather than net income; and 

4 ‘‘(ii) the minimum allotment described 

5 in the proviso in section 8(a) shall be equal 

6 to 40 percent of the cost of the thrifty food 

7 plan for a household containing 1 member, 

8 as determined by the Secretary under sec9 tion 3, rounded to the nearest whole dollar 

10 increment. 

11 ‘‘(6) DETERMINATION OF FUTURE ELIGI12 BILITY.—During the temporary benefit period under 

13 paragraph (4), the State agency shall provide to the 

14 household— 

15 ‘‘(A) an application to apply for benefits 

16 under the other provisions of this Act; and 

17 ‘‘(B) an opportunity to complete the appli18 cation process by the month immediately fol19 lowing the temporary benefit period, without a 

20 delay or suspension in the benefits of the house21 hold. 

22 ‘‘(7) LIMITATION.—This subsection shall not 

23 apply to individuals who— 

24 ‘‘(A) are members of households that cur25 rently receive benefits under this Act; or 


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1 ‘‘(B) have received benefits under this sub2 section in the preceding 12-month period.’’. 

3 (c) MEDICARE SAVINGS PROGRAM APPLICATIONS.— 

4 (1) IN GENERAL.—Section 1902(a) of the So5 cial Security Act (42 U.S.C. 1396a(a)) is amend6 ed— 

7 (A) in paragraph (72), by striking ‘‘and’’ 

8 at the end; 

9 (B) in paragraph (73), by striking the pe10 riod at the end and inserting ‘‘; and’’; and 

11 (C) by inserting after paragraph (73) the 

12 following new paragraph: 

13 ‘‘(74) provide that the State coordinates with 

14 the State agency that administers benefits under the 

15 supplemental nutrition assistance program estab16 lished under the Food and Nutrition Act of 2008 (7 

17 U.S.C. 2011 et seq.) to ensure that individuals ap18 plying for medical assistance provided under section 

19 1902(a)(10)(E), as described in sections 1905(p) 

20 and 1933, have the opportunity to apply for, estab21 lish eligibility for, and, if eligible, receive supple22 mental nutrition assistance program benefits.’’. 

23 (2) EFFECTIVE DATE.— 

24 (A) IN GENERAL.—Except as provided in 

25 subparagraph (B), the amendments made by 


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1 paragraph (1) take effect on the date that is 1 

2 year after the date of enactment of this Act. 

3 (B) EXTENSION OF EFFECTIVE DATE FOR

4 STATE LAW AMENDMENT.—In the case of a 

5 State plan under title XIX of the Social Secu6 rity Act (42 U.S.C. 1396 et seq.) which the 

7 Secretary of Health and Human Services deter8 mines requires State legislation in order for the 

9 plan to meet the additional requirements im10 posed by the amendments made by paragraph 

11 (1), the State plan shall not be regarded as fail12 ing to comply with the requirements of such 

13 title solely on the basis of its failure to meet 

14 these additional requirements before the first 

15 day of the first calendar quarter beginning after 

16 the close of the first regular session of the 

17 State legislature that begins after the date of 

18 enactment of this Act. For purposes of the pre19 vious sentence, in the case of a State that has 

20 a 2-year legislative session, each year of the ses21 sion is considered to be a separate regular ses22 sion of the State legislature. 

23 (3) REPORT TO CONGRESS.—Not later than 2 

24 years after the date of enactment of this Act, the 

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1 mit to Congress a report on the process each State 

2 uses to meet the requirements under section 

3 1902(a)(74) of the Social Security Act, as added by 

4 subsection (c). 

5 SEC. 11. EXPEDITING LOW-INCOME SUBSIDIES UNDER THE 

6 MEDICARE PRESCRIPTION DRUG PROGRAM. 

7 (a) TARGETED OUTREACH FOR LOW-INCOME SUB8 SIDIES.— 

9 (1) IN GENERAL.—Section 1860D–14 of the 

10 Social Security Act (42 U.S.C. 1395w–114) is 

11 amended by adding at the end the following new 

12 subsection: 

13 ‘‘(e) TARGETED OUTREACH FOR LOW-INCOME SUB14 SIDIES.— 

15 ‘‘(1) TARGETED IDENTIFICATION OF SUBSIDY16 ELIGIBLE INDIVIDUALS.— 

17 ‘‘(A) IN GENERAL.—The Commissioner of 

18 Social Security shall provide for the identifica19 tion of individuals who are potentially eligible 

20 for low-income assistance under this section 

21 through requests to the Secretary of the Treas22 ury in accordance with the criterion established 

23 under section 6103(l)(21) of the Internal Rev24 enue Code of 1986 for information indicating 


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1 whether the individual involved is likely eligible 

2 for such assistance. 

3 ‘‘(B) INITIATION OF IDENTIFICATIONS.— 

4 Not later than 90 days after the date of the en5 actment of this subsection, the Commissioner of 

6 Social Security shall begin the identification of 

7 individuals through the process described in 

8 subparagraph (A) and shall, by such date and 

9 through such process, submit to the Secretary 

10 of the Treasury requests for part D eligible in11 dividuals who the Commissioner has identified 

12 as potentially eligible for low-income subsidies 

13 under this section before such date of enact14 ment. 

15 ‘‘(2) NOTIFICATION OF POTENTIALLY ELIGIBLE

16 INDIVIDUALS.—In the case of each individual identi17 fied under paragraph (1) who has not otherwise ap18 plied for, or been determined eligible for, benefits 

19 under this section (or who has applied for and been 

20 determined ineligible for such benefits based on ex21 cess income, resources, or both), the Commissioner 

22 shall transmit by mail to the individual a letter in23 cluding the information and application required to 

24 be provided under subparagraphs (A), (B), and (D) 

25 of section 1144(c)(1). 


