59–010 

Calendar No. 317 

114TH CONGRESS REPORT " ! SENATE 1st Session 114–177 

AUDIT & APPEALS FAIRNESS, INTEGRITY, AND REFORMS 

IN MEDICARE ACT OF 2015 

DECEMBER 8, 2015.—Ordered to be printed 

Mr. HATCH, from the Committee on Finance, 

submitted the following 

R E P O R T 

[To accompany S. 2368] 

[Including cost estimate of the Congressional Budget Office] 

The Committee on Finance, having considered an original bill (S. 

2368) to amend title XVIII of the Social Security Act to improve the 

efficiency of the Medicare appeals process, and for other purposes, 

having considered the same, reports favorably thereon without 

amendment, and recommends that the bill do pass. 

CONTENTS 

Page 

I. LEGISLATIVE BACKGROUND .................................................................. 2 

II. EXPLANATION OF THE BILL ................................................................... 5 

A. SECTIONS 1–9, IMPROVEMENTS TO THE APPEALS PROCESS .................................................................................................. 5 

B. SECTION 10, REVIEW PROGRAM IMPROVEMENTS ............... 11 

C. SECTION 11, CREATION OF MEDICARE PROVIDER AND 

SUPPLIER OMBUDSMAN FOR REVIEWS AND APPEALS .... 14 

D. SECTION 12, LIMITING THE AUDIT AND RECOVERY PERIOD FOR PATIENT STATUS REVIEWS .................................. 15 

E. SECTION 13, INCENTIVES AND DISINCENTIVES FOR 

MEDICARE CONTRACTORS, PROVIDERS, AND SUPPLIERS ............................................................................................ 17 

III. BUDGET EFFECTS OF THE BILL ............................................................ 18 

A. COMMITTEE ESTIMATES ............................................................. 18 

B. BUDGET AUTHORITY .................................................................... 20 

C. CONSULTATION WITH CONGRESSIONAL BUDGET OFFICE ................................................................................................ 20 

IV. VOTES OF THE COMMITTEE .................................................................... 20 

V. REGULATORY IMPACT AND OTHER MATTERS ................................... 21 

A. REGULATORY IMPACT ................................................................. 21 

B. UNFUNDED MANDATES STATEMENT ...................................... 21 

VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED 21 


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I. LEGISLATIVE BACKGROUND

The Committee on Finance, having considered an original bill, 

Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act 

of 2015, to amend title XVIII of the Social Security Act intended 

to increase coordination and oversight of Medicare claims review 

contractors, implement new strategies to address the growing number of review contractor determination appeals, reduce review burdens on providers, and give review contractors the tools necessary 

to better protect the Medicare Trust Fund, having considered the 

same, reports favorably thereon as modified, and recommends that 

the bill, as modified, do pass. 

Background and need for legislative action 

Medicare audits and appeals pose a serious burden for health 

care providers and suppliers as well as for review contractors seeking to reduce federal healthcare programs’ improper payments. The 

Improper Payments Information Act of 2002 requires the Department of Health and Human Services (HHS) to identify programs 

within HHS that may be susceptible to significant improper payments. Improper payment estimates reported by HHS and other 

federal agencies are not intended to be an estimate of fraud. Instead, improper payments include any payments that should not 

have been made or that were made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or other legally applicable requirements. Office of Management and Budget guidance directs agencies to include in their calculations any payments for which insufficient or 

no documentation was found. 

Within HHS, the Centers for Medicare & Medicaid Services 

(CMS) measures the improper payment rate, and the associated 

dollar amount, each year for the Medicare fee-for-service program, 

Parts C and D, and Medicaid. In 2009, Medicare’s improper payment rate was 10.8 percent, or $30.8 billion. In 2011, the error rate 

decreased to 8.6 percent, or $28.8 billion, and by 2013, the error 

rate was back up to 10.1 percent, or $36 billion. CMS has attributed the error rate’s rise in part to new requirements for certain 

claims, particularly for DME and home health. 

The Medicare improper payment rate includes many different 

types of payments to many different types of providers and suppliers. The most common cause of improper payments during the 

2013 report period (accounting for 56.8 percent of total improper 

payments) was a lack of documentation to support the services or 

supplies billed to Medicare. Improper payments are not consistent 

across the fee-for-service programs. In 2013, Medicare Part A had 

an error rate of 8.1 percent. In Medicare Part B, payments to suppliers of durable medical equipment, prosthetics, orthotics and supplies (DMEPOS) had an error rate of 58.2 percent. 

CMS hires a variety of private review contractors to identify improper Medicare payments and lower error rates. Medicare Administrative Contractors (MAC) primarily process claims and handle 

related functions. As part of their administrative role, MACs also 

conduct certain claims reviews to identify and correct improper 

payments. Zone Program Integrity Contractors (ZPIC) investigate 

instances of suspected fraud, waste, and abuse and take approVerDate Sep 11 2014 06:58 Dec 10, 2015 Jkt 059010 PO 00000 Frm 00002 Fmt 6659 Sfmt 6602 E:\HR\OC\SR177.XXX SR177

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1 Improper payment determinations by other Medicare contractors (for example, Medicare 

audit contractors like RAs and ZPICs) are also appealed to the MAC. Providers have an opportunity to question an overpayment determination with the contractor that made the determination before making the formal appeal (request for redetermination) to the MAC. 2QICs do not process claims or conduct audits—they are only involved in the appeals process. 

QIC conduct independent reconsiderations of Medicare overpayment determinations and claims 

denials and are required to use clinicians (nurses and physicians) for cases involving questions 

of medical necessity. QICs were created by the Medicare, Medicaid, and SCHIP Benefits Improvement and Protection Act (BIPA) of 2000, which included provisions to improve the Medicare appeals process. Part of these provisions mandate that all second-level appeals be conducted QICs. 

priate corrective actions. The Supplemental Medical Review Contractor (SMRC) was created to identify and employ more efficient 

methods of medical review, such as data extrapolation. The SMRC 

conducts nationwide medical reviews as directed by CMS, including 

issues identified by CMS data analysis and/or by agencies including 

the HHS Office of Inspector General (HHS–OIG), the Government 

Accountability Office, and the Comprehensive Error Rate Testing 

(CERT) auditor. CERT auditors measure improper payments in the 

Medicare fee-for-service program to determine the annual improper 

payment rate. Finally, Recovery Auditors (RA), formerly referred to 

as Recovery Audit Contractors (RAC), identify and correct improper 

overpayments and underpayments in the Medicare program. Unlike other types of Medicare contractors that are paid in fixed 

amounts based on their costs, RAs are paid on a contingency 

basis—receiving 9 to 12.5 percent of the corrected improper payment amounts. This contingency fee structure gives RAs a financial 

incentive to identify and collect improper payments. 

