Qualified Medicare Beneficiary Enrollment Improvement and Protection Act of 1991 - Amends title XVIII (Medicare) of the Social Security Act to direct the Secretary of Health and Human Services to include in the annual mailing to Medicare beneficiaries: (1) a clear and simple explanation of the availability of and the requirements to qualify for Medicaid (title XIX of the Social Security Act) payment of their premiums, deductibles, and copayments under Medicare; (2) the toll-free telephone number to be established by the Secretary for information on such assistance; and (3) an initial application for such assistance.
Directs the Secretary to develop a poster containing the information listed above and distribute it to service providers in order to publicize the availability of such assistance.
Amends the Medicaid program to direct the Secretary to: (1) establish a process for using local Social Security Administration offices for the distribution and receipt of applications for such assistance; (2) transmit such applications to the appropriate State agency; (3) develop a form to be available at such offices which individuals may use to request additional information on or an application for such assistance; and (4) distribute such form to entities receiving grants for programs to provide services to older individuals.
Requires States to provide for a process for receiving, distributing, and processing applications for such assistance and for responding to requests for information on or applications for such assistance.
Allows individuals who qualified during a certain period for Medicaid payment of Medicare costs to temporarily apply for retroactive payment of any medical costs incurred but not paid under a State plan required to provide for making Medicaid payment of Medicare costs available to Medicare beneficiaries.
Allows States, in determining the income level for individuals who seek to qualify for Medicaid payment of Medicare costs, to exclude expenses for medical care incurred by the individual that are not reimbursed under a public program of the State or political subdivision thereof, a health plan, or Medicare.
Directs the Secretary to establish a grant program to provide outreach services to enable individuals who are entitled to receive Medicaid payment of Medicare costs to receive such assistance. Authorizes appropriations.
HR 3473 IH 102d CONGRESS 1st Session H. R. 3473 To amend title XVIII of the Social Security Act to require the Secretary of Health and Human Services to include a description of the medical assistance for medicare cost-sharing available under title XIX of such Act in the annual program notices sent to medicare beneficiaries, to amend title XIX of such Act to require States to make applications for such assistance available at local offices of the Social Security Administration and to accept such applications by mail, and for other purposes. IN THE HOUSE OF REPRESENTATIVES October 2, 1991 Mr. MOODY (for himself, Mr. KOSTMAYER, Mr. MCDERMOTT, Mr. STUDDS, Mr. ROYBAL, Mr. COYNE, Mr. DONNELLY, Mr. LEVIN of Michigan, Mr. BEVILL, Mr. REED, Mr. FRANK of Massachusetts, Mr. SABO, Ms. PELOSI, Mr. FASCELL, Mr. GUARINI, Mr. HORTON, Mr. MANTON, Mr. BILBRAY, Mr. SYNAR, Mr. OBERSTAR, Ms. OAKAR, Mr. JONTZ, Mr. AUCOIN, Mr. TOWNS, Mrs. LLOYD, Mr. DIXON, Mr. EVANS, Mr. KANJORSKI, Mr. ACKERMAN, Mr. KILDEE, Mr. OWENS of Utah, Mr. BRYANT, Mr. MCCANDLESS, Mr. TANNER, Mr. BORSKI, Mr. MFUME, and Mr. HALL of Ohio) introduced the following bill; which was referred jointly to the Committees on Ways and Means and Energy and Commerce A BILL To amend title XVIII of the Social Security Act to require the Secretary of Health and Human Services to include a description of the medical assistance for medicare cost-sharing available under title XIX of such Act in the annual program notices sent to medicare beneficiaries, to amend title XIX of such Act to require States to make applications for such assistance available at local offices of the Social Security Administration and to accept such applications by mail, and for other purposes. Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled, SECTION 1. SHORT TITLE; REFERENCES IN ACT. (a) SHORT TITLE- This Act may be cited as the `Qualified Medicare Beneficiary Enrollment Improvement and Protection Act of 1991'. (b) REFERENCES TO SOCIAL SECURITY ACT- Whenever in this Act an amendment is expressed in terms of an amendment to or repeal of a section or other provision, the reference shall be considered to be made to that section or other provision of the Social Security Act. SEC. 2. REQUIRING DESCRIPTION OF MEDICARE COST-SHARING IN ANNUAL NOTICE SENT TO MEDICARE BENEFICIARIES. (a) IN GENERAL- Section 1804 (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 (in a manner designed to attract the reader's attention and stated in plain English) of the availability of and the requirements for obtaining medical assistance for medicare cost-sharing under State plans approved under title XIX (including a description of changes in such availability and requirements from the previous year) and the toll-free telephone number for information on such assistance established under section 2(b)(2) of the Qualified Medicare Beneficiary Enrollment Improvement and Protection Act of 1991, together with an initial application for such assistance that may be returned to the Secretary and forwarded by the Secretary to the State in which the recipient resides.'