[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[S. 649 Introduced in Senate (IS)]
103d CONGRESS
1st Session
S. 649
To ensure proper and full implementation by the Department of Health
and Human Services of medicaid coverage for certain low-income medicare
beneficiaries.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
March 24 (legislative day, March 3), 1993
Mr. Riegle (for himself, Mr. Mitchell, Mr. Pryor, Mr. Cohen, Mr.
Kennedy, Mr. Simon, Mr. Leahy, Mr. Johnston, Mr. Sarbanes, and Mr.
Wofford) introduced the following bill; which was read twice and
referred to the Committee on Finance
_______________________________________________________________________
A BILL
To ensure proper and full implementation by the Department of Health
and Human Services of medicaid coverage for certain low-income medicare
beneficiaries.
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 ``Medicare Enrollment Improvement and
Protection Act of 1993''.
TITLE I--IMPROVING ENROLLMENT
SEC. 101. NOTIFICATION.
(a) In General.--Section 1804 of the Social Security Act (42 U.S.C.
1395b-2) is amended--
(1) by striking ``and'' at the end of paragraph (2),
(2) by striking the period at the end of paragraph (3) and
inserting ``, and'',
(3) by inserting after paragraph (3) the following new
paragraph:
``(4) a clear, simple explanation (designed to attract the
reader's attention and stated plainly in English and any other
language determined by the Secretary) of the eligibility
requirements and application procedures for receiving payment
of medicare cost-sharing (as defined in section 1905(p)(3)) by
qualified medicare beneficiaries (as defined in section
1905(p)(1)), qualified disabled and working individuals (as
defined in section 1905(s)), and individuals described in
section 1902(a)(10)(E)(iii).'', and
(4) by adding at the end thereof the following new
sentence: ``The portion of the notice containing the
explanation described in paragraph (4) shall also be prepared
in a manner suitable for posting and shall be distributed to
physicians, hospital offices, other medical facilities, and
entities receiving grants from the Secretary for programs
designed to provide services to individuals age 65 or older.''.
(b) Toll-Free Hotline.--The Secretary of Health and Human Services
shall establish a toll-free telephone number to provide individuals
with information on medicare cost-sharing (as defined in section
1905(p)(3) of the Social Security Act (42 U.S.C. 1396d(p)(3)),
including the availability of and requirements for obtaining such
medicare cost-sharing, where to go for applications, and documentation
needed for applying. Such information shall be offered to every caller
to the hotline regardless of the specific inquiry. All notices
described in section 1804(4) of the Social Security Act (42 U.S.C.
1395b-2(4)) shall include this toll-free telephone number.
(c) Effective Date.--The amendments made by subsection (a) shall
take effect on the date of the enactment of this Act.
SEC. 102. USE OF SOCIAL SECURITY ADMINISTRATION OFFICES AND SIMPLIFIED
APPLICATION PROCESSES.
(a) In General.--Title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) is amended by adding at the end thereof the following new
section:
``alternative locations for processing applications for qualified
medicare beneficiaries
``Sec. 1931. (a) In General.--The Secretary, through the Social
Security Administration and the Health Care Financing Administration,
shall provide, as an alternative to the procedure established by State
agencies under State plans under this title, a procedure (including
appropriate training of personnel by the Health Care Financing
Administration) to assist individuals in completing the application
form described in subsection (b) at Social Security Administration
offices (and any other Federal office, as determined appropriate by the
Secretary), and to accept by mail or in person such application form at
such offices. The Secretary shall ensure that adequate resources are
available to implement the procedure developed under this subsection.
``(b) Simplified Application Forms.--The Secretary shall develop a
short, simplified application form to determine if an individual meets
the requirements for status as a qualified medicare beneficiary under
section 1905(p)(1), a qualified disabled and working individual (as
defined in section 1905(s)), or an individual described in section
1902(a)(10)(E)(iii). The form shall be developed with the consultation
of consumer advocates and State agencies and shall be available in
offices described in subsection (a).