Despite CMS’s efforts, the improper payment rate in the Medicare program remains high. The Government Accountability Office 

found in fiscal year 2014, approximately 10 percent of the $603 billion Medicare payments were improperly paid. Dodaro, Gene L., 

Testimony before the Senate Committee on Finance, Fiscal Outlook: Addressing Improper Payments and the Tax Gap Would Improve the Government’s Fiscal Position, GAO–16–92T at 6 (Oct. 1, 

2015), available at http://www.gao.gov/assets/680/672884.pdf. 

The large number of improper payments has led to an increased 

number of audits to recapture improperly paid funds. Although 

CMS’s contractors are making progress recovering funds, the increase in audits has contributed to an extraordinary increase in appeals of payment determinations. 

Providers and beneficiaries are able to appeal Part A and Part 

B improper payment determinations made by MACs or other Medicare review contractors through a four-stage administrative appeals process. The first level of appeal is reviewed by a MAC, the 

contractor that processes the claim submitted for payment and that 

may have made the original improper payment determination.1 For 

the second level of appeal, providers and beneficiaries can appeal 

to a Qualified Independent Contractor (QIC) and receive an independent review conducted by clinicians.2 The third level of appeal 

is heard by an Administrative Law Judge (ALJ) at HHS’s Office of 

Medicare Hearings and Appeals (OMHA). For the third level, appellants must meet an amount in controversy threshold, which is 

updated on an annual basis ($150 for 2015). The fourth and final 

administrative stage of appeal is review by the Medicare Appeals 

Council (Appeals Council), which is a component of HHS’s Departmental Appeals Board (DAB). After exhausting these four adminisVerDate Sep 11 2014 06:58 Dec 10, 2015 Jkt 059010 PO 00000 Frm 00003 Fmt 6659 Sfmt 6602 E:\HR\OC\SR177.XXX SR177

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3 Improvements are Needed at the Administrative Law Judge Level of Medicare Appeals, HHS– 

OIG, OEI–02–10–00340 (November 2012); see also Nudelman, Jodi, Statement to the House 

Committee on Ways and Means, Subcommittee on Health, Current Hospital Issues in the Medicare Program, Hearing May 20, 2014. 

trative appeals, parties can seek judicial review in federal District 

Court. For judicial review, appellants must again meet an amount 

in controversy threshold, which is also updated on an annual basis 

($1460 for 2015). 

Although some beneficiaries appeal payment decisions, the majority of appellants (85 percent) are providers. Two percent of these 

providers accounted for nearly one-third of all ALJ appeals in FY 

2010. And, some provider-appellants filed many more appeals than 

others. On average, providers filed six appeals each, but 96 providers filed at least 50 appeals each, and one provider filed over 

1000 appeals.3 The vast majority of RA audits are not appealed (in 

2011, only 6.7 percent of RA improper payment determinations 

were appealed). 

Although most RA audit decisions are not appealed, the expansion of RA audits has coincided with the rise in appeals, which has 

contributed to the backlog at OMHA. At the time of this report, 

there are so many appeals being filed that the Office of Medicare 

Hearings and Appeals (OMHA) cannot docket an appeal for 20 to 

24 weeks and the backlog of cases is near 1,000,000. 

The HHS–OIG report found that some ALJs were more likely 

than others to make decisions that were fully favorable to appellants. Among the 66 ALJs, the fully favorable rate ranged from 18 

to 85 percent. HHS–OIG reported that ALJ staff stated that different philosophies among ALJs contribute to the variation in fully 

favorable rates. ALJ staff said that given the same facts and the 

same applicable Medicare policy, some ALJs would make decisions 

that are favorable to appellants, while others would not. 

This bill addresses the primary causes of the increase in appeals 

and the backlog itself. First, the bill will improve CMS oversight 

of audit contractors and require better coordination between auditors and CMS. The bill will ensure that all parties receive transparent data regarding review practices and appeal outcomes at 

each level of review. Second, the bill will require that CMS create 

new incentives to improve auditor accuracy. It will also require 

that CMS create an independent Ombudsman for Medicare Reviews and Appeals to assist in resolving complaints by appellants 

and those considering appeal. Finally, the bill will make needed reforms to and increase funding for the Medicare appeals process to 

address the appeals backlog and ensure timely reviews, without 

sacrificing quality. The bill will raise the amount in controversy for 

review by an ALJ to match the amount for review by a District 

Court. The bill will create a new Medicare magistrate program for 

cases with lower costs, allowing senior attorneys with expertise in 

Medicare law and policies to adjudicate cases in the same way as 

ALJs. It will allow for the use of sampling and extrapolation, with 

the appellant’s consent, to expedite the appeals process. The bill 

will also establish a voluntary alternate dispute resolution process 

for multiple pending claims with similar issues to be settled as a 

unit, rather than as individual appeals. 


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4Section 1155 also results in appeals under Medicare A/B, from a Quality Improvement Organization initial determination, and reconsideration, to an ALJ and the Council. A different 

amount in controversy currently applies ($200) and the rules are in part 478 of 42 CFR. In addition, sections 1852(g)(5), 1876(c)(5)(B), and 1860D–4(h) have appeal provisions for the Medicare 

managed care and prescription drug programs. 

The Committee recognizes the need to address this serious backlog to ease the burden on physicians and other health care providers and on beneficiaries. 

II. EXPLANATION OF THE BILL

The present law applicable to sections 2 through 6, and 8 of the 

bill is discussed at the beginning of section II, part A (there are no 

provisions in present law for sections 1, 7 and 9). Part A then explains the provisions of each section separately. The present law 

and provisions of sections 10, 11, 12, and 13 of the bill are discussed in section II, parts B, C, D, and E respectively. 

A. SECTIONS 1–9, IMPROVEMENTS TO THE APPEALS PROCESS

PRESENT LAW

Section 1869 of the Social Security Act (Act) 4 and accompanying 

regulations establish a process for making determinations with respect to benefits under Parts A and B of Medicare and appealing 

these determinations when a claim for benefits is denied in whole 

or in part. In accordance with regulations, the Secretary of HHS 

(the Secretary) is required to make an initial determination concerning, for example, the amount of benefits available to the individual, or whether payment may not (or may no longer be) made 

for an item or service. The appeals process created under section 

1869 offers up to five levels of review under which individuals (i.e., 

beneficiaries, providers, suppliers, and State Medicaid Agencies) 

may challenge an adverse initial determination. First, pursuant to 

this section and accompanying regulations, an individual may request a Medicare Administrative Contractor (MAC) to make a redetermination with respect to the claim. Redeterminations generally 

must be concluded no later than 60 days after the day the contractor receives the request. 

