II 111th CONGRESS 1st Session S. 1111 IN THE SENATE OF THE UNITED STATES May 20, 2009 Mr. Reid (for Mr. Rockefeller) introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To require the Secretary of Health and Human Services to enter into agreements with States to resolve outstanding claims for reimbursement under the Medicare program relating to the Special Disability Workload project.

1.

Short title

This Act may be cited as the Special Disability Workload Liability Resolution Act of 2009.

2.

Payment of Medicare liability to States as a result of the Special Disability Workload project

(a)

In general

The Secretary, in consultation with the Commissioner, shall work with each State to reach an agreement, not later than 6 months after the date of enactment of this Act, on the amount of a payment for the State related to the Medicare program liability as a result of the Special Disability Workload project, subject to the requirements of subsection (c). (b)

Payments

(1)

Deadline for making payments

Not later than 30 days after reaching an agreement with a State under subsection (a), the Secretary shall pay the State, from the amounts appropriated under paragraph (2), the payment agreed to for the State. (2)

Appropriation

Out of any money in the Treasury not otherwise appropriated, there is appropriated $4,000,000,000 for fiscal year 2010 for making payments to States under paragraph (1). (3)

Limitations

In no case may the aggregate amount of payments made by the Secretary to States under paragraph (1) exceed $4,000,000,000. (c)

Requirements

The requirements of this subsection are the following: (1)

Federal data used to determine amount of payments

The amount of the payment under subsection (a) for each State is determined on the basis of the most recent Federal data available, including the use of proxies and reasonable estimates as necessary, for determining expeditiously the amount of the payment that shall be made to each State that enters into an agreement under this section. The payment methodology shall consider the following factors: (A)The number of SDW cases found to have been eligible for benefits under the Medicare program and the month of the initial Medicare program eligibility for such cases. (B)The applicable non-Federal share of expenditures made by a State under the Medicaid program during the time period for SDW cases. (C)Such other factors as the Secretary and the Commissioner, in consultation with the States, determine appropriate. (2)

Conditions for payments

A State shall not receive a payment under this section unless the State— (A)waives the right to file a civil action (or to be a party to any action) in any Federal or State court in which the relief sought includes a payment from the United States to the State related to the Medicare liability under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) as a result of the Special Disability Workload project; and (B)releases the United States from any further claims for reimbursement of State expenditures as a result of the Special Disability Workload project (other than reimbursements being made under agreements in effect on the date of enactment of this Act as a result of such project, including payments made pursuant to agreements entered into under section 1616 of the Social Security Act or section 211(1)(1)(A) of Public Law 93–66). (3)

No individual state claims data required

No State shall be required to submit individual claims evidencing payment under the Medicaid program as a condition for receiving a payment under this section. (4)

Ineligible states

No State that is a party to a civil action in any Federal or State court in which the relief sought includes a payment from the United States to the State related to the Medicare liability under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) as a result of the Special Disability Workload project shall be eligible to receive a payment under this section while such an action is pending or if such an action is resolved in favor of the State. (d)

Definitions

In this section: (1)

Commissioner

The term Commissioner means the Commissioner of Social Security. (2)

Medicaid program

The term Medicaid program means the program of medical assistance established under title XIX of the Social Security Act (42 U.S.C. 1396a et seq.) and includes medical assistance provided under any waiver of that program approved under section 1115 or 1915 of such Act (42 U.S.C. 1315, 1396n) or otherwise. (3)

Medicare program

The term Medicare program means the program established under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.). (4)

Secretary

The term Secretary means the Secretary of Health and Human Services. (5)

Sdw case

The term SDW case means a case in the Special Disability Workload project involving an individual determined by the Commissioner to have been eligible for benefits under title II of the Social Security Act (42 U.S.C. 401 et seq.) for a period during which such benefits were not provided to the individual and who was, during all or part of such period, enrolled in a State Medicaid program. (6)

Special disability workload project

The term Special Disability Workload project means the project described in the 2008 Annual Report of the Board of Trustees of the Federal Old-Age and Survivors Insurance and Federal Disability Insurance Trust Funds, H.R. Doc. No. 110–104, 110th Cong. (2008). (7)

State

The term State means each of the 50 States and the District of Columbia.