Bill

Bill > S988


US S988

Improving Transparency and Accuracy in Medicare Part D Spending Act


summary

Introduced
04/02/2019
In Committee
04/02/2019
Crossed Over
Passed
Dead
12/31/2020

Introduced Session

116th Congress

Bill Summary

A bill 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 is a Medicare claim that is free of defects such as incomplete documentation. The bill specifies that after a pharmacy submits a clean claim, the PDP sponsor (or their agent) cannot retroactively reduce the payment on that claim, except in cases where the claim is found to not be clean during a routine audit as permitted by a written agreement between the pharmacy and the PDP sponsor. The amendment made by this bill would apply to contracts entered into on or after January 1, 2020.

Committee Categories

Budget and Finance

Sponsors (10)

Last Action

Read twice and referred to the Committee on Finance. (on 04/02/2019)

bill text


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