1732 
SEC. 1204. ENHANCED OVERSIGHT RELATING TO REIM-
BURSEMENTS FOR RETROACTIVE LOW IN-
COME SUBSIDY ENROLLMENT. 
(a) IN GENERAL.—In the case of a retro-
active LIS enrollment beneficiary who is en-
rolled under a prescription drug plan under 
part D of title XVIII of the Social Security Act 
(or an MA–PD plan under part C of such title), 
the beneficiary (or any eligible third party) is 
entitled to reimbursement by the plan for cov-
ered drug costs incurred by the beneficiary 
during the retroactive coverage period of the 
beneficiary in accordance with subsection (b) 
and in the case of such a beneficiary de-
scribed in subsection (c)(4)(A)(i), such reim-
bursement shall be made automatically by the 
plan upon receipt of appropriate notice the 
beneficiary is eligible for assistance described 
in such subsection (c)(4)(A)(i) without further 
information required to be filed with the plan 
by the beneficiary. 
(b) ADMINISTRATIVE REQUIREMENTS RELAT-
ING TO REIMBURSEMENTS.— 
(1) LINE-ITEM
DESCRIPTION.—Each re-
imbursement made by a prescription 
drug plan or MA–PD plan under sub-
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section (a) shall include a line-item de-
scription of the items for which the reim-
bursement is made. 
(2) TIMING
OF
REIMBURSEMENTS.—A 
prescription drug plan or MA–PD plan 
must make a reimbursement under sub-
section (a) to a retroactive LIS enroll-
ment beneficiary, with respect to a claim, 
not later than 45 days after— 
(A) in the case of a beneficiary de-
scribed in subsection (c)(4)(A)(i), the 
date on which the plan receives no-
tice from the Secretary that the bene-
ficiary is eligible for assistance de-
scribed in such subsection; or 
(B) in the case of a beneficiary de-
scribed in subsection (c)(4)(A)(ii), the 
date on which the beneficiary files 
the claim with the plan. 
(3) 
REPORTING
REQUIREMENT.—For 
each month beginning with January 2011, 
each prescription drug plan and each 
MA–PD plan shall report to the Secretary 
the following: 
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(A) The number of claims the plan 
has readjudicated during the month 
due to a beneficiary becoming retro-
actively eligible for subsidies avail-
able under section 1860D–14 of the 
Social Security Act. 
(B) The total value of the readju-
dicated claim amount for the month. 
(C) The Medicare Health Insur-
ance Claims Number of beneficiaries 
for whom claims were readjudicated. 
(D) For the claims described in 
subparagraphs (A) and (B), an attes-
tation to the Administrator of the 
Centers for Medicare & Medicaid 
Services of the total amount of reim-
bursement the plan has provided to 
beneficiaries for premiums and cost- 
sharing that the beneficiary overpaid 
for which the plan received payment 
from the Centers for Medicare & Med-
icaid Services. 
(c) DEFINITIONS.—For purposes of this sec-
tion: 
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(1) COVERED
DRUG
COSTS.—The term 
‘‘covered drug costs’’ means, with respect 
to a retroactive LIS enrollment bene-
ficiary enrolled under a prescription 
drug plan under part D of title XVIII of 
the Social Security Act (or an MA–PD 
plan under part C of such title), the 
amount by which— 
(A) the costs incurred by such 
beneficiary during the retroactive 
coverage period of the beneficiary for 
covered part D drugs, premiums, and 
cost-sharing under such title; exceeds 
(B) such costs that would have 
been incurred by such beneficiary 
during such period if the beneficiary 
had been both enrolled in the plan 
and recognized by such plan as quali-
fied during such period for the low 
income subsidy under section 1860D– 
14 of the Social Security Act to which 
the individual is entitled. 
(2) ELIGIBLE THIRD PARTY.—The term 
‘‘eligible third party’’ means, with respect 
to a retroactive LIS enrollment bene-
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ficiary, an organization or other third 
party that is owed payment on behalf of 
such beneficiary for covered drug costs 
incurred by such beneficiary during the 
retroactive coverage period of such bene-
ficiary. 
