Strengthening Medicare And Repaying Taxpayers Act of 2011- 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).
Declares that, in the case of a payment to the claimant by the Secretary, and beginning 120 days before the reasonably expected date of a settlement, judgment, award, or other payment, the claimant or applicable plan may at any time but only once: (1) notify the Secretary that a payment is reasonably expected, and (2) request a statement of the conditional payment reimbursement amount for any payments subject to the required reimbursement.
Requires the Secretary to respond to such a request, within 65 days after receiving it, with a statement of reimbursement amount.
Prescribes procedures for the claimant, an applicable plan, or specified related entities to follow if the Secretary fails to provide such a statement.
Specifies circumstances: (1) in which the claimant, an applicable plan, or specified related entities are shielded from liability for certain payments; and (2) in which the Secretary shall be exempt from any obligation for a statement of reimbursement.
Directs the Secretary to promulgate regulations establishing a right of appeal and appeals process, with respect to any determination for a payment made under such 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 play, may appeal such determination.
Exempts a primary plan, and an entity receiving payment from a primary plan, from any obligation to reimburse the appropriate Trust Fund for a Medicare payment by the Secretary with respect to any settlement, judgment, award, or other payment by an applicable plan constituting a total payment obligation to a claimant of not more than the single threshold amount calculated by the Chief Actuary of the Centers for Medicare & Medicaid Services (CMS). Requires the Chief Actuary to calculate and publish the single threshold amount annually.
Makes discretionary rather than mandatory the current civil money penalty for an applicable plan's noncompliance with requirements to submit insurance information about a claimant. Requires the severity of each penalty to be based on the knowing, willful, and repeated nature of the violation.
Prescribes requirements for the specification of practices for which sanctions will not be imposed on a plan (safe harbors).
Directs the Secretary to modify insurance information reporting requirements so that a plan, in complying with them, is permitted but not required to access or report beneficiary Social Security account numbers or health identification claim numbers.
Sets a three-year statute of limitations on a Medicare secondary payer claim by the Secretary for reimbursement against an applicable plan that becomes a Medicare primary payer pursuant to a settlement, judgment, award, or other judicial action.
[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[S. 1718 Introduced in Senate (IS)]
112th CONGRESS
1st Session
S. 1718
To amend title XVIII of the Social Security Act with respect to the
application of Medicare secondary payer rules for certain claims.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
October 17, 2011
Mr. Wyden (for himself, Mr. Portman, Mr. Nelson of Nebraska, and Mr.
Burr) introduced the following bill; which was read twice and referred
to the Committee on Finance
_______________________________________________________________________
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; TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Strengthening
Medicare And Repaying Taxpayers Act of 2011''.
(b) Table of Contents.--The table of contents of this Act is as
follows:
Sec. 1. Short title; table of contents.
Sec. 2. Expediting Secretarial determination of reimbursement amount to
improve program efficiency.
Sec. 3. Fiscal efficiency and revenue neutrality.
Sec. 4. Reporting requirement safe harbors.
Sec. 5. Use of social security numbers and other identifying
information in reporting.
Sec. 6. Statute of limitations.
SEC. 2. EXPEDITING SECRETARIAL DETERMINATION OF REIMBURSEMENT AMOUNT TO
IMPROVE PROGRAM EFFICIENCY.
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) Timely notice of conditional
payment reimbursement.--
``(I) Request for conditional
payment statement.--In the case of a
payment made by the Secretary pursuant
to clause (i) for items and services
provided to the claimant, the claimant
or applicable plan (as defined in
paragraph (8)(F)) may at any time
beginning 120 days before the
reasonably expected date of a
settlement, judgment, award, or other
payment, notify the Secretary that a
payment is reasonably expected, and
request from the Secretary, in
accordance with regulations, a
statement of the conditional payment
reimbursement amount (in this clause
referred to as a `statement of
reimbursement amount') for any payments
subject to reimbursement required under
clause (ii). A claimant or applicable
plan may request a statement under this
subclause only once with respect to
such settlement, judgment, award, or
other payment.
``(II) Secretarial response.--
``(aa) In general.--Not
later than 65 days after the
date of receipt of a request
under subclause (I), the
Secretary shall respond to such
request with a statement of
reimbursement amount, which
shall constitute the
conditional payment subject to
recovery under clause (ii)
related to such settlement,
judgment, award or other
payment.
``(bb) Case of secretarial
failure.--Subject to subclause
(III), if the Secretary fails
to provide such a statement of
reimbursement amount for items
or services subject to
reimbursement required under
clause (ii) in accordance with
this subclause, the claimant,
applicable plan, or an entity
that receives payment from an
applicable plan shall provide
an additional notice to the
Secretary of such failure. If
the Secretary fails to provide
a statement of reimbursement
amount within 30 days of the
date of such additional notice,
the claimant, applicable plan,
and 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 section
for any item or service related
to the request unless the
Secretary demonstrates (in
accordance with regulations)
that the failure was justified
due to exceptional
circumstances (as defined in
such regulations). Such
regulations shall define
exceptional circumstances in a
manner so that not more than 1
percent of the repayment
obligations under this
subclause would qualify as
exceptional circumstances.
