‘‘(4) In addition to the reasons for termination 
under subsection (b), the coverage period of an indi-
vidual described in paragraph (1) or (2) shall end 
when the individual becomes entitled to benefits 
under this title under subsection (a) or (b) of section 
226, or under section 226A, or is no longer eligible 
for such coverage as a result of the application of 
section 1836(b)(2). 
‘‘(5) The Secretary may conduct public edu-
cation activities to raise awareness of the availability 
of more comprehensive, individual health insurance 
coverage (as defined in section 2791 of the Public 
Health Service Act) for individuals eligible under 
section 1836(b) to enroll or to be deemed enrolled in 
the medical insurance program established under 
this part for purposes of coverage of immuno-
suppressive drugs.’’. 
(2) 
CONFORMING
AMENDMENTS.—Section 
1838(b) of the Social Security Act (42 U.S.C. 
1395q(b)) is amended, in the matter following para-
graph (2), by inserting ‘‘or section 1837(n)(3)’’ after 
‘‘section 1837(f)’’ each place it appears. 
(d) PREMIUMS FOR INDIVIDUALS ONLY ELIGIBLE 
FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—
(1) IN GENERAL.—Section 1839 of the Social 
Security Act (42 U.S.C. 1395r) is amended— 
(A) in subsection (b), by adding at the end 
the following new sentence: ‘‘No increase in the 
premium shall be effected for individuals who 
are enrolled pursuant to section 1836(b) for 
coverage only of immunosuppressive drugs.’’; 
and 
(B) by adding at the end the following new 
subsection: 
‘‘(j) DETERMINATION OF PREMIUM FOR INDIVID-
UALS ONLY ELIGIBLE
FOR COVERAGE
OF IMMUNO-
SUPPRESSIVE DRUGS.—The Secretary shall, during Sep-
tember of each year (beginning with 2022), determine and 
promulgate a monthly premium rate for the succeeding 
calendar year for individuals enrolled only for the purpose 
of coverage of immunosuppressive drugs under section 
1836(b). Such premium shall be equal to 15 percent of 
the monthly actuarial rate for enrollees age 65 and over 
(as would be determined in accordance with subsection 
(a)(1) if the reference to ‘one-half’ in such subsection were 
a reference to ‘100 percent’) for that succeeding calendar 
year. The monthly premium of each individual enrolled for 
coverage of immunosuppressive drugs under section 
1836(b) for each month shall be the amount promulgated
in this subsection. In the case of such individual not other-
wise enrolled under this part, such premium shall be in 
lieu of any other monthly premium applicable under this 
section. Such amount shall be adjusted in accordance with 
subsections (c), (f), and (i), but shall not be adjusted 
under subsection (b).’’. 
(2) SPECIAL RULE FOR APPLICATION OF HOLD 
HARMLESS PROVISIONS TO TRANSITIONING INDIVID-
UALS.—Section 1839(f) of the Social Security Act 
(42 U.S.C. 1395r(f)) is amended by adding at the 
end the following new sentence: ‘‘Any increase in the 
premium for an individual who was enrolled under 
section 1836(b) attributable to such individual oth-
erwise enrolling under this part shall not be taken 
into account in applying this subsection.’’. 
(3) SPECIAL RULE FOR APPLICATION OF PRE-
MIUM
SUBSIDY
REDUCTION
PROVISIONS.—Section 
1839(i)(3)(A)(ii)(II) of the Social Security Act (42 
U.S.C. 1395r(i)(3)(A)(ii)(II)) is amended by insert-
ing ‘‘except in the case of an individual enrolled 
under section 1836(b) and not otherwise enrolled 
under this part,’’ before ‘‘4 times’’. 
(e) GOVERNMENT CONTRIBUTION.—Section 1844(a) 
of the Social Security Act (42 U.S.C. 1395w(a)) is amend-
ed—
(1) in paragraph (3), by striking the period at 
the end and inserting ‘‘; plus’’; 
(2) by inserting after paragraph (3) the fol-
lowing new paragraph: 
‘‘(4) a Government contribution equal to the es-
timated aggregate reduction in premiums payable 
under part B that results from establishing the pre-
mium at 15 percent of the actuarial rate (as would 
be determined in accordance with section 1839(a)(1) 
if the reference to ‘one-half’ in such section were a 
reference to ‘100 percent’) under section 1839(j) in-
stead of 25 percent of such rate (as so determined) 
for individuals enrolled only for the purpose of cov-
erage of immunosuppressive drugs under section 
1836(b).’’; and 
(3) by adding the following sentence at the end 
of the flush matter following paragraph (4), as 
added by paragraph (2) of this subsection: 
‘‘The Government contribution under paragraph (4) 
shall be treated as premiums payable and deposited 
for purposes of subparagraphs (A) and (B) of para-
graph (1).’’. 
