PROPERTY OF NOV 1 6 REC'D i HCFA LIBRARY 105th CONGRESS H. R. 4799 2d Session To amend title XVIII of the Social Security Act and the Employee Retirement Income Security Act of 1974 to improve access to health insurance and Medicare benefits for individuals ages 55 to 65 to be fully funded through premiums and anti-fraud provisions, to amend title XIX of the Social Security Act to provide financial assistance for those individ- uals who are too poor to afford the premiums, and for other purposes. IN THE HOUSE OF REPRESENTATIVES October 10, 1998 Mr. Pallone introduced the following bill; which was referred to the Commit- tee on Ways and Means, and in addition to the Committees on Com- merce, and Education and the Workforce, 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 A BILL To amend title XVTII of the Social Security Act and the Employee Retirement Income Security Act of 1974 to improve access to health insurance and Medicare benefits for individuals ages 55 to 65 to be fully funded through premiums and anti-fraud provisions, to amend title XIX of the Social Security Act to provide financial assistance for those individuals who are too poor to afford the premiums, and for other purposes. 1 Be it enacted by the Senate and House ofRepresenta- 2 tives ofthe United States ofAmerica in Congress assembled, — SECTION SHORT TITLE; TABLE OF CONTENTS. 1. — (a) Short Title. This Act may be cited as the "Early Medicare Access and Affordability Act of 1998". — Table of Contents. (b) See. 1. Short title; table ofcontents. TITLE I—ACCESS TO MEDICARE BENEFITS FOR INDIVIDUALS 62- TO-65 YEARS OF AGE Sec. 101. Access to medicare benefits for individuals 62-to-65 years of age. "Part D Purchase of Medicare Benefits by Certain Individuals Age 62-TO-65 Years of Age "Sec. 1859. Program benefits; eligibility. "Sec. 1859A. Enrollment process; coverage. "Sec. 1859B. Premiums. "Sec. 1859C. Payment ofpremiums. "Sec. 1859D. Medicare EarlyAccess Trust Fund. "Sec. 1859E. Oversight and accountability. "Sec. 1859F. Administration and miscellaneous." TITLE II—ACCESS TO MEDICARE BENEFITS FOR DISPLACED WORKERS 55-TO-62 YEARS OF AGE Sec. 201. Access to Medicare benefits for displaced workers 55-to-62 years of age. TITLE III—COBRA PROTECTION FOR EARLY RETIREES — Subtitle A Amendments to the Employee Retirement Income Security Act of 1974 Sec. 301. COBRA continuation benefits for certain retired workers who lose re- tiree health coverage. — Subtitle B Amendments to the Public Health Service Act Sec. 311. COBRA continuation benefits for certain retired workers who lose re- tiree health coverage. — Subtitle C Amendments to the Internal Revenue Code of 1986 Sec. 321. COBRA continuation benefits for certain retired workers who lose re- tiree health coverage. TITLE IV—FINANCING Sec. 401. Reference to financing provisions. TITLE V—PROVISION OF PREMIUM ASSISTANCE FOR LOW-IN- COME INDIVIDUALS PURCHASING EARLY COVERAGE UNDER THE MEDICARE PROGRAM •HR 4799 IH —— 3 Sec. 501. Provision ofpremium assistance for low-income individuals purchasing early coverage under the Medicare program. TITLE I—ACCESS TO MEDICARE 1 BENEFITS FOR INDIVIDUALS 2 YEARS OF AGE 62-TO-65 3 4 SEC. 101. ACCESS TO MEDICARE BENEFITS FOR INDIVTD- 5 UALS 62-TO-65 YEARS OF AGE. — 6 (a) In General. Title XVLLT of the Social Security 7 Act is amended D 8 (1) by redesignating section 1859 and part 9 as section 1858 and part E, respectively; and 10 (2) by inserting after such section the following 1 1 new part: D 12 "Part Purchase of Medicare Benefits by 13 Certain Individuals Age 62-to-65 Years of Age 14 "sec. 1859. program benefits; eligibility. 15 "(a) Entitlement to Medicare Benefits for — 16 Enrolled Individuals. 17 "(1) In general.