To amend title XVIII of the Social Security Act to provide for a Medicare Prescription Drug Ombudsman.

Amends title XVIII (Medicare) of the Social Security Act to establish within the Department of Health and Human Services an Office of the Medicare Prescription Drug Ombudsman, appointed by the Secretary of Health and Human Services, whose assistance includes registering complaints and helping to resolve disputes about the benefits under prescription drug plans under Medicare part D (Voluntary Prescription Drug Benefit Program).

[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5433 Introduced in House (IH)]








109th CONGRESS
  2d Session
                                H. R. 5433

   To amend title XVIII of the Social Security Act to provide for a 
                 Medicare Prescription Drug Ombudsman.


_______________________________________________________________________


                    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.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 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.''.
                                 <all>