I 
111TH CONGRESS 
1ST SESSION H. R. 2700 
To amend part D of title XVIII of the Social Security Act to assist low- 
income individuals in obtaining subsidized prescription drug coverage 
under the Medicare prescription drug program by expediting the applica-
tion and qualification process and by revising the resource standards 
used to determine eligibility for such subsidies, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 4, 2009 
Mr. DOGGETT (for himself, Mr. ALTMIRE, Mr. ARCURI, Ms. BALDWIN, Mr. 
BECERRA, Ms. BERKLEY, Mr. BERMAN, Mr. BISHOP of New York, Mr. 
BLUMENAUER, Ms. BORDALLO, Mr. BOUCHER, Ms. CLARKE, Mr. CLAY, 
Mr. CLEAVER, Mr. CLYBURN, Mr. COHEN, Mr. CONNOLLY of Virginia, 
Mr. COSTELLO, Mr. CUMMINGS, Mr. DAVIS of Alabama, Mr. DAVIS of 
Illinois, Mr. DEFAZIO, Ms. DEGETTE, Mr. DELAHUNT, Ms. DELAURO, 
Mr. EDWARDS of Texas, Mr. FATTAH, Mr. FILNER, Mr. GENE GREEN 
of Texas, Mr. GRIJALVA, Mr. HASTINGS of Florida, Mr. HIGGINS, Mr. 
HINCHEY, Mr. HINOJOSA, Mr. HOLT, Mr. INSLEE, Mr. ISRAEL, Mr. 
JACKSON of Illinois, Ms. JACKSON-LEE of Texas, Mr. JOHNSON of Geor-
gia, Ms. KAPTUR, Mr. KILDEE, Ms. KILPATRICK of Michigan, Mr. 
KUCINICH, Mr. LANGEVIN, Ms. LEE of California, Mr. LEVIN, Mr. 
LEWIS of Georgia, Mr. LIPINSKI, Ms. ZOE LOFGREN of California, Ms. 
MCCOLLUM, Mr. MCDERMOTT, Mrs. MALONEY, Mr. MEEK of Florida, 
Mr. MEEKS of New York, Mr. MICHAUD, Mr. MOORE of Kansas, Mr. 
NADLER of New York, Mrs. NAPOLITANO, Mr. NEAL of Massachusetts, 
Ms. NORTON, Mr. ORTIZ, Mr. PAYNE, Mr. PASCRELL, Mr. PRICE of 
North Carolina, Mr. RANGEL, Mr. ROTHMAN of New Jersey, Mr. RUSH, 
Mr. RYAN of Ohio, Ms. LINDA T. SA´NCHEZ of California, Mr. SARBANES, 
Ms. SCHAKOWSKY, Ms. SHEA-PORTER, Mr. SIRES, Mr. STARK, Ms. SUT-
TON, Mr. VAN HOLLEN, Ms. WASSERMAN SCHULTZ, Mr. WEINER, Mr. 
WELCH, Mr. WEXLER, Ms. WOOLSEY, and Mr. YARMUTH) introduced the 
following bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committee on Ways and Means, for a pe-
riod to be subsequently determined by the Speaker, in each case for con-
sideration of such provisions as fall within the jurisdiction of the com-
mittee concerned 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00001
Fmt 6652
Sfmt 6652
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
A BILL 
To amend part D of title XVIII of the Social Security 
Act to assist low-income individuals in obtaining sub-
sidized prescription drug coverage under the Medicare 
prescription drug program by expediting the application 
and qualification process and by revising the resource 
standards used to determine eligibility for such subsidies, 
and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Prescription Coverage Now Act of 2009’’. 
(b) TABLE OF CONTENTS.—The table of contents for 
this Act is as follows: 
Sec. 1. Short title; table of contents. 
Sec. 2. Expediting low-income subsidies under the Medicare prescription drug 
program. 
Sec. 3. Enhanced oversight and enforcement relating to reimbursements for ret-
roactive LIS enrollment. 
Sec. 4. Modification of resource standards for determination of eligibility for 
low-income subsidy; simplification of income and asset rules. 
Sec. 5. Indexing deductible and cost-sharing above annual out-of-pocket thresh-
old for individuals with income below 150 percent of poverty 
line. 
Sec. 6. No impact on eligibility for benefits under other programs. 
