I
107TH CONGRESS
2D SESSION
H. R. 5276
To amend title XIX of the Social Security Act to improve the qualified
Medicare beneficiary (QMB) and special low-income Medicare beneficiary
(SLMB) programs within the Medicaid Program.
IN THE HOUSE OF REPRESENTATIVES
JULY 26, 2002
Mr. DINGELL (for himself, Mr. BROWN of Ohio, Mr. WAXMAN, and Mr.
STARK) introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce
A BILL
To amend title XIX of the Social Security Act to improve
the qualified Medicare beneficiary (QMB) and special
low-income Medicare beneficiary (SLMB) programs with-
in the Medicaid Program.
Be it enacted by the Senate and House of Representa-
tives 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 Beneficiary Assistance Improvement Act of
2002’’.
(b) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; table of contents.
Sec. 2. Renaming program to eliminate confusion.
Sec. 3. Expanding protections by increasing SLMB eligibility income level to
135 percent of poverty.
Sec. 4. Eliminating barriers to enrollment.
Sec. 5. Elimination of asset test.
Sec. 6. Improving assistance with out-of-pocket costs.
Sec. 7. Improving program information and coordination with State, local, and
other partners.
Sec. 8. Notices to certain new medicare beneficiaries.
SEC. 2. RENAMING PROGRAM TO ELIMINATE CONFUSION.
The programs of benefits for lower income medicare
beneficiaries provided under section 1902(a)(10)(E) of the
Social Security Act (42 U.S.C. 1396a(a)(10)(E)) shall be
known as the ‘‘Medicare Savings Programs’’.
SEC. 3. EXPANDING PROTECTIONS BY INCREASING SLMB
ELIGIBILITY INCOME LEVEL TO 135 PERCENT
OF POVERTY.
(a) IN GENERAL.—Section 1902(a)(10)(E)(iii) of the
Social Security Act (42 U.S.C. 1396a(a)(10)(E)(iii)) is
amended by striking ‘‘120 percent in 1995 and years
thereafter’’ and inserting ‘‘120 percent in 1995 through
2002 and 135 percent in 2003 and years thereafter’’.
(b) CONFORMING REMOVAL OF QI–1 AND QI–2 PRO-
VISIONS.—
(1) Section 1902(a)(10)(E) of such Act is fur-
ther amended—
(A) by adding ‘‘and’’ at the end of clause
(ii);
(B) by striking ‘‘and’’ at the end of clause
(iii); and
(C) by striking clause (iv).
(2) Section 1933 of such Act (42 U.S.C. 1396v)
is repealed.
(3) The amendments made by this subsection
shall take effect as of January 1, 2003.
(c) APPLICATION OF CHIP ENHANCED MATCHING
RATE FOR SLMB ASSISTANCE.—
(1) IN GENERAL.—Section 1905(b)(4) of such
Act (42 U.S.C. 1396d(b)(4)) is amended by insert-
ing ‘‘or section 1902(a)(10)(E)(iii)’’ after ‘‘section
1902(a)(10)(A)(ii)(XVIII)’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply to medical assistance
for medicare cost-sharing for months beginning with
January 2003.
SEC. 4. ELIMINATING BARRIERS TO ENROLLMENT.
(a) AUTOMATIC ELIGIBILITY FOR SSI RECIPIENTS IN
209(b) STATES
AND SSI CRITERIA STATES.—Section
1905(p) of the Social Security Act (42 U.S.C. 1396d(p))
is amended by adding at the end the following new para-
graph:
‘‘(6) In the case of a State which has elected treat-
ment under section 1902(f) for aged, blind, and disabled
individuals, individuals with respect to whom supplemental
security income payments are being paid under such title
are deemed for purposes of this title to be qualified medi-
care beneficiaries.’’.
(b) SELF-CERTIFICATION OF INCOME.—Such section
1905(p) is further amended by adding at the end the fol-
lowing new paragraph:
‘‘(7) In determining whether an individual qualifies
as a qualified medicare beneficiary or is eligible for bene-
fits under section 1902(a)(10)(E)(iii), the State shall per-
mit individuals to qualify on the basis of self-certifications
of income without the need to provide additional docu-
mentation.’’.
(c) AUTOMATIC REENROLLMENT WITHOUT NEED TO
REAPPLY.—
(1) IN GENERAL.—Such section 1905(p) is fur-
ther amended by adding at the end the following
new paragraph:
‘‘(8) In the case of an individual who has been deter-
mined to qualify as a qualified medicare beneficiary or to
be eligible for benefits under section 1902(a)(10)(E)(iii),
the individual shall be deemed to continue to be so quali-
fied or eligible without the need for any annual or periodic
application unless and until the individual notifies the
State that the individual’s eligibility conditions have
changed so that the individual is no longer so qualified
or eligible.’’.
(2) 
CONFORMING
AMENDMENT.—Section
1902(e)(8) of the Social Security Act (42 U.S.C.
1396a(e)(8)) is amended by striking the second sen-
tence.
(d) USE OF SIMPLIFIED APPLICATION PROCESS.—
Such section 1905(p) is further amended by adding at the
end the following new paragraph:
‘‘(9) A State shall permit individuals to apply to qual-
ify as a qualified medicare beneficiary or for benefits
under section 1902(a)(10)(E)(iii) through the use of the
simplified application form developed under section
1905(p)(5)(A) and shall permit such an application to be
made over the telephone or by mail, without the need for
an interview in person by the applicant or a representative
of the applicant.’’.