—An individual enrolled 18 under this part is entitled to the same benefits 19 under this title as an individual entitled to benefits A 20 under part and enrolled under part B. — 21 "(2) Definitions. For purposes of this part: 22 "(A) Federal or state cobra continu- — 23 ation provision. The term 'Federal or State COBEA 24 continuation provision' has the mean- •HR 4799 IH 4 ing given the term 'COBRA continuation provi- 1 2 sion' in section 2791(d)(4) of the Public Health 3 Service Act and includes a comparable State 4 program, as determined by the Secretary. 5 "(B) Federal health insurance pro — 6 gram defined. The term 'Federal health in- 7 surance program' means any of the following: 8 "(i) Medicare.—Part A or part B of 9 this title (other than by reason of this 10 part). — A 11 "(ii) Medicaid. State plan under 12 title XLX. FEHBP.— 13 "(in) The Federal employ- 14 ees health benefit program under chapter 15 89 of title 5, United States Code. — 16 "(iv) TRICARE. The TRICARE 17 program (as defined in section 1072(7) of 18 title 10, United States Code). — 19 "(v) Active duty military. Health 20 benefits under title 10, United States 21 Code, to an individual as a member of the 22 uniformed services of the United States. — 23 "(C) Group health plan. The term 24 'group health plan' has the meaning given such HR 4799 IH 1 term in section 2791(a)(1) of the Public Health 2 Service Act. 3 "(b) Eligibility of Individuals Age 62-to-65 — 4 Years of Age. — 5 "(1) In general. Subject to paragraph (2), 6 an individual who meets the following requirements 7 with respect to a month is eligible to enroll under 8 this part with respect to such month: 9 "(A) Age.—As of the last day of the 10 month, the individual has attained 62 years of 1 1 age, but has not attained 65 years of age. 12 "(B) Medicare eligibility (but for — 13 AGE). The individual would be eligible for ben- 14 efits under part A or part B for the month if 15 the individual were 65 years of age. 16 "(C) Not eligible for coverage 17 UNDER GROUP HEALTH PLANS OR FEDERAL — 18 HEALTH INSURANCE PROGRAMS. The individ- 19 ual is not eligible for benefits or coverage under 20 a Federal health insurance program (as defined 21 in subsection (a)(2)(B)) or under a group 22 health plan (other than such eligibility merely COBRA 23 through a Federal or State continu- 24 ation provision) as of the last day of the month 25 involved. HR 4799 IH 6 1 "(2) Limitation on eligibility if termi- — 2 NATED enrollment. If an individual described in 3 paragraph (1) enrolls under this part and coverage 4 of the individual is terminated under section 5 1859A(d) (other than because of age), the individual 6 is not again eligible to enroll under this subsection 7 unless the following requirements are met: 8 "(A) New coverage under group 9 HEALTH PLAN OR FEDERAL HEALTH INSUR- — 10 ANCE PROGRAM. After the date of termination 11 of coverage under such section, the individual 12 obtains coverage under a group health plan or 13 under a Federal health insurance program. 14 11(B) Subsequent loss of new cov- — 15 ERAGE. The individual subsequently loses eli- 16 gibility for the coverage described in subpara- 17 graph (A) and exhausts any eligibility the indi- 18 vidual may subsequently have for coverage COBRA 19 under a Federal or State continuation 20 provision. 21 "(3) Change in health plan eligibility — 22 does not affect coverage. In the case of an 23 individual who is eligible for and enrolls under this 24 part under this subsection, the individual's continued 25 entitlement to benefits under this part shall not be m •HR 4799 — — 7 1 affected by the individual's subsequent eligibility for 2 benefits or coverage described in paragraph (1)(C), 3 or entitlement to such benefits or coverage. 