Social Security Act §1862

(ii)Employerresponse.Within 30 days of the dateof receipt of the inquiry, the employer shall notify the intermediaryor carrier making the inquiry as to the determinations described inclause (i). An employer (other than a Federal or other governmentalentity) who willfully or repeatedly fails to provide timely and accuratenotice in accordance with the previous sentence shall be subject toa civil money penalty of not to exceed $1,000 for each individualwith respect to which such an inquiry is made. The provision of section 1128A (other than subsections(a) and (b)) shall apply to a civil money penalty under the previoussentence in the same manner as such provisions apply to a penaltyor proceeding under section 1128A(a).(D)Obtaining information from beneficiaries.Before an individual applies for benefits under part A or enrollsunder part B, the Administrator shall mail the individual a questionnaireto obtain information on whether the individual is covered under aprimary plan and the nature of the coverage provided under the plan,including the name, address, and identifying number of the plan.(E)Enddate.The provisions of this paragraphshall not apply to information required to be provided on or afterJuly 1, 2016.[565](6)Screeningrequirements for provider and suppliers.(A)In general.Notwithstanding any otherprovisions of this title, no payment may be made for any item or servicefurnished under part B unless the entity furnishing such item or servicecompletes (to the best of its knowledge and on the basis of informationobtained from the individual to whom the item or service is furnished)the portion of the claim form relating to the availability of otherhealth benefit plans.(B)Penalties.An entity that knowingly,willfully, and repeatedly fails to complete a claim form in accordancewith subparagraph (A) or provides inaccurate information relatingto the availability of other health benefit plans on a claim formunder such subparagraph shall be subject to a civil money penaltyof not to exceed $2,000 for each such incident. The provisions ofsection 1128A  (other than subsections (a) and (b)) shall apply to a civil moneypenalty under the previous sentence in the same manner as such provisionsapply to a penalty or proceeding under section 1128A(a).(7)Requiredsubmission of information by group health plans.(A)Requirement.On and after the firstday of the first calendar quarter beginning after the date that is1 year after the date of the enactment of this paragraph, an entityserving as an insurer or third party administrator for a group healthplan, as defined in paragraph (1)(A)(v), and, in the case of a grouphealth plan that is self-insured and self-administered, a plan administratoror fiduciary, shall(i)[566]secure from theplan sponsor and plan participants such information as the Secretaryshall specify for the purpose of identifying situations where thegroup health plan is or has been(I)a primaryplan to the program under this title; or(II)for calendarquarters beginning on or after January 1, 2020, a primary payer withrespect to benefits relating to prescription drug coverage under partD; and(ii)submit suchinformation to the Secretary in a form and manner (including frequency)specified by the Secretary.(B)Enforcement.(i)Ingeneral.An entity, a plan administrator,or a fiduciary described in subparagraph (A) that fails to complywith the requirements under such subparagraph shall be subject toa civil money penalty of $1,000 for each day of noncompliance foreach individual for which the information under such subparagraphshould have been submitted. The provisions of subsections (e) and(k) of section 1128A shall apply to a civil money penalty under the previous sentencein the same manner as such provisions apply to a penalty or proceedingunder section 1128A(a). A civil money penalty under this clause shall be in addition toany other penalties prescribed by law and in addition to any Medicaresecondary payer claim under this title with respect to an individual.(ii)Depositof amounts collected.Any amounts collectedpursuant to clause (i) shall be deposited in the Federal HospitalInsurance Trust Fund under section 1817.(C)Sharing of information.Notwithstandingany other provision of law, under terms and conditions establishedby the Secretary, the Secretary(i)shall share informationon entitlement under Part A and enrollment under Part B under thistitle with entities, plan administrators, and fiduciaries describedin subparagraph (A);(ii)may share theentitlement and enrollment information described in clause (i) withentities and persons not described in such clause; and(iii)may shareinformation collected under this paragraph as necessary for purposesof the proper coordination of benefits.(D)Implementation.Notwithstanding anyother provision of law, the Secretary may implement this paragraphby program instruction or otherwise.(8)Requiredsubmission of information by or on behalf of liability insurance (includingself-insurance), no fault insurance, and workers compensationlaws and plans.(A)Requirement.On and after the firstday of the first calendar quarter beginning after the date that is18 months after the date of the enactment of this paragraph, an applicableplan shall(i)determine whethera claimant (including an individual whose claim is unresolved) isentitled to benefits under the program under this title on any basis;and(ii)if the claimantis determined to be so entitled, submit the information describedin subparagraph (B) with respect to the claimant to the Secretaryin a form and manner (including frequency) specified by the Secretary.(B)Required information.The informationdescribed in this subparagraph is(i)the identityof the claimant for which the determination under subparagraph (A)was made; and(ii)such otherinformation as the Secretary shall specify in order to enable theSecretary to make an appropriate determination concerning coordinationof benefits, including any applicable recovery claim.Not later than 18 months after the date of enactment of thissentence, the Secretary shall modify the reporting requirements underthis paragraph so that an applicable plan in complying with such requirementsis permitted but not required to access or report to the Secretarybeneficiary social security account numbers or health identificationclaim numbers, except that the deadline for such modification shallbe extended by one or more periods (specified by the Secretary) ofup to 1 year each if the Secretary notifies the committees of jurisdictionof the House of Representatives and of the Senate that the prior deadlinefor such modification, without such extension, threatens patient privacyor the integrity of the secondary payer program under this subsection.Any such deadline extension notice shall include information on theprogress being made in implementing such modification and the anticipatedimplementation date for such modification.