I
105TH CONGRESS
1ST SESSION
H. R. 364
To amend title XVIII of the Social Security Act to provide for Medicare
contracting reforms, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 7, 1997
Mr. TOWNS introduced the following bill; which was referred to the Committee
on Commerce, and in addition to the Committee on Ways and Means,
for a period to be subsequently determined 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
for Medicare contracting reforms, 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 AND REFERENCES IN ACT.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Medicare Contractor Reform Amendments of 1996’’.
(b) REFERENCES IN ACT.—Except as otherwise ex-
pressly provided, whenever in this Act an amendment or
repeal is expressed in terms of an amendment to, or repeal
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of, a section or other provision, the reference shall be con-
sidered to be made a section or other provision of the So-
cial Security Act.
SEC. 2. INCREASED FLEXIBILITY IN CONTRACTING FOR
MEDICARE CLAIMS PROCESSING.
(a) CARRIERS TO INCLUDE ENTITIES THAT ARE
NOT INSURANCE COMPANIES.—
(1) Section 1842(a) (42 U.S.C. 1395u(a)) is
amended in the matter preceding paragraph (1) by
striking ‘‘with carriers’’ and inserting ‘‘with agencies
and organizations (hereafter in this section referred
to as ‘carriers’)’’.
(2) Section 1842(f) (42 U.S.C. 1395u(f)) is re-
pealed.
(b) CHOICE OF FISCAL INTERMEDIARIES BY PROVID-
ERS OF SERVICES; SECRETARIAL FLEXIBILITY IN ASSIGN-
ING FUNCTIONS TO INTERMEDIARIES AND CARRIERS.—
(1) Section 1816(a) (42 U.S.C. 1395h(a)) to
read as follows:
‘‘(a)(1) The Secretary may enter into contracts with
agencies or organizations to perform any or all of the fol-
lowing functions, or parts of those functions (or, to the
extent provided in a contract, to secure performance there-
of by other organizations):
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inserting ‘‘after evaluating the ability of the agency
or organization to fulfill the contract performance
requirements’’.
(B) The first sentence of section 1816(f)(1) (42
U.S.C. 1395h(f)(1)) is amended—
(i) by striking ‘‘develop standards, criteria,
and procedures’’ and inserting ‘‘, after public
notice and opportunity for comment, develop
contract performance requirements’’, and
(ii) by striking ‘‘, and the Secretary shall
establish standards and criteria with respect to
the efficient and effective administration of this
part’’.
(C) 
The 
second 
sentence 
of 
section
1842(b)(2)(A) 
(42 
U.S.C. 
1395u(b)(2)(A)) 
is
amended to read as follows: ‘‘The Secretary shall,
after public notice and opportunity for comment, de-
velop contract performance requirements for the effi-
cient and effective performance of contract obliga-
tions under this section.’’.
(D) 
Section 
1842(b)(2)(A) 
(42 
U.S.C.
1395u(b)(2)(A)) is amended by striking the third
sentence.
(E) 
Section 
1842(b)(2)(B) 
(42 
U.S.C.
1395u(b)(2)(B)) is amended in the matter preceding
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clause (i) by striking ‘‘establish standards’’ and in-
serting ‘‘develop contract performance require-
ments’’.
(F) 
Section 
1842(b)(2)(D) 
(42 
U.S.C.
1395u(b)(2)(D)) is amended by striking ‘‘standards
and criteria’’ each place is appears and inserting
‘‘contract performance requirements’’.
(4)(A) Section 1816(b) (42 U.S.C. 1395h(b)) is
amended in the matter preceding paragraph (1) by
striking ‘‘an agreement’’ and inserting ‘‘a contract’’.
(B) Paragraphs (1)(B) and (2)(A) of section
1816(b) (42 U.S.C. 1395h(b)) are each amended by
striking ‘‘agreement’’ and inserting ‘‘contract’’.
(C) The first sentence of section 1816(c)(1) (42
U.S.C. 1395h(c)(1)) is amended by striking ‘‘An
agreement’’ and inserting ‘‘A contract’’.
(D) The last sentence of section 1816(c)(1) (42
U.S.C. 1395h(c)(1)) is amended by striking ‘‘an
agreement’’ and inserting ‘‘a contract’’.
(E) 
Section 
1816(c)(2)(A) 
(42 
U.S.C.
1395h(c)(2)(A)) is amended in the matter preceding
clause (i) by striking ‘‘agreement’’ and inserting
‘‘contract’’.
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(F) 
Section 
1816(c)(3)(A) 
(42 
U.S.C.
1395h(c)(3)(A)) is amended by striking ‘‘agree-
ment’’ and inserting ‘‘contract’’.
(G) The first sentence of section 1816(f)(1) (42
U.S.C. 1395h(f)(1)) is amended by striking ‘‘an
agreement’’ and inserting ‘‘a contract’’.
(H) Section 1816(h) (42 U.S.C. 1395h(h)) is
amended—
(i) by striking ‘‘An agreement’’ and insert-
ing ‘‘A contract’’, and
(ii) by striking ‘‘the agreement’’ each place
it appears and inserting ‘‘the contract’’.
(I) Section 1816(i)(I) (42 U.S.C. 1395h(i)(1))
is amended by striking ‘‘an agreement’’ and insert-
ing ‘‘a contract’’.
(J) Section 1816(j) (42 U.S.C. 1395h(j)) is
amended by striking ‘‘An agreement’’ and inserting
‘‘A contract’’.
(K) Section 1816(k) (42 U.S.C. 1395h(k)) is
amended by striking ‘‘An agreement’’ and inserting
‘‘A contract’’.
(L) Section 1842(a) (42 U.S.C. 1395u(a)) is
amended in the matter preceding paragraph (1) is
amended by striking ‘‘agreements’’ and inserting
‘‘contracts’’.
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(M) 
Section 
1842(h)(3)(A) 
(42 
U.S.C.
1395u(h)(3)(A)) is amended by striking ‘‘an agree-
ment’’ and inserting ‘‘a contract’’.
(5) Section 1816(f)(1) (42 U.S.C. 1395h(f)(1))
is amended by striking the second sentence.
(6)(A) 
Section 
1816(c)(2)(A) 
(42 
U.S.C.
1395h(c)(2)(A)) is amended in the matter preceding
clause (i) by inserting ‘‘that provides for making
payments under this part’’ after ‘‘this section’’.
(B) 
Section 
1816(c)(3)(A) 
(42 
U.S.C.
1395h(c)(3)(A)) is amended by inserting ‘‘that pro-
vides for making payments under this part’’ after
‘‘this section’’.
(C) Section 1816(k) (42 U.S.C. 1395h(k)) is
amended by inserting ‘‘(as appropriate)’’ after ‘‘sub-
mit’’.
(D) Section 1842(a) (42 U.S.C. 1395u(a)) is
amended in the matter preceding paragraph (1) by
striking ‘‘some or all of the following functions’’ and
inserting ‘‘any or all of the following functions, or
parts of those functions’’.
(E) The first sentence of section 1842(b)(2)(C)
(42 U.S.C. 1395u(b)((2)(C)) is amended by insert-
ing ‘‘(as appropriate)’’ after ‘‘carriers’’.