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[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5284 Introduced in House (IH)]

112th CONGRESS
  2d Session
                                H. R. 5284

 To amend section 1862 of the Social Security Act with respect to the 
application of Medicare secondary payer rules to workers' compensation 
  settlement agreements and Medicare set-asides under such agreements.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                             April 27, 2012

 Mr. Reichert (for himself and Mr. Thompson of California) introduced 
  the following bill; which was referred to the Committee on Ways and 
 Means, and in addition to the Committee on Energy and Commerce, for a 
 period to be subsequently determined by the Speaker, in each case for 
consideration of such provisions as fall within the jurisdiction of the 
                          committee concerned

_______________________________________________________________________

                                 A BILL

 
 To amend section 1862 of the Social Security Act with respect to the 
application of Medicare secondary payer rules to workers' compensation 
  settlement agreements and Medicare set-asides under such agreements.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Medicare Secondary Payer and 
Workers' Compensation Settlement Agreements Act of 2012''.

SEC. 2. APPLICATION OF MEDICARE SECONDARY PAYER RULES TO CERTAIN 
              WORKERS' COMPENSATION SETTLEMENT AGREEMENTS AND QUALIFIED 
              MEDICARE SET-ASIDE PROVISIONS.

    (a) Threshold for Secondary Payer Provisions for Certain Workers' 
Compensation Settlement Agreements.--Section 1862 of the Social 
Security Act (42 U.S.C. 1395y) is amended--
            (1) in subsection (b)(2)(A)(ii), by inserting ``subject to 
        subsection (p),'' after ``(ii)''; and
            (2) by adding at the end the following new subsection:
    ``(p) Threshold for Secondary Payer Provisions for Certain Workers' 
Compensation Settlement Agreements.--
            ``(1) In general.--A workers' compensation law or plan 
        shall not be treated as a primary plan for purposes of 
        subsection (b) with respect to a workers' compensation 
        settlement agreement if the agreement (or claimant under the 
        agreement) is described in any of the following subparagraphs:
                    ``(A) Total settlement amount not exceeding 
                $25,000.--The agreement has a total settlement amount 
                (as determined under paragraph (2)) that does not 
                exceed $25,000 or such greater amount as the Secretary 
                may specify in regulations.
                    ``(B) Likely ineligibility of workers' compensation 
                claimant for medicare benefits.--The claimant under the 
                agreement--
                            ``(i) is not eligible for benefits under 
                        this title as of the effective date of the 
                        agreement; and
                            ``(ii) is unlikely to become so eligible, 
                        as determined under paragraph (3), within 30 
                        months after such effective date.
                    ``(C) No future medical expenses.--The claimant 
                under the agreement is not eligible for payment of 
                medical expenses, incurred after the effective date of 
                the agreement, that are available under the workers' 
                compensation law or plan of the jurisdiction in which 
                such agreement will be effective.
                    ``(D) No limitation on future medical expenses.--
                The agreement does not limit or extinguish the right of 
                the claimant involved to payment of medical expenses, 
                incurred after the effective date of such agreement, 
                that are available under the workers' compensation law 
                or plan of the jurisdiction in which the agreement will 
                be effective.
            ``(2) Determination of total settlement amount of workers' 
        compensation settlement agreement.--For purposes of paragraph 
        (1)(A) and subsection (q) and with respect to a work-related 
        injury or illness that is the subject of a workers' 
        compensation settlement agreement, the total settlement amount 
        of the agreement is the sum of monetary wage replacement 
        benefits, attorney fees, all future medical expenses, repayment 
        of Medicare conditional payments, payout totals for annuities 
        to fund the expenses listed above, and any previously settled 
        portion of the workers' compensation claim.
            ``(3) Determination of likely ineligibility of claimant for 
        medicare benefits.--For purposes of paragraph (1)(B)(ii), a 
        workers' compensation claimant shall be deemed unlikely to 
        become eligible for benefits under this title within 30 months 
        after the effective date of the agreement unless, as of the 
        effective date of the agreement, such claimant is insured, as 
        determined under subsection (c)(1) of section 223, for 
        disability insurance benefits under such section and is 
        described in any of the following subparagraphs:
                    ``(A) Awarded disability benefits.--The individual 
                has been awarded such disability insurance benefits.
