(B) 
SECTION
1862(b)(1)(C).—Section
1862(b)(1)(C) (42 U.S.C. 1395y(b)(1)(C)) is
amended in the matter preceding clause (i) by
striking ‘‘plan (as defined in subparagraph
(A)(v))—’’ and inserting ‘‘plan—’’.
(C) SECTIONS
1837
AND
1839.—Subpara-
graph (A) of the first sentence of section
1837(i)(1) (42 U.S.C. 1395p(i)(1)), subpara-
graph (B) of the first sentence of section
1837(i)(2) (42 U.S.C. 1395p(i)(2)), section
1837(i)(3)(A) (42 U.S.C. 1395p(i)(3)(A)), and
paragraph (2) of the second sentence of section
1839(b) (42 U.S.C. 1395r(b)), are each amend-
ed by striking ‘‘1862(b)(1)(A)(v)’’ and inserting
‘‘1862(b)(1)(E)(iv)’’.
(D) SECTION 5000 OF THE INTERNAL REV-
ENUE CODE.—Section 5000(b) of the Internal
Revenue Code of 1986 is amended to read as
follows:
‘‘(b) GROUP HEALTH PLAN.—For purposes of this
section, the term ‘group health plan’ has the meaning
given that term in section 1862(b)(1)(E)(iv) of the Social
Security Act (42 U.S.C. 1395y(b)(1)(E)(iv)).’’.
(E) SECTION
7701(a)
OF
THE
INTERNAL
REVENUE CODE.—Section 7701(a) of the Inter-
nal Revenue Code of 1986 is amended by add-
ing at the end the following:
‘‘(47) GROUP HEALTH PLAN.—The term ‘group
health plan’ means a plan (including a self-insured
plan) of, or contributed to by, an employer (includ-
ing a self-employed person) or employee organization
to provide health care (directly or otherwise) to the
employees, former employees, the employer, others
associated or formerly associated with the employer
in a business relationship, or their families.’’.
(F) SECTIONS 4980B, 9805, AND 6103 OF
THE
INTERNAL
REVENUE
CODE.—Sections
4980B, 9805, and 6103(l)(12)(E)(ii) of the In-
ternal Revenue Code of 1986 are amended by
striking ‘‘5000(b)(1)’’ each place it occurs and
inserting ‘‘7701(a)(47)’’.
(b) CONSOLIDATION OF SIZE REQUIREMENTS.—
(1) IN GENERAL.—Section 1862(b)(1)(E) (42
U.S.C. 1395y(b)(1)(E)) (as amended by subsection
(a)(1) of this section) is amended by adding at the
end the following:
‘‘(v) EXCLUSION OF GROUP HEALTH
PLANS OF SMALL AND MEDIUM EMPLOY-
ERS.—
‘‘(I) Subparagraph (A) does not
apply to a group health plan unless
the plan involves at least one employer
that has 20 or more employees in
each of 20 or more calendar weeks in
the current or preceding calendar
year.
‘‘(II) Subparagraph (B) does not
apply to a group health plan unless
the plan involves at least one employer
that has 100 or more employees in
each of 20 or more calendar weeks in
the current or preceding calendar
year.’’.
(2) CONFORMING AMENDMENTS.—
(A) 
SECTION
1862(b)(1)(A).—Section
1862(b)(1)(A) (42 U.S.C. 1395y(b)(1)(A)) (as
amended by subsection (a)(2)(A) of this sec-
tion) is amended—
(i) by striking clauses (ii) and (iii),
and
(ii) by redesignating clause (iv) as
clause (ii).
(B) 
SECTION
1862(b)(1)(B).—Section
1862(b)(1)(B) (42 U.S.C. 1395y(b)(1)(B)) is
amended—
(i) 
in 
the 
heading, 
by 
striking
‘‘LARGE’’,
(ii) in clause (i), by striking ‘‘large
group health plan (as defined in clause
(iv))’’ and inserting ‘‘group health plan’’,
and
(iii) by striking clause (iv).
(C) SECTION 1862(b)(2).—The second sen-
tence of section 1862(b)(2)(A) (42 U.S.C.
1395y(b)(2)(A)) is amended by striking ‘‘or
large group health plan’’.
(D) 
SECTION
1862(b)(3).—Section
1862(b)(3)(C) (42 U.S.C. 1395y(b)(3)(C)) is
amended—
(i) in the heading, by striking ‘‘OR A
LARGE GROUP HEALTH PLAN’’, and
(ii) in the first sentence, by striking
‘‘or a large group health plan’’.
