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[House Report 112-715]
[From the U.S. Government Printing Office]


112th Congress                                            Rept. 112-715
                        HOUSE OF REPRESENTATIVES
 2d Session                                                      Part 1

======================================================================



 
       STRENGTHENING MEDICARE AND REPAYING TAXPAYERS ACT OF 2012

                                _______
                                

               December 20, 2012.--Ordered to be printed

                                _______
                                

  Mr. Upton, from the Committee on Energy and Commerce, submitted the 
                               following

                              R E P O R T

                        [To accompany H.R. 1063]

      [Including cost estimate of the Congressional Budget Office]

    The Committee on Energy and Commerce, to whom was referred 
the bill (H.R. 1063) to amend title XVIII of the Social 
Security Act with respect to the application of Medicare 
secondary payer rules for certain claims, having considered the 
same, report favorably thereon with an amendment and recommend 
that the bill as amended do pass.

                                CONTENTS

                                                                   Page
Amendment........................................................     1
Purpose and Summary..............................................     5
Background and Need for Legislation..............................     5
Hearings.........................................................     7
Committee Consideration..........................................     7
Committee Votes..................................................     8
Committee Oversight Findings.....................................     8
Statement of General Performance Goals and Objectives............     8
New Budget Authority, Entitlement Authority, and Tax Expenditures     8
Earmarks, Limited Tax Benefits, and Limited Tariff Benefits......     8
Committee Cost Estimate..........................................     8
Congressional Budget Office Estimate.............................     8
Federal Mandates Statement.......................................    11
Advisory Committee Statement.....................................    11
Applicability to Legislative Branch..............................    11
Section-by-Section Analysis of the Legislation...................    11
Changes in Existing Law Made by the Bill, as Reported............    12

                               Amendment

    The amendment is as follows:
  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

  (a) Short Title.--This Act may be cited as the ``Strengthening 
Medicare And Repaying Taxpayers Act of 2012''.
  (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Determination of reimbursement amount through CMS website to 
improve program efficiency.
Sec. 3. Fiscal efficiency and revenue neutrality.
Sec. 4. Reporting requirement.
Sec. 5. Use of social security numbers and other identifying 
information in reporting.
Sec. 6. Statute of limitations.

SEC. 2. DETERMINATION OF REIMBURSEMENT AMOUNT THROUGH CMS WEBSITE TO 
                    IMPROVE PROGRAM EFFICIENCY.

  Section 1862(b)(2)(B) of the Social Security Act (42 U.S.C. 
1395y(b)(2)(B)) is amended by adding at the end the following new 
clause:
                          ``(vii) Use of website to determine final 
                        conditional reimbursement amount.--
                                  ``(I) Notice to secretary of expected 
                                date of a settlement, judgment, etc.--
                                In the case of a payment made by the 
                                Secretary pursuant to clause (i) for 
                                items and services provided to the 
                                claimant, the claimant or applicable 
                                plan (as defined in paragraph (8)(F)) 
                                may at any time beginning 120 days 
                                before the reasonably expected date of 
                                a settlement, judgment, award, or other 
                                payment, notify the Secretary that a 
                                payment is reasonably expected and the 
                                expected date of such payment.
                                  ``(II) Secretary providing access to 
                                claims information through a website.--
                                The Secretary shall maintain and make 
                                available to individuals to whom items 
                                and services are furnished under this 
                                title (and to authorized family or 
                                other representatives recognized under 
                                regulations and to an applicable plan 
                                which has obtained the consent of the 
                                individual) access to information on 
                                the claims for such items and services 
                                (including payment amounts for such 
                                claims), including those claims that 
                                are attributable to a specific injury 
                                or incident that forms the basis for a 
                                settlement, judgment, award or other 
                                payment relating to an injury or 
                                incident to which this subsection 
                                applies. Such access shall be provided 
                                to an individual, representative, or 
                                plan through a website that requires a 
                                password to gain access to the 
                                information. The Secretary shall update 
                                the information on claims and payments 
                                on such website in as timely a manner 
                                as possible but not later than 15 days 
                                after the date of receipt of such 
                                claims or the making of such payments, 
                                respectively. Information related to 
                                claims and payments subject to the 
                                notice under subclause (I) shall be 
                                maintained and made available 
                                consistent with the following:
                                          ``(aa) The information shall 
                                        be as complete as possible and 
                                        shall include provider or 
                                        supplier name, diagnosis codes 
                                        (if any), dates of service, and 
                                        conditional payment amounts.
                                          ``(bb) The information 
                                        accurately identifies those 
                                        claims and payments that are 
                                        related to an injury or 
                                        incident to which the 
                                        provisions of this subsection 
                                        apply.
                                          ``(cc) The website provides a 
                                        method for the receipt of 
                                        secure electronic 
                                        communications with the 
                                        individual, representative, or 
                                        plan involved.
                                          ``(dd) The website provides 
                                        that information is transmitted 
                                        from the website in a form that 
                                        includes an official time and 
                                        date that the information is 
                                        transmitted.
                                          ``(ee) The website shall 
                                        permit the individual, 
                                        representative, or plan to 
                                        download a statement of 
                                        reimbursement amounts (in this 
                                        clause referred to as a 
                                        `statement of reimbursement 
                                        amount') on payments for claims 
                                        under this title relating to a 
                                        specific injury or incident of 
                                        the individual.
                                  ``(III) Use of timely web download as 
                                basis for final conditional amount.--If 
                                an individual (or other claimant or 
                                applicable plan with the consent of the 
                                individual) obtains a statement of 
                                reimbursement amount from the website 
                                during the protected period as defined 
                                in subclause (V) and the related 
                                settlement, judgment, award or other 
                                payment is made during such period, 
                                then the last statement of 
                                reimbursement amount that is downloaded 
                                during such period and within 3 
                                business days before the date of the 
                                settlement, judgment, award, or other 
                                payment shall constitute the final 
                                conditional amount subject to recovery 
                                under clause (ii) related to such 
                                settlement, judgment, award, or other 
                                payment.
                                  ``(IV) Resolution of discrepancies.--
                                If the individual (or authorized 
                                representative) believes there is a 
                                discrepancy with the statement of 
                                reimbursement amount, the Secretary 
                                shall provide a timely process to 
                                resolve the discrepancy. Under such 
                                process the individual (or 
                                representative) must provide an 
                                alternate final conditional payment 
                                amount and documentation of the basis 
                                for such alternate amount. Within 15 
                                days after the date of receipt of such 
                                documentation, the Secretary shall 
                                determine whether there is a reasonable 
                                basis for such alternate final 
                                conditional payment amount. If the 
                                Secretary does not make such 
                                determination within the 15-day period, 
                                then the alternate final conditional 
                                payment amount shall become the final 
                                conditional payment amount. If the 
                                Secretary determines within such period 
                                that there is not a reasonable basis 
                                for the alternate amount, the original 
                                final conditional payment amount is 
                                reconfirmed. If the Secretary 
                                determines within such period that 
                                there is a reasonable basis for an 
                                alternate final conditional payment 
                                amount, the Secretary must respond in a 
                                timely manner by agreeing to the 
                                alternative final conditional payment 
                                amount or by providing documentation 
                                showing with good cause why the 
                                Secretary is not agreeing to such 
                                amount and either reconfirming the 
                                original final conditional payment 
                                amount or establishing another 
                                alternative final conditional payment 
                                amount. In no case shall the process 
                                under this subclause be treated as an 
                                appeals process or as establishing a 
                                right of appeal for a statement of 
                                reimbursement amount and there shall be 
                                no administrative or judicial review of 
                                the Secretary's determinations under 
                                this subclause.
                                  ``(V) Protected period.--In subclause 
                                (III), the term `protected period' 
                                means, with respect to a settlement, 
                                judgment, award or other payment 
                                relating to an injury or incident, the 
                                portion (if any) of the period 
                                beginning on the date of notice under 
                                subclause (I) with respect to such 
                                settlement, judgment, award, or other 
                                payment that is after the end of a 
                                Secretarial response period beginning 
                                on the date of such notice to the 
                                Secretary. Such Secretarial response 
                                period shall be a period of 65 days, 
                                except that such period may be extended 
                                by the Secretary for a period of an 
                                additional 30 days if the Secretary 
                                determines that additional time is 
                                required to address claims for which 
                                payment has been made. Such Secretarial 
                                response period shall be extended and 
                                shall not include any days for any part 
                                of which the Secretary determines (in 
                                accordance with regulations) that there 
                                was a failure in the claims and payment 
                                posting system and the failure was 
                                justified due to exceptional 
                                circumstances (as defined in such 
                                regulations). Such regulations shall 
                                define exceptional circumstances in a 
                                manner so that not more than 1 percent 
                                of the repayment obligations under this 
                                subclause would qualify as exceptional 
                                circumstances.
                                  ``(VI) Effective date.--The Secretary 
                                shall promulgate final regulations to 
                                carry out this clause not later than 9 
                                months after the date of the enactment 
                                of this clause.
                                  ``(VII) Website including successor 
                                technology.--In this clause, the term 
                                `website' includes any successor 
                                technology.
                          ``(viii) Right of appeal for secondary payer 
                        determinations relating to liability insurance 
                        (including self-insurance), no fault insurance, 
                        and workers' compensation laws and plans.--The 
                        Secretary shall promulgate regulations 
                        establishing a right of appeal and appeals 
                        process, with respect to any determination 
                        under this subsection for a payment made under 
                        this title for an item or service for which the 
                        Secretary is seeking to recover funds from an 
                        applicable plan (as defined in paragraph 
                        (8)(F)) that is a primary plan under subsection 
                        (A)(ii), under which the applicable plan 
                        involved, or an attorney, agent, or third party 
                        administrator on behalf of such plan, may 
                        appeal such determination. The individual 
                        furnished such an item or service shall be 
                        notified of the plan's intent to appeal such 
                        determination.''.

