,,ii #aad? ,,congress #b;d ,session ,s4 #cbcf ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,july #ad1 #bjaf,mr4 ,casey 7= himself & ,mr4 ,s*um]7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to e/abli% a sy/em to educate individuals approa*+ ,m$ic>e eligibility1 to simplify & mod]nize ! eligibility enrollm5t process1 & to provide = additional assi/ance = compla9ts & reque/s ( ,m$ic>e b5efici>ies t relate to _! enrollm5t 9 ! ,m$ic>e program1 & = o!r purposes4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,b5efici>y ,enrollm5t ,notification & ,eligibility ,simplification ,act ( #bjaf or ! ,,b5es ,act ( #bjaf4 #b4 ,eligibility & enrollm5t notification 7a7 ,notification ,requirem5ts ,section #ahjd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#b7 is am5d$ by add+ at ! end ! foll[+ new subsection3 7d7 ,eligibility ,in=mation 7#a7 ,coord9ation ( notice ,! ,secret>y1 9 consultation ) repres5tatives ( ea* ( ! gr\ps describ$ 9 p>agraph 7#b77;,a71 & 9 coord9ation ) ! ,commission] ( ,social ,security & ! ,secret>y ( ! ,treasury1 %all prep>e & di/ribute a notice1 9 accordance ) ?is subsection1 to pot5tially eligible ,m$ic>e individuals4 7#b7 ,gr\ps = consultation 7,a7 ,9 g5]al ,= purposes ( p>agraph 7#a71 ! gr\ps describ$ 9 ?is subp>agraph include ! foll[+3 7i7 ,individuals :o are m ?an #fj ye>s ( age4 7ii7 ,individuals ) disabilities4 7iii7 ,individuals ) end /age r5al disease4 7iv7 ,l[-income individuals & families4 7v7 ,employ]s 7includ+ human res\rces pr(essionals74 7vi7 ,/ates 7includ+ repres5tatives ( ,/ate-run ,heal? ,insurance ,ex*anges1 ,m$icaid (fices1 & ,dep>tm5ts ( ,insurance74 7vii7 ,/ate ,heal? ,insurance ,assi/ance ,programs4 7viii7 ,heal? insur]s4 7ix7 ,su* o!r gr\ps z specifi$ by ! ,secret>y4 7,b7 ,non-application ( ,,faca ,! ,f$]al ,advisory ,committee ,act %all n apply to consultations made pursuant to p>agraph 7#a7 ) gr\ps describ$ 9 subp>agraph 7,a74 7#c7 ,cont5ts ( ,notice ,! notice requir$ "u p>agraph 7#a7 %all conta9 in=mation on 7includ+ a cle>1 simple explanation (7-- 7,a7 7i7 eligibility = b5efits "u ?is title1 & 9 p>ticul> b5efits "u "p ,b2 7ii7 ! possibility ( a late enrollm5t p5alty = failure to timely enroll 7includ+ ! availability ( equitable relief72 & 7iii7 h[ to access ! ,website describ$ 9 p>agraph 7#e72 & 7,b7 ! ne$ = coord9ation ( b5efits "u "p ,b 7includ+ second>y & prim>y cov]age sc5>ios7 impos$ "u ?is title1 includ+ ! effects ( enrollm5t 9 retiree heal? cov]age2 gr\p heal? cov]age2 cov]age "u a gr\p heal? plan provid$ by an employ] pursuant to title ,,xxii ( ! ,public ,heal? ,s]vice ,act1 section #dihj;,b ( ! ,int]nal ,rev5ue ,code ( #aihf1 or title ,,vi ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd2 cov]age "u a qualifi$ heal? plan (f]$ ?r\gh an ,ex*ange e/abli%$ "u title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act2 & o!r widely available cov]age :i* may be available to pot5tially eligible ,m$ic>e