Lowering Medicare Premiums and Prescription Drug Costs Act

II 117TH CONGRESS 1ST SESSION S. 1844 To amend title XVIII of the Social Security Act to move Medicare cost- sharing benefits from Medicaid to Medicare, and for other purposes. IN THE SENATE OF THE UNITED STATES MAY 26, 2021 Mr. CASEY (for himself, Mr. BLUMENTHAL, Ms. STABENOW, and Mr. SAND- ERS) introduced the following bill; 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 Medi- care, and for other purposes. Be it enacted by the Senate and House of Representa- 1 tives of the United States of America in Congress assembled, 2 SECTION 1. SHORT TITLE. 3 This Act may be cited as the ‘‘Lowering Medicare 4 Premiums and Prescription Drug Costs Act’’. 5 SEC. 2. MEDICARE COST ASSISTANCE PROGRAM. 6 (a) IN GENERAL.—Title XVIII of the Social Security 7 Act (42 U.S.C. 1395 et seq.) is amended by adding at 8 the end the following new section: 9 VerDate Sep 11 2014 00:41 Jun 19, 2021 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\S1844.IS S1844 pbinns on DSKJLVW7X2PROD with BILLS 2 •S 1844 IS ‘‘SEC. 1899B. MEDICARE COST ASSISTANCE PROGRAM. 1 ‘‘(a) IN GENERAL.—Effective beginning January 1, 2 2023, in the case of a Medicare Cost Assistance Program 3 eligible individual (as defined in subsection (b)(1)), the 4 Secretary shall provide Medicare cost assistance for the 5 following costs incurred with respect to the individual: 6 ‘‘(1)(A) premiums under section 1818; and 7 ‘‘(B) premiums under section 1839. 8 ‘‘(2) Coinsurance under this title (including co- 9 insurance described in section 1813). 10 ‘‘(3) Deductibles established under this title (in- 11 cluding those described in section 1813 and section 12 1833(b)). 13 ‘‘(4) The difference between the amount that is 14 paid under section 1833(a) and the amount that 15 would be paid under such section if any reference to 16 a percent less than 100 percent therein were deemed 17 a reference to ‘100 percent’. 18 ‘‘(b) DETERMINATION OF ELIGIBILITY.— 19 ‘‘(1) MEDICARE COST ASSISTANCE PROGRAM 20 ELIGIBLE INDIVIDUAL DEFINED.—The term ‘Medi- 21 care Cost Assistance Program eligible individual’ 22 means an individual who— 23 ‘‘(A) is eligible for and is receiving medical 24 assistance for the payment of medicare cost- 25 sharing under a State Medicaid program pursu- 26 VerDate Sep 11 2014 00:41 Jun 19, 2021 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\S1844.IS S1844 pbinns on DSKJLVW7X2PROD with BILLS 3 •S 1844 IS ant to clause (i), (iii), or (iv) of section 1 1902(a)(10)(E) as of December 31, 2022; or 2 ‘‘(B)(i) is entitled to hospital insurance 3 benefits under part A (including an individual 4 entitled to such benefits pursuant to an enroll- 5 ment under section 1818); and 6 ‘‘(ii) has income at or below 200 percent of 7 the poverty line applicable to a family of the 8 size involved. 9 ‘‘(2) JOINT DETERMINATION BY COMMISSIONER 10 OF SOCIAL SECURITY FOR LIS AND MEDICARE COST 11 ASSISTANCE.— 12 ‘‘(A) IN GENERAL.—The determination of 13 whether an individual is a Medicare Cost As- 14 sistance Program eligible individual described in 15 paragraph (1) shall be determined by the Com- 16 missioner of Social Security jointly with the de- 17 termination of whether an individual is a sub- 18 sidy eligible individual described in section 19 1860D–14(a)(3). Such determination shall be 20 made with respect to eligibility for Medicare 21 cost assistance under this section and premium 22 and cost-sharing subsidies under section 23 1860D–14 upon application of an individual for 24 a determination with respect to eligibility for ei- 25 VerDate Sep 11 2014 00:41 Jun 19, 2021 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\S1844.IS S1844 pbinns on DSKJLVW7X2PROD with BILLS 4 •S 1844 IS ther such assistance or such subsidies. There 1 are authorized to be appropriated to the Social 2 Security Administration such sums as may be 3 necessary for the determination of eligibility 4 under this paragraph. 