SEC. 3. FISCAL EFFICIENCY AND REVENUE NEUTRALITY.

  (a) In General.--Section 1862(b) of the Social Security Act (42 
U.S.C. 1395y(b)) is amended--
          (1) in paragraph (2)(B)(ii), by striking ``A primary plan'' 
        and inserting ``Subject to paragraph (9), a primary plan''; and
          (2) by adding at the end the following new paragraph:
          ``(9) Exception.--
                  ``(A) In general.--Clause (ii) of paragraph (2)(B) 
                and any reporting required by paragraph (8) shall not 
                apply with respect to any settlement, judgment, award, 
                or other payment by an applicable plan constituting a 
                total payment obligation to a claimant of not more than 
                the single threshold amount calculated by the Secretary 
                under subparagraph (B) for the year involved.
                  ``(B) Annual computation of thresholds.--Not later 
                than November 15 before each year, the Secretary shall 
                calculate and publish a single threshold amount for 
                settlements, judgments, awards, or other payments for 
                conditional payment obligations arising from liability 
                insurance (including self-insurance) and for alleged 
                physical trauma-based incidents (excluding alleged 
                ingestion, implantation, or exposure cases) subject to 
                this section for that year. Each such annual single 
                threshold amount for a year shall be set such that the 
                expected average amount to be credited to the Medicare 
                trust funds of collections of conditional payments from 
                such settlements, judgments, awards, or other payments 
                for each of liability insurance (including self-
                insurance), workers' compensation laws or plans, and no 
                fault insurance subject to this section shall equal the 
                expected cost of collection incurred by the United 
                States (including payments made to contractors) for a 
                conditional payment from each of liability insurance 
                (including self-insurance) and alleged physical trauma- 
                based incidents (excluding alleged ingestion, 
                implantation or exposure cases) subject to this section 
                for the year. At the time of calculating, but before 
                publishing, the single threshold amount for a year, the 
                Secretary shall inform, and seek review of, the 
                Comptroller General of the United States with regard to 
                such amount. The Secretary shall include, as part of 
                such publication for a year--
                          ``(i) the expected cost of collection 
                        incurred by the United States (including 
                        payments made to contractors) for a conditional 
                        payment arising from liability insurance 
                        (including self-insurance) and from alleged 
                        physical trauma-based incidents (excluding 
                        alleged ingestion, implantation or exposure 
                        cases; and
                          ``(ii) a summary of the methodology and data 
                        used by the Secretary in computing each such 
                        threshold amount and such cost of collection.
                  ``(C) Treatment of ongoing expenses.--For purposes of 
                this paragraph and with respect to a settlement, 
                judgment, award, or other payment not otherwise 
                addressed in clause (ii) of paragraph (2)(B) involving 
                the ongoing responsibility for medical payments, such 
                payment shall include only the cumulative value of the 
                medical payments made.
                  ``(D) Report to congress.--Not later than November 15 
                before each year, the Secretary shall submit to the 
                Congress a report on a single threshold amount for 
                settlements, judgments, awards, or other payments for 
                conditional payment obligations arising from each of 
                liability insurance (including self-insurance) claims 
                for ingestion, implantation and exposure cases, workers 
                compensation cases, and no fault insurance cases 
                subject to this section for that year. For each such 
                report, the Secretary shall--
                          ``(i) calculate each such threshold amount by 
                        using the methodology described in subparagraph 
                        (B); and
                          ``(ii) include a summary of the methodology 
                        and data used in calculating each such 
                        threshold amount and the amount of expected 
                        savings under this title achieved by the 
                        Secretary implementing such thresholds.''.
  (b) Effective Date.--The amendments made by subsection (a) shall 
apply to years beginning more than 4\1/2\ months after the date of the 
enactment of this Act.

