Beneficiary Enrollment Notification and Eligibility Simplification Act of 2020

IIB 116TH CONGRESS 2D SESSION H. R. 2477 IN THE SENATE OF THE UNITED STATES DECEMBER 9, 2020 Received; read twice and referred to the Committee on Finance AN ACT To amend title XVIII of the Social Security Act to establish a system to notify individuals approaching Medicare eligi- bility, to simplify and modernize the eligibility enrollment process, 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 VerDate Sep 11 2014 07:36 Dec 10, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6201 E:\BILLS\H2477.RFS H2477 pbinns on DSKJLVW7X2PROD with BILLS 2 HR 2477 RFS SECTION 1. SHORT TITLE. 1 This Act may be cited as the ‘‘Beneficiary Enrollment 2 Notification and Eligibility Simplification Act of 2020’’ or 3 the ‘‘BENES Act of 2020’’. 4 SEC. 2. BENEFICIARY ENROLLMENT NOTIFICATION AND 5 ELIGIBILITY SIMPLIFICATION. 6 (a) ELIGIBILITY AND ENROLLMENT NOTICES.— 7 (1) AS PART OF SOCIAL SECURITY ACCOUNT 8 STATEMENT FOR INDIVIDUALS ATTAINING AGES 63 9 TO 65.— 10 (A) IN GENERAL.—Section 1143(a) of the 11 Social Security Act (42 U.S.C. 1320b–13(a)) is 12 amended by adding at the end the following 13 new paragraph: 14 ‘‘(4) MEDICARE ELIGIBILITY INFORMATION.— 15 ‘‘(A) IN GENERAL.—In the case of statements 16 provided on or after the date that is 2 years after 17 the date of the enactment of this paragraph to indi- 18 viduals who are attaining ages 63, 64, and 65, the 19 statement shall also include a notice containing the 20 information described in subparagraph (B). 21 ‘‘(B) CONTENTS OF NOTICE.—The notice re- 22 quired under subparagraph (A) shall include a clear, 23 simple explanation of— 24 ‘‘(i) eligibility for benefits under the Medi- 25 care program under title XVIII, and in par- 26 VerDate Sep 11 2014 07:36 Dec 10, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H2477.RFS H2477 pbinns on DSKJLVW7X2PROD with BILLS 3 HR 2477 RFS ticular benefits under parts B and C of such 1 title; 2 ‘‘(ii) the reasons a late enrollment penalty 3 for failure to timely enroll could be assessed 4 and how such late enrollment penalty is cal- 5 culated, in particular for benefits under such 6 part B; 7 ‘‘(iii) the availability of relief from such 8 late enrollment penalty and retroactive enroll- 9 ment under section 1837(h) (including as such 10 section is applied under sections 1818(c) and 11 1818A(c)(3)), with examples of circumstances 12 under which such relief may be granted and ex- 13 amples of circumstances under which such relief 14 would not be granted; 15 ‘‘(iv) coordination of benefits (including 16 primary and secondary coverage scenarios) pur- 17 suant to section 1862(b), in particular for bene- 18 fits under such part B; 19 ‘‘(v) enrollment, eligibility, and coordina- 20 tion of benefits under title XVIII with respect 21 to populations, for whom there are special con- 22 siderations, such as residents of Puerto Rico 23 and veterans; and 24 VerDate Sep 11 2014 07:36 Dec 10, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6201 E:\BILLS\H2477.RFS H2477 pbinns on DSKJLVW7X2PROD with BILLS 4 HR 2477 RFS ‘‘(vi) online resources and toll-free tele- 1 phone numbers of the Social Security Adminis- 2 tration and the Centers for Medicare & Med- 3 icaid Services (including 1–800–MEDICARE 4 and the national toll-free number of the Social 5 Security Administration) that provide informa- 6 tion on eligibility for benefits under the Medi- 7 care program under title XVIII, including 8 under part C of such title. 9 ‘‘(C) DEVELOPMENT OF NOTICE.— 10 ‘‘(i) IN GENERAL.