[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4645 Introduced in House (IH)]







109th CONGRESS
  1st Session
                                H. R. 4645

To amend title XVIII of the Social Security Act to provide broader and 
more informed protection to Medicare eligible individuals from abusive 
marketing practices of Medicare prescription drug plans and MA-PD plans 
 to permit enrollees under Medicare prescription drug plans that have 
         been sanctioned to elect to enroll under other plans.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           December 18, 2005

 Ms. Schwartz of Pennsylvania (for herself and Mrs. Lowey) introduced 
 the following bill; which was referred to the Committee on Energy and 
  Commerce, and in addition to the Committee on Ways and Means, 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 concerned

_______________________________________________________________________

                                 A BILL


 
To amend title XVIII of the Social Security Act to provide broader and 
more informed protection to Medicare eligible individuals from abusive 
marketing practices of Medicare prescription drug plans and MA-PD plans 
 to permit enrollees under Medicare prescription drug plans that have 
         been sanctioned to elect to enroll under other plans.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Preventing Medicare Seniors from 
being Confused due to Abusive Marketing (Prevent Medicare SCAMs) Act of 
2005''.

SEC. 2. STRICTER PENALTIES FOR MA-PD PLANS AND MEDICARE PRESCRIPTION 
              DRUG PLANS THAT VIOLATE MARKETING REQUIREMENTS.

    Section 1857(g) of the Social Security Act (42 U.S.C. 1395w-27(g)) 
is amended by adding at the end the following new paragraph:
            ``(5) Determinations related to violations of marketing 
        requirements of ma-pd plans and prescription drug plans.--For 
        purposes of paragraphs (2) and (3), in the case that the 
        Secretary makes a determination under paragraph (1)(E)(ii) or 
        subsection (c)(2) because an MA-PD plan under this part or a 
        prescription drug plan under part D is in violation of an 
        applicable requirement relating to marketing and such a 
        violation involves mail, phone calls, emails, or pieces of 
        other marketing material or communication specified by the 
        Secretary, each piece of mail, each phone call, each email, and 
        each piece of other marketing material or communication 
        involved shall represent a separate determination of such a 
        violation.''.

SEC. 3. PUBLIC NOTIFICATION OF MEDICARE PRESCRIPTION DRUG PLANS AND MA-
              PD PLANS THAT HABITUALLY RECEIVE INTERMEDIATE SANCTIONS.

    Section 1860D-4(a) of such Act (42 U.S.C. 13953-104(a)) is amended 
by adding at the end the following new paragraph:
            ``(5) Public notification of medicare prescription drug 
        plans and ma-pd plans with habitual violations.--
                    ``(A) In general.--For 2008 and each succeeding 
                year, not later than the notice and posting date 
                described in subparagraph (C) for such a year, the 
                Secretary shall--
                            ``(i) provide written notice to each part D 
                        eligible individual of the prescription drug 
                        habitual sanctions information described in 
                        subparagraph (B); and
                            ``(ii) post such information on the 
                        official public Internet site of the Department 
                        of Health and Human Services and the official 
                        public Internet site of the Centers of Medicare 
                        & Medicaid Services.
                    ``(B) Prescription drug habitual sanctions 
                information.--For purposes of subparagraph (A), the 
                prescription drug habitual sanctions information 
                described in this subparagraph for a year is the 
                following:
                            ``(i) The name of--
                                    ``(I) each prescription drug plan 
                                under this part to which the Secretary 
                                applied at least three sanctions under 
                                section 1857(g), as applied under 
                                section 1860D-12(b)(3)(E), during any 
                                24-month period that preceeds the 
                                applicable notice and posting date for 
                                such year; and
                                    ``(II) each MA-PD plan under part C 
                                to which the Secretary applied at least 
                                three sanctions under section 1857(g) 
                                during such 24-month period.
                            ``(ii) For each plan described in clause 
                        (i), a description of the date and type of 
                        violation for each sanction described in such 
                        clause.
                    ``(C) Notice and posting date.--For purposes of 
                this paragraph, the notice and posting date described 
                in this subparagraph for 2008 and each succeeding year 
                is the first day of the annual, coordinated election 
                period under section 1851(e)(3)(B)(iv) for such 
                year.''.

SEC. 4. PERMITTING MEDICARE BENEFICIARIES ENROLLED UNDER SANCTIONED 
              PRESCRIPTION DRUG PLANS TO ENROLL UNDER OTHER PLANS.

    Section 1860D-1(b)(3) of the Social Security Act (42 U.S.C. 1395w-
101(b)(3)) is amended by adding at the end the following new 
subparagraph:
            ``(F) Enrollment under sanctioned prescription drug plan.--
        In the case of a part D eligible individual who is enrolled in 
        a prescription drug plan, if enrollment in the plan is 
        suspended under section 1857(g)(3)(C), as applied under section 
        1860D-12(b)(3)(E), because of a failure of the plan to meet 
        applicable requirements relating to marketing or provision of 
        services, the special enrollment period shall be the period of 
        such suspension of enrollment.''.

SEC. 5. GAO STUDY ON ANTI-FRAUD AND ABUSE PROVISIONS AND SANCTIONS FOR 
              MEDICARE PRESCRIPTION DRUG BENEFIT AND UNDER MA-PD PLANS.

    (a) Study.--Not later than November 15, 2007, the Comptroller 
General of the United States shall conduct a study--
            (1) to identify and describe each anti-fraud and abuse 
        provision (including intermediate sanctions relating to such 
        provisions) that is applicable to an MA-PD plan under part C of 
        title XVIII of the Social Security Act or a prescription drug 
        plan under part D of such title; and
            (2) to assess the effectiveness of the provisions described 
        in paragraph (1) and the overall compliance of MA-PD plans 
        under part C of title XVIII of such Act and prescription drug 
        plans under part D of such title with such provisions.
    (b) Report.--Not later than May 15, 2008, the Comptroller General 
of the United States shall submit a report to Congress of the results 
of the study under subsection (a).
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