110 HR 6359 IH: Medicare Beneficiary Protection Act of U.S. House of Representatives 2008-06-24 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 110th CONGRESS 2d Session H. R. 6359 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.

1.

Short title

This Act may be cited as the Medicare Beneficiary Protection Act of 2008.

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.

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.

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.

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.