207
carrier with a contract under section 
1842. 
‘‘(2) An eligible entity with a contract 
under section 1893. 
Such term does not include, with respect to 
activities of a specific provider of services or 
supplier an entity that has no authority under 
this title or title IX with respect to such activi-
ties and such provider of services or sup-
plier.’’. 
(2) EFFECTIVE DATE.—The amendment 
made by paragraph (1) shall take effect 
on the date of the enactment of this Act. 
SEC. 302. SMALL PROVIDER TECHNICAL ASSISTANCE DEM-
ONSTRATION PROGRAM. 
(a) ESTABLISHMENT.—
(1) IN GENERAL.—The Secretary shall 
establish a demonstration program (in 
this section referred to as the ‘‘dem-
onstration program’’) under which tech-
nical assistance described in paragraph 
(2) is made available, upon request and 
on a voluntary basis, to small providers 
of services or suppliers in order to im-
prove compliance with the applicable re-
208
quirements of the programs under medi-
care program under title XVIII of the So-
cial Security Act (including provisions of 
title XI of such Act insofar as they relate 
to such title and are not administered by 
the Office of the Inspector General of the 
Department of Health and Human Serv-
ices). 
(2) FORMS OF TECHNICAL ASSISTANCE.—
The technical assistance described in this 
paragraph is—
(A) evaluation and recommenda-
tions regarding billing and related 
systems; and 
(B) information and assistance re-
garding 
policies 
and 
procedures 
under the medicare program, includ-
ing coding and reimbursement. 
(3) SMALL PROVIDERS OF SERVICES OR 
SUPPLIERS.—In this section, the term 
‘‘small providers of services or suppliers’’ 
means—
(A) a provider of services with 
fewer than 25 full-time-equivalent em-
ployees; or
209
(B) a supplier with fewer than 10 
full-time-equivalent employees. 
(b) QUALIFICATION
OF
CONTRACTORS.—In 
conducting the demonstration program, the 
Secretary shall enter into contracts with 
qualified organizations (such as peer review 
organizations or entities described in section 
1889(g)(2) of the Social Security Act, as in-
serted by section 5(f)(1)) with appropriate ex-
pertise with billing systems of the full range 
of providers of services and suppliers to pro-
vide the technical assistance. In awarding 
such contracts, the Secretary shall consider 
any prior investigations of the entity’s work 
by the Inspector General of Department of 
Health and Human Services or the Comp-
troller General of the United States. 
(c) DESCRIPTION
OF
TECHNICAL
ASSIST-
ANCE.—The 
technical 
assistance 
provided 
under the demonstration program shall in-
clude a direct and in-person examination of 
billing systems and internal controls of small 
providers of services or suppliers to deter-
mine program compliance and to suggest
210
more efficient or effective means of achieving 
such compliance. 
(d) AVOIDANCE OF RECOVERY ACTIONS FOR 
PROBLEMS
IDENTIFIED
AS
CORRECTED.—The 
Secretary shall provide that, absent evidence 
of fraud and notwithstanding any other provi-
sion of law, any errors found in a compliance 
review for a small provider of services or sup-
plier that participates in the demonstration
program shall not be subject to recovery ac-
tion if the technical assistance personnel 
under the program determine that—
(1) the problem that is the subject of 
the compliance review has been cor-
rected to their satisfaction within 30 days 
of the date of the visit by such personnel 
to the small provider of services or sup-
plier; and 
(2) such problem remains corrected 
for such period as is appropriate. 
The previous sentence applies only to claims 
filed as part of the demonstration program 
and lasts only for the duration of such pro-
gram and only as long as the small provider
211
of services or supplier is a participant in such 
program. 
(e) GAO EVALUATION.—Not later than 2 
years after the date of the date the dem-
onstration program is first implemented, the 
Comptroller General, in consultation with the 
Inspector General of the Department of 
Health and Human Services, shall conduct an 
evaluation of the demonstration program. The 
evaluation shall include a determination of 
whether claims error rates are reduced for 
small providers of services or suppliers who 
participated in the program and the extent of 
improper payments made as a result of the 
demonstration program. The Comptroller 
General shall submit a report to the Secretary 
and the Congress on such evaluation and 
shall include in such report recommendations 
regarding the continuation or extension of 
the demonstration program. 
