BETTER Act of 2019

IB Union Calendar No. 574 116TH CONGRESS 2D SESSION H. R. 3417 [Report No. 116–691, Part I] To amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improvements under the Medicare program. IN THE HOUSE OF REPRESENTATIVES JUNE 21, 2019 Mr. NEAL (for himself and Mr. BRADY) introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provi- sions as fall within the jurisdiction of the committee concerned DECEMBER 24, 2020 Reported from the Committee on Ways and Means with an amendment [Strike out all after the enacting clause and insert the part printed in italic] DECEMBER 24, 2020 Committee on Energy and Commerce discharged; committed to the Committee of the Whole House on the State of the Union and ordered to be printed [For text of introduced bill, see copy of bill as introduced on June 21, 2019] VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00001 Fmt 6652 Sfmt 6652 E:\BILLS\H3417.RH H3417 pbinns on DSKJLVW7X2PROD with BILLS 2 •HR 3417 RH A BILL To amend title XVIII of the Social Security Act to provide for patient improvements and rural and quality improve- ments under the Medicare program. VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6652 E:\BILLS\H3417.RH H3417 pbinns on DSKJLVW7X2PROD with BILLS 3 •HR 3417 RH 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; TABLE OF CONTENTS. 3 (a) SHORT TITLE.—This Act may be cited as the 4 ‘‘Beneficiary Education Tools, Telehealth, and Extenders 5 Reauthorization Act of 2019’’ or the ‘‘BETTER Act of 6 2019’’. 7 (b) TABLE OF CONTENTS.—The table of contents for 8 this Act is as follows: 9 Sec. 1. Short title; table of contents. TITLE I—PATIENT IMPROVEMENTS Sec. 101. Beneficiary enrollment notification and eligibility simplification. Sec. 102. Extension of funding outreach and assistance for low-income programs. Sec. 103. Medicare coverage of certain mental health telehealth services. Sec. 104. Requiring prescription drug plan sponsors to include real-time benefit information as part of such sponsor’s electronic prescription pro- gram under the Medicare program. Sec. 105. Transitional coverage and retroactive Medicare part D coverage for cer- tain low-income beneficiaries. TITLE II—RURAL AND QUALITY IMPROVEMENTS Sec. 201. Medicare GME treatment of hospitals establishing new medical resi- dency training programs after hosting medical resident rotators for short durations. Sec. 202. Extension of the work geographic index floor under the Medicare pro- gram. Sec. 203. Extension of funding for quality measure endorsement, input, and selec- tion under Medicare program. Sec. 204. Improving measurements under the skilled nursing facility value-based purchasing program under the Medicare program. TITLE I—PATIENT 10 IMPROVEMENTS 11 SEC. 101. BENEFICIARY ENROLLMENT NOTIFICATION AND 12 ELIGIBILITY SIMPLIFICATION. 13 (a) ELIGIBILITY AND ENROLLMENT NOTICES.— 14 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00003 Fmt 6652 Sfmt 6203 E:\BILLS\H3417.RH H3417 pbinns on DSKJLVW7X2PROD with BILLS 4 •HR 3417 RH (1) AS PART OF SOCIAL SECURITY ACCOUNT 1 STATEMENT FOR INDIVIDUALS ATTAINING AGES 63 TO 2 65.—Section 1143(a) of the Social Security Act (42 3 U.S.C. 1320b–13(a)) is amended by adding at the end 4 the following new paragraph: 5 ‘‘(4) MEDICARE ELIGIBILITY INFORMATION.— 6 ‘‘(A) IN GENERAL.—In the case of statements 7 provided on or after the date that is 2 years after the 8 date of the enactment of this paragraph to individ- 9 uals who are attaining ages 63, 64, and 65, the state- 10 ment shall also include a notice containing the infor- 11 mation described in subparagraph (B). 12 ‘‘(B) CONTENTS OF NOTICE.—The notice re- 13 quired under subparagraph (A) shall include a clear, 14 simple explanation of— 15 ‘‘(i) eligibility for benefits under the Medi- 16 care program under title XVIII, and in par- 17 ticular benefits under part B of such title; 18 ‘‘(ii) the reasons a late enrollment penalty 19 for failure to timely enroll could be assessed and 20 how such late enrollment penalty is calculated, 21 in particular for benefits under part B; 22 ‘‘(iii) the availability of relief from the late 23 enrollment penalty and retroactive enrollment 24 under section 1837(h) (including as such section 25 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00004 Fmt 6652 Sfmt 6203 E:\BILLS\H3417.RH H3417 pbinns on DSKJLVW7X2PROD with BILLS 5 •HR 3417 RH is applied under sections 1818(c) and 1 1818A(c)(3)), with examples of circumstances 2 under which such relief may be granted and ex- 3 amples of circumstances under which such relief 4 would not be granted; 5 ‘‘(iv) coordination of benefits (including 6 primary and secondary coverage scenarios) pur- 7 suant to section 1862(b), in particular for bene- 8 fits under part B of such title; and 9 ‘‘(v) information for populations, such as 10 residents of Puerto Rico and veterans, for whom 11 there are special considerations with respect to 12 enrollment, eligibility, and coordination of bene- 13 fits under title XVIII. 