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‘‘(4) COORDINATION
WITH
OUTREACH.—The 
Commissioner shall coordinate outreach activities 
under this subsection with outreach activities con-
ducted by States in connection with the low-income 
subsidy program and the medicare savings pro-
gram.’’. 
(e) MEDICAID AGENCY CONSIDERATION OF APPLICA-
TIONS.—Section 1935(a) of such Act (42 U.S.C. 1396u– 
5(a)) is amended by adding at the end the following new 
paragraph: 
‘‘(4) CONSIDERATION OF MSP APPLICATIONS.— 
The State shall accept medicare savings program ap-
plications transmitted under section 1144(c)(3) and 
act on such applications in the same manner and 
deadlines as if they had been submitted directly by 
the applicant.’’. 
(f) 
TRANSLATION
OF
MODEL
FORM.—Section 
1905(p)(5)(A) of the Social Security Act (42 U.S.C. 
1396d(p)(5)(A)) is amended by adding at the end the fol-
lowing: ‘‘The Secretary shall provide for the translation 
of such application form into at least the 10 languages 
(other than English) that are most often used by individ-
uals applying for hospital insurance benefits under section 
226 or 226A and shall make the translated forms available 
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to the States and to the Commissioner of Social Secu-
rity.’’. 
(g) DISCLOSURE OF TAX RETURN INFORMATION FOR 
PURPOSES
OF
PROVIDING
LOW-INCOME
SUBSIDIES 
UNDER MEDICARE.— 
(1) IN
GENERAL.—Subsection (l) of section 
6103 of the Internal Revenue Code of 1986 is 
amended by adding at the end the following new 
paragraph: 
‘‘(21) DISCLOSURE OF RETURN INFORMATION 
FOR
PURPOSES
OF
PROVIDING
LOW-INCOME
SUB-
SIDIES UNDER MEDICARE.— 
‘‘(A) RETURN INFORMATION FROM INTER-
NAL REVENUE SERVICE TO SOCIAL SECURITY 
ADMINISTRATION.—The Secretary, upon writ-
ten request from the Commissioner of Social 
Security, shall disclose to the officers and em-
ployees of the Social Security Administration 
with respect to any individual identified by the 
Commissioner as potentially eligible (based on 
information other than return information) for 
low-income subsidies under section 1860D–14 
of the Social Security Act— 
‘‘(i) whether the adjusted gross in-
come for the applicable year is less than 
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135 percent of the poverty line (as speci-
fied by the Commissioner in such request), 
‘‘(ii) whether such adjusted gross in-
come is between 135 percent and 150 per-
cent of the poverty line (as so specified), 
‘‘(iii) whether any designated distribu-
tions (as defined in section 3405(e)(1)) 
were reported with respect to such indi-
vidual under section 6047(d) for the appli-
cable year, and the amount (if any) of the 
distributions so reported, 
‘‘(iv) whether the return was a joint 
return for the applicable year, and 
‘‘(v) the applicable year. 
‘‘(B) APPLICABLE YEAR.— 
‘‘(i) IN GENERAL.—For the purposes 
of this paragraph, the term ‘applicable 
year’ means the most recent taxable year 
for which information is available in the 
Internal Revenue Service’s taxpayer data 
information systems, or, if there is no re-
turn filed for the individual for such year, 
the prior taxable year. 
‘‘(ii) NO
RETURN.—If no return is 
filed for such individual for both taxable 
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years referred to in clause (i), the Sec-
retary shall disclose the fact that there is 
no return filed for such individual for the 
applicable year in lieu of the information 
described in subparagraph (A). 
‘‘(C) RESTRICTION ON USE OF DISCLOSED 
INFORMATION.—Return information disclosed 
under this paragraph may be used only for the 
purpose of improving the efforts of the Social 
Security Administration to contact and assist 
eligible individuals for, and administering, low- 
income subsidies under section 1860D–14 of 
the Social Security Act. 
‘‘(D) TERMINATION.—No disclosure shall 
be made under this paragraph after the 2-year 
period beginning on the date of the enactment 
of this paragraph.’’. 
(2) PROCEDURES
AND
RECORDKEEPING
RE-
LATED TO DISCLOSURES.—Paragraph (4) of section 
6103(p) of such Code is amended by striking ‘‘or 
(17)’’ each place it appears and inserting ‘‘(17), or 
(21)’’. 
