I 

111TH CONGRESS 

1ST SESSION H. R. 2700 

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 

JUNE 4, 2009 

Mr. DOGGETT (for himself, Mr. ALTMIRE, Mr. ARCURI, Ms. BALDWIN, Mr. 

BECERRA, Ms. BERKLEY, Mr. BERMAN, Mr. BISHOP of New York, Mr. 

BLUMENAUER, Ms. BORDALLO, Mr. BOUCHER, Ms. CLARKE, Mr. CLAY, 

Mr. CLEAVER, Mr. CLYBURN, Mr. COHEN, Mr. CONNOLLY of Virginia, 

Mr. COSTELLO, Mr. CUMMINGS, Mr. DAVIS of Alabama, Mr. DAVIS of 

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

Mr. EDWARDS of Texas, Mr. FATTAH, Mr. FILNER, Mr. GENE GREEN

of Texas, Mr. GRIJALVA, Mr. HASTINGS of Florida, Mr. HIGGINS, Mr. 

HINCHEY, Mr. HINOJOSA, Mr. HOLT, Mr. INSLEE, Mr. ISRAEL, Mr. 

JACKSON of Illinois, Ms. JACKSON-LEE of Texas, Mr. JOHNSON of Georgia, Ms. KAPTUR, Mr. KILDEE, Ms. KILPATRICK of Michigan, Mr. 

KUCINICH, Mr. LANGEVIN, Ms. LEE of California, Mr. LEVIN, Mr. 

LEWIS of Georgia, Mr. LIPINSKI, Ms. ZOE LOFGREN of California, Ms. 

MCCOLLUM, Mr. MCDERMOTT, Mrs. MALONEY, Mr. MEEK of Florida, 

Mr. MEEKS of New York, Mr. MICHAUD, Mr. MOORE of Kansas, Mr. 

NADLER of New York, Mrs. NAPOLITANO, Mr. NEAL of Massachusetts, 

Ms. NORTON, Mr. ORTIZ, Mr. PAYNE, Mr. PASCRELL, Mr. PRICE of 

North Carolina, Mr. RANGEL, Mr. ROTHMAN of New Jersey, Mr. RUSH, 

Mr. RYAN of Ohio, Ms. LINDA T. SA ́NCHEZ of California, Mr. SARBANES, 

Ms. SCHAKOWSKY, Ms. SHEA-PORTER, Mr. SIRES, Mr. STARK, Ms. SUTTON, Mr. VAN HOLLEN, Ms. WASSERMAN SCHULTZ, Mr. WEINER, Mr. 

WELCH, Mr. WEXLER, Ms. WOOLSEY, and Mr. YARMUTH) 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 


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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 2009’’. 

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

7 this Act is as follows: 

Sec. 1. Short title; table of contents. 

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

program. 

Sec. 3. Enhanced oversight and enforcement relating to reimbursements for retroactive LIS enrollment. 

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

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

Sec. 5. Indexing deductible and cost-sharing above annual out-of-pocket threshold for individuals with income below 150 percent of poverty 

line. 

Sec. 6. No impact on eligibility for benefits under other programs. 

Sec. 7. Requiring individuals eligible for Medicare savings programs to be 

deemed to be subsidy eligible individuals. 

Sec. 8. Special enrollment period for subsidy eligible individuals. 

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

9 MEDICARE PRESCRIPTION DRUG PROGRAM. 

10 (a) TARGETED OUTREACH FOR LOW-INCOME SUB11 SIDIES.— 


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

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

3 amended by adding at the end the following new 

4 subsection: 

5 ‘‘(e) TARGETED OUTREACH FOR LOW-INCOME SUB6 SIDIES.— 

7 ‘‘(1) TARGETED IDENTIFICATION OF SUBSIDY8 ELIGIBLE INDIVIDUALS.— 

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

10 Social Security shall provide for the identifica11 tion of individuals who are potentially eligible 

12 for low-income assistance under this section 

13 through requests to the Secretary of the Treas14 ury in accordance with the criterion established 

15 under section 6103(l)(21) of the Internal Rev16 enue Code of 1986 for information indicating 

17 whether the individual involved is likely eligible 

18 for such assistance. 

