#aafth ,,congress #b;d ,session ,h4 ,r4 #bdgg ,,an ,,act ,to amend title ,,xviii of the ,social ,security ,act to establish a system to notify individuals approaching ,medicare eligibility1 to simplify and modernize the eligibility enrollment process1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,beneficiary ,enrollment ,notification and ,eligibility ,simplification ,act of #bjbj or the ,,benes ,act of #bjbj4 #b4 ,beneficiary enrollment notification and eligibility simplification 7a7 ,eligibility and enrollment notices 7#a7 ,as part of social security account statement for individuals attaining ages #fc to #fe 7,a7 ,in general ,section #aadc7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#ac7;a77 is amended by adding at the end the following new paragraph3 7#d7 ,medicare eligibility information 7,a7 ,in general ,in the case of statements provided on or after the date that is #b years after the date of the enactment of this paragraph to individuals who are attaining ages #fc1 #fd1 and #fe1 the statement shall also include a notice containing the information described in subparagraph 7,b74 7,b7 ,contents of ,notice ,the notice required under subparagraph 7,a7 shall include a clear1 simple explanation of-- 7i7 eligibility for benefits under the ,medicare program under title ,,xviii1 and in particular benefits under parts ,b and ,c of such title2 7ii7 the reasons a late enrollment penalty for failure to timely enroll could be assessed and how such late enrollment penalty is calculated1 in particular for benefits under such part ,b2 7iii7 the availability of relief from such late enrollment penalty and retroactive enrollment under section #ahcg7;h7 7including as such section is applied under sections #ahah7;c7 and #ahah;,a7c77#c771 with examples of circumstances under which such relief may be granted and examples of circumstances under which such relief would not be granted2 7iv7 coordination of benefits 7including primary and secondary coverage scenarios7 pursuant to section #ahfb7;b71 in particular for benefits under such part ,b2 7v7 enrollment1 eligibility1 and coordination of benefits under title ,,xviii with respect to populations1 for whom there are special considerations1 such as residents of ,puerto ,rico and veterans2 and 7vi7 online resources and toll-free telephone numbers of the ,social ,security ,administration and the ,centers for ,medicare ,medicaid ,services 7including #a-hjj-,,medicare and the national toll-free number of the ,social ,security ,administration7 that provide information on eligibility for benefits under the ,medicare program under title ,,xviii1 including under part ,c of such title4 7,c7 ,development of notice 7i7 ,in general ,the ,secretary1 in coordination with the ,commissioner of ,social ,security1 and taking into consideration information collected pursuant to clause 7ii71 shall1 not later than #ab months after the last day of the period for the request of information described in clause 7ii71 develop the notice to be provided pursuant to subparagraph 7,a74 7ii7 ,request for information ,not later than #f months after the date of the enactment of this paragraph1 the ,secretary shall request written information1 including recommendations1 from stakeholders 7including the groups described in subparagraph 7,d77 on the information to be included in the notice4 7iii7 ,notice improvement ,beginning #d years after the date of the enactment of this paragraph1 and not less than once every #b years thereafter1 the ,secretary1 in coordination with the ,commissioner of ,social ,security1 shall-- 7,i7 review the content of the notice to be provided under subparagraph 7,a72 7,,ii7 request written information1 including recommendations1 on such notice through a request for information process as described in clause 7ii72 and 7,,iii7 update and revise such notice as the ,secretary deems appropriate4 7,d7 ,groups ,for purposes of subparagraph 7,c77ii71 the groups described in this subparagraph include the following3 7i7 ,individuals who are #fj years of age or older4 7ii7 ,veterans4 7iii7 ,individuals with disabilities4 7iv7 ,individuals with end stage renal disease4 7v7 ,low-income individuals and families4 7vi7 ,employers 7including human resources professionals74 7vii7 ,states 7including representatives of ,state-run ,health ,insurance ,exchanges1 ,medicaid offices1 and ,departments of ,insurance74 7viii7 ,state ,health ,insurance ,assistance ,programs4 7ix7 ,health insurers4 7x7 ,health insurance agents and brokers4 7xi7 ,such other groups as specified by the ,secretary4 7,e7 ,posting of notice on websites ,the ,commissioner of ,social ,security and the ,secretary shall post the notice required under subparagraph 7,a7 on the public ,internet website of the ,social ,security ,administration and on ,medicare4gov 7or a successor website71 respectively4 7,f7 ,reimbursement of costs 7i7 ,in general ,effective for fiscal years beginning in the year in which the date of enactment of this paragraph occurs1 the ,commissioner of ,social ,security and the ,secretary shall enter into an agreement under which the ,secretary shall provide for the transfer1 from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda 7in such proportion as the ,secretary determines appropriate71 of such sums as necessary to cover the administrative costs of the ,commissioner's activities under this paragraph4 ,such agreement shall-- 7,i7 provide funds to the ,commissioner for the administrative costs of the ,social ,security ,administration's work related to the implementation of this paragraph1 including any initial costs incurred prior to the finalization of such