. (b) ADDITIONAL REQUIREMENTS FOR PUBLICIZING AVAILABILITY OF ASSISTANCE- (1) DISTRIBUTION OF NOTICE TO HEALTH CARE PROVIDERS- Not later than January 1, 1992, the Secretary of Health and Human Services shall develop a poster containing the notice provided to medicare beneficiaries under section 1804(4) of the Social Security Act (as added by subsection (a)) of the availability of and the requirements for obtaining medical assistance for medicare cost-sharing under State medicaid plans that is suitable for posting, and shall distribute the poster to physicians, hospitals, and other providers of services under the medicare program, and to entities receiving grants from the Secretary for programs designed to provide services to individuals age 65 or older. (2) ESTABLISHMENT OF TOLL-FREE HOTLINE- Not later than January 1, 1992, the Secretary of Health and Human Services shall establish and operate a toll-free telephone number to provide individuals with information on the availability of and the requirements for obtaining medical assistance for medicare cost-sharing under State medicaid plans. SEC. 3. USE OF SOCIAL SECURITY OFFICES FOR RECEIPT OF APPLICATIONS FOR MEDICARE COST-SHARING; REQUIRING STATES TO ACCEPT APPLICATIONS BY MAIL. (a) RECEIPT OF APPLICATIONS BY SOCIAL SECURITY ADMINISTRATION- Title XIX (42 U.S.C. 1396 et seq.) is amended by adding at the end the following new section: `RECEIPT BY SECRETARY OF APPLICATIONS FOR MEDICARE COST-SHARING `SEC. 1931. (a) IN GENERAL- The Secretary shall establish a process for the distribution and receipt of applications for medical assistance for medicare cost-sharing under section 1902(a)(10)(E) under which-- `(1) individuals applying for such assistance may obtain applications from local offices of the Social Security Administration in the State and submit applications to such offices; and `(2) personnel of such offices shall be trained to assist individuals in completing such applications. `(b) TRANSMISSION OF APPLICATIONS TO STATES- The Secretary shall transmit applications for assistance submitted by individuals under subsection (a) to the agency administering the State program under this title for the State in which the individual resides. `(c) DEVELOPMENT AND DISTRIBUTION OF FORM CONTAINING REQUEST FOR APPLICATION- `(1) DEVELOPMENT- Under the process established under subsection (a), the Secretary shall develop a form that contains-- `(A) a description (in English and other languages determined appropriate by the Secretary) of the availability of and the requirements for obtaining medical assistance for medicare cost-sharing under section 1902(a)(10)(E); and `(B) a pre-addressed reply card that an individual may mail to the agency administering the State program under this title for the State in which the individual resides to request additional information on or an application for such assistance. `(2) DISTRIBUTION- The Secretary shall distribute the form developed under paragraph (1) to entities receiving grants from the Secretary for programs designed to provide services to individuals age 65 or older and shall make the form available at local offices of the Social Security Administration.'. (b) REQUIREMENTS FOR STATE MEDICAID PLANS- (1) IN GENERAL- Section 1902(a) (42 U.S.C. 1396a) is amended-- (A) in paragraph (54)(B), by striking `; and' and inserting a semicolon; (B) in the paragraph (55)(B) added by section 4602(a)(3) of the Omnibus Budget Reconciliation Act of 1990 (hereafter referred to as `OBRA-1990'), by striking the period at the end and inserting a semicolon; (C) by redesignating the paragraph (55) added by section 4604(b)(3) of OBRA-1990 as paragraph (56); (D) in the paragraph (58) added by section 4751(a)(1)(C) of OBRA-1990, by striking the period at the end and inserting a semicolon; (E) by redesignating the paragraph (58) added by section 4752(c)(1)(C) of OBRA-1990 as paragraph (59) and by striking the period at the end of such paragraph and inserting `; and'; and (F) by inserting after paragraph (59) (as so redesignated) the following new paragraph: `(60) provide for a process for the receipt and processing of applications for medical assistance for medicare cost-sharing under paragraph (10)(E) under which-- `(A) the State shall receive and respond to requests for such assistance and shall distribute and process applications for such assistance by mail (except that nothing in this subparagraph shall be construed to prohibit a State from requiring an individual to appear before the State agency to confirm information provided in such an application), `(B) the State shall provide applications for such assistance to all local offices of the Social Security Administration located in the State, and `(C) if the State receives a request in the mail from an individual for information on or an application for such assistance (including a pre-addressed reply card developed by the Secretary under section 1931(c)), the State shall mail the information or application requested to the individual not later than 30 days after receiving the request.'