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1 ‘‘(3) FOLLOW-UP COMMUNICATIONS.—If an in2 dividual to whom a letter is transmitted under para3 graph (2) does not affirmatively respond to such let4 ter either by making an enrollment, completing an 

5 application, or declining either or both, the Commis6 sioner shall make additional attempts to contact the 

7 individual to obtain such an affirmative response. 

8 ‘‘(4) USE OF PREFERRED LANGUAGE IN SUBSE9 QUENT COMMUNICATIONS.—In the case an applica10 tion is completed by an individual pursuant to this 

11 subsection in which a language other than English 

12 is specified, the Commissioner shall provide that 

13 subsequent communications under this part to the 

14 individual shall be in such language as needed. 

15 ‘‘(5) CONSTRUCTION.—Nothing in this sub16 section shall be construed as precluding the Commis17 sioner from taking additional outreach efforts to en18 roll eligible individuals under this part and to pro19 vide low-income subsidies to eligible individuals. 

20 ‘‘(6) MAINTENANCE OF EFFORT WITH RESPECT

21 TO OUTREACH.—In no case shall the level of effort 

22 with respect to outreach to and enrollment of indi23 viduals who are potentially eligible for low-income 

24 assistance under this section after the date of the 

25 enactment of this subsection be less than such level 


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1 of effort before such date of enactment until at least 

2 90 percent of such potentially eligible individuals 

3 have affirmatively responded. 

4 ‘‘(7) GAO REPORT TO CONGRESS.—Not later 

5 than 2 years after the date of the first submission 

6 to the Secretary of the Treasury described in para7 graph (1)(B), the Comptroller General of the United 

8 States shall submit to Congress a report, with re9 spect to the 18-month period following the establish10 ment of the process described in paragraph (1)(A), 

11 on— 

12 ‘‘(A) the extent to which the percentage of 

13 individuals who are eligible for low-income as14 sistance under this section but not enrolled 

15 under this part has decreased during such pe16 riod; 

17 ‘‘(B) how the Commissioner of Social Se18 curity has used any savings resulting from the 

19 implementation of this section and section 

20 6103(l)(21) of the Internal Revenue Code of 

21 1986 to improve outreach to individual de22 scribed in subparagraph (A) to increase enroll23 ment of such individuals under this part; 

24 ‘‘(C) the effectiveness of using information 

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1 ance with section 6103(l)(21) of the Internal 

2 Revenue Code of 1986 for purposes of indi3 cating whether individuals are eligible for low4 income assistance under this section; and 

5 ‘‘(D) the effectiveness of the outreach con6 ducted by the Commissioner of Social Security 

7 based on the data described in subparagraph 

8 (C).’’. 

9 (2) CONFORMING AMENDMENT.—Section 

10 1144(c)(1) of the Social Security Act (42 U.S.C. 

11 1320b–14(c)(1)) is amended by inserting ‘‘(including 

12 through request to the Secretary of the Treasury 

13 pursuant to section 1860D–14(e))’’ before ‘‘, the 

14 Commissioner shall’’. 

15 (b) IMPROVEMENTS TO THE LOW-INCOME SUBSIDY

16 APPLICATIONS.—Section 1860D–14(a)(3) of the Social 

17 Security Act (42 U.S.C. 1395w–114(a)(3)) is amended— 

18 (1) in subparagraph (E), by striking clauses (ii) 

19 and (iii) and redesignating clause (iv) as clause (ii); 

20 (2) by redesignating subparagraphs (F) and 

21 (G) as subparagraphs (G) and (H), respectively; and 

22 (3) by inserting after subparagraph (E) the fol23 lowing new subparagraph: 

24 ‘‘(F) SIMPLIFIED LOW-INCOME SUBSIDY

25 APPLICATION AND PROCESS.— 


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1 ‘‘(i) IN GENERAL.—The Secretary, 

2 jointly with the Commissioner of Social Se3 curity, shall— 

4 ‘‘(I) develop a model, simplified 

5 application form and process con6 sistent with clause (ii) for the deter7 mination and verification of a part D 

8 eligible individual’s assets or resources 

9 under this paragraph; and 

10 ‘‘(II) provide such form to 

11 States. 

12 ‘‘(ii) DOCUMENTATION AND SAFE13 GUARDS.—Under such process— 

14 ‘‘(I) the application form shall 

15 consist of an attestation under penalty 

16 of perjury regarding the level of assets 

17 or resources (or combined assets and 

18 resources in the case of a married 

19 part D eligible individual) and valu20 ations of general classes of assets or 

21 resources; 

22 ‘‘(II) such form shall not require 

23 the submittal of additional docu24 mentation regarding income or assets; 


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1 ‘‘(III) matters attested to in the 

2 application shall be subject to appro3 priate methods of administrative 

4 verification; 

5 ‘‘(IV) the applicant shall be per6 mitted to authorize another individual 

7 to act as the applicant’s personal rep8 resentative with respect to commu9 nications under this part and the en10 rollment of the applicant into a pre11 scription drug plan (or MA–PD plan) 

12 and for low-income subsidies under 

13 this section; and 

14 ‘‘(V) the application form shall 

15 allow for the specification of a lan16 guage (other than English) that is 

17 preferred by the individual for subse18 quent communications with respect to 

19 the individual under this part. 

