,,ii #aadth ,,congress #b;d ,session ,s4 #ccga ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,september #ba1 #bjaf ,mr4 ,wyden 7for himself1 ,ms4 ,stabenow1 ,mr4 ,bennet1 ,mr4 ,nelson1 and ,mr4 ,brown7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend titles ,,ii1 ,,xviii1 and ,,xix of the ,social ,security ,act to improve the affordability and enrollment procedures of the ,medicare program1 and for other purposes4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,medicare ,affordability and ,enrollment ,act of #bjaf4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,protecting against high out-of-pocket expenditures for ,medicare fee-for-service benefits4 ,sec4 #c4 ,reducing cost-sharing1 aligning income and resource eligibility tests1 and simplifying enrollment for low-income beneficiaries4 ,sec4 #d4 ,reducing ,medicare cost-sharing for low-income beneficiaries4 ,sec4 #e4 ,eliminating the #bd-month waiting period for ,medicare coverage for individuals with disabilities4 ,sec4 #f4 ,improving ,medicare beneficiary enrollment procedures and effective dates of coverage4 ,sec4 #g4 ,eliminating exclusion of part ,d eligible individuals residing in territories from eligibility for premium and cost-sharing subsidies4 ,sec4 #h4 ,extending funding for low-income ,medicare beneficiary outreach and assistance education activities4 #b4 ,protecting against high out-of-pocket expenditures for ,medicare fee-for-service benefits ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is amended by adding at the end the following new section3 #ahii;,c4 ,protection against high out-of-pocket expenditures 7a7 ,in general ,notwithstanding any other provision of this title1 in the case of an individual entitled to1 or enrolled for1 benefits under part ,a or enrolled in part ,b1 if the amount of the out-of-pocket cost-sharing of such individual for a year 7beginning with #bjah7 equals or exceeds the annual out-of-pocket limit under subsection 7b7 for that year-- 7#a7 the amount otherwise payable under part ,a and the total amount of expenses incurred by the individual which would 7except for this section7 constitute incurred expenses for which benefits are payable under part ,b1 shall be #ajj percent of such amount for the remainder of that year2 and 7#b7 the individual shall not be responsible for out-of-pocket cost-sharing incurred during the remainder of that year4 7b7 ,annual out-of-,pocket limit 7#a7 ,in general ,the amount of the annual out-of-pocket limit under this subsection shall be-- 7,a7 for #bjah1 #e1ejj2 or 7,b7 for a subsequent year1 the amount specified in this subsection for the preceding year increased or decreased by the percentage change in the ,consumer ,price ,index for ,all ,urban ,consumers for the #ab-month period ending with ,june of such preceding year4 7#b7 ,rounding ,if any amount determined under paragraph 7#a77;,b7 is not a multiple of #e1 such amount shall be rounded to the nearest multiple of #e4 7c7 ,out-of-,pocket cost-,sharing defined 7#a7 ,in general ,subject to paragraphs 7#b7 and 7#c71 in this section1 the term out-of-pocket cost-sharing means1 with respect to an individual1 the amount of the expenses incurred by the individual that are attributable to-- 7,a7 deductibles1 coinsurance and copayments applicable under part ,a or ,b2 or 7,b7 for items and services that would have otherwise been covered under part ,a or ,b but for the exhaustion of those benefits4 7#b7 ,certain costs not included 7,a7 ,non-covered items and services ,expenses incurred for items and services which are not covered under part ,a or ,b shall not be considered incurred expenses for purposes of determining out-of-pocket cost-sharing under paragraph 7#a74 7,b7 ,items and services not furnished on an assignment-related basis ,if an item or service is furnished to an individual under this title and is not furnished on an assignment-related basis1 any additional expenses the individual incurs above the amount the individual would have incurred if the item or service was furnished on an assignment-related basis shall not be considered incurred expenses for purposes of determining out-of-pocket cost-sharing under paragraph 7#a74 7#c7 ,source of payment ,for purposes of paragraph 7#a71 the ,secretary shall consider expenses to be incurred by the individual without regard to whether the individual or another person1 including a ,state program1 an employer1 a medicare supplemental policy1 or other third-party coverage1 has paid for such expenses4 7d7 ,announcement of the annual out-of-,pocket limit ,the ,secretary shall 7beginning in #bjag7 announce 7in a manner intended to provide notice to all interested parties7 the annual out-of-pocket limit under this section that will be