I 

110TH CONGRESS 

1ST SESSION H. R. 1536 

To amend part D of title XVIII of the Social Security Act to assist lowincome individuals in obtaining subsidized prescription drug coverage 

under the Medicare prescription drug program by expediting the application and qualification process and by revising the resource standards 

used to determine eligibility for such subsidies, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 15, 2007 

Mr. DOGGETT (for himself, Mr. ABERCROMBIE, Mr. ACKERMAN, Mr. ALLEN, 

Mr. ANDREWS, Mr. BACA, Mr. BECERRA, Ms. BERKLEY, Mr. BERMAN, 

Mr. BERRY, Mr. BISHOP of Georgia, Mr. BISHOP of New York, Mr. 

BLUMENAUER, Ms. CORRINE BROWN of Florida, Mr. BUTTERFIELD, 

Mrs. CAPPS, Mr. CAPUANO, Mr. CARDOZA, Ms. CARSON, Ms. CASTOR, 

Mr. CHANDLER, Mrs. CHRISTENSEN, Ms. CLARKE, Mr. CLAY, Mr. 

CLEAVER, Mr. CLYBURN, Mr. COHEN, Mr. CONYERS, Mr. COSTELLO, 

Mr. COURTNEY, Mr. CROWLEY, Mr. CUELLAR, Mr. CUMMINGS, Mr. 

DAVIS of Alabama, Mr. DAVIS of Illinois, Mrs. DAVIS of California, Mr. 

DEFAZIO, Ms. DEGETTE, Mr. DELAHUNT, Ms. DELAURO, Mr. DOYLE, 

Mr. EDWARDS, Mr. ELLISON, Mr. EMANUEL, Mr. ENGEL, Mr. 

FALEOMAVAEGA, Mr. FARR, Mr. FATTAH, Mr. FILNER, Mr. FRANK of 

Massachusetts, Mr. GONZALEZ, Mr. GORDON of Tennessee, Mr. AL

GREEN of Texas, Mr. GENE GREEN of Texas, Mr. GRIJALVA, Mr. 

GUTIERREZ, Mr. HARE, Mr. HASTINGS of Florida, Ms. HERSETH, Mr. 

HIGGINS, Mr. HINCHEY, Mr. HINOJOSA, Ms. HIRONO, Mr. HONDA, Mr. 

INSLEE, Mr. ISRAEL, Mr. JACKSON of Illinois, Ms. JACKSON-LEE of 

Texas, Mr. JEFFERSON, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. 

JOHNSON of Georgia, Mrs. JONES of Ohio, Mr. KANJORSKI, Ms. KAPTUR, Mr. KENNEDY, Mr. KILDEE, Ms. KILPATRICK, Mr. KLEIN of Florida, Mr. KUCINICH, Mr. LANGEVIN, Mr. LANTOS, Mr. LARSON of Connecticut, Ms. LEE, Mr. LEVIN, Mr. LEWIS of Georgia, Mr. LIPINSKI, 

Mrs. LOWEY, Mr. LYNCH, Mrs. MALONEY of New York, Ms. MATSUI, 

Ms. MCCOLLUM of Minnesota, Mr. MCDERMOTT, Mr. MCGOVERN, Mr. 

MCNULTY, Mr. MEEHAN, Mr. MEEK of Florida, Mr. MEEKS of New 

York, Mr. MICHAUD, Ms. MILLENDER-MCDONALD, Mr. MILLER of North 

Carolina, Mr. GEORGE MILLER of California, Mr. MOORE of Kansas, Ms. 

MOORE of Wisconsin, Mr. MORAN of Virginia, Mr. NADLER, Mrs. 

NAPOLITANO, Mr. NEAL of Massachusetts, Ms. NORTON, Mr. OBERSTAR, 

Mr. OLVER, Mr. ORTIZ, Mr. PASCRELL, Mr. PASTOR, Mr. PAYNE, Mr. 


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POMEROY, Mr. PRICE of North Carolina, Mr. RANGEL, Mr. RODRIGUEZ, 

Mr. ROSS, Mr. ROTHMAN, Ms. ROYBAL-ALLARD, Mr. RUSH, Mr. RYAN

of Ohio, Ms. LINDA T. SA ́NCHEZ of California, Ms. LORETTA SANCHEZ

of California, Mr. SARBANES, Ms. SCHAKOWSKY, Mr. SCHIFF, Ms. 

