,,ii #aagth ,,congress #ast ,session ,s4 #ahdd ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #bf1 #bjba ,mr4 ,casey 7for himself1 ,mr4 ,blumenthal1 ,ms4 ,stabenow1 and ,mr4 ,sanders7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to move ,medicare cost-sharing benefits from ,medicaid to ,medicare1 and for other purposes4 #a4 ,short title ,this ,act may be cited as the ,lowering ,medicare ,premiums and ,prescription ,drug ,costs ,act4 #b4 ,medicare ,cost ,assistance ,program 7a7 ,in general ,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;,b4 ,medicare ,cost ,assistance ,program 7a7 ,in general ,effective beginning ,january #a1 #bjbc1 in the case of a ,medicare ,cost ,assistance ,program eligible individual 7as defined in subsection 7b77#a771 the ,secretary shall provide ,medicare cost assistance for the following costs incurred with respect to the individual3 7#a7 7,a7 premiums under section #ahah2 and 7,b7 premiums under section #ahci4 7#b7 ,coinsurance under this title 7including coinsurance described in section #ahac74 7#c7 ,deductibles established under this title 7including those described in section #ahac and section #ahcc7;b774 7#d7 ,the difference between the amount that is paid under section #ahcc7;a7 and the amount that would be paid under such section if any reference to a percent less than #ajj percent therein were deemed a reference to #ajj percent4 7b7 ,determination of eligibility 7#a7 ,medicare ,cost ,assistance ,program eligible individual defined ,the term ,medicare ,cost ,assistance ,program eligible individual means an individual who-- 7,a7 is eligible for and is receiving medical assistance for the payment of medicare cost-sharing under a ,state ,medicaid program pursuant to clause 7i71 7iii71 or 7iv7 of section #aijb7;a77#aj77;,e7 as of ,december #ca1 #bjbb2 or 7,b7 7i7 is entitled to hospital insurance benefits under part ,a 7including an individual entitled to such benefits pursuant to an enrollment under section #ahah72 and 7ii7 has income at or below #bjj percent of the poverty line applicable to a family of the size involved4 7#b7 ,joint determination by ,commissioner of ,social ,security for ,,lis and ,medicare cost assistance 7,a7 ,in general ,the determination of whether an individual is a ,medicare ,cost ,assistance ,program eligible individual described in paragraph 7#a7 shall be determined by the ,commissioner of ,social ,security jointly with the determination of whether an individual is a subsidy eligible individual described in section #ahfj;,d-#ad7;a77#c74 ,such determination shall be made with respect to eligibility for ,medicare cost assistance under this section and premium and cost-sharing subsidies under section #ahfj;,d-#ad upon application of an individual for a determination with respect to eligibility for either such assistance or such subsidies4 ,there are authorized to be appropriated to the ,social ,security ,administration such sums as may be necessary for the determination of eligibility under this paragraph4 7,b7 ,effective period ,determinations under this paragraph with respect to eligibility for each of such assistance or such subsidies shall be effective beginning with the month in which the individual applies for a determination described in subparagraph 7,a7 and shall remain in effect until such time as the ,secretary determines the individual is no longer eligible as determined under subparagraph 7,c77ii74 7,c7 ,redeterminations ,with respect to eligibility determinations under this paragraph-- 7i7 redeterminations shall be made at the same time with respect to eligibility for ,medicare cost assistance under this section and cost-sharing subsidies under section #ahfj;,d-#ad1 but not more frequently than once every #ab months2 7ii7 a redetermination shall automatically determine that an individual remains eligible for such assistance or subsidies unless-- 7,i7 the ,commissioner has information indicating that the individual's circumstances have changed such that the individual is no longer eligible for such assistance