,,ib ,union ,calendar ,no4 #cje #aafth ,,congress #b;d ,session ,h4 ,r4 #dfga ,report ,no4 #aaf-cha1 ,part ,i ,,in ,,the ,,house ,,of ,,representatives ,october #ae1 #bjai,mr4 ,kim 7for himself1 ,ms4 ,blunt ,rochester1 and ,mr4 ,evans7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,january #bd1 #bjbj;,additional sponsors3 ,mr4 ,cuellar1 ,ms4 ,matsui1 ,mr4 ,pascrell1 ,mr4 ,malinowski1 and ,mr4 ,norcross ,january #bd1 #bjbj,reported from the ,committee on ,energy and ,commerce ,january #bd1 #bjbj;,committee on ,ways and ,means discharged1 committed to the ,committee of the ,whole ,house on the ,state of the ,union1 and ordered to be printed ,a ,,bill ,to amend titles ,,xviii and ,,xix of the ,social ,security ,act to reduce cost-sharing1 align income and resource eligibility tests1 simplify enrollment1 and provide for other program improvements for low-income ,medicare beneficiaries4 #a4 ,short title ,this ,act may be cited as the ,helping ,seniors ,afford ,health ,care ,act4 #b4 ,reducing cost-sharing1 aligning income and resource eligibility tests1 simplifying enrollment1 and other program improvements for low-income beneficiaries 7a7 ,increase in income eligibility to #ace percent of ,,fpl for qualified ,medicare beneficiaries 7#a7 ,in general ,section #aije7p77#b77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77#b77;,a77 is amended by striking shall be at least the percent provided under subparagraph 7,b7 7but not more than #ajj percent7 of the official poverty line and all that follows through the period at the end and inserting the following3 shall be-- 7i7 before ,january #a1 #bjba1 at least the percent provided under subparagraph 7,b7 7but not more than #ajj percent7 of the official poverty line 7as defined by the ,office of ,management and ,budget1 and revised annually in accordance with section #fgc7b7 of the ,omnibus ,budget ,reconciliation ,act of #aiha7 applicable to a family of the size involved2 and 7ii7 on or after ,january #a1 #bjba1 equal to #ace percent of the official poverty line 7as so defined and revised7 applicable to a family of the size involved4 4 7#b7 ,not counting in-kind support and maintenance as income ,section #aije7p77#b77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77#b77;,d77 is amended by adding at the end the following new clause3 7iii7 ,in determining income under this subsection1 support and maintenance furnished in kind shall not be counted as income4 4 7b7 ,increase in income eligibility to #bjj 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;a7a77#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 #bjba1 and #bjj percent in #bjba 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 the ,social ,security ,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 8and section #aicc7;d704 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 7gg7 ,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 #bjba1 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 #bjah4 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 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 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 spouse2 and 7iv7 no balance in1 or benefits received under1 an employee pension benefit plan 7as defined in section #c of the ,employee ,retirement ,income ,security ,act of #aigd7 shall be taken into account4 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 ,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,g7 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 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,g7 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;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c77;,d771 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,g77 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 ,process for submitting claims during retroactive eligibility period ,section #aijb7;e77#h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7e77#h77 is further amended by adding at the end the following3 ,the ,secretary shall provide for a process under which claims for medical assistance under the ,state plan may be submitted for services furnished to such an individual during such #c-month period before the month in which the individual made application for assistance44 7,c7 ,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 4 7g7 ,medicaid treatment of certain ,medicare providers ,section #aijb7n7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7n77 is amended by adding at the end the following new paragraph3 7#d7 ,a ,state plan shall not deny a claim from a provider or supplier with respect to medicare cost-sharing described in subparagraph 7,b71 7,c71 or 7,d7 of section #aije7p77#c7 for an item or service which is eligible for payment under title ,,xviii on the basis that the provider or supplier does not have a provider agreement in effect under this title or does not otherwise serve all individuals entitled to medical assistance under this title4 ,the ,state shall create a mechanism through which provider or suppliers that do not otherwise have provider agreements with the ,state can bill the ,state for medicare cost-sharing for qualified medicare beneficiaries4 4 7h7 ,eligibility for other programs ,section #aije7p7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;d7p77 is amended by adding at the end the following new paragraph3 7#g7 ,notwithstanding any other provision of law1 any medical assistance for some or all medicare cost-sharing under this title shall not be considered income or resources in determining eligibility for1 or the amount of assistance or benefits provided under1 any other public benefit provided under ,federal law or the law of any ,state or political subdivision thereof4 4 7i7 ,treatment of qualified ,medicare beneficiaries1 specified low-,income ,medicare beneficiaries1 and other dual eligibles as medicare beneficiaries ,section #ahfb of the ,social ,security ,act 7#db ,u4,s4,c4 #aciey7 is amended by adding at the end the following new subsection3 7p7 ,treatment of ,qualified ,medicare ,beneficiaries 7,q,m,bs71 ,specified ,low-,income ,medicare ,beneficiaries 7,s,l,m,bs71 and ,other ,dual ,eligibles ,nothing in this title shall be construed as authorizing a provider of services or supplier to discriminate 7through a private contractual arrangement or otherwise7 against an individual who is otherwise entitled to services under this title on the basis that the individual is a qualified medicare beneficiary 7as defined in section #aije7p77#a771 a specified low-income medicare beneficiary1 or is otherwise eligible for medical assistance for medicare cost-sharing or other benefits under title ,,xix4 4 7j7 ,additional ,funding for ,state ,health ,insurance ,assistance ,programs 7#a7 ,grants 7,a7 ,in general ,the ,secretary of ,health and ,human ,services 7in this subsection referred to as the ,secretary7 shall use amounts made available under subparagraph 7,b7 to make grants to ,states for ,state health insurance assistance programs receiving assistance under section #dcfj of the ,omnibus ,budget ,reconciliation ,act of #aiij4 7,b7 ,funding ,for purposes of making grants under this subsection1 the ,secretary shall provide for the transfer1 from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i7 and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda of such ,act 7#db ,u4,s4,c4 #aciet71 in the same proportion as the ,secretary determines under section #ahec7;f7 of such ,act 7#db ,u4,s4,c4 #aciew-#bc7;f771 of #ej1jjj1jjj to the ,centers for ,medicare ,medicaid ,services ,program ,management ,account for each of the fiscal years #bjba through #bjbe1 to remain available until expended4 7#b7 ,amount of grants ,the amount of a grant to a ,state under this subsection from the total amount made available under paragraph 7#a7 shall be equal to the sum of the amount allocated to the ,state under paragraph 7#c77;,a7 and the amount allocated to the ,state under subparagraph 7#c77;,b74 7#c7 ,allocation to ,states 7,a7 ,allocation based on percentage of low-income beneficiaries ,the amount allocated to a ,state under this subparagraph from #b_/c of the total amount made available under paragraph 7#a7 shall be based on the number of individuals who meet the requirement under subsection 7a77#c77;,a77ii7 of section #ahfj;,d-#ad of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7 but who have not enrolled to receive a subsidy under such section #ahfj;,d-#ad relative to the total number of individuals who meet the requirement under such subsection 7a77#c77;,a77ii7 in each ,state1 as estimated by the ,secretary4 7,b7 ,allocation based on percentage of rural beneficiaries ,the amount allocated to a ,state under this subparagraph from #a_/c of the total amount made available under paragraph 7#a7 shall be based on the number of part ,d eligible individuals 7as defined in section #ahfj;,d-#a7;a77#c77;,a7 of such ,act 7#db ,u4,s4,c4 #aciew-#aja7;a77#c77;,a777 residing in a rural area relative to the total number of such individuals in each ,state1 as estimated by the ,secretary4 7#d7 ,portion of grant based on percentage of low-income beneficiaries to be used to provide outreach to individuals who may be subsidy eligible individuals or eligible for the ,medicare ,savings ,program ,each grant awarded under this subsection with respect to amounts allocated under paragraph 7#c77;,a7 shall be used to provide outreach to individuals who may be subsidy eligible individuals 7as defined in section #ahfj;,d-#ad7;a77#c77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#c77;,a777 or eligible for the program of medical assistance for payment of the cost of medicare cost-sharing under the ,medicaid program pursuant to sections #aijb7;a77#aj77;,e7 and #aicc of such ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,e71 #acifu-#c74 7k7 ,effective date 7#a7 ,in general ,except as provided in paragraph 7#b71 the amendments and repeal made by this section take effect on ,january #a1 #bjba1 and1 with respect to title ,,xix of the ,social ,security ,act1 apply to calendar quarters beginning on or after ,january #a1 #bjba4 7#b7 ,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 section1 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 ,january #bd1 #bjbj,reported from the ,committee on ,energy and ,commerce,january #bd1 #bjbj ,committee on ,ways and ,means discharged1 committed to the ,committee of the ,whole ,house on the ,state of the ,union1 and ordered to be printed