(e) ROLE OF SOCIAL SECURITY OFFICES.—
(1) ENROLLMENT AND PROVISION OF INFORMA-
TION AT SOCIAL SECURITY OFFICES.—Such section
is further amended by adding at the end the fol-
lowing new paragraph:
‘‘(10) The Commissioner of Social Security shall pro-
vide, through local offices of the Social Security
Administration—
‘‘(A) for the enrollment under State plans
under this title for appropriate medicare cost-shar-
ing benefits for individuals who qualify as a qualified
medicare beneficiary or for benefits under section
1902(a)(10)(E)(iii); and
‘‘(B) for providing oral and written notice of
the availability of such benefits.’’.
(2) 
CLARIFYING
AMENDMENT.—Section
1902(a)(5) of such Act (42 U.S.C. 1396a(a)(5)) is
amended by inserting ‘‘as provided in section
1905(p)(10)’’ before ‘‘except’’.
(f) OUTSTATIONING OF STATE ELIGIBILITY WORK-
ERS AT SSA FIELD OFFICES.—Section 1902(a)(55) of
such Act (42 U.S.C. 1396a(a)(55)) is amended—
(1) by striking ‘‘subsection (a)(10)(A)(i)(IV),
(a)(10)(A)(i)(VI), 
(a)(10)(A)(i)(VII), 
or
(a)(10)(A)(ii)(IX)’’ 
and 
inserting 
‘‘paragraph
(10)(A)(i)(IV), 
(10)(A)(i)(VI), 
(10)(A)(i)(VII),
(10)(A)(ii)(IX), or (10)(E)’’; and
(2) in subparagraph (A), by inserting ‘‘and in
the case of applications of individuals for medical as-
sistance under paragraph (10)(E), at locations that
include field offices of the Social Security Adminis-
tration’’.
SEC. 5. ELIMINATION OF ASSET TEST.
(a) IN GENERAL.—Section 1905(p)(1) of the Social
Security Act (42 U.S.C. 1396d(p)(1)) is amended—
(1) by adding ‘‘and’’ at the end of subpara-
graph (A);
(2) by striking ‘‘, and’’ at the end of subpara-
graph (B) and inserting a period; and
(3) by striking subparagraph (C).
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply to eligibility determinations for
medicare cost-sharing furnished for periods beginning on
or after January 1, 2003.
SEC. 6. IMPROVING ASSISTANCE WITH OUT-OF-POCKET
COSTS.
(a) ELIMINATING APPLICATION OF ESTATE RECOV-
ERY PROVISIONS.—Section 1917(b)(1)(B)(ii) of the Social
Security Act (42 U.S.C. 1396p(b)(1)(B)(ii)) is amended
by inserting ‘‘(but not including medical assistance for
medicare cost-sharing or for benefits described in section
1902(a)(10)(E))’’ before the period at the end.
(b) PROVIDING FOR 3-MONTHS RETROACTIVE ELIGI-
BILITY.—
(1) IN GENERAL.—Section 1905(a) of such Act
(42 U.S.C. 1396d(a)) is amended, in the matter be-
fore paragraph (1), by striking ‘‘described in sub-
section (p)(1), if provided after the month’’ and in-
serting ‘‘described in subsection (p)(1), if provided
in or after the third month before the month’’.
(2) CONFORMING AMENDMENTS.—(A) The first
sentence of section 1902(e)(8) of such Act (42
U.S.C. 1396a(e)(8)), as amended by section 4(c)(2),
is amended by striking ‘‘(8)’’ and the first sentence.
(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 ELIGI-
BILITY.—In the case of an individual who is de-
termined to be eligible for medical assistance
described in subparagraph (A) retroactively, the
Secretary shall provide a process whereby
claims previously for services furnished during
the period of retroactive eligibility which were
not submitted in accordance with such subpara-
graph are resubmitted and re-processed in ac-
cordance with such subparagraph.’’.
SEC. 7. IMPROVING PROGRAM INFORMATION AND COORDI-
NATION WITH STATE, LOCAL, AND OTHER
PARTNERS.
(a) DATA MATCH DEMONSTRATION PROJECT.—
(1) IN GENERAL.—The Secretary of Health and
Human Services (acting through the Administrator
of the Centers for Medicare & Medicaid Services),
the Secretary of the Treasury, and the Adminis-
trator of Social Security shall enter into an arrange-
ment under which a demonstration is conducted,
consistent with this subsection, for the exchange be-
tween the Centers for Medicare & Medicaid Services,
the Internal Revenue Service, and the Social Secu-
rity Administration of information in order to iden-
tity individuals who are medicare beneficiaries and
who, based on data from the Internal Revenue Serv-
ice that (such as their not filing tax returns or other
appropriate filters) are likely to be qualified medi-
care beneficiaries or individuals otherwise eligible for
medical assistance under section 1902(a)(10)(E) of
the 
Social 
Security 
Act 
(42 
U.S.C.
1396a(a)(10)(E)).
(2) LIMITATION ON USE OF INFORMATION.—
Specific information on income or related matters
exchanged under paragraph (1) may be disclosed
only as required to carry out subsection (b) and for
related Federal and State outreach efforts.
(3) PERIOD.—The project under this subsection
shall be for an initial period of 3 years and may be
extended for additional periods (not to exceed 3