I 
112TH CONGRESS 
1ST SESSION H. R. 1063 
To amend title XVIII of the Social Security Act with respect to the 
application of Medicare secondary payer rules for certain claims. 
IN THE HOUSE OF REPRESENTATIVES 
MARCH 14, 2011 
Mr. MURPHY of Pennsylvania (for himself and Mr. KIND) introduced the fol-
lowing 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 consider-
ation of such provisions as fall within the jurisdiction of the committee 
concerned 
A BILL 
To amend title XVIII of the Social Security Act with respect 
to the application of Medicare secondary payer rules 
for certain claims. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Strengthening Medicare And Repaying Taxpayers Act of 
2011’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
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Sec. 1. Short title; table of contents. 
Sec. 2. Expediting Secretarial determination of reimbursement amount to im-
prove program efficiency. 
Sec. 3. Fiscal efficiency and revenue neutrality. 
Sec. 4. Reporting requirement safe harbors. 
Sec. 5. Use of social security numbers and other identifying information in re-
porting. 
Sec. 6. Statute of limitations. 
SEC. 2. EXPEDITING SECRETARIAL DETERMINATION OF 
REIMBURSEMENT 
AMOUNT 
TO 
IMPROVE 
PROGRAM EFFICIENCY. 
Section 1862(b)(2)(B) of the Social Security Act (42 
U.S.C. 1395y(b)(2)(B)) is amended by adding at the end 
the following new clause: 
‘‘(vii) TIMELY
NOTICE
OF
CONDI-
TIONAL PAYMENT REIMBURSEMENT.— 
‘‘(I) REQUEST FOR CONDITIONAL 
PAYMENT
STATEMENT.—In the case 
of a payment made by the Secretary 
pursuant to clause (i) for items and 
services provided to the claimant, the 
claimant or applicable plan (as de-
fined in paragraph (8)(F)) may at 
any time beginning 120 days before 
the reasonably expected date of a set-
tlement, judgment, award, or other 
payment, notify the Secretary that a 
payment is reasonably expected, and 
request from the Secretary, in accord-
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ance with regulations, a statement of 
the conditional payment reimburse-
ment amount (in this clause referred 
to as a ‘statement of reimbursement 
amount’) for any payments subject to 
reimbursement required under clause 
(ii). A claimant or applicable plan 
may request a statement under this 
subclause only once with respect to 
such settlement, judgment, award, or 
other payment. 
‘‘(II) SECRETARIAL RESPONSE.— 
‘‘(aa) 
IN
GENERAL.—Not 
later than 65 days after the date 
of receipt of a request under sub-
clause (I), the Secretary shall re-
spond to such request with a 
statement 
of 
reimbursement 
amount, which shall constitute 
the conditional payment subject 
to recovery under clause (ii) re-
lated to such settlement, judg-
ment, award or other payment. 
‘‘(bb) 
CASE
OF
SECRE-
TARIAL
FAILURE.—Subject 
to 
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‘‘(IV) 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. Such 
regulations shall require the disclosure 
from a claimant or applicable plan of 
no more than the minimum amount of 
information necessary for the Sec-
retary to determine the amount of 
conditional payment subject to recov-
ery under clause (ii) related to such 
settlement, judgment, award, or other 
payment, and may require partial dis-
closure (but may not require full dis-
closure) of social security numbers or 
health identification claim numbers. 
‘‘(viii) RIGHT OF APPEAL.—The Sec-
retary shall promulgate regulations estab-
lishing a right of appeal and appeals proc-
ess, with respect to any determination 
under this subsection for a payment made 
under this title for an item or service 
under a primary plan, under which the ap-
plicable plan involved, or an attorney, 
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agent, or third party administrator on be-
half of such applicable plan, may appeal 
such determination. Such right of appeal 
shall— 
‘‘(I) include review through an 
administrative law judge and adminis-
trative review board, and access to ju-
dicial review in the district court of 
the United States for the judicial dis-
trict in which the appellant is located 
(or, in the case of an action brought 
jointly by more than one applicant, 
the judicial district in which the 
greatest number of applicants are lo-
cated) or in the District Court for the 
District of Columbia; and 
‘‘(II) be carried out in a manner 
similar to the appeals procedure under 
regulations for hearing procedures re-
specting notices of determinations of 
nonconformance of group health plans 
under this subsection.’’. 
SEC. 3. 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— 
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(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 constituting a total 
payment obligation to a claimant of not more 
than the single threshold amount calculated by 
the Chief Actuary of the Centers for Medicare 
& Medicaid Services under subparagraph (B) 
for the year involved. 