19 ‘‘(B) INITIATION OF IDENTIFICATIONS.— 

20 Not later than 90 days after the date of the en21 actment of this subsection, the Commissioner of 

22 Social Security shall begin the identification of 

23 individuals through the process described in 

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

25 through such process, submit to the Secretary 


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1 of the Treasury requests for part D eligible in2 dividuals who the Commissioner has identified 

3 as potentially eligible for low-income subsidies 

4 under this section before such date of enact5 ment. 

6 ‘‘(2) NOTIFICATION OF POTENTIALLY ELIGIBLE

7 INDIVIDUALS.—In the case of each individual identi8 fied under paragraph (1) who has not otherwise ap9 plied for, or been determined eligible for, benefits 

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

11 determined ineligible for such benefits based on ex12 cess income, resources, or both), the Commissioner 

13 shall transmit by mail to the individual a letter in14 cluding the information and application required to 

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

16 of section 1144(c)(1). 

17 ‘‘(3) FOLLOW-UP COMMUNICATIONS.—If an in18 dividual to whom a letter is transmitted under para19 graph (2) does not affirmatively respond to such let20 ter either by making an enrollment, completing an 

21 application, or declining either or both, the Commis22 sioner shall make additional attempts to contact the 

23 individual to obtain such an affirmative response. 

24 ‘‘(4) USE OF PREFERRED LANGUAGE IN SUBSE25 QUENT COMMUNICATIONS.—In the case an applicaVerDate Nov 24 2008 06:34 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2700.IH H2700

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1 tion is completed by an individual pursuant to this 

2 subsection in which a language other than English 

3 is specified, the Commissioner shall provide that 

4 subsequent communications under this part to the 

5 individual shall be in such language as needed. 

6 ‘‘(5) CONSTRUCTION.—Nothing in this sub7 section shall be construed as precluding the Commis8 sioner from taking additional outreach efforts to en9 roll eligible individuals under this part and to pro10 vide low-income subsidies to eligible individuals. 

11 ‘‘(6) MAINTENANCE OF EFFORT WITH RESPECT

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

13 with respect to outreach to and enrollment of indi14 viduals who are potentially eligible for low-income 

15 assistance under this section after the date of the 

16 enactment of this subsection be less than such level 

17 of effort before such date of enactment until at least 

18 90 percent of such potentially eligible individuals 

19 have affirmatively responded. 

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

21 than 2 years after the date of the first submission 

22 to the Secretary of the Treasury described in para23 graph (1)(B), the Comptroller General of the United 

24 States shall submit to Congress a report, with re25 spect to the 18-month period following the establishVerDate Nov 24 2008 06:34 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2700.IH H2700

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1 ment of the process described in paragraph (1)(A), 

2 on— 

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

4 individuals who are eligible for low-income as5 sistance under this section but not enrolled 

6 under this part has decreased during such pe7 riod; 

8 ‘‘(B) how the Commissioner of Social Se9 curity has used any savings resulting from the 

10 implementation of this section and section 

11 6103(l)(21) of the Internal Revenue Code of 

12 1986 to improve outreach to individual de13 scribed in subparagraph (A) to increase enroll14 ment of such individuals under this part; 

15 ‘‘(C) the effectiveness of using information 

16 from the Secretary of the Treasury in accord17 ance with section 6103(l)(21) of the Internal 

18 Revenue Code of 1986 for purposes of indi19 cating whether individuals are eligible for low20 income assistance under this section; and 

21 ‘‘(D) the effectiveness of the outreach con22 ducted by the Commissioner of Social Security 

23 based on the data described in subparagraph 

24 (C).’’. 


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1 (2) CONFORMING AMENDMENT.—Section 

2 1144(c)(1) of the Social Security Act (42 U.S.C. 

3 1320b–14(c)(1)) is amended by inserting ‘‘(including 

4 through request to the Secretary of the Treasury 

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

6 Commissioner shall’’. 

7 (b) IMPROVEMENTS TO THE LOW-INCOME SUBSIDY

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

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

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

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

12 (2) by redesignating subparagraphs (F) and 

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

14 (3) by inserting after subparagraph (E) the fol15 lowing new subparagraph: 

16 ‘‘(F) SIMPLIFIED LOW-INCOME SUBSIDY

17 APPLICATION AND PROCESS.— 

18 ‘‘(i) IN GENERAL.—The Secretary, 

19 jointly with the Commissioner of Social Se20 curity, shall— 

21 ‘‘(I) develop a model, simplified 

22 application form and process con23 sistent with clause (ii) for the deter24 mination and verification of a part D 