SCHWARTZ, Mr. SCOTT of Virginia, Mr. SCOTT of Georgia, Mr. SERRANO, 

Mr. SHERMAN, Mr. SIRES, Ms. SLAUGHTER, Ms. SOLIS, Mr. STARK, Mr. 

STUPAK, Ms. SUTTON, Mr. THOMPSON of Mississippi, Mr. TIERNEY, Mr. 

TOWNS, Mr. UDALL of New Mexico, Mr. VAN HOLLEN, Ms. VELA ́ZQUEZ, 

Ms. WASSERMAN SCHULTZ, Ms. WATERS, Ms. WATSON, Mr. WATT, Mr. 

WAXMAN, Mr. WEINER, Mr. WELCH of Vermont, Mr. WEXLER, Ms. 

WOOLSEY, Mr. WU, Mr. WYNN, Mr. YARMUTH, and Mr. LOEBSACK) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and 

Means, for a period to be subsequently determined by the Speaker, in 

each case for consideration of such provisions as fall within the jurisdiction of the committee concerned 

A BILL 

To amend part D of title XVIII of the Social Security 

Act to assist low-income individuals in obtaining subsidized prescription drug coverage under the Medicare 

prescription drug program by expediting the application 

and qualification process and by revising the resource 

standards used to determine eligibility for such subsidies, 

and for other purposes. 

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

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

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

5 ‘‘Prescription Coverage Now Act of 2007’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 


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Sec. 2. Expediting low-income subsidies under the Medicare prescription drug 

program. 

Sec. 3. Modification of resource standards for determination of eligibility for 

low-income subsidy; simplification of income and asset rules. 

Sec. 4. Indexing deductible and cost-sharing above annual out-of-pocket threshold for individuals with income below 150 percent of poverty 

line. 

Sec. 5. No impact on eligibility for benefits under other programs. 

Sec. 6. Screening by Commissioner of Social Security for eligibility under Medicare savings programs. 

Sec. 7. Special enrollment period for subsidy eligible individuals. 

Sec. 8. Waiver of late enrollment penalty for subsidy eligible individuals. 

1 SEC. 2. EXPEDITING LOW-INCOME SUBSIDIES UNDER THE 

2 MEDICARE PRESCRIPTION DRUG PROGRAM. 

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

4 Security Act (42 U.S.C. 1395w–114) is amended by add5 ing at the end the following new subsection: 

6 ‘‘(e) EXPEDITED APPLICATION AND ELIGIBILITY

7 PROCESS.— 

8 ‘‘(1) EXPEDITED PROCESS.— 

9 ‘‘(A) IN GENERAL.—The Secretary shall 

10 provide for an expedited process under this sub11 section for the qualification for low-income as12 sistance under this section through a request to 

13 the Secretary of the Treasury as provided in 

14 subparagraphs (B) and (C) for information suf15 ficient to identify whether the individual in16 volved is likely eligible for subsidies under this 

17 section based on such information and the 

18 amount of premium and cost-sharing subsidies 

19 for which they would qualify based on such in20 formation. Such process shall be conducted in 


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1 cooperation with the Commissioner of Social 

2 Security. 

3 ‘‘(B) OPT IN FOR NEWLY ELIGIBLE INDI4 VIDUALS.—Not later than 60 days after the 

5 date of the enactment of this subsection, the 

6 Secretary shall ensure that, as part of the 

7 Medicare enrollment process, enrolling individ8 uals— 

9 ‘‘(i) receive information describing the 

10 low-income subsidy provided under this 

11 section; and 

12 ‘‘(ii) are provided the opportunity to 

13 opt-in to the expedited process described in 

14 this subsection by requesting that the 

15 Commissioner of Social Security screen the 

16 individual involved for eligibility for such 

17 subsidy through a request to the Secretary 

18 of the Treasury under section 6103(l)(21) 

19 of the Internal Revenue Code of 1986. 

20 ‘‘(C) TRANSITION FOR CURRENTLY ELIGI21 BLE INDIVIDUALS.—In the case of any part D 

22 eligible individual to which subparagraph (B) 

23 did not apply at the time of such individual’s 

24 enrollment, the Secretary shall, not later than 

25 60 days after the date of the implementation of 


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1 subparagraph (B), request that the Commis2 sioner of Social Security screen such individual 

3 for eligibility for the low-income subsidy pro4 vided under this section through a request to 

5 the Secretary of the Treasury under section 

6 6103(l)(21) of the Internal Revenue Code of 

7 1986. 

