1214
(2) improve education and training 
opportunities 
for 
administrative 
law 
judges (and their staffs); and 
(3) increase the staff of the Depart-
mental Appeals Board. 
(d) 
CONFORMING
AMENDMENT.—Section 
1869(f)(2)(A)(i) (42 U.S.C. 1395ff(f)(2)(A)(i)), as 
added by section 522(a) of BIPA (114 Stat. 
2763A–543), is amended by striking ‘‘of the So-
cial Security Administration’’. 
SEC. 932. PROCESS FOR EXPEDITED ACCESS TO REVIEW. 
(a) EXPEDITED
ACCESS
TO
JUDICIAL
RE-
VIEW.—Section 1869(b) (42 U.S.C. 1395ff(b)) as 
amended by BIPA, is amended—
(1) in paragraph (1)(A), by inserting ‘‘, 
subject to paragraph (2),’’ before ‘‘to judi-
cial review of the Secretary’s final deci-
sion’’; 
(2) in paragraph (1)(F)—
(A) by striking clause (ii); 
(B) by striking ‘‘PROCEEDING’’ and 
all that follows through ‘‘DETERMINA-
TION’’ and inserting ‘‘DETERMINATIONS 
AND RECONSIDERATIONS’’; and
1215
(C) by redesignating subclauses 
(I) and (II) as clauses (i) and (ii) and 
by moving the indentation of such 
subclauses (and the matter that fol-
lows) 2 ems to the left; and 
(3) by adding at the end the following 
new paragraph: 
‘‘(2) EXPEDITED ACCESS TO JUDICIAL RE-
VIEW.—
‘‘(A) IN
GENERAL.—The Secretary 
shall establish a process under which 
a provider of services or supplier that 
furnishes an item or service or an in-
dividual entitled to benefits under 
part A or enrolled under part B, or 
both, who has filed an appeal under 
paragraph (1) may obtain access to 
judicial review when a review panel 
(described in subparagraph (D)), on 
its own motion or at the request of 
the appellant, determines that no en-
tity in the administrative appeals 
process has the authority to decide 
the question of law or regulation rel-
evant to the matters in controversy
1216
and that there is no material issue of 
fact in dispute. The appellant may 
make such request only once with re-
spect to a question of law or regula-
tion in a case of an appeal. 
‘‘(B) PROMPT DETERMINATIONS.—If, 
after 
or 
coincident 
with 
appro-
priately filing a request for an admin-
istrative hearing, the appellant re-
quests a determination by the appro-
priate review panel that no review 
panel has the authority to decide the 
question of law or regulations rel-
evant to the matters in controversy 
and that there is no material issue of 
fact in dispute and if such request is 
accompanied by the documents and 
materials as the appropriate review 
panel shall require for purposes of 
making such determination, such re-
view panel shall make a determina-
tion on the request in writing within 
60 days after the date such review 
panel receives the request and such 
accompanying documents and mate-
1217
rials. Such a determination by such 
review panel shall be considered a 
final decision and not subject to re-
view by the Secretary. 
‘‘(C) ACCESS TO JUDICIAL REVIEW.—
‘‘(i) IN GENERAL.—If the appro-
priate review panel—
‘‘(I) determines that there 
are no material issues of fact 
in dispute and that the only 
issue is one of law or regula-
tion that no review panel has 
the authority to decide; or 
‘‘(II) fails to make such de-
termination within the period 
provided under subparagraph 
(B); 
then the appellant may bring a 
civil action as described in this 
subparagraph. 
‘‘(ii) DEADLINE
FOR
FILING.—
Such action shall be filed, in the 
case described in—
‘‘(I) clause (i)(I), within 60 
days of date of the determina-
1218
tion described in such sub-
paragraph; or 
‘‘(II) clause (i)(II), within 
60 days of the end of the pe-
riod provided under subpara-
graph (B) for the determina-
tion. 
‘‘(iii) 
VENUE.—Such 
action 
shall be brought in the district 
court of the United States for the 
judicial district in which the ap-
pellant is located (or, in the case 
of an action brought jointly by 
more than one applicant, the judi-
cial district in which the greatest 
number of applicants are located) 
or in the district court for the 
District of Columbia. 
‘‘(iv) INTEREST ON AMOUNTS IN 
CONTROVERSY.—Where a provider 
of services or supplier seeks judi-
cial review pursuant to this para-
graph, the amount in controversy 
shall be subject to annual interest 
beginning on the first day of the
1219
first month beginning after the 
60-day period as determined pur-
suant to clause (ii) and equal to 
the rate of interest on obligations 
issued for purchase by the Fed-
eral 
Hospital 
Insurance 
Trust 
Fund and by the Federal Supple-
mentary Medical Insurance Trust 
Fund for the month in which the 
civil action authorized under this 
paragraph is commenced, to be 
awarded by the reviewing court 
in favor of the prevailing party. 
No interest awarded pursuant to 
the preceding sentence shall be 
deemed income or cost for the 
purposes of determining reim-
bursement due providers of serv-
ices or suppliers under this Act. 