Second, section 1869 of the Act permits any individual dissatisfied with the initial determination and the redetermination to file 

a request for reconsideration. Pursuant to section 1869(c), reconsiderations are conducted by Qualified Independent Contractors 

(QICs) that must meet certain specified requirements, and the Secretary is required to enter into contracts with no less than 4 of 

these entities. Reconsiderations must be processed within 60 days, 

subject to exception. Section 1869(b) of the Act also provides that 

an individual may request, and the Secretary must provide, an expedited determination or expedited reconsideration of an individual 

determination if an individual receives a notice that a provider of 

services plans to (1) terminate all services to an individual (and a 

physician certifies that failure to continue the provision of services 

likely places the individual’s health at significant risk), or (2) discharge the individual from the provider. 

In accordance with section 1869 and implementing regulations, if 

an individual is dissatisfied with a QIC’s reconsideration, or if the 

adjudication period for the QIC to conclude its reconsideration has 


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5 Except those appeals for an ALJ hearing brought under Section 1155 of the Act. 

6The amount in controversy (AIC) applies to the amount of the claim, and aggregation allows 

multiple claims that do not meet the AIC to be brought together to get a hearing—slight distinction, but an important one, as a single appeal may involve multiple claims. 

passed, the party may request a hearing before an Administrative 

Law Judge (ALJ). Section 1869(d) specifies that an ALJ must 

render a decision on such hearing no later than the end of the 90– 

day period following the date of when the request for the hearing 

was timely filed, subject to exception. Further, the Secretary must 

provide continuing education to these ALJs (as well as QICs) with 

respect to coverage of items or services under Medicare and certain 

policies of the Secretary, in order for such contractors and judges 

to make informed decisions on appeals. 

In order to be entitled to a hearing before an ALJ, certain 

amount in controversy requirements must be met. Section 1869(b) 

of the Act establishes amount in controversy threshold amounts for 

ALJ hearing requests for Medicare Part A and Part B appeals 5

that are subject to an annual adjustment. As indicated in a notice 

published in the Federal Register, for calendar year 2015, if the 

amount in controversy is less than $150, an ALJ hearing is not 

available to an individual under this section. In determining the 

amount in controversy, the Secretary, pursuant to regulations, 

must permit two or more appeals to be aggregated 6 if the appeals 

involve the similar or related services provided to the same individual by one or more providers or suppliers or common issues of 

law and fact arising from services provided to multiple individuals 

by one or more providers or suppliers. 

Section 1869(b)(3) of the Act currently states the following: ‘‘A 

provider of services or supplier may not introduce evidence in any 

appeal under this section that was not presented at the reconsideration conducted by the QIC under subsection (c) of this section, unless there is good cause which precluded the introduction of such 

evidence at or before that reconsideration.’’ 

After an ALJ hearing decision or dismissal has been issued, or 

if the ALJ has failed to render a decision within the specified timeframe, parties may request review by the Departmental Appeals 

Board of the Department of Health and Human Services (HHS), 

the final level of administrative appeal. Under section 1869(d) of 

the Act, in general, the Departmental Appeals Board must conduct 

and conclude its review and make a decision or remand the case 

to the ALJ for further consideration no later than 90 days following 

the date of a request for review. If a party wishes to appeal the 

decision of the Board, or the Board’s time frame for issuing a ruling 

has elapsed, judicial review may be requested. Claims are filed in 

U.S. district court, and are subject to an amount in controversy 

($1,460 for calendar year 2015) and other requirements. Additionally, section 1869(b) directs the Secretary to establish a process 

under which beneficiaries, providers, and suppliers can obtain expedited access to judicial review. This access may be granted if a 

review entity (comprised of at least three ALJs or members of the 

Departmental Appeals Board) determines that the Board does not 

have authority to decide questions of law or regulation relevant to 

matters in controversy, and there is no material issue of fact in dispute. A party may also bring an action in district court if the review entity generally fails to make a determination within 60 days. 


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According to the HHS, FY2016 Justification of Estimates for Appropriations Committees, the Office of Medicare Hearings and Appeals (OMHA) was appropriated discretionary funding of $82.4 million in FY2014 and $87.4 million in FY2015. HHS requested $270 

million in the President’s FY2016 budget proposal which included 

$140 million in discretionary budget authority and $130 million in 

program funding from proposed legislation. The $130 million in 

proposed FY2016 program funding from legislation includes indefinite mandatory authority to access a $125 million appropriation 

from Medicare Recovery Audit Contractor (RA) overpayment recoveries. 

EXPLANATION OF PROVISIONS

Section 1—Short title; table of contents 

Section 2—Increased resources for the Office of Medicare Hearings 

and Appeals and the Departmental Appeals Board 

The bill would require $127 million per year to be appropriated 

from the Medicare Hospital Insurance (HI) and Supplemental Medical Insurance (SMI) Trust Funds (in amounts to be determined at 

the Secretary’s discretion) beginning in FY2016, providing $125 

million to OMHA and $2 million to the Departmental Appeals 

Board of HHS for purposes of conducting reviews, hearings, and 

appeals. The funds appropriated would be available until spent and 

would be in addition to any other funds that may be available to 

OMHA and the Departmental Appeals Board for the same purposes. 

The bill would require the Government Accountability Office 

(GAO) to conduct a review of the use of the additional funds provided to determine if OMHA increased the number of appeals processed, decreased the time required to process an appeal, and 

achieved other program improvements. GAO would be required to 

report such information to Congress no later than December 31, 

2018. 

Section 3—Establishment of Medicare magistrate reviews and revision of amount in controversy thresholds 

The bill would establish within OMHA decision-making officials 

known as Medicare magistrates. Beginning on January 1, 2017, 

Medicare magistrates would perform reviews and render decisions 

in certain appeals described below. Medicare magistrates would be 

licensed attorneys with expertise in the Medicare statute, policies, 

and procedures, who would be appointed by the Secretary of HHS, 

and meet other qualifications as determined by the Secretary of 

HHS. 