14 ‘‘(C) DEVELOPMENT OF NOTICE.— 15 ‘‘(i) IN GENERAL.—The Secretary, in co- 16 ordination with the Commissioner of Social Se- 17 curity, and taking into consideration informa- 18 tion collected pursuant to clause (ii), shall, not 19 later than 12 months after the last day of the pe- 20 riod for the request of information described in 21 clause (ii), develop the notice to be provided pur- 22 suant to subparagraph (A). 23 ‘‘(ii) REQUEST FOR INFORMATION.—Not 24 later than 6 months after the date of the enact- 25 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00005 Fmt 6652 Sfmt 6203 E:\BILLS\H3417.RH H3417 pbinns on DSKJLVW7X2PROD with BILLS 6 •HR 3417 RH ment of this paragraph, the Secretary shall re- 1 quest written information, including rec- 2 ommendations, from stakeholders (including the 3 groups described in subparagraph (D)) on the 4 information to be included in the notice. 5 ‘‘(iii) NOTICE IMPROVEMENT.—Beginning 4 6 years after the date of enactment of this para- 7 graph, and not less than once every two years 8 thereafter, the Secretary, in coordination with 9 the Commissioner of Social Security, shall— 10 ‘‘(I) review the content of the notice to 11 be provided under subparagraph (A); 12 ‘‘(II) solicit recommendations on the 13 notice through a request for information 14 process as described in clause (ii); and 15 ‘‘(III) update and revise such notice as 16 the Secretary deems appropriate. 17 ‘‘(D) GROUPS FOR CONSULTATION.—For pur- 18 poses of subparagraph (C)(ii), the groups described in 19 this clause include the following: 20 ‘‘(i) Individuals who are 60 years of age or 21 older. 22 ‘‘(ii) Veterans. 23 ‘‘(iii) Individuals with disabilities. 24 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6203 E:\BILLS\H3417.RH H3417 pbinns on DSKJLVW7X2PROD with BILLS 7 •HR 3417 RH ‘‘(iv) Individuals with end stage renal dis- 1 ease. 2 ‘‘(v) Low-income individuals and families. 3 ‘‘(vi) Employers (including human re- 4 sources professionals). 5 ‘‘(vii) States (including representatives of 6 State-run Health Insurance Exchanges, Medicaid 7 offices, and Departments of Insurance). 8 ‘‘(viii) State Health Insurance Assistance 9 Programs. 10 ‘‘(ix) Health insurers. 11 ‘‘(x) Health insurance agents and brokers. 12 ‘‘(xi) Such other groups as specified by the 13 Secretary. 14 ‘‘(E) POSTING OF NOTICE ON WEBSITES.—The 15 Commissioner of Social Security and the Secretary 16 shall post the notice required under subparagraph (A) 17 in a prominent location on the public Internet 18 website of the Social Security Administration and on 19 the public Internet website of the Centers for Medicare 20 & Medicaid Services, respectively. 21 ‘‘(F) REIMBURSEMENT OF COSTS.— 22 ‘‘(i) IN GENERAL.—Effective for fiscal years 23 beginning in the year in which the date of enact- 24 ment of this paragraph occurs, the Commissioner 25 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00007 Fmt 6652 Sfmt 6203 E:\BILLS\H3417.RH H3417 pbinns on DSKJLVW7X2PROD with BILLS 8 •HR 3417 RH of Social Security and the Secretary shall enter 1 into an agreement which shall provide funding 2 to cover the administrative costs of the Commis- 3 sioner’s activities under this paragraph. Such 4 agreement shall— 5 ‘‘(I) provide funds to the Commissioner 6 for the full cost of the Social Security Ad- 7 ministration’s work related to the imple- 8 mentation of this paragraph, including any 9 costs incurred prior to the finalization of 10 such agreement; 11 ‘‘(II) provide such funding quarterly 12 in advance of the applicable quarter based 13 on estimating methodology agreed to by the 14 Commissioner and the Secretary; and 15 ‘‘(III) require an annual accounting 16 and reconciliation of the actual costs in- 17 curred and funds provided under this para- 18 graph. 19 ‘‘(ii) LIMITATION.—In no case shall funds 20 from the Social Security Administration’s Limi- 21 tation on Administrative Expenses be used to 22 carry out activities related to the implementa- 23 tion of this paragraph, except as the Commis- 24 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6203 E:\BILLS\H3417.RH H3417 pbinns on DSKJLVW7X2PROD with BILLS 9 •HR 3417 RH sioner determines is necessary in developing the 1 agreement under clause (i). 2 ‘‘(G) NO EFFECT ON OBLIGATION TO MAIL 3 STATEMENTS.—Nothing in this paragraph shall be 4 construed to relieve the Commissioner of Social Secu- 5 rity from any requirement under subsection (c), in- 6 cluding the requirement to mail a statement on an 7 annual basis to each eligible individual who is not re- 8 ceiving benefits under title II and for whom a mail- 9 ing address can be determined through such methods 10 as the Commissioner determines to be appropriate.’’