,i  #aad? ,,congress  #a/ ,session  ,h4 
,r4 #baef  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,april #cj1 #bjae ,mr4
 ,graves ( ,miss\ri 7= himself1 ,mr4    
,s*iff1 ,mr4 ,bo/1 ,mrs4 ,wagn]1 & ,mr4 
,craw=d7 introduc$ ! foll[+ bill2 :i* 0 
ref]r$ to ! ,committee on ,ways &       
,means1 & 9 addition to ! ,committee on 
,en]gy & ,comm]ce1 = a p]iod to be      
subsequ5tly det]m9$ by ! ,speak]1 9 ea* 
case = consid]ation ( su* provisions z  
fall )9 ! jurisdiction ( ! committee    
conc]n$  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
re=m ! practices ( recov]y audit        
contractors "u ! ,m$ic>e program1 & =   
o!r purposes4  #a4 ,%ort title ,?is ,act
 may be cit$ z ! ,m$ic>e ,audit         
,improvem5t ,act ( #bjae4  #b4 ,re=m+ ! 
practices ( recov]y audit contractors "u
 ! ,m$ic>e program  7a7 ,elim9ation (   
cont+5cy fee paym5t sy/em ,section      
#ahic7;h7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;ddd7h77 is am5d$-- 
7#a7 9 p>agraph 7#a71 by ins]t+ 1 =     

recov]y activities conduct$ dur+ a      
fiscal ye> be=e fiscal ye> #bjae aft]   
,"u ! contracts2 &  7#b7 by add+ at !   
end ! foll[+ new p>agraph3  7#aa7       
,paym5t = recov]y activities p]=m$ aft] 
fiscal ye> #bjad  7,a7 ,9 g5]al ,"u !   
contracts1 subject to p>agraphs 7,b7 &  
7,c71 paym5t %all be made to recov]y    
audit contractors = recov]y activities  
conduct$ dur+ fiscal ye> #bjae & ea*    
fiscal ye> !reaft] 9 ! same mann]1 & f !
 same am\nts1 z paym5t is made to       
eligible entities "u contracts ent]$    
into = recov]y activities conduct$ dur+ 
fiscal ye> #bjad "u subsection 7a74     
7,b7 ,prohibition on inc5tive paym5ts   
,"u ! contracts1 paym5t made to a       
recov]y audit contractor = recov]y      
activities conduct$ dur+ fiscal ye>     
#bjae or any fiscal ye> !reaft] may n   
include any inc5tive paym5ts4  7,c7     
,p]=mance acc\ntability  7i7 ,9 g5]al   
,"u ! contracts1 paym5t made to a       
recov]y audit contractor = recov]y      
activities conduct$ dur+ fiscal ye>     

#bjae or any fiscal ye> !reaft] %all1 9 
! case t ! contractor has a complex     
audit d5ial ov]turn rate at ! end ( su* 
fiscal ye> 7z calculat$ "u ! me?odology 
describ$ 9 clause 7iv77 t is 4#a or     
great]1 be r$uc$ 9 an am\nt det]m9$ 9   
accordance ) clause 7ii74  7ii7 ,paym5t 
r$uctions  7,i7 ,slid+ scale ( am\nt (  
r$uctions ,! ,secret>y %all e/abli%1 =  
purposes ( det]m9+ ! am\nt ( a r$uction 
9 paym5t to a recov]y audit contractor  
"u clause 7i7 = recov]y activities      
conduct$ dur+ fiscal ye>1 a l9e> slid+  
scale ( paym5t r$uctions = recov]y audit
 contractors = su* fiscal ye>4 ,"u su*  
l9e> slid+ scale1 ! am\nt ( su* a       
r$uction 9 paym5t to a recov]y audit    
contractor = a fiscal ye> %all be       
calculat$ 9 a mann] t provides = su*    
r$uction to be great] ?an ! r$uction =  
su* fiscal ye> = recov]y audit          
contractors t h complex audit d5ial     
ov]turn rates at ! end ( su* fiscal ye> 
7z calculat$ "u ! me?odology describ$ 9 
clause 7iv77 t are l[] ?an ! complex    

