I

105TH CONGRESS

2D SESSION H. R. 4836

To amend title XI of the Social Security Act and the Internal Revenue

Code of 1986 to establish a mechanism to promote the provision of

Medicare cost-sharing assistance to eligible low-income Medicare beneficiaries.

IN THE HOUSE OF REPRESENTATIVES

OCTOBER 14, 1998

Mr. MCDERMOTT (for himself, Mr. STARK, and Mr. MILLER of California) introduced the following bill; which was referred to the Committee on Ways

and Means, and in addition to the Committee on Commerce, 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 title XI of the Social Security Act and the Internal

Revenue Code of 1986 to establish a mechanism to promote the provision of Medicare cost-sharing assistance

to eligible low-income Medicare beneficiaries.

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

3 SECTION 1. SHORT TITLE.

4 This Act may be cited as the ‘‘QMB Improvement

5 Act of 1998’’.
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1 SEC. 2. MECHANISM PROMOTING PROVISION OF MEDICARE

2 COST-SHARING ASSISTANCE TO ELIGIBLE

3 LOW-INCOME MEDICARE BENEFICIARIES.

4 (a) IN GENERAL.—Part A of title XI of the Social

5 Security Act is amended by adding at the end the follow6 ing:

7 ‘‘PROMOTING PROVISION OF MEDICARE COST-SHARING

8 ASSISTANCE UNDER MEDICAID PROGRAM FOR IDEN9 TIFIED LOW-INCOME MEDICARE BENEFICIARIES

10 ‘‘SEC. 1147. (a) REQUIREMENT FOR DATA

11 MATCH.—

12 ‘‘(1) REQUESTING MATCHING INFORMATION.—

13 The Commissioner of Social Security shall, not less

14 often than annually beginning with 2001, transmit

15 to the Secretary of the Treasury a list of the names

16 and TINs of Medicare beneficiaries (as defined in

17 section 6103(l)(15) of the Internal Revenue Code of

18 1986) and request that such Secretary disclose to

19 the Secretary of Health and Human Services the in20 formation described in subparagraph (A) of such

21 section.

22 ‘‘(2) SPECIFICATION OF INCOME LEVELS.—The

23 Secretary shall specify—

24 ‘‘(A) the items that will be included in de25 termination of income for purposes of applying
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1 this section and section 6103(l)(15)(A)(i) of the

2 Internal Revenue Code of 1986; and

3 ‘‘(B) the levels of such income (based upon

4 a percentage of the Federal poverty guidelines)

5 that individuals may have and qualify for medi6 cal assistance under section 1902(a)(10)(E)(i)

7 of the Social Security Act (relating to assist8 ance for Medicare cost-sharing benefits under

9 the Medicaid program).

10 ‘‘(b) NOTICE TO INDIVIDUALS IDENTIFIED.—

11 ‘‘(1) INITIAL ELIGIBILITY.—The Secretary

12 promptly shall provide for an appropriate notice to

13 each individual identified under subsection (a) who

14 is described in section 6103(l)(15)(A)(i), of the fol15 lowing:

16 ‘‘(A) Subject to subparagraph (B), the in17 dividual is deemed eligible for some form of

18 medical assistance for some Medicare cost-shar19 ing under clause (i) or (iii) of section

20 1902(a)(10)(E), depending on the individual’s

21 level of income.

22 ‘‘(B) By accepting such assistance the in23 dividual is obligated to notify the Secretary if

24 the individual is not eligible for such assistance

25 due to—
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1 ‘‘(i) the individual having tax-exempt

2 income;

3 ‘‘(ii) the individual having countable

4 assets in excess of the maximum permis5 sible assets, if the individual resides in a

6 State that imposes an asset test for such

7 eligibility; or

8 ‘‘(iii) the individual otherwise is not

9 eligible for such assistance.

10 ‘‘(C) If the individual accepts such assist11 ance notwithstanding that the individual is not

12 eligible, the individual is liable to the State for

13 the amount of medical assistance provided (with

14 interest).

