MEDICARE SECONDARY PAYER REFORMS.

SEC. 151. MEDICARE SECONDARY PAYER REFORMS. (a) Improving Identification of Medicare Secondary Payer Situations.— (1) Survey of beneficiaries.— (A) In general.— Section 1862(b)(5) (42 U.S.C. 1395y(b)(5)) is amended by adding at the end the following new subparagraph: “(D) Obtaining information from beneficiaries.—Before an individual applies for benefits under part A or enrolls under part B, the Administrator shall mail the individual a questionnaire to obtain information on whether the individual is covered under a primary plan and the 108 STAT. 4433 nature of the coverage provided under the plan, including the name, address, and identifying number of the plan. (B) Distribution of questionnaire by contractor.— The Secretary of Health and Human Services shall enter into an agreement with an entity not later than 60 days after the date of the enactment of the Social Security Act Amendments of 1994, to distribute the questionnaire described in section 1862(b)(5)(D) of the Social Security Act (as added by subparagraph (A)). (C) No medicare secondary payer denial based on failure to complete questionnaire.— Section 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is amended by adding at the end the following new subparagraph: “(C) Treatment of questionnaires.— The Secretary may not fail to make payment under subparagraph (A) solely on the ground that an individual failed to complete a questionnaire concerning the existence of a primary plan.”. (2) Mandatory screening by providers and suppliers under part b.— (A) In general.—Section 1862(b) (42 U.S.C. 1395y(b)) is amended by adding at the end the following new paragraph: “(6) Screening requirements for providers and suppliers.— “(A) In general.— Notwithstanding any other provision of this title, no payment may be made for any item or service furnished under part B unless the entity furnishing such item or service completes (to the best of its knowledge and on the basis of information obtained from the individual to whom the item or service is furnished) the portion of the claim form relating to the availability of other health benefit plans. “(B) Penalties.— An entity that knowingly, willfully, and repeatedly fails to complete a claim form in accordance with subparagraph (A) or provides inaccurate information relating to the availability of other health benefit plans on a claim form under such subparagraph shall be subject to a civil money penalty of not to exceed $2,000 for each such incident The provisions of section 1128A (other than subsections (a) and (b)) shall apply to a civil money penalty under the previous sentence in the same manner as such provisions apply to a penalty or proceeding under section 1128A(a).”. (B) Effective date.— The amendment made by subparagraph (A) shall apply with respect to items and services furnished on or after the expiration of the 120-day period beginning on the date of the enactment of this Act (b) Improvements in Recovery of Payments From Primary Payers.— (1) Submission of reports on efforts to recover erroneous payments.— (A) Fiscal intermediaries under part a.—Section 1816 (42 U.S.C. 1396h) is amended by adding at the end the following new subsection: 108 STAT. 4434 “(k) An agreement with an agency or organization under this section shall require that such agency or organization submit an annual report to the Secretary describing the steps taken to recover payments made for items or services for which payment has been or could be made under a primary plan (as defined in section 1862(b)(2)(A)).”. (B) Carriers under part b.— Section 1842(b)(3) (42 U.S.C. 1395u(b)(3)) is amended— (i) by striking “and” at the end of subparagraph (G); (ii) by striking “and” at the end of subparagraph (H); and (iii) by inserting after subparagraph (H) the following new subparagraph: “(I) will submit annual reports to the Secretary describing the steps taken to recover payments made under this part for items or services for which payment has been or could be made under a primary plan (as defined in section 1862(b)(2)(A)); and”. (2) Requirements under carrier performance evaluation program.— (A) Fiscal intermediaries under part a.— Section 1816(f)(1)(A) (42 U.S.C. 1396h(f)(1)(A)) is amended by striking “processing” and inserting “processing (including the agency’s or organization’s success in recovering payments made under this title for services for which payment has been or could be made under a primary plan (as defined in section 1862(b)(2)(A)))”. (B) Carriers under part b.— Section 1842(b)(2) (42 U.S.C. 1395u(b)(2)) is amended by adding at the end the following new subparagraph: “(D) In addition to any other standards and criteria established by the Secretary for evaluating carrier performance under this paragraph relating to avoiding erroneous payments, the carrier shall be subject to standards and criteria relating to the carrier’s success in recovering payments made under this part for items or services for which payment has been or could be made under a primary plan (as defined in section 1862(b)(2)(A)).”. (3) Deadline for reimbursement by primary plans.— (A) In general.