Strengthening Medicare And Repaying Taxpayers Act of 2012

Bill: 112-hr-1063
Sponsor: Rep. Murphy, Tim [R-PA-18]
Introduced: 2011-03-14 in the House
Policy area: Health
Subjects: Administrative law and regulatory procedures
Administrative remedies
Department of Health and Human Services
Government information and archives
Health information and medical records
Medicare

Summary:
action_date: 2011-03-14
text: 
Strengthening Medicare And Repaying Taxpayers Act of 2011- Amends title XVIII (Medicare) of the Social Security Act with respect to any settlement, judgment, award, or other payment between a Medicare claimant and an applicable plan involving a payment made for items and services by the Secretary of Health and Human Services (HHS).
 
Declares that, in the case of a payment to the claimant by the Secretary, and beginning 120 days before the reasonably expected date of a settlement, judgment, award, or other payment, the claimant or applicable plan may at any time but only once: (1) notify the Secretary that a payment is reasonably expected, and (2) request a statement of the conditional payment reimbursement amount for any payments subject to the required reimbursement.
 
Requires the Secretary to respond to such a request, within 65 days after receiving it, with a statement of reimbursement amount. 
 
Prescribes procedures for the claimant, an applicable plan, or specified related entities to follow if the Secretary fails to provide such a statement. 
 
Specifies circumstances: (1) in which the claimant, an applicable plan, or specified related entities are shielded from liability for certain payments; and (2) in which the Secretary shall be exempt from any obligation for a statement of reimbursement. 
 
Directs the Secretary to promulgate regulations establishing a right of appeal and appeals process, with respect to any determination for a payment made under such title for an item or service under a primary plan, under which the applicable plan involved, or an attorney, agent, or third party administrator on behalf of such applicable plan, may appeal such determination.
 
Exempts a primary plan, and an entity receiving payment from a primary plan, from any obligation to reimburse the appropriate Trust Fund for a Medicare payment by the Secretary with respect to any settlement, judgment, award, or other payment by an applicable plan constituting a total payment obligation to a claimant of not more than the single threshold amount calculated by the Chief Actuary of the Centers for Medicare & Medicaid Services (CMS). Requires the Chief Actuary to calculate and publish the single threshold amount annually.
 
Makes discretionary rather than mandatory the current civil money penalty for an applicable plan's noncompliance with requirements to submit insurance information about a claimant. Requires the severity of each penalty to be based on the knowing, willful, and repeated nature of the violation.
 
Prescribes requirements for the specification of practices for which sanctions will not be imposed on a plan (safe harbors).
 
Directs the Secretary to modify insurance information reporting requirements so that a plan, in complying with them, is permitted but not required to access or report beneficiary Social Security account numbers or health identification claim numbers.
 
Sets a three-year statute of limitations on a Medicare secondary payer claim by the Secretary for reimbursement against an applicable plan that becomes a Medicare primary payer pursuant to a settlement, judgment, award, or other judicial action.

action_date: 2012-12-20
text: 
Strengthening Medicare And Repaying Taxpayers Act of 2012 - (Sec. 2) Amends title XVIII (Medicare) of the Social Security Act with respect to reimbursement to the Secretary of Health and Human Services (HHS) by a health plan for any conditional Medicare payment made by the Secretary for items and services on behalf of a claimant.
 
Authorizes a claimant or applicable plan, at any time within 120 days before the reasonably expected date of a settlement, judgment, award, or other payment, to notify the Secretary that such a payment is reasonably expected as well as its expected date.
 
Directs the Secretary to maintain and make available to individuals to whom items and services are furnished under Medicare (and their representatives) access through a password-requiring website to information for claims (including payment amounts), including those attributable to a specific injury or incident forming the basis for a settlement, judgment, award, or other payment. Specifies requirements for such information on the website. Requires the Secretary to update the website for any payment or claims information within 15 days of receiving a claim or making a payment.
 
Prescribes requirements for: (1) the use of a timely web download as the basis for a final conditional amount, and (2) resolution of discrepancies with the statement of reimbursement amount.
 
Grants the Secretary, upon notice of intent to settle, a protected period of between 65 and 95 days (except for exceptional circumstances) in which to post on the website claims received or payments made. Requires parties subject to repayment to draw down the final conditional payment amount from the website after conclusion of the protected period, but no more than three days before the date of settlement, judgment, award, or other payment.
 
Requires the Secretary also to: (1) respond promptly when notified of a discrepancy related to repayment amounts posted on the website; and (2) create a right of appeals, through regulation, for determinations made with respect to reimbursement.
 
(Sec. 3) Exempts a primary plan, and an entity receiving payment from a primary plan, from any obligation to reimburse the appropriate Trust Fund for a Medicare payment by the Secretary with respect to any settlement, judgment, award, or other payment by an applicable plan constituting a total payment obligation to a claimant of not more than the single threshold amount calculated by the Secretary. Requires the Secretary to calculate and publish annually the single threshold amount for settlements, judgments, awards, or other payments for conditional payment obligations arising from liability insurance (including self-insurance) and for alleged physical trauma-based incidents (excluding alleged ingestion, implantation, or exposure cases).
 
(Sec. 4) Makes discretionary rather than mandatory the current civil money penalty for an applicable plan's noncompliance with requirements to submit insurance information about a claimant.
 
Prescribes requirements for the specification of practices for which sanctions will and will not be imposed on a plan (safe harbors).
 
(Sec. 5) Directs the Secretary to modify insurance information reporting requirements so that a plan, in complying with them, is permitted but not required to access or report beneficiary Social Security account numbers or health identification claim numbers.
 
(Sec. 6) Sets a three-year statute of limitations on a Medicare secondary payer claim by the Secretary for reimbursement against an applicable plan that becomes a Medicare primary payer pursuant to a settlement, judgment, award, or other judicial action.


Legislative actions:
action_date: 2012-12-20
text: Reported (Amended) by the Committee on Energy and Commerce. H. Rept. 112-715, Part I.
action_date: 2012-12-20
text: Reported (Amended) by the Committee on Energy and Commerce. H. Rept. 112-715, Part I.
action_date: 2012-09-20
text: Ordered to be Reported (Amended) by Voice Vote.
action_date: 2012-09-20
text: Committee Consideration and Mark-up Session Held.
action_date: 2012-09-11
text: Forwarded by Subcommittee to Full Committee (Amended) .
action_date: 2012-09-11
text: Subcommittee Consideration and Mark-up Session Held.
action_date: 2011-03-17
text: Referred to the Subcommittee on Health.
action_date: 2011-03-15
text: Referred to the Subcommittee on Health.
action_date: 2011-03-14
text: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
action_date: 2011-03-14
text: Referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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.
action_date: 2011-03-14
text: Introduced in House
action_date: 2011-03-14
text: Introduced in House