or subsidies2 7,,ii7 the ,commissioner sends notice to the individual regarding such information that requests a response either confirming or correcting such information2 and 7,,iii7 the individual either confirms such information or fails to provide documentation indicating that such circumstances have not changed within #fj days of receiving the notice described in subclause 7,,ii72 7iii7 the ,commissioner shall establish procedures for appeals of such determinations that are similar to the procedures described in the third sentence of section #afca7;c77#a77;,a72 and 7iv7 judicial review of the final decision of the ,commissioner made after a hearing shall be available to the same extent1 and with the same limitations1 as provided in subsections 7g7 and 7h7 of section #bje4 7,d7 ,treatment of medicaid beneficiaries ,the ,secretary shall provide that individuals who are full-benefit dual eligible individuals 7as defined in section #aice7;c77#f77 or who are recipients of supplemental security income benefits under title ,,xvi shall be treated as a ,medicare ,cost ,assistance ,program eligible individual described in paragraph 7#a7 and1 in the case of such individual who is a part ,d eligible individual1 a subsidy eligible individual described in section #ahfj;,d-#ad7;a77#c74 7,e7 ,simplified application form 7i7 ,in general ,the ,secretary shall develop and distribute a simplified application form for use by individuals in applying for ,medicare cost assistance under this section and premium and cost-sharing subsidies under section #ahfj;,d-#ad4 ,such form shall be easily readable by applicants and uniform nationally4 ,the ,secretary shall provide for the translation of such application form into at least the #aj languages 7other than ,english7 that are most often used by individuals applying for hospital insurance benefits under section #bbf or #bbf;,a and shall make the translated forms available to the ,commissioner of ,social ,security4 7ii7 ,consultation ,in developing such form1 the ,secretary shall consult with beneficiary groups4 7#c7 ,income determinations ,for purposes of applying this section-- 7,a7 in the case of an individual who is not treated as a ,medicare ,cost ,assistance ,program eligible individual or a subsidy eligible individual under paragraph 7#b77;,d71 income shall be determined in the manner described under section #afab for purposes of the supplemental security income program1 except that support and maintenance furnished in kind shall not be counted as income2 and 7,b7 the term 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 7c7 ,beneficiary protections 7#a7 ,in general ,in the case in which the payment for ,medicare cost assistance for a ,medicare ,cost ,assistance ,program eligible individual with respect to an item or service is reduced or eliminated the individual shall not have any legal liability to make payment to a provider of services or supplier or to an organization described in section #aijc7m77#a77;,a7 for the service1 and any lawful sanction that may be imposed upon a provider of services or supplier or such an organization for excess charges under this title or title ,,xix shall apply to the imposition of any charge imposed upon the individual in such case4 7#b7 ,clarification ,this paragraph shall not be construed as preventing payment of any medicare cost assistance by a medicare supplemental policy or an employer retiree health plan on behalf of an individual4 7d7 ,administration 7#a7 ,in general ,the ,secretary shall establish procedures for the administration of the program under this section4 7#b7 ,funding ,for purposes of carrying out this section1 the ,secretary shall make payments from the ,federal ,hospital ,insurance ,trust ,fund under section #ahag and the ,federal ,supplementary ,medical ,insurance ,trust ,fund under section #ahda1 in such proportion as the ,secretary determines appropriate1 of such amounts as the ,secretary determines necessary to provide ,medicare cost assistance under this section4 7e7 ,references to medicare