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1 eligible individual’s assets or resources 

2 under this paragraph; and 

3 ‘‘(II) provide such form to 

4 States. 

5 ‘‘(ii) DOCUMENTATION AND SAFE6 GUARDS.—Under such process— 

7 ‘‘(I) the application form shall 

8 consist of an attestation under penalty 

9 of perjury regarding the level of assets 

10 or resources (or combined assets and 

11 resources in the case of a married 

12 part D eligible individual) and valu13 ations of general classes of assets or 

14 resources; 

15 ‘‘(II) such form shall not require 

16 the submittal of additional docu17 mentation regarding income or assets; 

18 ‘‘(III) matters attested to in the 

19 application shall be subject to appro20 priate methods of administrative 

21 verification; 

22 ‘‘(IV) the applicant shall be per23 mitted to authorize another individual 

24 to act as the applicant’s personal rep25 resentative with respect to commuVerDate Nov 24 2008 06:34 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2700.IH H2700

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1 nications under this part and the en2 rollment of the applicant into a pre3 scription drug plan (or MA–PD plan) 

4 and for low-income subsidies under 

5 this section; and 

6 ‘‘(V) the application form shall 

7 allow for the specification of a lan8 guage (other than English) that is 

9 preferred by the individual for subse10 quent communications with respect to 

11 the individual under this part. 

12 ‘‘(iii) NO RECOVERY FOR CERTAIN

13 SUBSIDIES IMPROPERLY PAID.—If an indi14 vidual in good faith and in the absence of 

15 fraud is provided low-income subsidies 

16 under this section, and if the individual is 

17 subsequently found not eligible for such 

18 subsidies, there shall be no recovery made 

19 against the individual because of such sub20 sidies improperly paid.’’. 

21 (c) DISCLOSURES TO FACILITATE IDENTIFICATION

22 OF INDIVIDUALS LIKELY TO BE ELIGIBLE FOR THE LOW23 INCOME ASSISTANCE UNDER THE MEDICARE PRESCRIP24 TION DRUG PROGRAM.— 

25 (1) IN GENERAL.— 


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1 Subsection (l) of section 6103 of the Inter2 nal Revenue Code of 1986 is amended by add3 ing at the end the following new paragraph: 

4 ‘‘(21) DISCLOSURE OF RETURN INFORMATION

5 TO FACILITATE IDENTIFICATION OF INDIVIDUALS

6 LIKELY TO BE ELIGIBLE FOR LOW-INCOME SUB7 SIDIES UNDER MEDICARE PRESCRIPTION DRUG PRO8 GRAM.— 

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

10 written request from the Commissioner of So11 cial Security, shall disclose to officers and em12 ployees of the Social Security Administration, 

13 with respect to any individual identified by the 

14 Commissioner— 

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

16 determined under subparagraph (B), such 

17 individual is likely to be eligible for low-in18 come assistance under section 1860D–14 

19 of the Social Security Act, or 

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

21 there is insufficient information available 

22 to the Secretary to make the determination 

23 described in clause (i). 

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

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1 graph, the Secretary, in consultation with the 

2 Commissioner of Social Security, shall develop 

3 the criterion by which the determination under 

4 subparagraph (A)(i) shall be made (and the cri5 terion for determining that insufficient informa6 tion is available to make such determination). 

7 Such criterion may include analysis of informa8 tion available on such individual’s return, the 

9 return of such individual’s spouse, and any in10 formation related to such individual or such in11 dividual’s spouse which is available on any in12 formation return.’’. 

13 (2) PROCEDURES AND RECORDKEEPING RE14 LATED TO DISCLOSURES.—Paragraph (4) of section 

15 6103(p) of such Code is amended by striking ‘‘or 

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

17 (21)’’. 

18 (3) EFFECTIVE DATE.—The amendments made 

19 by this subsection shall apply to disclosures made 

20 after the date of the enactment of this Act. 