(f) ENSURING COVERAGE UNDER THE MEDICARE 
SAVINGS PROGRAM.—
(1) IN GENERAL.—Section 1905(p)(1)(A) of the 
Social Security Act (42 U.S.C. 1396d(p)(1)(A)) is 
amended by inserting ‘‘or who is enrolled under part 
B for the purpose of coverage of immunosuppressive 
drugs under section 1836(b)’’ after ‘‘under section 
1818A)’’. 
(2) 
CONFORMING
AMENDMENTS.—Section 
1902(a)(10)(E) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(E)) is amended in each of 
clauses (iii) and (iv) by inserting ‘‘(including such 
individuals enrolled under section 1836(b))’’ after 
‘‘section 1905(p)(1)’’. 
(g) PART D.—Section 1860D–1(a)(3)(A) of the So-
cial Security Act (42 U.S.C. 1395w–101(a)(3)(A)) is 
amended by inserting ‘‘(but not including an individual en-
rolled solely for coverage of immunosuppressive drugs 
under section 1836(b))’’ before the period at the end. 
(h) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the 
United States (in this subsection referred to as the 
‘‘Comptroller General’’) shall conduct a study on the 
implementation of coverage of immunosuppressive 
drugs for kidney transplant patients under the Medi-
care program pursuant to the provisions of, and 
amendments made by, this section.
(2) REPORT.—Not later than January 1, 2025, 
the Comptroller General shall submit to Congress a 
report on the study conducted under paragraph (1), 
together with recommendations as the Comptroller 
General determines appropriate. 
SEC. 4. TRANSPARENCY OF MEDICARE SECONDARY PAYER 
REPORTING INFORMATION. 
(a) IN GENERAL.—Section 1862(b)(8)(G) of the So-
cial Security Act (42 U.S.C. 395y(b)(8)(G)) is amended— 
(1) by striking ‘‘INFORMATION.—The Sec-
retary’’ and inserting ‘‘INFORMATION.— 
‘‘(i) IN
GENERAL.—The Secretary’’; 
and 
(2) by adding at the end the following new 
clause: 
‘‘(ii) SPECIFIED
INFORMATION.—In 
responding to any query from an applica-
ble plan related to a determination de-
scribed in subparagraph (A)(i), the Sec-
retary, notwithstanding any other provision 
of law, shall provide to such applicable 
plan— 
‘‘(I) whether a claimant subject 
to the query is, or during the pre-
ceding 3-year period has been, entitled
to benefits under the program under 
this title on any basis; and 
‘‘(II) to the extent applicable, the 
plan name and address of any Medi-
care Advantage plan under part C 
and any prescription drug plan under 
part D in which the claimant is en-
rolled or has been enrolled during 
such period.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply with respect to queries from 
plans made on or after the date that is one year after 
the date of the enactment of this Act. 
SEC. 5. ESTABLISHING HOSPICE PROGRAM SURVEY AND 
ENFORCEMENT PROCEDURES UNDER THE 
MEDICARE PROGRAM. 
(a) SURVEY AND ENFORCEMENT PROCEDURES.— 
(1) IN GENERAL.—Part A of title XVIII of the 
Social Security Act (42 U.S.C. 1395c et seq.) is 
amended by adding at the end the following new sec-
tion: 
‘‘SEC. 1822. HOSPICE PROGRAM SURVEY AND ENFORCE-
MENT PROCEDURES. 
‘‘(a) SURVEYS.—
‘‘(1) FREQUENCY.—Any entity that is certified 
as a hospice program shall be subject to a standard 
survey by an appropriate State or local survey agen-
cy, or an approved accreditation agency, as deter-
mined by the Secretary, not less frequently than 
once every 36 months (and not less frequently than 
once every 24 months beginning October 1, 2021). 
‘‘(2) PUBLIC TRANSPARENCY OF SURVEY AND 
CERTIFICATION INFORMATION.— 
‘‘(A) SUBMISSION
OF
INFORMATION
TO 
THE SECRETARY.— 
‘‘(i) IN GENERAL.—Each State, and 
each national accreditation body with re-
spect to which the Secretary has made a 
finding under section 1865(a) respecting 
the accreditation of a hospice program by 
such body, shall submit, in a form and 
manner, and at a time, specified by the 
Secretary for purposes of this subpara-
graph, information respecting any survey 
or certification made with respect to a hos-
pice program by such State or body, as ap-
plicable. Such information shall include 
any inspection report made by such State 
or body with respect to such survey or cer-
tification, any enforcement actions taken 
as a result of such survey or certification, 
and any other information determined ap-
propriate by the Secretary. 
‘‘(ii) REQUIRED INCLUSION OF SPECI-
FIED
FORM.—With respect to a survey 
under this subsection carried out by a na-
tional accreditation body described in 
clause (i) on or after October 1, 2021, in-
formation described in such clause shall in-
clude Form 2567 (or a successor form), 
along with such additional information de-
termined appropriate by such body. 
