[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1474 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 1474

To amend title XVIII of the Social Security Act to require the sponsor 
 of a prescription drug plan or an organization offering an MA-PD plan 
   to promptly pay claims submitted under part D and to prohibit the 
     inclusion of certain identifying information of pharmacies on 
  explanatory prescription drug information and cards distributed by 
                    prescription drug plan sponsors.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 12, 2007

 Mr. Berry (for himself, Ms. Herseth, Mr. Jones of North Carolina, Mr. 
 Wicker, Mr. Allen, Mr. Aderholt, Mr. Ross, Mr. Graves, Mrs. Emerson, 
 Mr. Courtney, and Mr. Moran of Kansas) 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 require the sponsor 
 of a prescription drug plan or an organization offering an MA-PD plan 
   to promptly pay claims submitted under part D and to prohibit the 
     inclusion of certain identifying information of pharmacies on 
  explanatory prescription drug information and cards distributed by 
                    prescription drug plan sponsors.

    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 ``Fair and Speedy Treatment (FAST) of 
Medicare Prescription Drug Claims Act of 2007''.

SEC. 2. PROMPT PAYMENT BY MEDICARE PRESCRIPTION DRUG PLANS AND MA-PD 
              PLANS UNDER PART D.

    (a) Application to Prescription Drug Plans.--Section 1860D-12(b) of 
the Social Security Act (42 U.S.C. 1395w-112 (b)) is amended by adding 
at the end the following new paragraph:
            ``(4) Prompt payment of clean claims.--
                    ``(A) Prompt payment.--Each contract entered into 
                with a PDP sponsor under this subsection with respect 
                to a prescription drug plan offered by such sponsor 
                shall provide that payment shall be issued, mailed, or 
                otherwise transmitted with respect to all clean claims 
                submitted under this part within the applicable number 
                of calendar days after the date on which the claim is 
                received.
                    ``(B) Definitions.--In this paragraph:
                            ``(I) Clean claim.--The term `clean claim' 
                        means a claim, with respect to a covered part D 
                        drug, that has no apparent defect or 
                        impropriety (including any lack of any required 
                        substantiating documentation) or particular 
                        circumstance requiring special treatment that 
                        prevents timely payment from being made on the 
                        claim under this part.
                            ``(ii) Applicable number of calendar 
                        days.--The term `applicable number of calendar 
                        days' means--
                                    ``(I) with respect to claims 
                                submitted electronically, 14 calendar 
                                days; and
                                    ``(II) with respect to claims 
                                submitted otherwise, 30 calendar days.
                    ``(c) Interest payment.--If payment is not issued, 
                mailed, or otherwise transmitted within the applicable 
                number of calendar days (as defined in subparagraph 
                (B)) after a clean claim is received, interest shall be 
                paid at a rate used for purposes of section 3902(a) of 
                title 31, United States Code (relating to interest 
                penalties for failure to make prompt payments), for the 
                period beginning on the day after the required payment 
                date and ending on the date on which payment is made.
                    ``(D) Procedures involving claims.--
                            ``(I) Claims deemed to be clean claims.--
                                    ``(I) In general.--A claim for a 
                                covered part D drug shall be deemed to 
                                be a clean claim for purposes of this 
                                paragraph if the PDP sponsor involved 
                                does not provide a notification of 
                                deficiency to the claimant by the 10th 
                                day that begins after the date on which 
                                the claim is submitted.
                                    ``(II) Notification of 
                                deficiency.--For purposes of subclause 
                                (II), the term `notification of 
                                deficiency' means a notification that 
                                specifies all defects or improprieties 
                                in the claim involved and that lists 
                                all additional information or documents 
                                necessary for the proper processing and 
                                payment of the claim.
                            ``(ii) Payment of clean portions of 
                        claims.--A PDP sponsor shall, as appropriate, 
                        pay any portion of a claim for a covered part D 
                        drug that would be a clean claim but for a 
                        defect or impropriety in a separate portion of 
                        the claim in accordance with subparagraph (A).
                            ``(iii) Obligation to pay.--A claim for a 
                        covered part D drug submitted to a PDP sponsor 
                        that is not paid or contested by the provider 
                        within the applicable number of calendar days 
                        (as defined in subparagraph (B)) shall be 
                        deemed to be a clean claim and shall be paid by 
                        the PDP sponsor in accordance with subparagraph 
                        (A).
                            ``(iv) Date of payment of claim.--Payment 
                        of a clean claim under subparagraph (A) is 
                        considered to have been made on the date on 
                        which full payment is received by the provider.
                    ``(E) Electronic transfer of funds.--A PDP sponsor 
                shall pay all clean claims submitted electronically by 
                an electronic funds transfer mechanism.''.
    (b) Application to MA-PD Plans.--Section 1857(f) of such Act (42 
U.S.C. 1395w-27) is amended by adding at the end the following new 
paragraph:
            ``(3) Incorporation of certain prescription drug plan 
        contract requirements.--The provisions of section 1860D-
        12(b)(4) shall apply to contracts with a Medicare Advantage 
        organization in the same manner as they apply to contracts with 
        a PDP sponsor offering a prescription drug plan under part 
        D.''.
    (c) Effective Date.--The amendments made by this section shall 
apply to contracts entered into or renewed on or after the date of the 
enactment of this Act.

SEC. 3. RESTRICTION ON CO-BRANDING.

    (a) Application to Prescription Drug Information Disseminated.--
Subsection (a) of section 1860D-4 of the Social Security Act (42 U.S.C. 
1395w-104) is amended by adding at the end the following new paragraph:
            ``(5) Restriction on displaying pharmacy brand or trademark 
        information.--
                    ``(A) In general.--It is unlawful for a PDP sponsor 
                of a prescription drug plan to display on any 
                explanatory information described in subparagraph (B), 
                with respect to benefits provided under this part, the 
                brand or trademark of any pharmacy.
                    ``(B) Explanatory information described.--For 
                purposes of subparagraph (A), explanatory information 
                is each of the following:
                            ``(i) Information on evidence of coverage 
                        under this part.
                            ``(ii) Information that summarizes benefits 
                        provided under this part.
                            ``(iii) Enrollment and disenrollment forms.
                            ``(iv) Enrollment and disenrollment 
                        letters.
                            ``(v) Pharmacy directories.
                            ``(vi) Formulary information.
                            ``(vii) Grievance letters provided pursuant 
                        to subsection (f), coverage determination 
                        letters provided pursuant to subsection (g), 
                        and appeals letters provided pursuant to 
                        subsection (h).
                            ``(viii) Exceptions process letters.
                            ``(ix) Information contained in sales 
                        descriptions or sales presentations.''.
    (b) Application to Enrollee Cards.--Subsection (b)(2)(A) of such 
section is amended by adding at the end the following new sentence: 
``It is unlawful for a PDP sponsor of a prescription drug plan to 
display on such a card the name, brand, or trademark of any pharmacy.''
    (c) Effective Date.--
            (1) Explanatory information.--With respect to explanatory 
        information dispensed on or after the date of the enactment of 
        this Act, the amendment made by subsection (a) shall apply to 
        such information on and after the date that is 90 days after 
        such date of enactment.
            (2) Enrollee cards.--With respect to cards dispensed 
        before, on, or after the date of the enactment of this Act, the 
        amendment made by subsection (b) shall apply to such cards on 
        and after the date that is 90 days after such date of 
        enactment. Any card dispensed before such date that is 90 days 
        after the date of enactment that violates the second sentence 
        of section 1860D-4(b)(2)(A) of the Social Security Act, as 
        added by subsection (b), shall be reissued by such 90-day date.
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