(3) RETROACTIVE
COVERAGE
PERIOD.— 
The term ‘‘retroactive coverage period’’ 
means— 
(A) with respect to a retroactive 
LIS enrollment beneficiary described 
in paragraph (4)(A)(i), the period— 
(i) beginning on the effective 
date of the assistance described 
in such paragraph for which the 
individual is eligible; and 
(ii) ending on the date the 
plan effectuates the status of such 
individual as so eligible; and 
(B) with respect to a retroactive 
LIS enrollment beneficiary described 
in paragraph (4)(A)(ii), the period— 
(i) beginning on the date the 
individual is both entitled to ben-
efits under part A, or enrolled 
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under part B, of title XVIII of the 
Social Security Act and eligible 
for medical assistance under a 
State plan under title XIX of such 
Act; and 
(ii) ending on the date the 
plan effectuates the status of such 
individual as a full-benefit dual 
eligible individual (as defined in 
section 1935(c)(6) of such Act). 
(4) RETROACTIVE LIS ENROLLMENT BEN-
EFICIARY.— 
(A) IN GENERAL.—The term ‘‘retro-
active LIS enrollment beneficiary’’ 
means an individual who— 
(i) is enrolled in a prescrip-
tion drug plan under part D of 
title XVIII of the Social Security 
Act (or an MA–PD plan under 
part C of such title) and subse-
quently becomes eligible as a full- 
benefit dual eligible individual 
(as defined in section 1935(c)(6) of 
such Act), an individual receiving 
a low-income subsidy under sec-
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tion 1860D–14 of such Act, an in-
dividual 
receiving 
assistance 
under the Medicare Savings Pro-
gram implemented under clauses 
(i), 
(iii), 
and 
(iv) 
of 
section 
1902(a)(10)(E) of such Act, or an 
individual 
receiving 
assistance 
under the supplemental security 
income program under section 
1611 of such Act; or 
(ii) subject to subparagraph 
(B)(i), is a full-benefit dual eligi-
ble individual (as defined in sec-
tion 1935(c)(6) of such Act) who is 
automatically enrolled in such a 
plan 
under 
section 
1860D– 
1(b)(1)(C) of such Act. 
(B) EXCEPTION
FOR
BENEFICIARIES 
ENROLLED IN RFP PLAN.— 
(i) IN
GENERAL.—In no case 
shall an individual described in 
subparagraph (A)(ii) include an 
individual who is enrolled, pursu-
ant to a RFP contract described 
in clause (ii), in a prescription 
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drug plan offered by the sponsor 
of such plan awarded such con-
tract. 
(ii) 
RFP 
CONTRACT
DE-
SCRIBED.—The RFP contract de-
scribed in this section is a con-
tract entered into between the 
Secretary and a sponsor of a pre-
scription drug plan pursuant to 
the Centers for Medicare & Med-
icaid Services’ request for pro-
posals issued on February 17, 
2009, relating to Medicare part D 
retroactive coverage for certain 
low income beneficiaries, or a 
similar subsequent request for 
proposals. 
SEC. 1205. INTELLIGENT ASSIGNMENT IN ENROLLMENT. 
(a) IN GENERAL.—Section 1860D–1(b)(1)(C) 
of the Social Security Act (42 U.S.C. 1395w– 
101(b)(1)(C)) is amended by adding after ‘‘PDP 
region’’ the following: ‘‘or through use of an 
intelligent assignment process that is de-
signed to maximize the access of such indi-
vidual to necessary prescription drugs while 
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minimizing costs to such individual and to the 
program under this part to the greatest ex-
tent possible. In the case the Secretary enrolls 
such individuals through use of an intelligent 
assignment process, such process shall take 
into account the extent to which prescription 
drugs necessary for the individual are cov-
ered in the case of a PDP sponsor of a pre-
scription drug plan that uses a formulary, the 
use of prior authorization or other restric-
tions on access to coverage of such prescrip-
tion drugs by such a sponsor, and the overall 
quality of a prescription drug plan as meas-
ured by quality ratings established by the 
Secretary’’ 
(b) EFFECTIVE
DATE.—The amendment 
made by subsection (a) shall take effect for 
contract years beginning with 2012. 
SEC. 1206. SPECIAL ENROLLMENT PERIOD AND AUTOMATIC 
ENROLLMENT PROCESS FOR CERTAIN SUB-
SIDY ELIGIBLE INDIVIDUALS. 
(a) SPECIAL ENROLLMENT PERIOD.—Section 
1860D–1(b)(3)(D) of the Social Security Act (42 
U.S.C. 1395w–101(b)(3)(D)) is amended to read 
as follows: 
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‘‘(D) 
SUBSIDY
ELIGIBLE
INDIVID-
UALS.—In the case of an individual (as 
determined by the Secretary) who is 
determined under subparagraph (B) 
of section 1860D–14(a)(3) to be a sub-
sidy eligible individual.’’. 