                    ``(B) Applied for disability.--The individual has 
                applied for such disability insurance benefits.
                    ``(C) Anticipates appeal.--The individual has been 
                denied such disability insurance benefits but 
                anticipates appealing that decision.
                    ``(D) Appealing or refiling.--The individual is in 
                the process of appealing or refiling for such 
                disability insurance benefits.
                    ``(E) Minimum age.--The individual is at least 62 
                years and 6 months of age.
                    ``(F) End-stage renal disease.--The individual has 
                an end-stage renal disease condition but does not yet 
                qualify for health benefits under section 226A based on 
                such disease.
            ``(4) Definitions.--For purposes of this subsection and 
        subsection (q):
                    ``(A) Compromise agreement.--The term `compromise 
                agreement' means a workers' compensation settlement 
                agreement that--
                            ``(i) applies to a workers' compensation 
                        claim that is denied or contested, in whole or 
                        in part, by a workers' compensation payer 
                        involved under the workers' compensation law or 
                        plan applicable to the jurisdiction in which 
                        the agreement has been settled; and
                            ``(ii) does not provide for a payment of 
                        the full amount of benefits sought or that may 
                        be payable under the workers' compensation 
                        claim.
                    ``(B) Commutation agreement.--The term `commutation 
                agreement' means a workers' compensation settlement 
                agreement to settle all or a portion of a workers' 
                compensation claim, in which--
                            ``(i) liability for past and future 
                        benefits is not disputed; and
                            ``(ii) the parties to the agreement agree 
                        to include payment for future workers' 
                        compensation benefits payable after the date on 
                        which the agreement becomes effective.
                    ``(C) Workers' compensation claimant.--The term 
                `workers' compensation claimant' means a worker who--
                            ``(i) is or may be covered under a workers' 
                        compensation law or plan; and
                            ``(ii) submits a claim or accepts benefits 
                        under such law or plan for a work-related 
                        injury or illness.
                    ``(D) Workers' compensation law or plan.--
                            ``(i) In general.--The term `workers' 
                        compensation law or plan' means a law or 
                        program administered by a State or the United 
                        States to provide compensation to workers for a 
                        work-related injury or illness (or for 
                        disability or death caused by such an injury or 
                        illness), including the Longshore and Harbor 
                        Workers' Compensation Act (33 U.S.C. 901-944, 
                        948-950), chapter 81 of title 5, United States 
                        Code (known as the Federal Employees 
                        Compensation Act), the Black Lung Benefits Act 
                        (30 U.S.C. 931 et seq.), and part C of title 4 
                        of the Federal Coal Mine and Safety Act (30 
                        U.S.C. 901 et seq.), but not including the Act 
                        of April 22, 1908 (45 U.S.C. 51 et seq.) 
                        (popularly referred to as the Federal 
                        Employer's Liability Act).
                            ``(ii) Inclusion of similar compensation 
                        plan.--Such term includes a similar 
                        compensation plan established by an employer 
                        that is funded by such employer or the 
                        insurance carrier of such employer to provide 
                        compensation to a worker of such employer for a 
                        work-related injury or illness.
                    ``(E) Workers' compensation payer.--The term 
                `workers' compensation payer' means, with respect to a 
                workers' compensation law or plan, a workers' 
                compensation insurer, self-insurer, employer, 
                individual, or any other entity that is or may be 
                liable for the payment of benefits to a workers' 
                compensation claimant pursuant to the workers' 
                compensation law or plan.
                    ``(F) Workers' compensation settlement agreement.--
                The term `workers' compensation settlement agreement' 
                means an agreement, including a commutation agreement 
                or compromise agreement, or any combination of both, 
                between a workers' compensation claimant and one or 
                more workers' compensation payers which is intended--
                            ``(i) to foreclose the possibility of 
                        future payment of some or all workers' 
                        compensation benefits involved; and
                            ``(ii)(I) to compensate the claimant for a 
                        work-related injury or illness as provided for 
                        by a workers' compensation law or plan; or
                            ``(II) to eliminate cause for litigation 
                        involving issues in dispute between the 
                        claimant and payer.''.