20 ‘‘(iii) NO RECOVERY FOR CERTAIN

21 SUBSIDIES IMPROPERLY PAID.—If an indi22 vidual in good faith and in the absence of 

23 fraud is provided low-income subsidies 

24 under this section, and if the individual is 

25 subsequently found not eligible for such 


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1 subsidies, there shall be no recovery made 

2 against the individual because of such sub3 sidies improperly paid.’’. 

4 (c) DISCLOSURES TO FACILITATE IDENTIFICATION

5 OF INDIVIDUALS LIKELY TO BE ELIGIBLE FOR THE LOW6 INCOME ASSISTANCE UNDER THE MEDICARE PRESCRIP7 TION DRUG PROGRAM.— 

8 (1) IN GENERAL.— 

9 Subsection (l) of section 6103 of the Inter10 nal Revenue Code of 1986 is amended by add11 ing at the end the following new paragraph: 

12 ‘‘(21) DISCLOSURE OF RETURN INFORMATION

13 TO FACILITATE IDENTIFICATION OF INDIVIDUALS

14 LIKELY TO BE ELIGIBLE FOR LOW-INCOME SUB15 SIDIES UNDER MEDICARE PRESCRIPTION DRUG PRO16 GRAM.— 

17 ‘‘(A) IN GENERAL.—The Secretary, upon 

18 written request from the Commissioner of So19 cial Security, shall disclose to officers and em20 ployees of the Social Security Administration, 

21 with respect to any individual identified by the 

22 Commissioner— 

23 ‘‘(i) whether, based on the criterion 

24 determined under subparagraph (B), such 

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1 come assistance under section 1860D–14 

2 of the Social Security Act, or 

3 ‘‘(ii) that, based on such criterion, 

4 there is insufficient information available 

5 to the Secretary to make the determination 

6 described in clause (i). 

7 ‘‘(B) CRITERION.—Not later than 90 days 

8 after the date of the enactment of this para9 graph, the Secretary, in consultation with the 

10 Commissioner of Social Security, shall develop 

11 the criterion by which the determination under 

12 subparagraph (A)(i) shall be made (and the cri13 terion for determining that insufficient informa14 tion is available to make such determination). 

15 Such criterion may include analysis of informa16 tion available on such individual’s return, the 

17 return of such individual’s spouse, and any in18 formation related to such individual or such in19 dividual’s spouse which is available on any in20 formation return.’’. 

21 (2) PROCEDURES AND RECORDKEEPING RE22 LATED TO DISCLOSURES.—Paragraph (4) of section 

23 6103(p) of such Code is amended by striking ‘‘or 

24 (17)’’ each place it appears and inserting ‘‘(17), or 

25 (21)’’. 


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1 (3) EFFECTIVE DATE.—The amendments made 

2 by this subsection shall apply to disclosures made 

3 after the date of the enactment of this Act. 

4 SEC. 12. ENHANCED OVERSIGHT AND ENFORCEMENT RE5 LATING TO REIMBURSEMENTS FOR RETRO6 ACTIVE LIS ENROLLMENT. 

7 (a) IN GENERAL.—In the case of a retroactive LIS 

8 enrollment beneficiary (as defined in subsection (e)(4)) 

9 who is enrolled under a prescription drug plan under part 

10 D of title XVIII of the Social Security Act (or an MA– 

11 PD plan under part C of such title)— 

12 (1) the beneficiary (or any eligible third party) 

13 is entitled to reimbursement by the plan for covered 

14 drug costs (as defined in subsection (e)(1)) incurred 

15 by the beneficiary during the retroactive coverage 

16 period of the beneficiary in accordance with sub17 section (b) and in the case of such a beneficiary de18 scribed in subsection (e)(4)(A)(i), such reimburse19 ment shall be made automatically by the plan upon 

20 receipt of appropriate notice the beneficiary is eligi21 ble for assistance described in such subsection 

22 (e)(4)(A)(i) without further information required to 

23 be filed with the plan by the beneficiary; 


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1 (2) the Secretary of Health and Human Serv2 ices (in this section referred to as the ‘‘Secretary’’) 

3 shall not make payment to the plan— 

4 (A) in the case that the beneficiary is de5 scribed in subsection (e)(4)(A)(i), for premium 

6 subsidies and cost sharing subsidies under sec7 tion 1860D–14 of the Social Security Act (42 

8 U.S.C. 1395w–114) with respect to the provi9 sion of prescription drug coverage to the bene10 ficiary during such retroactive period; and 

11 (B) in the case that the beneficiary is de12 scribed in subsection (e)(4)(A)(ii), for direct 

13 subsidies under section 1860D–15(a)(1) of such 

14 Act and premium subsidies and cost-sharing 

15 subsidies under section 1860D–14 of such Act 

16 with respect to the provision of prescription 

17 drug coverage to the beneficiary during such 

18 retroactive period; 

19 unless the plan demonstrates to the Secretary that 

20 the plan has provided timely and accurate reim21 bursement to the beneficiary (or eligible third party) 

22 in accordance with paragraph (1); 

23 (3) the Secretary shall not make any payment 

24 described in paragraph (2) to the plan with respect 

25 to such beneficiary for any month of the retroactive 


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1 enrollment period during which no expenses for cov2 ered part D drugs (as defined in section 1860D–2(e) 

3 of the Social Security Act (42 U.S.C. 1395w– 

4 102(e)) were incurred by such beneficiary (or eligible 

5 third party on behalf of such beneficiary); and 

6 (4) any payment owed the plan pursuant to this 

7 section, taking into account paragraphs (2) and (3), 

8 shall be made at the time the Centers for Medicare 

9 & Medicaid Services reconciles payments for the en10 tire plan year following the end of the plan year, and 

11 not before such time. 