(b) 
AUTOMATIC
ENROLLMENT.—Section 
1860D–1(b)(1) of the Social Security Act (42 
U.S.C. 1395w–101(b)(1)) is amended by adding 
at the end the following new subparagraph: 
‘‘(D) SPECIAL RULE FOR SUBSIDY EL-
IGIBLE
INDIVIDUALS.—The process es-
tablished under subparagraph (A) 
shall include, in the case of an indi-
vidual described in section 1860D– 
1(b)(3)(D) who fails to enroll in a pre-
scription drug plan or an MA–PD 
plan during the special enrollment es-
tablished under such section applica-
ble to such individual, the application 
of the assignment process described 
in subparagraph (C) to such indi-
vidual in the same manner as such 
assignment process applies to a part 
D eligible individual described in 
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such subparagraph (C). Nothing in 
the previous sentence shall prevent 
an individual described in such sen-
tence from declining enrollment in a 
plan determined appropriate by the 
Secretary (or in the program under 
this part) or from changing such en-
rollment.’’. 
(c) EFFECTIVE
DATE.—The amendments 
made by this section shall apply to subsidy de-
terminations made for months beginning with 
January 2011. 
SEC. 1207. APPLICATION OF MA PREMIUMS PRIOR TO RE-
BATE IN CALCULATION OF LOW INCOME SUB-
SIDY BENCHMARK. 
(a) 
IN
GENERAL.—Section 
1860D– 
14(b)(2)(B)(iii) of the Social Security Act (42 
U.S.C. 1395w–114(b)(2)(B)(iii)) is amended by 
inserting before the period the following: ‘‘be-
fore the application of the monthly rebate 
computed under section 1854(b)(1)(C)(i) for 
that plan and year involved’’. 
(b) EFFECTIVE
DATE.—The amendment 
made by subsection (a) shall apply to subsidy 
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determinations made for months beginning 
with January 2011. 
Subtitle B—Reducing Health 
Disparities 
SEC. 1221. ENSURING EFFECTIVE COMMUNICATION IN 
MEDICARE. 
(a) ENSURING EFFECTIVE COMMUNICATION 
BY
THE CENTERS
FOR MEDICARE & MEDICAID 
SERVICES.— 
(1) STUDY ON MEDICARE PAYMENTS FOR 
LANGUAGE
SERVICES.—The Secretary of 
Health and Human Services shall conduct 
a study that examines the extent to 
which Medicare service providers utilize, 
offer, or make available language serv-
ices for beneficiaries who are limited 
English proficient and ways that Medi-
care should develop payment systems for 
language services. 
(2) ANALYSES.—The study shall in-
clude an analysis of each of the following: 
(A) How to develop and structure 
appropriate payment systems for lan-
guage services for all Medicare serv-
ice providers. 
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(E) How each of options described 
in a previous paragraph would be 
funded and how such funding would 
affect physician payments, a physi-
cian’s practice, and beneficiary cost- 
sharing. 
(F) The extent to which providers 
under parts A and B of title XVIII of 
the Social Security Act, MA organiza-
tions offering Medicare Advantage 
plans under part C of such title and 
PDP sponsors of a prescription drug 
plan under part D of such title utilize, 
offer, or make available language 
services for beneficiaries with limited 
English proficiency. 
(G) The nature and type of lan-
guage services provided by States 
under title XIX of the Social Security 
Act and the extent to which such 
services could be utilized by bene-
ficiaries and providers under title 
XVIII of such Act. 
(3) VARIATION IN PAYMENT SYSTEM DE-
SCRIBED.—The payment systems described 
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in paragraph (2)(A) may allow variations 
based upon types of service providers, 
available delivery methods, and costs for 
providing language services including 
such factors as— 
(A) the type of language services 
provided (such as provision of health 
care or health care related services 
directly in a non-English language by 
a bilingual provider or use of an in-
terpreter); 
(B) type of interpretation services 
provided (such as in-person, tele-
phonic, video interpretation); 
(C) the methods and costs of pro-
viding language services (including 
the costs of providing language serv-
ices with internal staff or through 
contract with external independent 
contractors or agencies, or both); 
(D) providing services for lan-
guages not frequently encountered in 
the United States; and 
(E) providing services in rural 
areas. 
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(4) REPORT.—The Secretary shall sub-
mit a report on the study conducted 
under subsection (a) to appropriate com-
mittees of Congress not later than 12 
months after the date of the enactment of 
this Act. 
