,,ii #aadth ,,congress #b;d ,session ,s4 #cbcf ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,july #ad1 #bjaf,mr4 ,casey 7for himself and ,mr4 ,schumer7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to establish a system to educate individuals approaching ,medicare eligibility1 to simplify and modernize the eligibility enrollment process1 and to provide for additional assistance for complaints and requests of ,medicare beneficiaries that relate to their enrollment in the ,medicare program1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,beneficiary ,enrollment ,notification and ,eligibility ,simplification ,act of #bjaf or the ,,benes ,act of #bjaf4 #b4 ,eligibility and enrollment notification 7a7 ,notification ,requirements ,section #ahjd of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#b7 is amended by adding at the end the following new subsection3 7d7 ,eligibility ,information 7#a7 ,coordination of notice ,the ,secretary1 in consultation with representatives of each of the groups described in paragraph 7#b77;,a71 and in coordination with the ,commissioner of ,social ,security and the ,secretary of the ,treasury1 shall prepare and distribute a notice1 in accordance with this subsection1 to potentially eligible ,medicare individuals4 7#b7 ,groups for consultation 7,a7 ,in general ,for purposes of paragraph 7#a71 the groups described in this subparagraph include the following3 7i7 ,individuals who are more than #fj years of age4 7ii7 ,individuals with disabilities4 7iii7 ,individuals with end stage renal disease4 7iv7 ,low-income individuals and families4 7v7 ,employers 7including human resources professionals74 7vi7 ,states 7including representatives of ,state-run ,health ,insurance ,exchanges1 ,medicaid offices1 and ,departments of ,insurance74 7vii7 ,state ,health ,insurance ,assistance ,programs4 7viii7 ,health insurers4 7ix7 ,such other groups as specified by the ,secretary4 7,b7 ,non-application of ,,faca ,the ,federal ,advisory ,committee ,act shall not apply to consultations made pursuant to paragraph 7#a7 with groups described in subparagraph 7,a74 7#c7 ,contents of ,notice ,the notice required under paragraph 7#a7 shall contain information on 7including a clear1 simple explanation of7-- 7,a7 7i7 eligibility for benefits under this title1 and in particular benefits under part ,b2 7ii7 the possibility of a late enrollment penalty for failure to timely enroll 7including the availability of equitable relief72 and 7iii7 how to access the ,website described in paragraph 7#e72 and 7,b7 the need for coordination of benefits under part ,b 7including secondary and primary coverage scenarios7 imposed under this title1 including the effects of enrollment in retiree health coverage2 group health coverage2 coverage under a group health plan provided by an employer pursuant to title ,,xxii of the ,public ,health ,service ,act1 section #dihj;,b of the ,internal ,revenue ,code of #aihf1 or title ,,vi of the ,employee ,retirement ,income ,security ,act of #aigd2 coverage under a qualified health plan offered through an ,exchange established under title ,i of the ,patient ,protection and ,affordable ,care ,act2 and other widely available coverage which may be available to potentially eligible ,medicare individuals4 7#d7 ,timing of notice to potential enrollees ,beginning one year after the date of the enactment of this subsection1 a notice required under paragraph 7#a7 shall be mailed 7or1 starting after #bjbe1 mailed or otherwise delivered7 to each potentially eligible ,medicare individual no less than two times in accordance with the following3 7,a7 ,the notice shall be initially provided to such individual no later than #f months prior to the date of such individual's initial enrollment period as provided under section #ahcg4 7,b7 ,the notice shall subsequently be provided to such individual no later than one month prior to such date4 7#e7 ,creation of a centralized enrollment website ,the information contained in notices required under this subsection shall be made available through a new ,website to be maintained by the ,secretary4 ,such ,website shall include both ,social ,security and ,medicare online tools in a coordinated and organized manner1 and shall also contain1 or link to1 such other eligibility tools1 services1 notices 7including with respect to the availability of equitable relief71 and other information as determined by the ,secretary1 in consultation with groups described in paragraph 7#b7 for the purposes of being available to potentially eligible ,medicare individuals4 7#f7 ,interagency coordination ,beginning not later than #b months after the date of the enactment of this subsection1 the ,secretary1 along with the ,secretary of the ,treasury and the ,commissioner of the ,social ,security ,administration1 shall undertake all necessary action and coordination to identify potentially eligible individuals and in order to provide such individuals with notifications under this subsection in accordance with paragraph 7#d74 7#g7 ,notification improvement ,the ,secretary shall1 no less than once every fiscal year1 review the content of the notices required under this subsection and the practices of providing such notices to individuals1 and shall update and revise such notices and practices as the ,secretary deems appropriate4 7#h7 ,potentially eligible ,medicare individual defined ,for purposes of this subsection1 the term potentially eligible ,medicare individual means an individual1 with respect to a month1 who is expected to satisfy the description