Page:United States Statutes at Large Volume 103 Part 3.djvu/163

 PUBLIC LAW 101-239—DEC. 19, 1989 103 STAT. 2231 "(C) INDIVIDUAI^ WITH END STAGE RENAL DISEASE.— A group health plan (as defined in subparagraph (A)(v))— "(i) may not take into account that an individual is entitled to benefits under this title solelv by reason of section 226A during the 12-month period which begins with the earlier of— "(I) the month in which a regular course of renal dialvBis is initiated, or "(U) in the case of an individual who receives a kidney transplant, the first month in which he would be eligible for benefits under part A (if he had filed an application for such benefits) under the provisions of section 226A(b)(l)(B); and "(ii) may not differentiate in the benefits it provides between individuals having end stage renal disease and other individuals covered by such plan on the basis of the existence of end stage renal disease, the need for rencd dialysis, or in any other manner; except that clause (ii) shall not prohibit a plan from taking into account that an individual is entitled to benefits under this title solely by reason of section 226A after the end of the 12-month period described in clause (i). "(2) MEDICARE SECONDARY PAYER.— "(A) IN GENERAL.— Payment under this title may not be made, except as provided in subparagraph (B), with respect to any item or service to the extent that— "(i) payment has been made, or can reasonably be expected to be made, with respect to the item or service as required under paragraph (1), or "(ii) payment has been made or can reasonably be expected to be made promptly (as determined in accord- ance with regulations) under a workmen's compensa- tion law or plan of the United States or a State or under an automobile or liability insurance policy or plan (including a self-insured plan) or under no fault insur- ance. In this subsection, the term 'primazy plan' means a group health plan or large group health plan, to the extent that clause (i) applies, and a workmen s compensation law or plan, an automobile or liability insurance policy or plan (including a self-insured plan) or no fault insurance, to the extent that clause (ii) applies. "(B) CONDITIONAL PAYMENT.— "(i) PRIMARY PLANS.—Any payment under this title with respect to any item or service to which subpara- graph (A) applies shall be conditioned on reimburse- ment to the appropriate Trust Fund established by this title when notice or other information is received that payment for such item or service has been or could be made under such subparagraph. "(ii) ACTION BY UNITED STATES. —In order to recover payment under this title for such an item or service, the United States may bring an action against an;y entity which is required or responsible under this subsection to pay with respect to such item or service (or any portion thereof) under a primary plan (and may, in accordance with paragraph (3)(A) collect double

