(1) the terms ‘‘health care provider’’, ‘‘health
plan’’, and ‘‘health care clearinghouse’’ have the
meaning given those terms in section 1171 of the
Social Security Act (42 U.S.C. 1320d) and section
160.103 of title 45, Code of Federal Regulations;
(2) the terms ‘‘small health plan’’ and ‘‘trans-
action’’ have the meaning given those terms in sec-
tion 160.103 of title 45, Code of Federal Regula-
tions; and
(3) the terms ‘‘health care claims or equivalent
encounter information transaction’’, ‘‘health care
payment and remittance advice transaction’’, ‘‘co-
ordination of benefits transaction’’, ‘‘health care
claim 
status 
transaction’’, 
‘‘enrollment 
and
disenrollment in a health plan transaction’’, ‘‘eligi-
bility for a health plan transaction’’, ‘‘health plan
premium payments transaction’’, and ‘‘referral cer-
tification and authorization transaction’’ have the
meanings given those terms in sections 162.1101,
162.1601, 
162.1801, 
162.1401, 
162.1501,
162.1201, 162.1701, and 162.1301 of title 45, Code
of Federal Regulations, respectively.
SEC. 2. ESTABLISHMENT OF MEDICARE ADMINISTRATIVE
FEE FOR SUBMISSION OF PAPER CLAIMS.
(a) IMPOSITION
OF
FEE.—Notwithstanding any
other provision of law, the Secretary of Health and
Human Services shall establish (in the form of a separate
fee or reduction of payment otherwise made under the
medicare program under title XVIII of the Social Security
Act) an administrative fee of $1 for the submission of a
claim in a paper or non-electronic form for items or serv-
ices for which payment is sought under such title.
(b) EXCEPTION AUTHORITY.—The Secretary—
(1) shall waive the imposition of a fee under
subsection (a) in cases in which—
(A) there is no method available for the
submission of claims other than in a written
form; or
(B) the person submitting the claim is a
small provider of services or supplier; and
(2) may waive the imposition of such a fee in
such unusual cases as the Secretary finds appro-
priate.
(c) EFFECTIVE DATE.—Subsection (a) applies to
claims submitted on or after October 16, 2003.
(d) USE OF FEES.—Amounts equivalent to the fees
collected under this section are hereby appropriated, and
shall remain available until expended, to the Secretary of
Health and Human Services for technical assistance and
enforcement activities related to subparts I through R of
part 162 of title 45, Code of Federal Regulations.
(e) DEFINITION.—For purposes of this section, the
term ‘‘small provider of services or supplier’’ means—
(1) an institutional provider of services (as de-
fined in section 1861(u) of the Social Security Act
(42 U.S.C. 1395x(u))) with fewer than 25 full-time
equivalent employees; or
(2) a physician, practitioner, or supplier with
fewer than 10 full-time equivalent employees.
SEC. 3. CLARIFICATION WITH RESPECT TO APPLICABILITY
OF ADMINISTRATIVE SIMPLIFICATION RE-
QUIREMENTS TO MEDICARE+CHOICE ORGA-
NIZATIONS.
Section 1171(5)(D) of the Social Security Act (42
U.S.C. 1320d(5)(D)) is amended by striking ‘‘Part A or
part B’’ and inserting ‘‘Parts A, B, or C’’.
SEC. 4. AUTHORIZATION OF APPROPRIATIONS FOR IMPLE-
MENTATION OF REGULATIONS.
(a) IN GENERAL.—Subject to subsection (b), and in
addition to any other amounts that may be authorized to
be appropriated, there are authorized to be appropriated
a total of $44,200,000, for—
(1) technical assistance, education and out-
reach, and enforcement activities related to subparts
I through R of part 162 of title 45, Code of Federal
Regulations; and
(2) adopting the standards required to be
adopted under section 1173 of the Social Security
Act (42 U.S.C. 1320d–2).
(b) REDUCTIONS.—
(1) MODEL FORM 14 DAYS LATE.—If the Sec-
retary fails to promulgate the model form described
in section 1(a)(4) by the date that is 14 days after
the deadline described in such section, the amount
referred to in subsection (a) shall be reduced by 25
percent.
(2) MODEL FORM 30 DAYS LATE.—If the Sec-
retary fails to promulgate the model form described
in section 1(a)(4) by the date that is 30 days after
the deadline described in such section, the amount
referred to in subsection (a) shall be reduced by 50
percent.
(3) MODEL FORM 45 DAYS LATE.—If the Sec-
retary fails to promulgate the model form described
in section 1(a)(4) by the date that is 45 days after
the deadline described in such section, the amount
referred to in subsection (a) shall be reduced by 75
percent.
(4) MODEL FORM 60 DAYS LATE.—If the Sec-
retary fails to promulgate the model form described
in section 1(a)(4) by the date that is 60 days after
the deadline described in such section, the amount
referred to in subsection (a) shall be reduced by 100
percent.
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