21 SEC. 3. ENHANCED OVERSIGHT AND ENFORCEMENT RE22 LATING TO REIMBURSEMENTS FOR RETRO23 ACTIVE LIS ENROLLMENT. 

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

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


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1 who is enrolled under a prescription drug plan under part 

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

3 PD plan under part C of such title)— 

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

5 is entitled to reimbursement by the plan for covered 

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

7 by the beneficiary during the retroactive coverage 

8 period of the beneficiary in accordance with sub9 section (b) and in the case of such a beneficiary de10 scribed in subsection (e)(4)(A)(i), such reimburse11 ment shall be made automatically by the plan upon 

12 receipt of appropriate notice the beneficiary is eligi13 ble for assistance described in such subsection 

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

15 be filed with the plan by the beneficiary; 

16 (2) the Secretary of Health and Human Serv17 ices (in this section referred to as the ‘‘Secretary’’) 

18 shall not make payment to the plan— 

19 (A) in the case that the beneficiary is de20 scribed in subsection (e)(4)(A)(i), for premium 

21 subsidies and cost sharing subsidies under sec22 tion 1860D–14 of the Social Security Act (42 

23 U.S.C. 1395w–114) with respect to the provi24 sion of prescription drug coverage to the bene25 ficiary during such retroactive period; and 


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1 (B) in the case that the beneficiary is de2 scribed in subsection (e)(4)(A)(ii), for direct 

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

4 Act and premium subsidies and cost-sharing 

5 subsidies under section 1860D–14 of such Act 

6 with respect to the provision of prescription 

7 drug coverage to the beneficiary during such 

8 retroactive period; 

9 unless the plan demonstrates to the Secretary that 

10 the plan has provided timely and accurate reim11 bursement to the beneficiary (or eligible third party) 

12 in accordance with paragraph (1); 

13 (3) the Secretary shall not make any payment 

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

15 to such beneficiary for any month of the retroactive 

16 enrollment period during which no expenses for cov17 ered part D drugs (as defined in section 1860D–2(e) 

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

19 102(e)) were incurred by such beneficiary (or eligible 

20 third party on behalf of such beneficiary); and 

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

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

23 shall be made at the time the Centers for Medicare 

24 & Medicaid Services reconciles payments for the enVerDate Nov 24 2008 06:34 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H2700.IH H2700

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1 tire plan year following the end of the plan year, and 

2 not before such time. 

3 (b) ADMINISTRATIVE REQUIREMENTS RELATING TO

4 REIMBURSEMENTS.— 

5 (1) LINE-ITEM DESCRIPTION.—Each reimburse6 ment made by a prescription drug plan or MA–PD 

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

8 description of the items for which the reimbursement 

9 is made. 

10 (2) TIMING OF REIMBURSEMENTS.—A prescrip11 tion drug plan or MA–PD plan must make a reim12 bursement under subsection (a)(1) to a retroactive 

13 LIS enrollment beneficiary, with respect to a claim, 

14 not later than 30 days after— 

15 (A) in the case of a beneficiary described 

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

17 plan receives notice from the Secretary that the 

18 beneficiary is eligible for assistance described in 

19 such subsection; or 

20 (B) in the case of a beneficiary described 

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

22 the beneficiary files the claim with the plan. 

23 (c) NOTICE REQUIREMENTS.— 

24 (1) BY SECRETARY OF HHS AND COMMISSION

25 OF THE SOCIAL SECURITY ADMINISTRATION.—The 


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1 Secretary, jointly with the Commissioner of the So2 cial Security Administration, shall ensure that each 

3 retroactive LIS enrollment beneficiary receives, with 

4 any letter or notification of eligibility for a low-in5 come subsidy under section 1860D–14 of the Social 

6 Security Act, a notice of their right to reimburse7 ment described in subsection (a)(1) for covered drug 

8 costs incurred during the retroactive coverage period 

9 of the beneficiary. Such notice shall— 

10 (A) with respect to a beneficiary described 

11 in subsection (e)(4)(A)(i), inform the bene12 ficiary of the beneficiary’s right to automatic 

13 reimbursement as described in subsection 

14 (a)(1); and 

15 (B) with respect to a beneficiary described 

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

17 of a clear process that the beneficiary should 

18 follow to seek such reimbursement. 