[567](C)Timing.Information shall be submittedunder subparagraph (A)(ii) within a time specified by the Secretaryafter the claim is resolved through a settlement, judgment, award,or other payment (regardless of whether or not there is a determinationor admission of liability).(D)Claimant.For purposes of subparagraph(A), the term claimant includes(i)an individualfiling a claim directly against the applicable plan; and(ii)an individualfiling a claim against an individual or entity insured or coveredby the applicable plan.(E)Enforcement.(i)Ingeneral.An applicable plan that failsto comply with the requirements under subparagraph (A) with respectto any claimant shall be subject to a civil money penalty of $1,000for each day of noncompliance with respect to each claimant may besubject to a civil penalty of up to $1,000 for each day of noncompliancewith respect to each claimant.[568]. The provisionsof subsections (e) and (k) of section 1128A shall apply to a civil money penaltyunder the previous sentence in the same manner as such provisionsapply to a penalty or proceeding under section 1128A(a) A civil money penalty underthis clause shall be in addition to any other penalties prescribedby law and in addition to any Medicare secondary payer claim underthis title with respect to an individual.(ii)Depositof amounts collected.Any amounts collectedpursuant to clause (i) shall be deposited in the Federal HospitalInsurance Trust Fund.(F)Applicable plan.In this paragraph,the term applicable plan means the following laws, plans,or other arrangements, including the fiduciary or administrator forsuch law, plan, or arrangement:(i)Liability insurance(including self-insurance).(ii)No fault insurance.(iii)Workerscompensation laws or plans.(G)Sharing of information.The Secretarymay share information collected under this paragraph as necessaryfor purposes of the proper coordination of benefits.(H)Implementation.Notwithstanding anyother provision of law, the Secretary may implement this paragraphby program instruction or otherwise.(I)[569]Regulations.Not later than 60 days after the date of the enactment of thissubparagraph, the Secretary shall publish a notice in the FederalRegister soliciting proposals, which will be accepted during a 60-dayperiod, for the specification of practices for which sanctions willand will not be imposed under subparagraph (E), including not imposingsanctions for good faith efforts to identify a beneficiary pursuantto this paragraph under an applicable entity responsible for reportinginformation. After considering the proposals so submitted, the Secretary,in consultation with the Attorney General, shall publish in the FederalRegister, including a 60-day period for comment, proposed specifiedpractices for which such sanctions will and will not be imposed. Afterconsidering any public comments received during such period, the Secretaryshall issue final rules specifying such practices.(9)[570]Exception.(A)In General.Clause (ii) of paragraph(2)(B) and any reporting required by paragraph (8) shall not applywith respect to any settlement, judgment, award, or other paymentby an applicable plan arising from liability insurance (includingself-insurance) and from alleged physical trauma-based incidents (excludingalleged ingestion, implantation, or exposure cases) constituting atotal payment obligation to a claimant of not more than the singlethreshold amount calculated by the Secretary under subparagraph (B)for the year involved.(B)Annual computation of threshold.(i)InGeneral.Not later than November 15 beforeeach year, the Secretary shall calculate and publish a single thresholdamount for settlements, judgments, awards, or other payments for obligationsarising from liability insurance (including self-insurance) and foralleged physical trauma-based incidents (excluding alleged ingestion,implantation, or exposure cases) subject to this section for thatyear. The annual single threshold amount for 2014[571]shall be set such that the estimated average amount tobe credited to the Medicare trust funds of collections of conditionalpayments from such settlements, judgments, awards, or other paymentsarising from liability insurance (including self-insurance) and forsuch alleged incidents subject to this section shall equal the estimatedcost of collection incurred by the United States (including paymentsmade to contractors) for a conditional payment arising from liabilityinsurance (including self-insurance) and for such alleged incidentssubject to this section for the year. At the time of calculating,but before publishing, the single threshold amount for a year, theSecretary shall inform, and seek review of, the Comptroller Generalof the United States with regard to such amount.(ii)Publication.The Secretary shall include, as part of such publication fora year(I)the estimatedcost of collection incurred by the United States (including paymentsmade to contractors) for a conditional payment arising from liabilityinsurance (including self-insurance) and for such alleged incidents;and(II)a summaryof the methodology and data used by the Secretary in computing suchthreshold amount and such cost of collection.(C)Exclusion of ongoing expenses.Forpurposes of this paragraph and with respect to a settlement, judgment,award, or other payment not otherwise addressed in clause (ii) ofparagraph (2)(B) that includes ongoing responsibility for medicalpayments (excluding settlements, judgments, awards, or other paymentsmade by a workers compensation law or plan or no fault insurance),the amount utilized for calculation of the threshold described insubparagraph (A) shall include only the cumulative value of the medicalpayments made under this title.(D)Report to congress.Not later thanNovember 15 before each year, the Secretary shall submit to the Congressa report on the single threshold amount for settlements, judgments,awards, or other payments for conditional payment obligations arisingfrom liability insurance (including self-insurance) and alleged incidentsdescribed in subparagraph (A) for that year and on the establishmentand application of similar thresholds for such payments for conditionalpayment obligations arising from worker compensation cases and fromno fault insurance cases subject to this section for the year. Foreach such report, the Secretary shall(i)calculate thethreshold amount by using the methodology applicable to certain liabilityclaims described in subparagraph (B); and(ii)include a summaryof the methodology and data used in calculating each threshold amountand the amount of estimated savings under this title achieved by theSecretary implementing each such threshold.(c)No payment maybe made under part B for any expenses incurred for