8 ‘‘(2) NOTIFICATION OF POTENTIALLY ELIGIBLE

9 INDIVIDUALS.—Under such process, in the case of 

10 each individual identified under paragraph (1) who 

11 has not otherwise applied for, or been determined el12 igible for, benefits under this section (or who has ap13 plied for and been determined ineligible for such 

14 benefits based only on excess resources), the Sec15 retary shall send them a letter (using basic, uncom16 plicated language) containing the following: 

17 ‘‘(A) ELIGIBILITY.—A statement that, 

18 based on the information obtained under para19 graph (1), the individual is likely eligible for 

20 low-income subsidies under this section. 

21 ‘‘(B) AMOUNT OF SUBSIDIES.—A descrip22 tion of the amount of premium and cost-sharing 

23 subsidies under this section for which the indi24 vidual would likely be eligible based on such in25 formation. 


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1 ‘‘(C) ENROLLMENT OPPORTUNITY.—In 

2 case the individual is not enrolled in a prescrip3 tion drug plan or MA–PD plan— 

4 ‘‘(i) a statement that— 

5 ‘‘(I) the individual has the oppor6 tunity to enroll in a prescription drug 

7 plan or MA–PD plan for benefits 

8 under this part, but is not required to 

9 be so enrolled; and 

10 ‘‘(II) if the individual has cred11 itable prescription drug coverage, the 

12 individual need not so enroll; 

13 ‘‘(ii) a list of the prescription drug 

14 plans and MA–PD plans in which the indi15 vidual is eligible to enroll; 

16 ‘‘(iii) an enrollment form that may be 

17 used to enroll in such a plan by mail and 

18 that provides that if the individual wishes 

19 to enroll but does not designate a plan, the 

20 Secretary is authorized to enroll the indi21 vidual in such a prescription drug plan se22 lected by the Secretary; and 

23 ‘‘(iv) a statement that the individual 

24 may also enroll online or by telephone, but, 

25 in order to qualify for low-income subVerDate Aug 31 2005 01:45 Mar 20, 2007 Jkt 059200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H1536.IH H1536

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1 sidies, the individual must complete the at2 testation described in subparagraph (D) or 

3 otherwise apply for such subsidies. 

4 ‘‘(D) ATTESTATION.—A one-page applica5 tion form that provides for a signed attestation, 

6 under penalty of law, as to the amount of in7 come and assets of the individual and con8 stitutes an application for the low-income sub9 sidies described in subparagraph (B). Such 

10 form— 

11 ‘‘(i) shall not require the submittal of 

12 additional documentation regarding income 

13 or assets; 

14 ‘‘(ii) shall permit the appointment of 

15 a personal representative described in 

16 paragraph (5); and 

17 ‘‘(iii) shall allow for the specification 

18 of a language (other than English) that is 

19 preferred by the individual for subsequent 

20 communications with respect to the indi21 vidual under this part. 

22 ‘‘(E) INFORMATION ON SHIP.—Information 

23 on how the individual may contact the State 

24 Health Insurance Assistance Program (SHIP) 

25 for the State in which the individual is located 


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1 in order to obtain assistance regarding enroll2 ment and benefits under this part. 

3 If a State is doing its own outreach to low-income 

4 seniors regarding enrollment and low-income sub5 sidies under this part, such process shall be coordi6 nated with the State’s outreach effort. 

7 ‘‘(3) FOLLOW-UP COMMUNICATIONS.—If the in8 dividual does not respond to the letter described in 

9 paragraph (2) either by making an enrollment de10 scribed in paragraph (2)(C), completing an attesta11 tion described in paragraph (2)(D), or declining ei12 ther or both, the Secretary shall make additional at13 tempts to contact the individual to obtain such an 

14 affirmative response. 

15 ‘‘(4) HOLD-HARMLESS.—Under such process, if 

16 an individual in good faith and in the absence of 

17 fraud executes an attestation described in paragraph 

18 (2)(D) and is provided low-income subsidies under 

19 this section on the basis of such attestation, if the 

20 individual is subsequently found not eligible for such 

21 subsidies, there shall be no recovery made against 

22 the individual because of such subsidies improperly 

23 paid. 