applicable for the succeeding year4 4 #c4 ,reducing cost-sharing1 aligning income and resource eligibility tests1 and simplifying enrollment for low-income beneficiaries 7a7 ,increase in income eligibility to #ace percent of ,,fpl for qualified ,medicare beneficiaries ,section #aije7p77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77#b77 is amended-- 7#a7 in subparagraph 7,a71 by striking #ajj percent and inserting #ace percent2 7#b7 in subparagraph 7,b7-- 7,a7 by striking and at the end of clause 7ii72 7,b7 by striking the period at the end of clause 7iii7 and inserting 1 and2 and 7,c7 by adding at the end the following3 7iv7 ,january #a1 #bjah1 is #ace percent4 2 and 7#c7 in subparagraph 7,c7-- 7,a7 by striking and at the end of clause 7iii72 7,b7 by striking the period at the end of clause 7iv7 and inserting 1 and2 and 7,c7 by adding at the end the following3 7v7 ,january #a1 #bjah1 is #ace percent4 4 7b7 ,increase in income eligibility to #aej percent of ,,fpl for specified low-,income ,medicare beneficiaries 7#a7 ,eligibility of individuals with incomes below #aej percent of ,,fpl ,section #aijb7;a77#aj77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7a77#aj77;,e77 is amended-- 7,a7 by adding and at the end of clause 7ii72 7,b7 in clause 7iii7-- 7i7 by striking and #abj percent in #aiie and years thereafter and inserting #abj percent in #aiie and years thereafter before #bjah1 and #aej percent in #bjah and years thereafter2 and 7ii7 by striking and at the end2 and 7,c7 by striking clause 7iv74 7#b7 ,references ,section #aije7p77#a7 of such ,act 7#db ,u4,s4,c4 #acif;d7p77#a77 is amended by adding at and below subparagraph 7,c7 the following flush sentence3 ,the term specified low-income medicare beneficiary means an individual described in section #aijb7;a77#aj77;,e77iii74 4 7#c7 ,conforming amendments 7,a7 ,the first sentence of section #aije7;b7 of such ,act 7#db ,u4,s4,c4 #acif;d7b77 is amended by striking and section #aicc7;d74 7,b7 ,section #aicc of such ,act 7#db ,u4,s4,c4 #acifu-#c7 is repealed4 7c7 #ajj percent ,,fmap ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended by adding at the end the following new subsection3 7ee7 ,increased ,,fmap for expanded medicare cost-,sharing populations 7#a7 ,in general ,notwithstanding subsection 7b71 with respect to expenditures described in paragraph 7#b7 the ,federal medical assistance percentage shall be equal to #ajj percent4 7#b7 ,expenditures described ,the expenditures described in this paragraph are expenditures made on or after ,january #a1 #bjah1 for medical assistance for medicare cost-sharing provided to any individual under clause 7i71 7ii71 or 7iii7 of section #aijb7;a77#aj77;,e7 who would not have been eligible for medicare cost-sharing under any such clause under the income or resource eligibility standards in effect on ,october #a1 #bjaf4 4 7d7 ,consolidation of low-,income subsidy resource eligibility tests 7#a7 ,in general ,section #ahfj;,d-#ad7;a77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c77 is amended-- 7,a7 by striking subparagraph 7,d72 7,b7 by redesignating subparagraphs 7,e7 through 7,g7 as subparagraphs 7,d7 through 7,f71 respectively2 and 7,c7 in the heading of subparagraph 7,d71 as so redesignated1 by striking ,alternative4 7#b7 ,clarification of certain rules relating to income and resource determinations ,section #ahfj;,d-#ad7;a77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c771 as amended by paragraph 7#a71 is amended by striking subparagraph 7,f7 and inserting the new following new subparagraphs3 7,f7 ,resource exclusions ,in determining the resources of an individual 7and the eligible spouse of the individual1 if any7 under section #afac for purposes of subparagraph 7,d7-- 7i7 no part of the value of any life insurance policy shall be taken into account2 7ii7 no part of the value of any vehicle shall be taken into account2 and 7iii7 there shall be excluded an amount equal to #a1ejj each with respect to any individual or eligible spouse of an individual who attests that some of the resources of such individual or spouse will be used to meet the burial and related expenses of such individual or spouse4 7,g7 ,family size ,in determining the size of the family of an individual for purposes of determining the income eligibility of such individual under this section1 an individual's family shall consist of-- 7i7 the individual2 7ii7 the individual's spouse who lives in the same household as the individual 7if any72 and 7iii7 any other individuals who-- 7,i7 are related to the individual whose income eligibility is in question or such individual's spouse who lives in the same household2 7,,ii7 are living in the same household as such individual2 and 7,,iii7 are dependent