agreement2 7,,ii7 provide such funding quarterly in advance of the applicable quarter based on estimating methodology agreed to by the ,commissioner and the ,secretary2 and 7,,iii7 require an annual accounting 7with a detailed description of the costs and methodology used to assess such costs7 and reconciliation of the actual costs incurred and funds provided under this paragraph4 7ii7 ,limitation ,in no case shall funds from the ,social ,security ,administration's ,limitation on ,administrative ,expenses be used to carry out activities related to the implementation of this paragraph1 except as the ,commissioner determines is necessary-- 7,i7 for the development of the agreement under clause 7i72 and 7,,ii7 on a temporary basis and subject to reimbursement under clause 7i77,i71 for the initial implementation of this paragraph4 7,g7 ,no effect on obligation to mail statements ,nothing in this paragraph shall be construed to relieve the ,commissioner of ,social ,security from any requirement under subsection 7c71 including the requirement to mail a statement on an annual basis to each eligible individual who is not receiving benefits under title ,,ii and for whom a mailing address can be determined through such methods as the ,commissioner determines to be appropriate4 4 7,b7 ,timing of statements ,section #aadc7;c77#b7 of such ,act 7#db ,u4,s4,c4 #acbj;b-#ac7;c77#b77 is amended by adding at the end the following3 ,with respect to statements provided to individuals who are attaining age #fe1 as described in subsection 7a77#d71 such statements shall be mailed not earlier than #f months and not later than #c months before the individual attains such age4 7#b7 ,social ,security beneficiaries ,title ,,xi of the ,social ,security ,act 7#db ,u4,s4,c4 #acja et seq47 is amended by inserting after section #aadd the following new section3 #aadd;,a4 ,medicare ,enrollment ,notification and ,eligibility ,notices for ,social ,security ,beneficiaries ,prior to ,medicare ,eligibility 7a7 ,notices 7#a7 ,in general ,the ,commissioner of ,social ,security shall distribute the notice to be provided pursuant to section #aadc7;a77#d71 as may be modified under paragraph 7#b71 to individuals entitled to monthly insurance benefits under title ,,ii in accordance with subsection 7b74 7#b7 ,authority to modify notice ,the ,secretary1 in coordination with the ,commissioner of ,social ,security1 may modify the notice to be distributed under paragraph 7#a7 as necessary to take into account the individuals described in such paragraph4 7#c7 ,posting of notice on websites ,the ,commissioner of ,social ,security and the ,secretary shall post the notice required to be distributed under paragraph 7#a7 on the public ,internet website of the ,social ,security ,administration and on ,medicare4gov 7or a successor website71 respectively4 7b7 ,timing ,beginning not later than #b years after the date of the enactment of this section1 a notice required under subsection 7a77#a7 shall be mailed to an individual described in such subsection-- 7#a7 in the third month before the date on which such individual's initial enrollment period begins as provided under section #ahcg2 and 7#b7 in the case of an individual with respect to whom section #bbf7;b7 applies 7except for an individual who will attain age #fe during the #bd month period described in such section71 in the month before such date on which such individual's initial enrollment period so begins4 7c7 ,reimbursement of costs 7#a7 ,in general ,effective for fiscal years beginning in the year in which the date of enactment of this section occurs1 the ,commissioner of ,social ,security and the ,secretary shall enter into an agreement under which the ,secretary shall provide for the transfer1 from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda 7in such proportion as the ,secretary determines appropriate71 of such sums as necessary to cover the administrative costs of the ,commissioner's activities under this section4 ,such agreement shall-- 7,a7 provide funds to the ,commissioner for the administrative costs of the ,social ,security ,administration's work related to the implementation of this section1 including any initial costs incurred prior to the finalization of such agreement2 7,b7 provide such funding quarterly in advance of the applicable quarter based on estimating methodology agreed to by the ,commissioner and the ,secretary2 and 7,c7 require an annual accounting 7with a detailed description of the costs and methodology used to assess such costs7 and reconciliation of the actual costs incurred and funds provided under this paragraph4 7#b7 ,limitation ,in no case shall funds from the ,social ,security ,administration's ,limitation on ,administrative ,expenses be used to carry out activities related to the implementation of this section1 except as the ,commissioner determines is necessary-- 7,a7 for the development of the agreement under paragraph 7#a72 and 7,b7 on a temporary basis and subject to reimbursement under paragraph 7#a77;,a71 for the initial implementation of this section4 4 7b7 ,beneficiary enrollment simplification 7#a7 ,effective date of coverage ,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 #ahcf7;a71 the first day of such month1 7,b7 in the case of an individual who first satisfies such paragraph in a month beginning before ,january #bjbc and who enrolls pursuant to such subsection 7d7-- 7i7 in such month in which he first satisfies such paragraph1 the first day of the month following the month in which he so enrolls1 7ii7 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 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 7,c7 