I 

108TH CONGRESS 

2D SESSION H. R. 4437

To amend part D of title XVIII of the Social Security Act to provide 

for low-income beneficiaries in the Medicare savings programs automatic 

enrollment and eligibility for low-income subsidies under the Medicare 

transitional and permanent prescription drug programs. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 20, 2004

Mr. DINGELL (for himself, Mr. RANGEL, Mr. WAXMAN, Mr. STARK, Mr. 

BROWN of Ohio, Ms. PELOSI, Mr. MARKEY, Mr. TOWNS, Mr. PALLONE, 

Mr. RUSH, Mr. STUPAK, Mr. ENGEL, Mr. WYNN, Ms. MCCARTHY of Missouri, Mr. STRICKLAND, Mrs. CAPPS, Mr. JOHN, Mr. ALLEN, Mr. DAVIS

of Florida, Mr. BECERRA, Mr. MCNULTY, Mr. DOGGETT, Mr. MATSUI, 

Mr. SANDLIN, and Mr. DEUTSCH) 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 provide for low-income beneficiaries in the Medicare savings programs automatic enrollment and eligibility for low-income subsidies under the Medicare transitional and permanent prescription drug programs.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
2

•HR 4437 IH 

1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Medicare Prescription 

3 Drug Low-Income Assistance Act of 2004’’. 

4 SEC. 2. ASSURANCE OF ASSISTANCE FOR LOW-INCOME 

5 BENEFICIARIES IN MEDICARE SAVINGS PRO6 GRAMS UNDER MEDICARE PRESCRIPTION 

7 DRUG DISCOUNT CARD AND TRANSITIONAL 

8 ASSISTANCE PROGRAM. 

9 (a) AUTOMATIC ENROLLMENT.—

10 (1) IN GENERAL.—Section 1860D–31(c)(1) of 

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

12 141(c)(1)) is amended by adding at the end the fol13 lowing new subparagraph: 

14 ‘‘(F) AUTOMATIC ENROLLMENT OF CER15 TAIN LOW-INCOME BENEFICIARIES IN MEDI16 CARE SAVINGS PROGRAMS.—

17 ‘‘(i) NOTICE OF ELIGIBILITY.—Not 

18 later than 45 days after the date an indi19 vidual described in clause (ii) is first eligi20 ble to enroll in an endorsed discount card 

21 program under this section, each State or 

22 the Secretary (at the option of each State) 

23 shall mail to each individual described in 

24 clause (ii), a notice stating the following: 

25 ‘‘(I) Such individual is eligible to 

26 enroll in an endorsed discount card 
3

•HR 4437 IH 

1 program and to receive transitional 

2 assistance under subsection (g). 

3 ‘‘(II) If such individual does not 

4 enroll before 30 days after the date of 

5 the notice, such individual will be 

6 automatically enrolled in an endorsed 

7 discount card program selected by the 

8 Secretary unless the individual noti9 fies the Secretary that such individual 

10 does not wish to be so enrolled. 

11 ‘‘(III) If such individual is auto12 matically enrolled in an endorsed dis13 count card program selected by the 

14 Secretary, the individual may enroll in 

15 another endorsed discount card pro16 gram selected by the individual during 

17 the 60-day period beginning on the 

18 date of such automatic enrollment. 

19 ‘‘(IV) If the individual is enrolled 

20 in an endorsed discount card program 

21 during 2004, the individual will be 

22 permitted to change enrollment under 

23 subsection (c)(1)(C)(ii) for 2005. 

24 ‘‘(V) There is no obligation to 

25 use the endorsed discount card pro-
4

•HR 4437 IH 

1 gram or transitional assistance when 

2 purchasing prescription drugs. 