on such individual or such individual's spouse who is living in the same household for at least one-half of their financial support4 4 7#c7 ,conforming amendments ,section #ahfj;,d-#ad7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77 is amended-- 7,a7 in paragraph 7#a71 in the matter preceding subparagraph 7,a71 by inserting 7as determined under paragraph 7#c77;,g77 after family of the size involved2 and 7,b7 in paragraph 7#c71 as amended by paragraphs 7#a7 and 7#b7-- 7i7 in subparagraph 7,a71 in the matter preceding clause 7i71 by striking subparagraph 7,f7 and inserting subparagraph 7,e72 7ii7 in subparagraph 7,a77ii71 by inserting 7as determined under subparagraph 7,g77 after family of the size involved2 7iii7 in subparagraph 7,a77iii71 by striking or 7,e72 7iv7 in subparagraph 7,b77v71 in the matter preceding subclause 7,i71 by striking subparagraph 7,f7 and inserting subparagraph 7,e72 and 7v7 in subparagraph 7,d77i71 in the matter preceding subclause 7,i71 by striking subject to the life insurance policy exclusion provided under subparagraph 7,g7 and inserting subject to the resource exclusions provided under subparagraph 7,f74 7e7 ,alignment of low-,income subsidy and medicare savings program income and resource eligibility tests 7#a7 ,application of ,medicaid spousal impoverishment resource allowance to ,,msp and ,,lis resource eligibility 7,a7 ,in general ,section #aije7p77#a77;,c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77#a77;,c77 is amended to read as follows3 7,c7 whose resources 7as determined under section #afac for purposes of the supplemental security income program subject to the resource exclusions under subparagraph 7,f7 of section #ahfj;,d-#ad7;a77#c77 do not exceed-- 7i7 in the case of an individual with a spouse1 an amount equal to the sum of the first amount specified in subsection 7f77#b77;,a77i7 of section #aibd 7as adjusted under subsection 7g7 of such section7 and the amount specified in subsection 7f77#b77;,a77ii77,,ii7 of such section 7as so adjusted72 or 7ii7 in the case of an individual who does not have a spouse1 an amount equal to #a_/b of the amount described in clause 7i74 4 7,b7 ,application to ,q,d,w,is ,section #aije7s77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7s77#c77 is amended to read as follows3 7#c7 whose resources 7as determined under section #afac for purposes of the supplemental security income program subject to the resource exclusions under subparagraph 7,f7 of section #ahfj;,d-#ad7;a77#c77 do not exceed-- 7,a7 in the case of an individual with a spouse1 the amount in effect for the year under clause 7i7 of subsection 7p77#a77;,c72 and 7,b7 in the case of an individual who does not have a spouse1 the amount in effect for the year under clause 7ii7 of subsection 7p77#a77;,c72 and 4 7,c7 ,application to ,,lis ,clause 7i7 of section #ahfj;,d-#ad7;a77#c77;,d71 as redesignated and amended by subsection 7d77#a71 is amended to read as follows3 7i7 ,in general ,the resources requirement of this subparagraph is that an individual's resources 7as determined under section #afac for purposes of the supplemental security income program subject to the resource exclusions provided under subparagraph 7,f77 do not exceed the amount in effect for the year under section #aije7p77#a77;,c77ii74 4 7f7 ,enrollment simplifications 7#a7 ,application of #c-month retroactive eligibility to ,q,m,bs 7,a7 ,in general ,section #aijb7;e77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#h77 is amended by striking after the end of the month in which the determination first occurs and inserting in or after the third month before the month in which the individual makes application for assistance4 7,b7 ,conforming amendment ,section #aije7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended1 in the matter preceding paragraph 7#a71 by striking or1 in the case of medicare cost-sharing with respect to a qualified medicare beneficiary described in subsection 7p77#a71 if provided after the month in which the individual becomes such a beneficiary4 7#b7 ,state option for #ab-month continuous eligibility for ,s,l,m,bs and ,q,w,d,is ,section #aijb7;e77#ab7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#ab77 is amended-- 7,a7 by redesignating subparagraphs 7,a7 and 7,b7 as clauses 7i7 and 7ii71 respectively2 7,b7 by inserting 7,a7 after 7#ab72 and 7,c7 by adding at the end the following3 7,b7 ,at the option of the ,state1 the plan may provide that an individual who is determined to be eligible for benefits under a ,state plan approved under this title under any of the following eligibility categories1 or who is redetermined to be eligible for such benefits under any of such categories1 shall be considered to meet the eligibility