‘‘(B) ANNUAL COMPUTATION OF THRESH-
OLDS.—Not later than November 15 before 
each year, the Chief Actuary of the Centers for 
Medicare & Medicaid Services shall calculate 
and publish a single threshold amount for set-
tlements, judgments, awards or other payments 
for conditional payment obligations arising from 
each of liability insurance (including self-insur-
ance), workers’ compensation laws or plans, and 
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no fault insurance subject to this section for 
that year. Each such annual single threshold 
amount for a year shall be set such that the ex-
pected average amount to be credited to the 
Medicare trust funds of collections of condi-
tional payments from such settlements, judg-
ments, awards, or other payments for each of li-
ability insurance (including self-insurance), 
workers’ compensation laws or plans, and no 
fault insurance subject to this section shall 
equal the expected average cost of collection in-
curred by the United States (including pay-
ments made to contractors) for a conditional 
payment from each of liability insurance (in-
cluding self-insurance), workers’ compensation 
laws or plans, and no fault insurance subject to 
this section for the year. The Chief Actuary 
shall include, as part of such publication for a 
year— 
‘‘(i) the expected average cost of col-
lection incurred by the United States (in-
cluding payments made to contractors) for 
a conditional payment arising from each of 
liability insurance (including self-insur-
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ance), no fault insurance, and workers’ 
compensation laws or plans; and 
‘‘(ii) a summary of the methodology 
and data used by such Chief Actuary in 
computing the threshold amount and such 
average cost of collection. 
‘‘(C) 
TREATMENT
OF
ONGOING
EX-
PENSES.—For purposes of this paragraph and 
with respect to a settlement, judgment, award, 
or other payment not otherwise addressed in 
clause (ii) of paragraph (2)(B) involving the on-
going responsibility for medical payments, such 
payment shall include only the cumulative value 
of the medical payments made and the purchase 
price of any annuity or similar instrument.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply to years beginning more than 
41⁄2 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 
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of up to $1,000 for each day of noncompliance. The 
severity of each such penalty shall be based on the 
knowing, willful, and repeated nature of the viola-
tion.’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(I) ESTABLISHMENT
OF
SAFE 
HARBORS.—Not later than 60 days 
after the date of the enactment of this 
subparagraph, the Secretary shall 
publish a notice in the Federal Reg-
ister soliciting proposals, which will be 
accepted during a 60-day period, for 
the specification of practices for which 
sanctions will not be imposed under 
subparagraph (E), including for good 
faith efforts to identify a beneficiary 
pursuant to this paragraph under an 
applicable entity responsible for re-
porting information, under which this 
paragraph will be deemed to have 
complied with the reporting require-
ments under this paragraph and will 
not be subject to such sanctions. After 
considering the proposals so sub-
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mitted, the Secretary, in consultation 
with the Attorney General, shall pub-
lish in the Federal Register, including 
a 60-day period for comment, pro-
posed specified practices for which 
such sanctions will not be imposed. 
After considering any public com-
ments received during such period, the 
Secretary shall issue final rules speci-
fying such practices.’’. 
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 
(after and below clause (ii)) the following: ‘‘Not later than 
1 year after the date of enactment of this sentence, the 
Secretary shall modify the reporting requirements under 
this paragraph so that an applicable plan in complying 
with such requirements is permitted but not required to 
access or report to the Secretary beneficiary social security 
account numbers or health identification claim numbers.’’. 
SEC. 6. STATUTE OF LIMITATIONS. 
(a) IN GENERAL.—Section 1862(b) of the Social Se-
curity Act (42 U.S.C. 1395y(b)) is amended— 
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(1) in paragraph (2)(B)(iii), by adding at the 
end the following new sentence: ‘‘An action may not 
be brought by the United States under this clause 
with respect to payment owed unless the complaint 
is filed not later than 3 years after the date of the 
receipt of notice of a settlement, judgment, award, 
or other payment made pursuant to paragraph (8) 
relating to such payment owed.’’; and 
(2) in paragraph (8)(E)(i), by adding at the 
end the following new sentence: ‘‘A civil money pen-
alty may not be imposed under this clause with re-
spect to failure to submit required information un-
less service of notice of intention to impose the pen-
alty is provided not later than 3 years after the date 
by which the information was required to be sub-
mitted.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply with respect to actions brought 
and penalties sought on or after 6 months after the date 
of the enactment of this Act. 
Æ 
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