IIB 
116TH CONGRESS 
2D SESSION 
H. R. 2477 
IN THE SENATE OF THE UNITED STATES 
DECEMBER 9, 2020 
Received; read twice and referred to the Committee on Finance 
AN ACT 
To amend title XVIII of the Social Security Act to establish 
a system to notify individuals approaching Medicare eligi-
bility, to simplify and modernize the eligibility enrollment 
process, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Beneficiary Enrollment 
Notification and Eligibility Simplification Act of 2020’’ or 
the ‘‘BENES Act of 2020’’. 
SEC. 2. BENEFICIARY ENROLLMENT NOTIFICATION AND 
ELIGIBILITY SIMPLIFICATION. 
(a) ELIGIBILITY AND ENROLLMENT NOTICES.— 
(1) AS PART OF SOCIAL SECURITY ACCOUNT 
STATEMENT FOR INDIVIDUALS ATTAINING AGES 63 
TO 65.— 
(A) IN GENERAL.—Section 1143(a) of the 
Social Security Act (42 U.S.C. 1320b–13(a)) is 
amended by adding at the end the following 
new paragraph: 
‘‘(4) MEDICARE ELIGIBILITY INFORMATION.— 
‘‘(A) IN GENERAL.—In the case of statements 
provided on or after the date that is 2 years after 
the date of the enactment of this paragraph to indi-
viduals who are attaining ages 63, 64, and 65, the 
statement shall also include a notice containing the 
information described in subparagraph (B). 
‘‘(B) CONTENTS OF NOTICE.—The notice re-
quired under subparagraph (A) shall include a clear, 
simple explanation of— 
‘‘(i) eligibility for benefits under the Medi-
care program under title XVIII, and in par-
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ticular benefits under parts B and C of such 
title; 
‘‘(ii) the reasons a late enrollment penalty 
for failure to timely enroll could be assessed 
and how such late enrollment penalty is cal-
culated, in particular for benefits under such 
part B; 
‘‘(iii) the availability of relief from such 
late enrollment penalty and retroactive enroll-
ment under section 1837(h) (including as such 
section is applied under sections 1818(c) and 
1818A(c)(3)), with examples of circumstances 
under which such relief may be granted and ex-
amples of circumstances under which such relief 
would not be granted; 
‘‘(iv) coordination of benefits (including 
primary and secondary coverage scenarios) pur-
suant to section 1862(b), in particular for bene-
fits under such part B; 
‘‘(v) enrollment, eligibility, and coordina-
tion of benefits under title XVIII with respect 
to populations, for whom there are special con-
siderations, such as residents of Puerto Rico 
and veterans; and 
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‘‘(vi) online resources and toll-free tele-
phone numbers of the Social Security Adminis-
tration and the Centers for Medicare & Med-
icaid Services (including 1–800–MEDICARE 
and the national toll-free number of the Social 
Security Administration) that provide informa-
tion on eligibility for benefits under the Medi-
care program under title XVIII, including 
under part C of such title. 
‘‘(C) DEVELOPMENT OF NOTICE.— 
‘‘(i) IN GENERAL.—The Secretary, in co-
ordination with the Commissioner of Social Se-
curity, and taking into consideration informa-
tion collected pursuant to clause (ii), shall, not 
later than 12 months after the last day of the 
period for the request of information described 
in clause (ii), develop the notice to be provided 
pursuant to subparagraph (A). 
‘‘(ii) REQUEST
FOR
INFORMATION.—Not 
later than 6 months after the date of the enact-
ment of this paragraph, the Secretary shall re-
quest 
written 
information, 
including 
rec-
ommendations, from stakeholders (including the 
groups described in subparagraph (D)) on the 
information to be included in the notice. 
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‘‘(iii) NOTICE
IMPROVEMENT.—Beginning 
4 years after the date of the enactment of this 
paragraph, and not less than once every 2 years 
thereafter, the Secretary, in coordination with 
the Commissioner of Social Security, shall— 
‘‘(I) review the content of the notice 
to be provided under subparagraph (A); 
‘‘(II) request written information, in-
cluding recommendations, on such notice 
through a request for information process 
as described in clause (ii); and 
‘‘(III) update and revise such notice 
as the Secretary deems appropriate. 
‘‘(D) GROUPS.—For purposes of subparagraph 
(C)(ii), the groups described in this subparagraph 
include the following: 
‘‘(i) Individuals who are 60 years of age or 
older. 
‘‘(ii) Veterans. 
‘‘(iii) Individuals with disabilities. 
‘‘(iv) Individuals with end stage renal dis-
ease. 
‘‘(v) Low-income individuals and families. 
‘‘(vi) Employers (including human re-
sources professionals). 
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‘‘(vii) States (including representatives of 
State-run Health Insurance Exchanges, Med-
icaid offices, and Departments of Insurance). 
‘‘(viii) State Health Insurance Assistance 
Programs. 
‘‘(ix) Health insurers. 
‘‘(x) Health insurance agents and brokers. 
‘‘(xi) Such other groups as specified by the 
Secretary. 
‘‘(E) POSTING OF NOTICE ON WEBSITES.—The 
Commissioner of Social Security and the Secretary 
shall post the notice required under subparagraph 
(A) on the public Internet website of the Social Se-
curity Administration and on Medicare.gov (or a 
successor website), respectively. 
‘‘(F) REIMBURSEMENT OF COSTS.— 
‘‘(i) IN
GENERAL.—Effective for fiscal 
years beginning in the year in which the date 
of enactment of this paragraph occurs, the 
Commissioner of Social Security and the Sec-
retary shall enter into an agreement under 
which the Secretary shall provide for the trans-
fer, from the Federal Hospital Insurance Trust 
Fund under section 1817 and the Federal Sup-
plementary Medical Insurance Trust Fund 
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under section 1841 (in such proportion as the 
Secretary determines appropriate), of such 
sums as necessary to cover the administrative 
costs of the Commissioner’s activities under this 
paragraph. Such agreement shall— 
‘‘(I) provide funds to the Commis-
sioner for the administrative costs of the 
Social Security Administration’s work re-
lated to the implementation of this para-
graph, including any initial costs incurred 
prior to the finalization of such agreement; 
‘‘(II) provide such funding quarterly 
in advance of the applicable quarter based 
on estimating methodology agreed to by 
the Commissioner and the Secretary; and 
‘‘(III) require an annual accounting 
(with a detailed description of the costs 
and methodology used to assess such costs) 
and reconciliation of the actual costs in-
curred and funds provided under this para-
graph. 
