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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2716 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 2716

  To amend title XIX of the Social Security Act to provide financial 
stability for seniors and people with disabilities through improvements 
                    in the Medicare Savings Program.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                              June 4, 2009

  Mr. Becerra (for himself and Mr. Doggett) 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 title XIX of the Social Security Act to provide financial 
stability for seniors and people with disabilities through improvements 
                    in the Medicare Savings Program.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Medicare Savings 
Program Improvement Act of 2009''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Increase in income levels for eligibility.
Sec. 3. Modification of resource standards.
Sec. 4. Eligibility for other programs.
Sec. 5. Effective date of MSP benefits.
Sec. 6. Treatment of qualified Medicare beneficiaries, specified low-
                            income Medicare beneficiaries, and other 
                            dual eligibles as medicare beneficiaries.
Sec. 7. Monitoring and enforcement of limitation on beneficiary 
                            liability.
Sec. 8. Medicaid treatment of certain Medicare providers.
Sec. 9. State provision of medical assistance to dual eligibles in MA 
                            plans.
Sec. 10. Medicare enrollment assistance.
Sec. 11. Medicaid agency consideration of low-income subsidy 
                            application and data transmittal.
Sec. 12. QMB buy-in of part A and part B premiums.
Sec. 13. Increasing availability of MSP applications through 
                            availability on the Internet and 
                            designation of preferred language.
Sec. 14. Medicare savings program applications.
Sec. 15. Repeal of payment limitation.

SEC. 2. INCREASE IN INCOME LEVELS FOR ELIGIBILITY.

    (a) Increase to 150 Percent of FPL for Qualified Medicare 
Beneficiaries.--
            (1) In general.--Section 1905(p)(2) of the Social Security 
        Act (42 U.S.C. 1396d(p)(2)) is amended--
                    (A) in subparagraph (A), by striking ``100 
                percent'' and inserting ``150 percent'';
                    (B) in subparagraph (B)--
                            (i) by striking ``and'' at the end of 
                        clause (ii);
                            (ii) by striking the period at the end of 
                        clause (iii) and inserting ``, and''; and
                            (iii) by adding at the end the following:
                            ``(iv) January 1, 2011, is 150 percent.''; 
                        and
                    (C) in subparagraph (C)--
                            (i) by striking ``and'' at the end of 
                        clause (iii);
                            (ii) by striking the period at the end of 
                        clause (iv) and inserting ``, and''; and
                            (iii) by adding at the end the following:
                            ``(v) January 1, 2011, is 150 percent.''.
            (2) Application of income test based on family size.--
        Section 1905(p)(2)(A) of such Act (42 U.S.C. 1396d(p)(2)(A)) is 
        amended by adding at the end the following: ``For purposes of 
        this subparagraph, family size means the applicant, the spouse 
        (if any) of the applicant if living in the same household as 
        the applicant, and the number of individuals who are related to 
        the applicant (or applicants), who are living in the same 
        household as the applicant (or applicants), and who are 
        dependent on the applicant (or the applicant's spouse) for at 
        least one-half of their financial support.''.
            (3) Not counting in-kind support and maintenance as 
        income.--Section 1905(p)(2)(D) of such Act (42 U.S.C. 
        1396d(p)(2)(D)) is amended by adding at the end the following 
        new clause:
                            ``(iii) In determining income under this 
                        subsection, support and maintenance furnished 
                        in kind shall not be counted as income.''.
    (b) Expansion of Specified Low-Income Medicare Beneficiary (SLMB) 
Program.--
            (1) Eligibility of individuals with incomes below 200 
        percent of fpl.--Section 1902(a)(10)(E) of the Social Security 
        Act (42 U.S.C. 1396b(a)(10)(E)) is amended--
                    (A) by adding ``and'' at the end of clause (ii);
                    (B) in clause (iii)--
                            (i) by striking ``and 120 percent in 1995 
                        and years thereafter'' and inserting ``, or 120 
                        percent in 1995 and any succeeding year before 
                        2011, or 200 percent in 2011 and years 
                        thereafter''; and
                            (ii) by striking ``and'' at the end; and
                    (C) by striking clause (iv).
            (2) References.--Section 1905(p)(1) of such Act (42 U.S.C. 
        1396d(p)(1)) is amended by adding at and below subparagraph (C) 
        the following: ``The term `specified low-income medicare 
        beneficiary' means an individual described in section 
        1902(a)(13)(iii).''.
    (c) Providing 100 Percent Federal Financing.--The third sentence of 
section 1905(b) of such Act (42 U.S.C. 1396d(b)) is amended by 
inserting before the period at the end the following: ``and with 
respect to medical assistance for Medicare cost-sharing provided under 
section 1902(a)(10)(E)(iii) and under section 1902(a)(10)(E)(i) with 
respect to individuals with income (as determined in accordance with 
subsection (p)(1)(B)) is greater than 100 percent of the official 
income poverty line applicable to a family of the size involved''.
    (d) Effective Date.--
            (1) Except as provided in paragraph (2), the amendments 
        made by this section shall take effect on January 1, 2011, and, 
        with respect to title XIX of the Social Security Act, shall 
        apply to calendar quarters beginning on or after January 1, 
        2011.
            (2) In the case of a State plan for medical assistance 
        under title XIX of the Social Security Act which the Secretary 
        of Health and Human Services determines requires State 
        legislation (other than legislation appropriating funds) in 
        order for the plan to meet the additional requirements imposed 
        by the amendments made by this section, the State plan shall 
        not be regarded as failing to comply with the requirements of 
        such title solely on the basis of its failure to meet these 
        additional requirements before the first day of the first 
        calendar quarter beginning after the close of the first regular 
        session of the State legislature that begins after the date of 
        the enactment of this Act. For purposes of the previous 
        sentence, in the case of a State that has a 2-year legislative 
        session, each year of such session shall be deemed to be a 
        separate regular session of the State legislature.