cost-,sharing ,effective beginning ,january #a1 #bjbc1 any reference to medicare cost-sharing described in section #aije7p7 shall be deemed a reference to ,medicare cost assistance under this section4 7f7 ,outreach efforts ,for provisions relating to outreach efforts to increase awareness of the availability of ,medicare cost assistance1 see section #aadd4 4 7b7 ,special enrollment period 7#a7 ,no premium penalty ,section #ahci7;b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acier7b77 is amended1 in the last sentence1 by inserting the following before the period3 or1 effective beginning ,january #a1 #bjbc1 for individuals who are ,medicare ,cost ,assistance ,program eligible individuals 7as defined in section #ahii;,b7b77#a7744 7#b7 ,special enrollment period ,section #ahcg of the ,social ,security ,act 7#db ,u4,s4,c4 #aciep7 is amended by adding at the end the following new subsection3 7o7 ,special enrollment period for ,medicare ,cost ,assistance ,program eligible individual 7#a7 ,in general ,effective beginning ,january #a1 #bjbc1 the ,secretary shall establish special enrollment periods for ,medicare ,cost ,assistance ,program eligible individuals 7as defined in section #ahii;,b7b77#a774 7#b7 ,coverage period ,in the case of an individual who enrolls during the special enrollment period provided under paragraph 7#a71 the coverage period under this part shall-- 7,a7 begin on the first day of the first month in which the individual applies for a determination under section #ahii;,b7b77#b77;,a72 and 7,b7 remain in effect until such time as the ,secretary determines the individual no longer eligible as determined under section #ahii;,b7b77#b77;,c77ii74 4 7#c7 ,conforming sunset of ,state agreements relating to enrollment of qualified medicare beneficiaries 7,a7 ,part ,a ,section #ahah7;g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acie;i-#b7;g77 is amended by adding at the end the following new paragraph3 7#c7 ,sunset ,this subsection shall not apply on or after ,january #a1 #bjbc4 4 7,b7 ,part ,b ,section #ahdc7;h7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciev7h77 is amended by adding at the end the following new paragraph3 7#c7 ,sunset with respect to qualified medicare beneficiaries ,this subsection shall not apply with respect to qualified medicare beneficiaries on or after ,january #a1 #bjbc4 4 7c7 ,public awareness campaign ,section #aadd of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#ad7 is amended by adding at the end the following new subsection3 7d7 ,public awareness campaign 7#a7 ,in general ,the ,commissioner shall conduct a public awareness campaign to educate ,medicare beneficiaries on the availability of ,medicare cost assistance for low-income individuals under section #ahii;,b4 7#b7 ,coordination ,in carrying out such public awareness campaign1 the ,commissioner shall coordinate with ,state health insurance assistance programs described in subsection 7a77#a77;,a7 of section #aai of the ,medicare ,improvements for ,patients and ,providers ,act of #bjjh 7#db ,u4,s4,c4 #acie;b-#c note771 the ,administrator of the ,administration for ,community ,living1 and the ,administrator of the ,centers for ,medicare ,medicaid ,services4 7#c7 ,funding ,there are hereby appropriated to the ,commissioner1 out of any funds in the ,treasury not otherwise appropriated1 #aj1jjj1jjj for each of fiscal years #bjbc through #bjbe1 to provide grants to ,state health insurance assistance programs to carry out outreach and education activities under the public awareness campaign pursuant to this subsection4 4 #c4 ,moving ,medicare cost-sharing benefits from ,medicaid to ,medicare 7a7 ,ending most ,medicare cost-,sharing benefits under ,medicaid ,section #aijb7;a77#aj7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77 is amended-- 7#a7 by inserting for calendar quarters beginning before ,january #a1 #bjbc1 before for making each place it appears in clauses 7i71 7iii71 and 7iv7 of subparagraph 7,e72 and 7#b7 in the matter following subparagraph 7,g7-- 7,a7 by inserting