    (b) Satisfaction of Secondary Payer Requirements Through Use of 
Qualified Medicare Set-asides Under Workers' Compensation Settlement 
Agreements.--Such section is further amended by adding at the end the 
following new subsection:
    ``(q) Treatment of Qualified Medicare Set-asides Under Workers' 
Compensation Settlement Agreements.--
            ``(1) Satisfaction of secondary payer requirements through 
        use of qualified medicare set-asides.--
                    ``(A) Full satisfaction of claim obligations.--
                            ``(i) In general.--If a workers' 
                        compensation settlement agreement, related to a 
                        claim of a workers' compensation claimant, 
                        includes a qualified Medicare set-aside (as 
                        defined in paragraph (2)), such set-aside shall 
                        satisfy any obligation with respect to the 
                        present or future payment reimbursement under 
                        subsection (b)(2) with respect to such claim. 
                        The Secretary shall have no further recourse, 
                        directly or indirectly, under this title with 
                        respect to such agreement.
                            ``(ii) Rule of construction.--Nothing in 
                        this section shall be construed as requiring 
                        the submission of a Medicare set-aside to the 
                        Secretary.
                    ``(B) Medicare set-aside and medicare set-aside 
                amount defined.--For purposes of this subsection:
                            ``(i) Medicare set-aside.--The term 
                        `Medicare set-aside' means, with respect to a 
                        workers' compensation settlement agreement, a 
                        provision in the agreement that provides for a 
                        payment of a lump sum, annuity, a combination 
                        of a lump sum and an annuity, or other amount 
                        that is in full satisfaction of the obligation 
                        described in subparagraph (A) for items and 
                        services that the workers' compensation 
                        claimant under the agreement received or is 
                        likely to receive under the applicable workers' 
                        compensation law and for which payment would be 
                        made under this title, but for subsection 
                        (b)(2)(A).
                            ``(ii) Medicare set-aside amount.--The term 
                        `Medicare set-aside amount' means, with respect 
                        to a Medicare set-aside, the amount described 
                        in clause (i).
            ``(2) Qualified medicare set-aside.--
                    ``(A) Requirements of qualified medicare set-
                aside.--For purposes of this subsection, the term 
                `qualified Medicare set-aside' is a Medicare set-aside 
                in which the Medicare set-aside amount reasonably takes 
                into account the full payment obligation described in 
                paragraph (1)(A), while meeting the requirements of 
                subparagraphs (B) and (C) and giving due consideration 
                to the following:
                            ``(i) The illness or injury giving rise to 
                        the workers' compensation claim involved.
                            ``(ii) The age and life expectancy of the 
                        claimant involved.
                            ``(iii) The reasonableness of and necessity 
                        for future medical expenses for treatment of 
                        the illness or injury involved.
                            ``(iv) The duration of and limitation on 
                        benefits payable under the workers' 
                        compensation law or plan involved.
                            ``(v) The regulations and case law relevant 
                        to the State workers' compensation law or plan 
                        involved.
                    ``(B) Items and services included.--A qualified 
                Medicare set-aside--
                            ``(i) shall include payment for items and 
                        services that are authorized for payment under 
                        this title as of the effective date of the 
                        workers' compensation settlement agreement 
                        involved and that are covered by the workers' 
                        compensation law or plan involved; and
                            ``(ii) is not required to provide for 
                        payment for items and services that are not 
                        described in clause (i).
                    ``(C) Payment requirements.--
                            ``(i) Required use of workers' compensation 
                        fee schedule.--
                                    ``(I) In general.--Except in the 
                                case of an optional direct payment of a 
                                Medicare set-aside made under paragraph 
                                (5)(A), the set-aside amount shall be 
                                based upon the payment amount for items 
                                and services under the workers' 
                                compensation fee schedule (effective as 
                                of the date of the agreement) 
                                applicable to the workers' compensation 
                                law or plan involved.