requirements met on the date of application and shall remain eligible for those benefits until the end of the #ab-month period following the date of the determination or redetermination of eligibility1 except that a ,state may provide for such determinations more frequently1 but not more frequently than once every #f months for an individual3 7i7 ,a specified low-income medicare beneficiary described in subsection 7a77#aj77;,e77iii7 of this section who is determined eligible for medicare cost sharing described in section #aije7p77#c77;,a77ii74 7ii7 ,a qualified disabled and working individual described in section #aije7s7 who is determined eligible for medicare cost-sharing described in section #aije7p77#c77;,a77i74 4 7#c7 ,state option to use ,express ,lane eligibility for the ,medicare ,savings ,program ,section #aijb7;e77#ac77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#ac77;,a77 is amended by adding at the end the following new clause3 7iii7 ,state option to extend express lane eligibility to other populations 7,i7 ,in general ,at the option of the ,state1 the ,state may apply the provisions of this paragraph with respect to determining eligibility under this title for an eligible individual 7as defined in subclause 7,,ii774 ,in applying this paragraph in the case of a ,state making such an option1 any reference in this paragraph to a child with respect to this title 7other than a reference to child health assistance7 shall be deemed to be a reference to an eligible individual4 7,,ii7 ,eligible individual defined ,in this clause1 the term eligible individual means any of the following3 7aa7 ,a qualified medicare beneficiary described in section #aije7p77#a7 for purposes of determining eligibility for medicare cost-sharing 7as defined in section #aije7p77#c774 7bb7 ,a specified low-income medicare beneficiary described in subsection 7a77#aj77;,e77iii7 of this section for purposes of determining eligibility for medicare cost-sharing described in section #aije7p77#c77;,a77ii74 7cc7 ,a qualified disabled and working individual described in section #aije7s7 for purposes of determining eligibility for medicare cost-sharing described in section #aije7p77#c77;,a77i74 7dd7 ,during the period that begins on the date of enactment of this clause and ends on ,december #ca1 #bjag1 a qualifying individual described in subsection 7a77#aj77;,e77iv7 for purposes of determining eligibility for medicare cost-sharing described in section #aije7p77#c77;,a77ii74 4 7g7 ,effective date 7#a7 ,in general ,except as provided in paragraphs 7#b7 and 7#c71 the amendments and repeal made by this section take effect on ,january #a1 #bjah1 and1 with respect to title ,,xix of the ,social ,security ,act1 apply to calendar quarters beginning on or after ,january #a1 #bjah4 7#b7 ,express lane eligibility for ,,msp ,the amendments made by subsection 7f77#c7 take effect on the date of enactment of this ,act4 7#c7 ,exception for ,state legislation ,in the case of a ,state plan for medical assistance under title ,,xix of the ,social ,security ,act which the ,secretary of ,health and ,human ,services determines requires ,state legislation 7other than legislation appropriating funds7 in order for the plan to meet the additional requirements imposed by the amendments and repeal made by this section 7other than the amendments made by subsection 7f77#c771 the ,state plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the ,state legislature that begins after the date of the enactment of this ,act4 ,for purposes of the previous sentence1 in the case of a ,state that has a #b-year legislative session1 each year of such session shall be deemed to be a separate regular session of the ,state legislature4 #d4 ,reducing ,medicare cost-sharing for low-income beneficiaries 7a7 ,in general ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq471 as amended by section #b1 is amended by adding at the end the following new section3 #ahii;,d4 ,reduction in ,medicare cost-sharing for low-income beneficiaries 7a7 ,in general ,notwithstanding any other provision of this title1 in the case of items and services furnished on or after ,january #a1 #bjah1 to an applicable low-income individual1 the amount of any coinsurance or copayment otherwise applicable to the item or service under part ,a or ,b shall be reduced by #ej percent4 7b7 ,applicable low-,income individual defined 7#a7 ,in general ,in this section1 the term applicable low-income individual means an individual-- 7,a7 entitled to1 or enrolled for1 benefits under part ,a or enrolled in part ,b2 7,b7 who is determined to have income that is greater than #ace percent and less than or equal to #bjj percent of the poverty line applicable to a family of the size involved2 