SEC. 3. MODIFICATION OF RESOURCE STANDARDS.

    (a) In General.--Section 1905(p) of the Social Security Act (42 
U.S.C. 1396d(p)) is amended--
            (1) in paragraph (1), by amending subparagraph (C) to read 
        as follows:
                    ``(C) whose resources (as determined under section 
                1613 for purposes of the supplemental income security 
                program, except as provided in paragraph (6)(B)) do not 
                exceed the amount described in paragraph (6)(A).'';
            (2) by redesignating paragraph (6) as paragraph (7); and
            (3) by inserting after paragraph (5) the following:
    ``(6)(A) The resource level specified in this subparagraph for--
            ``(i) for 2011, is $27,500 (or $55,000 in the case of the 
        combined value of the individual's assets or resources and the 
        assets or resources of the individual's spouse); and
            ``(ii) for a subsequent year is the applicable resource 
        level specified in this subparagraph for the previous year 
        increased by the annual percentage increase in the consumer 
        price index (all items; U.S. city average) as of September of 
        such previous year.
Any dollar amount established under clause (ii) that is not a multiple 
of $10 shall be rounded to the nearest multiple of $10.
    ``(B) In determining the resources of an individual (and their 
eligible spouse, if any) under section 1613 for purposes of paragraph 
(1)(C) (relating to qualified Medicare beneficiaries) or section 
1902(a)(10)(E)(iii) (relating to specified low-income medicare 
beneficiaries), the following additional exclusions shall apply:
            ``(i) No part of the value of any life insurance policy 
        shall be taken into account.
            ``(ii) No balance in, or benefits received under, an 
        employee pension benefit plan (as defined in section 3 of the 
        Employee Retirement Income Security Act of 1974) shall be taken 
        into account''.
    (b) Effective Date.--
            (1) Except as provided in paragraph (2), the amendments 
        made by this section shall apply to calendar quarters beginning 
        on or after January 1, 2011.
            (2) In the case of a State plan for medical assistance 
        under title XIX of the Social Security Act which the Secretary 
        of Health and Human Services determines requires State 
        legislation (other than legislation appropriating funds) in 
        order for the plan to meet the additional requirements imposed 
        by the amendments made by this section, the State plan shall 
        not be regarded as failing to comply with the requirements of 
        such title solely on the basis of its failure to meet these 
        additional requirements before the first day of the first 
        calendar quarter beginning after the close of the first regular 
        session of the State legislature that begins after the date of 
        the enactment of this Act. For purposes of the previous 
        sentence, in the case of a State that has a 2-year legislative 
        session, each year of such session shall be deemed to be a 
        separate regular session of the State legislature.