3 ‘‘(ii) INDIVIDUALS BENEFITING FROM

4 AUTOMATIC ENROLLMENT.—An individual 

5 described in this clause is a discount card 

6 eligible individual who—

7 ‘‘(I) is a recipient of supple8 mental security income benefits under 

9 title XVI, or is determined to be eligi10 ble for medical assistance under title 

11 XIX solely by reason of clause (i), 

12 (iii), or (iv) of section 1902(a)(10)(E); 

13 and 

14 ‘‘(II) has not enrolled in an en15 dorsed discount card program as of 

16 the date that is 30 days after the date 

17 the individual is first eligible to enroll 

18 in such a program. 

19 ‘‘(iii) AUTOMATIC ENROLLMENT.—

20 The Secretary shall enroll each individual 

21 described in clause (ii), who has not en22 rolled in an endorsed discount card pro23 gram or provided notice to the Secretary 

24 under clause (iv) as of the end of the 30-

25 day period beginning on the date of the no-
5

•HR 4437 IH 

1 tice to the individual under clause (i), in 

2 an endorsed discount card program se3 lected by the Secretary that serves resi4 dents of the State in which the individual 

5 resides. 

6 ‘‘(iv) OPT-OUT.—Clause (iii) shall not 

7 apply to an individual if the individual no8 tifies the Secretary before the end of the 

9 30-day period described in such clause that 

10 the individual does not wish to be auto11 matically enrolled under such clause. 

12 ‘‘(v) 60-DAY GRACE PERIOD TO

13 CHANGE CARD PROGRAM.—The Secretary 

14 shall permit each individual who is auto15 matically enrolled under clause (iii) to 

16 elect, during the 60-day period that begins 

17 on the date the individual is so enrolled, to 

18 enroll in a different endorsed discount card 

19 program selected by such individual. Such 

20 a change shall be treated as an exceptional 

21 case for purposes of subparagraph 

22 (C)(iii).’’. 

23 (b) PROVISION OF TRANSITIONAL ASSISTANCE.—
6

•HR 4437 IH 

1 (1) IN GENERAL.—Section 1860D–31(b) of 

2 such Act (42 U.S.C. 1395w–141(b)) is amended by 

3 adding at the end the following new paragraph: 

4 ‘‘(5) SPECIAL RULE FOR CERTAIN LOW-INCOME

5 BENEFICIARIES IN MEDICARE SAVINGS PROGRAMS.—

6 ‘‘(A) IN GENERAL.—Except as provided in 

7 subparagraph (C), individuals described in sub8 section (c)(1)(F)(ii) shall be treated as transi9 tional assistance eligible individuals. 

10 ‘‘(B) SPECIAL TRANSITIONAL ASSISTANCE

11 ELIGIBLE INDIVIDUALS.—Except as provided in 

12 subparagraph (C), such individuals who are re13 cipients of supplemental security income bene14 fits under title XVI or determined to be eligible 

15 for medical assistance under title XIX solely by 

16 reason of clause (i), (iii), or (iv) of section 

17 1902(a)(10)(E) shall be treated as special tran18 sitional assistance eligible individuals. 

19 ‘‘(C) APPLICATION OF DISQUALIFICATION

20 FOR INDIVIDUALS WITH PRESCRIPTION DRUG

21 COVERAGE.—The Secretary shall not apply sub22 paragraphs (A) and (B) in the case of an indi23 vidual if the Secretary finds that there is reason 

24 to believe that the individual is described in 
7

•HR 4437 IH 

1 paragraph (2)(B) (relating to individuals with 

2 certain prescription drug coverage).’’. 

3 (2) WAIVER OF SELF-CERTIFICATION AND

4 VERIFICATION.—Section 1860D–31(f) of such Act 

5 (42 U.S.C. 1395w–141(f)) is amended by adding at 

6 the end the following new paragraph: 

7 ‘‘(5) SPECIAL RULE FOR CERTAIN LOW-INCOME

8 BENEFICIARIES IN MEDICARE SAVINGS PROGRAMS.—

9 The provisions of paragraphs (2) and (3) shall not 

10 apply to individuals who are treated as transitional 

11 assistance eligible individuals under subsection 

12 (b)(5).’’. 

