,,ii  #aai? ,,congress  #b;d ,session   
,s4 #ejfb  ,,9 ,,! ,,s5ate ,,( ,,!      
,,unit$ ,,/ates  ,july #bb1 #bjbf,mr4   
,cassidy introduc$ ! foll[+ bill2 :i* 0 
read twice & ref]r$ to ! ,committee on  
,f9ance  ,a ,,bill  ,to am5d title      
,,xviii ( ! ,social ,security ,act to   
require m$ic>e adm9i/rative contractors1
 unifi$ program integrity contractors1 &
 qualifi$ indep5d5t contractors to pay !
 legal fees = c]ta9 durable m$ical      
equipm5t suppli]s t 7 incorrectly d5i$  
paym5t4  #a4 ,%ort title ,?is ,act may  
be cit$ z ! ,fee ,aw>ds = ,incorrect    
,reviews ,,dme ,appeals ,act or ! ,,fair
 ,,dme ,appeals ,act4  #b4 ,paym5t (    
legal fees = c]ta9 durable m$ical       
equipm5t suppli]s incorrectly d5i$      
paym5t  7a7 ,9 g5]al ,section #ahfi ( ! 
,social ,security ,act 7#db ,u4,s4,c4   
#acie;ff7 is am5d$ by add+ at ! end !   
foll[+ new subsection3  7j7 ,paym5t (   
c]ta9 legal fees = c]ta9 durable m$ical 
equipm5t suppli]s incorrectly d5i$      
paym5t  7#a7 ,9 g5]al  7,a7 ,paym5t (   

fees ,not)/&+ section #ejd ( title #e1  
,unit$ ,/ates ,code & section #bdab (   
title #bh1 ,unit$ ,/ates ,code 7commonly
 kn[n z ! ,equal ,access to ,ju/ice     
,act71 subject to ! succe$+ subp>agraphs
 ( ?is p>agraph1 9 ! ev5t a suppli] (   
durable m$ical equipm5t w9s a favorable 
f9al appeal ( an initial det]m9ation 7& 
at ! "t ( su* initial det]m9ation1 su*  
suppli] 0 a small bus9ess conc]n1 z     
def9$ 9 section #c ( ! ,small ,bus9ess  
,act 7#ae ,u4,s4,c4 #fcb77 by a cov]$   
contractor aris+ f or relat+ to ! claims
 adm9i/ration process involv+ durable   
m$ical equipm5t "u ?is title1 su* appeal
 0 he>d by ! ,(fice ( ,m$ic>e ,he>+s &  
,appeals1 & ! adm9i/rative law judge    
he>+ su* appeal det]m9es t su* initial  
det]m9ation 0 cle>ly errone\s1 0 n      
support$ by sub/antial evid5ce1 or fail$
 to foll[ applicable provisions ( law1  
regulation1 or in/ruction issu$ by !    
,secret>y 9 effect at ! "t ( ! initial  
det]m9ation1 su* contractor 7reg>dless (
 :e!r su* contractor is a nam$ p>ty 9 ! 

appeal7 %all pay ! reasonable attorney  
fees 7z applicable7 & litigation co/s ( 
su* suppli] result+ f ! appeal ( !      
initial det]m9ation-- 7i7 at ea* /age ( 
! appeal up to & includ+ ! he>+ be=e !  
,(fice ( ,m$ic>e ,he>+s & ,appeals2 &   
7ii7 includ+ any /age ( ! appeal at :i* 
su* suppli] did n receive a favorable   
decision4  7,b7 ,splitt+ ( fees ,if1    
dur+ ! claims adm9i/rative process "u   
?is title1 a cov]$ contractor affirm$ an
 initial det]m9ation t result$ 9 a      
favorable f9al appeal describ$ 9        
subp>agraph 7,a71 su* cov]$ contractor &
 ! cov]$ contractor :o made ! initial   
det]m9ation %all ev5ly split !          
reasonable attorney fees & litigation   
co/s describ$ 9 su* subp>agraph4  7,c7  
,application ,a suppli] ( durable m$ical
 equipm5t seek+ ! paym5t ( reasonable   
attorney fees & litigation co/s "u      
subp>agraph 7,a7 %all1 by n lat] ?an #cj
 days aft] ! date ! favorable f9al      
appeal 0 issu$-- 7i7 submit an          
application = su* fees & co/s ) evid5ce 

