(a) In general
The Secretary of Health and Human Services shall establish a health insurance advisory service program (in this section referred to as the "beneficiary assistance program") to assist medicare-eligible individuals with the receipt of services under the medicare and medicaid programs and other health insurance programs.
(b) Outreach elements
The beneficiary assistance program shall provide assistance—
(1) through operation using local Federal offices that provide information on the medicare program,
(2) using community outreach programs, and
(3) using a toll-free telephone information service.
(c) Assistance provided
The beneficiary assistance program shall provide for information, counseling, and assistance for medicare-eligible individuals with respect to at least the following:
(1) With respect to the medicare program—
(A) eligibility,
(B) benefits (both covered and not covered),
(C) the process of payment for services,
(D) rights and process for appeals of determinations,
(E) other medicare-related entities (such as peer review organizations, fiscal intermediaries, and carriers), and
(F) recent legislative and administrative changes in the medicare program.
(2) With respect to the medicaid program—
(A) eligibility, benefits, and the application process,
(B) linkages between the medicaid and medicare programs, and
(C) referral to appropriate State and local agencies involved in the medicaid program.
(3) With respect to medicare supplemental policies—
(A) the program under section 1395ss of this title and standards required under such program,
(B) how to make informed decisions on whether to purchase such policies and on what criteria to use in evaluating different policies,
(C) appropriate Federal, State, and private agencies that provide information and assistance in obtaining benefits under such policies, and
(D) other issues deemed appropriate by the Secretary.
The beneficiary assistance program also shall provide such other services as the Secretary deems appropriate to increase beneficiary understanding of, and confidence in, the medicare program and to improve the relationship between beneficiaries and the program.
(d) Educational material
The Secretary, through the Administrator of the Centers for Medicare & Medicaid Services, shall develop appropriate educational materials and other appropriate techniques to assist employees in carrying out this section.
(e) Notice to beneficiaries
The Secretary shall take such steps as are necessary to assure that medicare-eligible beneficiaries and the general public are made aware of the beneficiary assistance program.
(f) Report
The Secretary shall include, in an annual report transmitted to the Congress, a report on the beneficiary assistance program and on other health insurance informational and counseling services made available to medicare-eligible individuals. The Secretary shall include in the report recommendations for such changes as may be desirable to improve the relationship between the medicare program and medicare-eligible individuals.
Codification
Section was enacted as part of the Omnibus Budget Reconciliation Act of 1990, and not as part of the Social Security Act which comprises this chapter.
Amendments
2003—Subsec. (d). Pub. L. 108–173 substituted "Centers for Medicare & Medicaid Services" for "Health Care Financing Administration".
State Health Insurance Assistance Program Reporting Requirements
Pub. L. 115–123, div. E, title II, §50207(b), Feb. 9, 2018, 132 Stat. 187, provided that: "Beginning not later than April 1, 2019, and biennially thereafter, the Agency for Community Living [probably means the Administration for Community Living] shall electronically post on its website the following information, with respect to grants to States for State health insurance assistance programs, (such information to be presented by State and by entity receiving funds from the State to carry out such a program funded by such grant):
"(1) The amount of Federal funding provided to each such State for such program for the period involved and the amount of Federal funding provided by each such State for such program to each such entity for the period involved.
"(2) Information as the Secretary may specify, with respect to such programs carried out through such grants, consistent with the terms and conditions for receipt of such grants."
Medicare Enrollment Assistance
Pub. L. 110–275, title I, §119, July 15, 2008, 122 Stat. 2508, as amended by Pub. L. 111–148, title III, §3306, Mar. 23, 2010, 124 Stat. 470; Pub. L. 112–240, title VI, §610, Jan. 2, 2013, 126 Stat. 2351; Pub. L. 113–67, div. B, title I, §1110, Dec. 26, 2013, 127 Stat. 1198; Pub. L. 113–93, title I, §110, Apr. 1, 2014, 128 Stat. 1043; Pub. L. 114–10, title II, §208, Apr. 16, 2015, 129 Stat. 145; Pub. L. 115–123, div. E, title II, §50207(a), Feb. 9, 2018, 132 Stat. 186; Pub. L. 116–59, div. B, title IV, §1402, Sept. 27, 2019, 133 Stat. 1106; Pub. L. 116–69, div. B, title IV, §1402, Nov. 21, 2019, 133 Stat. 1138; Pub. L. 116–94, div. N, title I, §103, Dec. 20, 2019, 133 Stat. 3096; Pub. L. 116–136, div. A, title III, §3803(a), Mar. 27, 2020, 134 Stat. 428, provided that:
"(a)
"(1)
"(A)
"(B)
"(i) for fiscal year 2009, of $7,500,000;
"(ii) for the period of fiscal years 2010 through 2012, of $15,000,000;
"(iii) for fiscal year 2013, of $7,500,000;
"(iv) for fiscal year 2014, of $7,500,000;
"(v) for fiscal year 2015, of $7,500,000;
"(vi) for fiscal year 2016, of $13,000,000;
"(vii) for fiscal year 2017, of $13,000,000;
"(viii) for fiscal year 2018, of $13,000,000;
"(ix) for fiscal year 2019, of $13,000,000;
"(x) for fiscal year 2020, of $13,000,000; and
"(xi) for the period beginning on October 1, 2020, and ending on November 30, 2020, the amount equal to the pro rata portion of the amount appropriated for such period for fiscal year 2020.
