Home > 106th Congressional Bills > H.R. 4680 (rh) To amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program, and for other purposes. [Reported in House] ...H.R. 4680 (rh) To amend title XVIII of the Social Security Act to provide for a voluntary program for prescription drug coverage under the Medicare Program, to modernize the Medicare Program, and for other purposes. [Reported in House] ...
``(D) Annual reports.--Not later March 31 of each
year, the Administrator shall submit to Congress and
the President a report on the administration of parts C
and D during the previous fiscal year.
``(2) Staff.--
``(A) In general.--The Administrator, with the
approval of the Secretary, may employ, without regard
to chapter 31 of title 5, United States Code, such
officers and employees as are necessary to administer
the activities to be carried out through the Medicare
Benefits Administration.
``(B) Flexibility with respect to compensation.--
``(i) In general.--The staff of the
Medicare Benefits Administration shall, subject
to clause (ii), be paid without regard to the
provisions of chapter 51 and chapter 53 of such
title (relating to classification and schedule
pay rates).
``(ii) Maximum rate.--In no case may the
rate of compensation determined under clause
(i) exceed the rate of basic pay payable for
level IV of the Executive Schedule under
section 5315 of title 5, United States Code.
``(C) Limitation on full-time equivalent staffing
for current hcfa functions being transferred.--The
Administrator may not employ under this paragraph a
number of full-time equivalent employees, to carry out
functions that were previously conducted by the Health
Care Financing Administration and that are conducted by
the Administrator by reason of this section, that
exceeds the number of such full-time equivalent
employees authorized to be employed by the Health Care
Financing Administration to conduct such functions as
of the date of the enactment of this Act.
``(3) Redelegation of certain functions of the health care
financing administration.--
``(A) In general.--The Secretary, the
Administrator, and the Administrator of the Health Care
Financing Administration shall establish an appropriate
transition of responsibility in order to redelegate the
administration of part C from the Secretary and the
Administrator of the Health Care Financing
Administration to the Administrator as is appropriate
to carry out the purposes of this section.
``(B) Transfer of data and information.--The
Secretary shall ensure that the Administrator of the
Health Care Financing Administration transfers to the
Administrator of the Medicare Benefits Administration
such information and data in the possession of the
Administrator of the Health Care Financing
Administration as the Administrator of the Medicare
Benefits Administration requires to carry out the
duties described in paragraph (1).
``(C) Construction.--Insofar as a responsibility of
the Secretary or the Administrator of the Health Care
Financing Administration is redelegated to the
Administrator under this section, any reference to the
Secretary or the Administrator of the Health Care
Financing Administration in this title or title XI with
respect to such responsibility is deemed to be a
reference to the Administrator.
``(d) Office of Beneficiary Assistance.--
``(1) Establishment.--The Secretary shall establish within
the Medicare Benefits Administration an Office of Beneficiary
Assistance to carry out functions relating to medicare
beneficiaries under this title, including making determinations
of eligibility of individuals for benefits under this title,
providing for enrollment of medicare beneficiaries under this
title, and the functions described in paragraph (2). The Office
shall be separate operating division within the Administration.
``(2) Dissemination of information on benefits and appeals
rights.--
``(A) Dissemination of benefits information.--The
Office of Beneficiary Assistance shall disseminate to
medicare beneficiaries, by mail, by posting on the
Internet site of the Medicare Benefits Administration
and through the toll-free telephone number provided for
under section 1804(b), information with respect to the
following:
``(i) Benefits, and limitations on payment
(including cost-sharing, stop-loss provisions,
and formulary restrictions) under parts C and
D.
``(ii) Benefits, and limitations on payment
under parts A and B, including information on
medicare supplemental policies under section
1882.
Such information shall be presented in a manner so that
medicare beneficiaries may compare benefits under parts
A, B, D, and medicare supplemental policies with
benefits under Medicare+Choice plans under part C.