‘‘(ii) LIMITATION.—In no case shall funds 
from the Social Security Administration’s Limi-
tation on Administrative Expenses be used to 
carry out activities related to the implementa-
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tion of this paragraph, except as the Commis-
sioner determines is necessary— 
‘‘(I) for the development of the agree-
ment under clause (i); and 
‘‘(II) on a temporary basis and sub-
ject to reimbursement under clause (i)(I), 
for the initial implementation of this para-
graph. 
‘‘(G) NO
EFFECT
ON
OBLIGATION
TO
MAIL 
STATEMENTS.—Nothing in this paragraph shall be 
construed to relieve the Commissioner of Social Se-
curity from any requirement under subsection (c), 
including the requirement to mail a statement on an 
annual basis to each eligible individual who is not re-
ceiving benefits under title II and for whom a mail-
ing address can be determined through such meth-
ods as the Commissioner determines to be appro-
priate.’’. 
(B) TIMING
OF
STATEMENTS.—Section 
1143(c)(2) of such Act (42 U.S.C. 1320b- 
13(c)(2)) is amended by adding at the end the 
following: ‘‘With respect to statements provided 
to individuals who are attaining age 65, as de-
scribed in subsection (a)(4), such statements 
shall be mailed not earlier than 6 months and 
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not later than 3 months before the individual 
attains such age.’’ 
(2) SOCIAL
SECURITY
BENEFICIARIES.—Title 
XI of the Social Security Act (42 U.S.C. 1301 et 
seq.) is amended by inserting after section 1144 the 
following new section: 
‘‘MEDICARE
ENROLLMENT
NOTIFICATION
AND
ELIGI-
BILITY
NOTICES
FOR
SOCIAL
SECURITY
BENE-
FICIARIES PRIOR TO MEDICARE ELIGIBILITY 
‘‘Notices 
‘‘SEC. 1144A. (a) 
‘‘(1) IN GENERAL.—The Commissioner of So-
cial Security shall distribute the notice to be pro-
vided pursuant to section 1143(a)(4), as may be 
modified under paragraph (2), to individuals entitled 
to monthly insurance benefits under title II in ac-
cordance with subsection (b). 
‘‘(2) AUTHORITY
TO MODIFY NOTICE.—The 
Secretary, in coordination with the Commissioner of 
Social Security, may modify the notice to be distrib-
uted under paragraph (1) as necessary to take into 
account the individuals described in such paragraph. 
‘‘(3) POSTING OF NOTICE ON WEBSITES.—The 
Commissioner of Social Security and the Secretary 
shall post the notice required to be distributed under 
paragraph (1) on the public Internet website of the 
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Social Security Administration and on Medicare.gov 
(or a successor website), respectively. 
‘‘Timing 
‘‘(b) Beginning not later than 2 years after the date 
of the enactment of this section, a notice required under 
subsection (a)(1) shall be mailed to an individual described 
in such subsection— 
‘‘(1) in the third month before the date on 
which such individual’s initial enrollment period be-
gins as provided under section 1837; and 
‘‘(2) in the case of an individual with respect to 
whom section 226(b) applies (except for an indi-
vidual who will attain age 65 during the 24 month 
period described in such section), in the month be-
fore such date on which such individual’s initial en-
rollment period so begins. 
‘‘Reimbursement of Costs 
‘‘(c) 
‘‘(1) IN GENERAL.—Effective for fiscal years 
beginning in the year in which the date of enactment 
of this section occurs, the Commissioner of Social 
Security and the Secretary shall enter into an agree-
ment under which the Secretary shall provide for the 
transfer, from the Federal Hospital Insurance Trust 
Fund under section 1817 and the Federal Supple-
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mentary Medical Insurance Trust Fund under sec-
tion 1841 (in such proportion as the Secretary de-
termines appropriate), of such sums as necessary to 
cover the administrative costs of the Commissioner’s 
activities under this section. Such agreement shall— 
‘‘(A) provide funds to the Commissioner 
for the administrative costs of the Social Secu-
rity Administration’s work related to the imple-
mentation of this section, including any initial 
costs incurred prior to the finalization of such 
agreement; 
‘‘(B) provide such funding quarterly in ad-
vance of the applicable quarter based on esti-
mating methodology agreed to by the Commis-
sioner and the Secretary; and 
‘‘(C) require an annual accounting (with a 
detailed description of the costs and method-
ology used to assess such costs) and reconcili-
ation of the actual costs incurred and funds 
provided under this paragraph. 
‘‘(2) LIMITATION.—In no case shall funds from 
the Social Security Administration’s Limitation on 
Administrative Expenses be used to carry out activi-
ties related to the implementation of this section, ex-
cept as the Commissioner determines is necessary— 
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‘‘(A) for the development of the agreement 
under paragraph (1); and 
‘‘(B) on a temporary basis and subject to 
reimbursement under paragraph (1)(A), for the 
initial implementation of this section.’’. 
(b) BENEFICIARY ENROLLMENT SIMPLIFICATION.— 
(1) EFFECTIVE DATE OF COVERAGE.—Section 
1838(a) of the Social Security Act (42 U.S.C. 
