I
107TH CONGRESS
1ST SESSION
H. R. 3046
To amend title XVIII of the Social Security Act to provide regulatory relief,
appeals process reforms, contracting flexibility, and education improve-
ments under the Medicare Program, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
OCTOBER 4, 2001
Mr. TOOMEY (for himself, Ms. BERKLEY, Mr. BILIRAKIS, Mr. BROWN of Ohio,
Mr. TAUZIN, Mr. DINGELL, Mr. NORWOOD, Mr. HALL of Texas, Mr.
GREENWOOD, Mr. PALLONE, Mr. UPTON, Mrs. CAPPS, Mr. BURR of
North Carolina, Mr. STRICKLAND, Mr. BUYER, Mr. WAXMAN, Mr. DEAL
of Georgia, Mr. BARRETT of Wisconsin, Mr. WHITFIELD, Mr. STUPAK,
Mr. BRYANT, Mr. TOWNS, Mr. PICKERING, Mr. DEUTSCH, Mr. EHRLICH,
Mr. WYNN, Mr. BARTON of Texas, Mr. GREEN of Texas, Mr. BAKER,
and Mr. COOKSEY) introduced the following bill; which was referred to
the Committee on Ways and Means, and in addition to the Committee
on Energy and Commerce, for a period of time to be subsequently deter-
mined by the Speaker, in each case for consideration of such provisions
as fall within the jurisdiction of the committee concerned
A BILL
To amend title XVIII of the Social Security Act to provide
regulatory relief, appeals process reforms, contracting
flexibility, and education improvements under the Medi-
care Program, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; AMENDMENTS TO SOCIAL SECU-
RITY ACT; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Medicare Regulatory, Appeals, Contracting, and Edu-
cation Reform Act of 2001’’.
(b) AMENDMENTS TO SOCIAL SECURITY ACT.—Ex-
cept as otherwise specifically provided, whenever in this
Act an amendment is expressed in terms of an amendment
to or repeal of a section or other provision, the reference
shall be considered to be made to that section or other
provision of the Social Security Act.
(c) BIPA.—In this Act, the term ‘‘BIPA’’ means the
Medicare, Medicaid, and SCHIP Benefits Improvement
and Protection Act of 2000, as enacted into law by section
1(a)(6) of Public Law 106–554.
(d) TABLE OF CONTENTS.—The table of contents of
this Act is as follows:
Sec. 1. Short title; amendments to Social Security Act; table of contents.
Sec. 2. Findings.
Sec. 3. Construction.
TITLE I—REGULATORY REFORM
Sec. 101. Issuance of regulations.
Sec. 102. Compliance with changes in regulations and policies.
Sec. 103. Report on regulatory burdens.
Sec. 104. Report on the sustainable growth rate and regulatory costs.
TITLE II—APPEALS PROCESS REFORM
Sec. 201. Transfer of responsibility for medicare appeals.
Sec. 202. Expedited access to judicial review.
Sec. 203. Expedited review of certain provider agreement determinations.
Sec. 204. Revisions to medicare appeals process.
Sec. 205. Hearing rights related to decisions by the Secretary to deny or not
renew a medicare enrollment agreement; consultation before
changing provider enrollment forms.
Sec. 206. Appeals by providers when there is no other party available.
TITLE III—CONTRACTING REFORM
Sec. 301. Increased flexibility in medicare administration.
Sec. 302. Requirements for information security.
TITLE IV—EDUCATION AND OUTREACH IMPROVEMENTS
Sec. 401. Provider education and technical assistance.
Sec. 402. Access to and prompt responses from medicare administrative con-
tractors.
Sec. 403. Reliance on guidance.
Sec. 404. Facilitation of consistent information to providers.
Sec. 405. Policy development regarding evaluation and management (E & M)
documentation guidelines.
Sec. 406. Beneficiary outreach demonstration program.
TITLE V—REVIEW, RECOVERY, AND ENFORCEMENT REFORM
Sec. 501. Prepayment review.
Sec. 502. Recovery of overpayments.
Sec. 503. Process for correction of incomplete or missing data without pursuing
appeals process.
Sec. 504. Authority to waive a program exclusion.
SEC. 2. FINDINGS.
Congress finds the following:
(1) The overwhelming majority of providers of
services, physicians, practitioners, and suppliers in
the United States are law-abiding persons who pro-
vide important health care services to patients each
day.