audit d5ial ov]turn rate ( ! contractor 
at ! end ( su* fiscal ye> 7z s          
calculat$74  7,,ii7 ,mann] ( collect+   
r$uction ,! ,secret>y may assess &      
collect ! r$uctions 9 paym5t to recov]y 
audit contractors "u clause 7i7 9 su*   
mann] z ! ,secret>y may specify 7su* z  
by r$uc+ ! am\nt paid to ! contractor = 
recov]y activities conduct$ dur+ a      
fiscal ye> or by assess+ ! r$uction z a 
sep>ate p5alty paym5t to be paid to !   
,secret>y by ! contractor ) respect to  
ea* complex audit d5ial issu$ by !      
contractor t is ov]turn$ on appeal74    
7iii7 ,tim+ ( det]m9ations ( paym5t     
r$uctions ,! ,secret>y %all1 ) respect  
to a recov]y audit contractor1 det]m9e n
 lat] ?an six mon?s aft] ! end ( a      
fiscal ye>--  7,i7 :e!r to r$uce paym5t 
to ! recov]y audit contractor "u clause 
7i7 = recov]y activities conduct$ dur+  
su* fiscal ye>2 &  7,,ii7 9 ! case t !  
,secret>y det]m9es to s r$uce paym5t to 
! contractor1 ! am\nt ( su* paym5t      
r$uction4  7iv7 ,me?odology =           

calculation ( ov]turn$ complex audit    
d5ial ov]turn rate  7,i7 ,calculation ( 
ov]turn rate ,! ,secret>y %all calculate
 a complex audit d5ial ov]turn rate = a 
recov]y audit contractor = a fiscal ye> 
by-- 7aa7 det]m9+1 ) respect to !       
contract ent]$ into "u p>agraph 7#a7 by 
! contractor1 ! numb] ( complex audit   
d5ials issu$ by ! contractor "u !       
contract 7includ+ d5ials issu$ be=e su* 
fiscal ye> & dur+ su* fiscal ye>7 t are 
ov]turn$ on appeal2 &  7bb7 divid+ !    
numb] det]m9$ "u item 7aa7 by ! numb] ( 
complex audit d5ials issu$ by !         
contractor "u su* contract 7includ+     
d5ials issu$ be=e su* fiscal ye> & dur+ 
su* fiscal ye>74  7,,ii7 ,fairness &    
transp>5cy ,! ,secret>y %all calculate !
 p]c5tage describ$ 9 subclause 7,i7 9 a 
fair & transp>5t mann]4  7,,iii7        
,acc\nt+ = subsequ5tly ov]turn$ appeals 
,! ,secret>y %all calculate ! p]c5tage  
describ$ 9 subclause 7,i7 9 a mann] t   
acc\nts = ! likelihood t complex audit  
d5ials issu$ by ! contractor = su*      

fiscal ye> w be ov]turn$ on appeal 9 a  
subsequ5t fiscal ye>4  7,,iv7 ,complex  
audit d5ial def9$ ,9 ?is subp>agraph1 ! 
t]m complex audit d5ial means a d5ial by
 a recov]y audit contractor ( a claim = 
paym5t "u ?is title submitt$ by a       
hospital1 psy*iatric hospital1 or       
critical access hospital t is s d5i$ by 
! contractor aft] ! contractor has--    
7aa7 reque/$ t ! hospital1 psy*iatric   
hospital1 or critical access hospital1 9
 ord] to support su* claim = paym5t1    
provide support+ m$ical records to !    
contractor2 &  7bb7 review$ su* m$ical  
records 9 ord] to det]m9e :e!r an       
improp] paym5t has be5 made to !        
hospital1 psy*iatric hospital1 or       
critical access hospital = su* claim4   
7,v7 ,ov]turn$ on appeal def9$ ,9 ?is   
subp>agraph1 ! t]m ov]turn$ on appeal   
means1 ) respect to a complex audit     
d5ial1 a d5ial t is ov]turn$ on appeal  
at ! reconsid]ation level1 !            
r$et]m9ation level1 or ! adm9i/rative   
law judge he>+ level4  7,d7 ,application

