Medicare Secondary Payer Enhancement Act of 2010 - Amends title XVIII (Medicare) of the Social Security Act with respect to any settlement, judgment, award, or other payment between a Medicare claimant and an applicable plan involving a payment made for items and services by the Secretary of Health and Human Services (HHS). Prescribes requirements for a voluntary calculation and direct reimbursement by a Medicare claimant and an applicable plan to the Hospital Insurance Trust Fund or the Supplementary Medical Insurance Trust Fund, as appropriate, of a conditional payment of Medicare secondary payer claims for settlement purposes. Grants the Secretary the right to contest the amount of any such reimbursement, and the right of the claimant and plan to request a final recovery demand for reimbursement.
Declares that requirements to reimburse the appropriate Trust Fund for any payment made by the Secretary with respect to an item or service shall not apply with respect to any settlement, judgment, award, or other payment by an applicable plan: (1) constituting a total payment obligation to a claimant of not more than $5,000; or (2) involving the ongoing responsibility for other medical payments of not more than $5,000.
Changes from mandatory to discretionary the current civil money penalty for failure of an applicable plan to submit certain information to the Secretary with respect to any claimant. Prescribes requirements for the creation of safe harbors from such sanctions.
Directs the Secretary to modify reporting requirements for liability insurance (including self-insurance), no fault insurance, and workers' compensation laws and plans so that entities responsible for reporting information are not required to access or report to the Secretary beneficiary Social Security numbers or health identification numbers.
Sets a statute of limitations with respect to the recovery of payments by the United States.
Establishes $30 user fees, adjusted annually for inflation, for requests submitted to the Secretary for direct conditional payment reimbursement and for final demand of a conditional payment.
[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4796 Introduced in House (IH)]
111th CONGRESS
2d Session
H. R. 4796
To amend title XVIII of the Social Security Act with respect to the
application of Medicare secondary payer rules for certain claims.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
March 9, 2010
Mr. Patrick J. Murphy of Pennsylvania (for himself and Mr. Tim Murphy
of Pennsylvania) introduced the following bill; which was referred to
the Committee on Ways and Means, and in addition to the Committee on
Energy and Commerce, for a period to be subsequently determined by the
Speaker, in each case for consideration of such provisions as fall
within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To amend title XVIII of the Social Security Act with respect to the
application of Medicare secondary payer rules for certain claims.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Medicare Secondary Payer Enhancement
Act of 2010''.
SEC. 2. CALCULATION AND DIRECT PAYMENT OF MSP CLAIMS.
(a) Calculation and Direct Reimbursement of Conditional Payment for
Settlement Purposes.--
(1) Section 1862(b)(2)(B) of the Social Security Act (42
U.S.C. 1395y(b)(2)(B)) is amended by adding at the end the
following new clause:
``(vii)(I) Voluntary calculation and
payment of conditional payment.--In the case of
a settlement, judgment, award, or other payment
between a claimant and an applicable plan (as
defined in paragraph (8)(F)) involving a
payment made by the Secretary pursuant to
clause (i) for items and services provided to
the claimant, for purposes of determining the
amount of reimbursement required under clause
(ii) to the appropriate Trust Fund during the
90-day period preceding the reasonably expected
date of such settlement, judgment, award, or
other payment, the claimant and plan may--
``(aa) in good faith calculate the
amount of such reimbursement required
based upon available billing data for
such items and services provided; and
``(bb) reimburse such amount to the
appropriate Trust Fund, in accordance
with regulations promulgated by the
Secretary.
With respect to a payment made under
clause (i) for items and services
provided to a claimant and subject to
subclause (II), any reimbursement made
in accordance with this subclause shall
satisfy any obligation of the claimant
and the applicable plan under this
subsection.
``(II) Secretary's ability to contest
amount of payment.--In the case of a
reimbursement made to the appropriate Trust
Fund under subclause (I), during the 75-day
period beginning on the date of such
reimbursement, if the Secretary determines such
reimbursement made is not the total amount owed
under this subparagraph the Secretary shall
have the right to contest the amount of such
reimbursement made and to serve upon the
claimant and applicable plan a final demand for
the balance of the remaining amount so owed.
