US S988

Bill

Improving Transparency and Accuracy in Medicare Part D Spending Act

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)

Shelley Moore Capito (R)*, Marsha Blackburn (R), John Boozman (R), Susan Collins (R), Tom Cotton (R), Joni Ernst (R), Cory Gardner (R), Cindy Hyde-Smith (R), Rand Paul (R), Jon Tester (D),

Last Action

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

Official Document

https://www.congress.gov/bill/116th-congress/senate-bill/988/all-info

(3 Companion Bills)

Version:

Document Type	Source Location
State Bill Page	https://www.congress.gov/bill/116th-congress/senate-bill/988/all-info
BillText	https://www.congress.gov/116/bills/s988/BILLS-116s988is.pdf
Bill	https://www.congress.gov/116/bills/s988/BILLS-116s988is.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
HR803	Improving Transparency and Accuracy in Medicare Part D Spending Act	Referred to the Subcommittee on Health.	Same As

Bill > S988

US S988

summary

Introduced Session

Bill Summary

AI Summary

Committee Categories

Sponsors (10)

Last Action

Official Document

bill text

bill summary

bill summary

bill summary