SEC. 4. ELIGIBILITY FOR OTHER PROGRAMS.

    (a) In General.--Section 1905(p) of the Social Security Act (42 
U.S.C. 1396d(p)), as amended by section 2(a), is amended--
            (1) by redesignating paragraph (7) as paragraph (8); and
            (2) by inserting after paragraph (6) the following new 
        paragraph:
            ``(7) Notwithstanding any other provision of law, any 
        medical assistance for some or all medicare cost-sharing under 
        this title shall not be considered income or resources in 
        determining eligibility for, or the amount of assistance or 
        benefits provided under, any other public benefit provided 
        under Federal law or the law of any State or political 
        subdivision thereof.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to eligibility for benefits on or after January 1, 2010.

SEC. 5. EFFECTIVE DATE OF MSP BENEFITS.

    (a) Providing for 3 Months Retroactive Eligibility.--
            (1) In general.-- Section 1905(a) of the Social Security 
        Act (42 U.S.C. 1396d(a)) is amended, in the matter preceding 
        paragraph (1), by striking ``assistance or, in the case of 
        medicare cost-sharing'' and all that follows through 
        ``beneficiary)'' and inserting ``assistance)''.
            (2) Conforming amendments.--(A) Section 1902(e)(8) of such 
        Act (42 U.S.C. 1396a(e)(8)) is amended--
                    (i) by striking the first sentence; and
                    (ii) by striking ``such determination''.
            (B) Section 1848(g)(3) of such Act (42 U.S.C. 1395w-
        4(g)(3)) is amended by adding at the end the following new 
        subparagraph:
                    ``(C) Treatment of retroactive eligibility.--In the 
                case of an individual who is determined to be eligible 
                for medical assistance described in subparagraph (A) 
                retroactively, the Secretary shall provide a process 
                whereby claims which are submitted for services 
                furnished during the period of retroactive eligibility 
                and during a month in which the individual otherwise 
                would have been eligible for such assistance and which 
                were not submitted in accordance with such subparagraph 
                are resubmitted and re-processed in accordance with 
                such subparagraph.''.
    (b) Effective Date.--The amendments made by this section shall take 
effect on January 1, 2010, but shall not result in eligibility for 
benefits for medicare cost-sharing for months before January 2010.

SEC. 6. TREATMENT OF QUALIFIED MEDICARE BENEFICIARIES, SPECIFIED LOW-
              INCOME MEDICARE BENEFICIARIES, AND OTHER DUAL ELIGIBLES 
              AS MEDICARE BENEFICIARIES.

    (a) In General.--Section 1862 of the Social Security Act (42 U.S.C. 
1395y) is amended by adding at the end the following new subsection:
    ``(n) Treatment of Qualified Medicare Beneficiaries (QMBs), 
Specified Low-Income Medicare Beneficiaries (SLMBs), and Other Dual 
Eligibles.--Nothing in this title shall be construed as authorizing a 
provider of services or supplier to discriminate (through a private 
contractual arrangement or otherwise) against an individual who is 
otherwise entitled to services under this title on the basis that the 
individual is a qualified medicare beneficiary (as defined in section 
1905(p)(1)), a specified low-income medicare beneficiary, or is 
otherwise eligible for medical assistance for medicare cost-sharing or 
other benefits under title XIX.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to items and services furnished on or after the date of the 
enactment of this Act.