24 ‘‘(5) USE OF AUTHORIZED REPRESENTATIVE.— 

25 Under such process, with proper authorization 


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1 (which may be part of the attestation form described 

2 in paragraph (2)(D)), an individual may authorize 

3 another individual to act as the individual’s personal 

4 representative with respect to communications under 

5 this part and the enrollment of the individual under 

6 a prescription drug plan (or MA–PD plan) and for 

7 low-income subsidies under this section. 

8 ‘‘(6) USE OF PREFERRED LANGUAGE IN SUBSE9 QUENT COMMUNICATIONS.—In the case an attesta10 tion described in paragraph (2)(D) is completed and 

11 in which a language other than English is specified 

12 under clause (iii) of such paragraph, the Secretary 

13 shall provide that subsequent communications to the 

14 individual under this part shall be in such language. 

15 ‘‘(7) CONSTRUCTION.—Nothing in this sub16 section shall be construed as precluding the Sec17 retary from taking additional outreach efforts to en18 roll eligible individuals under this part and to pro19 vide low-income subsidies to eligible individuals.’’. 

20 (b) PRESCRIPTION DRUG PLANS REQUIRED TO PRO21 VIDE EXPEDITED LOW-INCOME SUBSIDY OPT-IN AS PART

22 OF APPLICATIONS.— 

23 (1) IN GENERAL.—Section 1860D– 

24 1(b)(1)(B)(vi) of such Act (42 U.S.C. 1395w– 

25 101(b)(1)(B)(vi)) is amended by inserting before the 


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1 period at the end the following: ‘‘, except that any 

2 application form distributed by a sponsor of a pre3 scription drug plan, or an organization offering an 

4 MA–PD plan, shall contain an option for a part D 

5 eligible individual to opt-in to the expedited process 

6 under section 1860D–14(e) for low-income assist7 ance subsidies under such section by requesting that 

8 the individual be screened for eligibility for such 

9 subsidy through a request to the Secretary of the 

10 Treasury under section 6103(l)(21) of the Internal 

11 Revenue Code of 1986’’. 

12 (2) EFFECTIVE DATE.—The amendment made 

13 by paragraph (1) shall apply to application forms for 

14 plan years beginning with 2008. 

15 (c) DISCLOSURE OF RETURN INFORMATION FOR

16 PURPOSES OF SCREENING INDIVIDUALS FOR ELIGIBILITY

17 FOR LOW-INCOME SUBSIDIES UNDER MEDICARE.— 

18 (1) IN GENERAL.—Subsection (l) of section 

19 6103 of the Internal Revenue Code of 1986 is 

20 amended by adding at the end the following new 

21 paragraph: 

22 ‘‘(21) DISCLOSURE OF RETURN INFORMATION

23 FOR PURPOSES OF PROVIDING LOW-INCOME SUB24 SIDIES UNDER MEDICARE.— 


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1 ‘‘(A) RETURN INFORMATION FROM INTER2 NAL REVENUE SERVICE TO SOCIAL SECURITY

3 ADMINISTRATION.—The Secretary, upon writ4 ten request from the Commissioner of Social 

5 Security under section 1860D–14(e)(1) of the 

6 Social Security Act, shall disclose to the Com7 missioner with respect to any taxpayer identi8 fied by the Commissioner— 

9 ‘‘(i)(I) whether the adjusted gross in10 come, as modified in accordance with spec11 ifications of the Secretary of Health and 

12 Human Services for purposes of carrying 

13 out such section, of such taxpayer and, if 

14 applicable, such taxpayer’s spouse, for the 

15 applicable year, exceeds the amounts speci16 fied by the Secretary of Health and 

17 Human Services in order to apply the 135 

18 and 150 percent poverty lines under such 

19 section, 

20 ‘‘(II) the adjusted gross income (as 

21 determined under subclause (I)), in the 

22 case of a taxpayer with respect to which 

23 such adjusted gross income exceeds the 

24 amount so specified for applying the 135 

25 percent poverty line and does not exceed 


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1 the amount so specified for applying the 

2 150 percent poverty line, 

3 ‘‘(III) whether the return was a joint 

4 return for the applicable year, and 

5 ‘‘(IV) the applicable year, or 

6 ‘‘(ii) if applicable, the fact that there 

7 is no return filed for such taxpayer for the 

8 applicable year. 

