SUBMISSION OF CLAIMS TO SUPPLEMENTAL INSURANCE CARRIERS.

SEC. 4081. SUBMISSION OF CLAIMS TO SUPPLEMENTAL INSURANCE CARRIERS. (a) In General.— Section 1842(h)(3) of the Social Security Act (42 U.S.C. 1395u(h)(3)) is amended by inserting “(A)” after “(3)” and by adding at the end the following new subparagraph: “(B) The Secretary shall establish a procedure whereby an individual enrolled under this part may assign, in an appropriate manner on the form claiming a benefit under this part for an item or service furnished by a participating physician or supplier, the individual’s rights of payment under a medicare supplemental policy (described in section 1882(g)(1)) in which the individual is enrolled. In the case such an assignment is properly executed and a claims determination101 STAT. 1330–127 is made by a carrier with a contract under this section, the carrier shall transmit to the private entity issuing the medicare supplemental policy notice of such fact and including such information as the Secretary determines is generally provided to enable the entity to decide whether (and the amount of) any payment is due under the policy. The Secretary may enter into arrangements for the transmittal of such information to entities electronically. The Secretary shall impose user fees for the transmittal of information under this subparagraph, whether electronically or otherwise.”. (b) Medigap Policy Standards.— Section 1882 of such Act (42 U.S.C. 1395ss) is amended— (1) in subsection (b)(1)— (A) by amending subparagraph (B) to read as follows: “(B) includes requirements equal to or more stringent than the requirements described in paragraphs (2) and (3) of subsection (c);”, 4343Paragraphs (B) and (C) were indented wrong. (B) by adding “and” at the end of subparagraph (C), and 4343Paragraphs (B) and (C) were indented wrong. (C) by inserting after subparagraph (C) the following new subparagraph: “(D) provides the Secretary periodically (but at least annually) with a list containing the name and address of the issuer of each such policy and the name and number of each such policy (including an indication of policies that have been previously approved, newly approved, or withdrawn from approval since the previous list was provided),”; (2) in subsection (c)— (A) by striking “and” at the end of paragraph (1), (B) by striking the period at the end of paragraph (2) and inserting “; and”, and (C) by inserting after paragraph (2) the following new paragraph: “(3) (A) accepts a notice under section 1842(h)(3)(B) as a claims form for benefits under such policy in lieu of any claims form otherwise required and agrees to make a payment determination on the basis of the information contained in such claims form; “(B) where such a notice is received— “(i) provides notice to such physician or supplier and the beneficiary of the payment determination, and “(ii) provides any appropriate payment directly to the participating physician or supplier involved; “(C) provides each enrollee at the time of enrollment a card listing the policy name and number and a single mailing address to which notices under section 1842(h)(3)(B) respecting the policy are to be sent; “(D) agrees to pay any user fees established under section 1842(h)(3)(B) with respect to information transmitted to the issuer of the policy; and “(E) provides to the Secretary at least annually, for transmittal to carriers, a single mailing address to which notices under section 1842(h)(3)(B) respecting the policy are to be sent.”. (c) Effective Dates.— (1) The amendment made by subsection (a) shall apply to contracts with carriers for claims for items and101 STAT. 1330–128 services furnished by participating physicians and suppliers on or after January 1, 1989. (2) (A) The amendments made by subsection (b) shall apply to medicare supplemental policies as of January 1, 1989 (or, if applicable, the date established under subparagraph (B)). (B) In the case of a State which the Secretary of Health and Human Services identifies as— (i) requiring State legislation (other than legislation appropriating funds) in order for medical supplemental policies to be changed to meet the requirements of section 1882(c)(3) of the Social Security Act, and (ii) having a legislature which is not scheduled to meet in 1988 in a legislative session in which such legislation may be considered, the date specified in this subparagraph is the first day of the first calendar quarter beginning after the close of the first legislative session of the State legislature that begins on or after January 1, 1989, and in which legislation described in clause (i) may be considered.