MEDICARE SECONDARY PAYOR (MSP) PROVISIONS.

SEC. 301. MEDICARE SECONDARY PAYOR (MSP) PROVISIONS.(a) Technical Amendment Concerning Secretary’s Authority To Make Conditional Payment When Certain Primary Plans Do Not Pay Promptly.—Section 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is amended—(1) in subparagraph (A)(ii), by striking “promptly (as determined in accordance with regulations)”; and(2) in subparagraph (B)—(A) by redesignating clauses (i) through (v) as clauses (ii) through (vi), respectively; and(B) by inserting before clause (ii), as so redesignated, the following new clause:“(i) Authority to make conditional payment.—The Secretary may make payment under this title with respect to an item or service if a primary plan described in subparagraph (A)(ii) has not made or cannot reasonably be expected to make payment with respect to such item or service promptly (as determined in accordance with regulations). Any such payment by the Secretary shall be conditioned on reimbursement to the appropriate Trust Fund in accordance with the succeeding provisions of this subsection.”.(b) Clarifying Amendments to Conditional Payment Provisions.—Section 1862(b)(2) (42 U.S.C. 1395y(b)(2)), as amended by subsection (a), is amended—117 STAT. 2222(1) in subparagraph (A), in the matter following clause (ii), by inserting the following sentence at the end: “An entity that engages in a business, trade, or profession shall be deemed to have a self-insured plan if it carries its own risk (whether by a failure to obtain insurance, or otherwise) in whole or in part.”; (2) in subparagraph (B)(ii), as redesignated by subsection (a)(2)(A)—(A) by striking the first sentence and inserting the following: “A primary plan, and an entity that receives payment from a primary plan, shall reimburse the appropriate Trust Fund for any payment made by the Secretary under this title with respect to an item or service if it is demonstrated that such primary plan has or had a responsibility to make payment with respect to such item or service. A primary plan’s responsibility for such payment may be demonstrated by a judgment, a payment conditioned upon the recipient’s compromise, waiver, or release (whether or not there is a determination or admission of liability) of payment for items or services included in a claim against the primary plan or the primary plan’s insured, or by other means.”; and(B) in the final sentence, by striking “on the date such notice or other information is received” and inserting “on the date notice of, or information related to, a primary plan’s responsibility for such payment or other information is received”; and(3) in subparagraph (B)(iii), as redesignated by subsection (a)(2)(A), by striking the first sentence and inserting the following: “In order to recover payment made under this title for an item or service, the United States may bring an action against any or all entities that are or were required or responsible (directly, as an insurer or self-insurer, as a third-party administrator, as an employer that sponsors or contributes to a group health plan, or large group health plan, or otherwise) to make payment with respect to the same item or service (or any portion thereof) under a primary plan. The United States may, in accordance with paragraph (3)(A) collect double damages against any such entity. In addition, the United States may recover under this clause from any entity that has received payment from a primary plan or from the proceeds of a primary plan’s payment to any entity.”.(c) Clerical Amendments.—Section 1862(b) (42 U.S.C. 1395y(b)) is amended—(1) in paragraph (1)(A), by moving the indentation of clauses (ii) through (v) 2 ems to the left; and(2) in paragraph (3)(A), by striking “such” before “paragraphs”.(d) Effective Dates.—The amendments made by this section shall be effective—(1) in the case of subsection (a), as if included in the enactment of title III of the Medicare and Medicaid Budget Reconciliation Amendments of 1984 (Public Law 98–369); and(2) in the case of subsections (b) and (c), as if included in the enactment of section 953 of the Omnibus Reconciliation Act of 1980 (Public Law 96–499; 94 Stat. 2647).117 STAT. 2223