(A) in subparagraph (A), by striking
‘‘and’’ at the end;
(B) in subparagraph (B), by striking
‘‘; and’’ and inserting a comma; and
(C) by adding at the end the following new
subparagraph:
‘‘(C) that such agency or organization is
using no less than 1 percent of its funding for
education programs for eligible providers under
section 1897.’’.
(c) EFFECTIVE DATE.—The amendments made by
this section shall take effect 60 days after the date of en-
actment of this Act.
SEC. 302. ADVISORY OPINIONS.
(a) STRAIGHT ANSWERS.—Fiscal intermediaries and
carriers shall do their utmost to provide health care pro-
viders with one, straight and correct answer regarding bill-
ing and cost reporting questions under the medicare pro-
gram, and will, when requested, give their true first and
last names to providers.
(b) WRITTEN REQUESTS.—
(1) IN GENERAL.—The Secretary shall establish
a process under which a health care provider may
request, in writing from a fiscal intermediary or car-
rier, assistance in addressing questionable coverage,
billing, documentation, coding and cost reporting
procedures under the medicare program and then
the fiscal intermediary or carrier shall respond in
writing within 30 business days with the correct bill-
ing or procedural answer.
(2) USE OF WRITTEN STATEMENT.—
(A) IN
GENERAL.—Subject to subpara-
graph (B), a written statement under para-
graph (1) may be used as proof against a fu-
ture audit or overpayment under the medicare
program.
(B) EXTRAPOLATION PROHIBITION.—Sub-
ject to subparagraph (C), no claim submitted
under this section shall be subject to extrapo-
lation.
(C) LIMITATION
ON
APPLICATION.—Sub-
paragraphs (A) and (B) shall not apply to cases
of fraudulent billing.
(3) SAFE HARBOR.—If a physician requests an
advisory opinion under this subsection, neither the
fiscal intermediary, the carrier, a contractor under
section 1893 of the Social Security Act (42 U.S.C.
1395ddd), nor any law enforcement agency may
begin an investigation or target such physician based
on any claim cited in the request.
TITLE IV—SUSTAINABLE
GROWTH RATE REFORMS
SEC. 401. INCLUSION OF REGULATORY COSTS IN THE CAL-
CULATION OF THE SUSTAINABLE GROWTH
RATE.
(a) IN GENERAL.—Section 1848(f)(2) of the Social
Security Act (42 U.S.C. 1395w–4(f)(2)) is amended—
(1) by redesignating subparagraphs (A) through
(D) as clauses (i) through (iv), respectively;
(2) by striking ‘‘SPECIFICATION
OF
GROWTH
RATE.—The sustainable growth rate’’ and inserting
‘‘SPECIFICATION OF GROWTH RATE.—
‘‘(A) 
IN
GENERAL.—The 
sustainable
growth rate’’; and
(3) by adding at the end the following new sub-
paragraphs:
‘‘(B) INCLUSION
OF
SGR
REGULATORY
COSTS.—The Secretary shall include in the esti-
mate established under clause (iv)—
‘‘(i) the costs for each physicians’
service resulting from any regulation im-
plemented by the Secretary during the year
for which the sustainable growth rate is es-
timated, including those regulations that
may be implemented during such year; and
‘‘(ii) the costs described in subpara-
graph (C).
‘‘(C) INCLUSION OF OTHER REGULATORY
COSTS.—The costs described in this subpara-
graph are any per procedure costs incurred by
each physicians’ practice in complying with
each regulation promulgated by the Secretary,
regardless of whether such regulation affects
the fee schedule established under subsection
(b)(1).
‘‘(D) INCLUSION
OF
COSTS
IN
REGU-
LATORY
IMPACT
ANALYSES.—With respect to
any regulation promulgated on or after January
1, 2001, that may impose a regulatory cost de-
scribed in subparagraph (B)(i) or (C) on a phy-
sician, the Secretary shall include in the regu-
latory impact analysis accompanying such regu-
lation an estimate of any such cost.’’.
(b) EFFECTIVE DATE.—The amendments made by
subsection (a) shall apply with respect to any estimate
made by the Secretary of Health and Human Services on
or after the date of enactment of this Act.
TITLE V—STUDIES AND
REPORTS
SEC. 501. GAO AUDIT AND REPORT ON COMPLIANCE WITH
CERTAIN STATUTORY ADMINISTRATIVE PRO-
CEDURE REQUIREMENTS.
(a) AUDIT.—The Comptroller General of the United
States shall conduct an audit of the compliance of the
Health Care Financing Administration and all regulations
promulgated by the Department of Health and Human
Resources under statutes administered by the Health Care
Financing Administration with—
(1) the provisions of such statutes;
(2) subchapter II of chapter 5 of title 5, United
States Code (including section 553 of such title);
and
(3) chapter 6 of title 5, United States Code.
(b) REPORT.—Not later than 18 months after the
date of enactment of this Act, the Comptroller General
shall submit to Congress a report on the audit conducted
under subsection (a), together with such recommendations
for legislative and administrative action as the Comp-
troller General determines appropriate.
SEC. 502. GAO STUDY AND REPORT ON PROVIDER PARTICI-
PATION.
(a) STUDY.—The Comptroller General of the United
States shall conduct a study on provider participation in
the medicare program to determine whether policies or en-
forcement efforts against health care providers have re-
duced access to care for medicare beneficiaries. Such study
shall include a determination of the total cost to physician
practices of compliance with medicare laws and regula-
tions, the number of physician audits, the actual overpay-
ments assessed in consent settlements, and the attendant
projected overpayments communicated to physicians as
part of the consent settlement process.
(b) REPORT.—Not later than 18 months after the
date of enactment of this Act, the Comptroller General
shall submit to Congress a report on the study conducted
under subsection (a), together with such recommendations
for legislative and administrative action as the Comp-
troller General determines appropriate.
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