15 ‘‘(2) CONTINUED ELIGIBILITY.—The Secretary

16 shall provide for an appropriate notice to each indi17 vidual identified under subsection (a) who is de18 scribed in section 6103(l)(15)(A)(ii), of the follow19 ing: ‘Unless the individual declines coverage or indi20 cates otherwise, the individual will be enrolled for

21 the appropriate assistance with Medicare cost-shar22 ing under the State plan operated under title XIX

23 for the State in which the individual resides.’

24 ‘‘(c) NOTICE TO STATE.—In the case of an individual

25 who is identified under this section and resides in a State,
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1 the Secretary shall provide for appropriate notice to the

2 State of the individual’s eligibility for medical assistance

3 under clause (i) or (iii) of section 1902(a)(10)(E), as the

4 case may be.’’.

5 (b) CONFORMING AMENDMENT TO MEDICAID PRO6 GRAM.—Section 1902 of such Act (42 U.S.C. 1396a) is

7 amended by adding at the end the following:

8 ‘‘(aa) A State shall treat an individual who is identi9 fied under section 1147(b) as being eligible for medical

10 assistance under clause (i) or (ii) of subsection (a)(10)(E)

11 as being so eligible, until the Secretary notifies the State

12 otherwise, with respect to medical assistance for items and

13 services furnished on or after the date of the notice.’’.

14 (c) AUTHORIZATION OF DISCLOSURE.—Section

15 6103(l) of the Internal Revenue Code of 1986 (relating

16 to disclosure of returns and return information for pur17 poses other than tax administration) is amended by add18 ing at the end the following new paragraph:

19 ‘‘(15) DISCLOSURE OF CERTAIN INFORMATION

20 IN ORDER TO QUALIFY FOR MEDICARE COST-SHAR21 ING ASSISTANCE.—

22 ‘‘(A) IN GENERAL.—The Secretary shall,

23 upon written request from the Commissioner of

24 Social Security, disclose to the Secretary of

25 Health and Human Services, whether with re-
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1 spect to any Medicare beneficiary (as defined in

2 paragraph (12)(E)(i)) identified by the Com3 missioner—

4 ‘‘(i) there has not been filed an in5 come tax return for the most recent period

6 for which the Secretary has information; or

7 there has been such a return filed and the

8 amount of the gross income (or the sum of

9 such elements of gross income as the Sec10 retary of Health and Human Services may

11 specify) is below such level (or levels) as

12 such Secretary may specify to carry out

13 section 1147(b) of the Social Security Act,

14 treating the number of dependents as the

15 size of the family involved; and

16 ‘‘(ii) whether, for such an individual

17 who qualified for Medicare cost-sharing as18 sistance described in section 1147 at any

19 time in the previous year, the individual is

20 still described in clause (i).

21 ‘‘(B) DISCLOSURE BY HEALTH CARE FI22 NANCING ADMINISTRATION.—With respect to

23 information disclosed under subparagraph (A),

24 the Administrator of the Health Care Financing

25 Administration may disclose to the appropriate
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1 officials of a State responsible for administra2 tion of a State plan under title XIX of the So3 cial Security Act the name, address, and TIN

4 of the preliminary eligibility determination.

5 ‘‘(C) SPECIAL RULES.—

6 ‘‘(i) RESTRICTIONS ON DISCLO7 SURE.—Information may be disclosed

8 under this paragraph only for purposes of,

9 and to the extent necessary in, determining

10 the extent to which an individual bene11 ficiary is entitled to medical assistance

12 under a State plan under title XIX of the

13 Social Security Act for some or all Medi14 care cost-sharing.

15 ‘‘(ii) TIMELY RESPONSES TO RE16 QUESTS.—Any request made under sub17 paragraph (A) shall be complied with as

18 soon as possible but in no event later than

19 60 days after the date the request was

20 made.’’.

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