 to exi/+ contracts ,n lat] ?an #fj days
 aft] ! date ( ! enactm5t ( ?is         
p>agraph1 ! ,secret>y %all modify1 z    
necess>y1 ea* contract "u p>agraph 7#a7 
t ! ,secret>y ent]$ into prior to su*   
date ( enactm5t 9 ord] to ensure t      
paym5t ) respect to recov]y activities  
conduct$ "u su* contract is made 9      
accordance ) ! requirem5ts describ$ 9   
?is p>agraph4  4  7b7 ,elim9ation (     
"o-,ye> timely fil+ limit ,to rebill "p 
,b claims  7#a7 ,9 g5]al ,section       
#ahdb7;b7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acieu7b77 is am5d$ by   
add+ at ! end ! foll[+ new p>agraph3    
7#bj7 ,exception to ! "o-ye> timely fil+
 limit = c]ta9 rebill$ claims  7,a7 ,9  
g5]al ,9 ! case ( a claim submitt$ "u   
?is "p by a hospital 7z def9$ 9         
subp>agraph 7,b77i77 = hospital s]vices 
) respect to :i* !re 0 a previ\s claim  
submitt$ "u "p ,a z inpati5t hospital   
s]vices or inpati5t critical access     
hospital s]vices t 0 d5i$ by a ,m$ic>e  
contractor 7z def9$ 9 subp>agraph       

7,b77ii77 because ( a det]m9ation t !   
inpati5t admission 0 n m$ically         
reasonable & necess>y "u section        
#ahfb7;a77#a77;,a71 ! deadl9e describ$ 9
 ?is p>agraph is #ahj days f ! date ( ! 
f9al d5ial ( su* claim "u "p ,a4  7,b7  
,def9itions ,9 ?is p>agraph3 7i7        
,hospital ,! t]m hospital has ! mean+   
giv5 su* t]m 9 section #ahfa7;e71 &     
includes a psy*iatric hospital 7z def9$ 
9 section #ahfa7;f77 & a critical access
 hospital 7z def9$ 9 section            
#ahfa7mm77#a774  7ii7 ,m$ic>e contractor
 ,! t]m ,m$ic>e contractor has ! mean+  
giv5 su* t]m "u section #ahhi7;g71 &    
includes a recov]y audit contractor ) a 
contract "u section #ahic7;h74  7iii7   
,f9al d5ial ,! t]m f9al d5ial means--   
7,i7 9 ! case t a hospital elects n to  
appeal a d5ial describ$ 9 subp>agraph   
7,a7 by a ,m$ic>e contractor1 ! date (  
su* d5ial2 or  7,,ii7 9 ! case t a      
hospital elects to appeal a su* a d5ial1
 ! date on :i* su* appeal is exhau/$4  4
  7#b7 ,con=m+ am5dm5ts  7,a7 ,section  

#ahce7;a77#a7 ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acien7a77#a77 is am5d$ 
by ins]t+ or1 9 ! case ( a claim        
describ$ 9 section #ahdb7;b77#bj71 ! no 
lat] ?an ! deadl9e describ$ 9 su*       
p>agraph aft] ! date ( s]vice4  7,b7    
,section #ahdb7;b77#c77;,b7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acieu7b77#c77;,b77 is am5d$ 9 ! flu%   
language foll[+ clause 7ii7 by ins]t+   
or1 9 ! case ( a claim describ$ 9       
section #ahdb7;b77#bj71 ! no lat] ?an ! 
deadl9e describ$ 9 su* p>agraph aft] !  
date ( s]vice4  7#c7 ,effective date ,! 
am5dm5ts made by ?is subsection %all    
take effect on ! date ( ! enactm5t ( ?is
 ,act & %all apply to claims submitt$ "u
 "p ,b ( title ,,xviii ( ! ,social      
,security ,act = hospital s]vices = :i* 
!re 0 a previ\s claim submitt$ "u "p ,a 
z inpati5t hospital s]vices or inpati5t 
critical access hospital s]vices t 0    
subject to a f9al d5ial 7z def9$ 9      
p>agraph 7#bj77;,b77iii7 ( section      
#ahdb7;b7 ( su* ,act 7#db ,u4,s4,c4     

#acieu7b77 on or aft] su* date (        
enactm5t4  7c7 ,m$ical docum5tation     
consid]$ = m$ical necessity reviews (   
claims = inpati5t hospital s]vices      
,section #ahfb7;a7 ( ! ,social ,security
 ,act 7#db ,u4,s4,c4 #aciey7a77 is am5d$
 by add+ at ! end ! foll[+ new s5t5ce3  
,a det]m9ation "u p>agraph 7#a7 ( :e!r  
inpati5t hospital s]vices or inpati5t   
critical access hospital s]vices furni%$
 to an individual on or aft] ! date ( ! 
enactm5t ( ?is s5t5ce are reasonable &  
necess>y %all be bas$ solely ^u         
in=mation available to ! admitt+        
physician at ! "t ( ! inpati5t admission
 ( ! individual = su* inpati5t s]vices1 
z docum5t$ 9 ! m$ical record4