( su* fees & co/s to ! adm9i/rative law 
judge :o he>d su* appeal2 &  7ii7 s]ve  
su* application on ea* cov]$ contractor 
t made ! initial det]m9ation or affirm$ 
su* initial det]m9ation4  7,d7          
,contractor response ,a cov]$ contractor
 %all h #cj days aft] ! date on :i* su* 
contractor is s]v$ an application "u    
clause 7ii7 ( subp>agraph 7,c7 to submit
 a response to ! adm9i/rative law judge 
describ$ 9 clause 7i7 ( su* subp>agraph4
  7,e7 ,det]m9ation  7i7 ,9 g5]al ,n    
lat] ?an #fj days aft] ! end ( !        
#cj-;day p]iod describ$ 9 subp>agraph   
7,d71 an adm9i/rative law judge describ$
 9 subp>agraph 7,c77i7 %all issue a     
det]m9ation z to ! am\nt 7if any7 (     
reasonable attorney fees & litigation   
co/s t %all be aw>d$ to a suppli] (     
durable m$ical equipm5t pursuant to     
subp>agraph 7,a74 ,9 mak+ su*           
det]m9ation1 ! adm9i/rative law judge   
%all--  7,i7 consid] evid5ce submitt$ 9 
! application describ$ 9 subp>agraph    
7,c77i7 & any response submitt$ "u      

subp>agraph 7,d72  7,,ii7 ) respect to  
reasonable attorney fees1 use ! lode/>  
me?od2 &  7,,iii7 if m ?an #a cov]$     
contractor 0 s]v$ "u subp>agraph        
7,c77ii71 specify ! am\nt ow$ by ea*    
cov]$ contractor4  7ii7 ,non-appealable 
decision ,any det]m9ation made pursuant 
to clause 7i7 %all n be appealable4     
7#b7 ,ineligibility ( c]ta9 paym5ts     
,p>agraph 7#a7 %all n apply to a        
favorable f9al appeal ( an initial      
det]m9ation by a cov]$ contractor won by
 a suppli] ( durable m$ical equipm5t :5 
! initial unfavorable det]m9ation       
result$ f-- 7,a7 su* suppli] fail+ to   
provide any requir$ docum5tation2  7,b7 
su* suppli] fail+ to comply ) any bill+ 
or submission requirem5t2 or  7,c7 a    
cov]$ contractor-- 7i7 apply+ curr5t law
 or guidance issu$ by ! ,secret>y 9     
effect at ! "t ! initial det]m9ation 0  
made1 & su* law or guidance _h *ang$ at 
! "t ( ! favorable f9al appeal2 or  7ii7
 apply+ a local cov]age det]m9ation 9   
effect at ! "t ( ! initial det]m9ation4 

7#c7 ,clawback ,if1 aft] any reasonable 
attorney fees or litigation co/s h be5  
aw>d$ to a suppli] ( durable m$ical     
equipm5t "u ?is subsection1 a c\rt or   
o!r adjudicator det]m9es t su* suppli]  
obta9$ a favorable f9al appeal ?r\gh    
fraud1 misrepres5tation1 or bad-fai?    
conduct1 su* suppli] %all be requir$ to 
return su* fees or co/s to ea* cov]$    
contractor :o 0 requir$ to pay su* fees 
or co/s to su* suppli]4  7#d7           
,def9itions ,9 ?is subsection3 7,a7     
,cov]$ contractor ,! t]m cov]$          
contractor means-- 7i7 an eligible      
entity ) a contract "u section #ahic2   
7ii7 a qualifi$ indep5d5t contractor 7z 
def9$ 9 subsection 7c77#b772 or  7iii7 a
 m$ic>e adm9i/rative contractor 7z def9$
 9 section #ahgd;,a7a77#c774  7,b7      
,favorable ,! t]m favorable means1 )    
respect to an appeal ( a decision aris+ 
f or relat+ to ! claims adm9i/ration    
process "u ?is title1 a decision t is   
decid$ 9 ! appellant's favor ) respect  
to e issue relat$ to cov]age & paym5t   

