Summary of Part D Low-Income Focused Legislation Currently Pending Before Congress

Several bills related to Low-Income Part D enrollees are currently pending before Congress (June 5, 2007).

S. 1102 (Bingaman): Part D Equity for Low-Income Seniors Act of 2007.

The bill covers four areas: simplifying and increasing enrollment in the LIS, liberalizing eligibility for LIS by changing resource limits, changing the index used for annual increases in deductibles and cost sharing for LIS beneficiaries, and removing LIS from impact on eligibility for other federal benefit programs. 

The enrollment section:  (1) authorizes the IRS to disclose to SSA income information on individuals who may be eligible for the LIS and requires SSA to establish an expedited process to screen these individuals for LIS and MSP eligibility; (2) requires SSA to notify such identified individuals and to use an application form that only requires attestation under penalty of perjury of the individual’s income and assets without additional documentation; (3) provides that an individual can specify a preferred non-English language and that SSA must subsequently communicate with the individual in that language; and (4) holds individuals harmless for good faith attestations that later prove erroneous.

The eligibility portion of the bill: (1) increases the resource limit for the LIS; and (2) excludes life insurance policy value, in-kind contributions and pension or retirement plan balances from resource counting; 

The index portion requires use of the Consumer Price Index (CPI) to determine annual increases in the deductible and cost sharing required of LIS beneficiaries.  Current law requires use of an index based on increases in the costs of Part D drugs.

Finally, the bill requires that benefits not be taken into account in determining eligibility for or benefit amounts under any other Federal program.

 

S 1103 (Bingaman) Helping Fill the Medicare Rx Gap Act of 2007.

The bill proposes to change TrOOP calculations so that costs incurred by the Indian Health Service, federally qualified health centers, Public Health hospitals, ADAPs and pharmaceutical company Patient Assistance Programs (PAPs) count towards TrOOP for a Part D beneficiary.  Prescription drugs provided by a PAP will be valued at the negotiated price of the drug under the beneficiary’s PDP or MA-PD as of the date the drug was distributed or donated. 

  

S. 1107 (Smith) Home and Community Services Copayment Equity Act of 2007.

The bill proposes a $0 copay for full-benefit duals in assisted living, board and care, or similar facilities such as a psychiatric health facility, a mental health rehabilitation center or a mental retardation developmental disability facility or receiving home and community based services under a Medicaid waiver.

  

S 1108 (Smith) Medicare Part D Outreach and Enrollment Enhancement Act of 2007.

The bill focuses on enrollment of LIS recipients, funding for LIS, SSA screening for Medicare Savings Programs, and a study of screening options. 

For LIS enrollments, the bill provides for a 90 day special enrollment period for newly eligible LIS beneficiaries, including those already enrolled in a Part D plan; changes the current random facilitated enrollment provision for such individuals to facilitated enrollment “in the prescription drug plan or MA-PD plan that is most appropriate for such individual;” guarantees a once a year SEP for all LIS recipients; and eliminates the late enrollment penalty for all LIS recipients. 

For funding, the bill authorizes annual appropriations for 2008-2011 of approximately $1/Medicare Part D eligible individuals to fund SHIP outreach programs for Part D.  In addition, it appropriates $4 million to the National Center on Senior Benefits Outreach and Enrollment to fund outreach and enrollment assistance for the LIS.

The Medicare Savings Plan screening portion of the bill requires that SSA screen all LIS applicants for MSP eligibility. 

Finally, the bill requires the Administration on Aging to conduct a study of screening processes used by Federal and state needs-based programs to determine the feasibility of creating a uniform screening process, of using the Internet to administer such a process or, if a unified screening process is not possible, of improving and streamlining current procedures. 

  

H.R. 2056 (Courtney) Medicare Part D Improvement Act of 2007. 

The bill addresses four areas: TrOOP calculation, late enrollment penalty, enrollment periods and LIS improvements.

For TrOOP, the bill’s provisions are identical to those of S.1103 except that the House bill includes payments by rural health clinics, which are not included in S.1103.

For the late enrollment penalty, the bill changes the late enrollment penalty to 10% of the annual base beneficiary premium, does not count periods of non enrollment during 2006 and 2007.  In addition, the bill creates a rebuttable presumption that an individual’s unintended, inadvertent or erroneous enrollment or nonenrollment is the result of an error or misrepresentation of a government agent.

The bill permits individuals to change plans whenever their plans change formularies.  In addition, all beneficiaries may change PDP or MA-PD plans during the first three months of each year, the same period in which there is an annual Open Enrollment Period for MA plans.

For the Low Income Subsidy, the bill removes the asset test and excludes all LIS eligible individuals from the late enrollment penalty

 

H.R. 1536 (Doggett) Prescription Coverage Now Act of 2007.

The bill requires expedited LIS screening and application, including opt-in provisions; changes in resource and income limits for LIS; changes the index for the LIS; eliminates LIS impact on eligibility for other federal programs; requires screening for MSP; establishes a special enrollment period for LIS recipients; and waives late enrollment penalties for LIS eligible individuals.  It is very similar to S.1102. 

For LIS screening, it authorizes the IRS to provide data to SSA and CMS to identify LIS eligible individuals.  It also requires that CMS establish an opt-in option for an expedited process of LIS screening.  It further requires that plans include opt-in provisions in their applications.  It requires a one page form with a simple attestation of resources and income, and with a provision allowing for specification of a preferred non-English language, which must be used thereafter by SSA.  It requires follow up by CMS if individuals fail to respond to outreach letters and includes a hold-harmless provision for erroneous attestations. SSA processing of LIS applications must include MSP screening.   

For resource limits, the bill changes the current resource limit for the full LIS from three times the SSI limit to six times the SSI limit, increased annually by the CPI.  To qualify for the partial subsidy, the dollar limit is four times the limit in place when the bill is enacted (the current limit is $11,710/$23,410).  Further, it exempts all life insurance values, pension or retirement plan balances from resource counting and in-kind support from income counting. 

It changes the index for LIS deductibles and cost-sharing to the CPI, and requires that LIS eligibility have no impact on eligibility for benefits under other Federal programs.  

The bill provides for facilitated enrollment of LIS qualified individuals into a plan appropriate to the individual, instead of random enrollment, and gives all LIS-eligibles one annual SEP.  Late enrollment penalties are waived for all LIS recipients.