SEC. 4. REPORTING REQUIREMENT.

  Section 1862(b)(8) of the Social Security Act (42 U.S.C. 1395y(b)(8)) 
is amended--
          (1) in the first sentence of subparagraph (E)(i), by striking 
        ``shall be subject'' and all that follows through the end of 
        the sentence and inserting the following: ``may be subject to a 
        civil money penalty of up to $1,000 for each day of 
        noncompliance with respect to each claimant.''; and
          (2) by adding at the end the following new subparagraph:
                  ``(I) Regulations.--Not later than 60 days after the 
                date of the enactment of this subparagraph, the 
                Secretary shall publish a notice in the Federal 
                Register soliciting proposals, which will be accepted 
                during a 60-day period, for the specification of 
                practices for which sanctions will and will not be 
                imposed under subparagraph (E), including not imposing 
                sanctions for good faith efforts to identify a 
                beneficiary pursuant to this paragraph under an 
                applicable entity responsible for reporting 
                information. After considering the proposals so 
                submitted, the Secretary, in consultation with the 
                Attorney General, shall publish in the Federal 
                Register, including a 60-day period for comment, 
                proposed specified practices for which such sanctions 
                will and will not be imposed. After considering any 
                public comments received during such period, the 
                Secretary shall issue final rules specifying such 
                practices.''.

SEC. 5. USE OF SOCIAL SECURITY NUMBERS AND OTHER IDENTIFYING 
                    INFORMATION IN REPORTING.

  Section 1862(b)(8)(B) of the Social Security Act (42 U.S.C. 
1395y(b)(8)(B)) is amended by adding at the end (after and below clause 
(ii)) the following:
                  ``Not later than 18 months after the date of 
                enactment of this sentence, the Secretary shall modify 
                the reporting requirements under this paragraph so that 
                an applicable plan in complying with such requirements 
                is permitted but not required to access or report to 
                the Secretary beneficiary social security account 
                numbers or health identification claim numbers, except 
                that the deadline for such modification shall be 
                extended by one or more periods (specified by the 
                Secretary) of up to 1 year each if the Secretary 
                notifies the committees of jurisdiction of the House of 
                Representatives and of the Senate that the prior 
                deadline for such modification, without such extension, 
                threatens patient privacy or the integrity of the 
                secondary payer program under this subsection. Any such 
                deadline extension notice shall include information on 
                the progress being made in implementing such 
                modification and the anticipated implementation date 
                for such modification.''.

SEC. 6. STATUTE OF LIMITATIONS.

  (a) In General.--Section 1862(b)(2)(B)(iii) of the Social Security 
Act (42 U.S.C. 1395y(b)(2)(B)(iii)) is amended by adding at the end the 
following new sentence: ``An action may not be brought by the United 
States under this clause with respect to payment owed unless the 
complaint is filed not later than 3 years after the date of the receipt 
of notice of a settlement, judgment, award, or other payment made 
pursuant to paragraph (8) relating to such payment owed.''.
  (b) Effective Date.--The amendment made by subsection (a) shall apply 
with respect to actions brought and penalties sought on or after 6 
months after the date of the enactment of this Act.

                          Purpose and Summary

    H.R. 1063 creates efficiencies in the Medicare Secondary 
Payer program that support beneficiary settlements and speed up 
the process of returning money to the Medicare Trust Fund.