Sec. 7. Requiring individuals eligible for Medicare savings programs to be 
deemed to be subsidy eligible individuals. 
Sec. 8. Special enrollment period for subsidy eligible individuals. 
SEC. 2. EXPEDITING LOW-INCOME SUBSIDIES UNDER THE 
MEDICARE PRESCRIPTION DRUG PROGRAM. 
(a) TARGETED OUTREACH FOR LOW-INCOME SUB-
SIDIES.— 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00002
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
(1) IN
GENERAL.—Section 1860D–14 of the 
Social Security Act (42 U.S.C. 1395w–114) is 
amended by adding at the end the following new 
subsection: 
‘‘(e) TARGETED OUTREACH FOR LOW-INCOME SUB-
SIDIES.— 
‘‘(1) TARGETED IDENTIFICATION OF SUBSIDY- 
ELIGIBLE INDIVIDUALS.— 
‘‘(A) IN GENERAL.—The Commissioner of 
Social Security shall provide for the identifica-
tion of individuals who are potentially eligible 
for low-income assistance under this section 
through requests to the Secretary of the Treas-
ury in accordance with the criterion established 
under section 6103(l)(21) of the Internal Rev-
enue Code of 1986 for information indicating 
whether the individual involved is likely eligible 
for such assistance. 
‘‘(B) INITIATION OF IDENTIFICATIONS.— 
Not later than 90 days after the date of the en-
actment of this subsection, the Commissioner of 
Social Security shall begin the identification of 
individuals through the process described in 
subparagraph (A) and shall, by such date and 
through such process, submit to the Secretary 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00003
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
of the Treasury requests for part D eligible in-
dividuals who the Commissioner has identified 
as potentially eligible for low-income subsidies 
under this section before such date of enact-
ment. 
‘‘(2) NOTIFICATION OF POTENTIALLY ELIGIBLE 
INDIVIDUALS.—In the case of each individual identi-
fied under paragraph (1) who has not otherwise ap-
plied for, or been determined eligible for, benefits 
under this section (or who has applied for and been 
determined ineligible for such benefits based on ex-
cess income, resources, or both), the Commissioner 
shall transmit by mail to the individual a letter in-
cluding the information and application required to 
be provided under subparagraphs (A), (B), and (D) 
of section 1144(c)(1). 
‘‘(3) FOLLOW-UP COMMUNICATIONS.—If an in-
dividual to whom a letter is transmitted under para-
graph (2) does not affirmatively respond to such let-
ter either by making an enrollment, completing an 
application, or declining either or both, the Commis-
sioner shall make additional attempts to contact the 
individual to obtain such an affirmative response. 
‘‘(4) USE OF PREFERRED LANGUAGE IN SUBSE-
QUENT COMMUNICATIONS.—In the case an applica-
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00004
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
tion is completed by an individual pursuant to this 
subsection in which a language other than English 
is specified, the Commissioner shall provide that 
subsequent communications under this part to the 
individual shall be in such language as needed. 
‘‘(5) CONSTRUCTION.—Nothing in this sub-
section shall be construed as precluding the Commis-
sioner from taking additional outreach efforts to en-
roll eligible individuals under this part and to pro-
vide low-income subsidies to eligible individuals. 
‘‘(6) MAINTENANCE OF EFFORT WITH RESPECT 
TO OUTREACH.—In no case shall the level of effort 
with respect to outreach to and enrollment of indi-
viduals who are potentially eligible for low-income 
assistance under this section after the date of the 
enactment of this subsection be less than such level 
of effort before such date of enactment until at least 
90 percent of such potentially eligible individuals 
have affirmatively responded. 
‘‘(7) GAO REPORT TO CONGRESS.—Not later 
than 2 years after the date of the first submission 
to the Secretary of the Treasury described in para-
graph (1)(B), the Comptroller General of the United 
States shall submit to Congress a report, with re-
spect to the 18-month period following the establish-
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00005
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
ment of the process described in paragraph (1)(A), 
on— 
‘‘(A) the extent to which the percentage of 
individuals who are eligible for low-income as-
sistance under this section but not enrolled 
under this part has decreased during such pe-
riod; 
‘‘(B) how the Commissioner of Social Se-
curity has used any savings resulting from the 
implementation of this section and section 
6103(l)(21) of the Internal Revenue Code of 
1986 to improve outreach to individual de-
scribed in subparagraph (A) to increase enroll-
ment of such individuals under this part; 
‘‘(C) the effectiveness of using information 
from the Secretary of the Treasury in accord-
ance with section 6103(l)(21) of the Internal 
Revenue Code of 1986 for purposes of indi-
cating whether individuals are eligible for low- 
income assistance under this section; and 
‘‘(D) the effectiveness of the outreach con-
ducted by the Commissioner of Social Security 
based on the data described in subparagraph 
(C).’’. 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
(2) 
CONFORMING
AMENDMENT.—Section 
1144(c)(1) of the Social Security Act (42 U.S.C. 