                                    ``(II) Workers' compensation fee 
                                schedule defined.--For purposes of this 
                                subsection, the term `workers' 
                                compensation fee schedule' means, with 
                                respect to a workers' compensation law 
                                or plan of a State or a similar plan 
                                applicable in a State, the schedule of 
                                payment amounts the State has 
                                established to pay providers for items 
                                and services furnished to workers who 
                                incur a work-related injury or illness 
                                as defined under such law or plan (or 
                                in the absence of such a schedule, the 
                                applicable medical reimbursement rate 
                                under such law or plan).
                            ``(ii) Optional proportional adjustment for 
                        compromise settlement agreements.--
                                    ``(I) In general.--In the case of a 
                                compromise settlement agreement, a 
                                workers' compensation claimant or 
                                workers' compensation payer who is 
                                party to the agreement may elect (but 
                                is not required) to calculate the 
                                Medicare set-aside amount of the 
                                agreement by applying a percentage 
                                reduction to the Medicare set-aside 
                                amount for the total settlement amount 
                                that could have been payable under the 
                                applicable workers' compensation law or 
                                similar plan involved had the denied or 
                                contested portion of the claim not been 
                                subject to a compromise agreement. The 
                                percentage reduction shall be equal to 
                                the denied or contested percentage of 
                                such total settlement. Such election 
                                may be made by a party to the agreement 
                                only with the written consent of the 
                                other party to the agreement.
                                    ``(II) Application.--If the 
                                workers' compensation claimant or 
                                workers' compensation payer elects to 
                                calculate the Medicare set-aside amount 
                                under this clause, the Medicare set-
                                aside shall be deemed a qualified 
                                Medicare set-aside.
                    ``(D) Certain medicare set-asides with safe harbor 
                amount deemed qualified medicare set-asides.--
                            ``(i) In general.--For purposes of this 
                        section and subject to clause (iv), a Medicare 
                        set-aside of a workers' compensation settlement 
                        agreement shall be deemed a qualified Medicare 
                        set-aside if the Medicare set-aside amount 
                        involved is the safe harbor amount for the 
                        agreement and the agreement does not exceed 
                        $250,000.
                            ``(ii) Written consent.--A safe harbor 
                        amount, with respect to a workers' compensation 
                        agreement, shall be treated as the Medicare 
                        set-aside amount for such agreement for 
                        purposes of clause (i) only upon written 
                        consent of all parties to the agreement.
                            ``(iii) Safe harbor amount defined.--For 
                        purposes of this subsection, the term `safe 
                        harbor amount' means, with respect to a 
                        workers' compensation settlement agreement, 15 
                        percent of the total settlement amount of the 
                        agreement (as determined under subsection 
                        (p)(2)), excluding repayment of conditional 
                        payments and previously settled portions of the 
                        claim involved. In applying the previous 
                        sentence for purposes of determining the safe 
                        harbor amount, with respect to a workers' 
                        compensation agreement, if the agreement 
                        includes an annuity, the cost (but not the 
                        payout of the annuity) shall be included in 
                        determining the total settlement amount of the 
                        agreement.
                            ``(iv) Mandatory direct payment of safe 
                        harbor amount.--A Medicare set-aside of a 
                        worker's compensation settlement agreement may 
                        not be treated as a qualified set-aside under 
                        clause (i) unless an election is made under 
                        paragraph (5)(A) to transfer to the Secretary a 
                        direct payment of such set-aside.
                    ``(E) Secretarial authority with respect to deemed 
                qualified medicare set-asides.--
                            ``(i) Determination.--If the Secretary 
                        determines, based on the data described in 
                        clause (ii), that the provisions of 
                        subparagraph (D) have caused a significant 
                        negative financial impact (as specified by the 
                        Chief Actuary of the Centers for Medicare & 
                        Medicaid Services) on the Federal Hospital 
                        Insurance Trust Fund under section 1817 or the 
                        Federal Supplementary Medical Insurance Trust 
                        Fund under section 1841, then the Secretary 
                        shall adopt rules to reduce such impact by 
                        modifying the amount of the percent described 
                        in subparagraph (D)(iii).
