the date of notice of such determination, shall 
be entitled to— 
‘‘(i) reconsideration of the determina-
tion by the Secretary (with respect to such 
determination); 
‘‘(ii) a hearing before an administra-
tive judge thereon after such reconsider-
ation; and 
‘‘(iii) judicial review of the Secretary’s 
final determination after such hearing. 
‘‘(B) DEADLINES FOR DECISIONS.— 
‘‘(i) RECONSIDERATIONS.— 
‘‘(I) IN
GENERAL.—The Sec-
retary shall conduct and conclude a 
reconsideration of a determination 
under subparagraph (A)(i) and mail 
the notice of the decision of such re-
consideration 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 RECONSIDER-
ATIONS.—If a party to the workers’ 
compensation settlement involved is 
VerDate Mar 15 2010 
05:01 May 18, 2013
Jkt 029200
PO 00000
Frm 00020
Fmt 6652
Sfmt 6201
E:\BILLS\H1982.IH
H1982
tjames on DSK6SPTVN1PROD with BILLS
dissatisfied with the Secretary’s deci-
sion 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 sub-
clause 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 de-
scribed in such subclause, the Sec-
retary shall be deemed to have ap-
proved the submission as submitted 
under paragraph (3)(A). 
‘‘(ii) HEARINGS.— 
‘‘(I) IN GENERAL.—An adminis-
trative 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 
VerDate Mar 15 2010 
05:01 May 18, 2013
Jkt 029200
PO 00000
Frm 00021
Fmt 6652
Sfmt 6201
E:\BILLS\H1982.IH
H1982
tjames on DSK6SPTVN1PROD with BILLS
a request for such hearing has been 
timely filed. 
‘‘(II) JUDICIAL REVIEW.—A deci-
sion under subclause (I) by an admin-
istrative law judge constitutes a final 
agency action and is subject to judi-
cial review. 
‘‘(III) FAILURE BY ADMINISTRA-
TIVE 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), not-
withstanding 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
LIABIL-
ITY.— 
‘‘(A) OPTIONAL
DIRECT
PAYMENT
OF 
MEDICARE SET-ASIDE AMOUNT.— 
VerDate Mar 15 2010 
05:01 May 18, 2013
Jkt 029200
PO 00000
Frm 00022
Fmt 6652
Sfmt 6201
E:\BILLS\H1982.IH
H1982
tjames on DSK6SPTVN1PROD with BILLS
‘‘(i) ELECTION FOR DIRECT PAYMENT 
OF MEDICARE SET-ASIDE.—With respect to 
a claim for which a workers’ compensation 
settlement agreement is established, a 
claimant or workers’ compensation payer 
who is party to the agreement may elect, 
but is not required, to transfer to the Sec-
retary a direct payment of the qualified 
Medicare set-aside. With respect to a quali-
fied Medicare set-aside paid directly to the 
Secretary, the parties involved may cal-
culate 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 serv-
ices under the workers’ compensation 
fee schedule (effective as of the date 
of the agreement) applicable to the 
VerDate Mar 15 2010 
05:01 May 18, 2013
Jkt 029200
PO 00000
Frm 00023
Fmt 6652
Sfmt 6201
E:\BILLS\H1982.IH
H1982
tjames on DSK6SPTVN1PROD with BILLS
workers’ compensation law or plan in-
volved, in accordance with paragraph 
(2)(C)(i)(I). 
‘‘(III) In the case of any Medi-
care set-aside, the payment amount 
applicable to the items and services 
under this title as in effect on the ef-
fective date of the agreement. 
Such transfer shall be in accordance with 
a procedure established by the Secretary 
and shall be made only upon written con-
sent of the other party to the agreement. 
‘‘(ii) ELECTION
SATISFYING
LIABIL-
ITY.—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 agree-
ment, required under subsection (b)(2) to 
be made by the claimant or payer to the 
Secretary. The Secretary shall have no fur-
ther recourse, directly or indirectly, under 
this title with respect to such agreement. 
‘‘(B) PROTECTION FROM CERTAIN LIABIL-
ITY.— 
VerDate Mar 15 2010 
05:01 May 18, 2013
Jkt 029200
PO 00000
Frm 00024
Fmt 6652
Sfmt 6201
E:\BILLS\H1982.IH
H1982
tjames on DSK6SPTVN1PROD with BILLS
‘‘(i) LIABILITY FOR MEDICARE SET- 
ASIDE PAYMENT GREATER THAN PAYMENT 
UNDER WORKERS’ COMPENSATION LAW.— 
No workers’ compensation claimant, work-
ers’ compensation payer, employer, admin-
istrator of the Medicare set-aside, legal 
representative of the claimant, payer, em-
ployer, or administrator, or any other 
party related to the claimant, payer, em-
ployer, 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’ com-
pensation fee schedule (or in the absence 
of such schedule, the medical reimburse-
ment rate) under the compensation law or 
plan of the jurisdiction where the agree-
ment will be effective. 
‘‘(ii) 
LIABILITY
FOR
PROVIDER 
CHARGES
GREATER
THAN
PAYMENT 
UNDER WORKERS’ COMPENSATION AGREE-
MENT.—With respect to a workers’ com-
pensation settlement agreement, a provider 
VerDate Mar 15 2010 
05:01 May 18, 2013
Jkt 029200
PO 00000
Frm 00025
Fmt 6652
Sfmt 6201
E:\BILLS\H1982.IH
H1982
tjames on DSK6SPTVN1PROD with BILLS