Secretary fails to provide a final demand 
for any item or service subject to reim-
bursement required under clause (ii) in ac-
cordance with subclause (I), the claimant, 
applicable plan, or an entity that receives 
payment from an applicable plan shall not 
be liable for and shall not be obligated to 
make payment subject to this subsection 
for any item or service related to the re-
quest for final demand for reimbursement. 
‘‘(ix) RIGHT OF APPEAL.—The Secretary 
shall promulgate regulations establishing a 
right of appeal and appeals process, with re-
spect to any requirement under clause (ii) for 
a payment made under this title for an item or 
service under a primary plan, under which the 
applicable plan involved, or an attorney, agent, 
or third party administrator on behalf of such 
applicable plan may appeal such requirement. 
Such right of review shall— 
‘‘(I) include review through an admin-
istrative law judge and administrative re-
view board, and access to judicial review in 
the district court of the United States for 
the judicial district in which the appellant 
VerDate Nov 24 2008 
03:03 Mar 11, 2010
Jkt 089200
PO 00000
Frm 00006
Fmt 6652
Sfmt 6201
E:\BILLS\H4796.IH
H4796
jbell on DSKDVH8Z91PROD with BILLS
is located (or, in the case of an action 
brought jointly by more than one appli-
cant, the judicial district in which the 
greatest number of applicants are located) 
or in the District Court for the District of 
Columbia; and 
‘‘(II) be carried out in a manner simi-
lar to the appeals procedure used for pur-
poses of subsection (a).’’. 
(2) CONFORMING AMENDMENT.—Clause (ii) of 
such section is amended by inserting after ‘‘60-day’’ 
the following ‘‘(or in the case of an applicable plan 
and reimbursement described in clause (vii) or (viii), 
90-day)’’. 
SEC. 3. THRESHOLD. 
(a) IN GENERAL.—Section 1862(b)(2)(B)(ii) of the 
Social Security Act (42 U.S.C. 1395y(b)(2)(B)(ii)) is 
amended— 
(1) by striking ‘‘(ii) REPAYMENT REQUIRED.— 
A primary plan’’ and inserting the following: 
‘‘(ii) REPAYMENT REQUIRED.— 
‘‘(I) IN
GENERAL.—A primary 
plan’’; and 
(2) by adding at the end the following new sub-
clause: 
VerDate Nov 24 2008 
03:03 Mar 11, 2010
Jkt 089200
PO 00000
Frm 00007
Fmt 6652
Sfmt 6201
E:\BILLS\H4796.IH
H4796
jbell on DSKDVH8Z91PROD with BILLS
‘‘(II) EXCEPTION.—Subclause (I) 
shall not apply with respect to the fol-
lowing payments under this title: 
‘‘(aa) Any settlement, judg-
ment, award, or other payment 
by an applicable plan constituting 
a total payment obligation to a 
claimant 
of 
not 
more 
than 
$5,000. 
‘‘(bb) Any settlement, judg-
ment, award, or other payment 
by an applicable plan involving 
the ongoing responsibility for 
medical payments not otherwise 
addressed in subclause (I), of not 
more than $5,000. For purposes 
of this subclause and with re-
spect to a settlement, judgment, 
award, or other payment pay-
ments not otherwise addressed in 
subclause (I) involving the ongo-
ing responsibility for medical 
payments, such payment shall in-
clude only the cumulative value 
of the medical payments made 
VerDate Nov 24 2008 
03:03 Mar 11, 2010
Jkt 089200
PO 00000
Frm 00008
Fmt 6652
Sfmt 6201
E:\BILLS\H4796.IH
H4796
jbell on DSKDVH8Z91PROD with BILLS
and the purchase price of any an-
nuity or similar instrument. 
The amounts under this subclause 
shall be adjusted each year based on 
the percentage increase in the Con-
sumer Price Index (rounded to the 
nearest multiple of $100) for the year 
involved.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply with respect to payments made 
on or after 3 months after the date of the enactment of 
this Act. 
SEC. 4. REPORTING REQUIREMENT SAFE HARBORS. 
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. The 
severity of each such penalty shall be based on the 
intentional nature of the violation.’’; and 
(2) by adding at the end the following new sub-
paragraph: 
VerDate Nov 24 2008 
03:03 Mar 11, 2010
Jkt 089200
PO 00000
Frm 00009
Fmt 6652
Sfmt 6201
E:\BILLS\H4796.IH
H4796
jbell on DSKDVH8Z91PROD with BILLS
‘‘(I) SAFE HARBORS.—Not later than 60 
days after the date of the enactment of this 
subparagraph, the Secretary shall publish a no-
tice in the Federal Register soliciting proposals, 
which will be accepted during a 60-day period, 
for the creation of safe harbors from sanctions 
imposed under subparagraph (E) under which 
entities responsible for reporting information 
under this paragraph will be deemed to have 
complied with the reporting requirements under 
this paragraph and will not be subject to such 
sanctions. After considering the proposals sub-
mitted pursuant to the preceding sentence, the 
Secretary, in consultation with the Attorney 
General, shall publish in the Federal Register, 
including a 60-day period for comment, pro-
posed safe harbors. After considering any public 
comments received during such period, the Sec-
retary shall issue final rules establishing safe 
harbors from penalties or other sanctions under 
subparagraph (E).’’. 
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 
VerDate Nov 24 2008 
03:03 Mar 11, 2010
Jkt 089200
PO 00000
Frm 00010
Fmt 6652
Sfmt 6201
E:\BILLS\H4796.IH
H4796
jbell on DSKDVH8Z91PROD with BILLS