(E) 
SECTION
1837(i)(1).—Section
1837(i)(1) (42 U.S.C. 1395p(i)(1)) is amend-
ed—
(i) in the first sentence, in subpara-
graph (A), by striking ‘‘(or the individual’s
spouse’s) current employment status’’ and
inserting ‘‘current employment status (or
the current employment status of a family
member of the individual)’’; and
(ii) by striking the second sentence.
(F) 
SECTION
1837(i)(2).—Section
1837(i)(2) (42 U.S.C. 1395p(i)(2)) is amend-
ed—
(i) in the first sentence, in subpara-
graph (B), by striking ‘‘(or the individual’s
spouse’s) current employment status’’ and
inserting ‘‘current employment status (or
the current employment status of a family
member of the individual)’’; and
(ii) by striking the second sentence.
(G) 
SECTION
1837(i)(3).—Section
1837(i)(3) (42 U.S.C. 1395p(i)(3)) is amend-
ed—
(i) by striking subparagraph (B), and
(ii) by striking ‘‘(3)(A)’’ and inserting
‘‘(3)’’.
(H) SECTION 1839(b).—Paragraph (2) of
the second sentence of section 1839(b) (42
U.S.C. 1395r(b)) is amended by striking ‘‘by
reason of the individual’s’’ and all that follows
through ‘‘section 1862(b)(1)(B)(iv))’’.
(I) SECTION 5000 OF THE INTERNAL REVE-
NUE
CODE.—Section 5000(c) of the Internal
Revenue Code of 1986 is amended by striking
‘‘or large group health plan’’ and all that fol-
lows up to the period and inserting ‘‘that at any
time during a calendar year does not comply
with any applicable requirement of paragraph
(1) or (2) of section 1862(b) of the Social Secu-
rity Act’’.
SEC. 403. INFORMATION REQUIREMENTS.
(a) INFORMATION FROM GROUP HEALTH PLANS.—
Section 1862(b) (42 U.S.C. 1395y(b)) is amended by add-
ing at the end the following:
‘‘(7) INFORMATION
FROM
GROUP
HEALTH
PLANS.—
‘‘(A) PROVISION
OF
INFORMATION
BY
GROUP HEALTH PLANS.—The administrator of
a group health plan (other than a plan exempt,
under paragraph (1)(E)(v), from the require-
ments of paragraph (1)) shall provide to the
Secretary any or all of the information elements
listed in subparagraph (C) in the manner and
at times (but not more frequently than 4 times
per year) the Secretary may specify, with re-
spect to each individual covered under the plan
and entitled to benefits under this title.
‘‘(B) PROVISION OF INFORMATION BY EM-
PLOYERS AND EMPLOYEE ORGANIZATIONS.—An
employer (or employee organization) that main-
tains or participates in a group health plan
(other than a plan exempt, under paragraph
(1)(E)(v), from the requirements of paragraph
(1)) shall provide to the administrator of the
plan any or all of the information elements list-
ed in subparagraph (C) in the manner and at
times (but not more frequently than 4 times per
year) the Secretary may specify, with respect to
each individual covered under the plan and enti-
tled to benefits under this title.
‘‘(C) INFORMATION ELEMENTS TO BE PRO-
VIDED.—The information elements to be pro-
vided under subparagraph (A) or (B) are:
‘‘(i) ELEMENTS CONCERNING THE IN-
DIVIDUAL.—Elements concerning the indi-
vidual are as follows:
‘‘(I) The individual’s name.
‘‘(II) The individual’s date of
birth.
‘‘(III) The individual’s social se-
curity number.
‘‘(IV) The number assigned by
the Secretary to the individual for
claims under this title.
‘‘(V) The family relationship of
the individual to the person who has
or had current employment status
with the employer.
‘‘(ii) ELEMENTS
CONCERNING
THE
FAMILY
MEMBER
WITH
CURRENT
OR
FORMER EMPLOYMENT STATUS.—Elements
concerning the family member with current
or former employment status are as fol-
lows:
‘‘(I) The name of the person in
the individual’s family who has or had
current employment status with the
employer.
‘‘(II) That person’s social secu-
rity number.
‘‘(III) The number or other iden-
tifier assigned by the plan to that per-
son.
‘‘(IV) The periods of coverage for
that person under the plan.
‘‘(V) The employment status of
that person (current or former) dur-
ing those periods of coverage.
‘‘(VI) The classes (of that per-
son’s family members) covered under
the plan.
‘‘(iii) PLAN
ELEMENTS.—Plan ele-
ments are as follows:
‘‘(I) The nature of the items and
services covered under the plan.
‘‘(II) The name and address to
which claims under the plan are to be
sent.
‘‘(iv) ELEMENTS
CONCERNING
THE
EMPLOYER.—Elements concerning the em-
ployer are as follows:
‘‘(I) The employer’s name.