in paragraph 7#a7 or 7#b7 of section #ahcf during such month or during any of the subsequent #aa months4 4 7b7 ,disclosure authority ,section #fajc7l7 of the ,internal ,revenue ,code of #aihf is amended by adding at the end the following new paragraph3 7#bc7 ,disclosure of return information to carry out eligibility notification requirements for certain programs 7,a7 ,in general ,the ,secretary1 upon request from the ,secretary of ,health and ,human ,services1 shall disclose to officers1 employees1 and contractors of the ,department of ,health and ,human ,services and the ,social ,security ,administration return information of any taxpayer who is a potentially eligible ,medicare individual 7as defined in section #ahjd7;d77#h7 of the ,social ,security ,act74 ,such return information shall be limited to-- 7i7 taxpayer identity information with respect to such taxpayer1 including the age and address or other location of such taxpayer2 7ii7 the filing status of such taxpayer2 7iii7 such other information as is prescribed by the ,secretary of ,health and ,human ,services by regulation as might indicate whether the taxpayer is eligible for coverage under such title2 and 7iv7 the taxable year with respect to which the preceding information relates or1 if applicable1 the fact that such information is not available4 7,b7 ,restriction on use of disclosed information ,return information disclosed under subparagraph 7,a7 may be used by officers1 employees1 and contractors of the ,department of ,health and ,human ,services or the ,social ,security ,administration only for the purposes of1 and to the extent necessary in1 establishing potential eligibility for benefits under title ,,xviii of the ,social ,security ,act4 4 7c7 ,computer matching agreement ,not later than #f months after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 the ,secretary of the ,treasury1 and the ,commissioner of ,social ,security shall enter into a computer matching agreement pursuant to section #eeb;a7o7 of title #e of the ,united ,states ,code for the purposes of implementing section #ahjd7;d7 of the ,social ,security ,act1 as added by subsection 7a71 and section #fajc7l77#bc7 of the ,internal ,revenue ,code of #aihf1 as added by subsection 7b74 7d7 ,report to ,congress ,not later than #d years after the date of the enactment of this ,act1 the ,secretary of ,health and ,human ,services1 ,secretary of the ,treasury1 and the ,commissioner of ,social ,security shall submit to ,congress a report on the process taken by the relevant agencies in implementing the notice requirement under subsection 7d7 of section #ahjd of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#b71 as added by subsection 7a7 of this section1 the status of notices created pursuant to such section1 and an evaluation of the effect of such notices on enrollment under title ,,xviii of the ,social ,security ,act4 ,such report shall be made publicly available4 #c4 ,beneficiary ,medicare part ,b enrollment periods and effective date of coverage 7a7 ,effective dates ,section #ahch7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieq7a77 is amended-- 7#a7 by amending paragraph 7#b7 to read as follows3 7#b7 7,a7 in the case of an individual who enrolls pursuant to subsection 7d7 of section #ahcg before the month in which he first satisfies paragraph 7#a7 or 7#b7 of section #ahcf1 the first day of such month2 7,b7 in the case of an individual not described in subparagraph 7,a7 who first satisfies such paragraph in a month beginning before ,january #bjah and who enrolls-- 7i7 pursuant to such subsection 7d7 in such month in which he first satisfies such paragraph1 the first day of the month following the month in which he so enrolls1 or 7ii7 pursuant to such subsection 7d7 in the month following such month in which he first satisfies such paragraph1 the first day of the second month following the month in which he so enrolls1 or 7iii7 pursuant to such subsection 7d7 more than one month following such month in which he satisfies such paragraph1 the first day of the third month following the month in which he so enrolls2 7,c7 in the case of an individual not described in subparagraph 7,a7 who enrolls pursuant to subsection 7e7 of section #ahcg in a month beginning before ,january #bjah1 the ,july #a following the month in which he so enrolls2 7,d7 in the case of an individual not described in subparagraph 7,a7 who first satisfies such paragraph in a month beginning on or after ,january #a1 #bjah1 and who enrolls pursuant to such subsection 7d7 in such month in which he first satisfies such paragraph or in any subsequent month1 the first day of the month following the month in which he so enrolls2 or 7,e7 in the case of an individual not described in subparagraph 7,a7 who enrolls pursuant to subsection 7e7 of section #ahcg in a month beginning on or after ,october #ae1 #bjag1 the first day of the month following the month in which he so enrolls4 2 and 7#b7 by amending paragraph 7#c7 to read as follows3 7#c7 7,a7 in the case of an individual who is deemed to have enrolled on or before the last day of the third month of his initial enrollment period beginning before ,january #a1 #bjah1 the first day of the month in which he first meets the applicable requirements of section #ahcf or ,july #a1 #aigc1 whichever is later1 or 7,b7 in the case of an individual who is deemed to have enrolled on or after the first day of the fourth month of his initial enrollment period beginning before ,january #a1 #bjah1 as prescribed under subparagraphs 7,b77i71 7,b77ii71 