furnished during calendar quarters beginning before ,january #a1 #bjbc after 7described in section #aije7p77#c772 7,b7 by striking 7,,xv7 and inserting 1 7,,xv72 7,c7 by striking and 7,,xviii7 and inserting 1 7,,xviii72 and 7,d7 by inserting 1 and 7,,xix7 no medical assistance for medicare cost-sharing1 other than medical assistance for medicare cost-sharing for qualified disabled and working individuals described in section #aije7s71 shall be made available after ,january #a1 #bjbc before the semicolon at the end4 7b7 ,conforming amendments 7#a7 ,title ,,xix 7,a7 ,section #aijc7;i7 of such ,act 7#db ,u4,s4,c4 #acif;b7i77 is amended-- 7i7 in paragraph 7#bf71 by striking 2 and and inserting a semicolon2 7ii7 in paragraph 7#bg71 by striking the period at the end and inserting 2 and2 and 7iii7 by inserting after paragraph 7#bg7 the following new paragraph3 7#bh7 with respect to any amount expended for medical assistance for medicare cost-sharing 7other than medical assistance for medicare cost-sharing for qualified disabled and working individuals described in section #aije7s77 furnished during calendar quarters beginning on or after ,january #a1 #bjbc4 4 7,b7 ,section #aije7;a7 of such ,act 7#db ,u4,s4,c4 #acif;d7a77 is amended1 in the first sentence1 by inserting furnished during calendar quarters beginning before ,january #a1 #bjbc after medicare cost-sharing4 7,c7 ,section #aicc7;g7 of such ,act 7#db ,u4,s4,c4 #acifu-#c7;g77 is amended-- 7i7 in paragraph 7#b77,q71 by striking paragraph 7#d71 for each subsequent year and inserting paragraphs 7#d7 and 7#e71 for each subsequent year before #bjbc2 and 7ii7 by adding at the end the following3 7#e7 ,sunset ,no individual shall be selected to be a qualifying individual for any calendar year or period under this section beginning on or after ,january #a1 #bjbc1 and no ,state allocation shall be made for any fiscal year or period under this section beginning on or after ,january #a1 #bjbc4 4 7,d7 ,section #aice7;a7 of such ,act 7#db ,u4,s4,c4 #acifu-#e7;a77 is amended-- 7i7 in paragraph 7#b71 by striking make determinations and inserting prior to ,january #a1 #bjbc1 make determinations2 and 7ii7 in paragraph 7#c71 by inserting prior to ,january #a1 #bjbc1 before the ,state shall4 7#b7 ,title ,,xi ,section #aadd of the ,social ,security ,act 7#db ,u4,s4,c4 #acbj;b-#ad7 is amended-- 7,a7 in subsection 7a7-- 7i7 in paragraph 7#a77;,a7-- 7,i7 by striking sections #aijb7;a77#aj77;,e7 and #aicc and inserting section #aijb7;a77#aj77;,e7 and 7prior to ,january #a1 #bjbc7 section #aicc2 7,,ii7 by striking for the transitional assistance under section #ahfj;,d-#ca7;f71 or and inserting a comma2 and 7,,iii7 by inserting 1 or for ,medicare premium and cost-sharing assistance under section #ahii;,b 7in the case of months beginning on or after ,january #a1 #bjbc7 before the semicolon2 and 7ii7 by striking paragraph 7#b7 and inserting the following3 7#b7 ,content of notice ,any notice furnished under paragraph 7#a7 shall state that eligibility for such medical assistance1 subsidies1 or program is conditioned upon meeting the applicable eligibility criteria4 2 7,b7 in subsection 7b77#a77;,a7-- 7i7 by striking sections #aijb7;a77#aj77;,e7 and #aicc and inserting section #aijb7;a77#aj77;,e7 and 7prior to ,january #a1 #bjbc7 section #aicc2 7ii7 by striking for transitional assistance under section #ahfj;,d-#ca7;f71 or2 and 7iii7 by inserting 1 or for ,medicare premium and cost-sharing assistance under section #ahii;,b before the semicolon2 and 7,c7 in subsection 7c7-- 7i7 in paragraph 7#a77;,b71 by inserting 1 and 7beginning ,january #a1 #bjbc17 provide an application for enrollment under the ,medicare ,savings ,program before the period2 7ii7 in paragraph 7#b71 in the paragraph header1 by inserting medicare savings program application and before lis application2 and 7iii7 in paragraph 7#g71 by striking means the program of medical assistance and all that follows through the period and inserting 8means-- 7,a7 prior to ,january #a1 #bjbc1 