19 (2) BY PRESCRIPTION DRUG PLANS.— 

20 (A) IN GENERAL.—Each prescription drug 

21 plan under part D of title XVIII of the Social 

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

23 such title) shall include in a notice from the 

24 plan to a retroactive LIS enrollment beneficiary 

25 described in subsection (e)(4)(A)(ii) a model noVerDate Nov 24 2008 06:34 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00015 Fmt 6652 Sfmt 6201 E:\BILLS\H2700.IH H2700

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1 tice developed under subparagraph (B) describ2 ing the process the beneficiary must follow to 

3 seek retroactive reimbursement. Such notice 

4 shall include any form required by the plan to 

5 complete such reimbursement and shall indicate 

6 the period of retroactive coverage for which the 

7 beneficiary is eligible for such reimbursement. 

8 (B) MODEL NOTICE.—The Secretary, 

9 jointly with the Commissioner of Social Secu10 rity, shall develop a model notice for purposes 

11 of subparagraph (A) and shall make such model 

12 notice available to all prescription drug plans 

13 under part D of title XVIII of the Social Secu14 rity Act (and MA–PD plans under part C of 

15 such title). 

16 (d) PUBLIC POSTING TO TRACK PAYMENTS.— 

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

18 after the date of the enactment of this Act, the Sec19 retary shall post (and annually update) on the public 

20 Internet website of the Department of Health and 

21 Human Services information on the total amount of 

22 payments made by the Secretary under subsection 

23 (a)(2) to prescription drug plans during the most re24 cent plan year for which plan data is available. 


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1 (2) SPECIFIC INFORMATION.—Such information 

2 posted— 

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

4 2016, shall include information on payments 

5 made for years beginning with 2006 and ending 

6 with the year for which the most current infor7 mation is available; and 

8 (B) in 2016 or a subsequent year, shall in9 clude information on payments made for at 

10 least the 10 previous years. 

11 (e) DEFINITIONS.—In this section: 

12 (1) COVERED DRUG COSTS.—The term ‘‘cov13 ered drug costs’’ means, with respect to a retroactive 

14 LIS enrollment beneficiary enrolled under a pre15 scription drug plan under part D of title XVIII of 

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

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

18 (A) the costs incurred by such beneficiary 

19 during the retroactive coverage period of the 

20 beneficiary for covered part D drugs, premiums, 

21 and cost-sharing under such title; exceeds 

22 (B) such costs that would have been in23 curred by such beneficiary during such period if 

24 the beneficiary had been both enrolled in the 

25 plan and recognized by such plan as qualified 


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1 during such period for the low income subsidy 

2 under section 1860D–14 of the Social Security 

3 Act to which the individual is entitled. 

4 (2) ELIGIBLE THIRD PARTY.—The term ‘‘eligi5 ble third party’’ means, with respect to a retroactive 

6 LIS enrollment beneficiary, an organization or other 

7 third party that paid on behalf of such beneficiary 

8 for covered drug costs incurred by such beneficiary 

9 during the retroactive coverage period of such bene10 ficiary. 

11 (3) RETROACTIVE COVERAGE PERIOD.—The 

12 term ‘‘retroactive coverage period’’ means— 

13 (A) with respect to a retroactive LIS en14 rollment beneficiary described in paragraph 

15 (4)(A)(i), the period— 

16 (i) beginning on the effective date of 

17 the assistance described in such paragraph 

18 for which the individual is eligible; and 

19 (ii) ending on the date the plan effec20 tuates the status of such individual as so 

21 eligible; and 

22 (B) with respect to a retroactive LIS en23 rollment beneficiary described in paragraph 

24 (4)(A)(ii), the period— 


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1 (i) beginning on the date the indi2 vidual is both entitled to benefits under 

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

4 XVIII of the Social Security Act and eligi5 ble for medical assistance under a State 

6 plan under title XIX of such Act; and 

7 (ii) ending on the date the plan effec8 tuates the status of such individual as a 

9 full-benefit dual eligible individual (as de10 fined in section 1935(c)(6) of such Act). 

11 (4) RETROACTIVE LIS ENROLLMENT BENE12 FICIARY.— 

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

14 LIS enrollment beneficiary’’ means an indi15 vidual who— 

16 (i) is enrolled in a prescription drug 

17 plan under part D of title XVIII of the So18 cial Security Act (or an MA–PD plan 

19 under part C of such title) and subse20 quently becomes eligible as a full-benefit 

21 dual eligible individual (as defined in sec22 tion 1935(c)(6) of such Act), an individual 

23 receiving a low-income subsidy under sec24 tion 1860D–14 of such Act, an individual 

25 receiving assistance under the Medicare 


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1 Savings Program implemented under 

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

3 1902(a)(10)(E) of such Act, or an indi4 vidual receiving assistance under the sup5 plemental security income program under 

6 section 1611 of such Act; or 

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

8 a full-benefit dual eligible individual (as 

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

10 who is automatically enrolled in such a 

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

12 such Act. 