(3) REPORT.—Not later than 18 months after 
the date of the enactment of this Act, the Secretary 
of the Treasury, after consultation with the Commis-
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sioner of Social Security, shall submit a written re-
port to Congress regarding the use of disclosures 
made under section 6103(l)(21) of the Internal Rev-
enue Code of 1986, as added by this subsection, in 
identifying individuals eligible for the low-income 
subsidies under section 1860D–14 of the Social Se-
curity Act. 
(4) EFFECTIVE DATE.—The amendment made 
by this subsection shall apply to disclosures made 
after the date of the enactment of this Act. 
(h) EFFECTIVE DATE.—Except as otherwise pro-
vided, the amendments made by this section shall take ef-
fect on January 1, 2009. 
SEC. 214. ELIMINATING APPLICATION OF ESTATE RECOV-
ERY. 
(a) IN GENERAL.—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 assist-
ance for medicare cost-sharing or for benefits described 
in section 1902(a)(10)(E))’’ before the period at the end. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect as of January 1, 2008. 
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SEC. 215. ELIMINATION OF PART D COST-SHARING FOR 
CERTAIN 
NON-INSTITUTIONALIZED 
FULL- 
BENEFIT DUAL ELIGIBLE INDIVIDUALS. 
(a) IN GENERAL.—Section 1860D–14(a)(1)(D)(i) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395w– 
114(a)(1)(D)(i)) is amended— 
(1) by striking ‘‘INSTITUTIONALIZED INDIVID-
UALS.—In’’ and inserting ‘‘ELIMINATION OF COST- 
SHARING FOR CERTAIN FULL-BENEFIT DUAL ELIGI-
BLE INDIVIDUALS.— 
‘‘(I) INSTITUTIONALIZED
INDI-
VIDUALS.—In’’; and 
(2) by adding at the end the following new sub-
clause: 
‘‘(II) CERTAIN
OTHER
INDIVID-
UALS.—In the case of an individual 
who is a full-benefit dual eligible indi-
vidual and with respect to whom there 
has been a determination that but for 
the provision of home and community 
based care (whether under section 
1915 or under a waiver under section 
1115) the individual would require the 
level of care provided in a hospital or 
a nursing facility or intermediate care 
facility for the mentally retarded the 
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cost of which could be reimbursed 
under the State plan under title XIX, 
the elimination of any beneficiary co-
insurance described in section 1860D– 
2(b)(2) (for all amounts through the 
total amount of expenditures at which 
benefits are available under section 
1860D–2(b)(4)).’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to drugs dispensed on or after 
January 1, 2009. 
SEC. 216. EXEMPTIONS FROM INCOME AND RESOURCES 
FOR DETERMINATION OF ELIGIBILITY FOR 
LOW-INCOME SUBSIDY. 
(a) IN GENERAL.—Section 1860D–14(a)(3) of the 
Social Security Act (42 U.S.C. 1395w–114(a)(3)), as 
amended by subsections (a) and (b) of section 213, is fur-
ther amended— 
(1) in subparagraph (C)(i), by inserting ‘‘and 
except that support and maintenance furnished in 
kind shall not be counted as income’’ after ‘‘section 
1902(r)(2)’’; 
(2) in subparagraph (D), in the matter before 
clause (i), by inserting ‘‘subject to the additional ex-
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clusions provided under subparagraph (G)’’ before 
‘‘)’’; 
(3) in subparagraph (E)(i), in the matter before 
subclause (I), by inserting ‘‘subject to the additional 
exclusions provided under subparagraph (G)’’ before 
‘‘)’’; and 
(4) by adding at the end the following new sub-
paragraph: 
‘‘(I) ADDITIONAL EXCLUSIONS.—In deter-
mining the resources of an individual (and the 
eligible spouse of the individual, if any) under 
section 1613 for purposes of subparagraphs (D) 
and (E) the following additional exclusions shall 
apply: 
‘‘(i) LIFE
INSURANCE
POLICY.—No 
part of the value of any life insurance pol-
icy shall be taken into account. 
‘‘(ii) 
PENSION
OR
RETIREMENT 
PLAN.—No balance in any pension or re-
tirement plan shall be taken into ac-
count.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall take effect on January 1, 2009, and shall 
apply to determinations of eligibility for months beginning 
with January 2009. 
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SEC. 217. COST-SHARING PROTECTIONS FOR LOW-INCOME 
SUBSIDY-ELIGIBLE INDIVIDUALS. 