12 (b) ADMINISTRATIVE REQUIREMENTS RELATING TO

13 REIMBURSEMENTS.— 

14 (1) LINE-ITEM DESCRIPTION.—Each reimburse15 ment made by a prescription drug plan or MA–PD 

16 plan under subsection (a)(1) shall include a line-item 

17 description of the items for which the reimbursement 

18 is made. 

19 (2) TIMING OF REIMBURSEMENTS.—A prescrip20 tion drug plan or MA–PD plan must make a reim21 bursement under subsection (a)(1) to a retroactive 

22 LIS enrollment beneficiary, with respect to a claim, 

23 not later than 30 days after— 

24 (A) in the case of a beneficiary described 

25 in subsection (e)(4)(A)(i), the date on which the 


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1 plan receives notice from the Secretary that the 

2 beneficiary is eligible for assistance described in 

3 such subsection; or 

4 (B) in the case of a beneficiary described 

5 in subsection (e)(4)(A)(ii), the date on which 

6 the beneficiary files the claim with the plan. 

7 (c) NOTICE REQUIREMENTS.— 

8 (1) BY SECRETARY OF HHS AND COMMISSION

9 OF THE SOCIAL SECURITY ADMINISTRATION.—The 

10 Secretary, jointly with the Commissioner of the So11 cial Security Administration, shall ensure that each 

12 retroactive LIS enrollment beneficiary receives, with 

13 any letter or notification of eligibility for a low-in14 come subsidy under section 1860D–14 of the Social 

15 Security Act, a notice of their right to reimburse16 ment described in subsection (a)(1) for covered drug 

17 costs incurred during the retroactive coverage period 

18 of the beneficiary. Such notice shall— 

19 (A) with respect to a beneficiary described 

20 in subsection (e)(4)(A)(i), inform the bene21 ficiary of the beneficiary’s right to automatic 

22 reimbursement as described in subsection 

23 (a)(1); and 

24 (B) with respect to a beneficiary described 

25 in subsection (e)(4)(A)(ii), include a description 


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1 of a clear process that the beneficiary should 

2 follow to seek such reimbursement. 

3 (2) BY PRESCRIPTION DRUG PLANS.— 

4 (A) IN GENERAL.—Each prescription drug 

5 plan under part D of title XVIII of the Social 

6 Security Act (and MA–PD plan under part C of 

7 such title) shall include in a notice from the 

8 plan to a retroactive LIS enrollment beneficiary 

9 described in subsection (e)(4)(A)(ii) a model no10 tice developed under subparagraph (B) describ11 ing the process the beneficiary must follow to 

12 seek retroactive reimbursement. Such notice 

13 shall include any form required by the plan to 

14 complete such reimbursement and shall indicate 

15 the period of retroactive coverage for which the 

16 beneficiary is eligible for such reimbursement. 

17 (B) MODEL NOTICE.—The Secretary, 

18 jointly with the Commissioner of Social Secu19 rity, shall develop a model notice for purposes 

20 of subparagraph (A) and shall make such model 

21 notice available to all prescription drug plans 

22 under part D of title XVIII of the Social Secu23 rity Act (and MA–PD plans under part C of 

24 such title). 

25 (d) PUBLIC POSTING TO TRACK PAYMENTS.— 


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1 (1) IN GENERAL.—Not later than one year 

2 after the date of the enactment of this Act, the Sec3 retary shall post (and annually update) on the public 

4 Internet website of the Department of Health and 

5 Human Services information on the total amount of 

6 payments made by the Secretary under subsection 

7 (a)(2) to prescription drug plans during the most re8 cent plan year for which plan data is available. 

9 (2) SPECIFIC INFORMATION.—Such information 

10 posted— 

11 (A) in 2010 or in a subsequent year before 

12 2016, shall include information on payments 

13 made for years beginning with 2006 and ending 

14 with the year for which the most current infor15 mation is available; and 

16 (B) in 2016 or a subsequent year, shall in17 clude information on payments made for at 

18 least the 10 previous years. 

19 (e) DEFINITIONS.—In this section: 

20 (1) COVERED DRUG COSTS.—The term ‘‘cov21 ered drug costs’’ means, with respect to a retroactive 

22 LIS enrollment beneficiary enrolled under a pre23 scription drug plan under part D of title XVIII of 

24 the Social Security Act (or an MA–PD plan under 

25 part C of such title), the amount by which— 


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1 (A) the costs incurred by such beneficiary 

2 during the retroactive coverage period of the 

3 beneficiary for covered part D drugs, premiums, 

4 and cost-sharing under such title; exceeds 

5 (B) such costs that would have been in6 curred by such beneficiary during such period if 

7 the beneficiary had been both enrolled in the 

8 plan and recognized by such plan as qualified 

9 during such period for the low income subsidy 

10 under section 1860D–14 of the Social Security 

11 Act to which the individual is entitled. 

12 (2) ELIGIBLE THIRD PARTY.—The term ‘‘eligi13 ble third party’’ means, with respect to a retroactive 

14 LIS enrollment beneficiary, an organization or other 

15 third party that paid on behalf of such beneficiary 

16 for covered drug costs incurred by such beneficiary 

17 during the retroactive coverage period of such bene18 ficiary. 