SEC. 7. MONITORING AND ENFORCEMENT OF LIMITATION ON BENEFICIARY 
              LIABILITY.

    (a) In General.--Section 1902(n) of the Social Security Act (42 
U.S.C. 1396b(n)) is amended--
            (1) by striking paragraph (2); and
            (2) in paragraph (3)--
                    (A) by striking ``In the case in which'' and all 
                that follows through `` the application of paragraph 
                (2)'' and inserting ``With respect to an item or 
                service'';
                    (B) in subparagraph (A), by striking ``(if any)''; 
                and
                    (C) by redesignating such paragraph as paragraph 
                (2).
    (b) Conforming Amendment.--Section 1905(p)(2) of such Act (42 
U.S.C. 1396d(p)(2)) is amended by striking ``(subject to section 
1902(n))''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2011.

SEC. 8. MEDICAID TREATMENT OF CERTAIN MEDICARE PROVIDERS.

    (a) In General.--Section 1902(n) of the Social Security Act (42 
U.S.C. 1396a(n)) is amended by adding at the end the following new 
paragraph:
    ``(3) A State plan shall not deny a claim from a provider or 
supplier with respect to medicare cost-sharing described in 
subparagraph (B), (C), or (D) of section 1905(p)(3) for an item or 
service which is eligible for payment under title XVIII on the basis 
that the provider or supplier does not have a provider agreement in 
effect under this title or does not otherwise serve all individuals 
entitled to medical assistance under this title. The State shall create 
a mechanism through which provider or suppliers that do not otherwise 
have provider agreements with the State can bill the State for medicare 
cost-sharing for qualified medicare beneficiaries.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to items and services furnished on or after the date of the 
enactment of this Act.

SEC. 9. STATE PROVISION OF MEDICAL ASSISTANCE TO DUAL ELIGIBLES IN MA 
              PLANS.

    (a) In General.--Section 1902(n) of the Social Security Act (42 
U.S.C. 1396b(n)), as amended by section 8(a), is further amended by 
adding at the end the following new paragraph:
    ``(4)(A) Each State shall--
            ``(i) identify those individuals who are eligible for 
        medical assistance for medicare cost-sharing and who are 
        enrolled with a Medicare Advantage plan under part C of title 
        XVIII; and
            ``(ii) for the individuals so identified, provide for 
        payment of medical assistance for the medicare cost-sharing 
        (including cost-sharing under a Medicare Advantage plan) to 
        which they are entitled.
    ``(B)(i) The Inspector General of the Department of Health and 
Human Services shall examine whether States are providing for medical 
assistance for Medicare cost-sharing for individuals enrolled in 
Medicare Advantage plans in accordance with this title. The Inspector 
General shall submit to the Secretary, not later than one year after 
the date of the enactment of this paragraph, a report on such 
examination and a finding as to whether States are failing to provide 
such medical assistance.
    ``(ii) If a report under clause (i) includes a finding that States 
are failing to provide such medical assistance, not later than 60 days 
after the date of receiving such report the Secretary shall submit to 
Congress a report that includes a plan of action on how to enforce such 
requirement.''.
    (b) Effective Date.--The amendment made by subsection (a) shall be 
effective as if included in the enactment of the Medicare Prescription 
Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173).

SEC. 10. MEDICARE ENROLLMENT ASSISTANCE.