in the case of an individual who first satisfies such paragraph in a month beginning on or after ,january #a1 #bjbc1 and who enrolls pursuant to such subsection 7d7 in such month in which he first satisfies such paragraph or in any subsequent month of his initial enrollment period1 the first day of the month following the month in which he so enrolls1 or 7,d7 in the case of an individual who enrolls pursuant to subsection 7e7 of section #ahcg in a month beginning-- 7i7 before ,january #a1 #bjbc1 the ,july #a following the month in which he so enrolls2 or 7ii7 on or after ,january #a1 #bjbc1 the first day of the month following the month in which he so enrolls2 or 2 and 7,b7 by amending paragraph 7#c7 to read as follows3 7#c7 in the case of an individual who is deemed to have enrolled-- 7,a7 on or before the last day of the third month of his initial enrollment period1 the first day of the month in which he first meets the applicable requirements of section #ahcf7;a7 or ,july #a1 #aigc1 whichever is later1 or 7,b7 on or after the first day of the fourth month of his initial enrollment period1 and where such month begins-- 7i7 before ,january #a1 #bjbc1 as prescribed under subparagraphs 7,b77i71 7,b77ii71 7,b77iii71 and 7,d77i7 of paragraph 7#b71 or 7ii7 on or after ,january #a1 #bjbc1 as prescribed under subparagraphs 7,c7 and 7,d77ii7 of paragraph 7#b74 4 7#b7 ,special enrollment periods for exceptional circumstances 7,a7 ,enrollment ,section #ahcg of the ,social ,security ,act 7#db ,u4,s4,c4 #aciep7 is amended by adding at the end the following new subsection3 7m7 ,beginning ,january #a1 #bjbc1 the ,secretary may establish special enrollment periods in the case of individuals who satisfy paragraph 7#a7 or 7#b7 of section #ahcf7;a7 and meet such exceptional conditions as the ,secretary may provide4 4 7,b7 ,coverage period ,section #ahch of the ,social ,security ,act 7#db ,u4,s4,c4 #acieq7 is amended by adding at the end the following new subsection3 7g7 ,notwithstanding subsection 7a71 in the case of an individual who enrolls during a special enrollment period pursuant to section #ahcg7m71 the coverage period shall begin on a date the ,secretary provides in a manner consistent 7to the extent practicable7 with protecting continuity of health benefit coverage4 4 7,c7 ,conforming amendment ,title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie et seq47 is amended-- 7i7 in section #ahah;,a7c77#c71 by striking subsections 7h7 and 7i7 of section #ahcg and inserting subsections 7h71 7i71 and 7m7 of section #ahcg2 and 7ii7 in section #ahci7;b71 in the first sentence1 by striking or 7l7 and inserting 1 7l71 or 7m74 7#c7 ,technical correction ,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 ,for purposes of determining any increase under this subsection for individuals whose enrollment occurs on or after ,january #a1 #bjbc1 the second sentence of this subsection shall be applied by substituting close of the month for close of the enrollment period each place it appears44 7#d7 ,report ,not later than ,january #a1 #bjbc1 the ,secretary of ,health and ,human ,services shall submit to the ,committee on ,ways and ,means and ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,finance and ,special ,committee on ,aging of the ,senate a report on how to align existing ,medicare enrollment periods under title ,,xviii of the ,social ,security ,act1 including the general enrollment period under part ,b of such title and the annual1 coordinated election period under the ,medicare ,advantage program under part ,c of such title and under the prescription drug program under part ,d of such title4 ,such report shall include recommendations consistent with the goals of maximizing coverage continuity and choice and easing beneficiary transition4 7#e7 ,,gao study and report 7,a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this section referred to as the ,comptroller ,general7 shall conduct a study on the activities carried out under this section4 ,such study shall include the following3 7i7 ,an analysis of the ,social ,security ,administration's use of the funds provided to carry out the activities described under this section and the amendments made by this section4 ,the ,comptroller ,general shall examine the amount of funds transferred from the ,federal ,hospital ,insurance ,trust ,fund and the ,federal ,supplementary ,medical ,insurance ,trust ,fund1 respectively1 for those activities2 how the funds were spent2 what procedures the agency had in place over the use of those funds2 and how the agency complied with those procedures4 7ii7 ,an evaluation of the notices described in sections #aadc7;a77#d77;,a7 and #aadd;,a7a7 of the ,social ,security ,act1 including1 to the extent data is available1 how the mailing of such notices affected enrollee behavior and the imposition of late enrollment penalties under ,medicare ,part ,b4 7iii7 ,any other area determined appropriate by the ,comptroller ,general4 7,b7 ,report ,not later than #e years after the date of enactment of this section1 the ,comptroller ,general shall submit to the ,committee on ,ways and ,means and ,committee on ,energy and ,commerce of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report containing the results of the study conducted under paragraph 7#a71 including recommendations for any legislative and administrative actions as the ,comptroller ,general determines appropriate4 7c7 ,funding ,section #ahjh of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;b-#i7 is amended by adding the end the following new subsection3 7e7 ,funding for implementation of beneficiary enrollment notification and eligibility