HR 6359 IHCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to enhance beneficiary protections under parts C and D of the Medicare Program.CommentsClose CommentsPermalink

June 24, 2008CommentsClose CommentsPermalink

Mrs. BIGGERT introduced the following bill; which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concernedCommentsClose CommentsPermalink

To amend title XVIII of the Social Security Act to enhance beneficiary protections under parts C and D of the Medicare Program.CommentsClose CommentsPermalink

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,CommentsClose CommentsPermalink

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘Medicare Beneficiary Protection Act of 2008’.CommentsClose CommentsPermalink

SEC. 2. MEDICARE PLAN COMPLAINT SYSTEM.

(a) System- Section 1808 of the Social Security Act (42 U.S.C. 1395b-9) is amended--CommentsClose CommentsPermalink





(1) in subsection (c)(2)--CommentsClose CommentsPermalink





(A) in subparagraph (B)(iii), by striking ‘adjustment; and’ and inserting ‘adjustment);’;CommentsClose CommentsPermalink





(B) in subparagraph (C), by striking the period at the end and inserting ‘; and’; andCommentsClose CommentsPermalink





(C) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





‘(D) develop and maintain the plan complaint system under subsection (d).’; andCommentsClose CommentsPermalink





(2) by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(d) Plan Complaint System-CommentsClose CommentsPermalink





‘(1) SYSTEM-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The Secretary shall develop and maintain a plan complaint system, (in this subsection referred to as the ‘system’) to--CommentsClose CommentsPermalink





‘(i) collect and maintain information on plan complaints;CommentsClose CommentsPermalink





‘(ii) track plan complaints from the date the complaint is logged into the system through the date the complaint is resolved; andCommentsClose CommentsPermalink





‘(iii) otherwise improve the process for reporting plan complaints.CommentsClose CommentsPermalink





‘(B) TIMEFRAME- The Secretary shall have the system in place by not later than the date that is 6 months after the date of enactment of this subsection.CommentsClose CommentsPermalink





‘(C) PLAN COMPLAINT DEFINED- In this subsection, the term ‘plan complaint’ means a complaint that is received (including by telephone, letter, e-mail, or any other means) by the Secretary (including by a regional office or the Medicare Beneficiary Ombudsman) from a Medicare Advantage eligible individual or a Part D eligible individual (or an individual representing such an individual) regarding Medicare Advantage organizations, Medicare Advantage plans, prescription drug plan sponsors, or prescription drug plans, including complaints relating to marketing, enrollment, covered drugs, premiums and cost-sharing, and participating providers.CommentsClose CommentsPermalink





‘(2) PROCESS CRITERIA- In developing the system, the Secretary shall establish a process for reporting plan complaints. Such process shall meet the following criteria:CommentsClose CommentsPermalink





‘(A) ACCESSIBLE- The process is widely known and easy to use.CommentsClose CommentsPermalink





‘(B) INVESTIGATIVE CAPACITY- The process involves the appropriate experts, resources, and methods to assess complaints and determine whether they reflect an underlying pattern.CommentsClose CommentsPermalink





‘(C) INTERVENTION AND FOLLOW-THROUGH- The process triggers appropriate interventions and monitoring based on substantiated complaints.CommentsClose CommentsPermalink





‘(D) QUALITY IMPROVEMENT ORIENTATION- The process guides quality improvement.CommentsClose CommentsPermalink





‘(E) RESPONSIVENESS- The process routinely provides consistent, clear, and substantive responses to complaints.CommentsClose CommentsPermalink





‘(F) TIMELINES- Each process step is completed within a reasonable, established time frame, and mechanisms exist to deal quickly with complaints of an emergency nature requiring immediate attention.CommentsClose CommentsPermalink





‘(G) OBJECTIVE- The process is unbiased, balancing the rights of each party.CommentsClose CommentsPermalink





‘(H) PUBLIC ACCOUNTABILITY- The process makes complaint information available to the public.CommentsClose CommentsPermalink