``(B) Dissemination of appeals rights
information.--The Office of Beneficiary Assistance
shall disseminate to medicare beneficiaries in the
manner provided under subparagraph (A) a description of
procedural rights (including grievance and appeals
procedures) of beneficiaries under the original
medicare fee-for-service program under parts A and B,
the Medicare+Choice program under part C, and the
Voluntary Prescription Drug Benefit Program under part
D.
``(3) Medicare ombudsman.--
``(A) In general.--Within the Office of Beneficiary
Assistance, there shall be a Medicare Ombudsman,
appointed by the Secretary from among individuals with
expertise and experience in the fields of health care
and advocacy, to carry out the duties described in
subparagraph (B).
``(B) Duties.--The Medicare Ombudsman shall--
``(i) receive complaints, grievances, and
requests for information submitted by a
medicare beneficiary, with respect to any
aspect of the medicare program;
``(ii) provide assistance with respect to
complaints, grievances, and requests referred
to in clause (i), including--
``(I) assistance in collecting
relevant information for such
beneficiaries, to seek an appeal of a
decision or determination made by a
fiscal intermediary, carrier,
Medicare+Choice organization, a PDP
sponsor under part D, or the Secretary;
and
``(II) assistance to such
beneficiaries with any problems arising
from disenrollment from a
Medicare+Choice plan under part C or a
prescription drug plan under part D;
and
``(iii) submit annual reports to Congress,
the Secretary, and the Medicare Policy Advisory
Board describing the activities of the Office,
and including such recommendations for
improvement in the administration of this title
as the Ombudsman determines appropriate.
``(C) Coordination with state ombudsman programs
and consumer organizations.--The Medicare Ombudsman
shall, to the extent appropriate, coordinate with State
medical Ombudsman programs, and with State- and
community-based consumer organizations, to--
``(i) provide information about the
medicare program; and
``(ii) conduct outreach to educate medicare
beneficiaries with respect to manners in which
problems under the medicare program may be
resolved or avoided.
``(e) Medicare Policy Advisory Board.--
``(1) Establishment.--There is established within the
Medicare Benefits Administration the Medicare Policy Advisory
Board (in this section referred to the `Board'). The Board
shall advise, consult with, and make recommendations to the
Administrator of the Medicare Benefits Administration with
respect to the administration of parts C and D, including the
review of payment policies under such parts.
``(2) Reports.--
``(A) In general.--With respect to matters of the
administration of parts C and D, the Board shall submit
to Congress and to the Administrator of the Medicare
Benefits Administration such reports as the Board
determines appropriate. Each such report may contain
such recommendations as the Board determines
appropriate for legislative or administrative changes
to improve the administration of such parts, including
the topics described in subparagraph (B). Each such
report shall be published in the Federal Register.
``(B) Topics described.--Reports required under
subparagraph (A) may include the following topics:
``(i) Fostering competition.--
Recommendations or proposals to increase
competition under parts C and D for services
furnished to medicare beneficiaries.
``(ii) Education and enrollment.--
Recommendations for the improvement to efforts
to provide medicare beneficiaries information
and education on the program under this title,
and specifically parts C and D, and the program
for enrollment under the title.
``(iii) Implementation of risk-
adjustment.--Evaluation of the implementation
under section 1853(a)(3)(C) of the risk
adjustment methodology to payment rates under
that section to Medicare+Choice organizations
offering Medicare+Choice plans that accounts
for variations in per capita costs based on
health status and other demographic factors.
``(iv) Disease management programs.--
Recommendations on the incorporation of disease
management programs under parts C and D.
``(v) Rural access.--Recommendations to
improve competition and access to plans under
parts C and D in rural areas.
``(C) Maintaining independence of board.--The Board
shall directly submit to Congress reports required
under subparagraph (A). No officer or agency of the
United States may require the Board to submit to any
officer or agency of the United States for approval,
comments, or review, prior to the submission to
Congress of such reports.