(a) IN GENERAL.—Section 1860D–14(a) of the So-
cial Security Act (42 U.S.C. 1395w–114(a)) is amended— 
(1) in paragraph (1)(D), by adding at the end 
the following new clause: 
‘‘(iv) OVERALL LIMITATION ON COST- 
SHARING.—In the case of all such individ-
uals, a limitation on aggregate cost-sharing 
under this part for a year not to exceed 5 
percent of income.’’; and 
(2) in paragraph (2), by adding at the end the 
following new subparagraph: 
‘‘(F) OVERALL LIMITATION ON COST-SHAR-
ING.—A limitation on aggregate cost-sharing 
under this part for a year not to exceed 5 per-
cent of income.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply as of January 1, 2009. 
SEC. 218. INTELLIGENT ASSIGNMENT IN ENROLLMENT. 
(a) IN GENERAL.—Section 1860D–1(b)(1) of the So-
cial Security Act (42 U.S.C. 1395w–101(b)(1)) is amend-
ed— 
(1) in the second sentence of subparagraph (C), 
by inserting ‘‘, subject to subparagraph (D),’’ before 
‘‘on a random basis’’; and 
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(2) by adding at the end the following new sub-
paragraph: 
‘‘(D) INTELLIGENT ASSIGNMENT.—In the 
case of any auto-enrollment under subpara-
graph (C), no part D eligible individual de-
scribed in such subparagraph shall be enrolled 
in a prescription drug plan which does not meet 
the following requirements: 
‘‘(i) FORMULARY.—The plan has a 
formulary that covers at least— 
‘‘(I) 95 percent of the 100 most 
commonly prescribed non-duplicative 
generic covered part D drugs for the 
population of individuals entitled to 
benefits under part A or enrolled 
under part B; and 
‘‘(II) 95 percent of the 100 most 
commonly prescribed non-duplicative 
brand name covered part D drugs for 
such population. 
‘‘(ii) 
PHARMACY
NETWORK.—The 
plan has a network of pharmacies that 
substantially exceeds the minimum require-
ments for prescription drug plans in the 
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State and that provides access in areas 
where lower income individuals reside. 
‘‘(iii) QUALITY.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (I), the plan has an above 
average score on quality ratings of the 
Secretary of prescription drug plans 
under this part. 
‘‘(II) EXCEPTION.—Subclause (I) 
shall not apply to a plan that is a new 
plan (as defined by the Secretary), 
with respect to the plan year involved. 
‘‘(iv) LOW
COST.—The total cost 
under this title of providing prescription 
drug coverage under the plan consistent 
with the previous clauses of this subpara-
graph is among the lowest 25th percentile 
of prescription drug plans under this part 
in the State. 
In the case that no plan meets the requirements 
under clauses (i) through (iv), the Secretary 
shall implement this subparagraph to the great-
est extent possible with the goal of protecting 
beneficiary access to drugs without increasing 
the cost relative to the enrollment process under 
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subparagraph (C) as in existence before the 
date of the enactment of this subparagraph.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect for enrollments effected on 
or after November 15, 2009. 
Subtitle C—Part D Beneficiary 
Improvements 
SEC. 221. INCLUDING COSTS INCURRED BY AIDS DRUG AS-
SISTANCE PROGRAMS AND INDIAN HEALTH 
SERVICE 
IN 
PROVIDING 
PRESCRIPTION 
DRUGS TOWARD THE ANNUAL OUT OF POCK-
ET THRESHOLD UNDER PART D. 
(a) IN GENERAL.—Section 1860D–2(b)(4)(C) of the 
Social Security Act (42 U.S.C. 1395w–102(b)(4)(C)) is 
amended— 
(1) in clause (i), by striking ‘‘and’’ at the end; 
(2) in clause (ii)— 
(A) by striking ‘‘such costs shall be treated 
as incurred only if’’ and inserting ‘‘subject to 
clause (iii), such costs shall be treated as in-
curred only if’’; 
(B) by striking ‘‘, under section 1860D– 
14, or under a State Pharmaceutical Assistance 
Program’’; and 
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(C) by striking the period at the end and 
inserting ‘‘; and’’; and 
(3) by inserting after clause (ii) the following 
new clause: 
‘‘(iii) such costs shall be treated as in-
curred and shall not be considered to be 
reimbursed under clause (ii) if such costs 
are borne or paid— 
‘‘(I) under section 1860D–14; 
‘‘(II) under a State Pharma-
ceutical Assistance Program; 
‘‘(III) by the Indian Health Serv-
ice, an Indian tribe or tribal organiza-
tion, or an urban Indian organization 
(as defined in section 4 of the Indian 
Health Care Improvement Act); or 
‘‘(IV) under an AIDS Drug As-
sistance Program under part B of 
title XXVI of the Public Health Serv-
ice Act.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to costs incurred on or after 
January 1, 2009. 
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