‘(3) STANDARD DATA REPORTING REQUIREMENTS-CommentsClose CommentsPermalink





‘(A) IN GENERAL- The Secretary shall establish standard data reporting requirements for reporting plan complaints under the system.CommentsClose CommentsPermalink





‘(B) MODEL ELECTRONIC COMPLAINT FORM- The Secretary shall develop a model electronic complaint form to be used for reporting plan complaints under the system. Such form shall be prominently displayed on the front page of the Medicare.gov Internet website and on the Internet website of the Medicare Beneficiary Ombudsman.CommentsClose CommentsPermalink





‘(4) ALL COMPLAINTS REQUIRED TO BE LOGGED INTO THE SYSTEM- Every plan complaint shall be logged into the system.CommentsClose CommentsPermalink





‘(5) CASEWORK NOTATIONS- The system shall provide for the inclusion of any casework notations throughout the complaint process on the record of a plan complaint.CommentsClose CommentsPermalink





‘(6) MEDICARE BENEFICIARY OMBUDSMAN- The Secretary shall carry out this subsection acting through the Medicare Beneficiary Ombudsman.’.CommentsClose CommentsPermalink





(b) Funding- There are authorized to be appropriated such sums as may be necessary for the costs of carrying out section 1808(d) of the Social Security Act, as added by subsection (a).CommentsClose CommentsPermalink





(c) Reports-CommentsClose CommentsPermalink





(1) SECRETARY-CommentsClose CommentsPermalink





(A) ONGOING STUDY- The Medicare Beneficiary Ombudsman (under subsection (c) of section 1808) of the Social Security Act (42 U.S.C. 1395b-9) shall conduct an ongoing study of the plan complaint system established under subsection (d) of such section (as added by subsection (a)), in this subsection referred to as the ‘system’. Such study shall include an analysis of--CommentsClose CommentsPermalink





(i) the numbers and types of complaints reported under the system;CommentsClose CommentsPermalink





(ii) geographic variations in such complaints;CommentsClose CommentsPermalink





(iii) the timeliness of agency or plan responses to such complaints; andCommentsClose CommentsPermalink





(iv) the resolution of such complaints.CommentsClose CommentsPermalink





(B) QUARTERLY REPORTS- Not later than 6 months after the implementation of the system, and every 3 months thereafter, the Secretary of Health and Human Services shall submit to Congress a report on the study conducted under subparagraph (A), together with recommendations for such legislation and administrative actions as the Secretary determines appropriate.CommentsClose CommentsPermalink





(2) INSPECTOR GENERAL- The Inspector General of the Department of Health and Human Services shall conduct an evaluation of the system. Not later than 1 year after the implementation of the system, the Inspector General shall submit to Congress a report on such evaluation, together with recommendations for such legislation and administrative actions as the Inspector General determines appropriate.CommentsClose CommentsPermalink

SEC. 3. REQUIREMENT FOR NON-NETWORK MEDICARE ADVANTAGE PRIVATE FEE-FOR-SERVICE PLANS TO DISCLOSE PROVIDERS THAT REFUSE TO ACCEPT ENROLLEES IN THE PLAN.

(a) In General- Section 1852(c)(1) of the Social Security Act (42 U.S.C. 1395w-22(c)(1)) is amended is amended by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





‘(J) In the case of a Medicare Advantage private fee-for-service plan that meets the access standards under subsection (d)(4), in whole or in part, through the establishment of payment rates meeting the requirements under subparagraph (A) of such subsection rather than through entering into written contracts as provided for under subparagraph (B) of such subsection, a list of providers in the service area of the plan who, during the previous 12 months, have refused to accept enrollees in the plan pursuant to the deeming provisions under subsection (j)(6).’.CommentsClose CommentsPermalink





(b) Effective Date- The amendment made by subsection (a) shall take effect on the date that is 90 days after the date of enactment of this Act.CommentsClose CommentsPermalink

SEC. 4. PROHIBITION ON PROVIDING CERTAIN INDUCEMENTS AND ON COLD-CALLING, CROSS-SELLING, AND UP-SELLING IN THE MARKETING OF MA PLANS AND PRESCRIPTION DRUG PLANS.