                  Background and Need for Legislation

    The Medicare Trust Fund (through the Centers for Medicare 
and Medicaid Services (CMS)) has the right to recover Medicare 
payments that should have been the responsibility of another 
payer.
    Congress authorized the Medicare Secondary Payer program in 
1980 (Sec. 1862(b) of the Social Security Act), which 
identified specific conditions under which Medicare is the 
secondary payer. Those are (1) a group health plan based on 
their own or a spouse's current employment; (2) individuals 
with Medicare coverage based solely on ESRD; (3) auto and other 
liability insurance; (4) no-fault liability insurance; and (5) 
workers' compensation situations, including the Black Lung 
program.
    CMS has not always been aware of situations where Medicare 
should not pay first, and as a result, Medicare has paid for 
services that were the financial responsibility of another 
payer. To address this particular issue, in 2008, Congress 
added mandatory reporting provisions for GHPs and NGHPs through 
the Medicare Improvements for Patients and Providers Act of 
2008 (MIPPA). Such provisions are designed to ensure Medicare 
is aware of situations where the Trust Fund is owed money.
    Mandatory reporting was initially supposed to begin in 
2009. CMS pushed the effective date to 2011 (for workers' 
compensation and no-fault insurers) and to 2012 (for other 
NGHPs, including most liability insurers), in part because of 
concerns raised by the industry. Previously, the industry had 
little or no interaction with the Medicare program, and raising 
awareness of the new requirements and how to comply with them 
took some time.
    With the new reporting requirements enacted under MIPAA, 
CMS should be able to identify which payments have been made by 
Medicare that should have been the primary responsibility of 
another payer, and therefore should be recovered, as well as 
situations in which CMS should avoid making Medicare payments 
when another payer is the primary. The requirements also 
included penalties for non-compliance with reporting. At the 
time, these requirements were estimated to save Medicare $1.1 
billion over 10 years.
    In most situations involving NGHPs, Medicare will initially 
pay for medical treatment related to the incident, and later 
seek to recover those payments. This occurs sometimes because 
treatment is provided before CMS is notified of the MSP 
situation. However, in most instances, CMS will continue to pay 
for the beneficiary's services while the situation is in 
resolution so that the beneficiary has access to needed medical 
services in a timely manner. These payments are called 
``conditional payments.'' Once a beneficiary and NGHP reach 
resolution, Medicare will seek to recover any conditional 
payments made.
    Congress has amended the MSP statute a number of times 
since 1980 in order to improve the program. However, the 
Committee is aware of problems and inefficiencies in the 
program.
    Many MSP claims today still cannot be settled in a timely 
or conclusive manner for beneficiaries. Under current law, 
there is no requirement for CMS to provide the parties with 
amounts due or the amount they should set aside to cover future 
payments before settlement so the parties can allocate 
appropriately and resolve these Medicare obligations during 
settlement.
    In response to confusion and concerns raised on the part of 
stakeholders once mandatory reporting began, CMS has made a 
number of improvements to the process for reporting settlements 
and getting a final conditional payment amount.
    Some of CMS's recent efforts include:
     On June 30, 2011, CMS established a minimum 
threshold of $25 for all recovery demands. (This is consistent 
with the threshold used by the Department of Treasury for 
collecting delinquent debt pursuant to the Debt Collection 
Improvement Act of 1996.)
     On September 6, 2011, CMS implemented a $300 
threshold for certain liability settlements. When established 
criteria are met, reporting and repayment is not required if 
the settlement is for $300 or less.
     On September 30, 2011, the Medicare Secondary 
Payer Recovery contractor implemented a self-service 
information feature to its customer service line. This feature 
gives callers the ability to get the most up-to-date demand/
conditional Payment amounts, and the dates that those letters 
were issued, without having to speak to a customer service 
representative. The self-service feature is available for 
extended hours, and callers have the option of requesting 
information on multiple cases during one phone call.
     Effective November 7, 2011, CMS implemented a 
simple fixed percentage option for certain types of settlements 
of $5,000 or less. Under this option, the beneficiary/
representative can elect to pay Medicare 25% of the settlement 
to resolve Medicare's recovery claim.
     On February 21, 2012, CMS implemented a process 
for certain settlements of $25,000 or less, where the 
beneficiary/representative can self-identify its conditional 
payment amount to Medicare prior to finalizing a settlement. If 
all criteria are met, Medicare will respond to the beneficiary 
within 60 days providing Medicare's final conditional payment 
amount prior to settlement.
     CMS implemented a Medicare Secondary Payer 
Recovery portal on July 2, 2012. The beneficiary can use this 
portal to obtain information about Medicare's claim payments, 
conditional payment amounts, etc., and input information 
related to authorizations, settlements, disputed claims, etc.
    While these improvements are designed to give the 
beneficiary finality with regard to certain settlements without 
eliminating Medicare's control over its own processes, the 
Committee remains concerned about the need for additional 
improvements to the process.

                                Hearings

    On June 22, 2011, the Subcommittee on Oversight and 
Investigations held a hearing entitled ``Protecting Medicare 
with Improvements to the Secondary Payer Regime.'' At the 
hearing, the Subcommittee examined the Medicare Secondary Payer 
system as well as methods to improve the Medicare program and 
protect the fiscal integrity of Medicare. The Subcommittee 
received testimony from:
            Ms. Deborah Taylor, Director of Financial 
        Management Centers for Medicare and Medicaid Services;
            Mr. James Cosgrove, Director of Health 
        Care, Government Accountability Office;
            Mr. Marc Salm, Vice President of Risk 
        Management, Publix Supermarkets, Inc.;
            Mr. Scott Gilliam, Vice President, 
        Cincinnati Insurance Company;
            Mr. Jason Matzus, Partner, Raizman 
        Frischman & Matzus, P.C.; and
            Ms. Ilene Stein, Federal Policy Director, 
        Medicare Rights Center.

                        Committee Consideration

    On September 13, 2012, the Subcommittee on Health met in 
open markup session and favorably forwarded H.R. 1063 to the 
full Committee, as amended, by a voice vote, a quorum being 
present.
    On September 20, 2012, the full Committee met in open 
markup session and ordered H.R. 1063 favorably reported to the 
House, as amended, by a voice vote, a quorum being present.

                            Committee Votes

    Clause 3(b) of rule XIII of the Rules of the House of 
Representatives requires the Committee to list the recorded 
votes on the motion to report legislation and amendments 
thereto. There were no record votes taken in connection with 
ordering H.R. 1063 reported.

                      Committee Oversight Findings

    Pursuant to clause 3(c)(1) of rule XIII of the Rules of the 
House of Representatives, the Committee held a hearing on the 
Medicare Secondary Payer program and made findings that are 
reflected in this report.

         Statement of General Performance Goals and Objectives

    The goal of H.R. 1063 is to improve the Medicare Secondary 
Payer system to improve the process of recouping Medicare Trust 
Fund money by encouraging speedier settlements, reducing 
unnecessary burdens currently that delay or stop settlements 
from going forward, and encouraging timely restitution for 
beneficiaries who have been injured through no fault of their 
own.

   New Budget Authority, Entitlement Authority, and Tax Expenditures

    In compliance with clause 3(c)(2) of rule XIII of the Rules 
of the House of Representatives, the Committee finds that H.R. 
1063 would result in no new or increased budget authority, 
entitlement authority, or tax expenditures or revenues.

      Earmarks, Limited Tax Benefits, and Limited Tariff Benefits

    In compliance with clause 9(e), 9(f), and 9(g) of rule XXI, 
the committee finds that H.R. 1063 contains no earmarks, 
limited tax benefits, or limited tariff benefits.

                        Committee Cost Estimate

    The Committee adopts as its own the cost estimate prepared 
by the Director of the Congressional Budget Office pursuant to 
section 402 of the Congressional Budget Act of 1974.

                  Congressional Budget Office Estimate

    Pursuant to clause 3(c)(3) of rule XIII of the Rules of the 
House of Representatives, the following is the cost estimate 
provided by the Congressional Budget Office pursuant to section 
402 of the Congressional Budget Act of 1974.

H.R. 1063--Strengthening Medicare and Repaying Taxpayers Act of 2011

    Summary: H.R. 1063 would modify the process through which 
the Medicare program is reimbursed when another payer (for 
example, a liability insurer) is responsible for a 
beneficiary's medical costs. In general, the provisions of H.R. 
1063 would make it easier for other payers to repay Medicare, 
thus reducing program costs.
    CBO estimates that enacting H.R. 1063 would reduce Medicare 
spending by $45 million over the 2013-2022 period. Pay-as-you-
go procedures apply because enacting the legislation would 
affect direct spending.
    The bill contains no intergovernmental or private-sector 
mandates as defined in the Unfunded Mandates Reform Act (UMRA).
    Estimated cost to the Federal Government: The estimated 
budgetary impact of H.R. 1063 is shown in the following table. 
The costs of this legislation fall within budget function 570 
(Medicare).

