To amend part D of title XVIII of the Social Security Act to provide for low-income beneficiaries in the Medicare savings programs automatic enrollment and eligibility for low-income subsidies under the Medicare transitional and permanent prescription drug programs.

May 20, 2004

Mr. DINGELL (for himself, Mr. RANGEL, Mr. WAXMAN, Mr. STARK, Mr. BROWN of Ohio, Ms. PELOSI, Mr. MARKEY, Mr. TOWNS, Mr. PALLONE, Mr. RUSH, Mr. STUPAK, Mr. ENGEL, Mr. WYNN, Ms. MCCARTHY of Missouri, Mr. STRICKLAND, Mrs. CAPPS, Mr. JOHN, Mr. ALLEN, Mr. DAVIS of Florida, Mr. BECERRA, Mr. MCNULTY, Mr. DOGGETT, Mr. MATSUI, Mr. SANDLIN, and Mr. DEUTSCH) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

To amend part D of title XVIII of the Social Security Act to provide for low-income beneficiaries in the Medicare savings programs automatic enrollment and eligibility for low-income subsidies under the Medicare transitional and permanent prescription drug programs.

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 Prescription Drug Low-Income Assistance Act of 2004'.

SEC. 2. ASSURANCE OF ASSISTANCE FOR LOW-INCOME BENEFICIARIES IN MEDICARE SAVINGS PROGRAMS UNDER MEDICARE PRESCRIPTION DRUG DISCOUNT CARD AND TRANSITIONAL ASSISTANCE PROGRAM.

(a) AUTOMATIC ENROLLMENT-

(1) IN GENERAL- Section 1860D-31(c)(1) of the Social Security Act (42 U.S.C. 1395w-141(c)(1)) is amended by adding at the end the following new subparagraph:

`(F) AUTOMATIC ENROLLMENT OF CERTAIN LOW-INCOME BENEFICIARIES IN MEDICARE SAVINGS PROGRAMS-

`(i) NOTICE OF ELIGIBILITY- Not later than 45 days after the date an individual described in clause (ii) is first eligible to enroll in an endorsed discount card program under this section, each State or the Secretary (at the option of each State) shall mail to each individual described in clause (ii), a notice stating the following:

`(I) Such individual is eligible to enroll in an endorsed discount card program and to receive transitional assistance under subsection (g).

`(II) If such individual does not enroll before 30 days after the date of the notice, such individual will be automatically enrolled in an endorsed discount card program selected by the Secretary unless the individual notifies the Secretary that such individual does not wish to be so enrolled.

`(III) If such individual is automatically enrolled in an endorsed discount card program selected by the Secretary, the individual may enroll in another endorsed discount card program selected by the individual during the 60-day period beginning on the date of such automatic enrollment.

`(IV) If the individual is enrolled in an endorsed discount card program during 2004, the individual will be permitted to change enrollment under subsection (c)(1)(C)(ii) for 2005.

`(V) There is no obligation to use the endorsed discount card program or transitional assistance when purchasing prescription drugs.

`(ii) INDIVIDUALS BENEFITING FROM AUTOMATIC ENROLLMENT- An individual described in this clause is a discount card eligible individual who--

`(I) is a recipient of supplemental security income benefits under title XVI, or is determined to be eligible for medical assistance under title XIX solely by reason of clause (i), (iii), or (iv) of section 1902(a)(10)(E); and

`(II) has not enrolled in an endorsed discount card program as of the date that is 30 days after the date the individual is first eligible to enroll in such a program.

`(iii) AUTOMATIC ENROLLMENT- The Secretary shall enroll each individual described in clause (ii), who has not enrolled in an endorsed discount card program or provided notice to the Secretary under clause (iv) as of the end of the 30-day period beginning on the date of the notice to the individual under clause (i), in an endorsed discount card program selected by the Secretary that serves residents of the State in which the individual resides.

`(iv) OPT-OUT- Clause (iii) shall not apply to an individual if the individual notifies the Secretary before the end of the 30-day period described in such clause that the individual does not wish to be automatically enrolled under such clause.

`(v) 60-DAY GRACE PERIOD TO CHANGE CARD PROGRAM- The Secretary shall permit each individual who is automatically enrolled under clause (iii) to elect, during the 60-day period that begins on the date the individual is so enrolled, to enroll in a different endorsed discount card program selected by such individual. Such a change shall be treated as an exceptional case for purposes of subparagraph (C)(iii).'.

