US HR803

Bill

Improving Transparency and Accuracy in Medicare Part D Spending Act

Introduced
01/25/2019

In Committee
03/01/2019

Crossed Over

Passed

Dead
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 and Medicare Advantage Prescription Drug (MA-PD) organizations from retroactively reducing payment on "clean claims" submitted by pharmacies. A "clean claim" refers to a Medicare claim that is free of defects such as incomplete documentation. The bill specifies that PDP sponsors cannot retroactively reduce payment on clean claims, except in cases where the claim is found to not be clean during a routine audit, as permitted by a written agreement between the PDP sponsor and the pharmacy. The bill's provisions apply to contracts entered into on or after January 1, 2020.

Committee Categories

Business and Industry, Health and Social Services

Sponsors (29)

Peter Welch (D)*, Rick Allen (R), Cindy Axne (D), Mo Brooks (R), G. Butterfield (D), Bradley Byrne (R), Buddy Carter (R), Doug Collins (R), Rick Crawford (R), Lloyd Doggett (D), Ron Estes (R), Jared Golden (D), Vicente Gonzalez (D), Tom Graves (R), Morgan Griffith (R), Jaime Herrera Beutler (R), French Hill (R), John Joyce (R), Bob Latta (R), Roger Marshall (R), Thomas Massie (R), Cathy McMorris Rodgers (R), Chellie Pingree (D), Jamie Raskin (D), Martha Roby (R), David Roe (R), Mike Rogers (R), John Sarbanes (D), Steve Womack (R),

Last Action

Referred to the Subcommittee on Health. (on 03/01/2019)

Official Document

https://www.congress.gov/bill/116th-congress/house-bill/803/all-info

(5 Companion Bills)

Version:

Document Type	Source Location
State Bill Page	https://www.congress.gov/bill/116th-congress/house-bill/803/all-info
BillText	https://www.congress.gov/116/bills/hr803/BILLS-116hr803ih.pdf
Bill	https://www.congress.gov/116/bills/hr803/BILLS-116hr803ih.pdf.pdf

Bill	Bill Name	Last Action	Type
HR1332	To address the high costs of health care services, prescription drugs, and health insurance coverage in the United States, and for other purposes.	Referred to the Subcommittee on Health.	Related
HR789	Improving Transparency and Accuracy in Medicare Part D Spending Act	Referred to the Subcommittee on Health.	Same As
HR8527	Fair Care Act of 2020	Referred to the Committee on Energy and Commerce, and in addition to the Committees on Ways and Means, Education and Labor, the Judiciary, Oversight and Reform, House Administration, Rules, the Budget, and Armed Services, 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.	Related
S4796	Fair Care Act of 2020	Read twice and referred to the Committee on Finance.	Related
S988	Improving Transparency and Accuracy in Medicare Part D Spending Act	Read twice and referred to the Committee on Finance.	Same As

Bill > HR803

US HR803

summary

Introduced Session

Bill Summary

AI Summary

Committee Categories

Sponsors (29)

Last Action

Official Document

bill text

bill summary

bill summary

bill summary