simplification ,for purposes of carrying out the provisions of and the amendments made by section #b of the ,,benes ,act of #bjbj1 the ,secretary shall provide for the transfer1 from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda 7in such proportion as the ,secretary determines appropriate71 to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account1 of #b1jjj1jjj for each fiscal year beginning with fiscal year #bjba1 to remain available until expended4 4 #c4 ,extended months of coverage of immunosuppressive drugs for kidney transplant patients and other renal dialysis provisions 7a7 ,medicare entitlement to immunosuppressive drugs for kidney transplant recipients 7#a7 ,in general ,section #bbf;,a7b77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #dbf-a7;b77#b77 is amended by inserting 7except for eligibility for enrollment under part ,b solely for purposes of coverage of immunosuppressive drugs described in section #ahfa7s77#b77;,j77 before 1 with the thirty-sixth month4 7#b7 ,individuals eligible only for coverage of immunosuppressive drugs 7,a7 ,in general ,section #ahcf of the ,social ,security ,act 7#db ,u4,s4,c4 #acieo7 is amended-- 7i7 by striking ,every and inserting 7a7 ,in general4--,every2 and 7ii7 by adding at the end the following new subsection3 7b7 ,individuals eligible for immunosuppressive drug coverage 7#a7 ,in general ,except as provided under paragraph 7#b71 every individual whose entitlement to insurance benefits under part ,a ends 7whether before1 on1 or after ,january #a1 #bjbc7 by reason of section #bbf;,a7b77#b7 is eligible to enroll or to be deemed to have enrolled in the medical insurance program established by this part solely for purposes of coverage of immunosuppressive drugs in accordance with section #ahcg7n74 7#b7 ,exception if other coverage is available 7,a7 ,in general ,an individual described in paragraph 7#a7 shall not be eligible for enrollment in the program for purposes of coverage described in such paragraph with respect to any period in which the individual1 as determined in accordance with subparagraph 7,b7-- 7i7 is enrolled in a group health plan or group or individual health insurance coverage1 as such terms are defined in section #bgia of the ,public ,health ,service ,act2 7ii7 is enrolled for coverage under the ,,tricare for ,life program under section #ajhf7;d7 of title #aj1 ,united ,states ,code2 7iii7 is enrolled under a ,state plan 7or waiver of such plan7 under title ,,xix and is eligible to receive benefits for immunosuppressive drugs described in this subsection under such plan 7or such waiver72 7iv7 is enrolled under a ,state child health plan 7or waiver of such plan7 under title ,,xxi and is eligible to receive benefits for such drugs under such plan 7or such waiver72 or 7v7 7,i7 is enrolled in the patient enrollment system of the ,department of ,veterans ,affairs established and operated under section #agje of title #ch1 ,united ,states ,code2 7,,ii7 is not required to enroll under section #agje of such title to receive immunosuppressive drugs described in this subsection2 or 7,,iii7 is otherwise eligible under a provision of title #ch1 ,united ,states ,code1 other than section #agaj of such title to receive immunosuppressive drugs described in this subsection4 7,b7 ,eligibility determinations 7i7 ,in general ,the ,secretary1 in coordination with the ,commissioner of ,social ,security1 shall establish a process for determining whether an individual described in paragraph 7#a7 who is to be enrolled or deemed to be enrolled in the medical insurance program described in such paragraph meets the requirements for such enrollment under this subsection1 including the requirement that the individual not be enrolled in other coverage as described in subparagraph 7,a74 7ii7 ,attestation regarding other coverage ,the process established under clause 7i7 shall include1 at a minimum1 a requirement that-- 7,i7 the individual provide to the ,commissioner an attestation that the individual is not enrolled and does not expect to enroll in such other coverage2 and 7,,ii7 the individual notify the ,commissioner within #fj days of enrollment in such other coverage4 4 7,b7 ,conforming amendment 7i7 ,in general ,sections #ahcg1 #ahch1 and #ahci of the ,social ,security ,act 7#db ,u4,s4,c4 #aciep1 #db ,u4,s4,c4 #acieq1 #db ,u4,s4,c4 #acier7 are each amended by striking #ahcf and inserting #ahcf7;a7 each place it appears4 7ii7 ,additional amendment ,section #ahcg7;j77#a7 of such ,act 7#db ,u4,s4,c4 #aciep7j77#a77 is amended by striking #ahcf7a7 and inserting #ahcf7;a77#a74 7b7 ,enrollment for individuals only eligible for coverage of immunosuppressive drugs ,section #ahcg of the ,social ,security ,act 7#db ,u4,s4,c4 #aciep71 as amended by section #b7;b77#b77;,a71 is further amended by adding at the end the following new subsection3 7n7 7#a7 ,any individual who is eligible for coverage of immunosuppressive drugs under section #ahcf7;b7 may enroll or be deemed to have enrolled only in such manner and form as may be prescribed by regulations1 and only during an enrollment period described in this subsection4 7#b7 ,an individual described in paragraph 7#a7 whose entitlement for hospital insurance benefits under part ,a ends by reason of section #bbf;,a7b77#b7 prior to ,january #a1 #bjbc1 may enroll beginning on ,october #a1 #bjbb1 or the day on which the individual first satisfies section #ahcf7;b71 whichever is later4 7#c7 ,an individual described in paragraph 7#a7 whose entitlement for hospital insurance benefits under part ,a ends by reason of section #bbf;,a7b77#b7 on or after ,january #a1 #bjbc1 shall be deemed to have