Date: July 31, 2007
House Ways and Means Committee Passes H.R. 3162,
The Children's Health and Medicare Protection (CHAMP) Act of 2007
On July 27, 2007, by a vote of 24 to 17, the House Ways and Means Committee passed H.R. 3162, the Children's Health and Medicare Protection (CHAMP) Act of 2007. This bill is also under consideration by the House Energy and Commerce Committee. The Senate is also considering a bill to reauthorize the Children's Health Insurance Program (S. 1893) which does not include SSA-related provisions. The House Ways and Means-passed bill contains the following provisions of interest to SSA.
Financial Assistance for Low-Income Medicare Beneficiaries
• Would direct the Commissioner of Social Security to provide MSP and LIS applications to individuals who apply for Medicare benefits with SSA. SSA would also be required to provide assistance to beneficiaries in completing these MSP applications, which would be forwarded to the State Medicaid Agency for processing. This provision would be effective January 1, 2009.
• Would require the Secretary of Health and Human Services to translate the existing simplified MSP form into at least the ten languages (other than English) most often used by individuals applying for benefits under Title II or Title XVIII.
• Would increase allowable assets for Medicare Savings Programs (MSPs) and the Low-Income Subsidy (LIS) program to $17,000 for an individual and $34,000 for a couple, in order to qualify for assistance with Medicare Part B and D costs. Would be effective January 2009, with limits increasing annually starting in 2010, by $1,000 per individual and $2,000 per couple.
• Would allow for self-certification of income and resources for individuals under the LIS program as well as automatic reenrollment for those individuals who lose deemed eligibility, effective January 1, 2009. Would also direct the Secretary of Health and Human Services to encourage States to adopt these LIS enrollment simplifications to MSPs.
• Would allow the Commissioner of Social Security to obtain certain adjusted gross income data including information on State, private or individual pensions and annuities from IRS to identify beneficiaries potentially eligible for the LIS, effective upon enactment.
• Would exempt the balance of a pension or retirement plan and the value of a life insurance policy from income and resources for determination of LIS eligibility . In kind support and maintenance (ISM) would also be exempted from LIS income determinations, effective January 1, 2009.
• Would eliminate the Part D late enrollment penalty for LIS-eligible individuals, effective on January 1, 2008.
• Would provide a special enrollment period for LIS-eligible individuals, allowing up to 90 days after notification of LIS status to select a Part D plan or Medicare Advantage (MA) plan that covers prescription drugs. This provision would take effect on January 1, 2008.
• Would permit mid-year changes in Part D enrollment for formulary changes that adversely impact an enrollee (by reducing access to his/her prescribed drug, unless such change was required for safety reasons). This provision would take effect on January 1, 2009.
• Would require that the lowest-income Medicare beneficiaries who are automatically assigned to a Part D plan, are assigned to a plan that: (1) covers 95 percent of the 100 brand name and 100 generic drugs most commonly used by Medicare beneficiaries; (2) provides pharmacy access that exceeds minimum standards, including access in areas where low-income beneficiaries reside; and (3) has a total cost among the lowest 25th percentile of plans where the beneficiary resides. This provision would be effective for the enrollment period beginning November 15, 2009.
• Would cap out-of-pocket spending under Part D to 2.5 percent of income annually for the lowest-income Medicare beneficiaries, effective January 1, 2009.
• Would eliminate Part D cost-sharing for certain non-institutionalized full benefit dual-eligible individuals, ensuring that dual-eligible beneficiaries receiving care through a home- and community-based care waiver are treated the same as beneficiaries who are in nursing homes. This provision would be effective January 1, 2009.
• Would make permanent the Qualified Individual (QI) program that provides assistance with premiums for certain low-income beneficiaries, while also raising the QI income limits to 150% of the Federal poverty level, effective January 1, 2008.
Medicare Advantage Program Changes
• Would revise Medicare Advantage (MA) plan enrollment practices to provide continuous open enrollment for full Medicaid dual eligibles and Qualified Medicare Beneficiaries (people with incomes up to 100% of poverty level). Would also provide a special election period to additional beneficiaries with special health needs, and extend the period that Medicare beneficiaries may return to their previous Medigap plan to 24 months. This provision would be effective upon enactment.
• Would prohibit auto-enrollment of Medicaid beneficiaries into a MA plan, effective upon enactment.
• The Medicare Advantage program would be renamed the Medicare Part C program, effective upon enactment.