                            ``(ii) Required data.--The determination 
                        under clause (i) shall be based on data on--
                                    ``(I) the projected effect of the 
                                provisions described in such paragraph 
                                on the Federal Hospital Insurance Trust 
                                Fund under section 1817 or the Federal 
                                Supplementary Medical Insurance Trust 
                                Fund under section 1841 during the 
                                three-year period beginning on the date 
                                of the enactment of this subsection; as 
                                compared to
                                    ``(II) data on the effect on such 
                                trust funds of the provisions of 
                                subsection (b), as in effect during the 
                                three-year period prior to such date of 
                                enactment.
            ``(3) Process for approval of qualified medicare set-
        asides.--
                    ``(A) Optional prior approval by secretary.--A 
                party to a workers' compensation settlement agreement 
                that includes a Medicare set-aside may submit to the 
                Secretary the set-aside for approval of the set-aside 
                as a qualified Medicare set-aside. The set-aside shall 
                be submitted in accordance with a procedure specified 
                by the Secretary.
                    ``(B) Notice of determination of approval or 
                disapproval.--Not later than 60 days after the date on 
                which the Secretary receives a submission under 
                subparagraph (A), the Secretary shall notify in writing 
                the parties to the workers' compensation settlement 
                agreement of the determination of approval or 
                disapproval. If the determination disapproves such 
                submission the Secretary shall include with such 
                notification the specific reasons for the disapproval. 
                A determination that disapproves a submission is not 
                valid if the determination does not include a specific 
                explanation of each deficiency of the submission.
            ``(4) Appeals.--
                    ``(A) In general.--A party to a workers' 
                compensation settlement agreement that is dissatisfied 
                with a determination under paragraph (3)(B), upon 
                filing a request for reconsideration with the Secretary 
                not later than 60 days after the date of notice of such 
                determination, shall be entitled to--
                            ``(i) reconsideration of the determination 
                        by the Secretary (with respect to such 
                        determination);
                            ``(ii) a hearing before an administrative 
                        judge thereon; and
                            ``(iii) judicial review of the Secretary's 
                        final determination after such hearing.
                    ``(B) Deadlines for decisions.--
                            ``(i) Reconsiderations.--
                                    ``(I) In general.--The Secretary 
                                shall conduct and conclude a 
                                reconsideration of a determination 
                                under subparagraph (A)(i) and mail the 
                                notice of the decision of such 
                                reconsideration to the party involved 
                                by not later than the last day of the 
                                30-day period beginning on the date 
                                that a request for such reconsideration 
                                has been timely filed.
                                    ``(II) Appeals of 
                                reconsiderations.--If a party to the 
                                workers' compensation settlement 
                                involved is dissatisfied with the 
                                Secretary's decision under subclause 
                                (I) that party may file an appeal 
                                within the 30-day period after the date 
                                of receipt of the notice of the 
                                decision under such subclause and 
                                request a hearing before an 
                                administrative law judge.
                                    ``(III) Failure by secretary to 
                                provide notice.--In the case of a 
                                failure by the Secretary to mail the 
                                notice of the decision under subclause 
                                (I) by the last day of the period 
                                described in such subclause, the 
                                Secretary shall be deemed to have 
                                approved the submission as submitted 
                                under paragraph (3)(A).
                            ``(ii) Hearings.--
                                    ``(I) In general.--An 
                                administrative law judge shall conduct 
                                and conclude a hearing on a decision of 
                                the Secretary under clause (i) and 
                                render a decision on such hearing by 
                                not later than the last day of the 90-
                                day period beginning on the date that a 
                                request for such hearing has been 
                                timely filed.
                                    ``(II) Judicial review.--A decision 
                                under subclause (I) by an 
                                administrative law judge constitutes a 
                                final agency action and is subject to 
                                judicial review.
                                    ``(III) Failure by administrative 
                                law judge to render timely decision.--
                                In the case of a failure by an 
                                administrative law judge to render a 
                                decision under subclause (I) by the 
                                last day of the period described in 
                                such subclause, the party requesting 
                                the hearing may seek judicial review of 
                                the decision under clause (i), 
                                notwithstanding any requirements for a 
                                hearing for purposes of the party's 
                                right to such judicial review.