enrolled in the medical insurance program established by this part for purposes of coverage of immunosuppressive drugs4 7#d7 ,the ,secretary shall establish a process under which an individual described in paragraph 7#a7 whose other coverage described in section #ahcf7;b77#b77;,a71 or coverage under this part 7including the medical insurance program established under this part for purposes of coverage of immunosuppressive drugs71 is terminated voluntarily or involuntary may enroll or reenroll1 if applicable1 in the medical insurance program established under this part for purposes of coverage of immunosuppressive drugs4 4 7c7 ,coverage period for individuals only eligible for coverage of immunosuppressive drugs 7#a7 ,in general ,section #ahch of the ,social ,security ,act 7#db ,u4,s4,c4 #acieq71 as amended by section #b7;b77#b77;,b71 is further amended by adding at the end the following new subsection3 7h7 ,in the case of an individual described in section #ahcf7;b77#a71 the following rules shall apply3 7#a7 ,in the case of such an individual who is deemed to have enrolled in part ,b for coverage of immunosuppressive drugs under section #ahcg7n77#c71 such individual's coverage period shall begin on the first day of the month in which the individual first satisfies section #ahcf7;b74 7#b7 ,in the case of such an individual who enrolls 7or reenrolls1 if applicable7 in part ,b for coverage of immunosuppressive drugs under paragraph 7#b7 or 7#d7 of section #ahcg7n71 such individual's coverage period shall begin on ,january #a1 #bjbc1 or the month following the month in which the individual so enrolls 7or reenrolls71 whichever is later4 7#c7 ,the provisions of subsections 7b7 and 7d7 shall apply with respect to an individual described in paragraph 7#a7 or 7#b74 7#d7 ,in addition to the reasons for termination under subsection 7b71 the coverage period of an individual described in paragraph 7#a7 or 7#b7 shall end when the individual becomes entitled to benefits under this title under subsection 7a7 or 7b7 of section #bbf1 or under section #bbf;,a1 or is no longer eligible for such coverage as a result of the application of section #ahcf7;b77#b74 7#e7 ,the ,secretary may conduct public education activities to raise awareness of the availability of more comprehensive1 individual health insurance coverage 7as defined in section #bgia of the ,public ,health ,service ,act7 for individuals eligible under section #ahcf7;b7 to enroll or to be deemed enrolled in the medical insurance program established under this part for purposes of coverage of immunosuppressive drugs4 4 7#b7 ,conforming amendments ,section #ahch7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acieq7b77 is amended1 in the matter following paragraph 7#b71 by inserting or section #ahcg7n77#c7 after section #ahcg7;f7 each place it appears4 7d7 ,premiums for individuals only eligible for coverage of immunosuppressive drugs 7#a7 ,in general ,section #ahci of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7 is amended-- 7,a7 in subsection 7b71 by adding at the end the following new sentence3 ,no increase in the premium shall be effected for individuals who are enrolled pursuant to section #ahcf7;b7 for coverage only of immunosuppressive drugs42 and 7,b7 by adding at the end the following new subsection3 7j7 ,determination of premium for individuals only eligible for coverage of immunosuppressive drugs ,the ,secretary shall1 during ,september of each year 7beginning with #bjbb71 determine and promulgate a monthly premium rate for the succeeding calendar year for individuals enrolled only for the purpose of coverage of immunosuppressive drugs under section #ahcf7;b74 ,such premium shall be equal to #ae percent of the monthly actuarial rate for enrollees age #fe and over 7as would be determined in accordance with subsection 7a77#a7 if the reference to one-half in such subsection were a reference to #ajj percent7 for that succeeding calendar year4 ,the monthly premium of each individual enrolled for coverage of immunosuppressive drugs under section #ahcf7;b7 for each month shall be the amount promulgated in this subsection4 ,in the case of such individual not otherwise enrolled under this part1 such premium shall be in lieu of any other monthly premium applicable under this section4 ,such amount shall be adjusted in accordance with subsections 7c71 7f71 and 7i71 but shall not be adjusted under subsection 7b74 4 7#b7 ,special rule for application of hold harmless provisions to transitioning individuals ,section #ahci7;f7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7f77 is amended by adding at the end the following new sentence3 ,any increase in the premium for an individual who was enrolled under section #ahcf7;b7 attributable to such individual otherwise enrolling under this part shall not be taken into account in applying this subsection44 7#c7 ,special rule for application of premium subsidy reduction provisions ,section #ahci7;i77#c77;,a77ii77,,ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7i77#c77;,a77ii77,,ii77 is amended by inserting except in the case of an individual enrolled under section #ahcf7;b7 and not otherwise enrolled under this part1 before #d times4 7e7 ,government contribution ,section #ahdd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew7a77 is amended-- 7#a7 in paragraph 7#c71 by striking the period at the end and inserting 2 plus2 7#b7 by inserting after paragraph 7#c7 the following new paragraph3 7#d7 a ,government contribution equal to the estimated aggregate reduction in premiums payable under part ,b that results from establishing the premium at #ae percent of the