rules or ! application ( eligibility1   
entitlem5t1 or premium rules4  7,c7     
,f9al appeal ,! t]m f9al appeal means ! 
la/ /age ( review available )9 ! claims 
adm9i/ration process "u ?is title 9     
:i*-- 7i7 ! only appeal available is a  
review by ! ,m$ic>e ,appeals ,c\ncil2 & 
7ii7 an adm9i/rative law judge ent]s a  
b9d+ det]m9ation ( ! rights or          
obligations ( ! p>ties4  7,d7           
,litigation co/s ,! t]m litigation co/s 
means1 ) respect to a favorable f9al    
appeal by a suppli] ( durable m$ical    
equipm5t1 out-(-pocket exp5ses 7n       
includ+ reasonable attorney fees7       
incurr$ 9 ! c\rse ( litigation t are    
traditionally taxable or recov]able by a
 prevail+ p>ty "u /atute1 rule1 or      
contract4  7,e7 ,reasonable attorney    
fees ,! t]m reasonable attorney fees    
means1 ) respect to a favorable f9al    
appeal by a suppli] ( durable m$ical    
equipm5t1 comp5sation = ! reasonable "t 
exp5d$ by an attorney or p>alegal on    
legal "w necess>y to litigation4  4  7b7

 ,m$ic>e adm9i/rative contractors       
,section #ahgd;,a7d77#d7 ( ! ,social    
,security ,act 7#db ,u4,s4,c4           
#aciekk-#a7;d77#d77 is am5d$-- 7#a7 9   
subp>agraph 7,a71 by /rik+ 7,b7 & 7,d7 &
 ins]t+ 7,b71 7,c71 & 7,d72 &  7#b7 9   
subp>agraph 7,c7-- 7,a7 by /rik+        
,indemnification4--,indemnification &   
ins]t+ ,indemnification4-- 7i7 ,9 g5]al 
,subject to clause 7ii71 indemnification
  2 &  7,b7 by add+ at ! end ! foll[+   
new clause3  7ii7 ,no indemnification = 
legal fees ,no reasonable attorney fees 
or litigation co/s aw>d$ to a suppli] ( 
durable m$ical equipm5t "u section      
#ahfi7;j7 %all be subject to            
indemnification by ! ,secret>y "u       
subp>agraph 7,a74  4  7c7 ,unifi$       
program integrity contractors ,section  
#ahic7;e7 ( ! ,social ,security ,act    
7#db ,u4,s4,c4 #acie;ddd7e77 is am5d$-- 
7#a7 by /rik+ ,liability4--,! ,secret>y 
& ins]t+ ,liability4-- 7#a7 ,9 g5]al    
,subject to p>agraph 7#b71 ! ,secret>y  
2 &  7#b7 by add+ at ! end ! foll[+ new 

p>agraph3  7#b7 ,paym5t ( c]ta9 legal   
fees ,any regulation promulgat$ by !    
,secret>y "u p>agraph 7#a7 %all n       
include any limitation ( a contractor's 
liability = any reasonable attorney fees
 or litigation co/s aw>d$ to a suppli] (
 durable m$ical equipm5t "u section     
#ahfi7;j74  4  7d7 ,qualifi$ indep5d5t  
contractors ,section #ahfi7;c77#e7 ( !  
,social ,security ,act 7#db ,u4,s4,c4   
#acie;ff7c77#e77 is am5d$-- 7#a7 by     
/rik+ liability4--,no qualifi$ & ins]t+ 
liability4-- 7,a7 ,9 g5]al ,subject to  
subp>agraph 7,b71 no qualifi$  2 &  7#b7
 by ins]t+ at ! end ! foll[+ new        
subp>agraph3  7,b7 ,paym5t ( c]ta9 legal
 fees ,subp>agraph 7,a7 %all n apply to 
any reasonable attorney fees or         
litigation co/s aw>d$ to a suppli] (    
durable m$ical equipm5t "u subsection   
7j74  4  7e7 ,implem5tation ,n lat] ?an 
#b ye>s aft] ! date ( enactm5t ( ?is    
,act1 ! ,secret>y %all promulgate       
regulations to c>ry out ! am5dm5ts made 
by ?is section4  7f7 ,effective date ,! 

am5dm5ts made by ?is section %all apply 
to contracts ent]$ into on or aft]      
,janu>y #a ( ! ye> foll[+ ! ye> 9 :i* ! 
,secret>y promulgates ! regulations     
describ$ 9 subsection 7e74