9 ‘‘(B) DEFINITION OF APPLICABLE YEAR.— 

10 For the purposes of this paragraph, the term 

11 ‘applicable year’ means the most recent taxable 

12 year for which information is available in the 

13 Internal Revenue Service’s taxpayer data infor14 mation systems, or, if there is no return filed 

15 for such taxpayer for such year, the prior tax16 able year. 

17 ‘‘(C) RESTRICTION ON INDIVIDUALS FOR

18 WHOM DISCLOSURE IS REQUESTED.—The Com19 missioner of Social Security shall only request 

20 information under this paragraph with respect 

21 to individuals who are described in subpara22 graph (C) of section 1860D–14(e)(1) of the So23 cial Security Act or who have requested that 

24 such request be made under subparagraph (B) 

25 of such section. 


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1 ‘‘(D) RETURN INFORMATION FROM SOCIAL

2 SECURITY ADMINISTRATION TO DEPARTMENT

3 OF HEALTH AND HUMAN SERVICES.—The Com4 missioner of Social Security shall, upon written 

5 request from the Secretary of Health and 

6 Human Services, disclose to the Secretary of 

7 Health and Human Services the information 

8 described in clauses (i) and (ii) of subparagraph 

9 (A). 

10 ‘‘(E) PERMISSIVE DISCLOSURE TO OFFI11 CERS, EMPLOYEES, AND CONTRACTORS.—The 

12 information described in clauses (i) and (ii) of 

13 subparagraph (A) may be disclosed among offi14 cers, employees, and contractors of the Social 

15 Security Administration and the Department of 

16 Health and Human Services for the purposes 

17 described in subparagraph (F). 

18 ‘‘(F) RESTRICTION ON USE OF DISCLOSED

19 INFORMATION.—Return information disclosed 

20 under this paragraph may be used only for the 

21 purposes of identifying eligible individuals for, 

22 and administering— 

23 ‘‘(i) low-income subsidies under sec24 tion 1860D–14 of the Social Security Act, 

25 and 


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1 ‘‘(ii) the Medicare Savings Program 

2 implemented under clauses (i), (iii), and 

3 (iv) of section 1902(a)(10)(E) of such Act. 

4 ‘‘(G) TERMINATION OF DISCLOSURES FOR

5 CERTAIN ELIGIBILITY DETERMINATIONS.—With 

6 respect to individuals who are described in sub7 paragraph (C) of section 1860D–14(e)(1) of the 

8 Social Security Act, return information may not 

9 be disclosed under this paragraph after the date 

10 that is one year after the date of the enactment 

11 of this paragraph.’’. 

12 (2) CONFIDENTIALITY.—Paragraph (3) of sec13 tion 6103(a) of such Code is amended by striking 

14 ‘‘or (20)’’ and inserting ‘‘(20), or (21)’’. 

15 (3) PROCEDURES AND RECORDKEEPING RE16 LATED TO DISCLOSURES.—Paragraph (4) of section 

17 6103(p) of such Code is amended by striking ‘‘or 

18 (20)’’ each place it appears and inserting ‘‘(20), or 

19 (21)’’. 

20 (4) UNAUTHORIZED DISCLOSURE OR INSPEC21 TION.—Paragraph (2) of section 7213(a) of such 

22 Code is amended by striking ‘‘or (20)’’ and inserting 

23 ‘‘(20), or (21)’’. 


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1 SEC. 3. MODIFICATION OF RESOURCE STANDARDS FOR DE2 TERMINATION OF ELIGIBILITY FOR LOW-IN3 COME SUBSIDY; SIMPLIFICATION OF INCOME 

4 AND ASSET RULES. 

5 (a) INCREASING THE RESOURCE STANDARD AP6 PLIED TO FULL LOW-INCOME SUBSIDY.—Subparagraph 

7 (D) of section 1860D–14(a)(3)(D) of the Social Security 

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

9 (1) in the heading, by striking ‘‘THREE TIMES’’; 

10 (2) in clause (i), by striking ‘‘and’’ at the end; 

11 (3) in clause (ii)— 

12 (A) by striking ‘‘a subsequent year’’ and 

13 inserting ‘‘2007’’; 

14 (B) by striking ‘‘this clause for the pre15 vious year’’ and inserting ‘‘clause (i) for 2006’’; 

16 and 

17 (C) by inserting ‘‘(or clause (i))’’ after 

18 ‘‘this clause’’; and 

19 (D) by striking the period at the end and 

20 inserting a semicolon; 

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

22 clauses: 

23 ‘‘(iii) for 2008, six times the max24 imum amount of resources that an indi25 vidual may have and obtain benefits under 


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1 such supplemental security income pro2 gram; and 

3 ‘‘(iv) for a subsequent year the re4 source limitation established under this 

5 clause (or clause (iii)) for the previous year 

6 increased by the annual percentage in7 crease in the consumer price index (all 

8 items; U.S. city average) as of September 

9 of such previous year.’’; and 

10 (5) in the last sentence, by inserting ‘‘or (iv)’’ 

11 after ‘‘clause (ii)’’. 