Amounts appropriated under this subparagraph shall remain available until expended.
"(2)
"(3)
"(A)
"(B)
"(4)
"(b)
"(1)
"(A)
"(B)
"(i) for fiscal year 2009, of $7,500,000;
"(ii) for the period of fiscal years 2010 through 2012, of $15,000,000;
"(iii) for fiscal year 2013, of $7,500,000;
"(iv) for fiscal year 2014, of $7,500,000;
"(v) for fiscal year 2015, of $7,500,000;
"(vi) for fiscal year 2016, of $7,500,000;
"(vii) for fiscal year 2017, of $7,500,000;
"(viii) for fiscal year 2018, of $7,500,000;
"(ix) for fiscal year 2019, of $7,500,000;
"(x) for fiscal year 2020, of $7,500,000; and
"(xi) for the period beginning on October 1, 2020, and ending on November 30, 2020, the amount equal to the pro rata portion of the amount appropriated for such period for fiscal year 2020.
Amounts appropriated under this subparagraph shall remain available until expended.
"(2)
"(3)
"(A)
"(B)
"(c)
"(1)
"(A)
"(B)
"(i) for fiscal year 2009, of $5,000,000;
"(ii) for the period of fiscal years 2010 through 2012, of $10,000,000;
"(iii) for fiscal year 2013, of $5,000,000;
"(iv) for fiscal year 2014, of $5,000,000;
"(v) for fiscal year 2015, of $5,000,000;
"(vi) for fiscal year 2016, of $5,000,000;
"(vii) for fiscal year 2017, of $5,000,000;
"(viii) for fiscal year 2018, of $5,000,000;
"(ix) for fiscal year 2019, of $5,000,000;
"(x) for fiscal year 2020, of $5,000,000; and
"(xi) for the period beginning on October 1, 2020, and ending on November 30, 2020, the amount equal to the pro rata portion of the amount appropriated for such period for fiscal year 2020.
Amounts appropriated under this subparagraph shall remain available until expended.
"(2)
"(d)
"(1)
"(A) maintain and update web-based decision support tools, and integrated, person-centered systems, designed to inform older individuals (as defined in section 102 of the Older Americans Act of 1965 (42 U.S.C. 3002)) about the full range of benefits for which the individuals may be eligible under Federal and State programs;
"(B) utilize cost-effective strategies to find older individuals with the greatest economic need (as defined in such section 102) and inform the individuals of the programs;
"(C) develop and maintain an information clearinghouse on best practices and the most cost-effective methods for finding older individuals with greatest economic need and informing the individuals of the programs; and
"(D) provide, in collaboration with related Federal agency partners administering the Federal programs, training and technical assistance on the most effective outreach, screening, and follow-up strategies for the Federal and State programs.
"(2)
"(i) for fiscal year 2009, of $5,000,000;
"(ii) for the period of fiscal years 2010 through 2012, of $5,000,000;
"(iii) for fiscal year 2013, of $5,000,000;
"(iv) for fiscal year 2014, of $5,000,000;
"(v) for fiscal year 2015, of $5,000,000;
"(vi) for fiscal year 2016, of $12,000,000;
"(vii) for fiscal year 2017, of $12,000,000;
"(viii) for fiscal year 2018, of $12,000,000;
"(ix) for fiscal year 2019, of $12,000,000;
"(x) for fiscal year 2020, of $12,000,000; and
"(xi) for the period beginning on October 1, 2020, and ending on November 30, 2020, the amount equal to the pro rata portion of the amount appropriated for such period for fiscal year 2020.
Amounts appropriated under this subparagraph shall remain available until expended.
"(e)
"(f)
"(g)
[Pub. L. 116–136, div. A, title III, §3803(b), Mar. 27, 2020, 134 Stat. 429, provided that: "The amendments made by subsection (a) [amending section 119 of Pub. L. 110–275, set out above] shall take effect as if included in the enactment of the Further Consolidated Appropriations Act, 2020 (Public Law 116–94)."]
Beneficiary Outreach Demonstration Program
Pub. L. 108–173, title IX, §924, Dec. 8, 2003, 117 Stat. 2395, provided that:
"(a)
"(b)
"(1)
"(2)
"(c)
"(d)
"(1)
"(A) utilization of, and satisfaction of those individuals referred to in subsection (a) with, the assistance provided under the program; and
"(B) the cost-effectiveness of providing beneficiary assistance through out-stationing medicare specialists at local offices of the Social Security Administration.
"(2)
Qualified Medicare Beneficiary Outreach
Pub. L. 103–432, title I, §154, Oct. 31, 1994, 108 Stat. 4437, provided that not later than 1 year after Oct. 31, 1994, the Secretary of Health and Human Services would establish and implement a method for obtaining information from newly eligible medicare beneficiaries that might be used to determine whether such beneficiaries may be eligible for medical assistance for medicare cost-sharing under State medicaid plans as qualified medicare beneficiaries, and for transmitting such information to the State in which such a beneficiary resides.
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