I 
108TH CONGRESS 
2D SESSION 
H. R. 4437
To amend part D of title XVIII of the Social Security Act to provide 
for low-income beneficiaries in the Medicare savings programs automatic 
enrollment and eligibility for low-income subsidies under the Medicare 
transitional and permanent prescription drug programs. 
IN THE HOUSE OF REPRESENTATIVES 
MAY 20, 2004
Mr. DINGELL (for himself, Mr. RANGEL, Mr. WAXMAN, Mr. STARK, Mr. 
BROWN of Ohio, Ms. PELOSI, Mr. MARKEY, Mr. TOWNS, Mr. PALLONE, 
Mr. RUSH, Mr. STUPAK, Mr. ENGEL, Mr. WYNN, Ms. MCCARTHY of Mis-
souri, Mr. STRICKLAND, Mrs. CAPPS, Mr. JOHN, Mr. ALLEN, Mr. DAVIS 
of Florida, Mr. BECERRA, Mr. MCNULTY, Mr. DOGGETT, Mr. MATSUI, 
Mr. SANDLIN, and Mr. DEUTSCH) 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 provi-
sions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend part D of title XVIII of the Social Security 
Act to provide for low-income beneficiaries in the Medi-
care savings programs automatic enrollment and eligi-
bility for low-income subsidies under the Medicare transi-
tional and permanent prescription drug programs.
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 ‘‘Medicare Prescription 
Drug Low-Income Assistance Act of 2004’’. 
SEC. 2. ASSURANCE OF ASSISTANCE FOR LOW-INCOME 
BENEFICIARIES IN MEDICARE SAVINGS PRO-
GRAMS UNDER MEDICARE PRESCRIPTION 
DRUG DISCOUNT CARD AND TRANSITIONAL 
ASSISTANCE PROGRAM. 
(a) AUTOMATIC ENROLLMENT.—
(1) IN GENERAL.—Section 1860D–31(c)(1) of 
the Social Security Act (42 U.S.C. 1395w–
141(c)(1)) is amended by adding at the end the fol-
lowing new subparagraph: 
‘‘(F) AUTOMATIC
ENROLLMENT
OF
CER-
TAIN
LOW-INCOME
BENEFICIARIES
IN
MEDI-
CARE SAVINGS PROGRAMS.—
‘‘(i) NOTICE
OF
ELIGIBILITY.—Not 
later than 45 days after the date an indi-
vidual described in clause (ii) is first eligi-
ble to enroll in an endorsed discount card 
program under this section, each State or 
the Secretary (at the option of each State) 
shall mail to each individual described in 
clause (ii), a notice stating the following: 
‘‘(I) Such individual is eligible to 
enroll in an endorsed discount card
program and to receive transitional 
assistance under subsection (g). 
‘‘(II) If such individual does not 
enroll before 30 days after the date of 
the notice, such individual will be 
automatically enrolled in an endorsed 
discount card program selected by the 
Secretary unless the individual noti-
fies the Secretary that such individual 
does not wish to be so enrolled. 
‘‘(III) If such individual is auto-
matically enrolled in an endorsed dis-
count card program selected by the 
Secretary, the individual may enroll in 
another endorsed discount card pro-
gram selected by the individual during 
the 60-day period beginning on the 
date of such automatic enrollment. 
‘‘(IV) If the individual is enrolled 
in an endorsed discount card program 
during 2004, the individual will be 
permitted to change enrollment under 
subsection (c)(1)(C)(ii) for 2005. 
‘‘(V) There is no obligation to 
use the endorsed discount card pro-
gram or transitional assistance when 
purchasing prescription drugs. 
‘‘(ii) INDIVIDUALS BENEFITING FROM 
AUTOMATIC ENROLLMENT.—An individual 
described in this clause is a discount card 
eligible individual who—
‘‘(I) is a recipient of supple-
mental security income benefits under 
title XVI, or is determined to be eligi-
ble for medical assistance under title 
XIX solely by reason of clause (i), 
(iii), or (iv) of section 1902(a)(10)(E); 
and 
‘‘(II) has not enrolled in an en-
dorsed discount card program as of 
the date that is 30 days after the date 
the individual is first eligible to enroll 
in such a program. 
‘‘(iii) 
AUTOMATIC
ENROLLMENT.—
The Secretary shall enroll each individual 
described in clause (ii), who has not en-
rolled in an endorsed discount card pro-
gram or provided notice to the Secretary 
under clause (iv) as of the end of the 30-
day period beginning on the date of the no-
tice to the individual under clause (i), in 
an endorsed discount card program se-
lected by the Secretary that serves resi-
dents of the State in which the individual 
resides. 
‘‘(iv) OPT-OUT.—Clause (iii) shall not 
apply to an individual if the individual no-
tifies the Secretary before the end of the 
30-day period described in such clause that 
the individual does not wish to be auto-
matically enrolled under such clause. 
