109 HR 5433 IH: To amend title XVIII of the Social Security Act to U.S. House of Representatives 2006-05-19 text/xml EN Pursuant to Title 17 Section 105 of the United States Code, this file is not subject to copyright protection and is in the public domain.

I 109th CONGRESS 2d Session H. R. 5433 IN THE HOUSE OF REPRESENTATIVES May 19, 2006 Ms. Hooley (for herself, Mr. DeFazio, and Mr. Blumenauer) 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 for a Medicare Prescription Drug Ombudsman.

1.

Medicare Prescription Drug Ombudsman

Section 1808 of the Social Security Act (42 U.S.C. 1395b–9) is amended by adding at the end the following new subsection: (d)

Medicare Prescription Drug Ombudsman

(1)

In general

There is hereby established within the Department of Health and Human Services an Office of the Medicare Prescription Drug Ombudsman (in this subsection referred to as the Office) to be headed by a Medicare Prescription Drug Ombudsman appointed by the Secretary. The Secretary shall appoint as such Ombudsman an individual who has expertise and experience in the fields of health care and education of (and assistance to) individuals entitled to benefits under this title with respect to prescription drug coverage under part D. (2)

Duties

The Medicare Prescription Drug Ombudsman through the Office shall— (A)receive complaints, grievances, and requests for information submitted by individuals entitled to benefits under part D, participating pharmacists, physicians, and hospitals; (B)provide assistance with respect to complaints, grievances, and requests referred to in subparagraph (A), including— (i)assistance in collecting relevant information for such individuals and seeking appeal of a decision or determination made by a PDP sponsor or MA organization; (ii)assistance to such individuals with any issues arising from disenrollment from a PDP under part C or an MA–PD plan under part D; and (iii)registering complaints about the benefits under prescription drug plans and MA–PD plans and helping resolve disputes between the Centers for Medicare and Medicaid, sponsors of prescription drug plans, and organizations offering MA–PD plans and individuals entitled to benefits under part D, participating pharmacists, physicians, and hospitals; (C)provide assistance to beneficiaries in relation to State medicaid programs under title XIX and drug manufacturers in accessing medically necessary drugs that are excluded from coverage under part D; and (D)submit annual reports to Congress and the Secretary that describe the activities of the Office and that include such recommendations for improvement in the administration of part D as the Medicare Prescription Drug Ombudsman determines appropriate. The annual report under subparagraph (D) in 2007 and 2009 shall include information on the number of cases described in subparagraph (C) that are handled and the success rates in finding alternative sources of prescription drug coverage..