(2) The Secretary of Health and Human Serv-
ices should work to streamline paperwork require-
ments under the medicare program and commu-
nicate clearer instructions to providers of services,
physicians, practitioners, and suppliers so that they
may spend more time caring for patients.
SEC. 3. CONSTRUCTION.
(a) NO EFFECT ON LEGAL AUTHORITY.—Nothing in
this Act shall be construed to compromise or affect exist-
ing legal authority for addressing fraud or abuse, whether
it be criminal prosecution, civil enforcement, or adminis-
trative remedies, including under sections 3729 through
3733 of title 31, United States Code (known as the False
Claims Act).
(b) NO EFFECT ON MEDICARE WASTE, FRAUD, AND
ABUSE EFFORTS.—Nothing in this Act shall be construed
to prevent or impede the Department of Health and
Human Services in any way from its ongoing efforts to
eliminate waste, fraud, and abuse in the medicare pro-
gram.
(c) CLARIFICATION RELATED TO MEDICARE TRUST
FUNDS.—The consolidation of medicare administrative
contracting set forth in this Act does not constitute (or
reflect any position on the issue of) consolidation of the
Federal Hospital Insurance Trust Fund and the Federal
Supplementary Medical Insurance Trust Fund.
TITLE I—REGULATORY REFORM
SEC. 101. ISSUANCE OF REGULATIONS.
(a) CONSOLIDATION OF PROMULGATION TO ONCE A
MONTH.—
(1) IN
GENERAL.—Section 1871 (42 U.S.C.
1395hh) is amended by adding at the end the fol-
lowing new subsection:
‘‘(d)(1) Subject to paragraph (2), the Secretary shall
issue proposed or final (including interim final) regula-
tions to carry out this title only on one business day of
every month.
‘‘(2) The Secretary may issue a proposed or final reg-
ulation described in paragraph (1) on any other day than
the day described in paragraph (1) if the Secretary—
‘‘(A) finds that issuance of such regulation on
another day is necessary to comply with require-
ments under law; or
‘‘(B) finds that with respect to that regulation
the limitation of issuance on the date described in
paragraph (1) is contrary to the public interest.
If the Secretary makes a finding under this paragraph,
the Secretary shall include such finding, and brief state-
ment of the reasons for such finding, in the issuance of
such regulation.’’.
(2) REPORT ON PUBLICATION OF REGULATIONS
ON A QUARTERLY BASIS.—Not later than 3 years
after the date of the enactment of this Act, the Sec-
retary of Health and Human Services (in this Act
referred to as the ‘‘Secretary’’) shall submit to Con-
gress a report on the feasibility of requiring that
regulations described in section 1871(d) of the So-
cial Security Act only be promulgated on a single
day every calendar quarter.
(3) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply to regulations promul-
gated on or after the date that is 30 days after the
date of the enactment of this Act.
(b) REGULAR
TIMELINE
FOR
PUBLICATION
OF
FINAL REGULATIONS.—
(1) IN GENERAL.—Section 1871(a) (42 U.S.C.
1395hh(a)) is amended by adding at the end the fol-
lowing new paragraph:
‘‘(3)(A) The Secretary, in consultation with the Di-
rector of the Office of Management and Budget, shall es-
tablish a regular timeline for the publication of final regu-
lations based on the previous publication of a proposed
regulation or an interim final regulation.
‘‘(B) With respect to publication of final regulations
based on the previous publication of a proposed regulation,
such timeline may vary among different regulations based
on differences in the complexity of the regulation, the
number and scope of comments received, and other rel-
evant factors.
‘‘(C)(i) With respect to the publication of final regu-
lations based on the previous publication of an interim
final regulation—
‘‘(I) subject to clause (ii), the Secretary shall
publish the final regulation within the 12-month pe-
riod that begins on the date of publication of the in-
terim final regulation;
‘‘(II) if a final regulation is not published by
the deadline established under this subparagraph,
the interim final regulation shall not continue in ef-
fect unless the Secretary publishes a notice described
in clause (ii) by such deadline; and
‘‘(III) the final regulation shall include re-
sponses to comments submitted in response to the
interim final regulation.
‘‘(ii) If the Secretary determines before the deadline
otherwise established in this subparagraph that there is
good cause, specified in a notice published before such
deadline, for delaying the deadline otherwise applicable
under this subparagraph, the deadline otherwise estab-
lished under this subparagraph shall be extended for such
period as the Secretary specifies in such notice.’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall take effect on the date of the
enactment of this Act. The Secretary of Health and
Human Services shall provide for an appropriate
transition to take into account the backlog of pre-
viously published interim final regulations.