13 (B) EXCEPTION FOR BENEFICIARIES EN14 ROLLED IN RFP PLAN.— 

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

16 individual described in subparagraph 

17 (A)(ii) include an individual who is en18 rolled, pursuant to a RFP contract de19 scribed in clause (ii), in a prescription 

20 drug plan offered by the sponsor of such 

21 plan awarded such contract. 

22 (ii) RFP CONTRACT DESCRIBED.— 

23 The RFP contract described in this section 

24 is a contract entered into between the Sec25 retary and a sponsor of a prescription drug 


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1 plan pursuant to the Centers for Medicare 

2 & Medicaid Services’ request for proposals 

3 issued on February 17, 2009, relating to 

4 Medicare part D retroactive coverage for 

5 certain low income beneficiaries, or a simi6 lar subsequent request for proposals. 

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

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

9 General of the United States shall submit to Congress a 

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

11 improve reimbursement for covered drug costs to retro12 active LIS enrollment beneficiaries and lower the amounts 

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

14 beneficiaries, to prescription drug plans under part D of 

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

16 under part C of such title). 

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

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

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

20 of such contract, the Secretary of Health and Human 

21 Services shall submit to Congress a report evaluating the 

22 program carried out through such contract. 

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

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


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1 subsidy determinations made on or after the date that is 

2 3 months after the date of the enactment of this Act. 

3 SEC. 4. MODIFICATION OF RESOURCE STANDARDS FOR DE4 TERMINATION OF ELIGIBILITY FOR LOW-IN5 COME SUBSIDY; SIMPLIFICATION OF INCOME 

6 AND ASSET RULES. 

7 (a) SINGLE AND INCREASED RESOURCE STANDARD

8 FOR LOW-INCOME SUBSIDIES.—Section 1860D–14(a) of 

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

10 amended— 

11 (1) in paragraph (1), by inserting ‘‘(or, for 

12 years after 2010, paragraph (3)(E))’’ after ‘‘para13 graph (3)(D)’’; 

14 (2) in paragraph (3)— 

15 (A) in subparagraph (A)(iii), by inserting 

16 ‘‘(or for a year after 2010, subparagraph (E))’’ 

17 before the period; 

18 (B) in subparagraph (D)(ii), by inserting 

19 ‘‘before 2011’’ after ‘‘subsequent year’’; and 

20 (C) in subparagraph (E)(i)— 

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

22 subclause (I); 

23 (ii) in subclause (II)— 


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1 (I) by striking ‘‘a subsequent 

2 year’’ and inserting ‘‘each of 2007 

3 through 2010’’; 

4 (II) by striking the period at the 

5 end and inserting a semicolon; 

6 (iii) by inserting after subclause (II) 

7 the following new subclauses: 

8 ‘‘(III) for 2011, $27,500 (or 

9 $55,000 in the case of the combined 

10 value of the individual’s assets or re11 sources and the assets or resources of 

12 the individual’s spouse); and 

13 ‘‘(IV) for a subsequent year the 

14 dollar amounts specified in this clause 

15 for the previous year increased by the 

16 annual percentage increase in the con17 sumer price index (all items; U.S. city 

18 average) as of September of such pre19 vious year.’’; and 

20 (iv) in the last sentence, by inserting 

21 ‘‘or (IV)’’ after ‘‘subclause (II)’’. 

22 (b) EXEMPTIONS FROM RESOURCES.— 

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

24 the Social Security Act (42 U.S.C. 1395w–114(a)(3) 

25 is further amended— 


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1 (A) in subparagraphs (D) and (E), by in2 serting ‘‘and the retirement plan exclusion 

3 under subparagraph (H)’’ after ‘‘subparagraph 

4 (G)’’ each place it appears; and 

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

6 subparagraph: 

7 ‘‘(H) RETIREMENT BENEFIT EXCLU8 SION.—In determining the resources of an indi9 vidual (and their eligible spouse, if any) under 

10 section 1613 for purposes of subparagraphs (D) 

11 and (E), no retirement benefit, such as an indi12 vidual retirement account or plan under section 

13 401(k) of the Internal Revenue Code of 1986, 

14 shall be taken into account.’’. 

