109 
‘‘(1) DISTRIBUTION OF APPLICATIONS TO APPLI-
CANTS
FOR
MEDICARE.—In the case of each indi-
vidual applying for hospital insurance benefits under 
section 226 or 226A, the Commissioner shall provide 
the following: 
‘‘(A) Information describing the low-income 
subsidy program under section 1860D–14 and 
the medicare savings program under title XIX. 
‘‘(B) An application for enrollment under 
such low-income subsidy program as well as an 
application 
form 
(developed 
under 
section 
1905(p)(5)) for medical assistance for medicare 
cost-sharing under title XIX. 
‘‘(C) Information on how the individual 
may obtain assistance in completing such appli-
cations, including information on how the indi-
vidual may contact the State health insurance 
assistance program (SHIP) for the State in 
which the individual is located. 
The Commissioner shall make such application forms 
available at local offices of the Social Security Ad-
ministration. 
‘‘(2) TRAINING
PERSONNEL
IN
ASSISTING
IN 
COMPLETING APPLICATIONS.—The Commissioner shall 
provide training to those employees of the Social Se-
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110 
curity Administration who are involved in receiving 
applications for benefits described in paragraph (1) 
in assisting applicants in completing a medicare sav-
ings program application described in paragraph (1). 
Such employees who are so trained shall provide such 
assistance upon request. 
‘‘(3) TRANSMITTAL
OF
COMPLETED
APPLICA-
TION.—If such an employee assists in completing such 
an application, the employee, with the consent of the 
applicant, shall transmit the completed application to 
the appropriate State medicaid agency for processing. 
‘‘(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 
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111 
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 individuals ap-
plying for hospital insurance benefits under section 226 or 
226A and shall make the translated forms available to the 
States and to the Commissioner of Social Security.’’. 
(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 AD-
MINISTRATION.—The Secretary, upon written re-
quest from the Commissioner of Social Security, 
shall disclose to the officers and employees of the 
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112 
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 income 
for the applicable year is less than 135 per-
cent of the poverty line (as specified 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 individual 
under section 6047(d) for the applicable 
year, and the amount (if any) of the dis-
tributions so reported, 
‘‘(iv) whether the return was a joint re-
turn 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’ 
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113 
means the most recent taxable year for 
which information is available in the Inter-
nal Revenue Service’s taxpayer data infor-
mation systems, or, if there is no return 
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 
years referred to in clause (i), the Secretary 
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 Se-
curity Administration to contact and assist eli-
gible individuals for, and administering, low-in-
come subsidies under section 1860D–14 of the 
Social Security Act. 
‘‘(D) TERMINATION.—No disclosure shall be 
made under this paragraph after the 2-year pe-
riod beginning on the date of the enactment of 
this paragraph.’’. 
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114 
(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 Commissioner of 
Social Security, shall submit a written report to Con-
gress regarding the use of disclosures made under sec-
tion 6103(l)(21) of the Internal Revenue Code of 
1986, as added by this subsection, in identifying indi-
viduals eligible for the low-income subsidies under 
section 1860D–14 of the Social Security 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 provided, 
the amendments made by this section shall take effect on 
January 1, 2009. 
SEC. 214. ELIMINATING APPLICATION OF ESTATE RECOV-
ERY. 
(a) IN GENERAL.—Section 1917(b)(1)(B)(ii) of the So-
cial Security Act (42 U.S.C. 1396p(b)(1)(B)(ii)) is amend-
ed by inserting ‘‘(but not including medical assistance for 
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115 
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 sub-
section (a) shall take effect as of January 1, 2008. 
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 ELIGIBLE 
INDIVIDUALS.— 
‘‘(I) INSTITUTIONALIZED INDIVID-
UALS.—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 
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116 
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 
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 sub-
section (a) shall apply to drugs dispensed on or after Janu-
ary 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 So-
cial Security Act (42 U.S.C. 1395w–114(a)(3)), as amended 
by subsections (a) and (b) of section 213, is further amend-
ed— 
(1) in subparagraph (C)(i), by inserting ‘‘and 
except that support and maintenance furnished in 
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117 
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-
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 account.’’. 
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118 
(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. 
SEC. 217. COST-SHARING PROTECTIONS FOR LOW-INCOME 
SUBSIDY-ELIGIBLE INDIVIDUALS. 
(a) IN GENERAL.—Section 1860D–14(a) of the Social 
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 2.5 
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 2.5 per-
cent of income.’’. 
(b) EFFECTIVE DATE.—The amendments made by sub-
section (a) shall apply as of January 1, 2009. 
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119 
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 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(D) INTELLIGENT
ASSIGNMENT.—In the 
case of any auto-enrollment under subparagraph 
(C), no part D eligible individual described in 
such subparagraph shall be enrolled in a pre-
scription drug plan which does not meet the fol-
lowing requirements: 
‘‘(i) FORMULARY.—The plan has a for-
mulary 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 
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brand name covered part D drugs for 
such population. 
‘‘(ii) PHARMACY NETWORK.—The plan 
has a network of pharmacies that substan-
tially exceeds the minimum requirements 
for prescription drug plans in the 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 cov-
erage under the plan consistent with the 
previous clauses of this subparagraph is 
among the lowest 25th percentile of pre-
scription drug plans under this part in the 
State. 