1320b–14(c)(1)) is amended by inserting ‘‘(including 
through request to the Secretary of the Treasury 
pursuant to section 1860D–14(e))’’ before ‘‘, the 
Commissioner shall’’. 
(b) IMPROVEMENTS TO THE LOW-INCOME SUBSIDY 
APPLICATIONS.—Section 1860D–14(a)(3) of the Social 
Security Act (42 U.S.C. 1395w–114(a)(3)) is amended— 
(1) in subparagraph (E), by striking clauses (ii) 
and (iii) and redesignating clause (iv) as clause (ii); 
(2) by redesignating subparagraphs (F) and 
(G) as subparagraphs (G) and (H), respectively; and 
(3) by inserting after subparagraph (E) the fol-
lowing new subparagraph: 
‘‘(F) SIMPLIFIED
LOW-INCOME
SUBSIDY 
APPLICATION AND PROCESS.— 
‘‘(i) IN
GENERAL.—The Secretary, 
jointly with the Commissioner of Social Se-
curity, shall— 
‘‘(I) develop a model, simplified 
application form and process con-
sistent with clause (ii) for the deter-
mination and verification of a part D 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
eligible individual’s assets or resources 
under this paragraph; and 
‘‘(II) 
provide 
such 
form 
to 
States. 
‘‘(ii) DOCUMENTATION
AND
SAFE-
GUARDS.—Under such process— 
‘‘(I) the application form shall 
consist of an attestation under penalty 
of perjury regarding the level of assets 
or resources (or combined assets and 
resources in the case of a married 
part D eligible individual) and valu-
ations of general classes of assets or 
resources; 
‘‘(II) such form shall not require 
the submittal of additional docu-
mentation regarding income or assets; 
‘‘(III) matters attested to in the 
application shall be subject to appro-
priate 
methods 
of 
administrative 
verification; 
‘‘(IV) the applicant shall be per-
mitted to authorize another individual 
to act as the applicant’s personal rep-
resentative with respect to commu-
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
nications under this part and the en-
rollment of the applicant into a pre-
scription drug plan (or MA–PD plan) 
and for low-income subsidies under 
this section; and 
‘‘(V) the application form shall 
allow for the specification of a lan-
guage (other than English) that is 
preferred by the individual for subse-
quent communications with respect to 
the individual under this part. 
‘‘(iii) NO
RECOVERY
FOR
CERTAIN 
SUBSIDIES IMPROPERLY PAID.—If an indi-
vidual in good faith and in the absence of 
fraud is provided low-income subsidies 
under this section, and if the individual is 
subsequently found not eligible for such 
subsidies, there shall be no recovery made 
against the individual because of such sub-
sidies improperly paid.’’. 
(c) DISCLOSURES TO FACILITATE IDENTIFICATION 
OF INDIVIDUALS LIKELY TO BE ELIGIBLE FOR THE LOW- 
INCOME ASSISTANCE UNDER THE MEDICARE PRESCRIP-
TION DRUG PROGRAM.— 
(1) IN GENERAL.— 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
Subsection (l) of section 6103 of the Inter-
nal Revenue Code of 1986 is amended by add-
ing at the end the following new paragraph: 
‘‘(21) DISCLOSURE OF RETURN INFORMATION 
TO
FACILITATE
IDENTIFICATION
OF
INDIVIDUALS 
LIKELY
TO
BE
ELIGIBLE
FOR
LOW-INCOME
SUB-
SIDIES UNDER MEDICARE PRESCRIPTION DRUG PRO-
GRAM.— 
‘‘(A) IN GENERAL.—The Secretary, upon 
written request from the Commissioner of So-
cial Security, shall disclose to officers and em-
ployees of the Social Security Administration, 
with respect to any individual identified by the 
Commissioner— 
‘‘(i) whether, based on the criterion 
determined under subparagraph (B), such 
individual is likely to be eligible for low-in-
come assistance under section 1860D–14 
of the Social Security Act, or 
‘‘(ii) that, based on such criterion, 
there is insufficient information available 
to the Secretary to make the determination 
described in clause (i). 