1395q(a)) is amended— 
(A) by amending paragraph (2) to read as 
follows: 
‘‘(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(a), the first day of such 
month, 
‘‘(B) in the case of an individual who first sat-
isfies such paragraph in a month beginning before 
January 2023 and who enrolls pursuant to such 
subsection (d)— 
‘‘(i) in such month in which he first satis-
fies such paragraph, the first day of the month 
following the month in which he so enrolls, 
‘‘(ii) in the month following such month in 
which he first satisfies such paragraph, the first 
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day of the second month following the month in 
which he so enrolls, or 
‘‘(iii) 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 who first satis-
fies such paragraph in a month beginning on or 
after January 1, 2023, and who enrolls pursuant to 
such subsection (d) in such month in which he first 
satisfies such paragraph or in any subsequent month 
of his initial enrollment period, the first day of the 
month following the month in which he so enrolls, or 
‘‘(D) in the case of an individual who enrolls 
pursuant to subsection (e) of section 1837 in a 
month beginning— 
‘‘(i) before January 1, 2023, the July 1 
following the month in which he so enrolls; or 
‘‘(ii) on or after January 1, 2023, the first 
day of the month following the month in which 
he so enrolls; or’’; and 
(B) by amending paragraph (3) to read as 
follows: 
‘‘(3) in the case of an individual who is deemed 
to have enrolled— 
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‘‘(A) on or before the last day of the third 
month of his initial enrollment period, the first 
day of the month in which he first meets the 
applicable requirements of section 1836(a) or 
July 1, 1973, whichever is later, or 
‘‘(B) on or after the first day of the fourth 
month of his initial enrollment period, and 
where such month begins— 
‘‘(i) before January 1, 2023, as pre-
scribed 
under 
subparagraphs 
(B)(i), 
(B)(ii), (B)(iii), and (D)(i) of paragraph 
(2), or 
‘‘(ii) on or after January 1, 2023, as 
prescribed under subparagraphs (C) and 
(D)(ii) of paragraph (2).’’. 
(2) SPECIAL ENROLLMENT PERIODS FOR EX-
CEPTIONAL CIRCUMSTANCES.— 
(A) ENROLLMENT.—Section 1837 of the 
Social Security Act (42 U.S.C. 1395p) is 
amended by adding at the end the following 
new subsection: 
‘‘(m) Beginning January 1, 2023, the Secretary may 
establish special enrollment periods in the case of individ-
uals who satisfy paragraph (1) or (2) of section 1836(a) 
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and meet such exceptional conditions as the Secretary may 
provide.’’. 
(B) COVERAGE PERIOD.—Section 1838 of 
the Social Security Act (42 U.S.C. 1395q) is 
amended by adding at the end the following 
new subsection: 
‘‘(g) Notwithstanding subsection (a), in the case of 
an individual who enrolls during a special enrollment pe-
riod pursuant to section 1837(m), the coverage period 
shall begin on a date the Secretary provides in a manner 
consistent (to the extent practicable) with protecting con-
tinuity of health benefit coverage.’’. 
(C) 
CONFORMING
AMENDMENT.—Title 
XVIII of the Social Security Act (42 U.S.C. 
1395 et seq.) is amended— 
(i) in section 1818A(c)(3), by striking 
‘‘subsections (h) and (i) of section 1837’’ 
and inserting ‘‘subsections (h), (i), and (m) 
of section 1837’’; and 
(ii) in section 1839(b), in the first 
sentence, by striking ‘‘or (l)’’ and inserting 
‘‘, (l), or (m)’’. 
(3) TECHNICAL CORRECTION.—Section 1839(b) 
of the Social Security Act (42 U.S.C. 1395r(b)) is 
amended by adding at the end the following new 
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sentence: ‘‘For purposes of determining any increase 
under this subsection for individuals whose enroll-
ment occurs on or after January 1, 2023, the second 
sentence of this subsection shall be applied by sub-
stituting ‘close of the month’ for ‘close of the enroll-
ment period’ each place it appears.’’. 
(4) REPORT.—Not later than January 1, 2023, 
the Secretary of Health and Human Services shall 
submit to the Committee on Ways and Means and 
Committee on Energy and Commerce of the House 
of Representatives and the Committee on Finance 
and Special Committee on Aging of the Senate a re-
port on how to align existing Medicare enrollment 
periods under title XVIII of the Social Security Act, 
including the general enrollment period under part 
B of such title and the annual, coordinated election 
period under the Medicare Advantage program 
under part C of such title and under the prescription 
drug program under part D of such title. Such re-
port shall include recommendations consistent with 
the goals of maximizing coverage continuity and 
choice and easing beneficiary transition. 
(5) GAO STUDY AND REPORT.— 
(A) STUDY.—The Comptroller General of 
the United States (in this section referred to as 
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the ‘‘Comptroller General’’) shall conduct a 
study on the activities carried out under this 
section. Such study shall include the following: 
(i) An analysis of the Social Security 
Administration’s use of the funds provided 
to carry out the activities described under 
this section and the amendments made by 
this section. The Comptroller General shall 
examine the amount of funds transferred 
from the Federal Hospital Insurance Trust 
Fund and the Federal Supplementary 
Medical Insurance Trust Fund, respec-
tively, for those activities; how the funds 
were spent; what procedures the agency 
had in place over the use of those funds; 
and how the agency complied with those 
procedures. 
(ii) An evaluation of the notices de-
scribed in sections 1143(a)(4)(A) and 
1144A(a) of the Social Security Act, in-
cluding, to the extent data is available, 
how the mailing of such notices affected 
enrollee behavior and the imposition of late 
enrollment penalties under Medicare Part 
B. 
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(iii) Any other area determined appro-
priate by the Comptroller General. 
(B) REPORT.—Not later than 5 years after 
the date of enactment of this section, the 
Comptroller General shall submit to the Com-
mittee on Ways and Means and Committee on 
Energy and Commerce of the House of Rep-
resentatives and the Committee on Finance of 
the Senate a report containing the results of 
the study conducted under paragraph (1), in-
cluding recommendations for any legislative and 
administrative actions as the Comptroller Gen-
eral determines appropriate. 
(c) FUNDING.—Section 1808 of the Social Security 
Act (42 U.S.C. 1395b–9) is amended by adding the end 
the following new subsection: 
‘‘(e) FUNDING
FOR IMPLEMENTATION
OF BENE-
FICIARY ENROLLMENT NOTIFICATION AND ELIGIBILITY 
SIMPLIFICATION.—For purposes of carrying out the provi-
sions of and the amendments made by section 2 of the 
BENES Act of 2020, the Secretary shall provide for the 
transfer, from the Federal Hospital Insurance Trust Fund 
under section 1817 and the Federal Supplementary Med-
ical Insurance Trust Fund under section 1841 (in such 
proportion as the Secretary determines appropriate), to 
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the Centers for Medicare & Medicaid Services Program 
Management Account, of $2,000,000 for each fiscal year 
beginning with fiscal year 2021, to remain available until 
expended.’’. 