(c) LIMITATIONS ON NEW MATTER IN FINAL REGU-
LATIONS.—
(1) IN GENERAL.—Section 1871(a) (42 U.S.C.
1395hh(a)), as amended by subsection (b), is further
amended by adding at the end the following new
paragraph:
‘‘(4) Insofar as a final regulation (other than
an interim final regulation) includes a provision that
is not a logical outgrowth of the relevant notice of
proposed rulemaking relating to such regulation,
that provision shall be treated as a proposed regula-
tion and shall not take effect until there is the fur-
ther opportunity for public comment and a publica-
tion of the provision again as a final regulation.’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply to final regulations
published on or after the date of the enactment of
this Act.
SEC. 102. COMPLIANCE WITH CHANGES IN REGULATIONS
AND POLICIES.
(a) NO
RETROACTIVE
APPLICATION
OF
SUB-
STANTIVE CHANGES.—
(1) IN
GENERAL.—Section 1871 (42 U.S.C.
1395hh), as amended by section 101(a), is amended
by adding at the end the following new subsection:
‘‘(e)(1)(A) A substantive change in regulations, man-
ual instructions, interpretative rules, statements of policy,
or guidelines of general applicability under this title shall
not be applied (by extrapolation or otherwise) retroactively
to items and services furnished before the effective date
of the change, unless the Secretary determines that—
‘‘(i) such retroactive application is necessary to
comply with statutory requirements; or
‘‘(ii) failure to apply the change retroactively
would be contrary to the public interest.’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply to substantive changes
issued on or after the date of the enactment of this
Act.
(b) TIMELINE FOR COMPLIANCE WITH SUBSTANTIVE
CHANGES AFTER NOTICE.—
(1) IN
GENERAL.—Section 1871(e)(1), as
added by subsection (a), is further amended by add-
ing at the end the following:
‘‘(B) A compliance action may be made against a pro-
vider of services, physician, practitioner, or other supplier
with respect to noncompliance with such a substantive
change only for items and services furnished on or after
the effective date of the change.
‘‘(C)(i) Except as provided in clause (ii), a sub-
stantive change may not take effect until not earlier than
the date that is the end of the 30-day period that begins
on the date that the Secretary has issued or published,
as the case may be, the substantive change.
‘‘(ii) The Secretary may provide for a substantive
change to take effect on a date the precedes the end of
the 30-day period under clause (i) if the Secretary finds
that waiver of such 30-day period is necessary to comply
with statutory requirements or that the application of such
30-day period is contrary to the public interest. If the Sec-
retary provides for an earlier effective date pursuant to
this clause, the Secretary shall include in the issuance or
publication of the substantive change a finding described
in the first sentence, and a brief statement of the reasons
for such finding.’’.
(2) EFFECTIVE DATE.—The amendment made
by paragraph (1) shall apply to compliance actions
undertaken on or after the date of the enactment of
this Act.
SEC. 103. REPORT ON REGULATORY BURDENS.
Section 1871 (42 U.S.C. 1395hh), as amended by
sections 101(a) and 102, is amended by adding at the end
the following new subsection:
‘‘(f)(1) Not later than 2 years after the date of the
enactment of this subsection, and every 2 years thereafter,
the Secretary shall submit to Congress a report with re-
spect to the administration of this title and areas of incon-
sistency or conflict among the various provisions under
law and regulation.
‘‘(2) In preparing a report under paragraph (1), the
Secretary shall collect—
‘‘(A) information from beneficiaries, providers
of services, physicians, practitioners, and other sup-
pliers, and from the individual under section 404 of
the Medicare Regulatory, Appeals, Contracting, and
Education Reform Act of 2001 with respect to such
areas of inconsistency and conflict; and
‘‘(B) information from medicare contractors
that tracks the nature of written and telephones in-
quiries.
‘‘(3) A report under paragraph (1) shall include a de-
scription of efforts by the Secretary to reduce such incon-
sistency or conflicts, and recommendations for legislation
or administrative action that the Secretary determines ap-
propriate to further reduce such inconsistency or con-
flicts.’’.
SEC. 104. REPORT ON THE SUSTAINABLE GROWTH RATE
AND REGULATORY COSTS.