19 (3) RETROACTIVE COVERAGE PERIOD.—The 

20 term ‘‘retroactive coverage period’’ means— 

21 (A) with respect to a retroactive LIS en22 rollment beneficiary described in paragraph 

23 (4)(A)(i), the period— 


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1 (i) beginning on the effective date of 

2 the assistance described in such paragraph 

3 for which the individual is eligible; and 

4 (ii) ending on the date the plan effec5 tuates the status of such individual as so 

6 eligible; and 

7 (B) with respect to a retroactive LIS en8 rollment beneficiary described in paragraph 

9 (4)(A)(ii), the period— 

10 (i) beginning on the date the indi11 vidual is both entitled to benefits under 

12 part A, or enrolled under part B, of title 

13 XVIII of the Social Security Act and eligi14 ble for medical assistance under a State 

15 plan under title XIX of such Act; and 

16 (ii) ending on the date the plan effec17 tuates the status of such individual as a 

18 full-benefit dual eligible individual (as de19 fined in section 1935(c)(6) of such Act). 

20 (4) RETROACTIVE LIS ENROLLMENT BENE21 FICIARY.— 

22 (A) IN GENERAL.—The term ‘‘retroactive 

23 LIS enrollment beneficiary’’ means an indi24 vidual who— 


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1 (i) is enrolled in a prescription drug 

2 plan under part D of title XVIII of the So3 cial Security Act (or an MA–PD plan 

4 under part C of such title) and subse5 quently becomes eligible as a full-benefit 

6 dual eligible individual (as defined in sec7 tion 1935(c)(6) of such Act), an individual 

8 receiving a low-income subsidy under sec9 tion 1860D–14 of such Act, an individual 

10 receiving assistance under the Medicare 

11 Savings Program implemented under 

12 clauses (i), (ii), (iii), and (iv) of section 

13 1902(a)(10)(E) of such Act, or an indi14 vidual receiving assistance under the sup15 plemental security income program under 

16 section 1611 of such Act; or 

17 (ii) subject to subparagraph (B)(i), is 

18 a full-benefit dual eligible individual (as 

19 defined in section 1935(c)(6) of such Act) 

20 who is automatically enrolled in such a 

21 plan under section 1860D–1(b)(1)(C) of 

22 such Act. 

23 (B) EXCEPTION FOR BENEFICIARIES EN24 ROLLED IN RFP PLAN.— 


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1 (i) IN GENERAL.—In no case shall an 

2 individual described in subparagraph 

3 (A)(ii) include an individual who is en4 rolled, pursuant to a RFP contract de5 scribed in clause (ii), in a prescription 

6 drug plan offered by the sponsor of such 

7 plan awarded such contract. 

8 (ii) RFP CONTRACT DESCRIBED.— 

9 The RFP contract described in this section 

10 is a contract entered into between the Sec11 retary and a sponsor of a prescription drug 

12 plan pursuant to the Centers for Medicare 

13 & Medicaid Services’ request for proposals 

14 issued on February 17, 2009, relating to 

15 Medicare part D retroactive coverage for 

16 certain low income beneficiaries, or a simi17 lar subsequent request for proposals. 

18 (f) GAO REPORT.—Not later than 24 months after 

19 the date of the enactment of this Act, the Comptroller 

20 General of the United States shall submit to Congress a 

21 report on the extent to which the provisions of this section 

22 improve reimbursement for covered drug costs to retro23 active LIS enrollment beneficiaries and lower the amounts 

24 of payments made by the Secretary, with respect to such 

25 beneficiaries, to prescription drug plans under part D of 


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1 title XVIII of the Social Security Act (and MA–PD plans 

2 under part C of such title). 

3 (g) REPORT TO CONGRESS.—In the case that an 

4 RFP contract described in subsection (e)(4)(B)(ii) is 

5 awarded, not later than two years after the effective date 

6 of such contract, the Secretary of Health and Human 

7 Services shall submit to Congress a report evaluating the 

8 program carried out through such contract. 

9 (h) EFFECTIVE DATE.—Paragraphs (2) and (3) of 

10 subsection (a) and subsections (b) and (c) shall apply to 

11 subsidy determinations made on or after the date that is 

12 3 months after the date of the enactment of this Act. 

13 SEC. 13. INTELLIGENT ASSIGNMENT IN ENROLLMENT. 

14 (a) IN GENERAL.—Section 1860D–1(b)(1) of the So15 cial Security Act (42 U.S.C. 1395w–101(b)(1), as amend16 ed by section 7(b), is amended— 

17 (1) in the second sentence of subparagraph (C), 

18 by striking ‘‘on a random basis among all such 

19 plans’’ and inserting ‘‘, subject to subparagraph (E), 

20 in the most appropriate plan for such individual’’; 

21 and 

22 (2) by adding at the end the following new sub23 paragraph: 

24 ‘‘(E) INTELLIGENT ASSIGNMENT.—In the 

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1 graph (C), no part D eligible individual de2 scribed in such subparagraph shall be enrolled 

3 in a prescription drug plan which does not meet 

4 requirements established by the Secretary.’’. 

5 (b) EFFECTIVE DATE.—The amendment made by 

6 subsection (a) shall apply to enrollments effected on or 

7 after November 15, 2010. 