Medicare magistrates would perform reviews and render decisions that are appealed to OMHA when the amount in controversy 

of an appealed claim is less than the new amount in controversy 

as established by this section (described below) for an ALJ hearing 

through OMHA but equal to or greater than the amount in controversy under current law for an ALJ hearing through OMHA (for 

example for FY2015 an appealed claim with an amount in controversy that falls in between $150 and $1,460). The current rules 

and guidelines that govern appeals adjudicated by ALJs would 

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ducted by Medicare magistrates. Decisions made by Medicare magistrates could be appealed to the Departmental Appeals Board but 

could not be appealed to the federal court level because the amount 

in controversy would be below the threshold required by the federal 

court level. 

The bill would increase the current amount in controversy 

threshold for Medicare appealed claims heard by an ALJ through 

the OMHA from the current amount of $150 set for FY2015 to a 

dollar threshold equal to the amount in controversy as required for 

Medicare appealed claims to be heard at the federal court level. 

The new threshold is effective in calendar year 2017 and would be 

indexed for inflation and updated annually as it is in current law. 

Section 4—Remanding appeals to the redetermination level with the 

introduction of new evidence 

Beginning on January 1, 2017, the bill would require a QIC; a 

Medicare magistrate, as established in section 2; an ALJ, or the 

Departmental Appeals Board to remand an appeal to the MAC for 

a redetermination when the appellant introduces new evidence into 

the administrative record at a subsequent level of appeal. 

The bill would provide an exception to the remand process described above when the introduction of new evidence is made by an 

individual entitled to, or enrolled for, benefits under part A or enrolled under part B, or CMS or its contractors, or justified due to 

1) an inadvertent omission or erroneous decision by a lower level 

adjudicator to omit the evidence from the administrative record despite its timely submission by the appellant, 2) an instance where 

a decision by a lower-level adjudicator was made on new or different grounds than the initial decision, or 3) other circumstances 

as determined by the Secretary of HHS. 

Section 5—Expedited access to appeals 

No later than January 1, 2017, the bill would require the Secretary of HHS to establish and implement a process whereby ALJs 

and Medicare magistrates, as established in section 2, could issue 

decisions, based on the evidence of record, without holding a hearing when there are no material issues of fact in dispute and the 

ALJ or the Medicare magistrate determines that there is a binding 

authority that controls the decision in the matter under review. 

The new process described above would apply to requests for review that are pending on or filed after the date of the enactment 

of this bill. 

The bill would require the Secretary of HHS to establish a process by which an appeal before an ALJ can be certified for expedited 

access to judicial review when 1) the appellant has not requested 

expedited access to judicial review, 2) there is no material fact in 

dispute, and 3) neither the ALJ nor the Departmental Appeals 

Board has the authority to decide the questions of law or regulation relevant to the matters in controversy. Such a determination 

would exhaust the administrative appeals process, rendering the 

appeal eligible for judicial review. 


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Section 6—Authority to use sampling and extrapolation methodologies and to consolidate appeals for administrative efficiency 

As of the date of enactment, the bill would allow for a review entity (e.g., a MAC or a QIC); a Medicare magistrate, as established 

in section 2; an ALJ, or the Departmental Appeals Board to consolidate more than one pending request for review or appeal into 

a single action or appeal if 1) the individual requests involve one 

or more common question of fact or law for similar claims submitted by the same individual or entity, 2) the party requests aggregation of claims, 3) the requests for review or appeal were included within a statistical sample during initial review or previous 

level of appeal, or 4) other circumstances that are identified by the 

Secretary of HHS prior to the use of consolidation that would promote administrative efficiency. 

The bill would require a request for review or appeal that had 

been previously consolidated at a lower level of appeal or involving 

claims that were included as part of an extrapolation to be submitted as a single request for review or appeal in order to be entitled to a review or hearing. When an appeal involves a decision 

that was based on a statistical sample at a lower level, the adjudicator’s decision of such appeal must be based on the same statistical sample. The bill would allow an adjudicator to use statistical 

sampling and extrapolation methodologies for any requests for review or appeals that are pending on or filed after the date of the 

enactment of this bill, with the consent of the appellant. 

Section 7—Identification and referral of fraud 

No later than January 1, 2017, the bill would require the Secretary of HHS, in consultation with HHS Inspector General and 

the Attorney General, to establish and implement a process by 

which OMHA and the Departmental Appeals Board would refer 

credible suspicion of fraudulent activity to appropriate law enforcement entities and CMS. 

Section 8—Study to assess hearing participation 

No later than January 1, 2017, the bill would require the Secretary of HHS to conduct a review to determine whether it would 

be feasible to increase the participation of the CMS or the review 

entity contractors (e.g., program integrity contractors, RAs, MACs, 

QICs) in appeal hearings conducted by OMHA, including a process 

to provide notice of a hearing to all relevant contractors. 

Section 9—Improvements to the Office of Medicare Hearings and 

Appeals 

Beginning in calendar year 2017, the bill would require OMHA 

to conduct annual training for all ALJs and Medicare magistrates 

on Medicare policies, including changes made to such policies in a 

given year. 

Beginning on January 1, 2017, in the instance the magistrate or 

ALJ reach a different decision than the QIC, the written decision 

of the magistrate or ALJ must explain the reason the decision 

reached by the Medicare magistrate or ALJ is different than the 

decision made by the QIC. 

Beginning on January 1, 2017, the bill would require the Secretary of HHS to publish annually on a publically accessible 


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website the following: 1) the percentage of appeals that receive 

fully favorable, partially favorable and unfavorable decisions; 2) 

such information (described in 1) for each individual ALJ and by 

type of service (e.g., Part A hospital, Part B, durable medical equipment); 3) the length of time elapsed between request for review and 

final decisions; 4) the instances in which the Departmental Appeals 

Board reversed or remanded the decisions of individual ALJs on 

the grounds that they diverted from Medicare policies and coverage; 5) the instances in which individual ALJs reached a decision 

that differed from the opinion of a physician employed by the QIC; 

and 6) other information as determined by the Secretary of HHS 

that would provide greater transparency of OMHA. 