‘‘(D) REVIEW
PANELS.—For pur-
poses of this subsection, a ‘review 
panel’ is a panel consisting of 3 mem-
bers (who shall be administrative law 
judges, members of the Departmental 
Appeals Board, or qualified individ-
1220
uals associated with a qualified inde-
pendent contractor (as defined in 
subsection (c)(2)) or with another 
independent entity) designated by the 
Secretary for purposes of making de-
terminations under this paragraph.’’. 
(b) APPLICATION TO PROVIDER AGREEMENT 
DETERMINATIONS.—Section 
1866(h)(1) 
(42 
U.S.C. 1395cc(h)(1)) is amended—
(1) by inserting ‘‘(A)’’ after ‘‘(h)(1)’’; 
and 
(2) by adding at the end the following 
new subparagraph: 
‘‘(B) An institution or agency described in 
subparagraph (A) that has filed for a hearing 
under subparagraph (A) shall have expedited 
access to judicial review under this subpara-
graph in the same manner as providers of 
services, suppliers, and individuals entitled to 
benefits under part A or enrolled under part 
B, or both, may obtain expedited access to ju-
dicial review under the process established 
under section 1869(b)(2). Nothing in this sub-
paragraph shall be construed to affect the ap-
plication of any remedy imposed under sec-
1221
tion 1819 during the pendency of an appeal 
under this subparagraph.’’. 
(c) EFFECTIVE
DATE.—The amendments 
made by this section shall apply to appeals 
filed on or after October 1, 2004. 
(d) EXPEDITED REVIEW
OF CERTAIN PRO-
VIDER AGREEMENT DETERMINATIONS.—
(1) TERMINATION
AND
CERTAIN
OTHER 
IMMEDIATE REMEDIES.—The Secretary shall 
develop and implement a process to expe-
dite proceedings under sections 1866(h) 
of the Social Security Act (42 U.S.C. 
1395cc(h)) in which the remedy of termi-
nation of participation, or a remedy de-
scribed in clause (i) or (iii) of section 
1819(h)(2)(B) of such Act (42 U.S.C. 1395i–
3(h)(2)(B)) which is applied on an imme-
diate basis, has been imposed. Under 
such process priority shall be provided in 
cases of termination. 
(2) INCREASED FINANCIAL SUPPORT.—In 
addition to any amounts otherwise ap-
propriated, to reduce by 50 percent the 
average time for administrative deter-
minations 
on 
appeals 
under 
section
1222
1866(h) of the Social Security Act (42 
U.S.C. 1395cc(h)), there are authorized to 
be appropriated (in appropriate part 
from the Federal Hospital Insurance 
Trust Fund and the Federal Supple-
mentary Medical Insurance Trust Fund) 
to the Secretary such additional sums for 
fiscal year 2005 and each subsequent fis-
cal year as may be necessary. The pur-
poses for which such amounts are avail-
able include increasing the number of ad-
ministrative law judges (and their staffs) 
and the appellate level staff at the De-
partmental Appeals Board of the Depart-
ment of Health and Human Services and 
educating such judges and staffs on long-
term care issues. 
SEC. 933. REVISIONS TO MEDICARE APPEALS PROCESS. 
(a) REQUIRING FULL
AND EARLY PRESEN-
TATION OF EVIDENCE.—
(1) IN
GENERAL.—Section 1869(b) (42 
U.S.C. 1395ff(b)), as amended by BIPA 
and as amended by section 932(a), is fur-
ther amended by adding at the end the 
following new paragraph:
1223
‘‘(3) REQUIRING FULL AND EARLY PRES-
ENTATION
OF
EVIDENCE
BY
PROVIDERS.—A 
provider of services or supplier may not 
introduce evidence in any appeal under 
this section that was not presented at the 
reconsideration conducted by the quali-
fied independent contractor under sub-
section (c), unless there is good cause 
which precluded the introduction of such 
evidence at or before that reconsider-
ation.’’. 
(2) EFFECTIVE DATE.—The amendment 
made by paragraph (1) shall take effect 
on October 1, 2004. 
(b) USE OF PATIENTS’ MEDICAL RECORDS.—
Section 
1869(c)(3)(B)(i) 
(42 
U.S.C. 
1395ff(c)(3)(B)(i)), as amended by BIPA, is 
amended by inserting ‘‘(including the medical 
records of the individual involved)’’ after 
‘‘clinical experience’’. 
(c) NOTICE REQUIREMENTS FOR MEDICARE 
APPEALS.— 
(1) INITIAL DETERMINATIONS AND REDE-
TERMINATIONS.—Section 1869(a) (42 U.S.C. 