8 SEC. 14. MEDICARE ENROLLMENT ASSISTANCE. 

9 (a) ADDITIONAL FUNDING FOR STATE HEALTH IN10 SURANCE ASSISTANCE PROGRAMS.— 

11 (1) GRANTS.— 

12 (A) IN GENERAL.—The Secretary of 

13 Health and Human Services (in this section re14 ferred to as the ‘‘Secretary’’) shall use amounts 

15 made available under subparagraph (B) to 

16 make grants to States for State health insur17 ance assistance programs receiving assistance 

18 under section 4360 of the Omnibus Budget 

19 Reconciliation Act of 1990. 

20 (B) FUNDING.—For purposes of making 

21 grants under this subsection, the Secretary 

22 shall provide for the transfer, from the Federal 

23 Hospital Insurance Trust Fund under section 

24 1817 of the Social Security Act (42 U.S.C. 

25 1395i) and the Federal Supplementary Medical 


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1 Insurance Trust Fund under section 1841 of 

2 such Act (42 U.S.C. 1395t), in the same pro3 portion as the Secretary determines under sec4 tion 1853(f) of such Act (42 U.S.C. 1395w– 

5 23(f)), of $14,000,000 to the Centers for Medi6 care & Medicaid Services Program Management 

7 Account for fiscal year 2011, to remain avail8 able until expended. 

9 (2) AMOUNT OF GRANTS.—The amount of a 

10 grant to a State under this subsection from the total 

11 amount made available under paragraph (1) shall be 

12 equal to the sum of the amount allocated to the 

13 State under paragraph (3)(A) and the amount allo14 cated to the State under subparagraph (3)(B). 

15 (3) ALLOCATION TO STATES.— 

16 (A) ALLOCATION BASED ON PERCENTAGE

17 OF LOW-INCOME BENEFICIARIES.—The amount 

18 allocated to a State under this subparagraph 

from 2 19 ⁄3 of the total amount made available 

20 under paragraph (1) shall be based on the num21 ber of individuals who meet the requirement 

22 under subsection (a)(3)(A)(ii) of section 

23 1860D–14 of the Social Security Act (42 

24 U.S.C. 1395w–114) but who have not enrolled 

25 to receive a subsidy under such section 1860D– 


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1 14 relative to the total number of individuals 

2 who meet the requirement under such sub3 section (a)(3)(A)(ii) in each State, as estimated 

4 by the Secretary. 

5 (B) ALLOCATION BASED ON PERCENTAGE

6 OF RURAL BENEFICIARIES.—The amount allo7 cated to a State under this subparagraph from 

1 8 ⁄3 of the total amount made available under 

9 paragraph (1) shall be based on the number of 

10 part D eligible individuals (as defined in section 

11 1860D–1(a)(3)(A) of such Act (42 U.S.C. 

12 1395w–101(a)(3)(A))) residing in a rural area 

13 relative to the total number of such individuals 

14 in each State, as estimated by the Secretary. 

15 (4) PORTION OF GRANT BASED ON PERCENT16 AGE OF LOW-INCOME BENEFICIARIES TO BE USED

17 TO PROVIDE OUTREACH TO INDIVIDUALS WHO MAY

18 BE SUBSIDY ELIGIBLE INDIVIDUALS OR ELIGIBLE

19 FOR THE MEDICARE SAVINGS PROGRAM.—Each 

20 grant awarded under this subsection with respect to 

21 amounts allocated under paragraph (3)(A) shall be 

22 used to provide outreach to individuals who may be 

23 subsidy eligible individuals (as defined in section 

24 1860D–14(a)(3)(A) of the Social Security Act (42 

25 U.S.C. 1395w–114(a)(3)(A)) or eligible for the 


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1 Medicare Savings Program (as defined in subsection 

2 (f)). 

3 (b) ADDITIONAL FUNDING FOR AREA AGENCIES ON

4 AGING.— 

5 (1) GRANTS.— 

6 (A) IN GENERAL.—The Secretary, acting 

7 through the Assistant Secretary for Aging, shall 

8 make grants to States for area agencies on 

9 aging (as defined in section 102 of the Older 

10 Americans Act of 1965 (42 U.S.C. 3002)) and 

11 Native American programs carried out under 

12 the Older Americans Act of 1965 (42 U.S.C. 

13 3001 et seq.). 

14 (B) FUNDING.—For purposes of making 

15 grants under this subsection, the Secretary 

16 shall provide for the transfer, from the Federal 

17 Hospital Insurance Trust Fund under section 

18 1817 of the Social Security Act (42 U.S.C. 

19 1395i) and the Federal Supplementary Medical 

20 Insurance Trust Fund under section 1841 of 

21 such Act (42 U.S.C. 1395t), in the same pro22 portion as the Secretary determines under sec23 tion 1853(f) of such Act (42 U.S.C. 1395w– 

24 23(f)), of $10,000,000 to the Administration on 


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1 Aging for fiscal year 2011, to remain available 

2 until expended. 

3 (2) AMOUNT OF GRANT AND ALLOCATION TO

4 STATES BASED ON PERCENTAGE OF LOW-INCOME

5 AND RURAL BENEFICIARIES.—The amount of a 

6 grant to a State under this subsection from the total 

7 amount made available under paragraph (1) shall be 

8 determined in the same manner as the amount of a 

9 grant to a State under subsection (a), from the total 

10 amount made available under paragraph (1) of such 

11 subsection, is determined under paragraph (2) and 

12 subparagraphs (A) and (B) of paragraph (3) of such 

13 subsection. 

14 (3) REQUIRED USE OF FUNDS.— 

15 (A) ALL FUNDS.—Subject to subparagraph 

16 (B), each grant awarded under this subsection 

17 shall be used to provide outreach to eligible 

18 Medicare beneficiaries regarding the benefits 

19 available under title XVIII of the Social Secu20 rity Act. 