(5) EXEMPTION
FROM
PAPERWORK
RE-
DUCTION
ACT.—Chapter 35 of title 44, 
United States Code (commonly known as 
the ‘‘Paperwork Reduction Act’’ ), shall 
not apply for purposes of carrying out 
this subsection. 
(6) 
AUTHORIZATION
OF
APPROPRIA-
TIONS.—There is authorized to be appro-
priated to carry out this subsection such 
sums as are necessary. 
(b) HEALTH PLANS.—Section 1857(g)(1) of 
the Social Security Act (42 U.S.C. 1395w– 
27(g)(1)) is amended— 
(1) by striking ‘‘or’’ at the end of sub-
paragraph (F); 
(2) by adding ‘‘or’’ at the end of sub-
paragraph (G); and 
(3) by inserting after subparagraph 
(G) the following new subparagraph: 
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‘‘(H) fails substantially to provide 
language services to limited English 
proficient beneficiaries enrolled in 
the plan that are required under 
law;’’. 
SEC. 1222. DEMONSTRATION TO PROMOTE ACCESS FOR 
MEDICARE BENEFICIARIES WITH LIMITED 
ENGLISH PROFICIENCY BY PROVIDING REIM-
BURSEMENT FOR CULTURALLY AND LINGUIS-
TICALLY APPROPRIATE SERVICES. 
(a) IN GENERAL.—Not later than 6 months 
after the date of the completion of the study 
described in section 1221(a), the Secretary, 
acting through the Centers for Medicare & 
Medicaid Services, shall carry out a dem-
onstration program under which the Sec-
retary shall award not fewer than 24 3-year 
grants to eligible Medicare service providers 
(as described in subsection (b)(1)) to improve 
effective communication between such pro-
viders and Medicare beneficiaries who are liv-
ing in communities where racial and ethnic 
minorities, including populations that face 
language barriers, are underserved with re-
spect to such services. In designing and car-
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rying out the demonstration the Secretary 
shall take into consideration the results of the 
study conducted under section 1221(a) and 
adjust, as appropriate, the distribution of 
grants so as to better target Medicare bene-
ficiaries who are in the greatest need of lan-
guage services. The Secretary shall not au-
thorize a grant larger than $500,000 over 
three years for any grantee. 
(b) ELIGIBILITY; PRIORITY.— 
(1) ELIGIBILITY.—To be eligible to re-
ceive a grant under subsection (a) an en-
tity shall— 
(A) be— 
(i) 
a 
provider 
of 
services 
under part A of title XVIII of the 
Social Security Act; 
(ii) a service provider under 
part B of such title; 
(iii) a part C organization of-
fering a Medicare part C plan 
under part C of such title; or 
(iv) a PDP sponsor of a pre-
scription drug plan under part D 
of such title; and 
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(B) prepare and submit to the 
Secretary an application, at such 
time, in such manner, and accom-
panied by such additional informa-
tion as the Secretary may require. 
(2) PRIORITY.— 
(A) DISTRIBUTION.—To the extent 
feasible, in awarding grants under 
this 
section, 
the 
Secretary 
shall 
award— 
(i) at least 6 grants to pro-
viders of services described in 
paragraph (1)(A)(i); 
(ii) at least 6 grants to service 
providers described in paragraph 
(1)(A)(ii); 
(iii) at least 6 grants to orga-
nizations described in paragraph 
(1)(A)(iii); and 
(iv) at least 6 grants to spon-
sors 
described 
in 
paragraph 
(1)(A)(iv). 
(B) 
FOR
COMMUNITY
ORGANIZA-
TIONS.—The Secretary shall give pri-
ority to applicants that have devel-
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viduals to access, understand, and benefit 
from health care or health care-related 
services. 
(5) 
INTERPRETING/INTERPRETATION.— 
The terms ‘‘interpreting’’ and ‘‘interpreta-
tion’’ mean the transmission of a spoken 
message from one language into another, 
faithfully, accurately, and objectively. 
(6) HEALTH CARE SERVICES.—The term 
‘‘health care services’’ means services 
that address physical as well as mental 
health conditions in all care settings. 
(7) HEALTH CARE-RELATED SERVICES.— 
The term ‘‘health care-related services’’ 
means human or social services programs 
or activities that provide access, referrals 
or links to health care. 
(8) LANGUAGE ACCESS.—The term ‘‘lan-
guage access’’ means the provision of lan-
guage services to an LEP individual de-
signed to enhance that individual’s ac-
cess to, understanding of or benefit from 
health care or health care-related serv-
ices. 
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