    (a) Additional Funding for State Health Insurance Assistance 
Programs.--
            (1) Grants.--
                    (A) In general.--The Secretary of Health and Human 
                Services (in this section referred to as the 
                ``Secretary'') shall use amounts made available under 
                subparagraph (B) to make grants to States for State 
                health insurance assistance programs receiving 
                assistance under section 4360 of the Omnibus Budget 
                Reconciliation Act of 1990.
                    (B) Funding.--For purposes of making grants under 
                this subsection, the Secretary shall provide for the 
                transfer, from the Federal Hospital Insurance Trust 
                Fund under section 1817 of the Social Security Act (42 
                U.S.C. 1395i) and the Federal Supplementary Medical 
                Insurance Trust Fund under section 1841 of such Act (42 
                U.S.C. 1395t), in the same proportion as the Secretary 
                determines under section 1853(f) of such Act (42 U.S.C. 
                1395w-23(f)), of $14,000,000 to the Centers for 
                Medicare & Medicaid Services Program Management Account 
                for fiscal year 2011, to remain available until 
                expended.
            (2) Amount of grants.--The amount of a grant to a State 
        under this subsection from the total amount made available 
        under paragraph (1) shall be equal to the sum of the amount 
        allocated to the State under paragraph (3)(A) and the amount 
        allocated to the State under subparagraph (3)(B).
            (3) Allocation to states.--
                    (A) Allocation based on percentage of low-income 
                beneficiaries.--The amount allocated to a State under 
                this subparagraph from \2/3\ of the total amount made 
                available under paragraph (1) shall be based on the 
                number of individuals who meet the requirement under 
                subsection (a)(3)(A)(ii) of section 1860D-14 of the 
                Social Security Act (42 U.S.C. 1395w-114) but who have 
                not enrolled to receive a subsidy under such section 
                1860D-14 relative to the total number of individuals 
                who meet the requirement under such subsection 
                (a)(3)(A)(ii) in each State, as estimated by the 
                Secretary.
                    (B) Allocation based on percentage of rural 
                beneficiaries.--The amount allocated to a State under 
                this subparagraph from \1/3\ of the total amount made 
                available under paragraph (1) shall be based on the 
                number of part D eligible individuals (as defined in 
                section 1860D-1(a)(3)(A) of such Act (42 U.S.C. 1395w-
                101(a)(3)(A))) residing in a rural area relative to the 
                total number of such individuals in each State, as 
                estimated by the Secretary.
            (4) Portion of grant based on percentage of low-income 
        beneficiaries to be used to provide outreach to individuals who 
        may be subsidy eligible individuals or eligible for the 
        medicare savings program.--Each grant awarded under this 
        subsection with respect to amounts allocated under paragraph 
        (3)(A) shall be used to provide outreach to individuals who may 
        be subsidy eligible individuals (as defined in section 1860D-
        14(a)(3)(A) of the Social Security Act (42 U.S.C. 1395w-
        114(a)(3)(A)) or eligible for the Medicare Savings Program (as 
        defined in subsection (f)).
    (b) Additional Funding for Area Agencies on Aging.--
            (1) Grants.--
                    (A) In general.--The Secretary, acting through the 
                Assistant Secretary for Aging, shall make grants to 
                States for area agencies on aging (as defined in 
                section 102 of the Older Americans Act of 1965 (42 
                U.S.C. 3002)) and Native American programs carried out 
                under the Older Americans Act of 1965 (42 U.S.C. 3001 
                et seq.).
                    (B) Funding.--For purposes of making grants under 
                this subsection, the Secretary shall provide for the 
                transfer, from the Federal Hospital Insurance Trust 
                Fund under section 1817 of the Social Security Act (42 
                U.S.C. 1395i) and the Federal Supplementary Medical 
                Insurance Trust Fund under section 1841 of such Act (42 
                U.S.C. 1395t), in the same proportion as the Secretary 
                determines under section 1853(f) of such Act (42 U.S.C. 
                1395w-23(f)), of $10,000,000 to the Administration on 
                Aging for fiscal year 2011, to remain available until 
                expended.
            (2) Amount of grant and allocation to states based on 
        percentage of low-income and rural beneficiaries.--The amount 
        of a grant to a State under this subsection from the total 
        amount made available under paragraph (1) shall be determined 
