I 

109TH CONGRESS 

2D SESSION H. R. 5433 

To amend title XVIII of the Social Security Act to provide for a Medicare 

Prescription Drug Ombudsman. 

IN THE HOUSE OF REPRESENTATIVES 

MAY 19, 2006 

Ms. HOOLEY (for herself, Mr. DEFAZIO, and Mr. BLUMENAUER) introduced 

the following bill; which was referred to the Committee on Energy and 

Commerce, and in addition to the Committee on Ways and Means, 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 

A BILL 

To amend title XVIII of the Social Security Act to provide 

for a Medicare Prescription Drug Ombudsman. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. MEDICARE PRESCRIPTION DRUG OMBUDSMAN. 

4 Section 1808 of the Social Security Act (42 U.S.C. 

5 1395b–9) is amended by adding at the end the following 

6 new subsection: 

7 ‘‘(d) MEDICARE PRESCRIPTION DRUG OMBUDS8 MAN.— 


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1 ‘‘(1) IN GENERAL.—There is hereby established 

2 within the Department of Health and Human Serv3 ices an Office of the Medicare Prescription Drug 

4 Ombudsman (in this subsection referred to as the 

5 ‘Office’) to be headed by a Medicare Prescription 

6 Drug Ombudsman appointed by the Secretary. The 

7 Secretary shall appoint as such Ombudsman an indi8 vidual who has expertise and experience in the fields 

9 of health care and education of (and assistance to) 

10 individuals entitled to benefits under this title with 

11 respect to prescription drug coverage under part D. 

12 ‘‘(2) DUTIES.—The Medicare Prescription 

13 Drug Ombudsman through the Office shall— 

14 ‘‘(A) receive complaints, grievances, and 

15 requests for information submitted by individ16 uals entitled to benefits under part D, partici17 pating pharmacists, physicians, and hospitals; 

18 ‘‘(B) provide assistance with respect to 

19 complaints, grievances, and requests referred to 

20 in subparagraph (A), including— 

21 ‘‘(i) assistance in collecting relevant 

22 information for such individuals and seek23 ing appeal of a decision or determination 

24 made by a PDP sponsor or MA organiza25 tion; 


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1 ‘‘(ii) assistance to such individuals 

2 with any issues arising from disenrollment 

3 from a PDP under part C or an MA–PD 

4 plan under part D; and 

5 ‘‘(iii) registering complaints about the 

6 benefits under prescription drug plans and 

7 MA–PD plans and helping resolve disputes 

8 between the Centers for Medicare and 

9 Medicaid, sponsors of prescription drug 

10 plans, and organizations offering MA–PD 

11 plans and individuals entitled to benefits 

12 under part D, participating pharmacists, 

13 physicians, and hospitals; 

14 ‘‘(C) provide assistance to beneficiaries in 

15 relation to State medicaid programs under title 

16 XIX and drug manufacturers in accessing 

17 medically necessary drugs that are excluded 

18 from coverage under part D; and 

19 ‘‘(D) submit annual reports to Congress 

20 and the Secretary that describe the activities of 

21 the Office and that include such recommenda22 tions for improvement in the administration of 

23 part D as the Medicare Prescription Drug Om24 budsman determines appropriate. 


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1 The annual report under subparagraph (D) in 2007 

2 and 2009 shall include information on the number 

3 of cases described in subparagraph (C) that are han4 dled and the success rates in finding alternative 

5 sources of prescription drug coverage.’’. 

Æ 


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