— Section 1862(b)(2)(B)(i) (42 U.S.C. 1395y(b)(2)(B)(i)) is amended by adding at the end the following sentence: “If reimbursement is not made to the appropriate Trust Fund before the expiration of the 60-day period that begins on the date such notice or other information is received, the Secretary may charge interest (beginning with the date on which the notice or other information is received) on the amount of the reimbursement until reimbursement is made (at a rate determined by the Secretary in accordance with regulations of the Secretary of the Treasury applicable to charges for late payments).”. (B) Conforming amendment.— The heading of clause (i) of section 1862(b)(2)(B) is amended to read as follows: “Repayment required.—”. (C) Effective date.— The amendments made by this paragraph shall apply to payments for items and services108 STAT. 4435 furnished on or after the date of the enactment of this Act. (4) Effective date.— The amendments made by paragraphs (1) and (2) shall apply to contracts with fiscal intermediaries and carriers under title XVIII of the Social Security Act for contract years beginning with 1995. (c) Miscellaneous and Technical Corrections.— (1) Effective as if included in the enactment of OBRA-1993, section 1862(b)(l)(A) (42 U.S.C. 1395y(b)(1)(A)), as amended by section 13561(e)(1) of OBRA-1993, is amended— (A) in clause (i)(II), by striking “over (and the individual’s spouse age 65 or older) who is covered under the plan by virtue of the individual’s current employment status with an employer” and inserting “older (and the spouse age 65 or older of any individual) who has current employment status with an employer”; and (B) in clause (ii), by striking “or employee organization that has 20 or more individuals in current employment status” and inserting “that has 20 or more employees”. (2) Effective as if included in the enactment of OBRA-1993, section 1837(i) (42 U.S.C. 1395p(i)) is amended— (A) by striking “as an active individual (as those terms are defined in section 1862(b)(1)(B)(iv))” each place it appears in the second sentence of paragraph (1), and the second sentence of paragraph (2) and inserting “(as that term is defined in section 1862(b)(1)(B)(iv)) by reason of the individual’s current employment status (or the current employment status of a family member of the individual)”; (B) in paragraph (3)(B), by striking “as an active individual in a large group health plan (as such terms are defined in section 1862(b)(l)(B)(iv))” and inserting “in a large group health plan (as that term is defined in section 1862(b)(1)(B)(iv)) by reason of the individual’s current employment status (or the current employment status of a family member of the individual)”; (C) in the second sentence of paragraph (2) (as amended by subparagraph (A)), by striking “as an active individual” and inserting “by reason of the individual’s current employment status (or the current employment status of a family member of the individual)”; and (D) by inserting “status” after “current employment” each place it appears in paragraphs (1)(A), (2)(B), (2)(C), and (3)(A). (3) Effective as if included in the enactment of OBRA-1993, the second sentence of section 1839(b) (42 U.S.C. 1395r(b)) is amended— (A) by inserting “status” after “current employment”, and (B) by striking “as an active individual (as those terms are defined in section 1862(b)(1)(B)(iv))” and inserting “(as that term is defined in section 1862(b)(l)(B)(iv)) by reason of the individual’s current employment status (or the current employment status of a family member of the individual)”. (4) Effective as if included in the enactment of OBRA-1990, the sentence in section 1862(b)(1)(C) added by section108 STAT. 4436 4203(c)(1)(B) of OBRA-1990 is amended by striking “clauses (i) and (ii)” and inserting “this subparagraph”. (5) Effective as if included in the enactment of OBRA-1989, section 1862(b)(1)(C) is amended in the matter after clause (ii), by striking “taking into account that” and inserting “paying benefits secondary to this title when”. (6) Effective as if included in the enactment of OBRA-1989, section 1862(b)(5)(C)(i) (42 U.S.C. 1395y(b)(5)(C)(i)) is amended by striking “6103(l)(12)(D)(iii)” and inserting “6103(1)(12)(E)(iii)”. (7) Effective as if included in the enactment of OBRA-1990, section 4203(c)(2) of such Act is amended— (A) by striking “the application of clause (iii)” and inserting “the second sentence”; (B) by striking “on individuals” and all that follows through “section 226A of such Act”; (C) in clause (ii), by striking “clause” and inserting “sentence”; (D) in clause (v), by adding “and” at the end; and (E) in clause (vi)— (i) by inserting “of such Act” after “1862(b)(1)(C)”, and (ii) by striking the period at the end and inserting the following: “, without regard to the number of employees covered by such plans.”. (8) Effective as if included in the enactment of OBRA-1990, section 4203(d) of OBRA-1990 is amended by striking “this subsection” and inserting “this section”. (9) Effective as if included in the enactment of OBRA-1993, section 13561(e)(1)(D) of OBRA-1993 is amended— (A) by inserting “effective as if included in the enactment of OBRA-1989,” after “(D)”, and (B) by striking “of each subparagraph”. (10) The amendment made by section 13561(e)(1)(G) of OBRA-1993, to the extent it relates to the definition of large group health plan, shall be effective as if included in the enactment of OBRA-1989.