5 ‘‘(B) EFFECTIVE PERIOD.—Determina- 6 tions under this paragraph with respect to eligi- 7 bility for each of such assistance or such sub- 8 sidies shall be effective beginning with the 9 month in which the individual applies for a de- 10 termination described in subparagraph (A) and 11 shall remain in effect until such time as the 12 Secretary determines the individual is no longer 13 eligible as determined under subparagraph 14 (C)(ii). 15 ‘‘(C) REDETERMINATIONS.—With respect 16 to eligibility determinations under this para- 17 graph— 18 ‘‘(i) redeterminations shall be made at 19 the same time with respect to eligibility for 20 Medicare cost assistance under this section 21 and cost-sharing subsidies under section 22 1860D–14, but not more frequently than 23 once every 12 months; 24 VerDate Sep 11 2014 00:41 Jun 19, 2021 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\S1844.IS S1844 pbinns on DSKJLVW7X2PROD with BILLS 5 •S 1844 IS ‘‘(ii) a redetermination shall automati- 1 cally determine that an individual remains 2 eligible for such assistance or subsidies un- 3 less— 4 ‘‘(I) the Commissioner has infor- 5 mation indicating that the individual’s 6 circumstances have changed such that 7 the individual is no longer eligible for 8 such assistance or subsidies; 9 ‘‘(II) the Commissioner sends no- 10 tice to the individual regarding such 11 information that requests a response 12 either confirming or correcting such 13 information; and 14 ‘‘(III) the individual either con- 15 firms such information or fails to pro- 16 vide documentation indicating that 17 such circumstances have not changed 18 within 60 days of receiving the notice 19 described in subclause (II); 20 ‘‘(iii) the Commissioner shall establish 21 procedures for appeals of such determina- 22 tions that are similar to the procedures de- 23 scribed in the third sentence of section 24 1631(c)(1)(A); and 25 VerDate Sep 11 2014 00:41 Jun 19, 2021 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\S1844.IS S1844 pbinns on DSKJLVW7X2PROD with BILLS 6 •S 1844 IS ‘‘(iv) judicial review of the final deci- 1 sion of the Commissioner made after a 2 hearing shall be available to the same ex- 3 tent, and with the same limitations, as pro- 4 vided in subsections (g) and (h) of section 5 205. 6 ‘‘(D) TREATMENT OF MEDICAID BENE- 7 FICIARIES.—The Secretary shall provide that 8 individuals who are full-benefit dual eligible in- 9 dividuals (as defined in section 1935(c)(6)) or 10 who are recipients of supplemental security in- 11 come benefits under title XVI shall be treated 12 as a Medicare Cost Assistance Program eligible 13 individual described in paragraph (1) and, in 14 the case of such individual who is a part D eli- 15 gible individual, a subsidy eligible individual de- 16 scribed in section 1860D–14(a)(3). 17 ‘‘(E) SIMPLIFIED APPLICATION FORM.— 18 ‘‘(i) IN GENERAL.—The Secretary 19 shall develop and distribute a simplified 20 application form for use by individuals in 21 applying for Medicare cost assistance 22 under this section and premium and cost- 23 sharing subsidies under section 1860D–14. 