individuals4 7#d7 ,tim+ ( notice to pot5tial enrollees ,beg9n+ "o ye> aft] ! date ( ! enactm5t ( ?is subsection1 a notice requir$ "u p>agraph 7#a7 %all be mail$ 7or1 />t+ aft] #bjbe1 mail$ or o!rwise deliv]$7 to ea* pot5tially eligible ,m$ic>e individual no less ?an two times 9 accordance ) ! foll[+3 7,a7 ,! notice %all be initially provid$ to su* individual no lat] ?an #f mon?s prior to ! date ( su* individual's initial enrollm5t p]iod z provid$ "u section #ahcg4 7,b7 ,! notice %all subsequ5tly be provid$ to su* individual no lat] ?an "o mon? prior to su* date4 7#e7 ,creation ( a c5traliz$ enrollm5t website ,! in=mation conta9$ 9 notices requir$ "u ?is subsection %all be made available ?r\gh a new ,website to be ma9ta9$ by ! ,secret>y4 ,su* ,website %all include bo? ,social ,security & ,m$ic>e onl9e tools 9 a coord9at$ & organiz$ mann]1 & %all also conta91 or l9k to1 su* o!r eligibility tools1 s]vices1 notices 7includ+ ) respect to ! availability ( equitable relief71 & o!r in=mation z det]m9$ by ! ,secret>y1 9 consultation ) gr\ps describ$ 9 p>agraph 7#b7 = ! purposes ( be+ available to pot5tially eligible ,m$ic>e individuals4 7#f7 ,int]ag5cy coord9ation ,beg9n+ n lat] ?an #b mon?s aft] ! date ( ! enactm5t ( ?is subsection1 ! ,secret>y1 along ) ! ,secret>y ( ! ,treasury & ! ,commission] ( ! ,social ,security ,adm9i/ration1 %all und]take all necess>y action & coord9ation to id5tify pot5tially eligible individuals & 9 ord] to provide su* individuals ) notifications "u ?is subsection 9 accordance ) p>agraph 7#d74 7#g7 ,notification improvem5t ,! ,secret>y %all1 no less ?an once e fiscal ye>1 review ! cont5t ( ! notices requir$ "u ?is subsection & ! practices ( provid+ su* notices to individuals1 & %all update & revise su* notices & practices z ! ,secret>y deems appropriate4 7#h7 ,pot5tially eligible ,m$ic>e individual def9$ ,= purposes ( ?is subsection1 ! t]m pot5tially eligible ,m$ic>e individual means an individual1 ) respect to a mon?1 :o is expect$ to satisfy ! description 9 p>agraph 7#a7 or 7#b7 ( section #ahcf dur+ su* mon? or dur+ any ( ! subsequ5t #aa mon?s4 4 7b7 ,disclosure au?ority ,section #fajc7l7 ( ! ,int]nal ,rev5ue ,code ( #aihf is am5d$ by add+ at ! end ! foll[+ new p>agraph3 7#bc7 ,disclosure ( return in=mation to c>ry out eligibility notification requirem5ts = c]ta9 programs 7,a7 ,9 g5]al ,! ,secret>y1 ^u reque/ f ! ,secret>y ( ,heal? & ,human ,s]vices1 %all disclose to (fic]s1 employees1 & contractors ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices & ! ,social ,security ,adm9i/ration return in=mation ( any taxpay] :o is a pot5tially eligible ,m$ic>e individual 7z def9$ 9 section #ahjd7;d77#h7 ( ! ,social ,security ,act74 ,su* return in=mation %all be limit$ to-- 7i7 taxpay] id5tity in=mation ) respect to su* taxpay]1 includ+ ! age & address or o!r location ( su* taxpay]2 7ii7 ! fil+ /atus ( su* taxpay]2 7iii7 su* o!r in=mation z is prescrib$ by ! ,secret>y ( ,heal? & ,human ,s]vices by regulation z might indicate :e!r ! taxpay] is eligible = cov]age "u su* title2 & 7iv7 ! taxable ye> ) respect to :i* ! prec$+ in=mation relates or1 if applicable1 ! fact t su* in=mation is n available4 7,b7 ,re/riction on use ( disclos$ in=mation ,return in=mation disclos$ "u subp>agraph 7,a7 may be us$ by (fic]s1 employees1 & contractors ( ! ,dep>tm5t ( ,heal? & ,human ,s]vices or ! ,social ,security ,adm9i/ration only = ! purposes (1 & to ! ext5t necess>y 91 e/abli%+ pot5tial eligibility = b5efits "u title ,,xviii ( ! ,social ,security ,act4 4 7c7 ,comput] mat*+ agreem5t ,n lat] ?an #f mon?s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices1 ! ,secret>y ( ! ,treasury1 & ! ,commission] ( ,social ,security %all ent] into a comput] mat*+ agreem5t pursuant to section #eeb;a7o7 ( title #e ( ! ,unit$ ,/ates ,code = ! purposes ( implem5t+ section #ahjd7;d7 ( ! ,social ,security ,act1 z add$ by subsection 7a71 & section #fajc7l77#bc7 ( ! ,int]nal ,rev5ue ,code ( #aihf1 z add$ by subsection 7b74 7d7 ,report to ,congress ,n lat] ?an #d ye>s aft] ! date ( ! enactm5t ( ?is ,act1 ! ,secret>y ( ,heal? & ,human ,s]vices1 ,secret>y ( ! ,treasury1 & ! ,commission] ( ,social ,security %all submit to ,congress a report on ! process tak5 by ! relevant ag5cies 9 implem5t+ ! notice requirem5t "u subsection 7d7 ( section #ahjd ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#b71 z add$ by subsection 7a7 ( ?is section1 ! /atus ( notices creat$ pursuant to su* section1 & an evaluation ( ! effect ( su* notices on enrollm5t "u title ,,xviii ( ! ,social ,security ,act4 ,su* report %all be made publicly available4 #c4 ,b5efici>y ,m$ic>e "p ,b enrollm5t p]iods & effective date ( cov]age 7a7 ,effective dates ,section #ahch7;a7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acieq7a77 is am5d$-- 7#a7 by am5d+ p>agraph 7#b7 to read z foll[s3 7#b7 7,a7 9 ! case ( an individual :o enrolls pursuant to subsection 7d7 ( section #ahcg be=e ! mon? 9 :i* he fir/ satisfies p>agraph 7#a7 or 7#b7 ( section #ahcf1 ! fir/ day ( su* mon?2 7,b7 9 ! case ( an individual n describ$ 9 subp>agraph 7,a7 :o fir/ satisfies su* p>agraph 9 a mon? beg9n+ be=e ,janu>y #bjah & :o enrolls-- 7i7 pursuant to su* subsection 7d7 9 su* mon? 9 :i* he fir/ satisfies su* p>agraph1 ! fir/ day ( ! mon? foll[+ ! mon? 9 :i* he s enrolls1 or 7ii7 pursuant to su* subsection 7d7 9 ! mon? foll[+ su* mon? 9 :i* he fir/ satisfies su* p>agraph1 ! fir/ day ( ! second mon? foll[+ ! mon? 9 :i* he s enrolls1 or 7iii7 pursuant to su* subsection 7d7 m ?an "o mon? foll[+ su* mon? 9 :i* he satisfies su* p>agraph1 ! fir/ day ( ! ?ird mon? foll[+ ! mon? 9 :i* he s enrolls2 7,c7 9 ! case ( an individual n describ$ 9 subp>agraph 7,a7 :o enrolls pursuant to subsection 7e7 ( section #ahcg 9 a mon? beg9n+ be=e ,janu>y #bjah1 ! ,july #a foll[+ ! mon? 9 :i* he s enrolls2 7,d7 9 ! case ( an individual n describ$ 9 subp>agraph 7,a7 :o fir/ satisfies su* p>agraph 9 a mon? beg9n+ on or aft] ,janu>y #a1 #bjah1 & :o enrolls pursuant to su* subsection 7d7 9 su* mon? 9 :i* he fir/ satisfies su* p>agraph or 9 any subsequ5t mon?1 ! fir/ day ( ! mon? foll[+ ! mon? 9 :i* he s enrolls2 or 7,e7 9 ! case ( an individual n describ$ 9 subp>agraph 7,a7 :o enrolls pursuant to subsection 7e7 ( section #ahcg 9 a mon? beg9n+ on or aft] ,octob] #ae1 #bjag1 ! fir/ day ( ! mon? foll[+ ! mon? 9 :i* he s enrolls4 2 & 7#b7 by am5d+ p>agraph 7#c7 to read z foll[s3 7#c7 7,a7 9 ! case ( an individual :o is deem$ to h enroll$ on or be=e ! la/ day ( ! ?ird mon? ( 8 initial enrollm5t p]iod beg9n+ be=e ,janu>y #a1 #bjah1 ! fir/ day ( ! mon? 9 :i* he fir/ meets ! applicable requirem5ts ( section #ahcf or ,july #a1 #aigc1 :i*ev] is lat]1 or 7,b7 9 ! case ( an individual :o is deem$ to h enroll$ on or aft] ! fir/ day ( ! f\r? mon? ( 8 initial enrollm5t p]iod beg9n+ be=e ,janu>y #a1 #bjah1 z prescrib$ "u subp>agraphs 7,b77i71 7,b77ii71 7,b77iii71 & 7,c7 ( p>agraph 7#b7 ( ?is subsection4 4 7b7 ,g5]al & special enrollm5t p]iods ,section #ahcg7;e7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciep7e77 is am5d$ to read z foll[s3 7e7 ,enrollm5t ,p]iods 7#a7 ,= cov]age dur+ ye>s be=e #bjah ,!re %all be a g5]al enrollm5t p]iod dur+ ! p]iod beg9n+ on ,janu>y #a & end+ on ,m>* #ca ( ea* ye> be=e #bjah4 7#b7 ,= cov]age dur+ ye>s beg9n+ ) #bjah ,= #bjah & ea* subsequ5t ye>3 7,a7 ,9 g5]al ,subject to subp>agraph 7,b71 !re %all be a g5]al enrollm5t p]iod beg9n+ on ,octob] #ae ( ! previ\s ye> ?r\gh ,decemb] #ca ( su* previ\s ye>4 7,b7 ,exceptional ,circum/ances ,! ,secret>y %all e/abli% special enrollm5t p]iods 9 ! case ( a pot5tially eligible ,m$ic>e individual 7z def9$ 9 section #ahjd7;d77#h77 :o meet su* exceptional conditions z ! ,secret>y may provide4 4 7c7 ,te*nical correction ,section #ahci7;b7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #acier7b77 is am5d$ /rik+ close ( ! enrollm5t p]iod ea* place x appe>s & ins]t+ close ( ! mon?4 #d4 ,revis+ b5efici>y appeal rights = good fai? enrollm5t mi/akes 7a7 ,9 g5]al ,subsection 7h7 ( section #ahcg ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciep7 is am5d$ to read z foll[s3 7h7 7#a7 ,9 any case 9 :i* ! ,secret>y f9ds t an individual's enrollm5t or non5rollm5t 9 ! insurance program e/abli%$ by ?is "p or "p ,a pursuant to section #ahah is un9t5tional1 inadv]t5t1 or errone\s1 :e!r ! result ( ! error1 misrepres5tation1 or inaction ( an (fic]1 employee1 or ag5t ( ! ,f$]al ,gov]nm5t or its in/rum5talities1 an employ]1 a repres5tative ( a gr\p heal? plan1 a ,/ate1 or = any o!r good fai? reason on ! "p ( su* individual1 ! ,secret>y %all take su* action 7includ+ ! designation = su* individual ( a special initial or subsequ5t enrollm5t p]iod1 includ+ retroactive enrollm5t1 ) a cov]age p]iod det]m9$ on ! basis !re( & ) appropriate adju/m5ts ( premiums7 z may be necess>y to correct or elim9ate ! effects ( su* error1 misrepres5tation1 or inaction4 ,! failure ( an individual to enroll 9 ! insurance program e/abli%$ by ?is "p or "p ,a pursuant to section #ahah due to enrollm5t "u a gr\p heal? plan2 cov]age pursuant to title ,,xxii ( ! ,public ,heal? ,s]vice ,act1 section #dihj;,b ( ! ,int]nal ,rev5ue ,code ( #aihf1 title ,,vi ( ! ,employee ,retirem5t ,income ,security ,act ( #aigd1 or title ,,xix2 or enrollm5t "u a qualifi$ heal? plan (f]$ ?r\gh an ,ex*ange e/abli%$ "u title ,i ( ! ,pati5t ,protection & ,af=dable ,c>e ,act %all "u ?is subsection abs5t exceptional circum/ances1 z det]m9$ by ! ,secret>y4 7#b7 ,! ,secret>y1 9 consultation ) ! ,commission] ( ,social ,security1 %all develop & publi% a =mal application = reque/+ an action ( ! ,secret>y "u p>agraph 7#a7 to correct or elim9ate ! effects ( an error1 misrepres5tation1 or inaction describ$ 9 su* p>agraph & det]m9e & publi% specific timel9es = timely resolution ( su* a reque/4 7#c7 ,! ,secret>y %all also require t all su* det]m9ations ) respect to su* reque/s %all be rea*$ )9 #ae bus9ess days ( ! submission ( su* application4 ,all det]m9ations %all be 9 writ+ ?r\gh a /&>d decision notice :i* %all include an explanation ( ! reasons = ! det]m9ation4 7#d7 7,a7 ,! ,commission] ( ,social ,security %all ent] into contracts ) indep5d5t review organizations 9 accordance ) ?is subsection = ! purpose ( review+ & det]m9+ individual appeals ( det]m9ations "u p>agraph 7#c7 ) respect to an application submitt$ pursuant to p>agraph 7#b7 relat+ to enrollm5t "u "p ,a or "p ,b4 7,b7 ,an individual :o receives an adv]se det]m9ation "u p>agraph 7#c7 ) respect to an application submitt$ pursuant to p>agraph 7#b7 may appeal to an indep5d5t review organization designat$ by ! ,commission4 ,any su* appeal mu/ be s5t to ! indep5d5t review organization )9 #ij days ( ! date ! individual receiv$ ! det]m9ation to be eligible = review4 ,! indep5d5t review organization %all review & rea* a det]m9ation ( ! review 9 writ+ )9 #de days ( ! receipt ( any su* appeal4 7,c7 ,! ,secret>y ( ! ,treasury may n ent] into a contract "u subp>agraph 7,a7 ) an indep5d5t review organization-- 7i7 unless ! organization has /aff t has ! appropriate k (1 & exp]i5ce )1 ! eligibility & coord9ation ( b5efits rules & regulations "u ?is title2 & 7ii7 to ! ext5t ! organization is a fiscal int]m$i>y "u section #ahaf1 a c>ri] "u section #ahdb1 or a ,m$ic>e adm9i/rative contractor "u section #ahgd;,a4 7,d7 ,! ,secret>y ( ,heal? & ,human ,s]vices %all provide = access by indep5d5t review organizations conduct+ appeal det]m9ations "u ?is subsection1 to ! database ( ! ,coord9ation ( ,b5efits ,contractor ( ! ,c5t]s = ,m$ic>e ,m$icaid ,s]vices z necess>y 9 ord] to conduct ! duties ( su* organizations to det]m9e appeals pursuant to ?is subsection4 4 7b7 ,effective date ,! am5dm5t made by subsection 7a7 %all take effect beg9n+ on ! date t is #f mon?s aft] ! date ( ! enactm5t ( ?is ,act4