[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6359 Introduced in House (IH)]







110th CONGRESS
  2d Session
                                H. R. 6359

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


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 24, 2008

 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 concerned

_______________________________________________________________________

                                 A BILL


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

    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 ``Medicare Beneficiary Protection Act 
of 2008''.

SEC. 2. MEDICARE PLAN COMPLAINT SYSTEM.

    (a) System.--Section 1808 of the Social Security Act (42 U.S.C. 
1395b-9) is amended--
            (1) in subsection (c)(2)--
                    (A) in subparagraph (B)(iii), by striking 
                ``adjustment; and'' and inserting ``adjustment);'';
                    (B) in subparagraph (C), by striking the period at 
                the end and inserting ``; and''; and
                    (C) by adding at the end the following new 
                subparagraph:
                    ``(D) develop and maintain the plan complaint 
                system under subsection (d).''; and
            (2) by adding at the end the following new subsection:
    ``(d) Plan Complaint System.--
            ``(1) System.--
                    ``(A) In general.--The Secretary shall develop and 
                maintain a plan complaint system, (in this subsection 
                referred to as the `system') to--
                            ``(i) collect and maintain information on 
                        plan complaints;
                            ``(ii) track plan complaints from the date 
                        the complaint is logged into the system through 
                        the date the complaint is resolved; and
                            ``(iii) otherwise improve the process for 
                        reporting plan complaints.
                    ``(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.
                    ``(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.
            ``(2) Process criteria.--In developing the system, the 
        Secretary shall establish a process for reporting plan 
        complaints. Such process shall meet the following criteria:
                    ``(A) Accessible.--The process is widely known and 
                easy to use.
                    ``(B) Investigative capacity.--The process involves 
                the appropriate experts, resources, and methods to 
                assess complaints and determine whether they reflect an 
                underlying pattern.
                    ``(C) Intervention and follow-through.--The process 
                triggers appropriate interventions and monitoring based 
                on substantiated complaints.
                    ``(D) Quality improvement orientation.--The process 
                guides quality improvement.
                    ``(E) Responsiveness.--The process routinely 
                provides consistent, clear, and substantive responses 
                to complaints.
                    ``(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.
                    ``(G) Objective.--The process is unbiased, 
                balancing the rights of each party.
                    ``(H) Public accountability.--The process makes 
                complaint information available to the public.
            ``(3) Standard data reporting requirements.--
                    ``(A) In general.--The Secretary shall establish 
                standard data reporting requirements for reporting plan 
                complaints under the system.
                    ``(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.
            ``(4) All complaints required to be logged into the 
        system.--Every plan complaint shall be logged into the system.
            ``(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.
            ``(6) Medicare beneficiary ombudsman.--The Secretary shall 
        carry out this subsection acting through the Medicare 
        Beneficiary Ombudsman.''.
    (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).
    (c) Reports.--
            (1) Secretary.--
                    (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--
                            (i) the numbers and types of complaints 
                        reported under the system;
                            (ii) geographic variations in such 
                        complaints;
                            (iii) the timeliness of agency or plan 
                        responses to such complaints; and
                            (iv) the resolution of such complaints.
                    (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.
            (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.

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:
                    ``(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).''.
    (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.

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--
            (1) in subparagraph (A)--
                    (A) by inserting ``or provide for meals or other 
                items of monetary value'' after ``rebates''; and
                    (B) by striking ``, and'' at the end and inserting 
                a semicolon;
            (2) in subparagraph (B), by striking the period at the end 
        and inserting ``; and''; and
            (3) by adding at the end the following new subparagraph:
                    ``(C) shall not permit a Medicare Advantage 
                organization to--
                            ``(i) market enrollment in a Medicare 
                        Advantage plan by telemarketing or in-home 
                        solicitation;
                            ``(ii) engage in the cross-selling of non-
                        Medicare products or services with products or 
                        services offered by a Medicare Advantage plan; 
                        or
                            ``(iii) engage in up-selling from 
                        prescription drug plans under part D to 
                        Medicare Advantage plans,
                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.''.
    (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:
    ``(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.''.
    (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.

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

    (a) Special Election Period During First 60 Days of Enrollment in a 
New Plan.--
            (1) In general.--Section 1851(e)(4) of the Social Security 
        Act (42 U.S.C. 1395w(e)(4)) is amended--
                    (A) in subparagraph (C), by striking ``or'' at the 
                end;
                    (B) by redesignating subparagraph (D) as 
                subparagraph (E); and
                    (C) by inserting after subparagraph (C) the 
                following new subparagraph:
                    ``(D) the individual has been enrolled in such plan 
                for fewer than 60 days; or''.
            (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.
    (b) Extension of the Annual, Coordinated Election Period.--
            (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''.
            (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.
    (c) Coordination Under Parts C and D of the Continuous Open 
Enrollment and Disenrollment Period for the First 3 Months of the 
Year.--
            (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),''.
            (2) Effective date.--The amendment made by paragraph (1) 
        shall take effect on January 1, 2009.
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