lations 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 
relate to a potential settlement, judg-
ment, award, or other payment . Such 
access shall be provided to an indi-
vidual, 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 pos-
sible but not later than 15 days after 
the date that payment is made. Infor-
mation related to claims and pay-
ments subject to the notice under sub-
clause (I) shall be maintained and 
made available consistent with the fol-
lowing: 
‘‘(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 accu-
rately identifies those claims and 
payments that are related to a 
potential settlement, judgment, 
award, or other payment to 
which the provisions of this sub-
section 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 trans-
mitted. 
‘‘(ee) The website shall per-
mit the individual, representative, 
or plan to download a statement 
of reimbursement amounts (in
this clause referred to as a ‘state-
ment of reimbursement amount’) 
on payments for claims under 
this title relating to a potential 
settlement, judgment, award, or 
other payment. 
‘‘(III) USE
OF
TIMELY
WEB 
DOWNLOAD AS BASIS FOR FINAL CON-
DITIONAL AMOUNT.—If an individual 
(or other claimant or applicable plan 
with the consent of the individual) ob-
tains a statement of reimbursement 
amount from the website during the 
protected period as defined in sub-
clause (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 DISCREP-
ANCIES.—If the individual (or author-
ized representative) believes there is a 
discrepancy with the statement of re-
imbursement amount, the Secretary 
shall provide a timely process to re-
solve the discrepancy. Under such 
process the individual (or representa-
tive) must provide documentation ex-
plaining the discrepancy and a pro-
posal to resolve such discrepancy. 
Within 11 business days after the 
date of receipt of such documentation, 
the Secretary shall determine whether 
there is a reasonable basis to include 
or remove claims on the statement of 
reimbursement. If the Secretary does 
not make such determination within 
the 11 business-day period, then the 
proposal to resolve the discrepancy 
shall be accepted. If the Secretary de-
termines within such period that there 
is not a reasonable basis to include or
remove claims on the statement of re-
imbursement, the proposal shall be re-
jected. If the Secretary determines 
within such period that there is a rea-
sonable basis to conclude there is a 
discrepancy, the Secretary must re-
spond in a timely manner by agreeing 
to the proposal to resolve the discrep-
ancy or by providing documentation 
showing with good cause why the Sec-
retary is not agreeing to such pro-
posal and establishing an alternate 
discrepancy resolution. 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 set-
tlement, judgment, award or other 
payment relating to an injury or inci-
dent, the portion (if any) of the period 
beginning on the date of notice under 
subclause (I) with respect to such set-
tlement, judgment, award, or other 
payment that is after the end of a 
Secretarial response period beginning 
on the date of such notice to the Sec-
retary. Such Secretarial response pe-
riod shall be a period of 65 days, ex-
cept that such period may be extended 
by the Secretary for a period of an 
additional 30 days if the Secretary de-
termines that additional time is re-
quired to address claims for which 
payment has been made. Such Secre-
tarial response period shall be ex-
tended and shall not include any days 
for any part of which the Secretary 
determines (in accordance with regu-
lations) 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 regu-
lations to carry out this clause not 
later than 9 months after the date of 
the enactment of this clause. 
‘‘(VII) WEBSITE INCLUDING SUC-
CESSOR
TECHNOLOGY.—In 
this 
clause, the term ‘website’ includes any 
successor technology. 
‘‘(viii) RIGHT OF APPEAL FOR SEC-
ONDARY PAYER DETERMINATIONS RELAT-
ING 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 seek-
ing to recover conditional payments from
an applicable plan (as defined in para-
graph (8)(F)) that is a primary plan under 
subsection (A)(ii), under which the applica-
ble 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 serv-
ice shall be notified of the plan’s intent to 
appeal such determination’’. 
SEC. 202. FISCAL EFFICIENCY AND REVENUE NEUTRALITY. 
(a) IN GENERAL.—Section 1862(b) of the Social Se-
curity Act (42 U.S.C. 1395y(b)) is amended— 
(1) in paragraph (2)(B)(ii), by striking ‘‘A pri-
mary 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 para-
graph (2)(B) and any reporting required by 
paragraph (8) shall not apply with respect to 
any settlement, judgment, award, or other pay-
ment by an applicable plan arising from liability 
insurance (including self-insurance) and from 
alleged physical trauma-based incidents (exclud-
ing alleged ingestion, implantation, or exposure 
cases) 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 THRESH-
OLD.— 
‘‘(i) IN
GENERAL.—Not later than 
November 15 before each year, the Sec-
retary shall calculate and publish a single 
threshold amount for settlements, judg-
ments, awards, or other payments for obli-
gations arising from liability insurance (in-
cluding self-insurance) and for alleged 
physical trauma-based incidents (excluding 
alleged ingestion, implantation, or exposure 
cases) subject to this section for that year. 
The annual single threshold amount for a 
year shall be set such that the estimated 
average amount to be credited to the Medi-
care trust funds of collections of condi-
tional payments from such settlements, 
judgments, awards, or other payments 
arising from liability insurance (including 
self-insurance) and for such alleged inci-
dents subject to this section shall equal the 
estimated 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 for such alleged inci-
dents subject to this section for the year. 
At the time of calculating, but before pub-
lishing, 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. 
‘‘(ii) PUBLICATION.— The Secretary 
shall include, as part of such publication 
for a year— 
‘‘(I) the estimated cost of collec-
tion incurred by the United States 
(including payments made to contrac-
tors) for a conditional payment aris-
ing from liability insurance (including 
self-insurance) and for such alleged 
incidents; and 
‘‘(II) a summary of the method-
ology and data used by the Secretary