H. R. 1—326
Act (42 U.S.C. 1395u) in the same manner as they apply
to medicare administrative contractors under such provisions.
(d) IMPROVED PROVIDER EDUCATION AND TRAINING.—
(1) IN
GENERAL.—Section 1889, as added by subsection
(a), is amended by adding at the end the following new sub-
sections:
‘‘(b) ENHANCED EDUCATION AND TRAINING.—
‘‘(1) ADDITIONAL RESOURCES.—There are authorized to be
appropriated to the Secretary (in appropriate part from the
Federal Hospital Insurance Trust Fund and the Federal Supple-
mentary Medical Insurance Trust Fund) such sums as may
be necessary for fiscal years beginning with fiscal year 2005.
‘‘(2) USE.—The funds made available under paragraph (1)
shall be used to increase the conduct by medicare contractors
of education and training of providers of services and suppliers
regarding billing, coding, and other appropriate items and may
also be used to improve the accuracy, consistency, and timeli-
ness of contractor responses.
‘‘(c) TAILORING EDUCATION AND TRAINING ACTIVITIES FOR SMALL
PROVIDERS OR SUPPLIERS.—
‘‘(1) IN GENERAL.—Insofar as a medicare contractor con-
ducts education and training activities, it shall tailor such
activities to meet the special needs of small providers of services
or suppliers (as defined in paragraph (2)). Such education and
training activities for small providers of services and suppliers
may include the provision of technical assistance (such as
review of billing systems and internal controls to determine
program compliance and to suggest more efficient and effective
means of achieving such compliance).
‘‘(2) SMALL PROVIDER OF SERVICES OR SUPPLIER.—In this
subsection, the term ‘small provider of services or supplier’
means—
‘‘(A) a provider of services with fewer than 25 full-
time-equivalent employees; or
‘‘(B) a supplier with fewer than 10 full-time-equivalent
employees.’’.
(2) EFFECTIVE DATE.—The amendment made by paragraph
(1) shall take effect on October 1, 2004.
(e) REQUIREMENT TO MAINTAIN INTERNET WEBSITES.—
(1) IN
GENERAL.—Section 1889, as added by subsection
(a) and as amended by subsection (d), is further amended
by adding at the end the following new subsection:
‘‘(d) INTERNET WEBSITES; FAQS.—The Secretary, and each
medicare contractor insofar as it provides services (including claims
processing) for providers of services or suppliers, shall maintain
an Internet website which—
‘‘(1) provides answers in an easily accessible format to
frequently asked questions, and
‘‘(2) includes other published materials of the contractor,
that relate to providers of services and suppliers under the programs
under this title (and title XI insofar as it relates to such programs).’’.
(2) EFFECTIVE DATE.—The amendment made by paragraph
(1) shall take effect on October 1, 2004.
(f) ADDITIONAL PROVIDER EDUCATION PROVISIONS.—
(1) IN
GENERAL.—Section 1889, as added by subsection
(a) and as amended by subsections (d) and (e), is further
amended by adding at the end the following new subsections:
H. R. 1—327
‘‘(e) ENCOURAGEMENT OF PARTICIPATION IN EDUCATION PRO-
GRAM ACTIVITIES.—A medicare contractor may not use a record
of attendance at (or failure to attend) educational activities or
other information gathered during an educational program con-
ducted under this section or otherwise by the Secretary to select
or track providers of services or suppliers for the purpose of con-
ducting any type of audit or prepayment review.
‘‘(f) CONSTRUCTION.—Nothing in this section or section 1893(g)
shall be construed as providing for disclosure by a medicare
contractor—
‘‘(1) of the screens used for identifying claims that will
be subject to medical review; or
‘‘(2) of information that would compromise pending law
enforcement activities or reveal findings of law enforcement-
related audits.
‘‘(g) DEFINITIONS.—For purposes of this section, the term ‘medi-
care contractor’ includes the following:
‘‘(1) A medicare administrative contractor with a contract
under section 1874A, including a fiscal intermediary with a
contract under section 1816 and a 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 activities and
such provider of services or supplier.’’.
(2) EFFECTIVE DATE.—The amendment made by paragraph
(1) shall take effect on the date of the enactment of this Act.
SEC. 922. SMALL PROVIDER TECHNICAL ASSISTANCE DEMONSTRATION
PROGRAM.
(a) ESTABLISHMENT.—
(1) IN
GENERAL.—The Secretary shall establish a dem-
onstration program (in this section referred to as the ‘‘dem-
onstration 
program’’) 
under 
which 
technical 
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 improve compliance with the applicable
requirements of the programs under medicare program under
title XVIII of the Social 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 Services).