``(3) Duty of administrator of medicare benefits
administration.--With respect to any report submitted by the
Board under paragraph (2)(A), not later than 90 days after the
report is submitted, the Administrator of the Medicare Benefits
Administration shall submit to Congress and the President an
analysis of recommendations made by the Board in such report.
Each such analysis shall be published in the Federal Register.
``(4) Membership.--
``(A) Appointment.--Subject to the succeeding
provisions of this paragraph, the Board shall consist
of seven members to be appointed as follows:
``(i) Three members shall be appointed by
the President.
``(ii) Two members shall be appointed by
the Speaker of the House of Representatives,
with the advice of the chairman and the ranking
minority member of the Committees on Ways and
Means and on Commerce of the House of
Representatives.
``(iii) Two members shall be appointed by
the President pro tempore of the Senate with
the advice of the chairman and the ranking
minority member of the Senate Committee on
Finance.
``(B) Qualifications.--The members shall be chosen
on the basis of their integrity, impartiality, and good
judgment, and shall be individuals who are, by reason
of their education and experience in health care
benefits management, exceptionally qualified to perform
the duties of members of the Board.
``(C) Prohibition on inclusion of federal
employees.--No officer or employee of the United States
may serve as a member of the Board.
``(5) Compensation.--Members of the Board shall receive,
for each day (including travel time) they are engaged in the
performance of the functions of the board, compensation at
rates not to exceed the daily equivalent to the annual rate in
effect for level IV of the Executive Schedule under section
5315 of title 5, United States Code.
``(6) Terms of office.--
``(A) In general.--The term of office of members of
the Board shall be 3 years.
``(B) Terms of initial appointees.--As designated
by the President at the time of appointment, of the
members first appointed--
``(i) one shall be appointed for a term of
1 year;
``(ii) three shall be appointed for terms
of 2 years; and
``(iii) three shall be appointed for terms
of 3 years.
``(C) Reappointments.--Any person appointed as a
member of the Board may not serve for more than 8
years.
``(D) Vacancy.--Any member appointed to fill a
vacancy occurring before the expiration of the term for
which the member's predecessor was appointed shall be
appointed only for the remainder of that term. A member
may serve after the expiration of that member's term
until a successor has taken office. A vacancy in the
Board shall be filled in the manner in which the
original appointment was made.
``(7) Chair.--The Chair of the Board shall be elected by
the members. The term of office of the Chair shall be 3 years.
``(8) Meetings.--The Board shall meet at the call of the
Chair, but in no event less than three times during each fiscal
year.
``(9) Director and staff.--
``(A) Appointment of director.--The Board shall
have a Director who shall be appointed by the Chair.
``(B) In general.--With the approval of the Board,
the Director may appoint, without regard to chapter 31
of title 5, United States Code, such additional
personnel as the Director considers appropriate.
``(C) Flexibility with respect to compensation.--
``(i) In general.--The Director and staff
of the Board shall, subject to clause (ii), be
paid without regard to the provisions of
chapter 51 and chapter 53 of such title
(relating to classification and schedule pay
rates).
``(ii) Maximum rate.--In no case may the
rate of compensation determined under clause
(i) exceed the rate of basic pay payable for
level IV of the Executive Schedule under
section 5315 of title 5, United States Code.
``(D) Assistance from the administrator of the
medicare benefits administration.--The Administrator of
the Medicare Benefits Administration shall make
available to the Board such information and other
assistance as it may require to carry out its
functions.
``(10) Contract authority.--The Board may contract with and
compensate government and private agencies or persons to carry
out its duties under this subsection, without regard to section
3709 of the Revised Statutes (41 U.S.C. 5).
``(f) Funding.--There is authorized to be appropriated, in
appropriate part from the Federal Hospital Insurance Trust Fund and
from the Federal Supplementary Medical Insurance Trust Fund (including
the Medicare Prescription Drug Account), such sums as are necessary to
carry out this section.''.
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