S.Amdt. 1082

1. Adds SEC. __. ACCELERATING THE RATE OF REDUCTION OF BENEFICIARY COPAYMENT LIABILITY UNDER THE MEDICARE HOSPITAL OUTPATIENT DEPARTMENT PROSPECTIVE PAYMENT SYSTEM at the end of subtitle B of title IV

   Adds a section

   In S. 1 · Reported to Senate

   (b) Report.--Not later than 1 year after the date of enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the study conducted under subsection (a). The report shall include recommendations regarding the use of more current data in computing geographic cost of practice indices as well as the use of data directly representative of physicians' costs (rather than proxy measures of such costs).

   Inserted: SEC. __. ACCELERATING THE RATE OF REDUCTION OF BENEFICIARY COPAYMENT LIABILITY UNDER THE MEDICARE HOSPITAL OUTPATIENT DEPARTMENT PROSPECTIVE PAYMENT SYSTEM.

   Inserted: Section 1833(t)(8)(C)(ii) (42 U.S.C. 1395l(t)(8)(C)(ii)) is amended--

   Inserted: (1) in subclause (V), by striking "and thereafter" and inserting "through 2008"; and

   Inserted: (2) by adding at the end the following new subclauses:

   Inserted: "(VI) For procedures performed in 2009, 36 percent.

   Inserted: "(VII) For procedures performed in 2010 and 2011, 34 percent.

   Inserted: "(VIII) For procedures performed in 2012, 32 percent.

   Inserted: "(IX) For procedures performed in 2013 and thereafter, 30 percent.".

   Inserted: SEC. __. MEDICARE SECONDARY PAYOR (MSP) PROVISIONS.

   Inserted: (a) Technical Amendment Concerning Secretary's Authority To Make Conditional Payment When Certain Primary Plans Do Not Pay Promptly.--

   Inserted: (1) In general.--Section 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is amended--

   Inserted: (A) in subparagraph (A)(ii), by striking "promptly (as determined in accordance with regulations)";

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   Inserted: (B) in subparagraph (B)--

   Inserted: (i) by redesignating clauses (i) through (iii) as clauses (ii) through (iv), respectively; and

   Inserted: (ii) by inserting before clause (ii), as so redesignated, the following new clause:

   Inserted: "(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.".

   Inserted: (2) Effective date.--The amendments made by paragraph (1) shall be effective as if included in the enactment of title III of the Medicare and Medicaid Budget Reconciliation Amendments of 1984 (Public Law 98-369).

   Inserted: (b) Clarifying Amendments to Conditional Payment Provisions.--Section 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is further amended--

   Inserted: (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.";

   Inserted: (2) in subparagraph (B)(ii), as redesignated by subsection (a)(2)(B)--

   Inserted: (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

   Inserted: (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

   Inserted: (3) in subparagraph (B)(iii), , as redesignated by subsection (a)(2)(B), 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.".

   Inserted: (c) Clerical Amendments.--Section 1862(b) (42 U.S.C. 1395y(b)) is amended--

   Inserted: (1) in paragraph (1)(A), by moving the indentation of clauses (ii) through (v) 2 ems to the left; and

   Inserted: (2) in paragraph (3)(A), by striking "such" before "paragraphs".

   Original wording

   At the end of subtitle B of title IV, add the following:

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As printed