actuarial rate 7as would be determined in accordance with section #ahci7;a77#a7 if the reference to one-half in such section were a reference to #ajj percent7 under section #ahci7;j7 instead of #be percent of such rate 7as so determined7 for individuals enrolled only for the purpose of coverage of immunosuppressive drugs under section #ahcf7;b74 2 and 7#c7 by adding the following sentence at the end of the flush matter following paragraph 7#d71 as added by paragraph 7#b7 of this subsection3 ,the ,government contribution under paragraph 7#d7 shall be treated as premiums payable and deposited for purposes of subparagraphs 7,a7 and 7,b7 of paragraph 7#a74 4 7f7 ,ensuring coverage under the ,medicare savings program 7#a7 ,in general ,section #aije7p77#a77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77#a77;,a77 is amended by inserting or who is enrolled under part ,b for the purpose of coverage of immunosuppressive drugs under section #ahcf7;b7 after under section #ahah;,a74 7#b7 ,conforming amendments ,section #aijb7;a77#aj77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,e77 is amended in each of clauses 7iii7 and 7iv7 by inserting 7including such individuals enrolled under section #ahcf7;b77 after section #aije7p77#a74 7g7 ,part ,d ,section #ahfj;,d-#a7;a77#c77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aja7;a77#c77;,a77 is amended by inserting 7but not including an individual enrolled solely for coverage of immunosuppressive drugs under section #ahcf7;b77 before the period at the end4 7h7 ,,gao study and report 7#a7 ,study ,the ,comptroller ,general of the ,united ,states 7in this subsection referred to as the ,comptroller ,general7 shall conduct a study on the implementation of coverage of immunosuppressive drugs for kidney transplant patients under the ,medicare program pursuant to the provisions of1 and amendments made by1 this section4 7#b7 ,report ,not later than ,january #a1 #bjbe1 the ,comptroller ,general shall submit to ,congress a report on the study conducted under paragraph 7#a71 together with recommendations as the ,comptroller ,general determines appropriate4 #d4 ,transparency of medicare secondary payer reporting information 7a7 ,in general ,section #ahfb7;b77#h77;,g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #ciey7b77#h77;,g77 is amended-- 7#a7 by striking information4--,the ,secretary and inserting information4-- 7i7 ,in general ,the ,secretary 2 and 7#b7 by adding at the end the following new clause3 7ii7 ,specified information ,in responding to any query from an applicable plan related to a determination described in subparagraph 7,a77i71 the ,secretary1 notwithstanding any other provision of law1 shall provide to such applicable plan-- 7,i7 whether a claimant subject to the query is1 or during the preceding #c-year period has been1 entitled to benefits under the program under this title on any basis2 and 7,,ii7 to the extent applicable1 the plan name and address of any ,medicare ,advantage plan under part ,c and any prescription drug plan under part ,d in which the claimant is enrolled or has been enrolled during such period4 4 7b7 ,effective date ,the amendments made by subsection 7a7 shall apply with respect to queries from plans made on or after the date that is one year after the date of the enactment of this ,act4 #e4 ,establishing hospice program survey and enforcement procedures under the ,medicare program 7a7 ,survey and enforcement procedures 7#a7 ,in general ,part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq47 is amended by adding at the end the following new section3 #ahbb4 ,hospice program survey and enforcement procedures 7a7 ,surveys 7#a7 ,frequency ,any entity that is certified as a hospice program shall be subject to a standard survey by an appropriate ,state or local survey agency1 or an approved accreditation agency1 as determined by the ,secretary1 not less frequently than once every #cf months 7and not less frequently than once every #bd months beginning ,october #a1 #bjba74 7#b7 ,public transparency of survey and certification information 7,a7 ,submission of information to the ,secretary 7i7 ,in general ,each ,state1 and each national accreditation body with respect to which the ,secretary has made a finding under section #ahfe7;a7 respecting the accreditation of a hospice program by such body1 shall submit1 in a form and manner1 and at a time1 specified by the ,secretary for purposes of this subparagraph1 information respecting any survey or certification made with respect to a hospice program by such ,state or body1 as applicable4 ,such information shall include any inspection report made by such ,state or body with respect to such survey or certification1 any enforcement actions taken as a result of such survey or certification1 and any other information determined appropriate by the ,secretary4 7ii7 ,required inclusion of specified form ,with respect to a survey under this subsection carried out by a national accreditation body described in clause 7i7 on or after ,october #a1 #bjba1 information described in such clause shall include ,form #befg 7or a successor form71 along with such additional information determined appropriate by such body4 7,b7 ,public disclosure of information ,beginning not later than ,october #a1 #bjbb1 the ,secretary shall publish the information submitted under subparagraph 7,a7 on the public website of the ,centers for ,medicare ,medicaid ,services in a manner that is prominent1 easily accessible1 readily understandable1 and searchable4 ,the ,secretary shall provide for the timely update of such information so published4 7#c7 ,consistency of surveys ,each ,state and