(2) FORMS OF TECHNICAL ASSISTANCE.—The technical assist-
ance described in this paragraph is—
(A) evaluation and recommendations regarding billing
and related systems; and
(B) information and assistance regarding policies and
procedures under the medicare program, including 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 employees; or
(B) a supplier with fewer than 10 full-time-equivalent
employees.
H. R. 1—328
(b) QUALIFICATION OF CONTRACTORS.—In conducting the dem-
onstration program, the Secretary shall enter into contracts with
qualified organizations (such as peer review organizations or enti-
ties described in section 1889(g)(2) of the Social Security Act, as
inserted by section 921(f)(1)) with appropriate expertise with billing
systems of the full range of providers of services and suppliers
to provide 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 Comptroller General of the United States.
(c) DESCRIPTION
OF TECHNICAL ASSISTANCE.—The technical
assistance provided under the demonstration program shall include
a direct and in-person examination of billing systems and internal
controls of small providers of services or suppliers to determine
program compliance and to suggest more efficient or effective means
of achieving such compliance.
(d) GAO EVALUATION.—Not later than 2 years after the date
the demonstration program is first implemented, the Comptroller
General, in consultation with the Inspector General of the Depart-
ment of Health and Human Services, shall conduct an evaluation
of the demonstration program. The evaluation shall include a deter-
mination of whether claims error rates are reduced for small pro-
viders 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 continu-
ation or extension of the demonstration program.
(e) FINANCIAL PARTICIPATION BY PROVIDERS.—The provision of
technical assistance to a small provider of services or supplier
under the demonstration program is conditioned upon the small
provider of services or supplier paying an amount estimated (and
disclosed in advance of a provider’s or supplier’s participation in
the program) to be equal to 25 percent of the cost of the technical
assistance.
(f) AUTHORIZATION OF APPROPRIATIONS.—There are authorized
to be appropriated, from amounts not otherwise appropriated in
the Treasury, such sums as may be necessary to carry out this
section.
SEC. 923. MEDICARE BENEFICIARY OMBUDSMAN.
(a) IN GENERAL.—Section 1808, as added and amended by
section 900, is amended by adding at the end the following new
subsection:
‘‘(c) MEDICARE BENEFICIARY OMBUDSMAN.—
‘‘(1) 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) individuals entitled to benefits under this title.
‘‘(2) DUTIES.—The Medicare Beneficiary Ombudsman
shall—
‘‘(A) 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 medicare program;
H. R. 1—329
‘‘(B) provide assistance with respect to complaints,
grievances, and requests referred to in subparagraph (A),
including—
‘‘(i) assistance in collecting relevant information
for such individuals, to seek an appeal of a decision
or determination made by a fiscal intermediary, car-
rier, MA organization, or the Secretary;
‘‘(ii) assistance to such individuals with any prob-
lems arising from disenrollment from an MA plan
under part C; and
‘‘(iii) assistance to such individuals in presenting
information under section 1839(i)(4)(C) (relating to
income-related premium adjustment; and
‘‘(C) submit annual reports to Congress and the Sec-
retary 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 advocate for any
increases in payments or new coverage of services, but may
identify issues and problems in payment or coverage policies.
‘‘(3) WORKING WITH HEALTH INSURANCE COUNSELING PRO-
GRAMS.—To the extent possible, the Ombudsman shall work
with health insurance counseling programs (receiving funding
under section 4360 of Omnibus Budget Reconciliation Act of
1990) to facilitate the provision of information to individuals
entitled to benefits under part A or enrolled under part B,
or both regarding MA plans and changes to those plans.
Nothing in this paragraph shall preclude further collaboration
between the Ombudsman and such programs.’’.
(b) DEADLINE FOR APPOINTMENT.—By not later than 1 year
after the date of the enactment of this Act, the Secretary shall
appoint the Medicare Beneficiary Ombudsman under section 1808(c)
of the Social Security Act, as added by subsection (a).
(c) FUNDING.—There are authorized to be appropriated to the
Secretary (in appropriate part from the Federal Hospital Insurance
Trust Fund, established under section 1817 of the Social Security
Act (42 U.S.C. 1395i), and the Federal Supplementary Medical
Insurance Trust Fund, established under section 1841 of such Act
(42 U.S.C. 1395t)) to carry out section 1808(c) of such Act (relating
to the Medicare Beneficiary Ombudsman), as added by subsection
(a), such sums as are necessary for fiscal year 2004 and each
succeeding fiscal year.
(d) USE
OF
CENTRAL, TOLL-FREE
NUMBER
(1–800–MEDI-
CARE).—
(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 fol-
lowing: ‘‘The Secretary shall provide, through the toll-free tele-
phone number 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 appropriate entities for the provision of
such information or assistance. Such toll-free number shall
be the toll-free number listed for general information and assist-
ance in the annual notice under subsection (a) instead of the
listing of numbers of individual contractors.’’.