Stop Excessive Narcotics in our Retirement Communities Protection Act of 2018 or the SENIOR Communities Protection Act of 2018
(Sec. 2) This bill authorizes the suspension of payments to a pharmacy under the Medicare prescription drug benefit and Medicare Advantage prescription drug plans pending the investigation of a credible allegation of fraud by the pharmacy. A fraud hotline tip, without other evidence, may not be considered a credible allegation of fraud.
[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5676 Introduced in House (IH)]
<DOC>
115th CONGRESS
2d Session
H. R. 5676
To amend title XVIII of the Social Security Act to authorize the
suspension of payments by Medicare prescription drug plans and MA-PD
plans pending investigations of credible allegations of fraud by
pharmacies.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 3, 2018
Mr. MacArthur (for himself, Mr. Collins of New York, Mr. Schweikert,
Ms. Kuster of New Hampshire, Mr. Blumenauer, and Mr. Tonko) 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 authorize the
suspension of payments by Medicare prescription drug plans and MA-PD
plans pending investigations of credible allegations of fraud by
pharmacies.
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 ``Stop Excessive Narcotics in our
Retirement Communities Protection Act'' or the ``SENIOR Communities
Protection Act''.
SEC. 2. SUSPENSION OF PAYMENTS BY MEDICARE PRESCRIPTION DRUG PLANS AND
MA-PD PLANS PENDING INVESTIGATIONS OF CREDIBLE
ALLEGATIONS OF FRAUD BY PHARMACIES.
(a) In General.--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:
``(7) Suspension of payments pending investigation of
credible allegations of fraud by pharmacies.--
``(A) In general.--The provisions of section
1862(o) shall apply with respect to a PDP sponsor with
a contract under this part, a pharmacy, and payments to
such pharmacy under this part in the same manner as
such provisions apply with respect to the Secretary, a
provider of services or supplier, and payments to such
provider of services or supplier under this title.
``(B) Rule of construction.--Nothing in this
paragraph shall be construed as limiting the authority
of a PDP sponsor to conduct postpayment review.''.
(b) Application to MA-PD Plans.--Section 1857(f)(3) of the Social
Security Act (42 U.S.C. 1395w-27(f)(3)) is amended by adding at the end
the following new subparagraph:
``(D) Suspension of payments pending investigation
of credible allegations of fraud by pharmacies.--
Section 1860D-12(b)(7).''.
(c) Conforming Amendment.--Section 1862(o)(3) of the Social
Security Act (42 U.S.C. 1395y(o)(3)) is amended by inserting ``,
section 1860D-12(b)(7) (including as applied pursuant to section
1857(f)(3)(D)),'' after ``this subsection''.
(d) Clarification Relating to Credible Allegation of Fraud.--
Section 1862(o) of the Social Security Act (42 U.S.C. 1395y(o)) is
amended by adding at the end the following new paragraph:
``(4) Credible allegation of fraud.--In carrying out this
subsection, section 1860D-12(b)(7) (including as applied
pursuant to section 1857(f)(3)(D)), and section 1903(i)(2)(C),
a fraud hotline tip (as defined by the Secretary) without
further evidence shall not be treated as sufficient evidence
for a credible allegation of fraud.''.
(e) Effective Date.--The amendments made by this section shall
apply with respect to plan years beginning on or after January 1, 2020.
<all>
Introduced in House
Introduced in House
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.
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.
Referred to the Subcommittee on Health.
Committee Consideration and Mark-up Session Held.
Ordered to be Reported (Amended) by Voice Vote.
Reported (Amended) by the Committee on Ways and Means. H. Rept. 115-759, Part I.
Reported (Amended) by the Committee on Ways and Means. H. Rept. 115-759, Part I.
Mr. Roskam moved to suspend the rules and pass the bill, as amended.
Considered under suspension of the rules. (consideration: CR H5261-5264)
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DEBATE - The House proceeded with forty minutes of debate on H.R. 5676.
At the conclusion of debate, the Yeas and Nays were demanded and ordered. Pursuant to the provisions of clause 8, rule XX, the Chair announced that further proceedings on the motion would be postponed.
Considered as unfinished business. (consideration: CR H5272)
Passed/agreed to in House: On motion to suspend the rules and pass the bill, as amended Agreed to by the Yeas and Nays: (2/3 required): 356 - 3 (Roll no. 270).(text: CR H5261-5262)
Roll Call #270 (House)On motion to suspend the rules and pass the bill, as amended Agreed to by the Yeas and Nays: (2/3 required): 356 - 3 (Roll no. 270). (text: CR H5261-5262)
Roll Call #270 (House)Motion to reconsider laid on the table Agreed to without objection.
Received in the Senate and Read twice and referred to the Committee on Finance.