7,b77iii71 and 7,c7 of paragraph 7#b7 of this subsection4 4 7b7 ,general and special enrollment periods ,section #ahcg7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciep7e77 is amended to read as follows3 7e7 ,enrollment ,periods 7#a7 ,for coverage during years before #bjah ,there shall be a general enrollment period during the period beginning on ,january #a and ending on ,march #ca of each year before #bjah4 7#b7 ,for coverage during years beginning with #bjah ,for #bjah and each subsequent year3 7,a7 ,in general ,subject to subparagraph 7,b71 there shall be a general enrollment period beginning on ,october #ae of the previous year through ,december #ca of such previous year4 7,b7 ,exceptional ,circumstances ,the ,secretary shall establish special enrollment periods in the case of a potentially eligible ,medicare individual 7as defined in section #ahjd7;d77#h77 who meet such exceptional conditions as the ,secretary may provide4 4 7c7 ,technical correction ,section #ahci7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7b77 is amended striking close of the enrollment period each place it appears and inserting close of the month4 #d4 ,revising beneficiary appeal rights for good faith enrollment mistakes 7a7 ,in general ,subsection 7h7 of section #ahcg of the ,social ,security ,act 7#db ,u4,s4,c4 #aciep7 is amended to read as follows3 7h7 7#a7 ,in any case in which the ,secretary finds that an individual's enrollment or nonenrollment in the insurance program established by this part or part ,a pursuant to section #ahah is unintentional1 inadvertent1 or erroneous1 whether the result of the error1 misrepresentation1 or inaction of an officer1 employee1 or agent of the ,federal ,government or its instrumentalities1 an employer1 a representative of a group health plan1 a ,state1 or for any other good faith reason on the part of such individual1 the ,secretary shall take such action 7including the designation for such individual of a special initial or subsequent enrollment period1 including retroactive enrollment1 with a coverage period determined on the basis thereof and with appropriate adjustments of premiums7 as may be necessary to correct or eliminate the effects of such error1 misrepresentation1 or inaction4 ,the failure of an individual to enroll in the insurance program established by this part or part ,a pursuant to section #ahah due to enrollment under a group health plan2 coverage pursuant to title ,,xxii of the ,public ,health ,service ,act1 section #dihj;,b of the ,internal ,revenue ,code of #aihf1 title ,,vi of the ,employee ,retirement ,income ,security ,act of #aigd1 or title ,,xix2 or enrollment under a qualified health plan offered through an ,exchange established under title ,i of the ,patient ,protection and ,affordable ,care ,act shall under this subsection absent exceptional circumstances1 as determined by the ,secretary4 7#b7 ,the ,secretary1 in consultation with the ,commissioner of ,social ,security1 shall develop and publish a formal application for requesting an action of the ,secretary under paragraph 7#a7 to correct or eliminate the effects of an error1 misrepresentation1 or inaction described in such paragraph and determine and publish specific timelines for timely resolution of such a request4 7#c7 ,the ,secretary shall also require that all such determinations with respect to such requests shall be reached within #ae business days of the submission of such application4 ,all determinations shall be in writing through a standard decision notice which shall include an explanation of the reasons for the determination4 7#d7 7,a7 ,the ,commissioner of ,social ,security shall enter into contracts with independent review organizations in accordance with this subsection for the purpose of reviewing and determining individual appeals of determinations under paragraph 7#c7 with respect to an application submitted pursuant to paragraph 7#b7 relating to enrollment under part ,a or part ,b4 7,b7 ,an individual who receives an adverse determination under paragraph 7#c7 with respect to an application submitted pursuant to paragraph 7#b7 may appeal to an independent review organization designated by the ,commission4 ,any such appeal must be sent to the independent review organization within #ij days of the date the individual received the determination to be eligible for review4 ,the independent review organization shall review and reach a determination of the review in writing within #de days of the receipt of any such appeal4 7,c7 ,the ,secretary of the ,treasury may not enter into a contract under subparagraph 7,a7 with an independent review organization-- 7i7 unless the organization has staff that has the appropriate knowledge of1 and experience with1 the eligibility and coordination of benefits rules and regulations under this title2 and 7ii7 to the extent the organization is a fiscal intermediary under section #ahaf1 a carrier under section #ahdb1 or a ,medicare administrative contractor under section #ahgd;,a4 7,d7 ,the ,secretary of ,health and ,human ,services shall provide for access by independent review organizations conducting appeal determinations under this subsection1 to the database of the ,coordination of ,benefits ,contractor of the ,centers for ,medicare ,medicaid ,services as necessary in order to conduct the duties of such organizations to determine appeals pursuant to this subsection4 4 7b7 ,effective date ,the amendment made by subsection 7a7 shall take effect beginning on the date that is #f months after the date of the enactment of this ,act4