SEC. 3. EXTENDED MONTHS OF COVERAGE OF IMMUNO-
SUPPRESSIVE DRUGS FOR KIDNEY TRANS-
PLANT PATIENTS AND OTHER RENAL DIALY-
SIS PROVISIONS. 
(a) 
MEDICARE
ENTITLEMENT
TO
IMMUNO-
SUPPRESSIVE DRUGS FOR KIDNEY TRANSPLANT RECIPI-
ENTS.— 
(1) IN GENERAL.—Section 226A(b)(2) of the 
Social Security Act (42 U.S.C. 426–1(b)(2)) is 
amended by inserting ‘‘(except for eligibility for en-
rollment under part B solely for purposes of cov-
erage of immunosuppressive drugs described in sec-
tion 1861(s)(2)(J))’’ before ‘‘, with the thirty-sixth 
month’’. 
(2) INDIVIDUALS
ELIGIBLE
ONLY
FOR
COV-
ERAGE OF IMMUNOSUPPRESSIVE DRUGS.— 
(A) IN GENERAL.—Section 1836 of the So-
cial Security Act (42 U.S.C. 1395o) is amend-
ed— 
(i) by striking ‘‘Every’’ and inserting 
‘‘(a) IN GENERAL.—Every’’; and 
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(ii) by adding at the end the following 
new subsection: 
‘‘(b) 
INDIVIDUALS
ELIGIBLE
FOR
IMMUNO-
SUPPRESSIVE DRUG COVERAGE.— 
‘‘(1) IN GENERAL.—Except as provided under 
paragraph (2), every individual whose entitlement to 
insurance benefits under part A ends (whether be-
fore, on, or after January 1, 2023) by reason of sec-
tion 226A(b)(2) is eligible to enroll or to be deemed 
to have enrolled in the medical insurance program 
established by this part solely for purposes of cov-
erage of immunosuppressive drugs in accordance 
with section 1837(n). 
‘‘(2) EXCEPTION
IF
OTHER
COVERAGE
IS 
AVAILABLE.— 
‘‘(A) IN
GENERAL.—An individual de-
scribed in paragraph (1) shall not be eligible for 
enrollment in the program for purposes of cov-
erage described in such paragraph with respect 
to any period in which the individual, as deter-
mined in accordance with subparagraph (B)— 
‘‘(i) is enrolled in a group health plan 
or group or individual health insurance 
coverage, as such terms are defined in sec-
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tion 2791 of the Public Health Service 
Act; 
‘‘(ii) is enrolled for coverage under the 
TRICARE for Life program under section 
1086(d) of title 10, United States Code; 
‘‘(iii) is enrolled under a State plan 
(or waiver of such plan) under title XIX 
and is eligible to receive benefits for im-
munosuppressive drugs described in this 
subsection under such plan (or such waiv-
er); 
‘‘(iv) is enrolled under a State child 
health plan (or waiver of such plan) under 
title XXI and is eligible to receive benefits 
for such drugs under such plan (or such 
waiver); or 
‘‘(v)(I) is enrolled in the patient en-
rollment system of the Department of Vet-
erans Affairs established and operated 
under section 1705 of title 38, United 
States Code; 
‘‘(II) is not required to enroll under 
section 1705 of such title to receive im-
munosuppressive drugs described in this 
subsection; or 
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‘‘(III) is otherwise eligible under a 
provision of title 38, United States Code, 
other than section 1710 of such title to re-
ceive immunosuppressive drugs described 
in this subsection. 
‘‘(B) ELIGIBILITY DETERMINATIONS.— 
‘‘(i) IN GENERAL.—The Secretary, in 
coordination with the Commissioner of So-
cial Security, shall establish a process for 
determining whether an individual de-
scribed in paragraph (1) who is to be en-
rolled or deemed to be enrolled in the med-
ical insurance program described in such 
paragraph meets the requirements for such 
enrollment under this subsection, including 
the requirement that the individual not be 
enrolled in other coverage as described in 
subparagraph (A). 
‘‘(ii) 
ATTESTATION
REGARDING 
OTHER
COVERAGE.—The process estab-
lished under clause (i) shall include, at a 
minimum, a requirement that— 
‘‘(I) the individual provide to the 
Commissioner an attestation that the 
individual is not enrolled and does not 
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expect to enroll in such other cov-
erage; and 
‘‘(II) the individual notify the 
Commissioner within 60 days of en-
rollment in such other coverage.’’. 
(B) CONFORMING AMENDMENT.— 
(i) IN
GENERAL.—Sections 1837, 
1838, and 1839 of the Social Security Act 
(42 U.S.C. 1395p, 42 U.S.C. 1395q, 42 
U.S.C. 1395r) are each amended by strik-
ing ‘‘1836’’ and inserting ‘‘1836(a)’’ each 
place it appears. 
(ii) ADDITIONAL
AMENDMENT.—Sec-
tion 1837(j)(1) of such Act (42 U.S.C. 
1395p(j)(1)) 
is 
amended 
by 
striking 
‘‘1836(1)’’ and inserting ‘‘1836(a)(1)’’. 
(b) ENROLLMENT FOR INDIVIDUALS ONLY ELIGIBLE 
FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.—Sec-
tion 1837 of the Social Security Act (42 U.S.C. 1395p), 
as amended by section 2(b)(2)(A), is further amended by 
adding at the end the following new subsection: 
‘‘(n)(1) Any individual who is eligible for coverage of 
immunosuppressive drugs under section 1836(b) may en-
roll or be deemed to have enrolled only in such manner 
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and form as may be prescribed by regulations, and only 
during an enrollment period described in this subsection. 
‘‘(2) An individual described in paragraph (1) whose 
entitlement for hospital insurance benefits under part A 
ends by reason of section 226A(b)(2) prior to January 1, 
2023, may enroll beginning on October 1, 2022, or the 
day on which the individual first satisfies section 1836(b), 
whichever is later. 