The bill would require the GAO to conduct a review of decisions 

rendered at OMHA to identify the frequency in which (i) ALJ or 

Medicare magistrate decisions diverted from CMS interpretation of 

Medicare policies and program instruction, (ii) ALJ or Medicare 

magistrate decisions demonstrate significant variation in the interpretation of similar Medicare policies or instruction, and (iii) ALJ 

or Medicare magistrate decisions failed to apply the applicable 

Medicare law, regulation, policy or instruction. Nothing in this section shall be construed as questioning the independence of the 

ALJs, but is to be used to provide empirical information regarding 

how ALJ decisions are reached. Data related to the frequency in 

which ALJ decisions diverted from Medicare law, regulation, policy, 

or coverage decisions shall focus on decisions adjudicated no less 

than one year after the enactment of this bill and may be evaluated through the use of sampling. This shall be reported to Congress no later than January 1, 2018. 

No later than July 1, 2018, the bill would require the Secretary 

of HHS to establish and implement a process to identify Medicare 

policies or coverage decisions that, when surrounded by similar 

facts or circumstances are most frequently interpreted differently 

by Medicare review entity contractors, Medicare magistrates, ALJs, 

or the Departmental Appeals Board. Such a process should determine whether further clarification or adjustment to such policies is 

needed to prevent future varied interpretations. 

The bill would require the Secretary of HHS to determine if the 

specialization of ALJs by type of appeal (i.e., the type of Medicare 

service or provider) and/or the mandatory use of clinical experts 

alongside ALJs would lead to more consistent decisions made by 

ALJs for cases with similar facts. The Secretary of HHS shall conduct a study to investigate such issues and report to Congress no 

later than July 1, 2018. 

Beginning in calendar year 2017, the bill would require the Secretary to establish alternative dispute resolution processes, including mediation, in which providers, suppliers, beneficiaries, or State 

Medicaid Agencies could voluntarily resolve large volumes of pending appeals involving similar issues of law or fact. As part of any 

settlement agreement, the appellant would be required to withdraw 

all requests for hearing or review for the claims covered by the settlement. The Secretary would have discretion to establish the program in a cost-effective manner, including consideration of thresholds and available resources. The Secretary of HHS would establish 

a process to coordinate with appropriate law enforcement officials 

and/or CMS to avoid inadvertent settlement or resolution of cases 


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7http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/MedicareFFS-Compliance-Programs/Medical-Review/InpatientHospitalReviews.html 

or appeals with suspected fraud or abuse, systematic gaming, or 

delays in the provision of care or other criminal activity. 

B. SECTION 10, REVIEW PROGRAM IMPROVEMENTS

PRESENT LAW

Current law does not specifically require the Secretary of HHS 

to establish guidelines and methodologies for reviewing reimbursement claims submitted by providers and suppliers. 

The Secretary is required to administer Medicare Parts A (Act, 

section 1816) and B (Act, section 1842) by contracting with MACs 

as identified at section 1874A of the Act. In addition, current law 

(Act, section 1893) established the Medicare Integrity Program 

(MIP), which requires the Secretary to contract with eligible entities to conduct program integrity activities. Under MIP, the Secretary is required to contract with Medicare RAs to identify Medicare overpayments and underpayments (Act, section 1893(h)). RAs 

are required to be paid only from funds that were recouped as a 

result of their reviews in the form of contingency fees which consist 

of a percentage of the overpayment and underpayment amounts 

they identify. The Secretary also was authorized to use a portion 

of RA recoveries to administer the RA program. All other RA overpayment funds recovered from providers are returned to the Medicare Trust Funds. Recently, § 505(b) of the Medicare Access and 

CHIP Reauthorization Act of 2015 (MACRA, P.L. 114–10) authorized the Secretary to use up to 15% of RA recoveries for additional 

purposes. 

In implementing MIP requirements, the Secretary also established contracts with other entities that include Zone Program Integrity Contractors (ZPIC), a Supplemental Medical Review Contractor (SMRC), and a Medicare-Medicaid Data Match Contractor 

(MMDMC). 

The Centers for Medicare & Medicaid Services uses Medicare 

contractors to review claims submitted by providers and suppliers 

both before and after claims are paid. MACs, in addition to initial 

and routine scanning for completeness and consistency, also conduct certain claim review activities prior to paying claims (prepayment review), as well as after paying claims (post-payment review). 

Other contractors such as RAs, ZPICs and SMRCs, also review 

Medicare claims after payment was made. Most post-payment 

claim reviews involve medical review, which CMS describes as ‘‘the 

collection of information and clinical review of medical records by 

Medicare contractor staff to ensure that payment was made only 

for services that met all Medicare coverage, coding, and medical necessity requirements.’’ 7 Medical review processes and decisions 

generally are guided by policies that may be provided in CMS 

manuals or required by CMS, but developed and implemented by 

contractor staff. Medical review processes and policies can vary depending on the contractor type—MAC, RA, ZPIC, QIC, SMRC, or 

MMDMC—conducting the review, the individual contractors, and 

the type of service under review. Current Medicare law gives Medicare contractors discretion to develop and tailor coverage decisions 

to local medical conventions and preferences; as a result there is 


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some variation in interpreting and enforcing medical review policies. 

CMS, through contractor oversight and contractor performance 

requirements, facilitates most coordination among MACs. CMS also 

has administrative policies and procedures to help minimize medical review duplication or inconsistency with Medicare law, regulations, and program instructions, but is not required to do so under 

current law. The Secretary also is required to assure that the duties of MACs do not overlap with other contractors, including RAs, 

although overlap with durable medical equipment (DME) suppliers 

is permitted (Act, section 1874A(a)(5)(A)). 

EXPLANATION OF PROVISION

The bill would require the Secretary of HHS to promote transparency and consistency in Medicare payment and coverage policy, 

as appropriate, and ensure that review entity contractors uniformly 

and consistently apply these policies and that Medicare magistrates, ALJs, and the Departmental Appeals Board are aware of 

and trained in these policies. Nothing in this section should be construed as questioning the independence of Medicare magistrates, 

ALJs, or the Departmental Appeals Board, but is to help ensure 

that consistent guidelines and methodologies exist and are available to those entities reviewing reimbursement claims submitted 

by providers and suppliers. 

The bill would require the Secretary of HHS to approve review 

guidelines and methodologies prior to their use in the review of any 

claims paid by Medicare. The bill would allow the Secretary of 

HHS to provide or establish a transition period by which existing 

reviews would be permitted to continue until such time as the Secretary of HHS is able to review and approve the review guidelines 

or methodologies. Review topics or guidelines that have been approved for use by the Secretary shall be made publically available 

on the CMS website, no less frequently than annually. Review topics shall be posted and publically available for a reasonable amount 

of time before they are used. The Secretary of HHS may prioritize 

the guideline and methodology approval process according to error 

rate, frequency of denials, and cost to the Medicare Trust Fund. 

