Sec. 2. Beneficiary enrollment notification and eligibility simplification

2,517 words·~11 min read·/bill/116/hr/2477/eh/section-2

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Section 1143(a) of the Social Security Act ( 42 U.S.C. 1320b–13(a) ) is amended by adding at the end the following new paragraph: In the case of statements provided on or after the date that is 2 years after the date of the enactment of this paragraph to individuals who are attaining ages 63, 64, and 65, the statement shall also include a notice containing the information described in subparagraph (B). The notice required under subparagraph

(A)shall include a clear, simple explanation of— eligibility for benefits under the Medicare program under title XVIII, and in particular benefits under parts B and C of such title; the reasons a late enrollment penalty for failure to timely enroll could be assessed and how such late enrollment penalty is calculated, in particular for benefits under such part B; the availability of relief from such late enrollment penalty and retroactive enrollment under section 1837(h) (including as such section is applied under sections 1818(c) and 1818A(c)(3)), with examples of circumstances under which such relief may be granted and examples of circumstances under which such relief would not be granted; coordination of benefits (including primary and secondary coverage scenarios) pursuant to section 1862(b), in particular for benefits under such part B; enrollment, eligibility, and coordination of benefits under title XVIII with respect to populations, for whom there are special considerations, such as residents of Puerto Rico and veterans; and online resources and toll-free telephone numbers of the Social Security Administration and the Centers for Medicare & Medicaid Services (including 1–800–MEDICARE and the national toll-free number of the Social Security Administration) that provide information on eligibility for benefits under the Medicare program under title XVIII, including under part C of such title. The Secretary, in coordination with the Commissioner of Social Security, and taking into consideration information collected pursuant to clause (ii), shall, not later than 12 months after the last day of the period for the request of information described in clause (ii), develop the notice to be provided pursuant to subparagraph (A). Not later than 6 months after the date of the enactment of this paragraph, the Secretary shall request written information, including recommendations, from stakeholders (including the groups described in subparagraph (D)) on the information to be included in the notice. Beginning 4 years after the date of the enactment of this paragraph, and not less than once every 2 years thereafter, the Secretary, in coordination with the Commissioner of Social Security, shall— review the content of the notice to be provided under subparagraph (A); request written information, including recommendations, on such notice through a request for information process as described in clause (ii); and update and revise such notice as the Secretary deems appropriate. For purposes of subparagraph (C)(ii), the groups described in this subparagraph include the following: Individuals who are 60 years of age or older. Veterans. Individuals with disabilities. Individuals with end stage renal disease. Low-income individuals and families. Employers (including human resources professionals). States (including representatives of State-run Health Insurance Exchanges, Medicaid offices, and Departments of Insurance). State Health Insurance Assistance Programs. Health insurers. Health insurance agents and brokers. Such other groups as specified by the Secretary. The Commissioner of Social Security and the Secretary shall post the notice required under subparagraph

(A)on the public Internet website of the Social Security Administration and on Medicare.gov (or a successor website), respectively. Effective for fiscal years beginning in the year in which the date of enactment of this paragraph occurs, the Commissioner of Social Security and the Secretary shall enter into an agreement under which the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), of such sums as necessary to cover the administrative costs of the Commissioner’s activities under this paragraph. Such agreement shall— provide funds to the Commissioner for the administrative costs of the Social Security Administration’s work related to the implementation of this paragraph, including any initial costs incurred prior to the finalization of such agreement; provide such funding quarterly in advance of the applicable quarter based on estimating methodology agreed to by the Commissioner and the Secretary; and require an annual accounting (with a detailed description of the costs and methodology used to assess such costs) and reconciliation of the actual costs incurred and funds provided under this paragraph. In no case shall funds from the Social Security Administration’s Limitation on Administrative Expenses be used to carry out activities related to the implementation of this paragraph, except as the Commissioner determines is necessary— for the development of the agreement under clause (i); and on a temporary basis and subject to reimbursement under clause (i)(I), for the initial implementation of this paragraph. Nothing in this paragraph shall be construed to relieve the Commissioner of Social Security from any requirement under subsection (c), including the requirement to mail a statement on an annual basis to each eligible individual who is not receiving benefits under title II and for whom a mailing address can be determined through such methods as the Commissioner determines to be appropriate. . Section 1143(c)(2) of such Act ( 42 U.S.C. 1320b-13(c)(2) ) is amended by adding at the end the following: With respect to statements provided to individuals who are attaining age 65, as described in subsection (a)(4), such statements shall be mailed not earlier than 6 months and not later than 3 months before the individual attains such age. Title XI of the Social Security Act ( 42 U.S.C. 1301 et seq.) is amended by inserting after section 1144 the following new section: The Commissioner of Social Security shall distribute the notice to be provided pursuant to section 1143(a)(4), as may be modified under paragraph (2), to individuals entitled to monthly insurance benefits under title II in accordance with subsection (b). The Secretary, in coordination with the Commissioner of Social Security, may modify the notice to be distributed under paragraph