‘‘(3) An individual described in paragraph (1) whose 
entitlement for hospital insurance benefits under part A 
ends by reason of section 226A(b)(2) on or after January 
1, 2023, shall be deemed to have enrolled in the medical 
insurance program established by this part for purposes 
of coverage of immunosuppressive drugs. 
‘‘(4) The Secretary shall establish a process under 
which an individual described in paragraph (1) whose 
other coverage described in section 1836(b)(2)(A), or cov-
erage under this part (including the medical insurance 
program established under this part for purposes of cov-
erage of immunosuppressive drugs), is terminated volun-
tarily or involuntary may enroll or reenroll, if applicable, 
in the medical insurance program established under this 
part for purposes of coverage of immunosuppressive 
drugs.’’. 
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(c) COVERAGE PERIOD FOR INDIVIDUALS ONLY ELI-
GIBLE
FOR
COVERAGE
OF
IMMUNOSUPPRESSIVE 
DRUGS.— 
(1) IN GENERAL.—Section 1838 of the Social 
Security Act (42 U.S.C. 1395q), as amended by sec-
tion 2(b)(2)(B), is further amended by adding at the 
end the following new subsection: 
‘‘(h) In the case of an individual described in section 
1836(b)(1), the following rules shall apply: 
‘‘(1) In the case of such an individual who is 
deemed to have enrolled in part B for coverage of 
immunosuppressive drugs under section 1837(n)(3), 
such individual’s coverage period shall begin on the 
first day of the month in which the individual first 
satisfies section 1836(b). 
‘‘(2) In the case of such an individual who en-
rolls (or reenrolls, if applicable) in part B for cov-
erage of immunosuppressive drugs under paragraph 
(2) or (4) of section 1837(n), such individual’s cov-
erage period shall begin on January 1, 2023, or the 
month following the month in which the individual 
so enrolls (or reenrolls), whichever is later. 
‘‘(3) The provisions of subsections (b) and (d) 
shall apply with respect to an individual described in 
paragraph (1) or (2). 
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‘‘(4) In addition to the reasons for termination 
under subsection (b), the coverage period of an indi-
vidual described in paragraph (1) or (2) shall end 
when the individual becomes entitled to benefits 
under this title under subsection (a) or (b) of section 
226, or under section 226A, or is no longer eligible 
for such coverage as a result of the application of 
section 1836(b)(2). 
‘‘(5) The Secretary may conduct public edu-
cation activities to raise awareness of the availability 
of more comprehensive, individual health insurance 
coverage (as defined in section 2791 of the Public 
Health Service Act) for individuals eligible under 
section 1836(b) to enroll or to be deemed enrolled in 
the medical insurance program established under 
this part for purposes of coverage of immuno-
suppressive drugs.’’. 
(2) 
CONFORMING
AMENDMENTS.—Section 
1838(b) of the Social Security Act (42 U.S.C. 
1395q(b)) is amended, in the matter following para-
graph (2), by inserting ‘‘or section 1837(n)(3)’’ after 
‘‘section 1837(f)’’ each place it appears. 
(d) PREMIUMS FOR INDIVIDUALS ONLY ELIGIBLE 
FOR COVERAGE OF IMMUNOSUPPRESSIVE DRUGS.— 
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(1) IN GENERAL.—Section 1839 of the Social 
Security Act (42 U.S.C. 1395r) is amended— 
(A) in subsection (b), by adding at the end 
the following new sentence: ‘‘No increase in the 
premium shall be effected for individuals who 
are enrolled pursuant to section 1836(b) for 
coverage only of immunosuppressive drugs.’’; 
and 
(B) by adding at the end the following new 
subsection: 
‘‘(j) DETERMINATION OF PREMIUM FOR INDIVID-
UALS ONLY ELIGIBLE
FOR COVERAGE
OF IMMUNO-
SUPPRESSIVE DRUGS.—The Secretary shall, during Sep-
tember of each year (beginning with 2022), determine and 
promulgate a monthly premium rate for the succeeding 
calendar year for individuals enrolled only for the purpose 
of coverage of immunosuppressive drugs under section 
1836(b). Such premium shall be equal to 15 percent of 
the monthly actuarial rate for enrollees age 65 and over 
(as would be determined in accordance with subsection 
(a)(1) if the reference to ‘one-half’ in such subsection were 
a reference to ‘100 percent’) for that succeeding calendar 
year. The monthly premium of each individual enrolled for 
coverage of immunosuppressive drugs under section 
1836(b) for each month shall be the amount promulgated 
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in this subsection. In the case of such individual not other-
wise enrolled under this part, such premium shall be in 
lieu of any other monthly premium applicable under this 
section. Such amount shall be adjusted in accordance with 
subsections (c), (f), and (i), but shall not be adjusted 
under subsection (b).’’. 
(2) SPECIAL RULE FOR APPLICATION OF HOLD 
HARMLESS PROVISIONS TO TRANSITIONING INDIVID-
UALS.—Section 1839(f) of the Social Security Act 
(42 U.S.C. 1395r(f)) is amended by adding at the 
end the following new sentence: ‘‘Any increase in the 
premium for an individual who was enrolled under 
section 1836(b) attributable to such individual oth-
erwise enrolling under this part shall not be taken 
into account in applying this subsection.’’. 
(3) SPECIAL RULE FOR APPLICATION OF PRE-
MIUM
SUBSIDY
REDUCTION
PROVISIONS.—Section 
1839(i)(3)(A)(ii)(II) of the Social Security Act (42 
U.S.C. 1395r(i)(3)(A)(ii)(II)) is amended by insert-
ing ‘‘except in the case of an individual enrolled 
under section 1836(b) and not otherwise enrolled 
under this part,’’ before ‘‘4 times’’. 