``(c) Additional Uses of Forms.--The Secretary shall periodically
(at such times as determined by the Secretary) mail the forms described
in subsection (b) to individuals potentially eligible for the status
described in such subsection, and shall provide such forms to
counselors in organizations described in section 105 of the Medicare
Enrollment Improvement and Protection Act of 1993 for use in
determining an individual's eligibility for such status.
``(d) Submission of Forms.--Except as provided in subsection (e),
the Secretary shall refer application forms described in subsection (b)
which are received by the Secretary to the appropriate State agency
designated under this title for review and decision.
``(e) Certification of Determination of Status.--
``(1) Certification to state.--If the Secretary, based upon
an application described in subsection (b), makes a
determination that an individual meets the requirements for the
status described in such subsection, the Secretary shall
certify such determination to the State in which the individual
resides.
``(2) State recognition of eligibility.--If the Secretary
certifies to the State that an individual meets the
requirements for such status, the individual shall be deemed to
have met the requirements for such status.
``(3) Continuing eligibility required.--Nothing in
paragraph (2) shall be construed to prohibit a State from
requiring an individual to continue to meet the requirements of
such status after the individual is deemed to have met the
requirements of such status under paragraph (2).''.
(b) Effective Date.--The amendments made by subsection (a) shall
take effect on the date of the enactment of this Act.
SEC. 103. MANDATORY DIRECT ENROLLMENT OF PART A ELIGIBLES.
(a) In General.--Paragraph (1) of section 1818(g) of the Social
Security Act (42 U.S.C. 1395i-2(e)) is amended by striking ``shall, at
the request of a State made after 1989, enter into a modification of an
agreement entered into with the State pursuant to section 1843(a)'' and
inserting ``shall enter into an agreement with each State under terms
described in section 1843''.
(b) Effective Date.--The amendment made by subsection (a) shall
take effect on the date of the enactment of this Act.
SEC. 104. OPTIONAL PRESUMPTIVE ELIGIBILITY.
(a) In General.--Title XIX of the Social Security Act (42 U.S.C.
1396 et seq.) is amended by inserting after section 1920 the following
new section:
``presumptive eligibility for qualified medicare beneficiaries
``Sec. 1920A. (a) In General.--A State plan approved under section
1902 may provide that during a presumptive eligibility period, medical
assistance may be made available for medicare cost-sharing (as
described in clauses (i), (ii), and (iii) of section 1902(a)(10)(E)) to
qualified medicare beneficiaries (as defined in section 1905(p)(1)),
qualified disabled and working individuals (as defined in section
1905(s)), and individuals described in section 1902(a)(10)(E)(iii)
without regard to whether a final determination of eligibility for such
assistance has been made.
``(b) Definitions.--For purposes of this section--
``(1) the term `presumptive eligibility period' means, with
respect to an individual described in subsection (a), the
period that--
``(A) begins with the date on which a qualified
provider determines, on the basis of preliminary
information, that the family income of the individual
does not exceed the applicable income level of
eligibility under the State plan, and
``(B) ends with (and includes) the earlier of--
``(i) the day on which a determination is
made with respect to the eligibility of the
individual for medical assistance described in
subsection (a) under the State plan, or
``(ii) in the case of an individual who
does not file an application by the last day of
the month following the month during which the
provider makes the determination referred to in
subparagraph (A), such last day, and
``(2) the term `qualified provider' means any provider
that--
``(A) is eligible for payments under a State plan
approved under this title, and
``(B) is determined by the State agency to be
capable of making determinations of the type described
in paragraph (1)(A).
``(c) Duties of State Agency, Qualified Providers, and
Presumptively Eligible Individuals.--
``(1) Duties of state agency.--The State agency shall
provide qualified providers with--
``(A) such forms as are necessary for an individual
described in subsection (a) to make application for
medical assistance described in subsection (a) under
the State plan, and
``(B) information on how to assist such individuals
in completing and filing such forms.
