summary
Introduced
01/24/2019
01/24/2019
In Committee
03/01/2019
03/01/2019
Crossed Over
Passed
Dead
12/31/2020
12/31/2020
Introduced Session
116th Congress
Bill Summary
To amend title XVIII of the Social Security Act to prohibit prescription drug plan sponsors and MA-PD organizations under the Medicare program from retroactively reducing payment on clean claims submitted by pharmacies. This bill prohibits Medicare prescription drug plan sponsors from retroactively reducing payment on clean claims submitted by pharmacies. (A "clean claim" is a Medicare claim that is free of defects such as incomplete documentation.)
AI Summary
This bill, the Improving Transparency and Accuracy in Medicare Part D Spending Act, prohibits Medicare prescription drug plan (PDP) sponsors from retroactively reducing payment on "clean claims" submitted by pharmacies. A "clean claim" is a Medicare claim that is free of defects such as incomplete documentation. The bill allows for retroactive increases in payment to a pharmacy if there is a written agreement between the PDP sponsor and the pharmacy. This amendment applies to contracts entered into on or after January 1, 2020.
Committee Categories
Business and Industry, Health and Social Services
Sponsors (4)
Last Action
Referred to the Subcommittee on Health. (on 03/01/2019)
Official Document
bill text
bill summary
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bill summary
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bill summary
| Document Type | Source Location |
|---|---|
| State Bill Page | https://www.congress.gov/bill/116th-congress/house-bill/789/all-info |
| BillText | https://www.congress.gov/116/bills/hr789/BILLS-116hr789ih.pdf |
| Bill | https://www.congress.gov/116/bills/hr789/BILLS-116hr789ih.pdf.pdf |
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