(e) GOVERNMENT CONTRIBUTION.—Section 1844(a) 
of the Social Security Act (42 U.S.C. 1395w(a)) is amend-
ed— 
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(1) in paragraph (3), by striking the period at 
the end and inserting ‘‘; plus’’; 
(2) by inserting after paragraph (3) the fol-
lowing new paragraph: 
‘‘(4) a Government contribution equal to the es-
timated aggregate reduction in premiums payable 
under part B that results from establishing the pre-
mium at 15 percent of the actuarial rate (as would 
be determined in accordance with section 1839(a)(1) 
if the reference to ‘one-half’ in such section were a 
reference to ‘100 percent’) under section 1839(j) in-
stead of 25 percent of such rate (as so determined) 
for individuals enrolled only for the purpose of cov-
erage of immunosuppressive drugs under section 
1836(b).’’; and 
(3) by adding the following sentence at the end 
of the flush matter following paragraph (4), as 
added by paragraph (2) of this subsection: 
‘‘The Government contribution under paragraph (4) 
shall be treated as premiums payable and deposited 
for purposes of subparagraphs (A) and (B) of para-
graph (1).’’. 
(f) ENSURING COVERAGE UNDER THE MEDICARE 
SAVINGS PROGRAM.— 
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(1) IN GENERAL.—Section 1905(p)(1)(A) of the 
Social Security Act (42 U.S.C. 1396d(p)(1)(A)) is 
amended by inserting ‘‘or who is enrolled under part 
B for the purpose of coverage of immunosuppressive 
drugs under section 1836(b)’’ after ‘‘under section 
1818A)’’. 
(2) 
CONFORMING
AMENDMENTS.—Section 
1902(a)(10)(E) of the Social Security Act (42 
U.S.C. 1396a(a)(10)(E)) is amended in each of 
clauses (iii) and (iv) by inserting ‘‘(including such 
individuals enrolled under section 1836(b))’’ after 
‘‘section 1905(p)(1)’’. 
(g) PART D.—Section 1860D–1(a)(3)(A) of the So-
cial Security Act (42 U.S.C. 1395w–101(a)(3)(A)) is 
amended by inserting ‘‘(but not including an individual en-
rolled solely for coverage of immunosuppressive drugs 
under section 1836(b))’’ before the period at the end. 
(h) GAO STUDY AND REPORT.— 
(1) STUDY.—The Comptroller General of the 
United States (in this subsection referred to as the 
‘‘Comptroller General’’) shall conduct a study on the 
implementation of coverage of immunosuppressive 
drugs for kidney transplant patients under the Medi-
care program pursuant to the provisions of, and 
amendments made by, this section. 
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(2) REPORT.—Not later than January 1, 2025, 
the Comptroller General shall submit to Congress a 
report on the study conducted under paragraph (1), 
together with recommendations as the Comptroller 
General determines appropriate. 
SEC. 4. TRANSPARENCY OF MEDICARE SECONDARY PAYER 
REPORTING INFORMATION. 
(a) IN GENERAL.—Section 1862(b)(8)(G) of the So-
cial Security Act (42 U.S.C. 395y(b)(8)(G)) is amended— 
(1) by striking ‘‘INFORMATION.—The Sec-
retary’’ and inserting ‘‘INFORMATION.— 
‘‘(i) IN
GENERAL.—The Secretary’’; 
and 
(2) by adding at the end the following new 
clause: 
‘‘(ii) SPECIFIED
INFORMATION.—In 
responding to any query from an applica-
ble plan related to a determination de-
scribed in subparagraph (A)(i), the Sec-
retary, notwithstanding any other provision 
of law, shall provide to such applicable 
plan— 
‘‘(I) whether a claimant subject 
to the query is, or during the pre-
ceding 3-year period has been, entitled 
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to benefits under the program under 
this title on any basis; and 
‘‘(II) to the extent applicable, the 
plan name and address of any Medi-
care Advantage plan under part C 
and any prescription drug plan under 
part D in which the claimant is en-
rolled or has been enrolled during 
such period.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply with respect to queries from 
plans made on or after the date that is one year after 
the date of the enactment of this Act. 
SEC. 5. ESTABLISHING HOSPICE PROGRAM SURVEY AND 
ENFORCEMENT PROCEDURES UNDER THE 
MEDICARE PROGRAM. 
(a) SURVEY AND ENFORCEMENT PROCEDURES.— 
(1) IN GENERAL.—Part A of title XVIII of the 
Social Security Act (42 U.S.C. 1395c et seq.) is 
amended by adding at the end the following new sec-
tion: 
‘‘SEC. 1822. HOSPICE PROGRAM SURVEY AND ENFORCE-
MENT PROCEDURES. 
‘‘(a) SURVEYS.— 
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‘‘(1) FREQUENCY.—Any entity that is certified 
as a hospice program shall be subject to a standard 
survey by an appropriate State or local survey agen-
cy, or an approved accreditation agency, as deter-
mined by the Secretary, not less frequently than 
once every 36 months (and not less frequently than 
once every 24 months beginning October 1, 2021). 
‘‘(2) PUBLIC TRANSPARENCY OF SURVEY AND 
CERTIFICATION INFORMATION.— 
‘‘(A) SUBMISSION
OF
INFORMATION
TO 
THE SECRETARY.— 
‘‘(i) IN GENERAL.—Each State, and 
each national accreditation body with re-
spect to which the Secretary has made a 
finding under section 1865(a) respecting 
the accreditation of a hospice program by 
such body, shall submit, in a form and 
manner, and at a time, specified by the 
Secretary for purposes of this subpara-
graph, information respecting any survey 
or certification made with respect to a hos-
pice program by such State or body, as ap-
plicable. Such information shall include 
any inspection report made by such State 
or body with respect to such survey or cer-
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tification, any enforcement actions taken 
as a result of such survey or certification, 
and any other information determined ap-
propriate by the Secretary. 
‘‘(ii) REQUIRED INCLUSION OF SPECI-
FIED
FORM.—With respect to a survey 
under this subsection carried out by a na-
tional accreditation body described in 
clause (i) on or after October 1, 2021, in-
formation described in such clause shall in-
clude Form 2567 (or a successor form), 
along with such additional information de-
termined appropriate by such body. 
‘‘(B) PUBLIC
DISCLOSURE
OF
INFORMA-
TION.—Beginning not later than October 1, 
2022, the Secretary shall publish the informa-
tion submitted under subparagraph (A) on the 
public website of the Centers for Medicare & 
Medicaid Services in a manner that is promi-
nent, easily accessible, readily understandable, 
and searchable. The Secretary shall provide for 
the timely update of such information so pub-
lished. 