The bill would require the Secretary of HHS to designate a point 

of contact to coordinate, oversee, and perform the following tasks, 

in order to improve upon the existing and future program integrity 

initiatives and to limit unnecessary provider or supplier burden. 

1. Develop a comprehensive strategy for claims review determinations made on either a prepayment, post-payment, or 

prior-authorization basis. The strategy shall focus on identifying and reducing those claim errors that have the largest impact on the error rate, pose the greatest risk to the Medicare 

Trust Fund, or are likely to negatively affect quality of care. 

In developing such strategy, the Secretary shall consider ways 

to reduce unnecessary burden on providers and suppliers and 

minimize any unintended effects of these policies on beneficiaries. Such strategy should utilize data and other sources 

including: claims data, Office of Inspector General reports, 

GAO reports, news reports, Medicare Payment Advisory Commission reports, and Comprehensive Error Rate Testing 

(CERT) reports; 


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2. Develop methods to ensure that there is not unnecessary 

duplication of review of specific individual claims among the 

review entity contractors used by the Department to conduct 

claims review, including the use of all available data; 

3. Work with all review entity contractors to develop a uniform, consistent, and transparent review process to reduce provider and supplier burden to the greatest extent possible by including a uniform approach for review entity contractors to notify parties of pending reviews and requests for medical documentation; improved communication with providers and suppliers; methods for providing review results; and better refinement of reviews to target claims that are at the highest risk 

for improper payments or other errors; and any other areas in 

which the Secretary determines provider and supplier burdens 

may be decreased; 

4. Identify CMS local coverage determinations (LCDs), national coverage determinations (NCDs), regulations, and program instructions that need updating or inappropriately conflict with other Medicare policies and make the appropriate 

modifications. Nothing in this section shall be construed as undermining the independent authority of Medicare magistrates, 

ALJs, or the Departmental Appeals Board; rather, these policies should be modified and updated in a manner consistent 

with all existing statute and regulations. In the event that the 

Secretary of HHS identifies a lack of necessary Medicare policies and review guidelines related to a particular issue, the 

Secretary of HHS shall establish such instructions, with input 

from stakeholders, as appropriate; 

5. Post on a publicly accessible website the volume and type 

of prepayment and post-payment claim reviews performed by 

the Medicare review contractors; 

6. Coordinate with OMHA and the Departmental Appeals 

Board to ensure that the improved methodologies and evidentiary standards established within this bill, such as the decision to remand an appeal, are properly implemented; 

7. Ensure that providers and suppliers subject to post-payment review are granted a discussion period with the contractor of at least 30 days from the letter from the review entity contractor regarding the result of the review; 

8. Develop qualification standards for review entity contractors to have audits conducted or approved by medical doctors 

with knowledge of relevant Medicare laws, policies, and program instruction, as appropriate. 

9. Determine whether additional punitive actions against review entity contractors could be taken and what, if any, financial incentives or disincentives could be used to promote the accuracy of a review entity’s reviews. 

The bill would require the Secretary to establish a secure internet based system for access by providers, and other appropriate entities, in order to determine status of claims under review by any 

Medicare audit or oversight contractor, or that is being processed 

as an appeal by a MAC, QIC, ALJ, or the Departmental Appeals 

Board. This system could be based on the existing database system 

of claims under review used by audit contractors, or a similar existing system. The Secretary shall report to Congress within 180 days 


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8http://www.medicare.gov/Pubs/pdf/10050.pdf. 

of passage of the Act on a plan to establish and operate such a portal. The Secretary shall ensure that such system does not impede 

any ongoing investigations of potential fraud. 

The bill would require, as part of the annual RA report to Congress under current law, the following information be included: (1) 

include number of claims corrected in the discussion period; (2) a 

separate calculation that identifies a total overturn rate for appeals 

in which an appealed claim is only once, based upon the decision 

made at the highest appeal level; (3) carefully describe the denominator of total audits and appeals, given the likelihood that many 

appeals in a given year will not have a decision in that year; and 

(4) consistently report complex Part A, complex Part B, semi-automated, and automated reviews separately. 

C. SECTION 11, CREATION OF MEDICARE PROVIDER AND SUPPLIER

OMBUDSMAN FOR REVIEWS AND APPEALS

PRESENT LAW

Under current law, the Secretary is not required to offer Medicare providers or suppliers access to an Ombudsman. According to 

CMS’s annual beneficiary publication, Medicare & You,8 an ombudsman is someone who reviews complaints and helps to resolve 

those complaints. 

Current law requires the Secretary to conduct a satisfaction survey at least every five years of beneficiaries as well as providers 

and suppliers who submitted appeals (Act, section 1869(e)) and to 

submit a report to Congress on the results of the survey. In addition, section 1808(c) of the Act requires the Secretary to appoint a 

Medicare Beneficiary Ombudsman. The Office of Medicare Ombudsman (OMO) was created to identify and address systemic 

issues that affect Medicare beneficiaries, but OMO does not assist 

providers, suppliers, or Medicare contractors in resolving complaints and other issues. 

EXPLANATION OF PROVISION

The bill would require the Secretary of HHS to establish a CMS 

OMBUDSMAN FOR MEDICARE REVIEWS AND APPEALS. The 

Medicare Provider & Supplier Ombudsman’s duties would include: 

1. Identifying, investigating, and assisting in the resolution of 

complaints and inquiries (including referring to the appropriate entity) involving Medicare review or appeals processes from appellants or those considering appeals. 

2. Identifying trends in complaints and inquiries regarding the 

current Medicare review and appeals systems to provide recommendations for improvements to the Secretary of HHS. Such 

recommendations would improve the efficacy and efficiency of the 

claims review and appeals system as well as communication to 

beneficiaries, providers, and suppliers regarding the claims review 

and appeals system. 

3. Designing a system by which to objectively measure and evaluate reviewer responsiveness to addressing provider and supplier 

issues and Ombudsman inquiries. 


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4. Providing administrative and technical assistance to appellants and those considering appeals. 

5. Publish data regarding the number of review determinations 

appealed, each appeal’s outcome, and aggregate appeal statistics 

for each contractor, provider and supplier type. Such data shall be 

displayed in a uniform, consistent, and easily understood format. 

6. Assisting in education and training efforts for providers, suppliers, and review entity contractors. 

7. Communicating with the Medicare Beneficiary Ombudsman to 

assist with the identifying, investigating, and resolution of beneficiary-related complaints, including those that overlap with reviews and appeals submitted by a provider. 