15 (2) EFFECTIVE DATE.—The amendments made 

16 by paragraph (1) shall apply for months beginning 

17 after 2011. 

18 (c) CLARIFICATION RELATING TO INCLUDING RE19 TIREMENT BENEFITS AS INCOME.—Nothing in subpara20 graph (H) of section 1860D–14(a)(3) of the Social Secu21 rity Act (42 U.S.C. 1395w–114(a)(3)), as added by sub22 section (b), shall be construed as affecting the inclusion 

23 of retirement benefits as income under section 

24 1612(a)(2)(B) of such Act (42 U.S.C. 1382a(a)(2)(B)). 


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1 (d) CLARIFICATION RELATING TO MIPPA EFFEC2 TIVE DATE FOR IN KIND EXCLUSIONS FROM INCOME.— 

3 Section 116(b) of the Medicare Improvements for Patients 

4 and Providers Act of 2008 is amended— 

5 (1) by inserting ‘‘(other than subsection 

6 (a)(1))’’ after ‘‘this section’’; and 

7 (2) by adding at the end the following new sen8 tence: ‘‘The amendment made by subsection (a)(1) 

9 shall take effect with respect to benefits provided 

10 after such date.’’. 

11 (e) INCREASING INCOME LIMITS FOR PARTIAL LIS 

12 ELIGIBILITY TO 200 PERCENT FPL AND FOR FULL LIS 

13 TO 150 PERCENT FPL.— 

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

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

16 amended— 

17 (A) in the heading, by striking ‘‘150’’ and 

18 inserting ‘‘200’’; 

19 (B) in paragraph (1)— 

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

21 and inserting ‘‘150’’; and 

22 (ii) by striking ‘‘135’’ and inserting 

23 ‘‘150’’; 

24 (C) in paragraph (2)— 


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

2 and inserting ‘‘200’’; and 

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

4 ‘‘135’’ and ‘‘150’’ and inserting ‘‘150’’ and 

5 ‘‘200’’, respectively; and 

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

7 ‘‘150’’ and inserting ‘‘200’’. 

8 (2) EFFECTIVE DATE.—The amendments made 

9 by paragraph (1) shall apply to determinations made 

10 on or after January 1, 2011. 

11 SEC. 5. INDEXING DEDUCTIBLE AND COST-SHARING ABOVE 

12 ANNUAL OUT-OF-POCKET THRESHOLD FOR 

13 INDIVIDUALS WITH INCOME BELOW 200 PER14 CENT OF POVERTY LINE. 

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

16 14(a)(4)(B) of the Social Security Act (42 U.S.C. 1395w– 

17 114(a)(4)(B)) is amended— 

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

19 (2) in clause (ii)— 

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

21 inserting ‘‘2008, 2009, and 2010’’; and 

22 (B) by striking the period at the end and 

23 inserting ‘‘; and’’; 

24 (3) by inserting after clause (ii) the following 

25 new clause: 


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1 ‘‘(iii) for 2011 and each succeeding 

2 year, the amount determined under this 

3 clause (or clause (ii)) for the previous year 

4 increased by the annual percentage in5 crease in the consumer price index (all 

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

7 of such previous year.’’; and 

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

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

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

11 14(a) of the Social Security Act (42 U.S.C. 1395w– 

12 114(a)) is amended— 

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

14 the copayment amount’’ and all that follows through 

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

16 ‘‘(I) for each of 2006 through 

17 2010, the copayment amount specified 

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

19 for the drug and year involved; and 

20 ‘‘(II) for 2011 and each suc21 ceeding year, the amount determined 

22 under this subparagraph for the pre23 vious year increased by the annual 

24 percentage increase in the consumer 

25 price index (all items; U.S. city averVerDate Nov 24 2008 06:34 Jun 06, 2009 Jkt 079200 PO 00000 Frm 00027 Fmt 6652 Sfmt 6201 E:\BILLS\H2700.IH H2700

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1 age) as of September of such previous 