--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                  By fiscal year, in millions of dollars--
                                                   -----------------------------------------------------------------------------------------------------
                                                     2013    2014    2015    2016    2017    2018    2019    2020    2021    2022   2013-2017  2013-2022
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                               CHANGES IN DIRECT SPENDING

Estimated Budget Authority........................      -2      -4      -4      -4      -4      -5      -5      -5      -6      -6       -18        -45
Estimated Outlays.................................      -2      -4      -4      -4      -4      -5      -5      -5      -6      -6       -18        -45
--------------------------------------------------------------------------------------------------------------------------------------------------------

    Basis of estimate: The estimate assumes that the bill would 
be enacted late in calendar year 2012 and that its provisions 
would take effect by the end of fiscal year 2013. Medicare is 
the ``secondary payer'' when another insurer has an obligation 
to pay for certain health spending by beneficiaries. For 
example, if a Medicare beneficiary is injured in a car 
accident, auto liability insurance is usually responsible for 
any resulting medical bills. Because establishing an insurer's 
obligation to pay can be time-consuming, the Medicare program 
will often pay for a beneficiary's medical costs until it can 
be determined which payer is liable for the costs. In such 
cases, Medicare makes ``conditional'' payments and seeks 
reimbursement from the other insurer.
    Section 2 of H.R. 1063 would modify the process through 
which beneficiaries and responsible insurers determine how much 
the Medicare program is owed for conditional payments. 
Beneficiaries, or their representatives, would be able to query 
a secure Web site and receive an estimate of Medicare's 
conditional payments. That amount would be factored into the 
settlement between the beneficiary and the insurer, allowing 
certainty about the amount that will be paid to Medicare out of 
the settlement funds for conditional payments made to that 
point.
    CBO analyzed data from stakeholders with respect to the 
difference in settlement timeliness between Medicare and non-
Medicare cases and the dollar value of settlements for Medicare 
beneficiaries. CBO estimates that section 2 would allow some 
settlements to occur more quickly and hasten repayment to 
Medicare. With respect to the number of settlements that occur, 
CBO estimates that section 2 will have two opposing effects: 
some cases would settle that otherwise would not, because of 
the easier access to information about the amount of the 
conditional payment, and some settlements would include a 
payment amount that is lower than it would be under current law 
because of the timing of the determination of the conditional 
payment. CBO estimates that the net effect of those two 
opposing effects would result in a slight reduction in outlays 
over the 2013-2022 period.
    Section 3 would exempt insurers from repaying Medicare for 
certain small claims. Based on information from the Medicare 
Secondary Payer Contractor, CBO believes that section 3 would 
codify current practice and thus would have no budgetary 
impact.
    H.R. 1063 would change current law with respect to civil 
monetary penalties, which may be levied on insurers that do not 
report on a timely basis their obligation to pay for medical 
expenses incurred by Medicare beneficiaries. Under Section 1862 
(b)(8) of the Social Security Act, there is a daily $1,000 
penalty for failure to report. Section 4 of the legislation 
would allow penalties at the discretion of the Secretary of the 
Department of Health and Human Services and also require 
notice-and-comment rulemaking to establish the conditions under 
which penalties will be assessed. CBO expects that this 
provision could reduce the penalties levied on insurers, but 
estimates that the amount of the change in penalty collections 
would not be significant.
    Section 5 would direct the Secretary to modify the 
reporting requirements under the Medicare Secondary Payer (MSP) 
statute to make optional the use of beneficiaries' Social 
Security Numbers or Health Insurance Claim Numbers. H.R. 1063 
would require the Secretary to change reporting requirements 
within 18 months of the legislation's enactment, but allows 
multiple one-year extensions if the Secretary notifies the 
relevant Congressional committees that such an extension is 
necessary to ensure beneficiary privacy or the efficient 
operation of the MSP system. CBO expects that the Secretary 
would receive multiple extensions of the deadline for this new 
requirement. As a result, CBO estimates that provision would 
have no significant budgetary effect over the 2013-2022 period.
    Section 6 would shorten the statute of limitations with 
respect to the federal government's ability to bring a 
complaint against an insurer or other third party for failure 
to comply with the MSP statute. CBO estimates that this 
provision would have no significant budgetary impact.
    Pay-As-You-Go considerations: The Statutory Pay-As-You-Go 
Act of 2010 establishes budget-reporting and enforcement 
procedures for legislation affecting direct spending or 
revenues. The net changes in outlays that are subject to those 
pay-as-you-go procedures are shown in the following table.

      CBO ESTIMATE OF PAY-AS-YOU-GO EFFECTS FOR H.R. 1063, AS ORDERED REPORTED BY THE HOUSE COMMITTEE ON ENERGY AND COMMERCE ON SEPTEMBER 20, 2012
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                                                  By fiscal year, in millions of dollars--
                                                   -----------------------------------------------------------------------------------------------------
                                                     2013    2014    2015    2016    2017    2018    2019    2020    2021    2022   2013-2017  2013-2022
--------------------------------------------------------------------------------------------------------------------------------------------------------
                                                       NET INCREASE OR DECREASE (-) IN THE DEFICIT

Statutory Pay-As-You-Go Impact....................      -2      -4      -4      -4      -4      -5      -5      -5      -6      -6       -18        -45
--------------------------------------------------------------------------------------------------------------------------------------------------------

    Intergovernmental and private-sector impact: H.R. 1063 
contains no intergovernmental or private-sector mandates as 
defined in UMRA and would impose no costs on state, local, or 
tribal governments.
    Estimate prepared by: Federal costs: Lara Robillard; Impact 
on state, local, and tribal governments: Lisa Ramirez-Branum; 
Impact on the private sector: Alexia Diorio.
    Estimate approved by: Holly Harvey, Deputy Assistant 
Director for Budget Analysis.

                       Federal Mandates Statement

    The Committee adopts as its own the estimate of Federal 
mandates prepared by the Director of the Congressional Budget 
Office pursuant to section 423 of the Unfunded Mandates Reform 
Act.

                      Advisory Committee Statement

    No advisory committees within the meaning of section 5(b) 
of the Federal Advisory Committee Act were created by this 
legislation.

                  Applicability to Legislative Branch

    The Committee finds that the legislation does not relate to 
the terms and conditions of employment or access to public 
services or accommodations within the meaning of section 
102(b)(3) of the Congressional Accountability Act.