and 7,c7 whose resources 7as determined under section #afac for purposes of the supplemental security income program subject to the resource exclusions provided under section #ahfj;,d-#ad7;a77#c77;,f77 do not exceed the amount in effect for the year under section #aije7p77#a77;,c77ii74 7#b7 ,income determinations ,for purposes of applying this section-- 7,a7 income shall be determined in the manner described in section #aije7p77#a77;,b71 without regard to the application of section #aijb7r77#b72 and 7,b7 poverty line has the meaning given such term in section #fgc7b7 of the ,community ,services ,block ,grant ,act 7#db ,u4,s4,c4 #iijb7b771 including any revision required by such section4 ,nothing in subparagraph 7,a7 shall be construed to affect the application of section #aijb7r77#b7 for the determination of eligibility for medical assistance under title ,,xix4 7c7 ,establishment of procedures for identification of applicable low-,income individuals and notification of providers of services and suppliers 7#a7 ,in general ,the ,secretary1 in consultation with the ,commissioner of ,social ,security and the ,secretary of the ,treasury1 shall establish procedures for-- 7,a7 the determination of whether an individual is an applicable low-income individual2 and 7,b7 the notification of providers of services and suppliers in the case where an individual is an applicable low-income individual so that the reduction in any coinsurance or copayment under subsection 7a7 is applied at the time the item or service is provided to the applicable low-income individual4 7#b7 ,determinations 7,a7 in general ,the provisions of section #ahfj;,d-#ad7;a77#c77;,b77i7 shall apply to the determination of whether an individual is an applicable low-income individual under this section in the same manner as such provisions apply to the determination of whether a part ,d eligible is a subsidy eligible individual under section #ahfj;,d-#ad7;a77#c77;,b77i74 7,b7 ,effective period ,determinations under this subsection shall be effective for a period determined appropriate by the ,secretary4 7d7 ,no effect on payment to providers of services or suppliers ,notwithstanding any other provision of this title1 in the case of an item or service for which the reduction in coinsurance or copayment under subsection 7a7 applies1 the amount of payment otherwise applicable for the item or service under part ,a or ,b shall be increased by the amount of the reduction in coinsurance or copayment under such subsection4 4 7b7 ,disclosure ,section #fajc7l77#g77;,d77ii7 of the ,internal ,revenue ,code of #aihf is amended-- 7#a7 by striking or subsidies and inserting 1 subsidies2 and 7#b7 by inserting 1 or reduced cost-sharing provided under section #ahii;,d before the period at the end4 #e4 ,eliminating the #bd-month waiting period for ,medicare coverage for individuals with disabilities 7a7 ,in general ,section #bbf7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dbf7;b77 is amended-- 7#a7 in paragraph 7#b77;,a71 by striking 1 and has for #bd calendar months been entitled to12 7#b7 in paragraph 7#b77;,b71 by striking 1 and has been for not less than #bd months12 7#c7 in paragraph 7#b77;,c77ii71 by striking 1 including the requirement that he has been entitled to the specified benefits for #bd months12 7#d7 in the first sentence1 by striking for each month beginning with the later of 7,i7 ,july #aigc or 7,,ii7 the twenty-fifth month of his entitlement or status as a qualified railroad retirement beneficiary described in paragraph 7#b71 and and inserting for each month for which the individual meets the requirements of paragraph 7#b71 beginning with the month following the month in which the individual meets the requirements of such paragraph1 and2 and 7#e7 in the second sentence1 by striking the twenty-fifth month of his entitlement and all that follows through paragraph 7#b77;,c7 and4 7b7 ,conforming amendments 7#a7 ,section #bbf ,section #bbf of the ,social ,security ,act 7#db ,u4,s4,c4 #dbf7 is amended by-- 7,a7 striking subsections 7e77#a77;,b71 7f71 and 7h72 and 7,b7 redesignating subsections 7g7 and 7i7 as subsections 7f7 and 7g71 respectively4 7#b7 ,medicare description ,section #ahaa7b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c7#b77 is amended by striking have been entitled for not less than #bd months and inserting are entitled4 7#c7 ,medicare coverage ,section #ahcg7;g77#a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciep7g77#a77 is amended by striking #beth month of and inserting month following the first month of4 7#d7 ,railroad retirement system ,section #g7;d77#b77;ii7 of the ,railroad ,retirement ,act of #aigd 7#de ,u4,s4,c4 #bca;f7d77#b77;ii77 is amended-- 7,a7 by striking has been entitled