        in the same manner as the amount of a grant to a State under 
        subsection (a), from the total amount made available under 
        paragraph (1) of such subsection, is determined under paragraph 
        (2) and subparagraphs (A) and (B) of paragraph (3) of such 
        subsection.
            (3) Required use of funds.--
                    (A) All funds.--Subject to subparagraph (B), each 
                grant awarded under this subsection shall be used to 
                provide outreach to eligible Medicare beneficiaries 
                regarding the benefits available under title XVIII of 
                the Social Security Act.
                    (B) Outreach to individuals who may be subsidy 
                eligible individuals or eligible for the medicare 
                savings program.--Subsection (a)(4) shall apply to each 
                grant awarded under this subsection in the same manner 
                as it applies to a grant under subsection (a).
    (c) Additional Funding for Aging and Disability Resource Centers.--
            (1) Grants.--
                    (A) In general.--The Secretary shall make grants to 
                Aging and Disability Resource Centers under the Aging 
                and Disability Resource Center grant program that are 
                established centers under such program on the date of 
                the enactment of this Act.
                    (B) Funding.--For purposes of making grants under 
                this subsection, the Secretary shall provide for the 
                transfer, from the Federal Hospital Insurance Trust 
                Fund under section 1817 of the Social Security Act (42 
                U.S.C. 1395i) and the Federal Supplementary Medical 
                Insurance Trust Fund under section 1841 of such Act (42 
                U.S.C. 1395t), in the same proportion as the Secretary 
                determines under section 1853(f) of such Act (42 U.S.C. 
                1395w-23(f)), of $10,000,000 to the Administration on 
                Aging for fiscal year 2011, to remain available until 
                expended.
            (2) Required use of funds.--Each grant awarded under this 
        subsection shall be used to provide outreach to individuals 
        regarding the benefits available under the Medicare 
        prescription drug benefit under part D of title XVIII of the 
        Social Security Act and under the Medicare Savings Program.
    (d) Coordination of Efforts To Inform Older Americans About 
Benefits Available Under Federal and State Programs.--
            (1) In general.--The Secretary, acting through the 
        Assistant Secretary for Aging, in cooperation with related 
        Federal agency partners, shall make a grant to, or enter into a 
        contract with, a qualified, experienced entity under which the 
        entity shall--
                    (A) maintain and update web-based decision support 
                tools, and integrated, person-centered systems, 
                designed to inform older individuals (as defined in 
                section 102 of the Older Americans Act of 1965 (42 
                U.S.C. 3002)) about the full range of benefits for 
                which the individuals may be eligible under Federal and 
                State programs;
                    (B) utilize cost-effective strategies to find older 
                individuals with the greatest economic need (as defined 
                in such section 102) and inform the individuals of the 
                programs;
                    (C) develop and maintain an information 
                clearinghouse on best practices and the most cost-
                effective methods for finding older individuals with 
                greatest economic need and informing the individuals of 
                the programs; and
                    (D) provide, in collaboration with related Federal 
                agency partners administering the Federal programs, 
                training and technical assistance on the most effective 
                outreach, screening, and follow-up strategies for the 
                Federal and State programs.
            (2) Funding.--For purposes of making a grant or entering 
        into a contract under paragraph (1), the Secretary shall 
        provide for the transfer, from the Federal Hospital Insurance 
        Trust Fund under section 1817 of the Social Security Act (42 
        U.S.C. 1395i) and the Federal Supplementary Medical Insurance 
        Trust Fund under section 1841 of such Act (42 U.S.C. 1395t), in 
        the same proportion as the Secretary determines under section 
        1853(f) of such Act (42 U.S.C. 1395w-23(f)), of $10,000,000 to 
        the Administration on Aging for fiscal year 2011, to remain 
        available until expended.
    (e) Medicare Savings Program Defined.--For purposes of this 
section, the term ``Medicare Savings Program'' means the program of 
medical assistance for payment of the cost of medicare cost-sharing 
under the Medicaid program pursuant to sections 1902(a)(10)(E) and 1933 
of the Social Security Act (42 U.S.C. 1396a(a)(10)(E), 1396u-3).