‘‘(II) The employer’s address.
‘‘(III) The employer identifica-
tion number of the employer.
‘‘(D) USE OF IDENTIFIERS.—The adminis-
trator of a group health plan shall utilize an
identifier for the plan (that the Secretary may
furnish) in providing information under sub-
paragraph (A) and in other transactions, as
may be specified by the Secretary, related to
the provisions of this subsection.
‘‘(E) 
APPLICABILITY
OF
ELECTRONIC
TRANSMISSION
REQUIREMENTS.—Part C of
title XI applies to the preceding subparagraphs
of this paragraph.
‘‘(F) PENALTY
FOR
NONCOMPLIANCE.—
Any entity that knowingly and willfully fails to
comply with a requirement imposed by subpara-
graphs (A), (B), (C), (D), or (E) is subject to
a civil money penalty not to exceed $1,000 for
each incident of failure. The provisions of sec-
tion 1128A (other than subsections (a) and (b))
apply to a civil money penalty under the pre-
vious sentence in the same manner as those
provisions apply to a penalty or proceeding
under section 1128A(a).’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) is effective 180 days after the date of enact-
ment of this Act.
SEC. 404. CLARIFICATION OF TIME AND FILING LIMITA-
TIONS.
(a) IN GENERAL.—Section 1862(b)(2)(B) (42 U.S.C.
1395y(b)(2)(B)) is amended by adding at the end the fol-
lowing:
‘‘(v) TIME, FILING, AND
RELATED
PROVISIONS UNDER PRIMARY PLAN.—Re-
quirements under a primary plan as to the
filing of a claim, time limitations for the
filing of a claim, information not main-
tained by the Secretary, or notification or
preadmission review, shall not apply to a
claim by the United States under clause
(ii) or (iii).’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) applies to items and services furnished after
1997.
SEC. 405. CLARIFICATION OF LIABILITY OF THIRD PARTY
ADMINISTRATORS.
(a) IN GENERAL.—Section 1862(b)(2)(B)(ii) (42
U.S.C. 1395y(b)(2)(B)(ii)) is amended by inserting ‘‘, or
which determines claims under the primary plan’’ after
‘‘primary plan’’.
(b) CLAIMS BETWEEN PARTIES OTHER THAN THE
UNITED STATES.—Section 1862(b)(2)(B) (42 U.S.C.
1395y(b)(2)(B)) (as amended by section 404 of this Act)
is amended by adding at the end the following:
‘‘(vi) 
CLAIMS
BETWEEN
PARTIES
OTHER
THAN
THE
UNITED
STATES.—A
claim by the United States under clause
(ii) or (iii) shall not preclude claims be-
tween other parties.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to items and services furnished
after 1997.
SEC. 406. CLARIFICATION OF PAYMENT AMOUNTS TO MEDI-
CARE.
(a) IN
GENERAL.—Section 1862(b)(2)(B)(i) (42
U.S.C. 1395y(b)(2)(B)(i)) is amended to read as follows:
‘‘(i) REPAYMENT REQUIRED.—
‘‘(I) IN GENERAL.—Any payment
under this title, with respect to any
item or service for which payment by
a primary plan is required under the
preceding provisions of this sub-
section, shall be conditioned on reim-
bursement to the appropriate Trust
Fund established by this title when
notice or other information is received
that payment for that item or service
has been or should have been made
under those provisions. If reimburse-
ment is not made to the appropriate
Trust Fund before the expiration of
the 60-day period that begins on the
date such notice 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 re-
imbursement until reimbursement is
made (at a rate determined by the
Secretary in accordance with regula-
tions of the Secretary of the Treasury
applicable to charges for late pay-
ments).
‘‘(II) 
DETERMINATION
OF
AMOUNT
OWED.—The amount owed
by a primary plan under the first sen-
tence of subclause (I) is the lesser of
the full primary payment required (if
that amount is readily determinable)
and the amount paid under this title
for that item or service.’’.
(b) CONFORMING AND TECHNICAL AMENDMENTS.—
(1) Subparagraphs (A)(i)(I) and (B)(i) of sec-
tion 1862(b)(1) (42 U.S.C. 1395y(b)(1)) are each
amended by inserting ‘‘(or eligible to be covered)’’
after ‘‘covered’’.
(2) 
Section 
1862(b)(1)(C)(ii) 
(42 
U.S.C.
1395y(b)(1)(C)(ii)) is amended by striking ‘‘covered
by such plan’’.
(3) 
Section 
1862(b)(2)(A) 
(42 
U.S.C.
1395y(b)(2)(A)) is amended in the matter preceding
clause (i) by striking ‘‘, except as provided in sub-
paragraph (B),’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall apply to items and services furnished
after 1997.
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