Not later than 18 months after the date of the enact-
ment of this Act, the Comptroller General of the United
States shall submit to Congress a report on the accuracy
of the sustainable growth rate (under section 1848(f) of
the Social Security Act, 42 U.S.C. 1395w–4(f)) in ac-
counting for regulatory costs.
TITLE II—APPEALS PROCESS
REFORM
SEC. 201. TRANSFER OF RESPONSIBILITY FOR MEDICARE
APPEALS.
(a) DESIGNATION OF MEDICARE-ONLY ADMINISTRA-
TIVE LAW JUDGES.—The Commissioner of Social Security
shall designate, not later than 60 days after the date of
the enactment of this Act, certain administrative law
judges of the Social Security Administration whose duties
to hear and decide appeals shall be limited to those ap-
peals arising under title XVIII of the Social Security Act,
including under section 1869 of such Act (as amended by
section 521 of BIPA, 114 Stat. 2763A–534). The Com-
missioner shall only provide for the assignment of such
appeals to the judges so designated.
(b) MEDICARE-SPECIFIC TRAINING.—Not later than
60 days after the date on which the Commissioner of So-
cial Security designates administrative law judges under
subsection (a), the Secretary of Health and Human Serv-
ices shall provide for appropriate education and training
of those judges with respect to appeals under the medicare
program. Such education and training shall be furnished
not less frequently than annually, and shall be updated
as the Secretary determines appropriate.
(c) TRANSITION PLAN.—
(1) IN GENERAL.—Not later than October 1,
2002, the Commissioner of Social Security and the
Secretary of Health and Human Services shall de-
velop and transmit to Congress a plan under which
administrative law judges responsible solely for hear-
ing appeals described in subsection (a)(1) are trans-
ferred from the responsibility of the Commissioner
and the Social Security Administration to the Sec-
retary and the Department of Health and Human
Services.
(2) CONTENTS.—The plan shall include infor-
mation on the following:
(A) WORKLOAD.—The number of such ad-
ministrative law judges and support staff re-
quired now and in the future to hear and decide
such cases in a timely manner, taking into ac-
count the current and anticipated claims vol-
ume, appeals, number of beneficiaries, and stat-
utory changes.
(B) COST PROJECTIONS.—Funding levels
required for fiscal year 2004 and subsequent
fiscal years under this subsection to hear such
cases in a timely manner.
(C) TRANSITION TIMETABLE.—A timetable
for the transition.
(D) REGULATIONS.—The establishment of
specific regulations to govern the appeals proc-
ess.
(E) CASE TRACKING.—The development of
a unified case tracking system that will facili-
tate the maintenance and transfer of case spe-
cific data across both the fee-for-service and
managed care components of the medicare pro-
gram.
(F) FEASIBILITY OF PRECEDENTIAL AU-
THORITY.—The feasibility of developing a proc-
ess to give decisions of the Departmental Ap-
peals Board in the Department of Health and
Human Services addressing broad legal issues
binding, precedential authority.
(G) ACCESS
TO
ADMINISTRATIVE
LAW
JUDGES.—The feasibility of filing appeals with
administrative law judges electronically, and the
feasibility of conducting hearings using tele- or
video-conference technologies.
(3) ADDITIONAL INFORMATION.—The plan may
also include recommendations for further Congres-
sional action, including modifications to the require-
ments and deadlines established under section 1869
of the Social Security Act (as amended by sections
521 and 522 of BIPA, 114 Stat. 2763A–534).
(d) TRANSFER OF ADJUDICATION AUTHORITY.—
(1) IN GENERAL.—Not later than October 1,
2003, the Commissioner of Social Security and the
Secretary shall provide for the transfer of responsi-
bility for the administrative law judges designated
under subsection (a) (and responsibilities of such
judges) from the Social Security Administration to
the Secretary of Health and Human Services.
(2) ASSURING INDEPENDENCE OF JUDGES.—
The Secretary shall effect such transfer in a manner
that assures the independence of such judges from
the Centers for Medicare & Medicaid Services and
its contractors.
(3) GEOGRAPHIC
DISTRIBUTION.—The Sec-
retary shall provide for an appropriate geographic
distribution of such judges throughout the United
States to ensure timely access to such judges.
(4) 
HIRING
AUTHORITY.—Subject 
to 
the
amounts provided in advance in appropriations Act,
the Secretary shall have authority to hire additional
administrative law judges to hear such cases, giving
priority to those judges with prior experience in han-
dling medicare appeals and in a manner consistent
with paragraph (3), and to hire support staff for
such judges.