SEC. 11. MEDICAID AGENCY CONSIDERATION OF LOW-INCOME SUBSIDY 
              APPLICATION AND DATA TRANSMITTAL.

    (a) Conforming Amendment to Section 1144.--The first sentence of 
section 1144(c)(3) of the Social Security Act (42 U.S.C. 1320b-
14(c)(3)), as added by section 113(a) of Public Law 110-275, is 
amended--
            (1) by striking ``transmittal''; and
            (2) by inserting ``as specified in section 1935(a)(4)'' 
        before the period at the end.
    (b) Clarifying Amendment to Section 1935.--Section 1935(a)(4) of 
the Social Security Act (42 U.S.C. 1396u-5(a)(4)), as added by section 
113(b) of Public Law 110-275, is amended by striking the last sentence 
and inserting the following: ``For the purpose of a State's obligation 
under section 1902(a)(8) to furnish medical assistance with reasonable 
promptness, the date of the electronic transmission of low income 
subsidy program data, as described in section 1144(c), from the 
Commissioner of Social Security to the State Medicaid Agency, shall 
constitute the date of filing of such application for benefits under 
the Medicare Savings Program. For the purpose of determining when such 
medical assistance will be made available, the State shall consider the 
date of the individual's application for the low income subsidy program 
to constitute the date of filing of an application for benefits under 
the Medicare Savings Program.''.
    (c) Effective Date.--The amendments made by this section are 
effective as if they had been included in the enactment of section 
113(b) of Public Law 110-275.
    (d) OIG Study.--The Inspector General of the Department of Health 
and Human Services shall examine the extent to which States are 
complying with the requirement, under amendments made by the Medicare 
Improvements for Patients and Providers Act of 2008 (Public Law 110-
275), that they initiate an application for Medicare Savings Program 
from data of the Social Security Administration suggesting eligibility.

SEC. 12. QMB BUY-IN OF PART A AND PART B PREMIUMS.

    (a) Requirement.--Section 1902(a) of the Social Security Act (42 
U.S.C. 1396a(a)) is amended--
            (1) in paragraph (72), by striking ``and'' at the end;
            (2) in paragraph (73), by striking the period at the end 
        and inserting ``; and''; and
            (3) by inserting after paragraph (73) the following new 
        paragraph:
            ``(74) provide that the State enters into a modification of 
        an agreement under section 1818(g).''.
    (b) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by this section take effect on the first day of 
        the first calendar quarter beginning 6 months after the date of 
        the enactment of this Act.
            (2) Extension of effective date for state law amendment.--
        In the case of a State plan under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
        Health and Human Services determines requires State legislation 
        in order for the plan to meet the additional requirements 
        imposed by the amendments made by this section, the State plan 
        shall not be regarded as failing to comply with the 
        requirements of such title solely on the basis of its failure 
        to meet these additional requirements before the first day of 
        the first calendar quarter beginning after the close of the 
        first regular session of the State legislature that begins 
        after the date of enactment of this Act. For purposes of the 
        previous sentence, in the case of a State that has a 2-year 
        legislative session, each year of the session is considered to 
        be a separate regular session of the State legislature.

SEC. 13. INCREASING AVAILABILITY OF MSP APPLICATIONS THROUGH 
              AVAILABILITY ON THE INTERNET AND DESIGNATION OF PREFERRED 
              LANGUAGE.