. 11 (2) INDIVIDUALS IN MEDICARE WAITING PE- 12 RIOD.—Title XI of the Social Security Act (42 U.S.C. 13 1301 et seq.) is amended by inserting after section 14 1144 the following new section: 15 ‘‘MEDICARE ENROLLMENT NOTIFICATION AND ELIGIBILITY 16 NOTICES FOR INDIVIDUALS IN MEDICARE WAITING PERIOD 17 ‘‘SEC. 1144A. (a) NOTICES.— 18 ‘‘(1) IN GENERAL.—The Commissioner of Social 19 Security shall distribute the notice to be provided 20 pursuant to section 1143(a)(4), as may be modified 21 under paragraph (2), to individuals in the 24-month 22 waiting period under section 226(b). 23 ‘‘(2) AUTHORITY TO MODIFY NOTICE.—The Sec- 24 retary, in coordination with the Commissioner of So- 25 cial Security, may modify the notice to be distributed 26 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6203 E:\BILLS\H3417.RH H3417 pbinns on DSKJLVW7X2PROD with BILLS 10 •HR 3417 RH under paragraph (1) as necessary to take into ac- 1 count the individuals described in such paragraph. 2 ‘‘(3) POSTING OF NOTICE ON WEBSITES.—The 3 Commissioner of Social Security and the Secretary 4 shall post the notice required to be distributed under 5 paragraph (1) in a prominent location on the public 6 Internet website of the Social Security Administra- 7 tion and on the public Internet website of the Centers 8 for Medicare & Medicaid Services, respectively. 9 ‘‘(b) TIMING.—Beginning not later than 2 years after 10 the date of the enactment of this section, a notice required 11 under subsection (a)(1) shall be mailed to an individual 12 no less than two times in accordance with the following: 13 ‘‘(1) The notice shall be provided to such indi- 14 vidual not later than 3 months prior to the date on 15 which such individual’s enrollment period begins as 16 provided under section 1837. 17 ‘‘(2) The notice shall subsequently be provided to 18 such individual not later than one month prior to 19 such date. 20 ‘‘(c) REIMBURSEMENT OF COSTS.— 21 ‘‘(1) IN GENERAL.—Effective for fiscal years be- 22 ginning in the year in which the date of enactment 23 of this section occurs, the Commissioner of Social Se- 24 curity and the Secretary shall enter into an agree- 25 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00010 Fmt 6652 Sfmt 6203 E:\BILLS\H3417.RH H3417 pbinns on DSKJLVW7X2PROD with BILLS 11 •HR 3417 RH ment which shall provide funding to cover the admin- 1 istrative costs of the Commissioner’s activities under 2 this section. Such agreement shall— 3 ‘‘(A) provide funds to the Commissioner for 4 the full cost of the Social Security Administra- 5 tion’s work related to the implementation of this 6 section, including any costs incurred prior to the 7 finalization of such agreement; 8 ‘‘(B) provide such funding quarterly in ad- 9 vance of the applicable quarter based on esti- 10 mating methodology agreed to by the Commis- 11 sioner and the Secretary; and 12 ‘‘(C) require an annual accounting and rec- 13 onciliation of the actual costs incurred and funds 14 provided under this section. 15 ‘‘(2) LIMITATION.—In no case shall funds from 16 the Social Security Administration’s Limitation on 17 Administrative Expenses be used to carry out activi- 18 ties related to the implementation of this section, ex- 19 cept as the Commissioner determines is necessary in 20 developing the agreement under paragraph (1).’’. 21 (b) BENEFICIARY ENROLLMENT SIMPLIFICATION.— 22 (1) EFFECTIVE DATE OF COVERAGE.—Section 23 1838(a) of the Social Security Act (42 U.S.C. 24 1395q(a)) is amended— 25 VerDate Sep 11 2014 18:11 Dec 26, 2020 Jkt 019200 PO 00000 Frm 00011 Fmt 6652 Sfmt 6203 E:\BILLS\H3417.RH H3417 pbinns on DSKJLVW7X2PROD with BILLS 12 •HR 3417 RH (A) by amending paragraph (2) to read as 1 follows: 2 ‘‘(2)(A) in the case of an individual who enrolls 3 pursuant to subsection (d) of section 1837 before the 4 month in which he first satisfies paragraph (1) or (2) 5 of section 1836, the first day of such month, 6 ‘‘(B) in the case of an individual who first satis- 7 fies such paragraph in a month beginning before Jan- 8 uary 2021 and who enrolls pursuant to such sub- 9 section (d)— 10 ‘‘(i) in such month in which he first satis- 11 fies such paragraph, the first day of the month 12 following the month in which he so enrolls, 13 ‘‘(ii) in the month following such month in 14 which he first satisfies such paragraph, the first 15 day of the second month following the month in 16 which he so enrolls, or 17 ‘‘(iii) more than one month following such 18 month in which he satisfies such paragraph, the 19 first day of the third month fo [Text truncated for display. 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