The claimant or applicable plan may make a
reimbursement to the appropriate Trust Fund in
the amount of such balance determined by the
Secretary or may pursue appeal of the amount of
the reimbursement determined by the Secretary
pursuant to the appeals process under clause
(ix). In any such appeal, the burden of proof
shall be on the claimant or applicable plan to
demonstrate that the reimbursement made to the
appropriate Trust fund under subclause (I) was
correct.
``(viii)(I) Request for final demand for
reimbursement.--In the case of a settlement,
judgment, award, or other payment between a
claimant and an applicable plan (as defined in
paragraph (8)(F)) involving a payment made by
the Secretary pursuant to clause (i) for items
and services provided to the claimant, the
claimant or applicable plan may at any time
beginning 120 days prior to the reasonably
expected date of such settlement, judgment,
award, or other payment, submit to the
Secretary, in accordance with regulations to be
promulgated by the Secretary, a request for a
recovery demand letter for reimbursement
required under clause (ii) of such payment. The
Secretary shall have 60 days to respond to such
request with such final demand. Not later than
60 days after the date of receipt of such final
demand, the claimant or applicable plan may
reimburse the appropriate Trust Fund for such
payment in the amount identified in such final
demand, in accordance with regulations
promulgated by the Secretary. With respect to a
payment made under clause (i) for items and
services provided to a claimant, any such
reimbursement made in accordance with this
subclause shall satisfy any obligations of the
claimant and the applicable plan under this
subsection.
``(II) Failure of the secretary to provide
final demand for conditional payment.--In the
case that the Secretary fails to provide a
final demand for any item or service subject to
reimbursement required under clause (ii) in
accordance with subclause (I), the claimant,
applicable plan, or an entity that receives
payment from an applicable plan shall not be
liable for and shall not be obligated to make
payment subject to this subsection for any item
or service related to the request for final
demand for reimbursement.
``(ix) Right of appeal.--The Secretary shall
promulgate regulations establishing a right of appeal
and appeals process, with respect to any requirement
under clause (ii) for a payment made under this title
for an item or service under a primary plan, under
which the applicable plan involved, or an attorney,
agent, or third party administrator on behalf of such
applicable plan may appeal such requirement. Such right
of review shall--
``(I) include review through an
administrative law judge and administrative
review board, and access to judicial review in
the district court of the United States for the
judicial district in which the appellant is
located (or, in the case of an action brought
jointly by more than one applicant, the
judicial district in which the greatest number
of applicants are located) or in the District
Court for the District of Columbia; and
``(II) be carried out in a manner similar
to the appeals procedure used for purposes of
subsection (a).''.
(2) Conforming amendment.--Clause (ii) of such section is
amended by inserting after ``60-day'' the following ``(or in
the case of an applicable plan and reimbursement described in
clause (vii) or (viii), 90-day)''.
SEC. 3. THRESHOLD.
(a) In General.--Section 1862(b)(2)(B)(ii) of the Social Security
Act (42 U.S.C. 1395y(b)(2)(B)(ii)) is amended--
(1) by striking ``(ii) repayment required.--A primary
plan'' and inserting the following:
``(ii) Repayment required.--
``(I) In general.--A primary
plan''; and
(2) by adding at the end the following new subclause:
``(II) Exception.--Subclause (I)
shall not apply with respect to the
following payments under this title:
``(aa) Any settlement,
judgment, award, or other
payment by an applicable plan
constituting a total payment
obligation to a claimant of not
more than $5,000.
``(bb) Any settlement,
judgment, award, or other
payment by an applicable plan
involving the ongoing
responsibility for medical
payments not otherwise
addressed in subclause (I), of
not more than $5,000. For
purposes of this subclause and
with respect to a settlement,
judgment, award, or other
payment payments not otherwise
addressed in subclause (I)
involving the ongoing
responsibility for medical
payments, such payment shall
include only the cumulative
value of the medical payments
made and the purchase price of
any annuity or similar
instrument.
The amounts under this subclause shall
be adjusted each year based on the
percentage increase in the Consumer
Price Index (rounded to the nearest
multiple of $100) for the year
involved.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply with respect to payments made on or after 3 months after the date
of the enactment of this Act.
SEC. 4. REPORTING REQUIREMENT SAFE HARBORS.
Section 1862(b)(8) of the Social Security Act (42 U.S.C.