(f) 
FINANCIAL
PARTICIPATION
BY
PRO-
VIDERS.—The provision of technical assistance 
to a small provider of services or supplier 
under the demonstration program is condi-
tioned upon the small provider of services or
212
supplier paying an amount estimated (and 
disclosed in advance of a provider’s or sup-
plier’s participation in the program) to be 
equal to 25 percent of the cost of the technical 
assistance. 
(g) AUTHORIZATION
OF APPROPRIATIONS.—
There are authorized to be appropriated to 
the Secretary (in appropriate part from the 
Federal Hospital Insurance Trust Fund and 
the Federal Supplementary Medical Insur-
ance Trust Fund) to carry out the demonstra-
tion program— 
(1) for fiscal year 2005, $1,000,000, and 
(2) for fiscal year 2006, $6,000,000. 
SEC. 303. MEDICARE PROVIDER OMBUDSMAN; MEDICARE 
BENEFICIARY OMBUDSMAN. 
(a) MEDICARE PROVIDER OMBUDSMAN.—Sec-
tion 1868 (42 U.S.C. 1395ee) is amended—
(1) by adding at the end of the head-
ing the following: ‘‘; MEDICARE PROVIDER 
OMBUDSMAN’’; 
(2) by inserting ‘‘PRACTICING PHYSI-
CIANS ADVISORY COUNCIL.—(1)’’ after ‘‘(a)’’; 
(3) in paragraph (1), as so redesig-
nated under paragraph (2), by striking
213
‘‘in this section’’ and inserting ‘‘in this 
subsection’’; 
(4) by redesignating subsections (b) 
and (c) as paragraphs (2) and (3), respec-
tively; and 
(5) by adding at the end the following 
new subsection: 
‘‘(b) MEDICARE
PROVIDER
OMBUDSMAN.—
The Secretary shall appoint within the De-
partment of Health and Human Services a 
Medicare Provider Ombudsman. The Om-
budsman shall—
‘‘(1) provide assistance, on a confiden-
tial basis, to providers of services and 
suppliers with respect to complaints, 
grievances, and requests for information 
concerning the programs under this title 
(including provisions of title XI insofar as 
they relate to this title and are not ad-
ministered by the Office of the Inspector 
General of the Department of Health and 
Human Services) and in the resolution of 
unclear or conflicting guidance given by 
the Secretary and medicare contractors 
to such providers of services and sup-
214
pliers regarding such programs and pro-
visions and requirements under this title 
and such provisions; and 
‘‘(2) submit recommendations to the 
Secretary for improvement in the admin-
istration of this title and such provisions, 
including—
‘‘(A) recommendations to respond 
to recurring patterns of confusion in 
this title and such provisions (includ-
ing recommendations regarding sus-
pending 
imposition 
of 
sanctions 
where there is widespread confusion 
in program administration), and 
‘‘(B) recommendations to provide 
for an appropriate and consistent re-
sponse (including not providing for 
audits) in cases of self-identified over-
payments by providers of services 
and suppliers. 
The Ombudsman shall not serve as an advo-
cate for any increases in payments or new 
coverage of services, but may identify issues 
and problems in payment or coverage poli-
cies.’’.
215
(b) MEDICARE BENEFICIARY OMBUDSMAN.—
Title XVIII is amended by inserting after sec-
tion 1806 the following new section: 
‘‘MEDICARE BENEFICIARY OMBUDSMAN 
‘‘SEC. 1807. (a) IN GENERAL.—The Secretary 
shall appoint within the Department of 
Health and Human Services a Medicare Bene-
ficiary Ombudsman who shall have expertise 
and experience in the fields of health care 
and education of (and assistance to) individ-
uals entitled to benefits under this title.