‘‘(v) 
60-DAY
GRACE
PERIOD
TO 
CHANGE CARD PROGRAM.—The Secretary 
shall permit each individual who is auto-
matically enrolled under clause (iii) to 
elect, during the 60-day period that begins 
on the date the individual is so enrolled, to 
enroll in a different endorsed discount card 
program selected by such individual. Such 
a change shall be treated as an exceptional 
case 
for 
purposes 
of 
subparagraph 
(C)(iii).’’. 
(b) PROVISION OF TRANSITIONAL ASSISTANCE.—
paragraph (2)(B) (relating to individuals with 
certain prescription drug coverage).’’. 
(2) WAIVER
OF
SELF-CERTIFICATION
AND 
VERIFICATION.—Section 1860D–31(f) of such Act 
(42 U.S.C. 1395w–141(f)) is amended by adding at 
the end the following new paragraph: 
‘‘(5) SPECIAL RULE FOR CERTAIN LOW-INCOME 
BENEFICIARIES IN MEDICARE SAVINGS PROGRAMS.—
The provisions of paragraphs (2) and (3) shall not 
apply to individuals who are treated as transitional 
assistance eligible individuals under subsection 
(b)(5).’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect as if included in the enact-
ment of section 101 of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Public Law 
108–173; 117 Stat. 2071). 
SEC. 3. ASSURANCE OF ASSISTANCE FOR LOW-INCOME 
BENEFICIARIES IN MEDICARE SAVINGS PRO-
GRAMS UNDER QUALIFIED PRESCRIPTION 
DRUG COVERAGE. 
(a) AUTOMATIC
ENROLLMENT.—Section 1860D–
1(b)(1)(C) of the Social Security Act (42 U.S.C. 1395w–
101(b)(1)(C)) is amended—
(1) by designating the matter beginning with 
‘‘The process established’’ as a clause (i) with the 
heading ‘‘IN GENERAL.—’’ and an appropriate in-
dentation; 
(2) by striking ‘‘a full-benefit dual eligible indi-
vidual (as defined in section 1935(c)(6)) who has 
failed to enroll in a prescription drug plan or an 
MA–PD plan’’ and inserting ‘‘described in clause 
(ii)’’; and 
(3) by adding at the end the following new 
clauses: 
‘‘(ii) INDIVIDUALS COVERED.—An in-
dividual described in this clause is an indi-
vidual who—
‘‘(I) is a full-benefit dual eligible 
individual (as defined in section 
1935(c)(6)), is a recipient of supple-
mental security income benefits under 
title XVI, or is determined to be eligi-
ble for medical assistance under title 
XIX solely by reason of clause (i), 
(iii), or (iv) of section 1902(a)(10)(E); 
and
‘‘(II) has failed to enroll in a pre-
scription drug plan or an MA–PD 
plan. 
‘‘(iii) APPLICATION OF NOTICE, OPT-
OUT, AND GRACE PERIOD IN CHANGE IN 
ENROLLMENT
PROVISIONS.—In carrying 
out this subparagraph, the Secretary shall 
provide for the application of notice and 
change in enrollment provisions with re-
spect to enrollment in prescription drug 
plans and MA–PD plans similar to those 
provided under clauses (i), (iv), and (v) of 
section 1860D–31(c)(1)(F) with respect to 
enrollment in endorsed discount card pro-
grams.’’. 
(b) PROVISION
OF PREMIUM
AND COST-SHARING 
SUBSIDIES.—Section 1860D–14(a)(3)(B)(v) of such Act 
(42 U.S.C. 1395w–114(a)(3)(B)(v)) is amended to read 
as follows: 
‘‘(v) TREATMENT OF MEDICAID BENE-
FICIARIES
AND
LOW-INCOME
BENE-
FICIARIES
IN
MEDICARE
SAVINGS
PRO-
GRAMS.—Subject to subparagraph (F), the 
Secretary shall provide that the following 
individuals who are part D eligible individ-
uals shall be treated as being determined 
to be subsidy eligible individuals described 
in paragraph (1): 
‘‘(I) Full-benefit dual eligible in-
dividuals 
(as 
defined 
in 
section 
1935(c)(6)). 
‘‘(II) Individuals who are recipi-
ents of supplemental security income 
benefits under title XVI. 
‘‘(III) Individuals who are deter-
mined to be eligible for medical assist-
ance under title XIX solely by reason 
of clause (i), (iii), or (iv) of section 
1902(a)(10)(E).’’. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall take effect as if included in the enact-
ment of section 101 of the Medicare Prescription Drug, 
Improvement, and Modernization Act of 2003 (Public Law 
108–173; 117 Stat. 2071).
Æ