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 #aicc2 and 7,b7 beginning ,january #a1 #bjbc1 the program for medical assistance for payment of the cost of medicare cost-sharing for qualified disabled and working individuals described in section #aije7s7 pursuant to section #aijb7;a77#aj77;,e77ii7 and medicare premium and cost-sharing assistance provided under section #ahii;,b4 4 7c7 ,ensuring that ,medicare cost-,sharing beneficiaries under ,medicaid receive ,medicare cost assistance ,not later than ,june #a1 #bjbb1 the ,secretary of ,health and ,human ,services and the ,commissioner of ,social ,security shall jointly develop and implement a transition plan to ensure that all individuals who are eligible for and are receiving medical assistance for the payment of medicare cost-sharing under a ,state ,medicaid program pursuant to clauses 7i71 7iii71 and 7iv7 of section #aijb7;a77#aj77;,e7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;a7a77#aj77;,e77 as of ,december #ca1 #bjbb1 receive ,medicare cost assistance under section #ahii;,b of such ,act1 as added by section #b1 as of ,january #a1 #bjbc4 #d4 ,enhancing prescription drug affordability by expanding access to assistance with out-of-pocket costs under ,medicare part ,d for low-income seniors and individuals with disabilities 7a7 ,expanding access ,section #ahfj;,d-#ad of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7 is amended-- 7#a7 in subsection 7a7-- 7,a7 in the heading1 by striking #aej percent and inserting #bjj percent2 7,b7 in paragraph 7#a7-- 7i7 in the heading1 by striking #ace percent and inserting #bjj percent2 and 7ii7 in the matter preceding subparagraph 7,a7-- 7,i7 by striking #ace percent and inserting #bjj percent2 and 7,,ii7 by striking and who meets the resources requirement described in paragraph 7#c77;,d7 or who is covered under this paragraph under paragraph 7#c77;,b77i7 and inserting or who is covered under this paragraph under paragraph 7#c77;,b77v72 7,c7 by striking paragraph 7#b72 7,d7 in paragraph 7#c7-- 7i7 in subparagraph 7,a7-- 7,i7 in clause 7i71 by adding and at the end2 7,,ii7 in clause 7ii7-- 7aa7 by striking #aej percent and inserting #bjj percent2 and 7bb7 by striking 2 and at the end and inserting a period2 and 7,,iii7 by striking clause 7iii72 7ii7 by striking subparagraphs 7,b7 and 7,c7 and inserting the following3 7,b7 ,determinations ,for provisions relating to joint determinations with respect to eligibility for ,medicare cost assistance under section #ahii;,b and premium and cost-sharing subsidies under this section1 see section #ahii;,b7b77#b74 7,c7 ,income determinations ,for purposes of applying this section-- 7i7 in the case of an individual who is not treated as a ,medicare cost-sharing assistance eligible individual and a subsidy eligible individual under section #ahii;,b7b77#b77;,d71 income shall be determined in the manner described under section #afab for purposes of the supplemental security income program1 except that support and maintenance furnished in kind shall not be counted as income2 and 7ii7 the term 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 4 7iii7 by striking subparagraphs 7,d71 7,e71 and 7,g72 and 7,e7 in paragraph 7#d71 by striking subparagraph 7,b72 and 7#b7 in subsection 7c77#a71 in the second sentence1 by striking subsections 7a77#a77;,d7 and 7a77#b77;,e7 and inserting subsection 7a77#a77;,d74 7b7 ,treatment of reduction of cost-,sharing for individuals receiving home and community based services ,section #ahfj;,d-#ad7;a77#a77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#aad7;a77#a77;,d77 is amended-- 7#a7 by striking who would be such an institutionalized individual or couple1 if the full-benefit dual eligible individual were not2 and 7#b7 by striking or subsection 7c7 or 7d7 of section #aiae or under a ,state plan amendment under subsection 7i7 of such section and inserting 1 section #aaae;,a1 section #aiae1 or under a ,state plan amendment4 7c7 ,effective date ,the amendments made by this section shall apply to plan year #bjbc and subsequent plan years4