2 year.’’; and 

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

4 the copayment or coinsurance amount’’ and all that 

5 follows through the period at the end and inserting 

6 ‘‘exceed— 

7 ‘‘(i) for each of 2006 through 2010, 

8 the copayment or coinsurance amount 

9 specified under section 1860D– 

10 2(b)(4)(A)(i)(I) for the drug and year in11 volved; and 

12 ‘‘(ii) for 2011 and each succeeding 

13 year, the amount determined under this 

14 clause for the previous year increased by 

15 the annual percentage increase in the con16 sumer price index (all items; U.S. city av17 erage) as of September of such previous 

18 year.’’. 

19 SEC. 6. NO IMPACT ON ELIGIBILITY FOR BENEFITS UNDER 

20 OTHER PROGRAMS. 

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

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

23 amended by section 4(b)(1)(B), is further amended— 


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1 (1) in subparagraph (A), in the matter pre2 ceding clause (i), by striking ‘‘subparagraph (F)’’ 

3 and inserting ‘‘subparagraphs (F) and (I)’’; and 

4 (2) by adding at the end the following new sub5 paragraph: 

6 ‘‘(I) NO IMPACT ON ELIGIBILITY FOR BEN7 EFITS UNDER OTHER PROGRAMS.—The avail8 ability of premium and cost-sharing subsidies 

9 under this section shall not be treated as bene10 fits or otherwise taken into account in deter11 mining an individual’s eligibility for, or the 

12 amount of benefits under, any other Federal 

13 program.’’. 

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

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

16 subsidies for months beginning after the date of the enact17 ment of this Act. 

18 SEC. 7. REQUIRING INDIVIDUALS ELIGIBLE FOR MEDICARE 

19 SAVINGS PROGRAMS TO BE DEEMED TO BE 

20 SUBSIDY ELIGIBLE INDIVIDUALS. 

21 (a) IN GENERAL.—Section 1860D–14(a)(3)(B)(v) of 

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

23 114(a)(3)(B)(v)) is amended— 

24 (1) in subclause (II)— 


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1 (A) by striking ‘‘may’’ and inserting 

2 ‘‘shall’’; and 

3 (B) by inserting ‘‘(ii),’’ after ‘‘clause (i),’’; 

4 and 

5 (2) by striking the second sentence. 

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

7 subsection (a) shall take effect as of the date of the enact8 ment of this Act and apply to determinations made for 

9 purposes of title XIX on or after the first date of the first 

10 plan year beginning after the date of the enactment of 

11 this Act. 

12 SEC. 8. SPECIAL ENROLLMENT PERIOD FOR SUBSIDY ELI13 GIBLE INDIVIDUALS. 

14 (a) IN GENERAL.—Section 1860D–1(b)(3) of the So15 cial Security Act (42 U.S.C. 1395w–101(b)(3)) is amend16 ed by adding at the end the following new subparagraph: 

17 ‘‘(F) ELIGIBILITY FOR LOW-INCOME SUB18 SIDY.— 

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

20 applicable subsidy eligible individual (as 

21 defined in clause (ii)), the special enroll22 ment period described in clause (iii). 

23 ‘‘(ii) APPLICABLE SUBSIDY ELIGIBLE

24 INDIVIDUAL DEFINED.—For purposes of 

25 this subparagraph, the term ‘applicable 


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1 subsidy eligible individual’ means a part D 

2 eligible individual who is not described in 

3 subparagraph (D) and who is determined 

4 under subparagraph (B) of section 

5 1860D–14(a)(3) to be a subsidy eligible in6 dividual (as defined in subparagraph (A) of 

7 such section), including such an individual 

8 who was enrolled in a prescription drug 

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

10 such determination. 

11 ‘‘(iii) SPECIAL ENROLLMENT PERIOD

12 DESCRIBED.—The special enrollment pe13 riod described in this clause, with respect 

14 to an applicable subsidy eligible individual, 

15 is the period beginning on the date the in16 dividual receives notification that such in17 dividual has been determined under section 

18 1860D–14(a)(3)(B) to be a subsidy eligible 

19 individual (as so defined) and ending on 

20 the date the individual is no longer so eligi21 ble.’’. 

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

23 this section shall apply to subsidy determinations made 

24 for months beginning with January 2010. 

Æ 


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