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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 
subparagraph (C) as in existence before the date 
of the enactment of this subparagraph.’’. 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (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 
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122 
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 Pro-
gram’’; and 
(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 re-
imbursed 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 Service 
Act.’’. 
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123 
(b) EFFECTIVE DATE.—The amendments made by sub-
section (a) shall apply to costs incurred on or after January 
1, 2009. 
SEC. 222. PERMITTING MID-YEAR CHANGES IN ENROLL-
MENT 
FOR 
FORMULARY 
CHANGES 
AD-
VERSELY IMPACT AN ENROLLEE. 
(a) IN GENERAL.—Section 1860D–1(b)(3) of the So-
cial Security Act (42 U.S.C. 1395w–101(b)(3)) is amended 
by adding at the end the following new subparagraph: 
‘‘(F) CHANGE IN FORMULARY RESULTING IN 
INCREASE IN COST-SHARING.— 
‘‘(i) IN GENERAL.—Except as provided 
in clause (ii), in the case of an individual 
enrolled in a prescription drug plan (or 
MA–PD plan) who has been prescribed a 
covered part D drug while so enrolled, if the 
formulary of the plan is materially changed 
(other than at the end of a contract year) 
so to reduce the coverage (or increase the 
cost-sharing) of the drug under the plan. 
‘‘(ii) EXCEPTION.—Clause (i) shall not 
apply in the case that a drug is removed 
from the formulary of a plan because of a 
recall or withdrawal of the drug issued by 
the Food and Drug Administration.’’. 
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124 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall apply to contract years beginning on or 
after January 1, 2009. 
SEC. 223. REMOVAL OF EXCLUSION OF BENZODIAZEPINES 
FROM REQUIRED COVERAGE UNDER THE 
MEDICARE PRESCRIPTION DRUG PROGRAM. 
(a) IN GENERAL.—Section 1860D–2(e)(2)(A) of the 
Social Security Act (42 U.S.C. 1395w–102(e)(2)(A)) is 
amended— 
(1) by striking ‘‘subparagraph (E)’’ and insert-
ing ‘‘subparagraphs (E) and (J)’’; and 
(2) by inserting ‘‘and benzodiazepines, respec-
tively’’ after ‘‘smoking cessation agents’’. 
(b) EFFECTIVE DATE.—The amendments made by sub-
section (a) shall apply to prescriptions dispensed on or after 
January 1, 2009. 
SEC. 
224. 
PERMITTING 
UPDATING 
DRUG 
COMPENDIA 
UNDER PART D USING PART B UPDATE PROC-
ESS. 
Section 1860D–4(b)(3)(C) of the Social Security Act 
(42 U.S.C. 1395w–104(b)(3)(C)) is amended by adding at 
the end the following new clause: 
‘‘(iv) UPDATING
DRUG
COMPENDIA 
USING
PART
B
PROCESS.—The Secretary 
may apply under this subparagraph the 
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125 
same process for updating drug compendia 
that is used for purposes of section 
1861(t)(2)(B)(ii).’’. 
SEC. 225. CODIFICATION OF SPECIAL PROTECTIONS FOR 
SIX PROTECTED DRUG CLASSIFICATIONS. 
(a) IN GENERAL.—Section 1860D–4(b)(3) of the So-
cial Security Act (42 U.S.C. 1395w–104(b)(3)) is amend-
ed— 
(1) in subparagraph (C)(i), by inserting ‘‘, ex-
cept as provided in subparagraph (G),’’ after ‘‘al-
though’’; and 
(2) by inserting after subparagraph (F) the fol-
lowing new subparagraph: 
‘‘(G) REQUIRED INCLUSION OF DRUGS IN 
CERTAIN THERAPEUTIC CLASSES.— 
‘‘(i) IN
GENERAL.—The formulary 
must include all or substantially all covered 
part D drugs in each of the following thera-
peutic classes of covered part D drugs: 
‘‘(I) Anticonvulsants. 
‘‘(II) Antineoplastics. 
‘‘(III) Antiretrovirals. 
‘‘(IV) Antidepressants. 
‘‘(V) Antipsychotics. 
‘‘(VI) Immunosuppresessants. 
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126 
‘‘(ii) USE
OF
UTILIZATION
MANAGE-
MENT TOOLS.—A PDP sponsor of a pre-
scription drug plan may use prior author-
ization or step therapy for the initiation of 
medications within one of the classifications 
specified in clause (i) but only when ap-
proved by the Secretary, except that such 
prior authorization or step therapy may not 
be used in the case of antiretrovirals and in 
the case of individuals who already are sta-
bilized on a drug treatment regimen.’’. 
(b) EFFECTIVE DATE.—The amendment made by sub-
section (a) shall apply for plan years beginning on or after 
January 1, 2009. 
SEC. 226. ELIMINATION OF MEDICARE PART D LATE EN-
ROLLMENT PENALTIES PAID BY LOW-INCOME 
SUBSIDY-ELIGIBLE INDIVIDUALS. 
(a) INDIVIDUALS WITH INCOME BELOW 135 PERCENT 
OF
POVERTY
LINE.—Paragraph (1)(A)(ii) of section 
1860D–14(a) of the Social Security Act (42 U.S.C. 1395w– 
114(a)) is amended to read as follows: 
‘‘(ii) 100 percent of any late enroll-
ment 
penalties 
imposed 
under 
section 
1860D–13(b) for such individual.’’. 
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