            ``(5) Administration of medicare set-aside provisions; 
        protection from certain liability.--
                    ``(A) Optional direct payment of medicare set-aside 
                amount.--
                            ``(i) Election for direct payment of 
                        medicare set-aside.--With respect to a claim 
                        for which a workers' compensation settlement 
                        agreement is established, a workers' 
                        compensation claimant or workers' compensation 
                        payer who is party to the agreement may elect, 
                        but is not required, to transfer to the 
                        Secretary a direct payment of the qualified 
                        Medicare set-aside. With respect to a qualified 
                        Medicare set-aside paid directly to the 
                        Secretary, the parties involved may calculate 
                        the Medicare set-aside amount of such set-aside 
                        using any of the following methods:
                                    ``(I) In the case of any Medicare 
                                set-aside of a compromise settlement 
                                agreement under paragraph (2)(C)(ii), 
                                the amount calculated in accordance 
                                with such paragraph.
                                    ``(II) In the case of any Medicare 
                                set-aside, the amount based upon the 
                                payment amount for items and services 
                                under the workers' compensation fee 
                                schedule (effective as of the date of 
                                the agreement) applicable to the 
                                workers' compensation law or plan 
                                involved, in accordance with paragraph 
                                (2)(C)(i)(I).
                                    ``(III) In the case of any Medicare 
                                set-aside, the payment amount 
                                applicable to the items and services 
                                under this title as in effect on the 
                                effective date of the agreement.
                        Such transfer shall be in accordance with a 
                        procedure established by the Secretary and 
                        shall be made only upon written consent of the 
                        other party to the agreement.
                            ``(ii) Election satisfying liability.--An 
                        election made under clause (i), with respect to 
                        a qualified Medicare set-aside shall satisfy 
                        any payment, in relation to the underlying 
                        claim of the related workers' compensation 
                        settlement agreement, required under subsection 
                        (b)(2) to be made by the claimant or payer to 
                        the Secretary. The Secretary shall have no 
                        further recourse, directly or indirectly, under 
                        this title with respect to such agreement.
                    ``(B) Requirement for timely notice of medicare 
                repayments owed by workers' compensation claimant or 
                payer to secretary.--
                            ``(i) In general.--Not later than 90 days 
                        after the date on which the Secretary receives 
                        a request from a workers' compensation claimant 
                        or workers' compensation payer for 
                        documentation of any conditional payment made 
                        under subsection (b)(2)(B)(i) on behalf of the 
                        claimant, the Secretary shall provide to the 
                        claimant or payer such documentation. Such 
                        documentation shall be sufficient for the 
                        claimant or payer to make a reasonable 
                        determination whether such a payment was for an 
                        item or service furnished in connection with 
                        the claimant's work related injury or illness 
                        involved. The claimant or payer may rely on the 
                        documentation provided under this clause in 
                        making such determination. Payment of the 
                        amount of the conditional payment, after 
                        deducting from such amount any procurement 
                        costs involved and any costs for unrelated and 
                        inappropriate items or services, shall 
                        discharge further liability with respect to the 
                        conditional payment.
                            ``(ii) Liability for reimbursements related 
                        to requested information.--If the Secretary 
                        fails to provide information in accordance with 
                        clause (i), then neither the claimant nor the 
                        payer described in such clause shall be liable 
                        for any reimbursement under subsection 
                        (b)(2)(B) with respect to the conditional 
                        payment for which information was requested 
                        under such clause.
                    ``(C) Protection from certain liability.--
                            ``(i) Liability for medicare set-aside 
                        payment greater than payment under workers' 
                        compensation law.--No workers' compensation 
                        claimant, workers' compensation payer, 
                        employer, administrator of the Medicare set-
                        aside, legal representative of the claimant, 
                        payer, employer, or administrator, or any other 
                        party related to the claimant, payer, employer, 
                        or administrator shall be liable for any 
                        payment amount established under a Medicare 
                        set-aside for an item or service provided to 
                        the claimant that is greater than the payment 
                        amount for the item or service established 
                        under the workers' compensation fee schedule 
                        (or in the absence of such schedule, the 
                        medical reimbursement rate) under the 
                        compensation law or plan of the jurisdiction 
                        where the agreement will be effective.
