SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Beneficiary Enrollment 
Notification and Eligibility Simplification Act of 2016’’ or 
the ‘‘BENES Act of 2016’’. 
SEC. 2. ELIGIBILITY AND ENROLLMENT NOTIFICATION. 
(a) NOTIFICATION REQUIREMENTS.—Section 1804 
of the Social Security Act (42 U.S.C. 1395b–2) is amend-
ed by adding at the end the following new subsection: 
‘‘(d) ELIGIBILITY INFORMATION.— 
‘‘(1) COORDINATION
OF
NOTICE.—The Sec-
retary, in consultation with representatives of each 
of the groups described in paragraph (2)(A), and in 
coordination with the Commissioner of Social Secu-
rity and the Secretary of the Treasury, shall prepare 
and distribute a notice, in accordance with this sub-
section, to potentially eligible Medicare individuals. 
‘‘(2) GROUPS FOR CONSULTATION.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1), the groups described in this subpara-
graph include the following: 
‘‘(i) Individuals who are more than 60 
years of age. 
‘‘(ii) Individuals with disabilities. 
‘‘(iii) Individuals with end stage renal 
disease. 
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‘‘(iv) Low-income individuals and fam-
ilies. 
‘‘(v) Employers (including human re-
sources professionals). 
‘‘(vi) States (including representatives 
of State-run Health Insurance Exchanges, 
Medicaid offices, and Departments of In-
surance). 
‘‘(vii) State Health Insurance Assist-
ance Programs. 
‘‘(viii) Health insurers. 
‘‘(ix) Such other groups as specified 
by the Secretary. 
‘‘(B) NON-APPLICATION
OF
FACA.—The 
Federal Advisory Committee Act shall not apply 
to consultations made pursuant to paragraph 
(1) with groups described in subparagraph (A). 
‘‘(3) CONTENTS
OF
NOTICE.—The notice re-
quired under paragraph (1) shall contain informa-
tion on (including a clear, simple explanation of)— 
‘‘(A)(i) eligibility for benefits under this 
title, and in particular benefits under part B; 
‘‘(ii) the possibility of a late enrollment 
penalty for failure to timely enroll (including 
the availability of equitable relief); and 
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‘‘(iii) how to access the Website described 
in paragraph (5); and 
‘‘(B) the need for coordination of benefits 
under part B (including secondary and primary 
coverage scenarios) imposed under this title, in-
cluding the effects of enrollment in retiree 
health coverage; group health coverage; cov-
erage under a group health plan provided by an 
employer pursuant to title XXII of the Public 
Health Service Act, section 4980B of the Inter-
nal Revenue Code of 1986, or title VI of the 
Employee Retirement Income Security Act of 
1974; coverage under a qualified health plan of-
fered through an Exchange established under 
title I of the Patient Protection and Affordable 
Care Act; and other widely available coverage 
which may be available to potentially eligible 
Medicare individuals. 
‘‘(4) TIMING
OF
NOTICE
TO
POTENTIAL
EN-
ROLLEES.—Beginning one year after the date of the 
enactment of this subsection, a notice required 
under paragraph (1) shall be mailed (or, starting 
after 2025, mailed or otherwise delivered) to each 
potentially eligible Medicare individual no less than 
two times in accordance with the following: 
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‘‘(A) The notice shall be initially provided 
to such individual no later than 6 months prior 
to the date of such individual’s initial enroll-
ment period as provided under section 1837. 
‘‘(B) The notice shall subsequently be pro-
vided to such individual no later than one 
month prior to such date. 
‘‘(5) CREATION OF A CENTRALIZED ENROLL-
MENT WEBSITE.—The information contained in no-
tices required under this subsection shall be made 
available through a new Website to be maintained by 
the Secretary. Such Website shall include both So-
cial Security and Medicare online tools in a coordi-
nated and organized manner, and shall also contain, 
or link to, such other eligibility tools, services, no-
tices (including with respect to the availability of eq-
uitable relief), and other information as determined 
by the Secretary, in consultation with groups de-
scribed in paragraph (2) for the purposes of being 
available to potentially eligible Medicare individuals. 