1395ff(a)), as amended by BIPA, is amend-
1224
ed by adding at the end the following 
new paragraphs: 
‘‘(4) REQUIREMENTS OF NOTICE OF DE-
TERMINATIONS.—With respect to an initial 
determination insofar as it results in a 
denial of a claim for benefits—
‘‘(A) the written notice on the de-
termination shall include—
‘‘(i) the reasons for the deter-
mination, including whether a 
local medical review policy or a 
local coverage determination was 
used; 
‘‘(ii) the procedures for ob-
taining 
additional 
information 
concerning the determination, in-
cluding the information described 
in subparagraph (B); and 
‘‘(iii) notification of the right 
to seek a redetermination or oth-
erwise appeal the determination 
and instructions on how to ini-
tiate 
such 
a 
redetermination 
under this section; and
1225
‘‘(B) the person provided such no-
tice may obtain, upon request, the 
specific provision of the policy, man-
ual, or regulation used in making the 
determination. 
‘‘(5) REQUIREMENTS OF NOTICE OF REDE-
TERMINATIONS.—With respect to a redeter-
mination insofar as it results in a denial 
of a claim for benefits—
‘‘(A) the written notice on the re-
determination shall include—
‘‘(i) the specific reasons for 
the redetermination; 
‘‘(ii) as appropriate, a sum-
mary of the clinical or scientific 
evidence used in making the rede-
termination; 
‘‘(iii) a description of the pro-
cedures for obtaining additional 
information concerning the rede-
termination; and 
‘‘(iv) notification of the right 
to appeal the redetermination 
and instructions on how to ini-
1226
tiate such an appeal under this 
section; 
‘‘(B) such written notice shall be 
provided in printed form and written 
in a manner calculated to be under-
stood by the individual entitled to 
benefits under part A or enrolled 
under part B, or both; and 
‘‘(C) the person provided such no-
tice may obtain, upon request, infor-
mation on the specific provision of 
the policy, manual, or regulation used 
in making the redetermination.’’. 
(2) 
RECONSIDERATIONS.—Section 
1869(c)(3)(E) (42 U.S.C. 1395ff(c)(3)(E)), as 
amended by BIPA, is amended—
(A) by inserting ‘‘be written in a 
manner calculated to be understood 
by the individual entitled to benefits 
under part A or enrolled under part 
B, or both, and shall include (to the 
extent appropriate)’’ after ‘‘in writing, 
’’; and 
(B) by inserting ‘‘and a notifica-
tion of the right to appeal such deter-
1227
mination and instructions on how to 
initiate such appeal under this sec-
tion’’ after ‘‘such decision,’’. 
(3) 
APPEALS.—Section 
1869(d) 
(42 
U.S.C. 1395ff(d)), as amended by BIPA, is 
amended—
(A) in the heading, by inserting ‘‘; 
NOTICE’’ after ‘‘SECRETARY’’; and 
(B) by adding at the end the fol-
lowing new paragraph: 
‘‘(4) NOTICE.—Notice of the decision of 
an administrative law judge shall be in 
writing in a manner calculated to be un-
derstood by the individual entitled to 
benefits under part A or enrolled under 
part B, or both, and shall include—
‘‘(A) the specific reasons for the 
determination (including, to the ex-
tent appropriate, a summary of the 
clinical or scientific evidence used in 
making the determination); 
‘‘(B) the procedures for obtaining 
additional 
information 
concerning 
the decision; and
1228
‘‘(C) notification of the right to 
appeal the decision and instructions 
on how to initiate such an appeal 
under this section.’’. 
(4) SUBMISSION
OF
RECORD
FOR
AP-
PEAL.—Section 1869(c)(3)(J)(i) (42 U.S.C. 
1395ff(c)(3)(J)(i)) by striking ‘‘prepare’’ 
and inserting ‘‘submit’’ and by striking 
‘‘with respect to’’ and all that follows 
through ‘‘and relevant policies’’. 
(d) 
QUALIFIED
INDEPENDENT
CONTRAC-
TORS.—
(1) 
ELIGIBILITY
REQUIREMENTS
OF 
QUALIFIED
INDEPENDENT
CONTRACTORS.—
Section 1869(c)(3) (42 U.S.C. 1395ff(c)(3)), 
as amended by BIPA, is amended—
(A) in subparagraph (A), by strik-
ing ‘‘sufficient training and expertise 
in medical science and legal matters’’ 
and 
inserting 
‘‘sufficient 
medical, 
legal, and other expertise (including 
knowledge of the program under this 
title) and sufficient staffing’’; and 
(B) by adding at the end the fol-
lowing new subparagraph:
1229
‘‘(K) 
INDEPENDENCE
REQUIRE-
MENTS.—
‘‘(i) IN
GENERAL.—Subject to 
clause 
(ii), 
a 
qualified 
inde-
pendent contractor shall not con-
duct any activities in a case un-
less the entity—
‘‘(I) is not a related party 
(as 
defined 
in 
subsection 
(g)(5)); 
‘‘(II) does not have a mate-
rial familial, financial, or pro-
fessional 
relationship 
with 
such a party in relation to 
such case; and 
‘‘(III) does not otherwise 
have a conflict of interest 
with such a party. 
‘‘(ii) EXCEPTION
FOR
REASON-
ABLE
COMPENSATION.—Nothing in 
clause (i) shall be construed to 
prohibit receipt by a qualified 
independent contractor of com-
pensation from the Secretary for 
the conduct of activities under