. (2) EFFECTIVE DATE- The amendments made by paragraph (1) shall apply to calendar quarters beginning on or after January 1, 1992, regardless of whether or not regulations to carry out such amendments have been promulgated by that date. SEC. 4. ESTABLISHMENT OF 3-MONTH RETROACTIVE ELIGIBILITY. (a) IN GENERAL- The first sentence of section 1905(a) (42 U.S.C. 1396d) is amended in the matter preceding clause (i) by striking `assistance or, in the case of' and all that follows through `such a beneficiary)' and inserting `assistance)'. (b) CONFORMING AMENDMENT- Section 1902(e)(8) (42 U.S.C. 1396a(e)(8)) is amended to read as follows: `(8) For purposes of payment to a State under section 1903(a), a determination that an individual is eligible to receive medical assistance for medicare cost-sharing under subsection (a)(10)(E) shall be considered to be valid for the 12-month period beginning on the date the individual applies to receive such assistance, 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 for medical assistance for medicare cost-sharing under title XIX of the Social Security Act filed after December 31, 1991. SEC. 5. RETROACTIVE PAYMENT OF MEDICARE COST-SHARING INCURRED BUT NOT RECEIVED. (a) IN GENERAL- Subject to subsections (b) and (c), if an individual is eligible to receive medical assistance for medicare cost-sharing under a State plan for medical assistance under title XIX of the Social Security Act pursuant to section 1902(a)(10)(E) during the year preceding the first year for which section 1931 of such Act (as added by section 3(a)) is in effect, the Secretary of Health and Human Services shall make payments to the individual for any medicare cost-sharing incurred by the individual during the year for which payment was not made under the applicable State plan for medical assistance under title XIX of such Act. (b) REQUIREMENT FOR APPLICATION- No payment may be made to an individual under subsection (a) unless the individual applies for medical assistance for medicare cost-sharing under a State plan for medical assistance under title XIX of the Social Security Act during the first year for which section 1931 of such Act (as added by section 3(a)) is in effect. (c) LIMITATION ON COST-SHARING COVERED- Subsection (a) shall not apply to any medicare cost-sharing incurred by an individual if the State plan for medical assistance under title XIX of the Social Security Act is not required to provide for making medical assistance available for such medicare cost-sharing under section 1902(a)(10)(E) of such Act. SEC. 6. PERMITTING SPENDDOWN FOR QUALIFIED MEDICARE BENEFICIARIES. (a) IN GENERAL- Section 1905(p) (42 U.S.C. 1396d(p)) is amended-- (1) in paragraph (1)(B), by striking `paragraph (2)(D)' and inserting `paragraph (2)(D) or paragraph (2)(E)'; and (2) in paragraph (2), by adding at the end the following new paragraph: `(E) In determining the income of an individual under this subsection, a State may exclude expenses for medical care incurred by the individual that are not reimbursed under a public program of the State or political subdivision thereof, a health benefit plan, or title XVIII.'. (b) CONFORMING AMENDMENT- Section 1902(f)(1) (42 U.S.C. 1396a(f)(1)) is amended in the first sentence, by striking `and except with respect to qualified medicare beneficiaries,'. (c) EFFECTIVE DATE- The amendments made by subsections (a) and (b) shall apply to calendar quarters beginning on or after January 1, 1992, regardless of whether or not regulations to carry out such amendments have been promulgated by that date. SEC. 7. OUTREACH GRANTS FOR INFORMATION, COUNSELING, AND ASSISTANCE. (a) ESTABLISHMENT OF GRANT PROGRAM- (1) IN GENERAL- Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services (in this section referred to as the `Secretary') shall make grants to eligible entities to establish and operate an information, counseling, and assistance program meeting the requirements of subsection (b)(2) to enable individuals who are entitled to receive medical assistance for medicare cost-sharing under State plans for medical assistance under title XIX of the Social Security Act to receive such assistance. (2) DISTRIBUTION AMONG STATE AND PRIVATE RECIPIENTS- Of the grants made under this section, 50 percent shall be made to States and 50 percent shall be made to non-governmental entities. (3) AMOUNT OF GRANTS- The Secretary shall prescribe