For carrying out, except as otherwise provided, titles XI, XVIII, XIX, and XXI of the Social Security Act, titles XIII and XXVII of the Public Health Service Act, and the Clinical Laboratory Improvement Amendments of 1988, not to exceed

Explanation

Provides a one-year appropriation from the HI and SMI Trust funds for the administration of the Medicare, Medicaid, and State Children's Health Insurance programs. The HI Trust Fund will be reimbursed for the Federal Funds

$2,733,507,000, to be transferred from the allocation of these costs through an

1/ The FY 2002 actual column reflects final (net) appropriation after all rescissions, transfers and reprogrammings.

2/ This column reflects the current estimate for FY 2003. Appropriated funds in the FY 2003 President's budget were $2,538,330,000.

3/ The fiscal years 2002 and 2003 columns include a $73.0 million comparability adjustment relating to the costs of processing Medicare appeals pursuant to the Benefits Improvement and Protection Act of 2000 (BIPA).

1/ The FY 2002 actual column reflects final (net) appropriation after all rescissions, transfers and reprogrammings. 2/ This column reflects the current estimate for FY 2003. Appropriated funds in the FY 2003 President's budget were $2,538,330,000.

3/ The fiscal year 2002 and 2003 columns include a $73.0 million comparability adjustment relating to the costs of processing Medicare appeals pursuant to the Benefits Improvement and Protection Act of 2000 (BIPA).

4/ If enacted, the user fees proposed in fiscal year 2003 and 2004 will offset our Program Management appropriation on a dollar-for-dollar basis, so that our overall program level remains unchanged.

PROGRAM MANAGEMENT

Proposed Legislation Summary

The CMS proposes new financing mechanisms totaling $201.0 million in FY 2004. These legislative proposals, and the estimated dollars associated with each, where applicable, are as follows:

PROGRAM MANAGEMENT

Medicare Operations User Fees ($201,000,000)

Charge providers who forward duplicate or unprocessable claims $2.50 per claim. ($195,000,000)

Providers who submit duplicate claims or claims with inaccurate or insufficient information are imposing an unnecessary workload on the claims processing system. In many cases, providers submit duplicate claims because they become impatient waiting for payment.

CMS and its contractors go to great lengths to ensure providers are aware of billing requirements and the need to submit accurate claims. Charging a fee would heighten provider awareness of these issues and deter this type of action. The fees received from this activity would be credited to CMS's Program Management appropriation. CMS assumes it will begin collecting this fee on March 1, 2003. The FY 2004 estimate cited above reflects a full year of collections as well an increase in the user fee from $1.50 to $2.50.

Charge providers a $50 filing fee for an appeal filed under CMS's new qualified independent review process. ($6,000,000)

CMS proposes a $50 user fee for providers who file appeals with the new qualified independent contractors (QIC) mandated by BIPA section 521. This fee is expected to raise $6 million in the first year. These funds will be used to develop an integrated, electronic case control system that will track the Medicare appeals. This new system will allow for accurate record keeping and improve the efficiency of the appeals process. No fee will be charged to beneficiaries filing appeals. The fees received from this activity will be credited to CMS's Program Management appropriation.