D. SECTION 12, LIMITING THE AUDIT AND RECOVERY PERIOD FOR

PATIENT STATUS REVIEWS

PRESENT LAW

Current law also requires RA contracts to permit RAs to review 

claims in the current fiscal year and retrospectively for up to four 

additional fiscal years, for a total of five fiscal years (SSA 

§ 1893(h)(4)(A) and (B)). According to the RA Statement of Work 

currently in effect, the look-back period is measured from the date 

of the initial determination to the daate of the RA issues the medical records request letter for complex reviews, the overpayment notification letter for semi-automated reviews, or the demand letter 

for automated reviews. Currently, CMS has limited the RA lookback period to three fiscal years. 

Section 6404 of the Patient Protection and Affordable Care Act 

(ACA, P.L. 111–148) amended the SSA to limit the maximum period for provider and supplier submission of Medicare claims to one 

calendar year from the date of service (SSA § 1814(a), § 1842(b)(3), 

and § 1835(a)). Under the new RA contracts, CMS indicated that it 

would limit the RA look-back period to six months from the date 

of service for patient status reviews, where hospitals submitted 

claims within three months of the date of service. 

To comply with timely filing rules, as stated above, hospitals 

must submit a claim within one year from the date of service, but 

the RAs have a three year look-back period. When a RA issues a 

decision denying an inpatient status claim that is more than one 

year from the date of service, the hospital is unable to re-bill as an 

outpatient service because the time period for filing a claim has expired. 

For most acute care hospitals, Medicare uses two distinct payment systems for inpatient and outpatient services. Hospitals can 

sometimes receive substantially higher payments for the same 

services if patients were admitted to the hospital as inpatients 

rather than treated as outpatients. 

A number of hospital claims reviewed by RAs since FY2010 were 

identified as inappropriate payments because RAs determined that 

the care should have been delivered in outpatient settings rather 

than the inpatient setting where hospitals delivered the services, 

so the claims were not reasonable and necessary for payment under 

Medicare Part A. When these (Part A) inpatient claims were denied, under the prior CMS policy, hospitals were prohibited from 

resubmitting the claims as (Part B) outpatient claims, except for a 


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limited number of services. Hospitals appealed many of these 

claims. Some claims were overturned at third and fourth appeal 

levels (ALJ and Medicare Appeals Council levels); other claims are 

pending in the appeal process. 

On March 13, 2013, CMS issued a Ruling that established a 

process for handling these claims that were being appealed, which 

allowed rebilling of inpatient services under Part B when an inpatient claim was denied. CMS also published a rule finalizing the 

policy on rebilling these claims under Part B, on how claims should 

be re-submitted, and on how the resolution of claims already appealed could be expedited. The rule also clarified when it would 

generally be appropriate for an inpatient admission to be paid 

under Medicare Part A, referred to as the Two-Midnight Rule, 

which stipulated that in cases where a doctor expects a patient 

would require a hospital stay for at least two midnights, it would 

be considered a medically necessary inpatient stay. CMS believed 

that the Ruling and the Rule on Medicare Part B inpatient billing 

would help to clarify appropriate billing procedures and reduce 

overpayments and appeals. 

Even under the Part B inpatient billing policy, hospitals may be 

unable to resubmit denied Part A inpatient claims under Part B 

because providers and suppliers must submit claims within one calendar year of the date of service to comply with timely filing rules, 

whereas RAs can look back three previous fiscal years when reviewing claims. If RAs review Part A inpatient claims from three 

fiscal years ago prior and deny claims, under timely filing rules, it 

is too late for the hospital to resubmit the claim under Part B for 

payment. 

The Protecting Access to Medicare Act of 2014 (PAMA, P.L. 113– 

93) required the Secretary to prohibit RAs from reviewing inpatient 

claims for patient status (whether a patient is an inpatient or an 

outpatient) with admission dates between October 1, 2013 and 

March 31, 2015 (PAMA, § 111—Extension of Two-Midnight Rule). 

PAMA also specifically permitted the Secretary to review inpatient 

claims if there was evidence of systemic gaming, fraud, abuse, or 

delays in the provision of care. Under PAMA, other Medicare contractors, such as MACs, are permitted to review a sample of inpatient claims to assess compliance and educate providers on Medicare’s Two-Midnight rule under a Probe and Educate process. 

MACRA extended the PAMA provisions at § 111 that prohibited 

RA reviews of patient status on inpatient claims from April 1, 2015 

through September 30, 2015 (MACRA, § 521—Extension of TwoMidnight PAMA Rules on Certain Medical Review Activities). 

MACRA also stipulated that the Secretary was permitted to pursue 

fraud and abuse activities under RA authority or otherwise. 

EXPLANATION OF PROVISION

The bill would prohibit RAs from conducting patient status reviews (i.e., inpatient versus outpatient status) more than 6 months 

after the date of service if the claim was submitted within 3 

months of the date of service. 

The bill would require the Secretary to study the potential burden on providers and suppliers of the look-back period under current law and the impact of shortening the look-back period for 

other RA audits, including audits for physicians and other health 


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care providers and suppliers, and would provide the Secretary with 

discretion to implement a look-back period to a period of less than 

three years. The bill would require the Secretary to make the study 

publicly available. 

The bill would direct the Secretary of Health and Human Services no later than six months after the enactment of this bill to 

submit a report to Congress with recommendations to change the 

recovery audit payment structure, in budget-neutral matter, from 

an incentive-based model to a non-incentive based approach without additional financial burdens on providers. 

E. SECTION 13, INCENTIVES AND DISINCENTIVES FOR MEDICARE

CONTRACTORS, PROVIDERS, AND SUPPLIERS

PRESENT LAW

Medicare law requires participating providers and suppliers to 

comply with Medicare requirements stipulated in the Act as well 

as CMS regulations. Medicare law also requires the Secretary to 

provide incentives for MACs to provide quality service and to promote efficiency (Act, section 1874A(b)(1)(D)). In addition, the Secretary is required to develop contract performance requirements for 

MAC duties and standards for measuring MAC’s performance in 

meeting those requirements (Act, section 1874A(b)(3)). Moreover, in 

developing standards for measuring MAC performance, the Secretary is required to consult with stakeholders and to make the 

performance standards publicly available. 

MACRA required MACs to have an improper payment outreach 

and education program that would provide outreach, education, 

training, and technical assistance to providers and suppliers within 

each contractor’s geographic service area (Act, section 1874A(a)(4)). 