‘‘(B) CRITERION.—Not later than 90 days 
after the date of the enactment of this para-
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
graph, the Secretary, in consultation with the 
Commissioner of Social Security, shall develop 
the criterion by which the determination under 
subparagraph (A)(i) shall be made (and the cri-
terion for determining that insufficient informa-
tion is available to make such determination). 
Such criterion may include analysis of informa-
tion available on such individual’s return, the 
return of such individual’s spouse, and any in-
formation related to such individual or such in-
dividual’s spouse which is available on any in-
formation return.’’. 
(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) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to disclosures made 
after the date of the enactment of this Act. 
SEC. 3. ENHANCED OVERSIGHT AND ENFORCEMENT RE-
LATING TO REIMBURSEMENTS FOR RETRO-
ACTIVE LIS ENROLLMENT. 
(a) IN GENERAL.—In the case of a retroactive LIS 
enrollment beneficiary (as defined in subsection (e)(4)) 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00011
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
who is 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)— 
(1) the beneficiary (or any eligible third party) 
is entitled to reimbursement by the plan for covered 
drug costs (as defined in subsection (e)(1)) incurred 
by the beneficiary during the retroactive coverage 
period of the beneficiary in accordance with sub-
section (b) and in the case of such a beneficiary de-
scribed in subsection (e)(4)(A)(i), such reimburse-
ment shall be made automatically by the plan upon 
receipt of appropriate notice the beneficiary is eligi-
ble for assistance described in such subsection 
(e)(4)(A)(i) without further information required to 
be filed with the plan by the beneficiary; 
(2) the Secretary of Health and Human Serv-
ices (in this section referred to as the ‘‘Secretary’’) 
shall not make payment to the plan— 
(A) in the case that the beneficiary is de-
scribed in subsection (e)(4)(A)(i), for premium 
subsidies and cost sharing subsidies under sec-
tion 1860D–14 of the Social Security Act (42 
U.S.C. 1395w–114) with respect to the provi-
sion of prescription drug coverage to the bene-
ficiary during such retroactive period; and 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00012
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
(B) in the case that the beneficiary is de-
scribed in subsection (e)(4)(A)(ii), for direct 
subsidies under section 1860D–15(a)(1) of such 
Act and premium subsidies and cost-sharing 
subsidies under section 1860D–14 of such Act 
with respect to the provision of prescription 
drug coverage to the beneficiary during such 
retroactive period; 
unless the plan demonstrates to the Secretary that 
the plan has provided timely and accurate reim-
bursement to the beneficiary (or eligible third party) 
in accordance with paragraph (1); 
(3) the Secretary shall not make any payment 
described in paragraph (2) to the plan with respect 
to such beneficiary for any month of the retroactive 
enrollment period during which no expenses for cov-
ered part D drugs (as defined in section 1860D–2(e) 
of the Social Security Act (42 U.S.C. 1395w– 
102(e)) were incurred by such beneficiary (or eligible 
third party on behalf of such beneficiary); and 
(4) any payment owed the plan pursuant to this 
section, taking into account paragraphs (2) and (3), 
shall be made at the time the Centers for Medicare 
& Medicaid Services reconciles payments for the en-
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00013
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
tire plan year following the end of the plan year, and 
not before such time. 
(b) ADMINISTRATIVE REQUIREMENTS RELATING TO 
REIMBURSEMENTS.— 
(1) LINE-ITEM DESCRIPTION.—Each reimburse-
ment made by a prescription drug plan or MA–PD 
plan under subsection (a)(1) shall include a line-item 
description of the items for which the reimbursement 
is made. 
(2) TIMING OF REIMBURSEMENTS.—A prescrip-
tion drug plan or MA–PD plan must make a reim-
bursement under subsection (a)(1) to a retroactive 
LIS enrollment beneficiary, with respect to a claim, 
not later than 30 days after— 
(A) in the case of a beneficiary described 
in subsection (e)(4)(A)(i), the date on which the 
plan receives notice from the Secretary that the 
beneficiary is eligible for assistance described in 
such subsection; or 
(B) in the case of a beneficiary described 
in subsection (e)(4)(A)(ii), the date on which 
the beneficiary files the claim with the plan. 