24 Such form shall be easily readable by ap- 25 VerDate Sep 11 2014 00:41 Jun 19, 2021 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\S1844.IS S1844 pbinns on DSKJLVW7X2PROD with BILLS 7 •S 1844 IS plicants and uniform nationally. The Sec- 1 retary shall provide for the translation of 2 such application form into at least the 10 3 languages (other than English) that are 4 most often used by individuals applying for 5 hospital insurance benefits under section 6 226 or 226A and shall make the translated 7 forms available to the Commissioner of So- 8 cial Security. 9 ‘‘(ii) CONSULTATION.—In developing 10 such form, the Secretary shall consult with 11 beneficiary groups. 12 ‘‘(3) INCOME DETERMINATIONS.—For purposes 13 of applying this section— 14 ‘‘(A) in the case of an individual who is 15 not treated as a Medicare Cost Assistance Pro- 16 gram eligible individual or a subsidy eligible in- 17 dividual under paragraph (2)(D), income shall 18 be determined in the manner described under 19 section 1612 for purposes of the supplemental 20 security income program, except that support 21 and maintenance furnished in kind shall not be 22 counted as income; and 23 ‘‘(B) the term ‘poverty line’ has the mean- 24 ing given such term in section 673(2) of the 25 VerDate Sep 11 2014 00:41 Jun 19, 2021 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\S1844.IS S1844 pbinns on DSKJLVW7X2PROD with BILLS 8 •S 1844 IS Community Services Block Grant Act (42 1 U.S.C. 9902(2)), including any revision re- 2 quired by such section. 3 ‘‘(c) BENEFICIARY PROTECTIONS.— 4 ‘‘(1) IN GENERAL.—In the case in which the 5 payment for Medicare cost assistance for a Medicare 6 Cost Assistance Program eligible individual with re- 7 spect to an item or service is reduced or eliminated 8 the individual shall not have any legal liability to 9 make payment to a provider of services or supplier 10 or to an organization described in section 11 1903(m)(1)(A) for the service, and any lawful sanc- 12 tion that may be imposed upon a provider of services 13 or supplier or such an organization for excess 14 charges under this title or title XIX shall apply to 15 the imposition of any charge imposed upon the indi- 16 vidual in such case. 17 ‘‘(2) CLARIFICATION.—This paragraph shall 18 not be construed as preventing payment of any 19 medicare cost assistance by a medicare supplemental 20 policy or an employer retiree health plan on behalf 21 of an individual. 22 ‘‘(d) ADMINISTRATION.— 23 VerDate Sep 11 2014 00:41 Jun 19, 2021 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\S1844.IS S1844 pbinns on DSKJLVW7X2PROD with BILLS 9 •S 1844 IS ‘‘(1) IN GENERAL.—The Secretary shall estab- 1 lish procedures for the administration of the pro- 2 gram under this section. 3 ‘‘(2) FUNDING.—For purposes of carrying out 4 this section, the Secretary shall make payments from 5 the Federal Hospital Insurance Trust Fund under 6 section 1817 and the Federal Supplementary Med- 7 ical Insurance Trust Fund under section 1841, in 8 such proportion as the Secretary determines appro- 9 priate, of such amounts as the Secretary determines 10 necessary to provide Medicare cost assistance under 11 this section. 12 ‘‘(e) REFERENCES TO MEDICARE COST-SHARING.— 13 Effective beginning January 1, 2023, any reference to 14 medicare cost-sharing described in section 1905(p) shall 15 be deemed a reference to Medicare cost assistance under 16 this section. 17 ‘‘(f) OUTREACH EFFORTS.—For provisions relating 18 to outreach efforts to increase awareness of the availability 19 of Medicare cost assistance, see section 1144.’’. 20 (b) SPECIAL ENROLLMENT PERIOD.— 21 (1) NO PREMIUM PENALTY.—Section 1839(b) 22 of the Social Security Act (42 U.S.C. 1395r(b)) is 23 amended, in the last sentence, by inserting the fol- 24 lowing before the period: ‘‘or, effective beginning 25 VerDate Sep 11 2014 00:41 Jun 19, 2021 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\S1844.IS S1844 pbinns on DSKJLVW7X2PROD with BILLS 10 •S 1844 IS January 1, 2023, for individuals who are Medicare 1 Cost Assistance Program eligible individuals (as de- 2 fined in section 1899B(b)(1)).’’