—The Secretary, in co- 11 ordination with the Commissioner of Social Se- 12 curity, and taking into consideration informa- 13 tion collected pursuant to clause (ii), shall, not 14 later than 12 months after the last day of the 15 period for the request of information described 16 in clause (ii), develop the notice to be provided 17 pursuant to subparagraph (A). 18 ‘‘(ii) REQUEST FOR INFORMATION.—Not 19 later than 6 months after the date of the enact- 20 ment of this paragraph, the Secretary shall re- 21 quest written information, including rec- 22 ommendations, from stakeholders (including the 23 groups described in subparagraph (D)) on the 24 information to be included in the notice. 25 VerDate Sep 11 2014 07:36 Dec 10, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6201 E:\BILLS\H2477.RFS H2477 pbinns on DSKJLVW7X2PROD with BILLS 5 HR 2477 RFS ‘‘(iii) NOTICE IMPROVEMENT.—Beginning 1 4 years after the date of the enactment of this 2 paragraph, and not less than once every 2 years 3 thereafter, the Secretary, in coordination with 4 the Commissioner of Social Security, shall— 5 ‘‘(I) review the content of the notice 6 to be provided under subparagraph (A); 7 ‘‘(II) request written information, in- 8 cluding recommendations, on such notice 9 through a request for information process 10 as described in clause (ii); and 11 ‘‘(III) update and revise such notice 12 as the Secretary deems appropriate. 13 ‘‘(D) GROUPS.—For purposes of subparagraph 14 (C)(ii), the groups described in this subparagraph 15 include the following: 16 ‘‘(i) Individuals who are 60 years of age or 17 older. 18 ‘‘(ii) Veterans. 19 ‘‘(iii) Individuals with disabilities. 20 ‘‘(iv) Individuals with end stage renal dis- 21 ease. 22 ‘‘(v) Low-income individuals and families. 23 ‘‘(vi) Employers (including human re- 24 sources professionals). 25 VerDate Sep 11 2014 07:36 Dec 10, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6201 E:\BILLS\H2477.RFS H2477 pbinns on DSKJLVW7X2PROD with BILLS 6 HR 2477 RFS ‘‘(vii) States (including representatives of 1 State-run Health Insurance Exchanges, Med- 2 icaid offices, and Departments of Insurance). 3 ‘‘(viii) State Health Insurance Assistance 4 Programs. 5 ‘‘(ix) Health insurers. 6 ‘‘(x) Health insurance agents and brokers. 7 ‘‘(xi) Such other groups as specified by the 8 Secretary. 9 ‘‘(E) POSTING OF NOTICE ON WEBSITES.—The 10 Commissioner of Social Security and the Secretary 11 shall post the notice required under subparagraph 12 (A) on the public Internet website of the Social Se- 13 curity Administration and on Medicare.gov (or a 14 successor website), respectively. 15 ‘‘(F) REIMBURSEMENT OF COSTS.— 16 ‘‘(i) IN GENERAL.—Effective for fiscal 17 years beginning in the year in which the date 18 of enactment of this paragraph occurs, the 19 Commissioner of Social Security and the Sec- 20 retary shall enter into an agreement under 21 which the Secretary shall provide for the trans- 22 fer, from the Federal Hospital Insurance Trust 23 Fund under section 1817 and the Federal Sup- 24 plementary Medical Insurance Trust Fund 25 VerDate Sep 11 2014 07:36 Dec 10, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H2477.RFS H2477 pbinns on DSKJLVW7X2PROD with BILLS 7 HR 2477 RFS under section 1841 (in such proportion as the 1 Secretary determines appropriate), of such 2 sums as necessary to cover the administrative 3 costs of the Commissioner’s activities under this 4 paragraph. Such agreement shall— 5 ‘‘(I) provide funds to the Commis- 6 sioner for the administrative costs of the 7 Social Security Administration’s work re- 8 lated to the implementation of this para- 9 graph, including any initial costs incurred 10 prior to the finalization of such agreement; 11 ‘‘(II) provide such funding quarterly 12 in advance of the applicable quarter based 13 on estimating methodology agreed to by 14 the Commissioner and the Secretary; and 15 ‘‘(III) require an annual accounting 16 (with a detailed description of the costs 17 and methodology used to assess such costs) 18 and reconciliation of the actual costs in- 19 curred and funds provided under this para- 20 graph. 