12 (b) INCREASING THE ALTERNATE RESOURCE

13 STANDARD.—Subparagraph (E)(i) of such section is 

14 amended— 

15 (1) by striking ‘‘and’’ at the end of subclause 

16 (I); 

17 (2) in subclause (II)— 

18 (A) by striking ‘‘a subsequent year’’ and 

19 inserting ‘‘2007’’; 

20 (B) by striking ‘‘in this subclause (or sub21 clause (I)) for the previous year’’ and inserting 

22 ‘‘in subclause (I) for 2006’’; and 

23 (C) by striking the period at the end and 

24 inserting a semicolon; 


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1 (3) by inserting after subclause (II) the fol2 lowing new subclauses: 

3 ‘‘(III) for 2008, $27,500 (or 

4 $55,000 in the case of the combined 

5 value of the individual’s assets or re6 sources and the assets or resources of 

7 the individual’s spouse); and 

8 ‘‘(IV) for a subsequent year the 

9 dollar amounts specified in this sub10 clause (or subclause (III)) for the pre11 vious year increased by the annual 

12 percentage increase in the consumer 

13 price index (all items; U.S. city aver14 age) as of September of such previous 

15 year.’’; and 

16 (4) in the last sentence, by inserting ‘‘or (IV)’’ 

17 after ‘‘subclause (II)’’. 

18 (c) EXEMPTIONS FROM RESOURCES.—Such section 

19 is further amended— 

20 (1) in subparagraphs (D) and (E), by inserting 

21 ‘‘, except as provided in subparagraph (G)’’ after 

22 ‘‘supplemental security income program’’; and 

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


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1 ‘‘(G) ADDITIONAL EXCLUSIONS.—In deter2 mining the resources of an individual (and their 

3 eligible spouse, if any) under section 1613 for 

4 purposes of subparagraphs (D) and (E), the 

5 following additional exclusions shall apply for 

6 months beginning after the date of the enact7 ment of this subparagraph: 

8 ‘‘(i) LIFE INSURANCE POLICY.—No 

9 part of the value of any life insurance pol10 icy shall be taken into account. 

11 ‘‘(ii) PENSION OR RETIREMENT

12 PLAN.—No balance in any pension or re13 tirement plan shall be taken into ac14 count.’’. 

15 (d) NOT COUNTING IN-KIND SUPPORT AND MAINTE16 NANCE AS INCOME.—Such section is further amended in 

17 subparagraph (C)(i), by inserting ‘‘and except that sup18 port and maintenance furnished in kind shall not be count19 ed as income for months beginning after the date of the 

20 enactment of the Prescription Coverage Now Act of 2007’’ 

21 after ‘‘section 1902(r)(2)’’. 


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1 SEC. 4. INDEXING DEDUCTIBLE AND COST-SHARING ABOVE 

2 ANNUAL OUT-OF-POCKET THRESHOLD FOR 

3 INDIVIDUALS WITH INCOME BELOW 150 PER4 CENT OF POVERTY LINE. 

5 (a) INDEXING DEDUCTIBLE.—Section 1860D– 

6 14(a)(4)(B) of the Social Security Act (42 U.S.C. 1395w– 

7 114(a)(4)(B)) is amended— 

8 (1) in clause (i), by striking ‘‘or’’; 

9 (2) in clause (ii)— 

10 (A) by striking ‘‘a subsequent year’’ and 

11 inserting ‘‘2008’’; 

12 (B) by striking ‘‘this clause (or clause (i)) 

13 for the previous year’’ and inserting ‘‘clause (i) 

14 for 2007’’; and 

15 (C) by striking the period at the end and 

16 inserting ‘‘; and’’; 

17 (3) by adding after clause (ii) the following new 

18 clause: 

19 ‘‘(iii) for 2008 and each succeeding 

20 year, the amount determined under this 

21 subparagraph for the previous year in22 creased by the annual percentage increase 

23 in the consumer price index (all items; 

24 U.S. city average) as of September of such 

25 previous year.’’; and 


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1 (4) in the last sentence, by striking ‘‘clause (i) 

2 or (ii)’’ and inserting ‘‘clause (i), (ii), or (iii)’’. 