(c) NOTICE REQUIREMENTS.— 
(1) BY SECRETARY OF HHS AND COMMISSION 
OF THE SOCIAL SECURITY ADMINISTRATION.—The 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00014
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
Secretary, jointly with the Commissioner of the So-
cial Security Administration, shall ensure that each 
retroactive LIS enrollment beneficiary receives, with 
any letter or notification of eligibility for a low-in-
come subsidy under section 1860D–14 of the Social 
Security Act, a notice of their right to reimburse-
ment described in subsection (a)(1) for covered drug 
costs incurred during the retroactive coverage period 
of the beneficiary. Such notice shall— 
(A) with respect to a beneficiary described 
in subsection (e)(4)(A)(i), inform the bene-
ficiary of the beneficiary’s right to automatic 
reimbursement as described in subsection 
(a)(1); and 
(B) with respect to a beneficiary described 
in subsection (e)(4)(A)(ii), include a description 
of a clear process that the beneficiary should 
follow to seek such reimbursement. 
(2) BY PRESCRIPTION DRUG PLANS.— 
(A) IN GENERAL.—Each prescription drug 
plan under part D of title XVIII of the Social 
Security Act (and MA–PD plan under part C of 
such title) shall include in a notice from the 
plan to a retroactive LIS enrollment beneficiary 
described in subsection (e)(4)(A)(ii) a model no-
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00015
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
tice developed under subparagraph (B) describ-
ing the process the beneficiary must follow to 
seek retroactive reimbursement. Such notice 
shall include any form required by the plan to 
complete such reimbursement and shall indicate 
the period of retroactive coverage for which the 
beneficiary is eligible for such reimbursement. 
(B) 
MODEL
NOTICE.—The 
Secretary, 
jointly with the Commissioner of Social Secu-
rity, shall develop a model notice for purposes 
of subparagraph (A) and shall make such model 
notice available to all prescription drug plans 
under part D of title XVIII of the Social Secu-
rity Act (and MA–PD plans under part C of 
such title). 
(d) PUBLIC POSTING TO TRACK PAYMENTS.— 
(1) IN
GENERAL.—Not later than one year 
after the date of the enactment of this Act, the Sec-
retary shall post (and annually update) on the public 
Internet website of the Department of Health and 
Human Services information on the total amount of 
payments made by the Secretary under subsection 
(a)(2) to prescription drug plans during the most re-
cent plan year for which plan data is available. 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00016
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
(2) SPECIFIC INFORMATION.—Such information 
posted— 
(A) in 2010 or in a subsequent year before 
2016, shall include information on payments 
made for years beginning with 2006 and ending 
with the year for which the most current infor-
mation is available; and 
(B) in 2016 or a subsequent year, shall in-
clude information on payments made for at 
least the 10 previous years. 
(e) DEFINITIONS.—In this section: 
(1) COVERED DRUG COSTS.—The term ‘‘cov-
ered drug costs’’ means, with respect to a retroactive 
LIS enrollment beneficiary enrolled under a pre-
scription 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 in-
curred by such beneficiary during such period if 
the beneficiary had been both enrolled in the 
plan and recognized by such plan as qualified 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00017
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
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 ‘‘eligi-
ble third party’’ means, with respect to a retroactive 
LIS enrollment beneficiary, an organization or other 
third party that paid 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 en-
rollment 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 effec-
tuates the status of such individual as so 
eligible; and 
(B) with respect to a retroactive LIS en-
rollment beneficiary described in paragraph 
(4)(A)(ii), the period— 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00018
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
(i) beginning on the date the indi-
vidual is both entitled to benefits under 
part A, or enrolled under part B, of title 
XVIII of the Social Security Act and eligi-
ble for medical assistance under a State 
plan under title XIX of such Act; and 
(ii) ending on the date the plan effec-
tuates the status of such individual as a 
full-benefit dual eligible individual (as de-
fined in section 1935(c)(6) of such Act). 
