REQUIRING MEDICARE BUY-IN OF PREMIUMS AND COST-SHARING FOR INDIGENT MEDICARE BENEFICIARIES.

SEC. 301. REQUIRING MEDICARE BUY-IN OF PREMIUMS AND COST-SHARING FOR INDIGENT MEDICARE BENEFICIARIES. (a) Requirement.— (1) Section 1902(a)(10)(E) (42 U.S.C. 1396a(a)(10)(E)) is amended by striking “at the option of a State, but”. (2) Section 1905(p)(1)(B) (42 U.S.C. 1396d(p)(1)(B)) is amended by striking “and the election of the State”. (b) Phasing-In Required Income Standard to 100 Percent of Poverty Level.—Section 1905(p)(2)(A) (42 U.S.C. 1396d(p)(2)(A)) is amended— (1) by striking “may not exceed a percentage (not more than 100 percent)” and inserting “shall be at least the percent provided under clause (ii) (but not more than 100 percent)”, (2) by inserting “(i)” after “(2)(A)”, and (3) by adding at the end the following new clause: “(ii) Except as provided in clause (iii), the percent provided under this clause, with respect to eligibility for medical assistance on or after— “(I) January 1, 1989, is 85 percent, “(II) January 1, 1990, is 90 percent, “(III) January 1, 1991, is 95 percent, and “(IV) January 1, 1992, is 100 percent “(iii) In the case of a State which has elected treatment under section 1902(f) and which, as of January 1, 1987, used an income standard for individuals age 65 or older which was more restrictive 102 STAT. 749than the income standard established under the supplemental security income program under title XVI, the percent provided under clause (ii), with respect to eligibility for medical assistance on or after— “(I) January 1, 1989, is 80 percent, “(II) January 1, 1990, is 85 percent, “(III) January 1, 1991, is 90 percent, “(IV) January 1, 1992, is 95 percent, and “(V) January 1, 1993, is 100 percent.”. (c) Resource Standard.—Section 1905(p) (42 U.S.C. 1396d(p)) is amended— (1) in paragraph (1)(C), by striking “(2)(A)” and inserting “(2) ”; (2) in paragraph (1)(D), by striking “(except as provided in paragraph (2)(B))” and inserting “twice”; and (3) in paragraph (2)— (A) in subparagraph (A), by striking “(2)(A)” and inserting “(2)”, and (B) by striking subparagraph (B). (d) Medicare Coverage.— Section 1905(p) (42 U.S.C. 1396d(p)) is amended— (1) in paragraph (3)(A), by striking “under part B and (if applicable) under section 1818” and inserting “under title )(VIII (including under part B and, if applicable, under section 1818)”; (2) by amending subparagraphs (B) and (C) of paragraph (3) to read as follows: “(B) Coinsurance under title )(VIII (including coinsurance described in section 1813). “(C) Subject to paragraph (4), deductibles established under title XVIII (including those described in section 1813, 1833(b), and section 1834(c)(1)).”; and (3) by adding at the end the following new paragraph: “(4) In a State which provides medical assistance for prescribed drugs under section 1905(a)(12), instead of providing to qualified medicare beneficiaries, under paragraph (3)(C), medicare cost-sharing with respect to the annual deductible for covered outpatient drugs under section 1834(c)(1), the State may provide to such beneficiaries, before charges for covered outpatient drugs for a year reach such deductible amount, benefits for prescribed drugs in the same amount, duration, and scope as the benefits made available under the State plan for individuals described in section 1902(a)(10)(A)(i).”. (e) Conforming Amendments.— (1) Section 1843 (42 U.S.C. 1395v) is amended by inserting “or after 1988” in subsections (a), (g)(1), and (h)(1) after “during 1981”. (2) Section 1902 (42 U.S.C. 1396a) is amended— (A) in subsection (a)(10)(A)(ii)()(), by striking “subject to subsection (m)(3),”, (B) in subsection (a)(10)(E), by striking “subject to subsection (m)(3),”; (C) in subsection (a)(17), by striking “(m)(4), and (m)(5)” and inserting “(m)(3), and (m)(4)”, and (D) in subsection (m), by striking paragraph (3) and by redesignating paragraphs (4) and (5) as paragraphs (3) and (4), respectively. 102 STAT. 750 (3) The amendment made by paragraph (1) shall take effect on January 1, 1989, and the amendments made by paragraph (2) shall take effect on July 1, 1989. (f) Technical Amendment.—Effective as though included in the enactment of the Omnibus Budget Reconciliation Act of 1986, paragraph (2) of section 9403(g) of such Act is amended to read as follows: “(2) Payment of medicare cost-sharing.—Section 1903(a)(1)(42 U.S.C. 1396b(a)(1)) is amended by inserting ‘including expenditures for medicare cost-sharing and’ before ‘including expenditures’.”. (g) Treatment of Certain States.— (1) States operating under demonstration projects.—In the case of any State which is providing medical assistance to its residents under a waiver granted under section 1115(a) of the Social Security Act, the Secretary of Health and Human Services shall require the State to meet the requirement of section 1902(a)(10)(E) of the Social Security Act in the same manner as the State would be required to meet such requirement if the State had in effect a plan approved under title)(I)( of such Act. (2) Commonwealths and territories.—Section 1905(p) (42 U.S.C. 1396d(p)), as amended by subsection (d)(3), is further amended by adding at the end the following new paragraph: “(5) Notwithstanding any other provision of this title, in the case of a State (other than the 50 States and the District of Columbia)— “(A) the requirement stated in section 1902(a)(10)(E) shall be optional, and “(B) for purposes of paragraph (2)(A), the State may substitute for the percent provided under clause (ii) of such paragraph any percent.”. (h) Effective Date.— (1) The amendments made by this section apply (except as provided in subsections (e) and (f) and under paragraph (2)) to payments under title XIX of the Social Security Act for calendar quarters beginning on or after January 1, 1989, without regard to whether or not final regulations to carry out such amendments have been promulgated by such date, with respect to medical assistance for— (A) monthly premiums under title XVIII of such Act for months beginning with January 1989, and (B) items and services furnished on and after January 1, 1989. (2) In the case of a State plan for medical assistance under title XIX of the Social Security Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan to meet the additional requirements imposed by the amendments made by this section, the State plan shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet these additional requirements before the first day of the first session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.