‘‘(3) CONSISTENCY OF SURVEYS.—Each State 
and the Secretary shall implement programs to 
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measure and reduce inconsistency in the application 
of survey results among surveyors. 
‘‘(4) SURVEY TEAMS.— 
‘‘(A) IN GENERAL.—In the case of a sur-
vey conducted under this subsection on or after 
October 1, 2021, by more than 1 individual, 
such survey shall be conducted by a multidisci-
plinary team of professionals (including a reg-
istered professional nurse). 
‘‘(B) PROHIBITION OF CONFLICTS OF IN-
TEREST.—Beginning October 1, 2021, a State 
may not use as a member of a survey team 
under this subsection an individual who is serv-
ing (or has served within the previous 2 years) 
as a member of the staff of, or as a consultant 
to, the program surveyed respecting compliance 
with the requirements of section 1861(dd) or 
who has a personal or familial financial interest 
in the program being surveyed. 
‘‘(C) TRAINING.—The Secretary shall pro-
vide, not later than October 1, 2021, for the 
comprehensive training of State and Federal 
surveyors, and any surveyor employed by a na-
tional accreditation body described in paragraph 
(2)(A)(i), in the conduct of surveys under this 
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subsection, including training with respect to 
the review of written plans for providing hospice 
care (as described in section 1814(a)(7)(B)). 
No individual shall serve as a member of a sur-
vey team with respect to a survey conducted on 
or after such date unless the individual has suc-
cessfully completed a training and testing pro-
gram in survey and certification techniques that 
has been approved by the Secretary. 
‘‘(5) FUNDING.—The Secretary shall provide 
for the transfer, from the Federal Hospital Insur-
ance Trust Fund under section 1817 to the Centers 
for Medicare & Medicaid Services Program Manage-
ment Account, of $10,000,000 for each fiscal year 
(beginning with fiscal year 2022) for purposes of 
carrying out this subsection and subsection (b). 
Sums so transferred shall remain available until ex-
pended. Any transfer pursuant to this paragraph 
shall be in addition to any transfer pursuant to sec-
tion 3(a)(2) of the Improving Medicare Post-Acute 
Care Transformation Act of 2014. 
‘‘(b) SPECIAL FOCUS PROGRAM.— 
‘‘(1) IN GENERAL.—The Secretary shall con-
duct a special focus program for enforcement of re-
quirements for hospice programs that the Secretary 
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has identified as having substantially failed to meet 
applicable requirements of this Act. 
‘‘(2) PERIODIC SURVEYS.—Under such special 
focus program, the Secretary shall conduct surveys 
of each hospice program in the special focus pro-
gram not less than once every 6 months. 
‘‘(c) ENFORCEMENT.— 
‘‘(1) SITUATIONS INVOLVING IMMEDIATE JEOP-
ARDY.—If the Secretary determines on the basis of 
a standard survey or otherwise that a hospice pro-
gram that is certified for participation under this 
title is no longer in compliance with the require-
ments specified in section 1861(dd) and determines 
that the deficiencies involved immediately jeopardize 
the health and safety of the individuals to whom the 
program furnishes items and services, the Secretary 
shall take immediate action to remove the jeopardy 
and correct the deficiencies through the remedy de-
scribed in paragraph (5)(B)(iii) or terminate the cer-
tification of the program, and may provide, in addi-
tion, for 1 or more of the other remedies described 
in paragraph (5)(B). 
‘‘(2) SITUATIONS NOT INVOLVING IMMEDIATE 
JEOPARDY.—If the Secretary determines on the 
basis of a standard survey or otherwise that a hos-
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pice program that is certified for participation under 
this title is no longer in compliance with the require-
ments specified in section 1861(dd) and determines 
that the deficiencies involved do not immediately 
jeopardize the health and safety of the individuals to 
whom the program furnishes items and services, the 
Secretary may (for a period not to exceed 6 months) 
impose remedies developed pursuant to paragraph 
(5)(A), in lieu of terminating the certification of the 
program. If, after such a period of remedies, the 
program is still no longer in compliance with such 
requirements, the Secretary shall terminate the cer-
tification of the program. 
‘‘(3) PENALTY
FOR
PREVIOUS
NONCOMPLI-
ANCE.—If the Secretary determines that a hospice 
program that is certified for participation under this 
title is in compliance with the requirements specified 
in section 1861(dd) but, as of a previous period, did 
not meet such requirements, the Secretary may pro-
vide for a civil monetary penalty under paragraph 
(5)(B)(i) for the days in which the Secretary finds 
that the program was not in compliance with such 
requirements. 
‘‘(4) OPTION
TO
CONTINUE
PAYMENTS
FOR 
NONCOMPLIANT
HOSPICE
PROGRAMS.—The Sec-
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retary may continue payments under this title with 
respect to a hospice program not in compliance with 
the requirements specified in section 1861(dd) over 
a period of not longer than 6 months, if— 
‘‘(A) the State or local survey agency finds 
that it is more appropriate to take alternative 
action to assure compliance of the program with 
such requirements than to terminate the certifi-
cation of the program; 
‘‘(B) the program has submitted a plan 
and timetable for corrective action to the Sec-
retary for approval and the Secretary approves 
the plan of corrective action; and 
‘‘(C) the program agrees to repay to the 
Federal Government payments received under 
this title during such period if the corrective ac-
tion is not taken in accordance with the ap-
proved plan and timetable. 
The Secretary shall establish guidelines for approval 
of corrective actions requested by hospice programs 
under this paragraph. 
‘‘(5) REMEDIES.— 
‘‘(A) DEVELOPMENT.— 
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‘‘(i) IN GENERAL.—Not later than Oc-
tober 1, 2021, the Secretary shall develop 
and implement— 
‘‘(I) a range of remedies to apply 
to hospice programs under the condi-
tions described in paragraphs (1) 
through (4); and 
‘‘(II) appropriate procedures for 
appealing determinations relating to 
the imposition of such remedies. 