to an annuity and inserting is entitled to an annuity2 7,b7 by striking 1 for not less than #bd months2 and 7,c7 by striking could have been entitled for #bd calendar months1 and4 7c7 ,effective date ,the amendments made by this section shall apply to insurance benefits under title ,,xviii of the ,social ,security ,act with respect to items and services furnished in months beginning after ,december #bjag4 #f4 ,improving ,medicare beneficiary enrollment procedures and effective dates of coverage 7a7 ,general enrollment period ,section #ahcg7;e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciep7e77 is amended to read as follows3 7e7 ,general and special enrollment periods 7#a7 ,general enrollment 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 ,subject to subparagraph 7,b71 there shall be a general enrollment period beginning on ,october #ae and ending on ,december #ca of #bjag and each subsequent year4 7#b7 ,special enrollment ,beginning ,january #a1 #bjah1 the ,secretary shall establish special enrollment periods in the case of an individual who meets such exceptional conditions as the ,secretary may provide4 4 7b7 ,effective dates of coverage 7#a7 ,in general ,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 month1 or 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 #a1 #bjah1 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 enrolls1 or 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-- 7i7 before ,april #a1 #bjag1 the ,july #a following the month in which he so enrolls1 or 7ii7 on or after ,october #a1 #bjag1 the first day of the month following the month in which he so enrolls1 or 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 month in the initial enrollment period1 the first day of the month following the month in which he so enrolls2 or 2 and 7,b7 in paragraph 7#c71 by striking subparagraphs 7,b71 7,c71 7,d71 and 7,e7 of paragraph 7#b7 of this subsection and inserting subparagraphs 7,b7 and 7,c7 of paragraph 7#b71 as applicable4 7#b7 ,technical correction ,section #ahci7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7b77 is amended1 in the second sentence1 by striking close of the enrollment period each place it appears and inserting close of the month4 7c7 ,application of the part ,a late enrollment penalty time limitation provision to the part ,b late enrollment penalty 7#a7 ,in general ,section #ahci7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7b77 is amended by adding at the end the following new sentence3 ,any percent increase in an individual's monthly premium under the first sentence shall only apply to premiums paid during a period equal to twice the number of months in the full #ab-month periods described in the first sentence44 7#b7 ,conforming amendment to the part ,a late enrollment penalty ,section #ahah7;c77#f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#b7;c77#f77 is amended by striking and shall only apply to premiums paid during a period equal to twice the number of months in the full #ab-month periods described in that section4 7#c7 ,effective date 7,a7 ,in general ,the amendments made by this section shall take effect on the date of the enactment of this ,act and shall apply to premiums for months beginning on or after ,january #a1 #bjah4 7,b7 ,counting of months ,in applying the amendment made by paragraph 7#a71 months 7occurring before1 during1 or after the month that includes the date of the enactment of this ,act7 in which an individual's monthly premium is increased under subsection 7b7 of section #ahci of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7 shall be taken into account in determining whether the limitation under the last sentence of such subsection 7b71 as added by paragraph 7#a71 is applicable4 7d7 ,application of part ,b deemed enrollment process to residents of ,puerto ,rico2 special enrollment period and limit on late enrollment penalties 7#a7 ,application of part ,b deemed enrollment process to residents of ,puerto ,rico ,section #ahcg7;f77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciep7f77#c77 is amended by striking 1 exclusive of ,puerto ,rico4 7#b7 ,effective date ,the amendment made by paragraph 7#a7 shall apply to individuals whose initial enrollment period under section #ahcg7;d7 of the ,social ,security ,act begins on or after the first day of the effective month1 specified by the ,secretary of ,health and ,human ,services under section #ahci7;j77#a77;,c7 of such ,act1 as added by subsection 7c77#b74 7#c7 ,transition providing special enrollment period and limit on late enrollment penalties for certain ,medicare beneficiaries ,section #ahci of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7 is amended-- 7,a7 in the first sentence of subsection 