‘‘(6) INTERAGENCY COORDINATION.—Beginning 
not later than 2 months after the date of the enact-
ment of this subsection, the Secretary, along with 
the Secretary of the Treasury and the Commissioner 
of the Social Security Administration, shall under-
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take all necessary action and coordination to identify 
potentially eligible individuals and in order to pro-
vide such individuals with notifications under this 
subsection in accordance with paragraph (4). 
‘‘(7) NOTIFICATION IMPROVEMENT.—The Sec-
retary shall, no less than once every fiscal year, re-
view the content of the notices required under this 
subsection and the practices of providing such no-
tices to individuals, and shall update and revise such 
notices and practices as the Secretary deems appro-
priate. 
‘‘(8) POTENTIALLY ELIGIBLE MEDICARE INDI-
VIDUAL DEFINED.—For purposes of this subsection, 
the term ‘potentially eligible Medicare individual’ 
means an individual, with respect to a month, who 
is expected to satisfy the description in paragraph 
(1) or (2) of section 1836 during such month or 
during any of the subsequent 11 months.’’. 
(b) DISCLOSURE AUTHORITY.—Section 6103(l) of 
the Internal Revenue Code of 1986 is amended by adding 
at the end the following new paragraph: 
‘‘(23) DISCLOSURE OF RETURN INFORMATION 
TO CARRY OUT ELIGIBILITY NOTIFICATION REQUIRE-
MENTS FOR CERTAIN PROGRAMS.— 
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‘‘(A) IN GENERAL.—The Secretary, upon 
request from the Secretary of Health and 
Human Services, shall disclose to officers, em-
ployees, and contractors of the Department of 
Health and Human Services and the Social Se-
curity Administration return information of any 
taxpayer who is a potentially eligible Medicare 
individual (as defined in section 1804(d)(8) of 
the Social Security Act). Such return informa-
tion shall be limited to— 
‘‘(i) taxpayer identity information 
with respect to such taxpayer, including 
the age and address or other location of 
such taxpayer; 
‘‘(ii) the filing status of such tax-
payer; 
‘‘(iii) such other information as is pre-
scribed by the Secretary of Health and 
Human Services by regulation as might in-
dicate whether the taxpayer is eligible for 
coverage under such title; and 
‘‘(iv) the taxable year with respect to 
which the preceding information relates or, 
if applicable, the fact that such informa-
tion is not available. 
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‘‘(B) RESTRICTION ON USE OF DISCLOSED 
INFORMATION.—Return information disclosed 
under subparagraph (A) may be used by offi-
cers, employees, and contractors of the Depart-
ment of Health and Human Services or the So-
cial Security Administration only for the pur-
poses of, and to the extent necessary in, estab-
lishing potential eligibility for benefits under 
title XVIII of the Social Security Act.’’. 
(c) COMPUTER MATCHING AGREEMENT.—Not later 
than 6 months after the date of the enactment of this Act, 
the Secretary of Health and Human Services, the Sec-
retary of the Treasury, and the Commissioner of Social 
Security shall enter into a computer matching agreement 
pursuant to section 552a(o) of title 5 of the United States 
Code for the purposes of implementing section 1804(d) of 
the Social Security Act, as added by subsection (a), and 
section 6103(l)(23) of the Internal Revenue Code of 1986, 
as added by subsection (b). 
(d) REPORT TO CONGRESS.—Not later than 4 years 
after the date of the enactment of this Act, the Secretary 
of Health and Human Services, the Secretary of the 
Treasury, and the Commissioner of Social Security shall 
submit to Congress a report on the process taken by the 
relevant agencies in implementing the notice requirement 
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under subsection (d) of section 1804 of the Social Security 
Act (42 U.S.C. 1395b–2), as added by subsection (a) of 
this section, the status of notices created pursuant to such 
section, and an evaluation of the effect of such notices on 
enrollment under title XVIII of the Social Security Act. 
