I
106TH CONGRESS
1ST SESSION
H. R. 854
To amend title XIX of the Social Security Act to provide for the presumptive
eligibility of Medicare beneficiaries for the qualified Medicare beneficiary
and special low-income Medicare beneficiary programs, and for other
purposes.
IN THE HOUSE OF REPRESENTATIVES
FEBRUARY 25, 1999
Mr. BENTSEN introduced the following bill; which was referred to the
Committee on Commerce
A BILL
To amend title XIX of the Social Security Act to provide
for the presumptive eligibility of Medicare beneficiaries
for the qualified Medicare beneficiary and special low-
income Medicare beneficiary programs, and for other
purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Low-Income Medicare
Beneficiary Assistance Act of 1999’’.
SEC. 2. PRESUMPTIVE ELIGIBILITY OF CERTAIN LOW-IN-
COME INDIVIDUALS FOR MEDICARE COST-
SHARING UNDER THE QMB OR SLMB PRO-
GRAM.
Title XIX of the Social Security Act is amended by
inserting after section 1920A the following new section:
‘‘PRESUMPTIVE ELIGIBILITY OF CERTAIN LOW-INCOME
INDIVIDUALS
‘‘SEC. 1920B. (a) A State plan approved under sec-
tion 1902 shall provide for making medical assistance with
respect to medicare cost-sharing covered under the State
plan available to a low-income individual on the date the
low-income individual becomes entitled to benefits under
part A of title XVIII during a presumptive eligibility pe-
riod.
‘‘(b) For purposes of this section:
‘‘(1) The term ‘low-income individual’ means an
individual who at the age of 65 years is described—
‘‘(A) in section 1902(a)(10)(E)(i), or
‘‘(B) in section 1902(a)(10)(E)(iii).
‘‘(2) The term ‘medicare cost-sharing’—
‘‘(A) with respect to an individual de-
scribed in paragraph (1)(A), has the meaning
given such term in section 1905(p)(3).
‘‘(B) with respect to an individual de-
scribed in paragraph (1)(B), has the meaning
given such term in section 1905(p)(3)(A).
‘‘(3) The term ‘presumptive eligibility period’
means, with respect to a low-income individual, the
period that—
‘‘(A) begins with the date on which a
qualified entity determines, on the basis of pre-
liminary information, that the income and re-
sources of the individual do not exceed the ap-
plicable income and resource level of eligibility
under the State plan, and
‘‘(B) ends with (and includes) the earlier
of—
‘‘(i) the day on which a determination
is made with respect to the eligibility of
the low-income individual for medical as-
sistance for medical cost-sharing under the
State plan, or
‘‘(ii) in the case of a low-income indi-
vidual on whose behalf an application is
not filed by the last day of the month fol-
lowing the month during which the entity
makes the determination referred to in
subparagraph (A), such last day.
‘‘(4)(A) Subject to subparagraph (B), the term
‘qualified entity’ means any of the following:
‘‘(i) Qualified individuals within the Social
Security Administration.
‘‘(ii) An entity determined by the State
agency to be capable of making determinations
of the type described in paragraph (3).
‘‘(B) The Secretary may issue regulations fur-
ther limiting those entities that may become quali-
fied entities in order to prevent fraud and abuse and
for other reasons.
‘‘(c)(1) The State agency, after consultation with the
Secretary, shall provide qualified entities with—
‘‘(A) such forms as are necessary for an appli-
cation to be made on behalf of a low-income individ-
ual for medical assistance for medical cost-sharing
under the State plan, and
‘‘(B) information on how to assist low-income
individuals and other persons in completing and fil-
ing such forms.
‘‘(2) A qualified entity that determines under sub-
section (b)(2)(A) that a low-income individual is presump-
tively eligible for medical assistance for medical cost-shar-
ing under a State plan shall—
SEC. 3. AUTHORIZATION OF APPROPRIATIONS FOR OUT-
REACH EFFORTS.
There is authorized to be appropriated to the Sec-
retary of Health and Human Services $12,000,000 for the
purpose of conducting outreach efforts to increase aware-
ness of the availability of medical assistance for medicare
cost-sharing under a State plan under title XIX of the
Social Security Act to eligible low-income medicare bene-
ficiaries described in clauses (i) and (iii), respectively, of
section 
1902(a)(10)(E) 
of 
such 
Act 
(42 
U.S.C.
1396a(a)(10)(E)).
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