(5) FINANCING.—Amounts payable under law
to the Commissioner for such judges from the Fed-
eral Hospital Insurance Trust Fund and the Federal
Supplementary Medical Insurance Trust Fund shall
become payable to the Secretary for the judges so
transferred.
(6) SHARED
OFFICE
SPACE.—The Secretary
shall enter into such arrangements with the Com-
missioner as may be appropriate for transferred ad-
ministrative law judges to share office space, sup-
port staff, and other resources, with appropriate re-
imbursement from the Trust Funds described in
paragraph (5).
(e) INCREASED FINANCIAL SUPPORT.—In addition to
any amounts otherwise appropriated, to ensure timely ac-
tion on appeals before administrative law judges consistent
with section 1869 of the Social Security Act (as amended
by section 521 of BIPA, 114 Stat. 2763A–534), there are
authorized to be appropriated (in appropriate part from
the Federal Hospital Insurance Trust Fund and the Fed-
eral Supplementary Medical Insurance Trust Fund) to the
Secretary to increase the number of administrative law
judges (and their staffs) under subsection (d)(4) and to
improve education and training opportunities for adminis-
trative law judges (and their staffs), such sums as are nec-
essary for fiscal year 2003 and each subsequent fiscal
year.
SEC. 202. EXPEDITED ACCESS TO JUDICIAL REVIEW.
(a) IN
GENERAL.—Section 1869(b) (42 U.S.C.
1395ff(b)), as amended by section 521 of BIPA, 114 Stat.
2763A–534, is amended—
(1) in paragraph (1)(A), by inserting ‘‘, subject
to paragraph (2),’’ before ‘‘to judicial review of the
Secretary’s final decision’’; and
(2) 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
service or supplier that furnishes an item or
service or a beneficiary who has filed an appeal
under paragraph (1) (other than an appeal filed
under paragraph (1)(F)) 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
the Departmental Appeals Board does not have
the authority to decide the question of law or
regulation relevant to the matters in con-
troversy and that there is no material issue of
fact in dispute. The appellant may make such
request only once with respect to a question of
law or regulation for a specific matter in dis-
pute in a case of an appeal.
‘‘(B) PROMPT DETERMINATIONS.—If, after
or coincident with appropriately filing a request
for an administrative hearing, the appellant re-
quests a determination by the appropriate re-
view panel that the Departmental Appeals
Board does not have the authority to decide the
question of law or regulations relevant to the
matters in controversy and that there is no ma-
terial issue of fact in dispute and if such re-
quest is accompanied by the documents and
materials as the appropriate review panel shall
require for purposes of making such determina-
tion, such review panel shall make a determina-
tion on the request in writing within 60 days
after the date such review panel receives the re-
quest and such accompanying documents and
materials. Such a determination by such review
panel shall be considered a final decision and
not subject to review by the Secretary.
‘‘(C) ACCESS TO JUDICIAL REVIEW.—
‘‘(i) IN GENERAL.—If the appropriate
review panel—
‘‘(I) determines that there are no
material issues of fact in dispute and
that the only issue is one of law or
regulation that the Departmental Ap-
peals Board does not have authority
to decide; or
‘‘(II) fails to make such deter-
mination 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 determination described
in such subparagraph; or
‘‘(II) clause (i)(II), within 60
days of the end of the period provided
under subparagraph (B) for the deter-
mination.
‘‘(iii) VENUE.—Such action shall be
brought in the district court of the United
States for the judicial district in which the
appellant is located (or, in the case of an
action brought jointly by more than one
applicant, the judicial district in which the
greatest number of applicants are located)
or in the district court for the District of
Columbia.
‘‘(iv) INTEREST ON ANY AMOUNTS IN
CONTROVERSY.—Where a provider of serv-
ices or supplier seeks judicial review pursu-
ant to this paragraph, the amount in con-
troversy (if any) shall be subject to annual
interest beginning on the first day of the
first month beginning after the 60-day pe-
riod as determined pursuant to clause (ii)
and equal to the rate of interest on obliga-
tions issued for purchase by the Federal
Supplementary Medical Insurance Trust
Fund for the month in which the civil ac-
tion authorized under this paragraph is
commenced, to be awarded by the review-
ing court in favor of the prevailing party.