3 (b) INDEXING COST-SHARING.—Section 1860D– 

4 14(a) of the Social Security Act (42 U.S.C. 1395w– 

5 114(a)) is amended— 

6 (1) in paragraph (1)(D)(iii), by striking ‘‘exceed 

7 the copayment amount’’ and all that follows through 

8 the period at the end and inserting ‘‘exceed— 

9 ‘‘(I) for 2006 and 2007, the co10 payment amount specified under sec11 tion 1860D–2(b)(4)(A)(i)(I) for the 

12 drug and year involved; and 

13 ‘‘(II) for 2008 and each suc14 ceeding year, the amount determined 

15 under this subparagraph for the pre16 vious year increased by the annual 

17 percentage increase in the consumer 

18 price index (all items; U.S. city aver19 age) as of September of such previous 

20 year.’’; and 

21 (2) in paragraph (2)(E), by striking ‘‘exceed 

22 the copayment or coinsurance amount’’ and all that 

23 follows through the period at the end and inserting 

24 ‘‘exceed— 


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1 ‘‘(i) for 2006 and 2007, the copay2 ment or coinsurance amount specified 

3 under section 1860D–2(b)(4)(A)(i)(I) for 

4 the drug and year involved; and 

5 ‘‘(ii) for 2008 and each succeeding 

6 year, the amount determined under this 

7 clause for the previous year increased by 

8 the annual percentage increase in the con9 sumer price index (all items; U.S. city av10 erage) as of September of such previous 

11 year.’’. 

12 SEC. 5. NO IMPACT ON ELIGIBILITY FOR BENEFITS UNDER 

13 OTHER PROGRAMS. 

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

15 Social Security Act (42 U.S.C. 1395w–114(a)(3)), as 

16 amended by section 3(c)(2), is amended— 

17 (1) in subparagraph (A), in the matter pre18 ceding clause (i), by striking ‘‘subparagraph (F)’’ 

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

20 (2) by adding at the end the following new sub21 paragraph: 

22 ‘‘(H) NO IMPACT ON ELIGIBILITY FOR

23 BENEFITS UNDER OTHER PROGRAMS.—The 

24 availability of premium and cost-sharing sub25 sidies under this section shall not be treated as 


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1 benefits or otherwise taken into account in de2 termining an individual’s eligibility for, or the 

3 amount of benefits under, any other Federal 

4 program.’’. 

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

6 subsection (a) shall apply to premium and cost-sharing 

7 subsidies for months beginning after the date of the enact8 ment of this Act. 

9 SEC. 6. SCREENING BY COMMISSIONER OF SOCIAL SECU10 RITY FOR ELIGIBILITY UNDER MEDICARE 

11 SAVINGS PROGRAMS. 

12 (a) IN GENERAL.—Section 1860D–14(a)(3)(B)(i) of 

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

14 114(a)(3)(B)(i)) is amended by inserting after the first 

15 sentence the following: ‘‘As part of making an eligibility 

16 determination under the preceding sentence for an indi17 vidual, the Commissioner shall make a determination of 

18 the individual’s eligibility for medical assistance for any 

19 medicare cost-sharing described in section 1905(p)(3) and, 

20 if the individual is eligible for any such medicare cost21 sharing, transmit the data necessary to verify such eligi22 bility to the appropriate State Medicaid agency.’’. 

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

24 subsection (a) shall apply to determinations made for 


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1 months beginning after the date of the enactment of this 

2 Act. 

3 SEC. 7. SPECIAL ENROLLMENT PERIOD FOR SUBSIDY ELI4 GIBLE INDIVIDUALS. 

5 (a) IN GENERAL.—Section 1860D–1(b)(3) of the So6 cial Security Act (42 U.S.C. 1395w–101(b)(3)) is amend7 ed by adding at the end the following new subparagraph: 

8 ‘‘(F) ELIGIBILITY FOR LOW-INCOME SUB9 SIDY.— 

10 ‘‘(i) IN GENERAL.—In the case of an 

11 applicable subsidy eligible individual (as 

12 defined in clause (ii)), the special enroll13 ment period described in clause (iii). 