             Section-by-Section Analysis of the Legislation


Section 1. Short title

    Section 1 establishes the short title of the bill as the 
``Strengthening Medicare And Repaying Taxpayers Act of 2012''.

Sec. 2. Determination of reimbursement amount through CMS website to 
        improve program efficiency

    Section 2 requires the Secretary to maintain and make 
available to individuals to whom items and services are 
furnished under this title (and representatives) access to 
information through a website for items and services (including 
payment amounts) for claims that are attributable to a specific 
injury or incident that forms the basis for a settlement, 
judgment, award, or other payment relating to an injury or 
incident to which this subsection applies. The Secretary shall 
update this website for any payment or claims information 
within 15 days of receipt of such claim or payment made, 
respectively. Upon notice of intent to settle, the Secretary 
has a protected period of no less than 65 days, but no more 
than 95 days (except for exceptional circumstances), in which 
to post claims received or payments made on the website. After 
conclusion of the protected period, but no more than 72 hours 
from the date of settlement, parties subject to repayment are 
required to draw down the final conditional payment amount from 
the website.
    The bill requires the Secretary to respond promptly when 
notified of a discrepancy related to repayment amounts posted 
on the website and create a right of appeals, through 
regulation, for determinations made under this subsection.

Sec. 3. Fiscal efficiency and revenue neutrality

    Section 3 requires the Secretary to calculate, on an annual 
basis, a single threshold amount under which the cost of 
seeking repayment of a claim costs the Medicare program more 
than it expects to receive in repayment. Such threshold shall 
be reviewed by the Comptroller General of the United States and 
submitted to Congress no later than November 15 of each year.

Sec. 4. Reporting requirement

    Section 4 changes the current mandatory $1,000 per day per 
claimant penalty for reporting failures under the Medicare 
Secondary Payer statute to a requirement that parties ``may be 
subject to a civil money penalty of up to $1,000 for each day 
of noncompliance with respect to each claimant'' in order to 
allow the Secretary more discretion when assessing fines. Such 
a change reflects the committees desire to grant the Secretary 
more flexibility when dealing with good faith efforts.

Sec. 5. Use of social security numbers and other identifying 
        information in reporting

    Section 5 requires the Secretary to modify existing 
reporting requirements within 18 months of enactment so that an 
applicable plan in complying with such requirements is 
permitted but not required to access or report to the Secretary 
beneficiary social security account numbers or health 
identification claim numbers. This deadline may be extended 
annually if the Secretary certifies to the committees of 
jurisdiction in the House and Senate that such a system 
threatens patient privacy or the integrity of the Medicare 
Secondary Payer system.

Sec. 6. Statute of limitations

    Section 6 creates a statute of limitations under the 
Medicare Secondary Payer statute so that the Medicare program 
may not seek repayment from beneficiaries or other related 
parties three years after the date the Secretary receives a 
notice of settlement.

         Changes in Existing Law Made by the Bill, as Reported

  In compliance with clause 3(e) of rule XIII of the Rules of 
the House of Representatives, changes in existing law made by 
the bill, as reported, are shown as follows (existing law 
proposed to be omitted is enclosed in black brackets, new 
matter is printed in italic, existing law in which no change is 
proposed is shown in roman):

                          SOCIAL SECURITY ACT




           *       *       *       *       *       *       *
TITLE XVIII--HEALTH INSURANCE FOR THE AGED AND DISABLED

           *       *       *       *       *       *       *



Part E--Miscellaneous Provisions

           *       *       *       *       *       *       *



        EXCLUSIONS FROM COVERAGE AND MEDICARE AS SECONDARY PAYER

  Sec. 1862. (a) * * *
  (b) Medicare as Secondary Payer.--
          (1) * * *
          (2) Medicare secondary payer.--
                  (A) * * *
                  (B) Conditional payment.--
                          (i) * * *
                          (ii) Repayment required.--[A primary 
                        plan] Subject to paragraph (9), 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. If 
                        reimbursement is not made to the 
                        appropriate Trust Fund before the 
                        expiration of the 60-day period that 
                        begins on the date notice of, or 
                        information related to, a primary 
                        plan's responsibility for such payment 
                        or other information is received, the 
                        Secretary may charge interest 
                        (beginning with the date on which the 
                        notice or other information is 
                        received) on the amount of the 
                        reimbursement until reimbursement is 
                        made (at a rate determined by the 
                        Secretary in accordance with 
                        regulations of the Secretary of the 
                        Treasury applicable to charges for late 
                        payments).
                          (iii) Action by united states.--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. The United 
                        States may not recover from a third-
                        party administrator under this clause 
                        in cases where the third-party 
                        administrator would not be able to 
                        recover the amount at issue from the 
                        employer or group health plan and is 
                        not employed by or under contract with 
                        the employer or group health plan at 
                        the time the action for recovery is 
                        initiated by the United States or for 
                        whom it provides administrative 
                        services due to the insolvency or 
                        bankruptcy of the employer or plan. An 
                        action may not be brought by the United 
                        States under this clause with respect 
                        to payment owed unless the complaint is 
                        filed not later than 3 years after the 
                        date of the receipt of notice of a 
                        settlement, judgment, award, or other 
                        payment made pursuant to paragraph (8) 
                        relating to such payment owed.