``(III) Notice to secretary.--In
the event that a settlement, judgment,
award, or other payment does not occur
(or is no longer reasonably expected to
occur) within 120 days of the date of
an original request under subclause (I)
with respect to a settlement, judgment,
award, or other payment, the claimant
or the applicable plan shall timely
notify the Secretary, and the Secretary
shall be exempt from any obligation
under subclause (II) with respect to a
statement of reimbursement amount
relating to such settlement, judgment,
award, or other payment related to the
notice.
``(IV) Effective date.--The
Secretary shall promulgate final
regulations to carry out this clause
not later than 9 months after the date
of the enactment of this clause. Such
regulations shall require the
disclosure from a claimant or
applicable plan of no more than the
minimum amount of information necessary
for the Secretary to determine the
amount of conditional payment subject
to recovery under clause (ii) related
to such settlement, judgment, award, or
other payment, and may require partial
disclosure (but may not require full
disclosure) of social security numbers
or health identification claim numbers.
``(viii) Right of appeal.--The Secretary
shall promulgate regulations establishing a
right of appeal and appeals process, with
respect to any determination under this
subsection 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 determination. Such right of appeal
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 under
regulations for hearing procedures
respecting notices of determinations of
nonconformance of group health plans
under this subsection.''.
SEC. 3. FISCAL EFFICIENCY AND REVENUE NEUTRALITY.
(a) In General.--Section 1862(b) of the Social Security Act (42
U.S.C. 1395y(b)) is amended--
(1) in paragraph (2)(B)(ii), by striking ``A primary plan''
and inserting ``Subject to paragraph (9), a primary plan''; and
(2) by adding at the end the following new paragraph:
``(9) Exception.--
``(A) In general.--Clause (ii) of paragraph (2)(B)
and any reporting required by paragraph (8) shall not
apply with respect to any settlement, judgment, award,
or other payment by an applicable plan constituting a
total payment obligation to a claimant of not more than
the single threshold amount calculated by the Chief
Actuary of the Centers for Medicare & Medicaid Services
under subparagraph (B) for the year involved.
``(B) Annual computation of thresholds.--Not later
than November 15 before each year, the Chief Actuary of
the Centers for Medicare & Medicaid Services shall
calculate and publish a single threshold amount for
settlements, judgments, awards or other payments for
conditional payment obligations arising from each of
liability insurance (including self-insurance),
workers' compensation laws or plans, and no fault
insurance subject to this section for that year. Each
such annual single threshold amount for a year shall be
set such that the expected average amount to be
credited to the Medicare trust funds of collections of
conditional payments from such settlements, judgments,
awards, or other payments for each of liability
insurance (including self-insurance), workers'
compensation laws or plans, and no fault insurance
subject to this section shall equal the expected
average cost of collection incurred by the United
States (including payments made to contractors) for a
conditional payment from each of liability insurance
(including self-insurance), workers' compensation laws
or plans, and no fault insurance subject to this
section for the year. The Chief Actuary shall include,
as part of such publication for a year--
``(i) the expected average cost of
collection incurred by the United States
(including payments made to contractors) for a
conditional payment arising from each of
liability insurance (including self-insurance),
no fault insurance, and workers' compensation
laws or plans; and
``(ii) a summary of the methodology and
data used by such Chief Actuary in computing
the threshold amount and such average cost of
collection.
``(C) Treatment of ongoing expenses.--For purposes
of this paragraph and with respect to a settlement,
judgment, award, or other payment not otherwise
addressed in clause (ii) of paragraph (2)(B) 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.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply to years beginning more than 4\1/2\ 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 knowing, willful, and repeated nature of the
violation.''; and
(2) by adding at the end the following new subparagraph:
``(I) Establishment of 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 specification of
practices for which sanctions will not
be imposed under subparagraph (E),
including for good faith efforts to
identify a beneficiary pursuant to this
paragraph under an applicable entity
responsible for reporting information,
under which 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 so submitted, the Secretary,
in consultation with the Attorney
General, shall publish in the Federal
Register, including a 60-day period for
comment, proposed specified practices
for which such sanctions will not be
imposed. After considering any public
comments received during such period,
the Secretary shall issue final rules
specifying such practices.''.
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: ``Not later than 1 year after the date of
enactment of this sentence, the Secretary shall modify the reporting
requirements under this paragraph so that an applicable plan in
complying with such requirements is permitted but not required to
access or report to the Secretary beneficiary social security account
numbers or health identification claim numbers.''.
SEC. 6. STATUTE OF LIMITATIONS.
(a) In General.--Section 1862(b) of the Social Security Act (42
U.S.C. 1395y(b)) is amended--
(1) in paragraph (2)(B)(iii), by adding at the end the
following new sentence: ``An action may not be brought by the
United States under this clause with respect to payment owed
unless the complaint is filed not later than 3 years after the
date of the receipt of notice of a settlement, judgment, award,
or other payment made pursuant to paragraph (8) relating to
such payment owed.''; and
(2) in paragraph (8)(E)(i), by adding at the end the
following new sentence: ``A civil money penalty may not be
imposed under this clause with respect to failure to submit
required information unless service of notice of intention to
impose the penalty is provided not later than 3 years after the
date by which the information was required to be submitted.''.
(b) Effective Date.--The amendments made by subsection (a) shall
apply with respect to actions brought and penalties sought on or after
6 months after the date of the enactment of this Act.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S6602)
Read twice and referred to the Committee on Finance. (text of measure as introduced: CR S6602-6603)
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