21 ‘‘(ii) LIMITATION.—In no case shall funds 22 from the Social Security Administration’s Limi- 23 tation on Administrative Expenses be used to 24 carry out activities related to the implementa- 25 VerDate Sep 11 2014 07:36 Dec 10, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6201 E:\BILLS\H2477.RFS H2477 pbinns on DSKJLVW7X2PROD with BILLS 8 HR 2477 RFS tion of this paragraph, except as the Commis- 1 sioner determines is necessary— 2 ‘‘(I) for the development of the agree- 3 ment under clause (i); and 4 ‘‘(II) on a temporary basis and sub- 5 ject to reimbursement under clause (i)(I), 6 for the initial implementation of this para- 7 graph. 8 ‘‘(G) NO EFFECT ON OBLIGATION TO MAIL 9 STATEMENTS.—Nothing in this paragraph shall be 10 construed to relieve the Commissioner of Social Se- 11 curity from any requirement under subsection (c), 12 including the requirement to mail a statement on an 13 annual basis to each eligible individual who is not re- 14 ceiving benefits under title II and for whom a mail- 15 ing address can be determined through such meth- 16 ods as the Commissioner determines to be appro- 17 priate.’’. 18 (B) TIMING OF STATEMENTS.—Section 19 1143(c)(2) of such Act (42 U.S.C. 1320b- 20 13(c)(2)) is amended by adding at the end the 21 following: ‘‘With respect to statements provided 22 to individuals who are attaining age 65, as de- 23 scribed in subsection (a)(4), such statements 24 shall be mailed not earlier than 6 months and 25 VerDate Sep 11 2014 07:36 Dec 10, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2477.RFS H2477 pbinns on DSKJLVW7X2PROD with BILLS 9 HR 2477 RFS not later than 3 months before the individual 1 attains such age.’’ 2 (2) SOCIAL SECURITY BENEFICIARIES.—Title 3 XI of the Social Security Act (42 U.S.C. 1301 et 4 seq.) is amended by inserting after section 1144 the 5 following new section: 6 ‘‘MEDICARE ENROLLMENT NOTIFICATION AND ELIGI- 7 BILITY NOTICES FOR SOCIAL SECURITY BENE- 8 FICIARIES PRIOR TO MEDICARE ELIGIBILITY 9 ‘‘Notices 10 ‘‘SEC. 1144A. (a) 11 ‘‘(1) IN GENERAL.—The Commissioner of So- 12 cial Security shall distribute the notice to be pro- 13 vided pursuant to section 1143(a)(4), as may be 14 modified under paragraph (2), to individuals entitled 15 to monthly insurance benefits under title II in ac- 16 cordance with subsection (b). 17 ‘‘(2) AUTHORITY TO MODIFY NOTICE.—The 18 Secretary, in coordination with the Commissioner of 19 Social Security, may modify the notice to be distrib- 20 uted under paragraph (1) as necessary to take into 21 account the individuals described in such paragraph. 22 ‘‘(3) POSTING OF NOTICE ON WEBSITES.—The 23 Commissioner of Social Security and the Secretary 24 shall post the notice required to be distributed under 25 paragraph (1) on the public Internet website of the 26 VerDate Sep 11 2014 07:36 Dec 10, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2477.RFS H2477 pbinns on DSKJLVW7X2PROD with BILLS 10 HR 2477 RFS Social Security Administration and on Medicare.gov 1 (or a successor website), respectively. 2 ‘‘Timing 3 ‘‘(b) Beginning not later than 2 years after the date 4 of the enactment of this section, a notice required under 5 subsection (a)(1) shall be mailed to an individual described 6 in such subsection— 7 ‘‘(1) in the third month before the date on 8 which such individual’s initial enrollment period be- 9 gins as provided under section 1837; and 10 ‘‘(2) in the case of an individual with respect to 11 whom section 226(b) applies (except for an indi- 12 vidual who will attain age 65 during the 24 month 13 period described in such section), in the month be- 14 fore such date on which such individual’s initial en- 15 rollment period so begins. 