           *       *       *       *       *       *       *

                          (vii) Use of website to determine 
                        final conditional reimbursement 
                        amount.--
                                  (I) Notice to Secretary of 
                                expected date of a settlement, 
                                judgment, etc.--In the case of 
                                a payment made by the Secretary 
                                pursuant to clause (i) for 
                                items and services provided to 
                                the claimant, the claimant or 
                                applicable plan (as defined in 
                                paragraph (8)(F)) may at any 
                                time beginning 120 days before 
                                the reasonably expected date of 
                                a settlement, judgment, award, 
                                or other payment, notify the 
                                Secretary that a payment is 
                                reasonably expected and the 
                                expected date of such payment.
                                  (II) Secretary providing 
                                access to claims information 
                                through a website.--The 
                                Secretary shall maintain and 
                                make available to individuals 
                                to whom items and services are 
                                furnished under this title (and 
                                to authorized family or other 
                                representatives recognized 
                                under regulations and to an 
                                applicable plan which has 
                                obtained the consent of the 
                                individual) access to 
                                information on the claims for 
                                such items and services 
                                (including payment amounts for 
                                such claims), including those 
                                claims that are attributable to 
                                a specific injury or incident 
                                that forms the basis for a 
                                settlement, judgment, award or 
                                other payment relating to an 
                                injury or incident to which 
                                this subsection applies. Such 
                                access shall be provided to an 
                                individual, representative, or 
                                plan through a website that 
                                requires a password to gain 
                                access to the information. The 
                                Secretary shall update the 
                                information on claims and 
                                payments on such website in as 
                                timely a manner as possible but 
                                not later than 15 days after 
                                the date of receipt of such 
                                claims or the making of such 
                                payments, respectively. 
                                Information related to claims 
                                and payments subject to the 
                                notice under subclause (I) 
                                shall be maintained and made 
                                available consistent with the 
                                following:
                                          (aa) The information 
                                        shall be as complete as 
                                        possible and shall 
                                        include provider or 
                                        supplier name, 
                                        diagnosis codes (if 
                                        any), dates of service, 
                                        and conditional payment 
                                        amounts.
                                          (bb) The information 
                                        accurately identifies 
                                        those claims and 
                                        payments that are 
                                        related to an injury or 
                                        incident to which the 
                                        provisions of this 
                                        subsection apply.
                                          (cc) The website 
                                        provides a method for 
                                        the receipt of secure 
                                        electronic 
                                        communications with the 
                                        individual, 
                                        representative, or plan 
                                        involved.
                                          (dd) The website 
                                        provides that 
                                        information is 
                                        transmitted from the 
                                        website in a form that 
                                        includes an official 
                                        time and date that the 
                                        information is 
                                        transmitted.
                                          (ee) The website 
                                        shall permit the 
                                        individual, 
                                        representative, or plan 
                                        to download a statement 
                                        of reimbursement 
                                        amounts (in this clause 
                                        referred to as a 
                                        ``statement of 
                                        reimbursement amount'') 
                                        on payments for claims 
                                        under this title 
                                        relating to a specific 
                                        injury or incident of 
                                        the individual.
                                  (III) Use of timely web 
                                download as basis for final 
                                conditional amount.--If an 
                                individual (or other claimant 
                                or applicable plan with the 
                                consent of the individual) 
                                obtains a statement of 
                                reimbursement amount from the 
                                website during the protected 
                                period as defined in subclause 
                                (V) and the related settlement, 
                                judgment, award or other 
                                payment is made during such 
                                period, then the last statement 
                                of reimbursement amount that is 
                                downloaded during such period 
                                and within 3 business days 
                                before the date of the 
                                settlement, judgment, award, or 
                                other payment shall constitute 
                                the final conditional amount 
                                subject to recovery under 
                                clause (ii) related to such 
                                settlement, judgment, award, or 
                                other payment.
                                  (IV) Resolution of 
                                discrepancies.--If the 
                                individual (or authorized 
                                representative) believes there 
                                is a discrepancy with the 
                                statement of reimbursement 
                                amount, the Secretary shall 
                                provide a timely process to 
                                resolve the discrepancy. Under 
                                such process the individual (or 
                                representative) must provide an 
                                alternate final conditional 
                                payment amount and 
                                documentation of the basis for 
                                such alternate amount. Within 
                                15 days after the date of 
                                receipt of such documentation, 
                                the Secretary shall determine 
                                whether there is a reasonable 
                                basis for such alternate final 
                                conditional payment amount. If 
                                the Secretary does not make 
                                such determination within the 
                                15-day period, then the 
                                alternate final conditional 
                                payment amount shall become the 
                                final conditional payment 
                                amount. If the Secretary 
                                determines within such period 
                                that there is not a reasonable 
                                basis for the alternate amount, 
                                the original final conditional 
                                payment amount is reconfirmed. 
                                If the Secretary determines 
                                within such period that there 
                                is a reasonable basis for an 
                                alternate final conditional 
                                payment amount, the Secretary 
                                must respond in a timely manner 
                                by agreeing to the alternative 
                                final conditional payment 
                                amount or by providing 
                                documentation showing with good 
                                cause why the Secretary is not 
                                agreeing to such amount and 
                                either reconfirming the 
                                original final conditional 
                                payment amount or establishing 
                                another alternative final 
                                conditional payment amount. In 
                                no case shall the process under 
                                this subclause be treated as an 
                                appeals process or as 
                                establishing a right of appeal 
                                for a statement of 
                                reimbursement amount and there 
                                shall be no administrative or 
                                judicial review of the 
                                Secretary's determinations 
                                under this subclause.
                                  (V) Protected period.--In 
                                subclause (III), the term 
                                ``protected period'' means, 
                                with respect to a settlement, 
                                judgment, award or other 
                                payment relating to an injury 
                                or incident, the portion (if 
                                any) of the period beginning on 
                                the date of notice under 
                                subclause (I) with respect to 
                                such settlement, judgment, 
                                award, or other payment that is 
                                after the end of a Secretarial 
                                response period beginning on 
                                the date of such notice to the 
                                Secretary. Such Secretarial 
                                response period shall be a 
                                period of 65 days, except that 
                                such period may be extended by 
                                the Secretary for a period of 
                                an additional 30 days if the 
                                Secretary determines that 
                                additional time is required to 
                                address claims for which 
                                payment has been made. Such 
                                Secretarial response period 
                                shall be extended and shall not 
                                include any days for any part 
                                of which the Secretary 
                                determines (in accordance with 
                                regulations) that there was a 
                                failure in the claims and 
                                payment posting system and the 
                                failure was justified due to 
                                exceptional circumstances (as 
                                defined in such regulations). 
                                Such regulations shall define 
                                exceptional circumstances in a 
                                manner so that not more than 1 
                                percent of the repayment 
                                obligations under this 
                                subclause would qualify as 
                                exceptional circumstances.
                                  (VI) Effective date.--The 
                                Secretary shall promulgate 
                                final regulations to carry out 
                                this clause not later than 9 
                                months after the date of the 
                                enactment of this clause.
                                  (VII) Website including 
                                successor technology.--In this 
                                clause, the term ``website'' 
                                includes any successor 
                                technology.
                          (viii) Right of appeal for secondary 
                        payer determinations relating to 
                        liability insurance (including self-
                        insurance), no fault insurance, and 
                        workers' compensation laws and plans.--
                        The Secretary shall promulgate 
                        regulations establishing a right of 
                        appeal and appeals process, with 
                        respect to any determination under this 
                        subsection for a payment made under 
                        this title for an item or service for 
                        which the Secretary is seeking to 
                        recover funds from an applicable plan 
                        (as defined in paragraph (8)(F)) that 
                        is a primary plan under subsection 
                        (A)(ii), under which the applicable 
                        plan involved, or an attorney, agent, 
                        or third party administrator on behalf 
                        of such plan, may appeal such 
                        determination. The individual furnished 
                        such an item or service shall be 
                        notified of the plan's intent to appeal 
                        such determination.