(4) RETROACTIVE
LIS
ENROLLMENT
BENE-
FICIARY.— 
(A) IN GENERAL.—The term ‘‘retroactive 
LIS enrollment beneficiary’’ means an indi-
vidual who— 
(i) is enrolled in a prescription drug 
plan under part D of title XVIII of the So-
cial 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 sec-
tion 1935(c)(6) of such Act), an individual 
receiving a low-income subsidy under sec-
tion 1860D–14 of such Act, an individual 
receiving assistance under the Medicare 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00019
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
Savings 
Program 
implemented 
under 
clauses (i), (ii), (iii), and (iv) of section 
1902(a)(10)(E) of such Act, or an indi-
vidual receiving assistance under the sup-
plemental security income program under 
section 1611 of such Act; or 
(ii) subject to subparagraph (B)(i), is 
a full-benefit dual eligible individual (as 
defined in section 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 EN-
ROLLED IN RFP PLAN.— 
(i) IN GENERAL.—In no case shall an 
individual 
described 
in 
subparagraph 
(A)(ii) include an individual who is en-
rolled, pursuant to a RFP contract de-
scribed in clause (ii), in a prescription 
drug plan offered by the sponsor of such 
plan awarded such contract. 
(ii) RFP CONTRACT
DESCRIBED.— 
The RFP contract described in this section 
is a contract entered into between the Sec-
retary and a sponsor of a prescription drug 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
plan pursuant to the Centers for Medicare 
& Medicaid Services’ request for proposals 
issued on February 17, 2009, relating to 
Medicare part D retroactive coverage for 
certain low income beneficiaries, or a simi-
lar subsequent request for proposals. 
(f) GAO REPORT.—Not later than 24 months after 
the date of the enactment of this Act, the Comptroller 
General of the United States shall submit to Congress a 
report on the extent to which the provisions of this section 
improve reimbursement for covered drug costs to retro-
active LIS enrollment beneficiaries and lower the amounts 
of payments made by the Secretary, with respect to such 
beneficiaries, to prescription drug plans under part D of 
title XVIII of the Social Security Act (and MA–PD plans 
under part C of such title). 
(g) REPORT TO CONGRESS.—In the case that an 
RFP contract described in subsection (e)(4)(B)(ii) is 
awarded, not later than two years after the effective date 
of such contract, the Secretary of Health and Human 
Services shall submit to Congress a report evaluating the 
program carried out through such contract. 
(h) EFFECTIVE DATE.—Paragraphs (2) and (3) of 
subsection (a) and subsections (b) and (c) shall apply to 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
subsidy determinations made on or after the date that is 
3 months after the date of the enactment of this Act. 
SEC. 4. MODIFICATION OF RESOURCE STANDARDS FOR DE-
TERMINATION OF ELIGIBILITY FOR LOW-IN-
COME SUBSIDY; SIMPLIFICATION OF INCOME 
AND ASSET RULES. 
(a) SINGLE AND INCREASED RESOURCE STANDARD 
FOR LOW-INCOME SUBSIDIES.—Section 1860D–14(a) of 
the Social Security Act (42 U.S.C. 1395w–114(a)) is 
amended— 
(1) in paragraph (1), by inserting ‘‘(or, for 
years after 2010, paragraph (3)(E))’’ after ‘‘para-
graph (3)(D)’’; 
(2) in paragraph (3)— 
(A) in subparagraph (A)(iii), by inserting 
‘‘(or for a year after 2010, subparagraph (E))’’ 
before the period; 
(B) in subparagraph (D)(ii), by inserting 
‘‘before 2011’’ after ‘‘subsequent year’’; and 
(C) in subparagraph (E)(i)— 
(i) by striking ‘‘and’’ at the end of 
subclause (I); 
(ii) in subclause (II)— 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
(I) by striking ‘‘a subsequent 
year’’ and inserting ‘‘each of 2007 
through 2010’’; 
(II) by striking the period at the 
end and inserting a semicolon; 
(iii) by inserting after subclause (II) 
the following new subclauses: 
‘‘(III) for 2011, $27,500 (or 
$55,000 in the case of the combined 
value of the individual’s assets or re-
sources and the assets or resources of 
the individual’s spouse); and 
‘‘(IV) for a subsequent year the 
dollar amounts specified in this clause 
for the previous year increased by the 
annual percentage increase in the con-
sumer price index (all items; U.S. city 
average) as of September of such pre-
vious year.’’; and 
(iv) in the last sentence, by inserting 
‘‘or (IV)’’ after ‘‘subclause (II)’’. 