21 (B) OUTREACH TO INDIVIDUALS WHO MAY

22 BE SUBSIDY ELIGIBLE INDIVIDUALS OR ELIGI23 BLE FOR THE MEDICARE SAVINGS PROGRAM.— 

24 Subsection (a)(4) shall apply to each grant 

25 awarded under this subsection in the same 


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1 manner as it applies to a grant under sub2 section (a). 

3 (c) ADDITIONAL FUNDING FOR AGING AND DIS4 ABILITY RESOURCE CENTERS.— 

5 (1) GRANTS.— 

6 (A) IN GENERAL.—The Secretary shall 

7 make grants to Aging and Disability Resource 

8 Centers under the Aging and Disability Re9 source Center grant program that are estab10 lished centers under such program on the date 

11 of the enactment of this Act. 

12 (B) FUNDING.—For purposes of making 

13 grants under this subsection, the Secretary 

14 shall provide for the transfer, from the Federal 

15 Hospital Insurance Trust Fund under section 

16 1817 of the Social Security Act (42 U.S.C. 

17 1395i) and the Federal Supplementary Medical 

18 Insurance Trust Fund under section 1841 of 

19 such Act (42 U.S.C. 1395t), in the same pro20 portion as the Secretary determines under sec21 tion 1853(f) of such Act (42 U.S.C. 1395w– 

22 23(f)), of $10,000,000 to the Administration on 

23 Aging for fiscal year 2011, to remain available 

24 until expended. 


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1 (2) REQUIRED USE OF FUNDS.—Each grant 

2 awarded under this subsection shall be used to pro3 vide outreach to individuals regarding the benefits 

4 available under the Medicare prescription drug ben5 efit under part D of title XVIII of the Social Secu6 rity Act and under the Medicare Savings Program. 

7 (d) COORDINATION OF EFFORTS TO INFORM OLDER

8 AMERICANS ABOUT BENEFITS AVAILABLE UNDER FED9 ERAL AND STATE PROGRAMS.— 

10 (1) IN GENERAL.—The Secretary, acting 

11 through the Assistant Secretary for Aging, in co12 operation with related Federal agency partners, shall 

13 make a grant to, or enter into a contract with, a 

14 qualified, experienced entity under which the entity 

15 shall— 

16 (A) maintain and update web-based deci17 sion support tools, and integrated, person-cen18 tered systems, designed to inform older individ19 uals (as defined in section 102 of the Older 

20 Americans Act of 1965 (42 U.S.C. 3002)) 

21 about the full range of benefits for which the 

22 individuals may be eligible under Federal and 

23 State programs; 

24 (B) utilize cost-effective strategies to find 

25 older individuals with the greatest economic 


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1 need (as defined in such section 102) and in2 form the individuals of the programs; 

3 (C) develop and maintain an information 

4 clearinghouse on best practices and the most 

5 cost-effective methods for finding older individ6 uals with greatest economic need and informing 

7 the individuals of the programs; and 

8 (D) provide, in collaboration with related 

9 Federal agency partners administering the Fed10 eral programs, training and technical assistance 

11 on the most effective outreach, screening, and 

12 follow-up strategies for the Federal and State 

13 programs. 

14 (2) FUNDING.—For purposes of making a 

15 grant or entering into a contract under paragraph 

16 (1), the Secretary shall provide for the transfer, 

17 from the Federal Hospital Insurance Trust Fund 

18 under section 1817 of the Social Security Act (42 

19 U.S.C. 1395i) and the Federal Supplementary Med20 ical Insurance Trust Fund under section 1841 of 

21 such Act (42 U.S.C. 1395t), in the same proportion 

22 as the Secretary determines under section 1853(f) of 

23 such Act (42 U.S.C. 1395w–23(f)), of $10,000,000 

24 to the Administration on Aging for fiscal year 2011, 

25 to remain available until expended. 


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1 (e) MEDICARE SAVINGS PROGRAM DEFINED.—For 

2 purposes of this section, the term ‘‘Medicare Savings Pro3 gram’’ means the program of medical assistance for pay4 ment of the cost of medicare cost-sharing under the Med5 icaid program pursuant to sections 1902(a)(10)(E) and 

6 1933 of the Social Security Act (42 U.S.C. 

7 1396a(a)(10)(E), 1396u–3). 

8 SEC. 15. QMB BUY-IN OF PART A AND PART B PREMIUMS. 

9 (a) REQUIREMENT.—Section 1902(a) of the Social 

10 Security Act (42 U.S.C. 1396a(a)), as amended by section 

11 10, is amended— 

12 (1) in paragraph (73), by striking ‘‘and’’ at the 

13 end; 

14 (2) in paragraph (74), by striking the period at 

15 the end and inserting ‘‘; and’’; and 

16 (3) by inserting after paragraph (74) the fol17 lowing new paragraph: 

18 ‘‘(75) provide that the State enters into a modi19 fication of an agreement under section 1818(g).’’. 

20 (b) EFFECTIVE DATE.— 

21 (1) IN GENERAL.—Except as provided in para22 graph (2), the amendments made by this section 

23 take effect on the date that is 6 months after the 

24 date of enactment of this Act. 