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

14 this section shall take effect as if included in the enact15 ment of section 101 of the Medicare Prescription Drug, 

16 Improvement, and Modernization Act of 2003 (Public Law 

17 108–173; 117 Stat. 2071). 

18 SEC. 3. ASSURANCE OF ASSISTANCE FOR LOW-INCOME 

19 BENEFICIARIES IN MEDICARE SAVINGS PRO20 GRAMS UNDER QUALIFIED PRESCRIPTION 

21 DRUG COVERAGE. 

22 (a) AUTOMATIC ENROLLMENT.—Section 1860D–

23 1(b)(1)(C) of the Social Security Act (42 U.S.C. 1395w–

24 101(b)(1)(C)) is amended—
8

•HR 4437 IH 

1 (1) by designating the matter beginning with 

2 ‘‘The process established’’ as a clause (i) with the 

3 heading ‘‘IN GENERAL.—’’ and an appropriate in4 dentation; 

5 (2) by striking ‘‘a full-benefit dual eligible indi6 vidual (as defined in section 1935(c)(6)) who has 

7 failed to enroll in a prescription drug plan or an 

8 MA–PD plan’’ and inserting ‘‘described in clause 

9 (ii)’’; and 

10 (3) by adding at the end the following new 

11 clauses: 

12 ‘‘(ii) INDIVIDUALS COVERED.—An in13 dividual described in this clause is an indi14 vidual who—

15 ‘‘(I) is a full-benefit dual eligible 

16 individual (as defined in section 

17 1935(c)(6)), is a recipient of supple18 mental security income benefits under 

19 title XVI, or is determined to be eligi20 ble for medical assistance under title 

21 XIX solely by reason of clause (i), 

22 (iii), or (iv) of section 1902(a)(10)(E); 

23 and 
9

•HR 4437 IH 

1 ‘‘(II) has failed to enroll in a pre2 scription drug plan or an MA–PD 

3 plan. 

4 ‘‘(iii) APPLICATION OF NOTICE, OPT5 OUT, AND GRACE PERIOD IN CHANGE IN

6 ENROLLMENT PROVISIONS.—In carrying 

7 out this subparagraph, the Secretary shall 

8 provide for the application of notice and 

9 change in enrollment provisions with re10 spect to enrollment in prescription drug 

11 plans and MA–PD plans similar to those 

12 provided under clauses (i), (iv), and (v) of 

13 section 1860D–31(c)(1)(F) with respect to 

14 enrollment in endorsed discount card pro15 grams.’’. 

16 (b) PROVISION OF PREMIUM AND COST-SHARING

17 SUBSIDIES.—Section 1860D–14(a)(3)(B)(v) of such Act 

18 (42 U.S.C. 1395w–114(a)(3)(B)(v)) is amended to read 

19 as follows: 

20 ‘‘(v) TREATMENT OF MEDICAID BENE21 FICIARIES AND LOW-INCOME BENE22 FICIARIES IN MEDICARE SAVINGS PRO23 GRAMS.—Subject to subparagraph (F), the 

24 Secretary shall provide that the following 

25 individuals who are part D eligible individ-
10

•HR 4437 IH 

1 uals shall be treated as being determined 

2 to be subsidy eligible individuals described 

3 in paragraph (1): 

4 ‘‘(I) Full-benefit dual eligible in5 dividuals (as defined in section 

6 1935(c)(6)). 

7 ‘‘(II) Individuals who are recipi8 ents of supplemental security income 

9 benefits under title XVI. 

10 ‘‘(III) Individuals who are deter11 mined to be eligible for medical assist12 ance under title XIX solely by reason 

13 of clause (i), (iii), or (iv) of section 

14 1902(a)(10)(E).’’. 

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

16 this section shall take effect as if included in the enact17 ment of section 101 of the Medicare Prescription Drug, 

18 Improvement, and Modernization Act of 2003 (Public Law 

19 108–173; 117 Stat. 2071).

Æ