4 "SEC. 1859A. ENROLLMENT PROCESS; COVERAGE. — 5 "(a) In General. An individual may enroll in the 6 program established under this part only in such manner 7 and form as may be prescribed by regulations, and only 8 during an enrollment period prescribed by the Secretary 9 consistent with the provisions of this section. Such regula- 10 tions shall provide a process under which 11 "(1) individuals eligible to enroll as of a month 12 are permitted to pre-enroll during a prior month 13 within an enrollment period described in subsection 14 (b); and 15 "(2) each individual seeking to enroll under sec- 16 tion 1859(b) is notified, before enrolling, of the de- 17 ferred monthly premium amount the individual will 18 be liable for under section 18590(b) upon attaining 19 65 years of age as determined under section 20 1859B(c)(3). — 21 "(b) Enrollment Periods. — 22 "(1) Individuals 62-to-65 years of age. In 23 the case of individuals eligible to enroll under this 24 part under section 1859(b) •HR 4799 IH 8 — 1 "(A) Initial enrollment period. If 2 the individual is eligible to enroll under such 3 section for July 1999, the enrollment period 4 shall begin on May 1, 1999, and shall end on 5 August 31, 1999. Any such enrollment before 6 July 1, 1999, is conditioned upon compliance 7 with the conditions of eligibility for July 1999. — 8 "(B) Subsequent periods. If the indi- 9 vidual is eligible to enroll under such section for 10 a month after July 1999, the enrollment period 1 1 shall begin on the first day of the second month 12 before the month in which the individual first is 13 eligible to so enroll and shall end four months 14 later. Any such enrollment before the first day 15 of the third month of such enrollment period is 16 conditioned upon compliance with the condi- 17 tions of eligibility for such third month. 18 "(2) Authority to correct for govern- — 19 MENT ERRORS. The provisions of section 1837(h) 20 apply with respect to enrollment under this part in 21 the same manner as they apply to enrollment under 22 part B. — 23 "(c) Date Coverage Begins. — 24 "(1) In general. The period during which 25 an individual is entitled to benefits under this part •HR 4799 IH 9 1 shall begin as follows, but in no case earlier than 2 July 1, 1999: 3 "(A) In the case of an individual who en- 4 rolls (including pre-enrolls) before the month in 5 which the individual satisfies eligibility for en- 6 rollment under section 1859, the first day of 7 such month of eligibility. 8 "(B) In the case of an individual who en- 9 rolls during or after the month in which the in- 10 dividual first satisfies eligibility for enrollment 1 1 under such section, the first day of the follow- 12 ing month. 13 "(2) Authority to provide for partial — 14 MONTHS OF COVERAGE. Under regulations, the 15 Secretary may, in the Secretary's discretion, provide 16 for coverage periods that include portions of a 17 month in order to avoid lapses of coverage. — 18 "(3) Limitation on payments. No payments 19 may be made under this title with respect to the ex- 20 penses of an individual enrolled under this part un- 21 less such expenses were incurred by such individual 22 during a period which, with respect to the individual, 23 is a coverage period under this section. — 24 "(d) Termination of Coverage. •HR 4799 IH 10 — 1 "(1) In general. An individual's coverage 2 period under this part shall continue until the indi- 3 vidual's enrollment has been terminated at the earli- 4 est of the following: — 5 "(A) General provisions. — 6 "(i) Notice. The individual files no- 7 tice (in a form and manner prescribed by 8 the Secretary) that the individual no 9 longer wishes to participate in the insur- 10 ance program under this part. — 11 "(ii) Nonpayment of premiums. 12 The individual fails to make payment of 13 premiums required for enrollment under 14 this part. — 15 "(iii) Medicare eligibility. The 16 individual becomes entitled to benefits A B 17 under part or enrolled under part 18 (other than by reason of this part). — 19 "(B) Termination based on age. The 20 individual attains 65 years of age. — 21 "(2) Effectdte date of termination. — 22 "(A) Notice. The termination of a cov- 23 erage period under paragraph (l)(A)(i) shall 24 take effect at the close of the month following 25 for which the notice is filed. •HR 4799 IH