Remedies developed pursuant to the pre-
ceding sentence shall include the remedies 
specified in subparagraph (B). 
‘‘(ii) CONDITIONS OF IMPOSITION OF 
REMEDIES.—Not later than October 1, 
2021, the Secretary shall develop and im-
plement specific procedures with respect to 
the conditions under which each of the 
remedies developed under clause (i) is to 
be applied, including the amount of any 
fines and the severity of each of these rem-
edies. Such procedures shall be designed so 
as to minimize the time between identifica-
tion of deficiencies and imposition of these 
remedies and shall provide for the imposi-
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tion of incrementally more severe fines for 
repeated or uncorrected deficiencies. 
‘‘(B) SPECIFIED
REMEDIES.—The rem-
edies specified in this subparagraph are the fol-
lowing: 
‘‘(i) Civil monetary penalties in an 
amount not to exceed $10,000 for each day 
of noncompliance by a hospice program 
with the requirements specified in section 
1861(dd). 
‘‘(ii) Suspension of all or part of the 
payments to which a hospice program 
would otherwise be entitled under this title 
with respect to items and services fur-
nished by a hospice program on or after 
the date on which the Secretary determines 
that remedies should be imposed pursuant 
to paragraph (2). 
‘‘(iii) The appointment of temporary 
management to oversee the operation of 
the hospice program and to protect and as-
sure the health and safety of the individ-
uals under the care of the program while 
improvements are made in order to bring 
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the program into compliance with all such 
requirements. 
‘‘(C) PROCEDURES.— 
‘‘(i) CIVIL MONETARY PENALTIES.— 
‘‘(I) IN
GENERAL.—Subject to 
subclause (II), the provisions of sec-
tion 1128A (other than subsections 
(a) and (b)) shall apply to a civil mon-
etary penalty under this subsection in 
the same manner as such provisions 
apply to a penalty or proceeding 
under section 1128A(a). 
‘‘(II) RETENTION
OF
AMOUNTS 
FOR
HOSPICE
PROGRAM
IMPROVE-
MENTS.—The Secretary may provide 
that any portion of civil monetary 
penalties collected under this sub-
section may be used to support activi-
ties that benefit individuals receiving 
hospice care, including education and 
training programs to ensure hospice 
program compliance with the require-
ments of section 1861(dd). 
‘‘(ii) SUSPENSION
OF
PAYMENT.—A 
finding to suspend payment under sub-
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paragraph (B)(ii) shall terminate when the 
Secretary finds that the program is in sub-
stantial compliance with all such require-
ments. 
‘‘(iii) TEMPORARY
MANAGEMENT.— 
The temporary management under sub-
paragraph (B)(iii) shall not be terminated 
until the Secretary has determined that the 
program has the management capability to 
ensure continued compliance with all the 
requirements referred to in such subpara-
graph. 
‘‘(D) RELATIONSHIP
TO
OTHER
REM-
EDIES.—The remedies developed under sub-
paragraph (A) are in addition to sanctions oth-
erwise available under State or Federal law and 
shall not be construed as limiting other rem-
edies, including any remedy available to an indi-
vidual at common law.’’. 
(2) AVAILABILITY OF HOSPICE ACCREDITATION 
SURVEYS.—Section 1865(b) of the Social Security 
Act (42 U.S.C. 1395bb(b)) is amended by inserting 
‘‘or, beginning on the date of the enactment of the 
BENES Act of 2020, a hospice program’’ after 
‘‘home health agency’’. 
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(3) STATE
PROVISION
OF
HOSPICE
PROGRAM 
INFORMATION.— 
(A) IN GENERAL.—Section 1864(a) of the 
Social Security Act (42 U.S.C. 1395aa(a)) is 
amended in the sixth sentence— 
(i) by inserting ‘‘and hospice pro-
grams’’ after ‘‘information on home health 
agencies’’; 
(ii) by inserting ‘‘or the hospice pro-
gram’’ after ‘‘the home health agency’’; 
(iii) by inserting ‘‘or the hospice pro-
gram’’ after ‘‘with respect to the agency’’; 
and 
(iv) by inserting ‘‘and hospice pro-
grams’’ after ‘‘with respect to home health 
agencies’’. 
(B) EFFECTIVE DATE.—The amendments 
made by subparagraph (A) shall apply with re-
spect to agreements entered into on or after, or 
in effect as of, the date that is 1 year after the 
date of the enactment of this Act. 
(4) CONFORMING AMENDMENTS.— 
(A) DEFINITION
OF
A
HOSPICE
PRO-
GRAM.—Section 1861(dd)(4) of the Social Secu-
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rity Act (42 U.S.C. 1395x(dd)(4)) is amended 
by striking subparagraph (C). 
(B) CONTINUATION OF FUNDING.—Section 
3(a)(2) of the Improving Medicare Post-Acute 
Care Transformation Act of 2014 is amended 
by inserting ‘‘and section 1822(a)(1) of such 
Act,’’ after ‘‘as added by paragraph (1),’’. 
(b) INCREASING PAYMENT REDUCTIONS FOR FAIL-
URE
TO MEET QUALITY DATA REPORTING REQUIRE-
MENTS.—Section 1814(i)(5)(A)(i) of the Social Security 
Act (42 U.S.C. 1395f(i)(5)(A)(i)) is amended by inserting 
‘‘(or, for fiscal year 2023 and each subsequent fiscal year, 
4 percentage points)’’ before the period. 
(c) REPORT.—Not later than 36 months after the 
date of the enactment of this Act, the Comptroller General 
of the United States shall submit to the Committee on 
Ways and Means of the House of Representatives and the 
Committee on Finance of the Senate a report containing 
an analysis of the effects of the amendments made by sub-
section (a), including the frequency of application of rem-
edies specified in section 1822(c)(5)(B) of the Social Secu-
rity Act (as added by such subsection), on access to, and 
quality of, care furnished by hospice programs under part 
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A of title XVIII of the Social Security Act (42 U.S.C. 
1395c et seq.). 
Passed the House of Representatives December 8, 
2020. 
Attest: 
CHERYL L. JOHNSON, 
Clerk. 
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