Such report shall be made publicly available. 
SEC. 3. BENEFICIARY MEDICARE PART B ENROLLMENT PE-
RIODS AND EFFECTIVE DATE OF COVERAGE. 
(a) EFFECTIVE DATES.—Section 1838(a) of the So-
cial Security Act (42 U.S.C. 1395q(a)) is amended— 
(1) by amending paragraph (2) to read as fol-
lows: 
‘‘(2)(A) in the case of an individual who enrolls 
pursuant to subsection (d) of section 1837 before 
the month in which he first satisfies paragraph (1) 
or (2) of section 1836, the first day of such month, 
‘‘(B) in the case of an individual not described 
in subparagraph (A) who first satisfies such para-
graph in a month beginning before January 2018 
and who enrolls— 
‘‘(i) pursuant to such subsection (d) in 
such month in which he first satisfies such 
paragraph, the first day of the month following 
the month in which he so enrolls, 
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‘‘(ii) pursuant to such subsection (d) in the 
month following such month in which he first 
satisfies such paragraph, the first day of the 
second month following the month in which he 
so enrolls, or 
‘‘(iii) pursuant to such subsection (d) more 
than one month following such month in which 
he satisfies such paragraph, the first day of the 
third month following the month in which he so 
enrolls, 
‘‘(C) in the case of an individual not described 
in subparagraph (A) who enrolls pursuant to sub-
section (e) of section 1837 in a month beginning be-
fore January 2018, the July 1 following the month 
in which he so enrolls, 
‘‘(D) in the case of an individual not described 
in subparagraph (A) who first satisfies such para-
graph in a month beginning on or after January 1, 
2018, and who enrolls pursuant to such subsection 
(d) in such month in which he first satisfies such 
paragraph or in any subsequent month, the first day 
of the month following the month in which he so en-
rolls, or 
‘‘(E) in the case of an individual not described 
in subparagraph (A) who enrolls pursuant to sub-
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section (e) of section 1837 in a month beginning on 
or after October 15, 2017, the first day of the 
month following the month in which he so enrolls.’’; 
and 
(2) by amending paragraph (3) to read as fol-
lows: 
‘‘(3)(A) in the case of an individual who is 
deemed to have enrolled on or before the last day of 
the third month of his initial enrollment period be-
ginning before January 1, 2018, the first day of the 
month in which he first meets the applicable require-
ments of section 1836 or July 1, 1973, whichever is 
later, or 
‘‘(B) in the case of an individual who is deemed 
to have enrolled on or after the first day of the 
fourth month of his initial enrollment period begin-
ning before January 1, 2018, as prescribed under 
subparagraphs (B)(i), (B)(ii), (B)(iii), and (C) of 
paragraph (2) of this subsection.’’. 
(b) GENERAL
AND SPECIAL ENROLLMENT PERI-
ODS.—Section 1837(e) of the Social Security Act (42 
U.S.C. 1395p(e)) is amended to read as follows: 
‘‘(e) ENROLLMENT PERIODS.— 
‘‘(1) FOR COVERAGE DURING YEARS BEFORE 
2018.—There shall be a general enrollment period 
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during the period beginning on January 1 and end-
ing on March 31 of each year before 2018. 
‘‘(2) FOR COVERAGE DURING YEARS BEGINNING 
WITH 2018.—For 2018 and each subsequent year: 
‘‘(A) IN
GENERAL.—Subject to subpara-
graph (B), there shall be a general enrollment 
period beginning on October 15 of the previous 
year through December 31 of such previous 
year. 
‘‘(B) 
EXCEPTIONAL
CIRCUMSTANCES.— 
The Secretary shall establish special enrollment 
periods in the case of a potentially eligible 
Medicare individual (as defined in section 
1804(d)(8)) who meets such exceptional condi-
tions as the Secretary may provide.’’. 
(c) TECHNICAL CORRECTION.—Section 1839(b) of 
the Social Security Act (42 U.S.C. 1395r(b)) is amended 
striking ‘‘close of the enrollment period’’ each place it ap-
pears and inserting ‘‘close of the month’’. 