‘‘(B) PUBLIC
DISCLOSURE
OF
INFORMA-
TION.—Beginning not later than October 1, 
2022, the Secretary shall publish the informa-
tion submitted under subparagraph (A) on the 
public website of the Centers for Medicare & 
Medicaid Services in a manner that is promi-
nent, easily accessible, readily understandable, 
and searchable. The Secretary shall provide for 
the timely update of such information so pub-
lished. 
‘‘(3) CONSISTENCY OF SURVEYS.—Each State 
and the Secretary shall implement programs to
measure and reduce inconsistency in the application 
of survey results among surveyors. 
‘‘(4) SURVEY TEAMS.— 
‘‘(A) IN GENERAL.—In the case of a sur-
vey conducted under this subsection on or after 
October 1, 2021, by more than 1 individual, 
such survey shall be conducted by a multidisci-
plinary team of professionals (including a reg-
istered professional nurse). 
‘‘(B) PROHIBITION OF CONFLICTS OF IN-
TEREST.—Beginning October 1, 2021, a State 
may not use as a member of a survey team 
under this subsection an individual who is serv-
ing (or has served within the previous 2 years) 
as a member of the staff of, or as a consultant 
to, the program surveyed respecting compliance 
with the requirements of section 1861(dd) or 
who has a personal or familial financial interest 
in the program being surveyed. 
‘‘(C) TRAINING.—The Secretary shall pro-
vide, not later than October 1, 2021, for the 
comprehensive training of State and Federal 
surveyors, and any surveyor employed by a na-
tional accreditation body described in paragraph 
(2)(A)(i), in the conduct of surveys under this
subsection, including training with respect to 
the review of written plans for providing hospice 
care (as described in section 1814(a)(7)(B)). 
No individual shall serve as a member of a sur-
vey team with respect to a survey conducted on 
or after such date unless the individual has suc-
cessfully completed a training and testing pro-
gram in survey and certification techniques that 
has been approved by the Secretary. 
‘‘(5) FUNDING.—The Secretary shall provide 
for the transfer, from the Federal Hospital Insur-
ance Trust Fund under section 1817 to the Centers 
for Medicare & Medicaid Services Program Manage-
ment Account, of $10,000,000 for each fiscal year 
(beginning with fiscal year 2022) for purposes of 
carrying out this subsection and subsection (b). 
Sums so transferred shall remain available until ex-
pended. Any transfer pursuant to this paragraph 
shall be in addition to any transfer pursuant to sec-
tion 3(a)(2) of the Improving Medicare Post-Acute 
Care Transformation Act of 2014. 
‘‘(b) SPECIAL FOCUS PROGRAM.— 
‘‘(1) IN GENERAL.—The Secretary shall con-
duct a special focus program for enforcement of re-
quirements for hospice programs that the Secretary
has identified as having substantially failed to meet 
applicable requirements of this Act. 
‘‘(2) PERIODIC SURVEYS.—Under such special 
focus program, the Secretary shall conduct surveys 
of each hospice program in the special focus pro-
gram not less than once every 6 months. 
‘‘(c) ENFORCEMENT.— 
‘‘(1) SITUATIONS INVOLVING IMMEDIATE JEOP-
ARDY.—If the Secretary determines on the basis of 
a standard survey or otherwise that a hospice pro-
gram that is certified for participation under this 
title is no longer in compliance with the require-
ments specified in section 1861(dd) and determines 
that the deficiencies involved immediately jeopardize 
the health and safety of the individuals to whom the 
program furnishes items and services, the Secretary 
shall take immediate action to remove the jeopardy 
and correct the deficiencies through the remedy de-
scribed in paragraph (5)(B)(iii) or terminate the cer-
tification of the program, and may provide, in addi-
tion, for 1 or more of the other remedies described 
in paragraph (5)(B). 
‘‘(2) SITUATIONS NOT INVOLVING IMMEDIATE 
JEOPARDY.—If the Secretary determines on the 
basis of a standard survey or otherwise that a hos-
pice program that is certified for participation under 
this title is no longer in compliance with the require-
ments specified in section 1861(dd) and determines 
that the deficiencies involved do not immediately 
jeopardize the health and safety of the individuals to 
whom the program furnishes items and services, the 
Secretary may (for a period not to exceed 6 months) 
impose remedies developed pursuant to paragraph 
(5)(A), in lieu of terminating the certification of the 
program. If, after such a period of remedies, the 
program is still no longer in compliance with such 
requirements, the Secretary shall terminate the cer-
tification of the program. 
‘‘(3) PENALTY
FOR
PREVIOUS
NONCOMPLI-
ANCE.—If the Secretary determines that a hospice 
program that is certified for participation under this 
title is in compliance with the requirements specified 
in section 1861(dd) but, as of a previous period, did 
not meet such requirements, the Secretary may pro-
vide for a civil monetary penalty under paragraph 
(5)(B)(i) for the days in which the Secretary finds 
that the program was not in compliance with such 
requirements. 
‘‘(4) OPTION
TO
CONTINUE
PAYMENTS
FOR 
NONCOMPLIANT
HOSPICE
PROGRAMS.—The Sec-