MEDICARE AS SECONDARY PAYER.

SEC. 13601. MEDICARE AS SECONDARY PAYER. (a) Extension of and Modifications to Data Match Program.— (1) Section 1862(b)(5)(C)(iii) (42 U.S.C. 1395y(b)(5)(C)(iii)) is amended by striking “1995” and inserting “1998”. (2) Section 6103(l)(12) of the Internal Revenue Code of 1986 is amended— (A) in subparagraph (B)(i), by inserting “, above an amount (if any) specified by the Secretary of Health and Human Services,” after “section 3401(a))”; (B) in subparagraph (B)(ii), in the matter preceding subclause (I) by inserting “, above an amount (if any) specified by the Secretary of Health and Human Services,” after “wages”; and (C) in subparagraph (F)— (i) in clause (i), by striking “1995” and inserting “1998”, (ii) in clause (ii)(I), by striking “1994” and inserting “1997”, and (iii) in clause (ii)(II), by striking “1995” and inserting “1998”. (b) Extension of Medicare Secondary Payer to Disabled Beneficiaries.— Section 1862(b)(1)(B)(iii) (42 U.S.C. 1395y(b)(1)(B)(iii)) is amended by striking “1995” and inserting “1998”. (c) Extension of 18-month Rule for ESRD Beneficiaries.— Section 1862(b)(1) (42 U.S.C. 1395y(b)(1)) is amended— (1) in the second sentence of subparagraph (C), by striking “on or before January 1, 1996” and inserting “before October 1, 1998”; (2) in each of subparagraphs (A)(iv) and (B)(ii)— (A) by striking “Clause (i) shall not apply” and inserting “Subparagraph (C) shall apply instead of clause (i)”, and (B) by inserting “(without regard to entitlement under section 226)” after “individual is, or”; and (3) in subparagraph (C), by striking “benefits under this title solely by reason of” and inserting “or eligible for benefits under this title under” each place it appears. (d) Application of Aggregation Rules.— (1) In general.— Section 1862(b)(1) (42 U.S.C. 1395y(b)(1)) is amended by adding at the end the following new subparagraph: “(E) General provisions.— For purposes of this subsection: “(i) Aggregation rules.— “(I) All employers treated as a single employer under subsection (a) or (b) of section 52 of the 107 STAT. 594Internal Revenue Code of 1986 shall be treated as a single employer. “(II) All employees of the members of an affiliated service group (as defined in section 414(m) of such Code) shall be treated as employed by a single employer. “(III) Leased employees (as defined in section 414(n)(2) of such Code) shall be treated as employees of the person for whom they perform services to the extent they are so treated under section 414(n) of such Code. In applying sections of the Internal Revenue Code of 1986 under this clause, the Secretary shall rely upon regulations and decisions of the Secretary of the Treasury respecting such sections.”. (2) Conforming amendment.— Section 5000(b)(2) of the Internal Revenue Code of 1986 (relating to large group health plans) is amended by adding at the end the following: “For purposes of the preceding sentence— “(A) all employers treated as a single employer under subsection (a) or (b) of section 52 shall be treated as a single employer, “(B) all employees of the members of an affiliated service group (as defined in section 414(m)) shall be treated as employed by a single employer, and “(C) leased employees (as defined in section 414(n)(2)) shall be treated as employees of the person for whom they perform services to the extent they are so treated under section 414(n).”. (3) The amendments made by this subsection shall take effect 90 days after the date of the enactment of this Act. (e) Uniform Treatment of Current Employment Status.— (1) In general.— Section 1862(b)(1) (42 U.S.C. 1395y(b)(1)) is amended— (A) in subparagraph (A)(i), by amending subclauses (I) and (II) to read as follows: “(I) may not take into account that an individual (or the individual’s spouse) who is covered under the plan by virtue of the individual’s current employment status with an employer is entitled to benefits under this title under section 226(a), and “(II) shall provide that any individual age 65 or 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 shall be entitled to the same benefits under the plan under the same conditions as any such individual (or spouse) under age 65.”; (B) in subparagraph (A)(ii), by striking “unless the plan” and all that follows through “employees” and inserting “unless the plan is a plan of, or contributed to by, an employer or employee organization that has 20 or more individuals in current employment status”; (C) in subparagraph (A)(iii), by striking “by virtue of employment” and all that follows through “calendar year or” and inserting “by virtue of current employment status 107 STAT. 595with an employer that does not have 20 or more individuals in current employment status for each working day in each of 20 or more calendar weeks in the current calendar year and”; (D) in subparagraph (A)(v), by “, inserting without regard to section 5000(d) of such Code” before the period at the end of each subparagraph; (E) in the heading of subparagraph (B), by striking “active”; (F) in subparagraph (B)(i), by striking “clause (iv)(II)) may not take into account that an active individual (as defined in clause (iv)(I))” and inserting “clause (iv)) may not take into account that an individual (or a member of the individual’s family) who is covered under the plan by virtue of the individual’s current employment status with an employer”; (G) by amending clause (iv) of subparagraph (B) to read as follows: “(iv) Large group health plan defined.—In this subparagraph, the term ‘large group health plan’ has the meaning given such term in section 5000(b)(2) of the Internal Revenue Code of 1986, without regard to section 5000(d) of such Code.”; and (H) by adding at the end of subparagraph (E), as added by subsection (d)(1), the following: “(ii) Current employment status defined.— An individual has ‘current employment status’ with an employer if the individual is an employee, is the employer, or is associated with the employer in a business relationship. “(iii) Treatment of self-employed persons as employers.— The term ‘employer’ includes a self-employed person.”. (2) (A) section 5000 of the Internal Revenue Code of 1986 is amended— (i) in subsection (a), by inserting “(including a self-employed person)” after “employer”, (ii) by amending paragraph (1) of subsection (b) to read as follows: “(1) Group health plan.— The term ‘group health plan’ means a plan (including a self-insured plan) of, or contributed to by, an employer (including a self-employed person) or employee organization to provide health care (directly or otherwise) to the employees, former employees, the employer, others associated or formerly associated with the employer in a business relationship, or their families.”, and (iii) in subsection (c), by striking “of section 1862(b)(1)” and inserting “of paragraph (1), or with the requirements of paragraph (2), of section 1862(b)”. (B) Section 6103(l)(12)(E)(ii) of such Code is amended to read as follows: “(ii) Group health plan.— The term ‘group health plan’ means any group health plan (as defined in section 5000(b)(1)). (f) Retroactive Exemption for Certain Situations Involving Religious Orders.— Section 1862(b)(1)(D) of the Social Security Act applies, with respect to items and services furnished before 107 STAT. 596October 1, 1989, to any claims that the Secretary of Health and Human Services had not identified as of that date as subject to the provisions of section 1862(b) of such Act.