(1)as necessary to take into account the individuals described in such paragraph. The Commissioner of Social Security and the Secretary shall post the notice required to be distributed under paragraph

(1)on the public Internet website of the Social Security Administration and on Medicare.gov (or a successor website), respectively. Beginning not later than 2 years after the date of the enactment of this section, a notice required under subsection (a)(1) shall be mailed to an individual described in such subsection— in the third month before the date on which such individual’s initial enrollment period begins as provided under section 1837; and in the case of an individual with respect to whom section 226(b) applies (except for an individual who will attain age 65 during the 24 month period described in such section), in the month before such date on which such individual’s initial enrollment period so begins. Effective for fiscal years beginning in the year in which the date of enactment of this section occurs, the Commissioner of Social Security and the Secretary shall enter into an agreement under which the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), of such sums as necessary to cover the administrative costs of the Commissioner’s activities under this section. Such agreement shall— provide funds to the Commissioner for the administrative costs of the Social Security Administration’s work related to the implementation of this section, including any initial costs incurred prior to the finalization of such agreement; provide such funding quarterly in advance of the applicable quarter based on estimating methodology agreed to by the Commissioner and the Secretary; and require an annual accounting (with a detailed description of the costs and methodology used to assess such costs) and reconciliation of the actual costs incurred and funds provided under this paragraph. In no case shall funds from the Social Security Administration’s Limitation on Administrative Expenses be used to carry out activities related to the implementation of this section, except as the Commissioner determines is necessary— for the development of the agreement under paragraph (1); and on a temporary basis and subject to reimbursement under paragraph (1)(A), for the initial implementation of this section. . Section 1838(a) of the Social Security Act ( 42 U.S.C. 1395q(a) ) is amended— by amending paragraph

(2)to read as follows: in the case of an individual who enrolls pursuant to subsection

(d)of section 1837 before the month in which he first satisfies paragraph

(1)or

(2)of section 1836(a), the first day of such month, in the case of an individual who first satisfies such paragraph in a month beginning before January 2023 and who enrolls pursuant to such subsection (d)— in such month in which he first satisfies such paragraph, the first day of the month following the month in which he so enrolls, in the month following such month in which he first satisfies such paragraph, the first day of the second month following the month in which he so enrolls, or more than one month following such month in which he satisfies such paragraph, the first day of the third month following the month in which he so enrolls, in the case of an individual who first satisfies such paragraph in a month beginning on or after January 1, 2023, and who enrolls pursuant to such subsection

(d)in such month in which he first satisfies such paragraph or in any subsequent month of his initial enrollment period, the first day of the month following the month in which he so enrolls, or in the case of an individual who enrolls pursuant to subsection

(e)of section 1837 in a month beginning— before January 1, 2023, the July 1 following the month in which he so enrolls; or on or after January 1, 2023, the first day of the month following the month in which he so enrolls; or ; and by amending paragraph