‘‘(b) DUTIES.—The Medicare Beneficiary 
Ombudsman shall—
‘‘(1) receive complaints, grievances, 
and requests for information submitted 
by individuals entitled to benefits under 
part A or enrolled under part B, or both, 
with respect to any aspect of the medi-
care program; 
‘‘(2) provide assistance with respect 
to complaints, grievances, and requests 
referred to in paragraph (1), including—
‘‘(A) assistance in collecting rel-
evant information for such individ-
uals, to seek an appeal of a decision 
or determination made by a fiscal
216
intermediary, 
carrier, 
Medicare+Choice organization, or the 
Secretary; and 
‘‘(B) assistance to such individ-
uals with any problems arising from 
disenrollment 
from 
a 
Medicare+Choice plan under part C; 
and 
‘‘(3) submit annual reports to Con-
gress and the Secretary that describe the 
activities of the Office and that include 
such recommendations for improvement 
in the administration of this title as the 
Ombudsman determines appropriate. 
The Ombudsman shall not serve as an advo-
cate for any increases in payments or new 
coverage of services, but may identify issues 
and problems in payment or coverage poli-
cies. 
‘‘(c) WORKING
WITH
HEALTH
INSURANCE 
COUNSELING PROGRAMS.—To the extent pos-
sible, the Ombudsman shall work with health 
insurance counseling programs (receiving 
funding under section 4360 of Omnibus Budg-
et Reconciliation Act of 1990) to facilitate the
217
provision of information to individuals enti-
tled to benefits under part A or enrolled 
under 
part 
B, 
or 
both 
regarding 
Medicare+Choice plans and changes to those 
plans. Nothing in this subsection shall pre-
clude further collaboration between the Om-
budsman and such programs.’’. 
(c) DEADLINE FOR APPOINTMENT.—The Sec-
retary shall appoint the Medicare Provider 
Ombudsman and the Medicare Beneficiary 
Ombudsman, under the amendments made by 
subsections (a) and (b), respectively, by not 
later than 1 year after the date of the enact-
ment of this Act. 
(d) FUNDING.—There are authorized to be 
appropriated to the Secretary (in appropriate 
part from the Federal Hospital Insurance 
Trust Fund and the Federal Supplementary 
Medical Insurance Trust Fund) to carry out 
the provisions of subsection (b) of section 
1868 of the Social Security Act (relating to the 
Medicare Provider Ombudsman), as added by 
subsection (a)(5) and section 1807 of such Act 
(relating to the Medicare Beneficiary Om-
budsman), as added by subsection (b), such
218
sums as are necessary for fiscal year 2004 and 
each succeeding fiscal year. 
(e) USE OF CENTRAL, TOLL-FREE NUMBER 
(1–800–MEDICARE).—
(1) PHONE
TRIAGE
SYSTEM; LISTING
IN 
MEDICARE
HANDBOOK
INSTEAD
OF
OTHER 
TOLL-FREE NUMBERS.—Section 1804(b) (42 
U.S.C. 1395b–2(b)) is amended by adding 
at the end the following: ‘‘The Secretary 
shall provide, through the toll-free num-
ber 1–800–MEDICARE, for a means by 
which individuals seeking information 
about, or assistance with, such programs 
who phone such toll-free number are 
transferred (without charge) to appro-
priate entities for the provision of such 
information or assistance. Such toll-free 
number shall be the toll-free number list-
ed for general information and assistance 
in the annual notice under subsection (a) 
instead of the listing of numbers of indi-
vidual contractors.’’. 
(2) MONITORING ACCURACY.—
(A) STUDY.—The Comptroller Gen-
eral of the United States shall con-
219
duct a study to monitor the accuracy 
and consistency of information pro-
vided to individuals entitled to bene-
fits under part A or enrolled under 
part B, or both, through the toll-free 
number 1–800–MEDICARE, including 
an assessment of whether the infor-
mation provided is sufficient to an-
swer questions of such individuals. In 
conducting the study, the Comp-
troller General shall examine the edu-
cation and training of the individuals 
providing information through such 
number. 
(B) REPORT.—Not later than 1 
year after the date of the enactment 
of this Act, the Comptroller General 
shall submit to Congress a report on 
the study conducted under subpara-
graph (A). 
SEC. 304. BENEFICIARY OUTREACH DEMONSTRATION PRO-
GRAM. 
(a) IN GENERAL.—The Secretary shall es-
tablish a demonstration program (in this sec-
tion referred to as the ‘‘demonstration pro-