[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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