the ,secretary shall implement programs to measure and reduce inconsistency in the application of survey results among surveyors4 7#d7 ,survey teams 7,a7 ,in general ,in the case of a survey conducted under this subsection on or after ,october #a1 #bjba1 by more than #a individual1 such survey shall be conducted by a multidisciplinary team of professionals 7including a registered professional nurse74 7,b7 ,prohibition of conflicts of interest ,beginning ,october #a1 #bjba1 a ,state may not use as a member of a survey team under this subsection an individual who is serving 7or has served within the previous #b years7 as a member of the staff of1 or as a consultant to1 the program surveyed respecting compliance with the requirements of section #ahfa7;dd7 or who has a personal or familial financial interest in the program being surveyed4 7,c7 ,training ,the ,secretary shall provide1 not later than ,october #a1 #bjba1 for the comprehensive training of ,state and ,federal surveyors1 and any surveyor employed by a national accreditation body described in paragraph 7#b77;,a77i71 in the conduct of surveys under this subsection1 including training with respect to the review of written plans for providing hospice care 7as described in section #ahad7;a77#g77;,b774 ,no individual shall serve as a member of a survey team with respect to a survey conducted on or after such date unless the individual has successfully completed a training and testing program in survey and certification techniques that has been approved by the ,secretary4 7#e7 ,funding ,the ,secretary shall provide for the transfer1 from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account1 of #aj1jjj1jjj for each fiscal year 7beginning with fiscal year #bjbb7 for purposes of carrying out this subsection and subsection 7b74 ,sums so transferred shall remain available until expended4 ,any transfer pursuant to this paragraph shall be in addition to any transfer pursuant to section #c7;a77#b7 of the ,improving ,medicare ,post-,acute ,care ,transformation ,act of #bjad4 7b7 ,special focus program 7#a7 ,in general ,the ,secretary shall conduct a special focus program for enforcement of requirements for hospice programs that the ,secretary has identified as having substantially failed to meet applicable requirements of this ,act4 7#b7 ,periodic surveys ,under such special focus program1 the ,secretary shall conduct surveys of each hospice program in the special focus program not less than once every #f months4 7c7 ,enforcement 7#a7 ,situations involving immediate jeopardy ,if the ,secretary determines on the basis of a standard survey or otherwise that a hospice program that is certified for participation under this title is no longer in compliance with the requirements specified in section #ahfa7;dd7 and determines that the deficiencies involved immediately jeopardize the health and safety of the individuals to whom the program furnishes items and services1 the ,secretary shall take immediate action to remove the jeopardy and correct the deficiencies through the remedy described in paragraph 7#e77;,b77iii7 or terminate the certification of the program1 and may provide1 in addition1 for #a or more of the other remedies described in paragraph 7#e77;,b74 7#b7 ,situations not involving immediate jeopardy ,if the ,secretary determines on the basis of a standard survey or otherwise that a hospice program that is certified for participation under this title is no longer in compliance with the requirements specified in section #ahfa7;dd7 and determines that the deficiencies involved do not immediately jeopardize the health and safety of the individuals to whom the program furnishes items and services1 the ,secretary may 7for a period not to exceed #f months7 impose remedies developed pursuant to paragraph 7#e77;,a71 in lieu of terminating the certification of the program4 ,if1 after such a period of remedies1 the program is still no longer in compliance with such requirements1 the ,secretary shall terminate the certification of the program4 7#c7 ,penalty for previous noncompliance ,if the ,secretary determines that a hospice program that is certified for participation under this title is in compliance with the requirements specified in section #ahfa7;dd7 but1 as of a previous period1 did not meet such requirements1 the ,secretary may provide for a civil monetary penalty under paragraph 7#e77;,b77i7 for the days in which the ,secretary finds that the program was not in compliance with such requirements4 7#d7 ,option to continue payments for noncompliant hospice programs ,the ,secretary may continue payments under this title with respect to a hospice program not in compliance with the requirements specified in section #ahfa7;dd7 over a period of not longer than #f months1 if-- 7,a7 the ,state or local survey agency finds that it is more appropriate to take alternative action to assure compliance of the program with such requirements than to terminate the certification of the program2 7,b7 the program has submitted a plan and timetable for corrective action to the ,secretary for approval and the ,secretary approves the plan of corrective action2 and 7,c7 the program agrees to repay to the ,federal ,government payments received under this title during such period if the corrective action is not taken in accordance with the approved plan and timetable4 ,the ,secretary shall establish guidelines for approval of corrective actions requested by hospice programs under this paragraph4 7#e7 ,remedies 7,a7 ,development 7i7 ,in general ,not later than ,october #a1 #bjba1 the ,secretary shall develop and implement-- 7,i7 a range of remedies