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医疗保险二次支付者(MSP)条款变更——医疗保健财务管理局。通知。

Changes to Medicare Secondary Payer (MSP) provisions--HCFA. Notice.

出版信息

Fed Regist. 1991 Jan 11;56(8):1200-2.

PMID:10109426
Abstract

This notice describes how subsections 6202(b), (c), and (e) of the Omnibus Budget Reconciliation Act of 1989 (Pub. L. 101-239) affect the Medicare Program These subsections: Create uniform rules for computing Medicare secondary payments for all MSP situations; Exempt from the MSP provisions services performed for a religious order by members of the order who take a vow of poverty; Prohibit group health plans (GHPs) from "taking into account" that an individual is entitled to Medicare when Medicare is the secondary payer; Prohibit GHPs from differentiating, in the services they provide, between individuals with end-stage renal disease (ESRD) and other individuals covered by the plan; Require that GHPs of employers of 20 or more employees provide the same benefits under the same conditions to employees age 65 or older and employees' spouses age 65 or older as they provide to employees and spouses under age 65; Impose a 25 percent excise tax on contributions that employers and employee organizations make to nonconforming GHPs, i.e., plans that do not comply with the MSP provisions; Extend to all MSP situations the Federal Government's right to take legal action to collect double damages if a primary plan fails to comply with the Medicare secondary payment requirements of the law; Make the provisions for special enrollment periods for the disabled parallel to those in effect for the working aged. The statutory changes made by subsections 6202(b), (c), and (e) can be put into effect without first issuing regulations because it is clear on the face of the statute what the Congress intended.(ABSTRACT TRUNCATED AT 250 WORDS)

摘要

本通知描述了1989年《综合预算协调法案》(公法第101 - 239号)第6202(b)、(c)和(e)节如何影响医疗保险计划。这些条款:为所有医疗保险二次支付(MSP)情况制定统一的计算规则;豁免遵守贫困誓言的宗教团体成员为该团体提供的服务适用MSP条款;禁止团体健康计划(GHP)在医疗保险为二次支付方时“考虑”个人有权享受医疗保险这一情况;禁止GHP在其提供的服务中区分终末期肾病(ESRD)患者和该计划覆盖的其他人员;要求拥有20名或更多员工的雇主的GHP在相同条件下为65岁及以上的员工及其65岁及以上的配偶提供与为65岁以下的员工及其配偶提供的相同福利;对雇主和员工组织向不符合规定的GHP(即不遵守MSP条款的计划)所缴纳的款项征收25%的消费税;将联邦政府在主要计划未遵守法律的医疗保险二次支付要求时采取法律行动收取双倍赔偿金的权利扩展到所有MSP情况;使针对残疾人士的特殊注册期规定与针对在职年龄人士的现行规定平行。第6202(b)、(c)和(e)节所做的法定变更无需先发布法规即可生效,因为法规表面上很清楚国会的意图。(摘要截断于250字)

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