    (a) Requirement for States.--
            (1) In general.--Section 1902(a) of the Social Security Act 
        (42 U.S.C. 1396a(a)), as amended by section 12, is amended--
                    (A) in paragraph (73), by striking ``and''at the 
                end;
                    (B) in paragraph (74), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by inserting after paragraph (74) the following 
                new paragraph:
            ``(75) provide--
                    ``(A) that the application for medical assistance 
                for Medicare cost-sharing under this title used by the 
                State allows an individual to specify a preferred 
                language for subsequent communication and, in the case 
                in which a language other than English is specified, 
                provide that subsequent communications under this title 
                to the individual shall be in such language; and
                    ``(B) that the State makes such application 
                available through an Internet website and provides for 
                such application to be completed on such website.''.
            (2) Effective date.--The amendments made by this subsection 
        take effect on and after the first day of the first calendar 
        quarter beginning 2 years after the date of the enactment of 
        this Act.
    (b) Requirement for the Secretary.--Section 1905(p)(5) of the 
Social Security Act (42 U.S.C. 1396d(p)(5)) is amended by adding at the 
end the following new sentence: ``Such form shall allow an individual 
to specify a preferred language for subsequent communication.''

SEC. 14. MEDICARE SAVINGS PROGRAM APPLICATIONS.

    (a) In General.--Section 1902(a) of the Social Security Act (42 
U.S.C. 1396a(a)), as amended by sections 12 and 13, is further 
amended--
            (1) in paragraph (74), by striking ``and''at the end;
            (2) in paragraph (75), by striking the period at the end 
        and inserting ``; and''; and
            (3) by inserting after paragraph (75) the following new 
        paragraph:
            ``(76) provide that the State coordinates with the State 
        agency that administers benefits under the supplemental 
        nutrition assistance program established under the Food and 
        Nutrition Act of 2008 (7 U.S.C. 2011 et seq.) to ensure that 
        individuals applying for medical assistance provided under 
        paragraph (10)(E), as described in sections 1905(p) and 1933, 
        have the opportunity to apply for, establish eligibility for, 
        and, if eligible, receive supplemental nutrition assistance 
        program benefits.''.
    (b) Effective Date.--
            (1) In general.--Except as provided in paragraph (2), the 
        amendments made by subsection (a) take effect on the first day 
        of the first calendar quarter beginning 6 months after the date 
        of the enactment of this Act.
            (2) Extension of effective date for state law amendment.--
        In the case of a State plan under title XIX of the Social 
        Security Act (42 U.S.C. 1396 et seq.) which the Secretary of 
        Health and Human Services determines requires State legislation 
        in order for the plan to meet the additional requirements 
        imposed by the amendments made by subsection (a), the State 
        plan shall not be regarded as failing to comply with the 
        requirements of such title solely on the basis of its failure 
        to meet these additional requirements before the first day of 
        the first calendar quarter beginning after the close of the 
        first regular session of the State legislature that begins 
        after the date of enactment of this Act. For purposes of the 
        previous sentence, in the case of a State that has a 2-year 
        legislative session, each year of the session is considered to 
        be a separate regular session of the State legislature.
    (c) Report to Congress.--Not later than 1 year after the date of 
enactment of this Act, the Secretary of Health and Human Services shall 
submit to Congress a report on the process each State uses to meet the 
requirements under section 1902(a)(76) of the Social Security Act, as 
added by subsection (a).

SEC. 15. REPEAL OF PAYMENT LIMITATION.

    (a) In General.--Section 1902(n) of the Social Security Act (42 
U.S.C. 1396a(n)) is amended--
            (1) by striking paragraphs (2) and (3); and
            (2) in paragraph (1)--
                    (A) by striking ``(n)(1)'' and inserting ``(n)''; 
                and
                    (B) by striking ``may provide'' and inserting 
                ``shall provide''.
    (b) Conforming Amendments.--(1) Section 1902(a)(10) of such Act is 
amended, in the subclause (VIII) following subparagraph (G), by 
striking ``subsection (n) and''.
    (2) Section 1905(p)(2) of such Act (42 U.S.C. 1396d(p)(2)) is 
amended by striking ``(subject to section 1902(n))''.
    (c) Effective Date.--The amendments made by this section shall 
apply to items and services furnished on or after January 1, 2010.
                                 <all>
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