SEC. 4. REVISING BENEFICIARY APPEAL RIGHTS FOR GOOD 
FAITH ENROLLMENT MISTAKES. 
(a) IN GENERAL.—Subsection (h) of section 1837 of 
the Social Security Act (42 U.S.C. 1395p) is amended to 
read as follows: 
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‘‘(h)(1) In any case in which the Secretary finds that 
an individual’s enrollment or nonenrollment in the insur-
ance program established by this part or part A pursuant 
to section 1818 is unintentional, inadvertent, or erroneous, 
whether the result of the error, misrepresentation, or inac-
tion of an officer, employee, or agent of the Federal Gov-
ernment or its instrumentalities, an employer, a represent-
ative of a group health plan, a State, or for any other 
good faith reason on the part of such individual, the Sec-
retary shall take such action (including the designation for 
such individual of a special initial or subsequent enroll-
ment period, including retroactive enrollment, with a cov-
erage period determined on the basis thereof and with ap-
propriate adjustments of premiums) as may be necessary 
to correct or eliminate the effects of such error, misrepre-
sentation, or inaction. The failure of an individual to enroll 
in the insurance program established by this part or part 
A pursuant to section 1818 due to enrollment under a 
group health plan; coverage pursuant to title XXII of the 
Public Health Service Act, section 4980B of the Internal 
Revenue Code of 1986, title VI of the Employee Retire-
ment Income Security Act of 1974, or title XIX; or enroll-
ment under a qualified health plan offered through an Ex-
change established under title I of the Patient Protection 
and Affordable Care Act shall under this subsection ab-
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sent exceptional circumstances, as determined by the Sec-
retary. 
‘‘(2) The Secretary, in consultation with the Commis-
sioner of Social Security, shall develop and publish a for-
mal application for requesting an action of the Secretary 
under paragraph (1) to correct or eliminate the effects of 
an error, misrepresentation, or inaction described in such 
paragraph and determine and publish specific timelines 
for timely resolution of such a request. 
‘‘(3) The Secretary shall also require that all such 
determinations with respect to such requests shall be 
reached within 15 business days of the submission of such 
application. All determinations shall be in writing through 
a standard decision notice with shall include an expla-
nation of the reasons for the determination. 
‘‘(4)(A) The Commissioner of Social Security shall 
enter into contracts with independent review organizations 
in accordance with this subsection for the purpose of re-
viewing and determining individual appeals of determina-
tions under paragraph (3) with respect to an application 
submitted pursuant to paragraph (2) relating to enroll-
ment under part A or part B. 
‘‘(B) An individual who receives an adverse deter-
mination under paragraph (3) with respect to an applica-
tion submitted pursuant to paragraph (2) may appeal to 
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an independent review organization designated by the 
Commission. Any such appeal must be sent to the inde-
pendent review organization within 90 days of the date 
the individual received the determination to be eligible for 
review. The independent review organization shall review 
and reach a determination of the review in writing within 
45 days of the receipt of any such appeal. 
‘‘(C) The Secretary of the Treasury may not enter 
into a contract under subparagraph (A) with an inde-
pendent review organization— 
‘‘(i) unless the organization has staff that has 
the appropriate knowledge of, and experience with, 
the eligibility and coordination of benefits rules and 
regulations under this title; and 
‘‘(ii) to the extent the organization is a fiscal 
intermediary under section 1816, a carrier under 
section 1842, or a Medicare administrative con-
tractor under section 1874A. 
‘‘(D) The Secretary of Health and Human Services 
shall provide for access by independent review organiza-
tions conducting appeal determinations under this sub-
section, to the database of the Coordination of Benefits 
Contractor of the Centers for Medicare & Medicaid Serv-
ices as necessary in order to conduct the duties of such 
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organizations to determine appeals pursuant to this sub-
section.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect beginning on the date that 
is 6 months after the date of the enactment of this Act. 
Æ 
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