(a) Medicare Advantage Program- Section 1851(h)(4) of the Social Security Act (42 U.S.C. 1395w-21(h)(4)) is amended--CommentsClose CommentsPermalink





(1) in subparagraph (A)--CommentsClose CommentsPermalink





(A) by inserting ‘or provide for meals or other items of monetary value’ after ‘rebates’; andCommentsClose CommentsPermalink





(B) by striking ‘, and’ at the end and inserting a semicolon;CommentsClose CommentsPermalink





(2) in subparagraph (B), by striking the period at the end and inserting ‘; and’; andCommentsClose CommentsPermalink





(3) by adding at the end the following new subparagraph:CommentsClose CommentsPermalink





‘(C) shall not permit a Medicare Advantage organization to--CommentsClose CommentsPermalink





‘(i) market enrollment in a Medicare Advantage plan by telemarketing or in-home solicitation;CommentsClose CommentsPermalink





‘(ii) engage in the cross-selling of non-Medicare products or services with products or services offered by a Medicare Advantage plan; orCommentsClose CommentsPermalink





‘(iii) engage in up-selling from prescription drug plans under part D to Medicare Advantage plans,CommentsClose CommentsPermalink





except that in no case shall the prohibitions under this subparagraph be construed as prohibiting such telemarketing, in-home solicitation, cross-selling, or up-selling that is conducted at the request of the individual.’.CommentsClose CommentsPermalink





(b) Medicare Prescription Drug Program- Section 1860D-4 of the Social Security Act (42 U.S.C. 1395w-104) is amended by adding at the end the following new subsection:CommentsClose CommentsPermalink





‘(l) Prohibition on Certain Marketing Practices- The limitations on marketing practices under section 1851(h)(4)(C) shall apply to a PDP sponsor and a prescription drug plan in the same manner as such limitations apply to Medicare Advantage organizations and Medicare Advantage plans.’.CommentsClose CommentsPermalink





(c) Effective Date- The amendments made by this section shall take effect on the date that is 90 days after the date of enactment of this Act.CommentsClose CommentsPermalink

SEC. 5. ENROLLMENT IMPROVEMENTS UNDER MEDICARE PARTS C AND D.

(a) Special Election Period During First 60 Days of Enrollment in a New Plan-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1851(e)(4) of the Social Security Act (42 U.S.C. 1395w(e)(4)) is amended--CommentsClose CommentsPermalink





(A) in subparagraph (C), by striking ‘or’ at the end;CommentsClose CommentsPermalink





(B) by redesignating subparagraph (D) as subparagraph (E); andCommentsClose CommentsPermalink





(C) by inserting after subparagraph (C) the following new subparagraph:CommentsClose CommentsPermalink





‘(D) the individual has been enrolled in such plan for fewer than 60 days; or’.CommentsClose CommentsPermalink





(2) EFFECTIVE DATE- The amendments made by paragraph (1) shall take effect on the date that is 90 days after the date of enactment of this Act.CommentsClose CommentsPermalink





(b) Extension of the Annual, Coordinated Election Period-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1851(e)(3)(B)(iv) of the Social Security Act (42 U.S.C. 1395w-1(e)(3)(B)(iv)) is amended by striking ‘November 15’ and inserting ‘October 1’.CommentsClose CommentsPermalink





(2) EFFECTIVE DATE- The amendment made by paragraph (1) shall apply to annual, coordinated election periods beginning after the date of enactment of this Act.CommentsClose CommentsPermalink





(c) Coordination Under Parts C and D of the Continuous Open Enrollment and Disenrollment Period for the First 3 Months of the Year-CommentsClose CommentsPermalink





(1) IN GENERAL- Section 1860D-1(b)(1)(B)(iii) of the Social Security Act (42 U.S.C. 1395w-101(b)(1)(B)(iii)) is amended by striking ‘, (C),’.CommentsClose CommentsPermalink





(2) EFFECTIVE DATE- The amendment made by paragraph (1) shall take effect on January 1, 2009.CommentsClose CommentsPermalink