7b71 by inserting subject to section #ahci7;j77#b71 after subsection 7i77#d7 or 7l7 of section #ahcg12 and 7,b7 by adding at the end the following new subsection3 7j7 ,special rules for certain residents of ,puerto ,rico 7#a7 ,special enrollment period1 coverage period for residents who are eligible but not enrolled 7,a7 ,in general ,in the case of a transition individual 7as defined in paragraph 7#c77 who is not enrolled under this part as of the day before the first day of the effective month 7as defined in subparagraph 7,c771 the ,secretary shall provide for a special enrollment period under section #ahcg of #g months beginning with such effective month during which the individual may be enrolled under this part4 7,b7 ,coverage period ,in the case of such an individual who enrolls during such special enrollment period1 the coverage period under section #ahch shall begin on the first day of the second month after the month in which the individual enrolls4 7,c7 ,effective month defined ,in this section1 the term effective month means a month1 not earlier than ,october #bjag and not later than ,january #bjah1 specified by the ,secretary4 7#b7 ,reduction in late enrollment penalties for current enrollees and individuals enrolling during transition 7,a7 ,in general ,in the case of a transition individual who is enrolled under this part as of the day before the first day of the effective month or who enrolls under this part on or after the date of the enactment of this subsection but before the end of the special enrollment period under paragraph 7#a77;,a71 the amount of the late enrollment penalty imposed under section #ahci7;b7 shall be recalculated by reducing the penalty to #ae percent of the penalty otherwise established4 7,b7 ,application ,subparagraph 7,a7 shall be applied in the case of a transition individual who-- 7i7 is enrolled under this part as of the month before the effective month1 for premiums for months beginning with such effective month2 or 7ii7 enrolls under this part on or after the date of the enactment of this ,act and before the end of the special enrollment period under paragraph 7#a77;,a71 for premiums for months during the coverage period under this part which occur during or after the effective month4 7,c7 ,loss of reduction if individual terminates enrollment ,subparagraph 7,a7 shall not apply to a transition individual if the individual terminates enrollment under this part after the end of the special enrollment period under paragraph 7#a74 7#c7 ,transition individual defined ,in this section1 the term transition individual means an individual who resides in ,puerto ,rico and who would have been deemed enrolled under this part pursuant to section #ahcg7;f7 before the first day of the effective month but for the fact that the individual was a resident of ,puerto ,rico1 regardless of whether the individual is enrolled under this part as of such first day4 4 #g4 ,eliminating exclusion of part ,d eligible individuals residing in territories from eligibility for premium and cost-sharing subsidies 7a7 ,in general ,section #ahfj;,d-#ad7;a77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c771 as amended by section #c7;d71 is amended-- 7#a7 in subparagraph 7,a71 in the matter preceding clause 7i71 by striking subject to subparagraph 7,e712 7#b7 in subparagraph 7,b77v71 in the matter preceding subclause 7,i71 by striking ,subject to subparagraph 7,e71 the ,secretary and inserting ,the ,secretary2 7#c7 in subparagraph 7,c71 by adding at the end the following new sentence3 ,in the case of an individual who is not a resident of the #ej ,states or the ,district of ,columbia1 the poverty line 7as such term is defined in clause 7ii77 that shall apply to such individual shall be the poverty line for the #dh contiguous ,states and the ,district of ,columbia42 7#d7 by striking subparagraph 7,e71 as redesignated by section #c7;d77#a72 and 7#e7 by redesignating subparagraphs 7,f7 and 7,g71 as added by section #c7;d77#b71 as subparagraphs 7,e7 and 7,f71 respectively4 7b7 ,application of ,medicaid provisions ,section #aice of the ,social ,security ,act 7#db ,u4,s4,c4 #acifu-#e7 is amended-- 7#a7 in subsection 7a71 by striking subject to subsection 7e7 in the matter preceding paragraph 7#a72 and 7#b7 by striking subsection 7e74 7c7 ,conforming amendments 7#a7 ,section #aajh7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acjh7;f77 is amended by striking and section #aice7;e77#a77;,b7 in the matter preceding clause 7i74 7#b7 ,section #ahfj;,d-#ad7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a771 as amended by section #c7;d71 is amended-- 7,a7 in paragraph 7#a71 in the matter preceding subparagraph 7,a71 by striking subparagraph 7#c77;,g7 and inserting