to apply to hospice programs under the conditions described in paragraphs 7#a7 through 7#d72 and 7,,ii7 appropriate procedures for appealing determinations relating to the imposition of such remedies4 ,remedies developed pursuant to the preceding sentence shall include the remedies specified in subparagraph 7,b74 7ii7 ,conditions of imposition of remedies ,not later than ,october #a1 #bjba1 the ,secretary shall develop and implement specific procedures with respect to the conditions under which each of the remedies developed under clause 7i7 is to be applied1 including the amount of any fines and the severity of each of these remedies4 ,such procedures shall be designed so as to minimize the time between identification of deficiencies and imposition of these remedies and shall provide for the imposition of incrementally more severe fines for repeated or uncorrected deficiencies4 7,b7 ,specified remedies ,the remedies specified in this subparagraph are the following3 7i7 ,civil monetary penalties in an amount not to exceed #aj1jjj for each day of noncompliance by a hospice program with the requirements specified in section #ahfa7;dd74 7ii7 ,suspension of all or part of the payments to which a hospice program would otherwise be entitled under this title with respect to items and services furnished by a hospice program on or after the date on which the ,secretary determines that remedies should be imposed pursuant to paragraph 7#b74 7iii7 ,the appointment of temporary management to oversee the operation of the hospice program and to protect and assure the health and safety of the individuals under the care of the program while improvements are made in order to bring the program into compliance with all such requirements4 7,c7 ,procedures 7i7 ,civil monetary penalties 7,i7 ,in general ,subject to subclause 7,,ii71 the provisions of section #aabh;,a 7other than subsections 7a7 and 7b77 shall apply to a civil monetary penalty under this subsection in the same manner as such provisions apply to a penalty or proceeding under section #aabh;,a7a74 7,,ii7 ,retention of amounts for hospice program improvements ,the ,secretary may provide that any portion of civil monetary penalties collected under this subsection may be used to support activities that benefit individuals receiving hospice care1 including education and training programs to ensure hospice program compliance with the requirements of section #ahfa7;dd74 7ii7 ,suspension of payment ,a finding to suspend payment under subparagraph 7,b77ii7 shall terminate when the ,secretary finds that the program is in substantial compliance with all such requirements4 7iii7 ,temporary management ,the temporary management under subparagraph 7,b77iii7 shall not be terminated until the ,secretary has determined that the program has the management capability to ensure continued compliance with all the requirements referred to in such subparagraph4 7,d7 ,relationship to other remedies ,the remedies developed under subparagraph 7,a7 are in addition to sanctions otherwise available under ,state or ,federal law and shall not be construed as limiting other remedies1 including any remedy available to an individual at common law4 4 7#b7 ,availability of hospice accreditation surveys ,section #ahfe7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;bb7b77 is amended by inserting or1 beginning on the date of the enactment of the ,,benes ,act of #bjbj1 a hospice program after home health agency4 7#c7 ,state provision of hospice program information 7,a7 ,in general ,section #ahfd7;a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;aa7a77 is amended in the sixth sentence-- 7i7 by inserting and hospice programs after information on home health agencies2 7ii7 by inserting or the hospice program after the home health agency2 7iii7 by inserting or the hospice program after with respect to the agency2 and 7iv7 by inserting and hospice programs after with respect to home health agencies4 7,b7 ,effective date ,the amendments made by subparagraph 7,a7 shall apply with respect to agreements entered into on or after1 or in effect as of1 the date that is #a year after the date of the enactment of this ,act4 7#d7 ,conforming amendments 7,a7 ,definition of a hospice program ,section #ahfa7;dd77#d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciex7dd77#d77 is amended by striking subparagraph 7,c74 7,b7 ,continuation of funding ,section #c7;a77#b7 of the ,improving ,medicare ,post-,acute ,care ,transformation ,act of #bjad is amended by inserting and section #ahbb7;a77#a7 of such ,act1 after as added by paragraph 7#a714 7b7 ,increasing payment reductions for failure to meet quality data reporting requirements ,section #ahad7;i77#e77;,a77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;f7i77#e77;,a77i77 is amended by inserting 7or1 for fiscal year #bjbc and each subsequent fiscal year1 #d percentage points7 before the period4 7c7 ,report ,not later than #cf months after the date of the enactment of this ,act1 the ,comptroller ,general of the ,united ,states shall submit to the ,committee on ,ways and ,means of the ,house of ,representatives and the ,committee on ,finance of the ,senate a report containing an analysis of the effects of the amendments made by subsection 7a71 including the frequency of application of remedies specified in section #ahbb7;c77#e77;,b7 of the ,social ,security ,act 7as added by such subsection71 on access to1 and quality of1 care furnished by hospice programs under part ,a of title ,,xviii of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;c et seq474 ,passed the ,house of ,representatives ,december #h1 #bjbj4;,clerk4