``(2) Duties of qualified providers.--A qualified provider
that determines under subsection (b)(1)(A) that such an
individual is presumptively eligible for such medical
assistance under a State plan shall--
``(A) notify the State agency of the determination
within 5 working days after the date on which the
determination is made, and
``(B) inform the individual at the time the
determination is made that such individual is required
to make application for such medical assistance under
the State plan by no later than the last day of the
month following the month during which the
determination is made.
``(3) Duties of presumptively eligible individuals.--An
individual who is determined by a qualified provider to be
presumptively eligible for medical assistance under a State
plan shall make application for such medical assistance under
such plan by no later than the last day of the month following
the month during which the determination is made.''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply to calendar quarters beginning on or after January 1, 1994,
without regard to whether or not regulations to implement such
amendment are promulgated by such date.
SEC. 105. OUTREACH GRANTS.
(a) Grants.--
(1) In general.--The Secretary of Health and Human Services
(in this section referred to as the ``Secretary'') shall make
grants, one-half to State agencies and one-half to
organizations approved under paragraph (2), that submit
applications to the Secretary that meet the requirements of
this section for the purpose of providing information,
counseling, and assistance to older individuals who may be
eligible for, but who are not receiving, benefits as qualified
medicare beneficiaries (as defined in section 1905(p)(1) of the
Social Security Act (42 U.S.C. 1396d(p)(1)), qualified disabled
and working individuals (as defined in section 1905(s) of such
Act (42 U.S.C. 1396d(s)), and individuals described in section
1902(a)(10)(E)(iii) of such Act (42 U.S.C. 1396a(a)(10)(E)) (in
this section referred to as ``eligible individuals''). The
Secretary shall prescribe regulations to establish a minimum
level of funding for a grant issued under this section.
(2) Approved organizations.--For purposes of paragraph (1),
an organization shall be approved by the Secretary to submit an
application for grant funding (as described in subsection (b))
if, as determined by the Secretary, such organization has local
entities that can assist older individuals with information and
applications to determine if such individuals are eligible
individuals.
(b) Grant Applications.--
(1) Submissions.--In submitting an application under this
section, a State agency or approved organization may
consolidate and coordinate an application that consists of
parts prepared by more than one department of such State agency
or organization.
(2) Program requirements.--As part of an application for a
grant under this section, a State agency or approved
organization shall submit a plan for an information,
counseling, and assistance program. Such program shall--
(A) establish or improve upon an information,
counseling, and assistance program that provides
counseling and assistance to eligible individuals in
need of information that may assist such individuals in
applying for medicare cost-sharing (as defined in
section 1905(p)(3) of the Social Security Act (42
U.S.C. 1396d(p)(3));
(B) establish a system of referrals to appropriate
Federal, State, or local departments or agencies for
assistance with problems related to enrollment in and
full implementation of such medicare cost-sharing
program, as determined by the Secretary;
(C) provide for a sufficient number of staff
positions (including volunteer positions) necessary to
provide the services of the information, counseling,
and assistance program;
(D) provide for the collection and dissemination of
timely and accurate enrollment information to staff
members;
(E) provide for training programs for staff members
(including volunteer staff members);
(F) provide for the coordination of the exchange of
enrollment information between the staff of departments
and agencies of the State government and the staff of
the information, counseling, and assistance program;
(G) make recommendations concerning consumer issues
and complaints related to such enrollment to agencies
and departments of the State government and the Federal
Government responsible for providing such medicare
cost-sharing;
(H) establish an outreach program to provide the
enrollment information and counseling described in
subparagraph (A) and the assistance described in
subparagraph (B) to eligible individuals; and
(I) demonstrate, to the satisfaction of the
Secretary, an ability to provide the counseling and
assistance required under this section.
(c) Administration.--The State agency or approved organization
shall operate the information, counseling, and assistance program in
locations other than State welfare offices, including facilities
operated by any area agency on aging (as defined in section 102(a)(17)
of the Older Americans Act of 1965), meals on wheels program, senior
center, and other location determined by the Secretary in consultation
with such agency or organization.