(b) EXEMPTIONS FROM RESOURCES.— 
(1) IN GENERAL.—Section 1860D–14(a)(3) of 
the Social Security Act (42 U.S.C. 1395w–114(a)(3) 
is further amended— 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
(A) in subparagraphs (D) and (E), by in-
serting ‘‘and the retirement plan exclusion 
under subparagraph (H)’’ after ‘‘subparagraph 
(G)’’ each place it appears; and 
(B) by adding at the end the following new 
subparagraph: 
‘‘(H) 
RETIREMENT
BENEFIT
EXCLU-
SION.—In determining the resources of an indi-
vidual (and their eligible spouse, if any) under 
section 1613 for purposes of subparagraphs (D) 
and (E), no retirement benefit, such as an indi-
vidual retirement account or plan under section 
401(k) of the Internal Revenue Code of 1986, 
shall be taken into account.’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply for months beginning 
after 2011. 
(c) CLARIFICATION RELATING TO INCLUDING RE-
TIREMENT BENEFITS AS INCOME.—Nothing in subpara-
graph (H) of section 1860D–14(a)(3) of the Social Secu-
rity Act (42 U.S.C. 1395w–114(a)(3)), as added by sub-
section (b), shall be construed as affecting the inclusion 
of 
retirement 
benefits 
as 
income 
under 
section 
1612(a)(2)(B) of such Act (42 U.S.C. 1382a(a)(2)(B)). 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00024
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
(d) CLARIFICATION RELATING TO MIPPA EFFEC-
TIVE DATE FOR IN KIND EXCLUSIONS FROM INCOME.— 
Section 116(b) of the Medicare Improvements for Patients 
and Providers Act of 2008 is amended— 
(1) by inserting ‘‘(other than subsection 
(a)(1))’’ after ‘‘this section’’; and 
(2) by adding at the end the following new sen-
tence: ‘‘The amendment made by subsection (a)(1) 
shall take effect with respect to benefits provided 
after such date.’’. 
(e) INCREASING INCOME LIMITS FOR PARTIAL LIS 
ELIGIBILITY TO 200 PERCENT FPL AND FOR FULL LIS 
TO 150 PERCENT FPL.— 
(1) IN GENERAL.—Section 1860D–14(a) of the 
Social Security Act (42 U.S.C. 1395w–114(a)) is 
amended— 
(A) in the heading, by striking ‘‘150’’ and 
inserting ‘‘200’’; 
(B) in paragraph (1)— 
(i) in the heading, by striking ‘‘135’’ 
and inserting ‘‘150’’; and 
(ii) by striking ‘‘135’’ and inserting 
‘‘150’’; 
(C) in paragraph (2)— 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
(i) in the heading, by striking ‘‘150’’ 
and inserting ‘‘200’’; and 
(ii) in subparagraph (A), by striking 
‘‘135’’ and ‘‘150’’ and inserting ‘‘150’’ and 
‘‘200’’, respectively; and 
(D) in paragraph (3)(A)(ii), by striking 
‘‘150’’ and inserting ‘‘200’’. 
(2) EFFECTIVE DATE.—The amendments made 
by paragraph (1) shall apply to determinations made 
on or after January 1, 2011. 
SEC. 5. INDEXING DEDUCTIBLE AND COST-SHARING ABOVE 
ANNUAL OUT-OF-POCKET THRESHOLD FOR 
INDIVIDUALS WITH INCOME BELOW 200 PER-
CENT OF POVERTY LINE. 
(a) 
INDEXING
DEDUCTIBLE.—Section 
1860D– 
14(a)(4)(B) of the Social Security Act (42 U.S.C. 1395w– 
114(a)(4)(B)) is amended— 
(1) in clause (i), by striking ‘‘or’’; 
(2) in clause (ii)— 
(A) by striking ‘‘a subsequent year’’ and 
inserting ‘‘2008, 2009, and 2010’’; and 
(B) by striking the period at the end and 
inserting ‘‘; and’’; 
(3) by inserting after clause (ii) the following 
new clause: 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00026
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
age) as of September of such previous 
year.’’; and 
(2) in paragraph (2)(E), by striking ‘‘exceed 
the copayment or coinsurance amount’’ and all that 
follows through the period at the end and inserting 
‘‘exceed— 
‘‘(i) for each of 2006 through 2010, 
the copayment or coinsurance amount 
specified 
under 
section 
1860D– 
2(b)(4)(A)(i)(I) for the drug and year in-
volved; and 
‘‘(ii) for 2011 and each succeeding 
year, the amount determined under this 
clause for the previous year increased by 
the annual percentage increase in the con-
sumer price index (all items; U.S. city av-
erage) as of September of such previous 
year.’’. 