. 3 (2) SPECIAL ENROLLMENT PERIOD.—Section 4 1837 of the Social Security Act (42 U.S.C. 1395p) 5 is amended by adding at the end the following new 6 subsection: 7 ‘‘(o) SPECIAL ENROLLMENT PERIOD FOR MEDICARE 8 COST ASSISTANCE PROGRAM ELIGIBLE INDIVIDUAL.— 9 ‘‘(1) IN GENERAL.—Effective beginning Janu- 10 ary 1, 2023, the Secretary shall establish special en- 11 rollment periods for Medicare Cost Assistance Pro- 12 gram eligible individuals (as defined in section 13 1899B(b)(1)). 14 ‘‘(2) COVERAGE PERIOD.—In the case of an in- 15 dividual who enrolls during the special enrollment 16 period provided under paragraph (1), the coverage 17 period under this part shall— 18 ‘‘(A) begin on the first day of the first 19 month in which the individual applies for a de- 20 termination under section 1899B(b)(2)(A); and 21 ‘‘(B) remain in effect until such time as 22 the Secretary determines the individual no 23 longer eligible as determined under section 24 1899B(b)(2)(C)(ii).’’. 25 VerDate Sep 11 2014 00:41 Jun 19, 2021 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\S1844.IS S1844 pbinns on DSKJLVW7X2PROD with BILLS 11 •S 1844 IS (3) CONFORMING SUNSET OF STATE AGREE- 1 MENTS RELATING TO ENROLLMENT OF QUALIFIED 2 MEDICARE BENEFICIARIES.— 3 (A) PART A.—Section 1818(g) of the So- 4 cial Security Act (42 U.S.C. 1395i–2(g)) is 5 amended by adding at the end the following 6 new paragraph: 7 ‘‘(3) SUNSET.—This subsection shall not apply on or 8 after January 1, 2023.’’. 9 (B) PART B.—Section 1843(h) of the So- 10 cial Security Act (42 U.S.C. 1395v(h)) is 11 amended by adding at the end the following 12 new paragraph: 13 ‘‘(3) SUNSET WITH RESPECT TO QUALIFIED MEDI- 14 CARE BENEFICIARIES.—This subsection shall not apply 15 with respect to qualified medicare beneficiaries on or after 16 January 1, 2023.’’. 17 (c) PUBLIC AWARENESS CAMPAIGN.—Section 1144 18 of the Social Security Act (42 U.S.C. 1320b–14) is 19 amended by adding at the end the following new sub- 20 section: 21 ‘‘(d) PUBLIC AWARENESS CAMPAIGN.— 22 ‘‘(1) IN GENERAL.—The Commissioner shall 23 conduct a public awareness campaign to educate 24 Medicare beneficiaries on the availability of Medicare 25 VerDate Sep 11 2014 00:41 Jun 19, 2021 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\S1844.IS S1844 pbinns on DSKJLVW7X2PROD with BILLS 12 •S 1844 IS cost assistance for low-income individuals under sec- 1 tion 1899B. 2 ‘‘(2) COORDINATION.—In carrying out such 3 public awareness campaign, the Commissioner shall 4 coordinate with State health insurance assistance 5 programs described in subsection (a)(1)(A) of sec- 6 tion 119 of the Medicare Improvements for Patients 7 and Providers Act of 2008 (42 U.S.C. 1395b–3 8 note)), the Administrator of the Administration for 9 Community Living, and the Administrator of the 10 Centers for Medicare & Medicaid Services. 11 ‘‘(3) FUNDING.—There are hereby appropriated 12 to the Commissioner, out of any funds in the Treas- 13 ury not otherwise appropriated, $10,000,000 for 14 each of fiscal years 2023 through 2025, to provide 15 grants to State health insurance assistance pro- 16 grams to carry out outreach and education activities 17 under the public awareness campaign pursuant to 18 this subsection.’’. 19 SEC. 3. MOVING MEDICARE COST-SHARING BENEFITS 20 FROM MEDICAID TO MEDICARE. 21 (a) ENDING MOST MEDICARE COST-SHARING BENE- 22 FITS UNDER MEDICAID.—Section 1902( [Text truncated for display. Full text available on Congress.gov.]