(d) Maintenance of Effort.--Any funds appropriated for the
activities under this section shall supplement, and shall not supplant,
funds that are expended for similar purposes under any Federal, State,
or local program.
(e) Annual Applicant Report.--A State agency or approved
organization that receives a grant under subsection (a) shall, not
later than 180 days after receiving such grant, and annually
thereafter, issue an annual report to the Secretary that includes
information concerning--
(1) the number of individuals served by the information,
counseling, and assistance program of such State agency or
organization; and
(2) the problems that eligible individuals encounter in
enrolling for medicare cost-sharing.
(f) Report to Congress.--Not later than 180 days after the date of
enactment of this section, and annually thereafter, the Secretary shall
issue a report to the Committee on Finance of the Senate, the Special
Committee on Aging of the Senate, the Committee on Ways and Means of
the House of Representatives, the Committee on Energy and Commerce of
the House of Representatives, and the Select Committee on Aging of the
House of Representatives that--
(1) summarizes the allocation of funds authorized for
grants under this section and the expenditure of such funds;
(2) outlines the problems that eligible individuals
encounter in enrolling for medicare cost-sharing;
(3) makes recommendations that the Secretary determines to
be appropriate to address the problems described in paragraph
(2); and
(4) in the case of the first report issued 2 years after
the date of enactment of this section, evaluates the
effectiveness of counseling programs established under this
program, and makes recommendations regarding continued
authorization of funds for these purposes.
(g) Authorization of Appropriations for Grants.--There are
authorized to be appropriated, in equal parts from the Federal Hospital
Insurance Trust Fund and from the Federal Supplementary Medical
Insurance Trust Fund, $30,000,000 for each of the fiscal years 1994,
1995, and 1996, and $10,000,000 for each of the fiscal years beginning
after fiscal year 1996, to fund the grant programs described in this
section.
TITLE II--APPLICATION OF OTHER MEDICAID ELIGIBILITY RULES
SEC. 201. OTHER MEDICAID ELIGIBILITY RULES.
(a) In General.--Subsection (a) of section 1905 of the Social
Security Act (42 U.S.C. 1396d) is amended by striking ``or, in the case
of medicare cost-sharing with respect to a qualified medicare
beneficiary described in subsection (p)(1), if provided after the month
in which the individual becomes such a beneficiary)'' and inserting
``or, in the case of medicare cost-sharing with respect to a qualified
medicare beneficiary (as defined in subsection (p)(1)), a qualified
disabled and working individual (as defined in subsection (s)), or an
individual described in section 1902(a)(10)(E)(iii), if provided in or
after the third month before the month in which the individual makes
application to become such a beneficiary or individual)''.
(b) Conforming Amendment.--Paragraph (8) of section 1902(e) of the
Social Security Act (42 U.S.C. 1396a(e)) is amended to read as follows:
``(8) For purposes of payment to a State under section 1903(a), if
an individual is determined to be a qualified medicare beneficiary (as
defined in section 1905(p)(1)), a qualified disabled and working
individual (as defined in section 1905(s)), or an individual described
in subsection (a)(10)(E)(iii), such determination shall be considered
to be valid for an individual for a period of 12 months from the date
of application, except that a State may provide for such determinations
more frequently, but not more frequently than once every 6 months for
an individual.''.
(c) Effective Date.--The amendments made by this section shall
apply with respect to applications filed after December 31, 1993.
TITLE III--REPORT
SEC. 301. REPORT BY SECRETARY.
The Secretary of Health and Human Services shall report to the
Congress not later than 12 months after the date of enactment of this
Act on the activities of the Department of Health and Human Services to
ensure enrollment and full implementation of the benefits described in
section 1902(a)(10)(E) of the Social Security Act (42 U.S.C.
1396a(a)(10)(E)) and the effectiveness of each such activity. Such
report shall also include any recommendations regarding any proposed
legislation necessary to further improve such enrollment and
implementation.
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S 649 IS----2