           *       *       *       *       *       *       *

          (8) Required submission of information by or on 
        behalf of liability insurance (including self-
        insurance), no fault insurance, and workers' 
        compensation laws and plans.--
                  (A) * * *
                  (B) Required information.--The information 
                described in this subparagraph is--
                          (i) * * *

           *       *       *       *       *       *       *

                Not later than 18 months after the date of 
                enactment of this sentence, the Secretary shall 
                modify the reporting requirements under this 
                paragraph so that an applicable plan in 
                complying with such requirements is permitted 
                but not required to access or report to the 
                Secretary beneficiary social security account 
                numbers or health identification claim numbers, 
                except that the deadline for such modification 
                shall be extended by one or more periods 
                (specified by the Secretary) of up to 1 year 
                each if the Secretary notifies the committees 
                of jurisdiction of the House of Representatives 
                and of the Senate that the prior deadline for 
                such modification, without such extension, 
                threatens patient privacy or the integrity of 
                the secondary payer program under this 
                subsection. Any such deadline extension notice 
                shall include information on the progress being 
                made in implementing such modification and the 
                anticipated implementation date for such 
                modification.

           *       *       *       *       *       *       *

                  (E) Enforcement.--
                          (i) In general.--An applicable plan 
                        that fails to comply with the 
                        requirements under subparagraph (A) 
                        with respect to any claimant [shall be 
                        subject to a civil money penalty of 
                        $1,000 for each day of noncompliance 
                        with respect to each claimant.] may be 
                        subject to a civil money penalty of up 
                        to $1,000 for each day of noncompliance 
                        with respect to each claimant. The 
                        provisions of subsections (e) and (k) 
                        of section 1128A shall apply to a civil 
                        money penalty under the previous 
                        sentence in the same manner as such 
                        provisions apply to a penalty or 
                        proceeding under section 1128A(a). A 
                        civil money penalty under this clause 
                        shall be in addition to any other 
                        penalties prescribed by law and in 
                        addition to any Medicare secondary 
                        payer claim under this title with 
                        respect to an individual.

           *       *       *       *       *       *       *

                  (I) Regulations.--Not later than 60 days 
                after the date of the enactment of this 
                subparagraph, the Secretary shall publish a 
                notice in the Federal Register soliciting 
                proposals, which will be accepted during a 60-
                day period, for the specification of practices 
                for which sanctions will and will not be 
                imposed under subparagraph (E), including not 
                imposing sanctions for good faith efforts to 
                identify a beneficiary pursuant to this 
                paragraph under an applicable entity 
                responsible for reporting information. After 
                considering the proposals so submitted, the 
                Secretary, in consultation with the Attorney 
                General, shall publish in the Federal Register, 
                including a 60-day period for comment, proposed 
                specified practices for which such sanctions 
                will and will not be imposed. After considering 
                any public comments received during such 
                period, the Secretary shall issue final rules 
                specifying such practices.
          (9) Exception.--
                  (A) In general.--Clause (ii) of paragraph 
                (2)(B) and any reporting required by paragraph 
                (8) shall not apply with respect to any 
                settlement, judgment, award, or other payment 
                by an applicable plan constituting a total 
                payment obligation to a claimant of not more 
                than the single threshold amount calculated by 
                the Secretary under subparagraph (B) for the 
                year involved.
                  (B) Annual computation of thresholds.--Not 
                later than November 15 before each year, the 
                Secretary shall calculate and publish a single 
                threshold amount for settlements, judgments, 
                awards, or other payments for conditional 
                payment obligations arising from liability 
                insurance (including self-insurance) and for 
                alleged physical trauma-based incidents 
                (excluding alleged ingestion, implantation, or 
                exposure cases) subject to this section for 
                that year. Each such annual single threshold 
                amount for a year shall be set such that the 
                expected average amount to be credited to the 
                Medicare trust funds of collections of 
                conditional payments from such settlements, 
                judgments, awards, or other payments for each 
                of liability insurance (including self-
                insurance), workers' compensation laws or 
                plans, and no fault insurance subject to this 
                section shall equal the expected cost of 
                collection incurred by the United States 
                (including payments made to contractors) for a 
                conditional payment from each of liability 
                insurance (including self-insurance) and 
                alleged physical trauma- based incidents 
                (excluding alleged ingestion, implantation or 
                exposure cases) subject to this section for the 
                year. At the time of calculating, but before 
                publishing, the single threshold amount for a 
                year, the Secretary shall inform, and seek 
                review of, the Comptroller General of the 
                United States with regard to such amount. The 
                Secretary shall include, as part of such 
                publication for a year--
                          (i) the expected cost of collection 
                        incurred by the United States 
                        (including payments made to 
                        contractors) for a conditional payment 
                        arising from liability insurance 
                        (including self-insurance) and from 
                        alleged physical trauma-based incidents 
                        (excluding alleged ingestion, 
                        implantation or exposure cases; and
                          (ii) a summary of the methodology and 
                        data used by the Secretary in computing 
                        each such threshold amount and such 
                        cost of collection.
                  (C) Treatment of ongoing expenses.--For 
                purposes of this paragraph and with respect to 
                a settlement, judgment, award, or other payment 
                not otherwise addressed in clause (ii) of 
                paragraph (2)(B) involving the ongoing 
                responsibility for medical payments, such 
                payment shall include only the cumulative value 
                of the medical payments made.
                  (D) Report to congress.--Not later than 
                November 15 before each year, the Secretary 
                shall submit to the Congress a report on a 
                single threshold amount for settlements, 
                judgments, awards, or other payments for 
                conditional payment obligations arising from 
                each of liability insurance (including self-
                insurance) claims for ingestion, implantation 
                and exposure cases, workers compensation cases, 
                and no fault insurance cases subject to this 
                section for that year. For each such report, 
                the Secretary shall--
                          (i) calculate each such threshold 
                        amount by using the methodology 
                        described in subparagraph (B); and
                          (ii) include a summary of the 
                        methodology and data used in 
                        calculating each such threshold amount 
                        and the amount of expected savings 
                        under this title achieved by the 
                        Secretary implementing such thresholds.

           *       *       *       *       *       *       *


                                  

```