No interest awarded pursuant to the pre-
ceding sentence shall be deemed income or
cost for the purposes of determining reim-
bursement due providers of services, physi-
cians, practitioners, and other suppliers
under this Act.
‘‘(D) REVIEW PANEL DEFINED.—For pur-
poses of this subsection, a ‘review panel’ is a
panel of 3 members from the Departmental Ap-
peals Board, selected for the purpose of making
determinations under this paragraph.’’.
(b) APPLICATION TO PROVIDER AGREEMENT DETER-
MINATIONS.—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 sub-
paragraph:
‘‘(B) An institution or agency described in subpara-
graph (A) that has filed for a hearing under subparagraph
(A) shall have expedited access to judicial review under
this subparagraph in the same manner as providers of
services, suppliers, and beneficiaries may obtain expedited
access to judicial review under the process established
under section 1869(b)(2). Nothing in this subparagraph
shall be construed to affect the application of any remedy
imposed under section 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, 2003.
SEC. 203. EXPEDITED REVIEW OF CERTAIN PROVIDER
AGREEMENT DETERMINATIONS.
(a) TERMINATION
AND IMMEDIATE SANCTIONS.—
The Secretary shall develop and implement a process to
expedite proceedings under sections 1866(h) of the Social
Security Act (42 U.S.C. 1395cc(h)) in which the sanction
of termination of participation or a sanction described in
clause (i) or (iii) of section 1819(h)(2)(B) of such Act (42
U.S.C. 1395i–3(h)(2)(B)) has been imposed. Under such
process priority shall be provided in cases of termination.
(b) INCREASED FINANCIAL SUPPORT.—In addition
to any amounts otherwise appropriated, to reduce by 50
percent the average time for administrative determina-
tions on appeals under section 1866(h) of the Social Secu-
rity 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 such sums for fiscal year 2003 and
each subsequent fiscal year as may be necessary to in-
crease the number of administrative law judges (and their
staffs) at the Departmental Appeals Board of the Depart-
ment of Health and Human Services and to educate such
judges and staff on long-term care issues.
SEC. 204. REVISIONS TO MEDICARE APPEALS PROCESS.
(a) TIMEFRAMES FOR THE COMPLETION OF THE
RECORD.—Section 1869(b) (42 U.S.C. 1395ff(b)), as
amended by section 521 of BIPA, 114 Stat. 2763A–534,
and as amended in section 202(a), is further amended by
adding at the end the following new paragraph:
‘‘(3) TIMELY SUBMISSION OF EVIDENCE.—
‘‘(A) DEADLINE FOR SUBMISSION OF EVI-
DENCE.—The deadline to complete the record
in an appeal is 90 days after the date the re-
quest for appeal is filed. The appellant in such
enactment of this Act, the Secretary of Health and
Human Services shall submit to the appropriate commit-
tees of Congress a legislative proposal providing for such
technical and conforming amendments in the law as are
required by the provisions of this section.
(g) REPORTS ON IMPLEMENTATION.—
(1) PROPOSAL
FOR
IMPLEMENTATION.—The
Secretary shall submit a report to Congress not later
than one year after the date of the enactment of this
Act that describes the Secretary’s plan for imple-
mentation of the amendments made by this section.
(2) STATUS OF IMPLEMENTATION.—The Sec-
retary shall submit a report to Congress not later
than October 1, 2006, that describes the status of
implementation of such amendments and that in-
cludes a description of the following:
(A) The number of contracts that have
been competitively bid as of such date.
(B) The distribution of functions among
contracts and contractors.
(C) A timeline for complete transition to
full competition.
(D) A detailed description of how the Sec-
retary of Health and Human Services has
tion guidelines for evaluation and management physician
services under the title XVIII of the Social Security Act
on or after the date of the enactment of this Act unless
the Secretary—
(1) has developed the guidelines in collaboration
with practicing physicians (including both generalists
and specialists) and provided for an assessment of
the proposed guidelines by the physician community;
(2) has established a plan that contains specific
goals, including a schedule, for improving the use of
such guidelines;
(3) has conducted appropriate and representa-
tive pilot projects under subsection (b) to test the
evaluation and management documentation guide-
lines;
(4) finds that the objectives described in sub-
section (c) will be met in the implementation of such
guidelines; and
(5) has established, and is implementing, a pro-
gram to educate physicians on the use of such guide-
lines.
The Secretary may make changes to the manner in which
existing evaluation and management documentation guide-
lines are implemented to reduce paperwork burdens on
physicians.