SEC. 301. MEDICARE SECONDARY PAYOR (MSP) PROVISIONS.
(a) TECHNICAL AMENDMENT CONCERNING SECRETARY'S
AUTHORITY TO MAKE CONDITIONAL PAYMENT WHEN CERTAIN PRIMARY PLANS DO NOT PAY
PROMPTLY- Section 1862(b)(2) (42 U.S.C. 1395y(b)(2)) is amended--
(1) in subparagraph (A)(ii), by striking
`promptly (as determined in accordance with regulations)'; and
(2) in subparagraph (B)--
(A) by redesignating clauses
(i) through (v) as clauses (ii) through (vi), respectively; and
(B) by inserting before clause
(ii), as so redesignated, the following new clause:
`(i) AUTHORITY TO MAKE CONDITIONAL PAYMENT- The Secretary may make
payment under this title with respect to an item or service if a primary
plan described in subparagraph (A)(ii) has not made or cannot reasonably
be expected to make payment with respect to such item or service
promptly (as determined in accordance with regulations). Any such
payment by the Secretary shall be conditioned on reimbursement to the
appropriate Trust Fund in accordance with the succeeding provisions of
this subsection.'.
(b) CLARIFYING AMENDMENTS TO CONDITIONAL PAYMENT
PROVISIONS- Section 1862(b)(2) (42 U.S.C. 1395y(b)(2)), as amended by subsection
(a), is amended--
(1) in subparagraph (A), in the matter
following clause (ii), by inserting the following sentence at the end: `An
entity that engages in a business, trade, or profession shall be deemed to
have a self-insured plan if it carries its own risk (whether by a failure
to obtain insurance, or otherwise) in whole or in part.';
(2) in subparagraph (B)(ii), as redesignated
by subsection (a)(2)(A)--
(A) by striking the first sentence
and inserting the following: `A primary plan, and an entity that receives
payment from a primary plan, shall reimburse the appropriate Trust Fund
for any payment made by the Secretary under this title with respect to an
item or service if it is demonstrated that such primary plan has or had
a responsibility to make payment with respect to such item or service. A
primary plan's responsibility for such payment may be demonstrated by a
judgment, a payment conditioned upon the recipient's compromise, waiver,
or release (whether or not there is a determination or admission of liability)
of payment for items or services included in a claim against the primary
plan or the primary plan's insured, or by other means.'; and
(B) in the final sentence,
by striking `on the date such notice or other information is received' and
inserting `on the date notice of, or information related to, a primary plan's
responsibility for such payment or other information is received'; and
(3) in subparagraph (B)(iii), as redesignated
by subsection (a)(2)(A), by striking the first sentence and inserting the
following: `In order to recover payment made under this title for an item
or service, the United States may bring an action against any or all entities
that are or were required or responsible (directly, as an insurer or self-insurer,
as a third-party administrator, as an employer that sponsors or contributes
to a group health plan, or large group health plan, or otherwise) to make
payment with respect to the same item or service (or any portion thereof)
under a primary plan. The United States may, in accordance with paragraph
(3)(A) collect double damages against any such entity. In addition, the United
States may recover under this clause from any entity that has received payment
from a primary plan or from the proceeds of a primary plan's payment to any
entity.'.
(c) CLERICAL AMENDMENTS- Section 1862(b) (42
U.S.C. 1395y(b)) is amended--
(1) in paragraph (1)(A), by moving
the indentation of clauses (ii) through (v) 2 ems to the left; and
(2) in paragraph (3)(A), by striking
`such' before `paragraphs'.
(d) EFFECTIVE DATES- The amendments made by
this section shall be effective--
(1) in the case of subsection (a),
as if included in the enactment of title III of the Medicare and Medicaid
Budget Reconciliation Amendments of 1984 (Public Law 98-369); and
(2) in the case of subsections (b)
and (c), as if included in the enactment of section 953 of the Omnibus Reconciliation
Act of 1980 (Public Law 96-499; 94 Stat. 2647).
