Title: Enrollment REFORM Act
Policy area: Health

Summary:
Enrollment Reshaping Entry For Older, Retiring Members Act or the Enrollment REFORM Act
This bill establishes and otherwise modifies requirements relating to coordinated coverage between employer health insurance and Medicare.
Specifically, the bill prohibits employer-sponsored health plans for certain smaller employers from reducing benefits for employees who are eligible for Medicare but have not yet enrolled. Additionally, for purposes of calculating the Medicare late enrollment penalty, an individual seeking to demonstrate proof of enrollment in an employer-sponsored health plan may not be required to provide proof for more than the immediately preceding 36-month period, with specified exceptions.

[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1928 Introduced in Senate (IS)]

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116th CONGRESS
  1st Session
                                S. 1928

    To amend title XVIII of the Social Security Act to improve the 
      enrollment of retiring individuals in the Medicare program.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             June 20, 2019

Mr. Portman (for himself and Mr. Casey) introduced the following bill; 
     which was read twice and referred to the Committee on Finance

_______________________________________________________________________

                                 A BILL


 
    To amend title XVIII of the Social Security Act to improve the 
      enrollment of retiring individuals in the Medicare program.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Enrollment Reshaping Entry For 
Older, Retiring Members Act'' or the ``Enrollment REFORM Act''.

SEC. 2. COORDINATION OF MEDICARE BENEFITS WITH OTHER HEALTH CARE 
              INSURANCE.

    (a) In General.--Section 1862(b)(1)(A) of the Social Security Act 
(42 U.S.C. 1395y(b)(1)(A)) is amended by adding at the end the 
following new clause:
                            ``(vi) Coordination of benefits with other 
                        health care insurance.--Notwithstanding any 
                        other provision of law, in the event that an 
                        individual is enrolled in an employer group 
                        health plan (including a multiemployer or 
                        multiple employer group health plan) by virtue 
                        of current employment status with an employer 
                        that does not have 20 or more individuals in 
                        current employment status for each working day 
                        in each of 20 or more calendar weeks in the 
                        current calendar year and the preceding 
                        calendar year and the individual is eligible 
                        but not enrolled in coverage under part B, such 
                        employer group health plan shall not reduce 
                        benefits under the plan with respect to the 
                        individual on the basis that the individual 
                        could have been enrolled in coverage under part 
                        B. Nothing in the preceding sentence shall 
                        require such employer group health plan to 
                        provide coverage to an individual who elects to 
                        enroll in coverage under part B or to prohibit 
                        such plan from terminating such coverage or 
                        reducing benefits if such individual makes such 
                        election.''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to items and services furnished on or after the date of the 
enactment of this Act.

SEC. 3. LIMITATION ON DOCUMENTATION AN INDIVIDUAL IS REQUIRED TO 
              PROVIDE IN ORDER TO DEMONSTRATE EMPLOYMENT-BASED HEALTH 
              INSURANCE FOR PURPOSES OF AVOIDING THE PART B LATE 
              ENROLLMENT PENALTY.

    (a) In General.--Section 1839 of the Social Security Act (42 U.S.C. 
1395r) is amended--
            (1) in subsection (b), in the second sentence, by striking 
        ``For purposes'' and inserting ``Subject to subsection (j), for 
        purposes''; and
            (2) by adding at the end the following new subsection:
    ``(j) Limitation on Documentation an Individual Is Required To 
Provide in Order To Demonstrate Employment-Based Health Insurance for 
Purposes of Avoiding the Late Enrollment Penalty.--
            ``(1) Limitation.--Subject to paragraph (2), for purposes 
        of demonstrating enrollment in a group health plan or a large 
        group health plan for a period of time under the second 
        sentence of subsection (b), the Secretary may not require an 
        individual to provide documentation of such enrollment for more 
        than the 36-month period immediately preceding the close of the 
        enrollment period in which the individual enrolled (or 
        reenrolled).
            ``(2) Limitation not applicable if individual is unable to 
        provide documentation for entire 36-month period.--In the case 
        where an individual is unable to provide documentation of 
        enrollment described in paragraph (1) for the entire preceding 
        36-month period described in such paragraph, the limitation 
        under paragraph (1) shall not apply.
            ``(3) Individual can provide additional documentation.--
        Nothing in this subsection shall preclude an individual from 
        providing the Secretary with documentation of enrollment for 
        periods prior to the preceding 36-month period described in 
        paragraph (1), including in the case where the limitation under 
        paragraph (1) does not apply because of the application of 
        paragraph (2).''.
    (b) Effective Date.--The amendment made by subsection (a) shall 
apply to calculations of premiums under such section 1839 made on or 
after the date of the enactment of this Act.
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