14 ‘‘(ii) APPLICABLE SUBSIDY ELIGIBLE

15 INDIVIDUAL DEFINED.—For purposes of 

16 this subparagraph, the term ‘applicable 

17 subsidy eligible individual’ means a part D 

18 eligible individual who is determined under 

19 subparagraph (B) of section 1860D– 

20 14(a)(3) to be a subsidy eligible individual 

21 (as defined in subparagraph (A) of such 

22 section), and includes such an individual 

23 who was enrolled in a prescription drug 

24 plan or an MA–PD plan on the date of 

25 such determination. 


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1 ‘‘(iii) SPECIAL ENROLLMENT PERIOD

2 DESCRIBED.—The special enrollment pe3 riod described in this clause, with respect 

4 to an applicable subsidy eligible individual, 

5 is the 90-day period beginning on the date 

6 the individual receives notification that 

7 such individual has been determined under 

8 section 1860D–14(a)(3)(B) to be a subsidy 

9 eligible individual (as so defined).’’. 

10 (b) AUTOMATIC ENROLLMENT PROCESS FOR CER11 TAIN SUBSIDY ELIGIBLE INDIVIDUALS.—Section 1860D– 

12 1(b)(1) is amended by adding at the end the following new 

13 subparagraph: 

14 ‘‘(D) SPECIAL RULE FOR SUBSIDY ELIGI15 BLE INDIVIDUALS.—The process established 

16 under subparagraph (A) shall include, in the 

17 case of an applicable subsidy eligible individual 

18 (as defined in clause (ii) of paragraph (3)(F)) 

19 who fails to enroll in a prescription drug plan 

20 or an MA–PD plan during the special enroll21 ment period described in clause (iii) of such 

22 paragraph applicable to such individual, a proc23 ess for the facilitated enrollment of the indi24 vidual in the prescription drug plan or MA–PD 

25 plan that is most appropriate for such indiVerDate Aug 31 2005 01:45 Mar 20, 2007 Jkt 059200 PO 00000 Frm 00024 Fmt 6652 Sfmt 6201 E:\BILLS\H1536.IH H1536

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1 vidual (as determined by the Secretary). Noth2 ing in the previous sentence shall prevent an in3 dividual described in such sentence from declin4 ing enrollment in a plan determined appropriate 

5 by the Secretary (or in the program under this 

6 part) or from changing such enrollment.’’. 

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

8 this section shall apply to subsidy determinations made 

9 for months beginning with January 2008. 

10 SEC. 8. WAIVER OF LATE ENROLLMENT PENALTY FOR SUB11 SIDY ELIGIBLE INDIVIDUALS. 

12 (a) IN GENERAL.—Section 1860D–13(b) of the So13 cial Security Act (42 U.S.C. 1395w–113(b)) is amended 

14 by adding at the end the following new paragraph: 

15 ‘‘(8) WAIVER OF LATE ENROLLMENT PENALTY

16 FOR SUBSIDY ELIGIBLE INDIVIDUALS.—In the case 

17 of a subsidy eligible individual (as defined in para18 graph (3)(A) of section 1860D–14(a)) who is deter19 mined to be entitled to a subsidy in accordance with 

20 paragraph (1) or (2) of such section, there shall not 

21 be an increase under paragraph (1) in the monthly 

22 premium of such individual for any month in which 

23 such individual is determined to be so entitled.’’. 


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1 (b) CONFORMING AMENDMENT.—Section 1860D– 

2 14(a)(1)(A) of such Act (42 U.S.C. 1395w–114(a)(1)(A)) 

3 is amended— 

4 (1) by striking ‘‘equal to—’’ and all that follows 

5 through ‘‘(i) 100 percent’’ and inserting ‘‘equal to 

6 100 percent’’; 

7 (2) by striking ‘‘; plus’’ and inserting a period; 

8 and 

9 (3) by striking clause (ii). 

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

11 this section shall apply to premiums and subsidies for 

12 months beginning with January 2008. Nothing in this sec13 tion shall be construed as affecting the waiver of any late 

14 enrollment penalties for subsidy eligible individuals that 

15 may have been effected by administrative action for 

16 months before such month. 

Æ 


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