MEDICAID PAYMENT RATES FOR CERTAIN MEDICARE COSTSHARING.

SEC. 4714. MEDICAID PAYMENT RATES FOR CERTAIN MEDICARE COSTSHARING. (a) Clarification Regarding State Liability for Medicare Cost-Sharing.— (1) In general.—Section 1902(n) (42 U.S.C. 1396a(n)) is amended— (A) by inserting “(1)” after “(n)”, and (B) by adding at the end the following: “(2) In carrying out paragraph (1), a State is not required to provide any payment for any expenses incurred relating to payment for deductibles, coinsurance, or copayments for medicare costsharing to the extent that payment under title XVIII for the service would exceed the payment amount that otherwise would be made 111 STAT. 510under the State plan under this title for such service if provided to an eligible recipient other than a medicare beneficiary. “(3) In the case in which a State’s payment for medicare cost-sharing for a qualified medicare beneficiary with respect to an item or service is reduced or eliminated through the application of paragraph (2)— “(A) for purposes of applying any limitation under title XVIII on the amount that the beneficiary may be billed or charged for the service, the amount of payment made under title XVIII plus the amount of payment (if any) under the State plan shall be considered to be payment in full for the service; “(B) the beneficiary shall not have any legal liability to make payment to a provider or to an organization described in section 1903(m)(1)(A) for the service; and “(C) any lawful sanction that may be imposed upon a provider or such an organization for excess charges under this title or title XVIII shall apply to the imposition of any charge imposed upon the individual in such case. This paragraph shall not be construed as preventing payment of any medicare cost-sharing by a medicare supplemental policy or an employer retiree health plan on behalf of an individual.”. (2) Conforming clarification.—Section 1905(p)(3) (42 U.S.C. 1396d(p)(3)) is amended by inserting “(subject to section 1902(n)(2))” after “means”. (b) Limitation on Medicare Providers.— (1) Provider agreements.—Section 1866(a)(1)(A) (42 U.S.C. 1395cc(a)(1)(A)) is amended— (A) by inserting “(i)” after “(A)”, and (B) by inserting before the comma at the end the following: “, and (ii) not to impose any charge that is prohibited under section 1902(n)(3)”. (2) Nonparticipating providers.—Section 1848(g)(3)(A) (42 U.S.C. 1395w–4(g)(3)(A)) is amended by inserting before the period at the end the following: “and the provisions of section 1902(n)(3)(A) apply to further limit permissible charges under this section”. (c) Effective Date.—The amendments made by this section shall apply to payment for (and with respect to provider agreements with respect to) items and services furnished on or after the date of the enactment of this Act. The amendments made by subsection (a) shall also apply to payment by a State for items and services furnished before such date if such payment is the subject of a law suit that is based on the provisions of sections 1902(n) and 1905(p) of the Social Security Act and that is pending as of, or is initiated after, the date of the enactment of this Act.