16 ‘‘Reimbursement of Costs 17 ‘‘(c) 18 ‘‘(1) IN GENERAL.—Effective for fiscal years 19 beginning in the year in which the date of enactment 20 of this section occurs, the Commissioner of Social 21 Security and the Secretary shall enter into an agree- 22 ment under which the Secretary shall provide for the 23 transfer, from the Federal Hospital Insurance Trust 24 Fund under section 1817 and the Federal Supple- 25 VerDate Sep 11 2014 07:36 Dec 10, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6201 E:\BILLS\H2477.RFS H2477 pbinns on DSKJLVW7X2PROD with BILLS 11 HR 2477 RFS mentary Medical Insurance Trust Fund under sec- 1 tion 1841 (in such proportion as the Secretary de- 2 termines appropriate), of such sums as necessary to 3 cover the administrative costs of the Commissioner’s 4 activities under this section. Such agreement shall— 5 ‘‘(A) provide funds to the Commissioner 6 for the administrative costs of the Social Secu- 7 rity Administration’s work related to the imple- 8 mentation of this section, including any initial 9 costs incurred prior to the finalization of such 10 agreement; 11 ‘‘(B) provide such funding quarterly in ad- 12 vance of the applicable quarter based on esti- 13 mating methodology agreed to by the Commis- 14 sioner and the Secretary; and 15 ‘‘(C) require an annual accounting (with a 16 detailed description of the costs and method- 17 ology used to assess such costs) and reconcili- 18 ation of the actual costs incurred and funds 19 provided under this paragraph. 20 ‘‘(2) LIMITATION.—In no case shall funds from 21 the Social Security Administration’s Limitation on 22 Administrative Expenses be used to carry out activi- 23 ties related to the implementation of this section, ex- 24 cept as the Commissioner determines is necessary— 25 VerDate Sep 11 2014 07:36 Dec 10, 2020 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6201 E:\BILLS\H2477.RFS H2477 pbinns on DSKJLVW7X2PROD with BILLS 12 HR 2477 RFS ‘‘(A) for the development of the agreement 1 under paragraph (1); and 2 ‘‘(B) on a temporary basis and subject to 3 reimbursement under paragraph (1)(A), for the 4 initial implementation of this section.’’. 5 (b) BENEFICIARY ENROLLMENT SIMPLIFICATION.— 6 (1) EFFECTIVE DATE OF COVERAGE.—Section 7 1838(a) of the Social Security Act (42 U.S.C. 8 1395q(a)) is amended— 9 (A) by amending paragraph (2) to read as 10 follows: 11 ‘‘(2)(A) in the case of an individual who enrolls 12 pursuant to subsection (d) of section 1837 before 13 the month in which he first satisfies paragraph (1) 14 or (2) of section 1836(a), the first day of such 15 month, 16 ‘‘(B) in the case of an individual who first sat- 17 isfies such paragraph in a month beginning before 18 January 2023 and who enrolls pursuant to such 19 subsection (d)— 20 ‘‘(i) in such month in which he first satis- 21 fies such paragraph, the first day of the month 22 following the month in which he so enrolls, 23 ‘‘(ii) in the month following such month in 24 which he first satisfies such paragraph, the first 25 VerDate Sep 11 2014 07:36 Dec 10, 2020 Jkt 019200 PO 00000 Frm 00012 Fmt 6652 Sfmt 6201 E:\BILLS\H2477.RFS H2477 pbinns on DSKJLVW7X2PROD with BILLS 13 HR 2477 RFS day of the second month following the month in 1 which he so enrolls, or 2 ‘‘(iii) more than one month foll [Text truncated for display. 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