                            ``(ii) Liability for provider charges 
                        greater than payment under workers' 
                        compensation agreement.--With respect to a 
                        workers' compensation settlement agreement, a 
                        provider may not bill (or collect any amount 
                        from) the workers' compensation claimant, 
                        workers' compensation payer, employer, 
                        administrator of the Medicare set-aside, legal 
                        representative of the claimant, payer, 
                        employer, or administrator, or any other party 
                        related to the claimant, payer, employer, or 
                        administrator an amount for items and services 
                        provided to the claimant that is greater than 
                        the payment rate for such items and services 
                        established under the Medicare set-aside of the 
                        agreement. No person is liable for payment of 
                        any amounts billed for an item or service in 
                        violation of the previous sentence. If a 
                        provider willfully bills (or collects an 
                        amount) for such an item or service in 
                        violation of such sentence, the Secretary may 
                        apply sanctions against the provider in 
                        accordance with section 1842(j)(2) in the same 
                        manner as such section applies with respect to 
                        a physician. Paragraph (4) of section 1842(j) 
                        shall apply under this clause in the same 
                        manner as such paragraph applies under such 
                        section.
            ``(6) Treatment of state workers' compensation law.--For 
        purposes of this subsection and subsection (p), if a workers' 
        compensation settlement agreement is accepted, reviewed, 
        approved, or otherwise finalized in accordance with the 
        workers' compensation law of the jurisdiction in which such 
        agreement will be effective, such acceptance, review, approval, 
        or other finalization shall be deemed conclusive as to any and 
        all matters within the jurisdiction of the workers' 
        compensation law, including the determination of reasonableness 
        of the settlement value; any allocations of settlement funds; 
        the projection of future indemnity or medical benefits that may 
        be payable under the State workers' compensation law; and, in 
        the case of a compromise agreement, the total amount that could 
        have been payable for a claim which is the subject of such 
        agreement in accordance with paragraph (2)(C)(ii). A 
        determination made by applicable authority for a jurisdiction 
        that a workers' compensation settlement agreement is in 
        accordance with the workers' compensation law of the 
        jurisdiction shall not be subject to review by the 
        Secretary.''.
    (c) Conforming Amendments.--Subsection (b) of such section is 
further amended--
            (1) in paragraph (2)(B)(ii), by striking ``A primary plan'' 
        and inserting ``Subject to subsections (p) and (q), a primary 
        plan'';
            (2) in paragraph (2)(B)(iii)--
                    (A) in the first sentence, by striking ``In order 
                to recover payment'' and inserting ``Subject to 
                subsection (q), in order to recover payment''; and
                    (B) in the third sentence, by striking ``In 
                addition'' and inserting ``Subject to subsection (q), 
                in addition''; and
            (3) in paragraph (3)(A), by striking ``There is established 
        a private cause of action'' and inserting ``Subject to 
        subsection (q), there is established a private cause of 
        action''.
    (d) Modernizing Terminology for Purposes of Medicare Secondary 
Payer Provisions.--Subsection (b)(2)(A) of such section is amended by 
striking ``workmen's compensation law or plan'' and inserting 
``workers' compensation law or plan'' each place it appears.

SEC. 3. LIMITATION ON LIABILITY.

    The parties to a workers' compensation settlement agreement which 
met the provisions of section 1862(b) of the Social Security Act (42 
U.S.C. 1395y (b)) on the effective date of settlement shall be accepted 
as meeting the requirements of such section notwithstanding changes in 
law, regulations, or administrative interpretation of such provisions 
after the effective date of such settlement. Nothing in section 1862(b) 
of the Social Security Act (42 U.S.C. 1395y (b)) shall authorize the 
Secretary of Health and Human Services to impose liability that is 
additional to the liability in effect on the date of the enactment of 
this Act with respect to a workers' compensation settlement agreement 
the effective date of which is before such date of enactment, except in 
the case of fraud.

SEC. 4. EFFECTIVE DATE.

    The amendments made by this Act shall apply to a workers' 
compensation settlement agreement with an effective date on or after 
the date of the enactment of this Act.
                                 <all>
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