SEC. 6. NO IMPACT ON ELIGIBILITY FOR BENEFITS UNDER 
OTHER PROGRAMS. 
(a) IN GENERAL.—Section 1860D–14(a)(3) of the 
Social Security Act (42 U.S.C. 1395w–114(a)(3)), as 
amended by section 4(b)(1)(B), is further amended— 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00028
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
(1) in subparagraph (A), in the matter pre-
ceding clause (i), by striking ‘‘subparagraph (F)’’ 
and inserting ‘‘subparagraphs (F) and (I)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(I) NO IMPACT ON ELIGIBILITY FOR BEN-
EFITS UNDER OTHER PROGRAMS.—The avail-
ability of premium and cost-sharing subsidies 
under this section shall not be treated as bene-
fits or otherwise taken into account in deter-
mining an individual’s eligibility for, or the 
amount of benefits under, any other Federal 
program.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to premium and cost-sharing 
subsidies for months beginning after the date of the enact-
ment of this Act. 
SEC. 7. REQUIRING INDIVIDUALS ELIGIBLE FOR MEDICARE 
SAVINGS PROGRAMS TO BE DEEMED TO BE 
SUBSIDY ELIGIBLE INDIVIDUALS. 
(a) IN GENERAL.—Section 1860D–14(a)(3)(B)(v) of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395w– 
114(a)(3)(B)(v)) is amended— 
(1) in subclause (II)— 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00029
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
(A) by striking ‘‘may’’ and inserting 
‘‘shall’’; and 
(B) by inserting ‘‘(ii),’’ after ‘‘clause (i),’’; 
and 
(2) by striking the second sentence. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall take effect as of the date of the enact-
ment of this Act and apply to determinations made for 
purposes of title XIX on or after the first date of the first 
plan year beginning after the date of the enactment of 
this Act. 
SEC. 8. SPECIAL ENROLLMENT PERIOD FOR SUBSIDY ELI-
GIBLE INDIVIDUALS. 
(a) IN GENERAL.—Section 1860D–1(b)(3) of the So-
cial Security Act (42 U.S.C. 1395w–101(b)(3)) is amend-
ed by adding at the end the following new subparagraph: 
‘‘(F) ELIGIBILITY FOR LOW-INCOME SUB-
SIDY.— 
‘‘(i) IN GENERAL.—In the case of an 
applicable subsidy eligible individual (as 
defined in clause (ii)), the special enroll-
ment period described in clause (iii). 
‘‘(ii) APPLICABLE SUBSIDY ELIGIBLE 
INDIVIDUAL
DEFINED.—For purposes of 
this subparagraph, the term ‘applicable 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00030
Fmt 6652
Sfmt 6201
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS
subsidy eligible individual’ means a part D 
eligible individual who is not described in 
subparagraph (D) and who is determined 
under 
subparagraph 
(B) 
of 
section 
1860D–14(a)(3) to be a subsidy eligible in-
dividual (as defined in subparagraph (A) of 
such section), including such an individual 
who was enrolled in a prescription drug 
plan or an MA–PD plan on the date of 
such determination. 
‘‘(iii) SPECIAL ENROLLMENT PERIOD 
DESCRIBED.—The special enrollment pe-
riod described in this clause, with respect 
to an applicable subsidy eligible individual, 
is the period beginning on the date the in-
dividual receives notification that such in-
dividual has been determined under section 
1860D–14(a)(3)(B) to be a subsidy eligible 
individual (as so defined) and ending on 
the date the individual is no longer so eligi-
ble.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
this section shall apply to subsidy determinations made 
for months beginning with January 2010. 
Æ 
VerDate Nov 24 2008 
06:34 Jun 06, 2009
Jkt 079200
PO 00000
Frm 00031
Fmt 6652
Sfmt 6301
E:\BILLS\H2700.IH
H2700
jbell on PROD1PC69 with BILLS