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1 (2) EXTENSION OF EFFECTIVE DATE FOR

2 STATE LAW AMENDMENT.—In the case of a State 

3 plan under title XIX of the Social Security Act (42 

4 U.S.C. 1396 et seq.) which the Secretary of Health 

5 and Human Services determines requires State legis6 lation in order for the plan to meet the additional 

7 requirements imposed by the amendments made by 

8 this section, the State plan shall not be regarded as 

9 failing to comply with the requirements of such title 

10 solely on the basis of its failure to meet these addi11 tional requirements before the first day of the first 

12 calendar quarter beginning after the close of the 

13 first regular session of the State legislature that be14 gins after the date of enactment of this Act. For 

15 purposes of the previous sentence, in the case of a 

16 State that has a 2-year legislative session, each year 

17 of the session is considered to be a separate regular 

18 session of the State legislature. 

19 SEC. 16. INCREASING AVAILABILITY OF MSP APPLICATIONS 

20 THROUGH AVAILABILITY ON THE INTERNET 

21 AND DESIGNATION OF PREFERRED LAN22 GUAGE. 

23 (a) REQUIREMENT FOR STATES.— 


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1 (1) IN GENERAL.—Section 1902(a) of the So2 cial Security Act (42 U.S.C. 1396a(a)), as amended 

3 by section 15, is amended— 

4 (A) in paragraph (74), by striking ‘‘and’’ 

5 at the end; 

6 (B) in paragraph (75), by striking the pe7 riod at the end and inserting ‘‘; and’’; and 

8 (C) by inserting after paragraph (75) the 

9 following new paragraph: 

10 ‘‘(76) provide— 

11 ‘‘(A) that the application for medical as12 sistance for medicare cost-sharing under this 

13 title used by the State allows an individual to 

14 specify a preferred language for subsequent 

15 communication and, in the case in which a lan16 guage other than English is specified, provide 

17 that subsequent communications under this title 

18 to the individual shall be in such language; and 

19 ‘‘(B) that the State makes such application 

20 available through an Internet website and pro21 vides for such application to be completed on 

22 such website.’’. 

23 (2) EFFECTIVE DATE.— 

24 (A) IN GENERAL.—Except as provided in 

25 subparagraph (B), the amendments made by 


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1 this subsection take effect on the date that is 

2 2 years after the date of enactment of this Act. 

3 (B) EXTENSION OF EFFECTIVE DATE FOR

4 STATE LAW AMENDMENT.—In the case of a 

5 State plan under title XIX of the Social Secu6 rity Act (42 U.S.C. 1396 et seq.) which the 

7 Secretary of Health and Human Services deter8 mines requires State legislation in order for the 

9 plan to meet the additional requirements im10 posed by the amendments made by this sub11 section, the State plan shall not be regarded as 

12 failing to comply with the requirements of such 

13 title solely on the basis of its failure to meet 

14 these additional requirements before the first 

15 day of the first calendar quarter beginning after 

16 the close of the first regular session of the 

17 State legislature that begins after the date of 

18 enactment of this Act. For purposes of the pre19 vious sentence, in the case of a State that has 

20 a 2-year legislative session, each year of the ses21 sion is considered to be a separate regular ses22 sion of the State legislature. 

23 (b) REQUIREMENT FOR THE SECRETARY.—Section 

24 1905(p)(5) of the Social Security Act (42 U.S.C. 

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1 lowing new sentence: ‘‘Such form shall allow an individual 

2 to specify a preferred language for subsequent commu3 nication.’’. 

4 SEC. 17. STATE MEDICAID AGENCY CONSIDERATION OF 

5 LOW-INCOME SUBSIDY APPLICATION AND 

6 DATA TRANSMITTAL. 

7 (a) TECHNICAL AMENDMENTS.— 

8 (1) IN GENERAL.—Section 1144(c)(3)(A)(i) of 

9 the Social Security Act (42 U.S.C. 1320b– 

10 14(c)(3)(A)(i)), as amended by section 10, is amend11 ed— 

12 (A) by striking ‘‘transmittal’’; and 

13 (B) by inserting ‘‘(as specified in section 

14 1935(a)(4))’’ before the semicolon at the end. 

15 (2) EFFECTIVE DATE.—The amendments made 

16 by this subsection shall take effect as if included in 

17 the enactment of section 113(a) of the Medicare Im18 provements for Patients and Providers Act of 2008 

19 (Public Law 110–275). 

20 (b) CLARIFICATION OF STATE MEDICAID AGENCY

21 CONSIDERATION OF LOW-INCOME SUBSIDY APPLICA22 TION.—Section 1935(a)(4) of the Social Security Act (42 

23 U.S.C. 1396u–5(a)(4)), as added by section 113(b) of the 

24 Medicare Improvements for Patients and Providers Act of 

25 2008 (Public Law 110–275), is amended— 


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1 (1) by striking ‘‘PROGRAM.—The State’’ and 

2 inserting ‘‘PROGRAM.— 

3 ‘‘(A) IN GENERAL.—The State’’; 

4 (2) in subparagraph (A), as inserting by para5 graph (1), by striking the second sentence; and 

6 (3) by adding at the end the following new sub7 paragraphs: 

8 ‘‘(B) For purposes of a State’s obligation 

9 under section 1902(a)(8) to furnish medical as10 sistance with reasonable promptness, the date 

11 of the electronic transmission by the Commis12 sioner of Social Security to the State Medicaid 

13 agency of data under section 1144(c)(3) shall 

14 be the date of the filing of such application for 

15 benefits under the Medicare Savings Program. 

16 ‘‘(C) For the purpose of determining when 

17 medical assistance shall be made available for 

18 medicare cost-sharing under this title, the State 

19 shall consider the date of the application for 

20 low-income subsidies under section 1860D–14 

21 to be the date of the filing of an application for 

22 benefits under the Medicare Savings Pro23 gram.’’. 

Æ 


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