regulations to establish a minimum level of funding for a grant issued under this section. (b) ELIGIBILITY FOR GRANTS- (1) IN GENERAL- An entity is eligible to receive a grant under this section if-- (A) the entity submits to the Secretary, at such time and in such form as the Secretary may require, an application containing the information described in paragraph (2); and (B) in the case of a non-governmental entity, the entity provides the Secretary with information on its ability to operate benefits information, counseling, and assistance programs for individuals age 65 and older (including information on its prior experience in operating programs providing services to such individuals), together with such other information as the Secretary may require. (2) PROGRAM REQUIREMENTS- As part of an application for a grant under this section, an entity 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 individuals in need of information that may assist them in applying for medical assistance for medicare cost-sharing under a State plan for medical assistance under title XIX of the Social Security Act; (B) establish a system of referral to appropriate Federal or State departments or agencies for assistance with problems related to receiving such medical assistance; (C) provide for a sufficient number of staff positions (including volunteer positions) necessary to provide the services of the program; (D) provide for the collection and dissemination of timely and accurate information on eligibility and enrollment requirements for such medical assistance to staff members; (E) provide for training programs for staff members (including volunteer staff members); (F) provide for the coordination of the exchange of information on eligibility and enrollment requirements for such medical assistance between the staff of departments and agencies of the State government and the staff of the program; (G) make recommendations concerning consumer issues and complaints related to eligibility and enrollment procedures for such medical assistance to appropriate agencies and departments of the State government and the Federal Government; and (H) establish an outreach program to provide the information and counseling described in subparagraph (A) and the assistance described in subparagraph (B) to eligible individuals. (c) LOCATIONS FOR ADMINISTRATION OF PROGRAM- An entity receiving a grant under this section shall operate the information, counseling, and assistance program funded with such grant at locations which are other than those used for the receipt and processing of applications for aid under part A of title IV of the Social Security Act, including Area Agencies on Aging, meals on wheels programs, senior centers, and other locations determined appropriate by the Secretary in consultation with such agency or organization. (d) MAINTENANCE OF EFFORT- An entity receiving a grant under this section shall use funds provided under the grant to supplement, and not to supplant, any funds expended by the recipient under any other program providing services similar to those provided under the information, counseling, and assistance program funded with the grant. (e) ANNUAL REPORTS BY RECIPIENTS- Each entity receiving a grant under subsection (a) shall, not later than 180 days after receiving the grant and annually thereafter, issue a report to the Secretary that includes information concerning-- (1) the number of individuals served by the information, counseling, and assistance program funded with such grant; and (2) the problems that individuals encounter in applying for medical assistance for medicare cost-sharing under title XIX of the Social Security Act. (f) REPORT TO CONGRESS- Not later than 2 years after the date of the 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 individuals encounter in applying for medical assistance for medicare cost-sharing under title XIX of the Social Security Act; (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 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- 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 1992, 1993, and 1994, and $10,000,000 for each fiscal year beginning after fiscal year 1994, for grants under this section. SEC. 8. REPORT TO CONGRESS. Not later than 1 year after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit a report to Congress describing the steps taken by the Secretary to carry out this Act, together with any recommendations for additional legislation to ensure that individuals entitled to receive medical assistance for medicare cost-sharing under State plans for medical assistance under title XIX of the Social Security Act receive such assistance.
Introduced in House
Introduced in House
Referred to the House Committee on Energy and Commerce.
Referred to the House Committee on Ways and Means.
Referred to the Subcommittee on Health.
Referred to the Subcommittee on Health and the Environment.
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