(3)to read as follows: in the case of an individual who is deemed to have enrolled— on or before the last day of the third month of his initial enrollment period, the first day of the month in which he first meets the applicable requirements of section 1836(a) or July 1, 1973, whichever is later, or on or after the first day of the fourth month of his initial enrollment period, and where such month begins— before January 1, 2023, as prescribed under subparagraphs (B)(i), (B)(ii), (B)(iii), and (D)(i) of paragraph (2), or on or after January 1, 2023, as prescribed under subparagraphs

(C)and (D)(ii) of paragraph (2). . Section 1837 of the Social Security Act ( 42 U.S.C. 1395p ) is amended by adding at the end the following new subsection: Beginning January 1, 2023, the Secretary may establish special enrollment periods in the case of individuals who satisfy paragraph

(1)or

(2)of section 1836(a) and meet such exceptional conditions as the Secretary may provide. . Section 1838 of the Social Security Act ( 42 U.S.C. 1395q ) is amended by adding at the end the following new subsection: Notwithstanding subsection (a), in the case of an individual who enrolls during a special enrollment period pursuant to section 1837(m), the coverage period shall begin on a date the Secretary provides in a manner consistent (to the extent practicable) with protecting continuity of health benefit coverage. . Title XVIII of the Social Security Act ( 42 U.S.C. 1395 et seq.) is amended— in section 1818A(c)(3), by striking subsections

(h)and

(i)of section 1837 and inserting subsections (h), (i), and

(m)of section 1837 ; and in section 1839(b), in the first sentence, by striking or

(l)and inserting , (l), or

(m). Section 1839(b) of the Social Security Act ( 42 U.S.C. 1395r(b) ) is amended by adding at the end the following new sentence: For purposes of determining any increase under this subsection for individuals whose enrollment occurs on or after January 1, 2023, the second sentence of this subsection shall be applied by substituting . close of the month for close of the enrollment period each place it appears. Not later than January 1, 2023, the Secretary of Health and Human Services shall submit to the Committee on Ways and Means and Committee on Energy and Commerce of the House of Representatives and the Committee on Finance and Special Committee on Aging of the Senate a report on how to align existing Medicare enrollment periods under title XVIII of the Social Security Act, including the general enrollment period under part B of such title and the annual, coordinated election period under the Medicare Advantage program under part C of such title and under the prescription drug program under part D of such title. Such report shall include recommendations consistent with the goals of maximizing coverage continuity and choice and easing beneficiary transition. The Comptroller General of the United States (in this section referred to as the Comptroller General ) shall conduct a study on the activities carried out under this section. Such study shall include the following: An analysis of the Social Security Administration’s use of the funds provided to carry out the activities described under this section and the amendments made by this section. The Comptroller General shall examine the amount of funds transferred from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund, respectively, for those activities; how the funds were spent; what procedures the agency had in place over the use of those funds; and how the agency complied with those procedures. An evaluation of the notices described in sections 1143(a)(4)(A) and 1144A(a) of the Social Security Act, including, to the extent data is available, how the mailing of such notices affected enrollee behavior and the imposition of late enrollment penalties under Medicare Part B. Any other area determined appropriate by the Comptroller General. Not later than 5 years after the date of enactment of this section, the Comptroller General shall submit to the Committee on Ways and Means and Committee on Energy and Commerce of the House of Representatives and the Committee on Finance of the Senate a report containing the results of the study conducted under paragraph (1), including recommendations for any legislative and administrative actions as the Comptroller General determines appropriate. Section 1808 of the Social Security Act ( 42 U.S.C. 1395b–9 ) is amended by adding the end the following new subsection: For purposes of carrying out the provisions of and the amendments made by section 2 of the BENES Act of 2020, the Secretary shall provide for the transfer, from the Federal Hospital Insurance Trust Fund under section 1817 and the Federal Supplementary Medical Insurance Trust Fund under section 1841 (in such proportion as the Secretary determines appropriate), to the Centers for Medicare & Medicaid Services Program Management Account, of $2,000,000 for each fiscal year beginning with fiscal year 2021, to remain available until expended. .

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