CMS also requires all Medicare contractors to provide outreach 

and education to providers and suppliers and provides guidance to 

Medicare contractors on communications and interactions with providers and suppliers in the Medicare Contractor Beneficiary and 

Provider Communications Manual, Chapter 6—Provider Customer 

Service Program (Rev. 31, 02–13–2015). This manual identifies a 

number of Medicare contractor requirements to provide education, 

outreach, and overall support through the Provider Customer Service Program (PCSP). CMS makes data available on the results of 

the PCSP on its Contractor-Provider Customer Service Program 

website including contractor performance data. 

In July 2014, CMS announced the establishment of a Provider 

Relations Coordinator. CMS indicated that the Provider Relations 

Coordinator was intended to improve communications between providers and CMS and to help increase program transparency while 

offering more efficient resolutions to providers affected by the review process. Providers were instructed to raise broader concerns 

with the Provider Relations Coordinator, but to continue to interact 

with MACs and RAs on individual claim questions. 

EXPLANATION OF PROVISION

The bill would require the Secretary to establish and implement, 

no later than January 1, 2017, a system that takes into account the 

denial rate as a percentage of claims audited and final determination of appeals by type of issue (for example, patient classification 


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or medical necessity for specific procedures) by which providers or 

suppliers with a low error rate for claims subject to additional document requests over a two-year period are exempt from audits by 

RAs and MACs on a post-payment basis for one year unless there 

is evidence of systematic gaming, fraud, abuse, or delays in the 

provision of care. 

The Secretary of HHS shall assess the frequency in which decisions being made by the review entity contractors are consistent 

with Medicare payment and coverage law, regulations and program 

instruction (but taking into account geographical variation that are 

a result of local coverage determinations). The Secretary of HHS 

may use sampling to fulfill this requirement. The results of the validation shall be posted to the CMS website. 

The bill would require the Secretary to adjust the number of 

medical records a review entity can request from a provider or supplier for the purposes of review based on the assessment described 

above. This adjustment would be directly related to the accuracy of 

the review entity’s reviews. Contractors with an accuracy rate of 

95% or more may be eligible to request additional medical records. 

Contractors with an accuracy rate of less than 95% may be limited 

in their ability to request medical records, according to a sliding 

scale established by the Secretary. 

EFFECTIVE DATE

The provision is effective upon enactment. 

III. BUDGET EFFECTS OF THE BILL

A. COMMITTEE ESTIMATES

In compliance with paragraph 11(a) of Rule XXVI of the Standing Rules of the Senate, the following Congressional Budget Office 

estimate is made concerning the estimated budget effects of the 

revenue provisions of the ‘‘Audit & Appeals Fairness, Integrity, and 

Reforms in Medicare Act of 2015’’ as reported. 

The bill is estimated to have the following effects on federal 

budget receipts for fiscal years 2016–2025: 


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9 Pub. L. No. 93–344. 

Summary 

The bill would authorize the appropriation of $127 million per 

year from the Medicare Hospital Insurance (HI) and Supplemental 

Medical Insurance (SMI) Trust Funds (in amounts to be determined at the Secretary HHS’s discretion) beginning in FY2016, 

providing $125 million to OMHA and $2 million to the Departmental Appeals Board of HHS for purposes of conducting reviews, 

hearings, and appeals. The funds appropriated would be available 

until spent and would be in addition to any other funds that may 

be available to OMHA and the Departmental Appeals Board for the 

same purposes. Implementing the Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2015 would cost $1.31 billion 

over the 2016–2025 period, assuming appropriation of the specified 

amounts. 

For this estimate, CBO assumes that the legislation will be enacted near the beginning of fiscal year 2016 and that the amounts 

specified will be appropriate in that year. Enacting the Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act of 2015 

would affect direct spending or revenues; therefore, pay-as-you-go 

procedures apply. The bill would not impose intergovernmental or 

private sector mandates as defined in the Unfunded Mandates Reform Act and would impose no costs on state, local, or tribal governments. The annual estimated budgetary impact of the Audit & 

Appeals Fairness, Integrity, and Reforms in Medicare Act of 2015 

is shown in the table above. 

B. BUDGET AUTHORITY

Budget authority 

In compliance with section 308(a)(1) of the Congressional Budget 

and Impoundment Control Act of 1974 (‘‘Budget Act’’),9 the Committee states that the bill as reported involves increased budget authority (see table in Part A., above). 

Tax expenditures 

In compliance with section 308(a)(1) of the Budget Act, the Committee states that the bill does not involve increased tax expenditures. 

C. CONSULTATION WITH CONGRESSIONAL BUDGET OFFICE

In accordance with section 403 of the Budget Act, the Committee 

advises that the Congressional Budget Office has submitted the 

preceding cost estimate on the bill. 

IV. VOTES OF THE COMMITTEE

In compliance with paragraph 7(b) of rule XXVI of the Standing 

Rules of the Senate, the Committee states that, with a majority 

present, the ‘‘Audit & Appeals Fairness, Integrity, and Reforms in 

Medicare Act of 2015’’ or the ‘‘AFIRM Act’’ was amended and ordered favorably reported on June 3, 2015 as follows: 

Final Passage of the Audit & Appeals Fairness, Integrity, and 

Reforms in Medicare Act of 2015 or the AFIRM Act—approved by 

voice vote. 


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V. REGULATORY IMPACT AND OTHER MATTERS

A. REGULATORY IMPACT

Pursuant to paragraph 11(b) of rule XXVI of the Standing Rules 

of the Senate, the Committee makes the following statement concerning the regulatory impact that might be incurred in carrying 

out the provisions of the bill. 

Impact on individuals and businesses, personal privacy and paperwork 

The bill is not expected to impose additional administrative requirements or regulatory burdens on individuals. The bill is expected to reduce administrative requirements and regulatory burdens on some businesses. 

The provisions of the bill do not impact personal privacy. 

B. UNFUNDED MANDATES STATEMENT

This information is provided in accordance with section 423 of 

the Unfunded Mandates Reform Act of 1995 (Pub. L. No. 104–4). 

The Committee has determined that the bill does not contain any 

private sector mandates. The Committee has determined that the 

bill contains no intergovernmental mandate. 

VI. CHANGES IN EXISTING LAW MADE BY THE BILL, AS REPORTED

In the opinion of the Committee, it is necessary in order to expedite the business of the Senate, to dispense with the requirements 

of paragraph 12 of rule XXVI of the Standing Rules of the Senate 

(relating to the showing of changes in existing law made by the bill 

as reported by the Committee). 

Æ 


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