(b) PROVISION OF TRANSITIONAL ASSISTANCE-

(1) IN GENERAL- Section 1860D-31(b) of such Act (42 U.S.C. 1395w-141(b)) is amended by adding at the end the following new paragraph:

`(5) SPECIAL RULE FOR CERTAIN LOW-INCOME BENEFICIARIES IN MEDICARE SAVINGS PROGRAMS-

`(A) IN GENERAL- Except as provided in subparagraph (C), individuals described in subsection (c)(1)(F)(ii) shall be treated as transitional assistance eligible individuals.

`(B) SPECIAL TRANSITIONAL ASSISTANCE ELIGIBLE INDIVIDUALS- Except as provided in subparagraph (C), such individuals who are recipients of supplemental security income benefits under title XVI or determined to be eligible for medical assistance under title XIX solely by reason of clause (i), (iii), or (iv) of section 1902(a)(10)(E) shall be treated as special transitional assistance eligible individuals.

`(C) APPLICATION OF DISQUALIFICATION FOR INDIVIDUALS WITH PRESCRIPTION DRUG COVERAGE- The Secretary shall not apply subparagraphs (A) and (B) in the case of an individual if the Secretary finds that there is reason to believe that the individual is described in paragraph (2)(B) (relating to individuals with certain prescription drug coverage).'.

(2) WAIVER OF SELF-CERTIFICATION AND VERIFICATION- Section 1860D-31(f) of such Act (42 U.S.C. 1395w-141(f)) is amended by adding at the end the following new paragraph:

`(5) SPECIAL RULE FOR CERTAIN LOW-INCOME BENEFICIARIES IN MEDICARE SAVINGS PROGRAMS- The provisions of paragraphs (2) and (3) shall not apply to individuals who are treated as transitional assistance eligible individuals under subsection (b)(5).'.

(c) EFFECTIVE DATE- The amendments made by this section shall take effect as if included in the enactment of section 101 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2071).

SEC. 3. ASSURANCE OF ASSISTANCE FOR LOW-INCOME BENEFICIARIES IN MEDICARE SAVINGS PROGRAMS UNDER QUALIFIED PRESCRIPTION DRUG COVERAGE.

(a) AUTOMATIC ENROLLMENT- Section 1860D-1(b)(1)(C) of the Social Security Act (42 U.S.C. 1395w-101(b)(1)(C)) is amended--

(1) by designating the matter beginning with `The process established' as a clause (i) with the heading `IN GENERAL- ' and an appropriate indentation;

(2) by striking `a full-benefit dual eligible individual (as defined in section 1935(c)(6)) who has failed to enroll in a prescription drug plan or an MA-PD plan' and inserting `described in clause (ii)'; and

(3) by adding at the end the following new clauses:

`(ii) INDIVIDUALS COVERED- An individual described in this clause is an individual who--

`(I) is a full-benefit dual eligible individual (as defined in section 1935(c)(6)), is a recipient of supplemental security income benefits under title XVI, or is determined to be eligible for medical assistance under title XIX solely by reason of clause (i), (iii), or (iv) of section 1902(a)(10)(E); and

`(II) has failed to enroll in a prescription drug plan or an MA-PD plan.

`(iii) APPLICATION OF NOTICE, OPT-OUT, AND GRACE PERIOD IN CHANGE IN ENROLLMENT PROVISIONS- In carrying out this subparagraph, the Secretary shall provide for the application of notice and change in enrollment provisions with respect to enrollment in prescription drug plans and MA-PD plans similar to those provided under clauses (i), (iv), and (v) of section 1860D-31(c)(1)(F) with respect to enrollment in endorsed discount card programs.'.

(b) PROVISION OF PREMIUM AND COST-SHARING SUBSIDIES- Section 1860D-14(a)(3)(B)(v) of such Act (42 U.S.C. 1395w-114(a)(3)(B)(v)) is amended to read as follows:

`(v) TREATMENT OF MEDICAID BENEFICIARIES AND LOW-INCOME BENEFICIARIES IN MEDICARE SAVINGS PROGRAMS- Subject to subparagraph (F), the Secretary shall provide that the following individuals who are part D eligible individuals shall be treated as being determined to be subsidy eligible individuals described in paragraph (1):

`(I) Full-benefit dual eligible individuals (as defined in section 1935(c)(6)).

`(II) Individuals who are recipients of supplemental security income benefits under title XVI.

`(III) Individuals who are determined to be eligible for medical assistance under title XIX solely by reason of clause (i), (iii), or (iv) of section 1902(a)(10)(E).'.

(c) EFFECTIVE DATE- The amendments made by this section shall take effect as if included in the enactment of section 101 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (Public Law 108-173; 117 Stat. 2071).

END