1395y(b)(8)) is amended--
(1) in the first sentence of subparagraph (E)(i), by
striking ``shall be subject'' and all that follows through the
end of the sentence and inserting the following: ``may be
subject to a civil money penalty of up to $1,000 for each day
of noncompliance. The severity of each such penalty shall be
based on the intentional nature of the violation.''; and
(2) by adding at the end the following new subparagraph:
``(I) Safe harbors.--Not later than 60 days after
the date of the enactment of this subparagraph, the
Secretary shall publish a notice in the Federal
Register soliciting proposals, which will be accepted
during a 60-day period, for the creation of safe
harbors from sanctions imposed under subparagraph (E)
under which entities responsible for reporting
information under this paragraph will be deemed to have
complied with the reporting requirements under this
paragraph and will not be subject to such sanctions.
After considering the proposals submitted pursuant to
the preceding sentence, the Secretary, in consultation
with the Attorney General, shall publish in the Federal
Register, including a 60-day period for comment,
proposed safe harbors. After considering any public
comments received during such period, the Secretary
shall issue final rules establishing safe harbors from
penalties or other sanctions under subparagraph (E).''.
SEC. 5. USE OF SOCIAL SECURITY NUMBERS AND OTHER IDENTIFYING
INFORMATION IN REPORTING.
Section 1862(b)(8)(B) of the Social Security Act (42 U.S.C.
1395y(b)(8)(B)) is amended by adding at the end (after and below clause
(ii)) the following sentence: ``Not later than one year after the date
of enactment of the Medicare Secondary Payer Enhancement Act of 2010,
the Secretary shall modify the reporting requirements under this
paragraph so that entities responsible for reporting information under
this paragraph are not required to access or report to the Secretary
beneficiary social security numbers or health identification claim
numbers.''.
SEC. 6. STATUTE OF LIMITATIONS.
(a) In General.--Section 1862(b)(2)(B)(iii) of the Social Security
Act (42 U.S.C. 1395y(b)(2)(B)(iii)) is amended by adding at the end the
following sentence: ``Every action brought by the United States or an
officer or agency thereof under this clause shall be barred unless the
complaint is filed not later than three years after the date of the
receipt of notice of a settlement or other payment giving rise to
recovery of a payment made pursuant to paragraph (8).''.
(b) Effective Date.--The amendment made by subsection (a) shall
apply with respect to actions brought on or after 6 months after the
date of the enactment of this Act.
SEC. 7. USER FEE.
Section 1862(b) of the Social Security Act (42 U.S.C. 1395y(b)) is
amended by adding the following new paragraph:
``(9) User fees.--
``(A) In general.--Beginning 90 days after the date
of the enactment of the Medicare Secondary Payer
Enhancement Act of 2010, and annually thereafter for
the 10-year period beginning on such date of enactment,
the Secretary shall assess and collect fees in
accordance with this paragraph as follows:
``(i) Direct conditional payment
reimbursement fee.--Each person or entity that
submits a payment to fulfill the reimbursement
requirement pursuant to paragraph (2)(B)(vii)
shall be subject to a fee of $30 for each
payment reimbursed to the Secretary.
``(ii) Request for final demand of
conditional payment fee.--Each person that
submits a request for a recover demand letter
of conditional payment under paragraph
(2)(B)(viii) shall be subject to a fee of $30
for each such request submitted to the
Secretary. In the case of a person or entity
that pays a fee under this clause, such person
or entity shall not also be subject to the fee
under clause (i).
``(B) Inflation adjustment.--For fiscal year 2010
and subsequent fiscal years, the amount of the fees
specified in subparagraph (A) shall be adjusted by the
Secretary by notice, published in the Federal Register,
to reflect any percent changes in the Consumer Price
Index for all urban consumers (all items; U.S. city
average) for the 12 month period ending June 30 of the
preceding fiscal year.
``(C) Collection of unpaid fees.--In any case where
the Secretary does not receive payment of a fee
assessed under subparagraph (A) by the date that is 30
days after the date such fee is due, such fee shall be
treated as a claim of the United States Government
subject to subchapter II of chapter 37 of title 31,
United States Code.''.
<all>
Introduced in House
Introduced in House
Referred to House Ways and Means
Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to House Energy and Commerce
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