subparagraph 7#c77;,f72 and 7,b7 in paragraph 7#c7-- 7i7 in subparagraph 7,a77ii71 by striking subparagraph 7,g7 and inserting subparagraph 7,f72 and 7ii7 in subparagraph 7,d77i71 by striking subparagraph 7,f7 and inserting subparagraph 7,e74 7#c7 ,section #aije of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7 is amended-- 7,a7 in subsection 7p7-- 7i7 in paragraph 7#a77;,c71 by striking subparagraph 7,f7 and inserting subparagraph 7,e72 and 7ii7 in clause 7iii7 of paragraph 7#b77;,d71 as added by section #c7;e77#b77;,a77ii71 by striking section #ahfj;,d-#ad7;a77#c77;,g7 and inserting section #ahfj;,d-#ad7;a77#c77;,f72 and 7,b7 in subsection 7s7-- 7i7 in paragraph 7#b71 by striking section #ahfj;,d-#ad7;a77#c77;,g7 and inserting section #ahfj;,d-#ad7;a77#c77;,f72 and 7ii7 in paragraph 7#c71 by striking subparagraph 7,f7 and inserting subparagraph 7,e74 7d7 ,effective date ,the amendments made by this section shall take effect on ,january #a1 #bjag4 #h4 ,extending funding for low-income ,medicare beneficiary outreach and assistance education activities 7a7 ,additional funding for state health insurance programs ,section #aai of the ,medicare ,improvements for ,patients and ,providers ,act of #bjjh 7#db ,u4,s4,c4 #acie;b-#c note71 as amended by section #ccjf of the ,patient ,protection and ,affordable ,care ,act 7,public ,law #aaa-adh71 section #faj of the ,american ,taxpayer ,relief ,act of #bjab 7,public ,law #aab-bdj71 section #aaaj of the ,pathway for ,,sgr ,reform ,act of #bjac 7,public ,law #aac-fg71 section #aaj of the ,protecting ,access to ,medicare ,act of #bjad 7,public ,law #aac-ic71 and section #bjh of the ,medicare ,access and ,,chip ,reauthorization ,act of #bjae 7,public ,law #aad-aj7 is amended-- 7#a7 in subsection 7a77#a77;,b7-- 7,a7 in clause 7vi71 by striking and at the end2 7,b7 in clause 7vii71 by striking the period at the end and inserting 2 and2 and 7,c7 by inserting after clause 7vii7 at the end the following new clause3 7viii7 for fiscal year #bjah and each subsequent year1 of the amount transferred under this subparagraph for the preceding fiscal year1 increased by the percentage increase determined under subsection 7h7 for the fiscal year4 2 and 7#b7 by adding at the end the following new subsection3 7h7 ,for purposes of subsections 7a77#a77;,b77viii71 7b77#a77;,b77viii71 7c77#a77;,b77viii71 and 7d77#b77viii71 the percentage increase determined under this subsection for a fiscal year is equal to the sum of the-- 7#a7 the percentage increase in the consumer price index for all urban consumers 7all items2 ,united ,states city average7 for the #ab-month period ending with ,july preceding the beginning of the fiscal year2 and 7#b7 the percentage increase in the average number of individuals enrolled in part ,b of title ,,xviii of the ,social ,security ,act1 from the preceding fiscal year to such fiscal year1 as estimated by the ,chief ,actuary of the ,centers for ,medicare ,medicaid ,services4 4 7b7 ,additional funding for area agencies on aging ,subsection 7b77#a77;,b7 of such section #aai1 as so amended1 is amended-- 7#a7 in clause 7vi71 by striking and at the end2 7#b7 in clause 7vii71 by striking the period at the end and inserting 2 and2 and 7#c7 by inserting after clause 7vii7 the following new clause3 7viii7 for fiscal year #bjah and each subsequent year1 of the amount transferred under this subparagraph for the preceding fiscal year1 increased by the percentage increase determined under subsection 7h7 for the fiscal year4 4 7c7 ,additional funding for aging and disability resource centers ,subsection 7c77#a77;,b7 of such section #aai1 as so amended1 is amended-- 7#a7 in clause 7vi71 by striking and at the end2 7#b7 in clause 7vii71 by striking the period at the end and inserting 2 and2 and 7#c7 by inserting after clause 7vii7 the following new clauses3 7viii7 for fiscal year #bjah and each subsequent year1 of the amount transferred under this subparagraph for the preceding fiscal year1 increased by the percentage increase determined under subsection 7h7 for the fiscal year4 4 7d7 ,additional funding for contract with the national center for benefits and outreach enrollment ,subsection 7d77#b7 of such section #aai1 as so amended1 is amended-- 7#a7 in clause 7vi71 by striking and at the end2 7#b7 in clause 7vii71 by striking the period at the end and inserting 2 and2 7#c7 by inserting after clause 7vii7 the following new clause3 7viii7 for fiscal year #bjah and each subsequent year1 of the amount transferred under this paragraph for the preceding fiscal year1 increased by the percentage increase determined under subsection 7h7 for the fiscal year4 2 and 7#d7 in the flush sentence at the end1 by striking subparagraph and inserting paragraph4