I 
109TH CONGRESS 
2D SESSION 
H. R. 5182 
To amend title XVIII of the Social Security Act to require the sponsor 
of a prescription drug plan or an organization offering an MA–PD 
plan to promptly pay claims submitted under part D, and for other 
purposes. 
IN THE HOUSE OF REPRESENTATIVES 
APRIL 25, 2006 
Mr. JONES of North Carolina (for himself, Mr. BERRY, Mr. RANGEL, Mr. 
MORAN of Kansas, Mr. WEINER, Mr. MARSHALL, Mr. TAYLOR of Mis-
sissippi, Mr. JEFFERSON, Mr. ETHERIDGE, Mr. WICKER, Mr. ROSS, Mr. 
WEXLER, Mr. HOLDEN, Mr. DOYLE, Mr. MOORE of Kansas, Mr. BROWN 
of Ohio, Mr. ABERCROMBIE, and Mr. ALLEN) 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 sub-
sequently 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 require 
the sponsor of a prescription drug plan or an organiza-
tion offering an MA–PD plan to promptly pay claims 
submitted under part D, and for other purposes. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
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SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Fair and Speedy 
Treatment (FAST) of Medicare Prescription Drug Claims 
Act of 2006’’. 
SEC. 2. PROMPT PAYMENT BY MEDICARE PRESCRIPTION 
DRUG PLANS AND MA–PD PLANS UNDER 
PART D. 
(a) APPLICATION TO PRESCRIPTION DRUG PLANS.— 
Section 1860D–12(b) of the Social Security Act (42 
U.S.C. 1395w–112 (b)) is amended by adding at the end 
the following new paragraph: 
‘‘(4) PROMPT PAYMENT OF CLEAN CLAIMS.— 
‘‘(A) PROMPT
PAYMENT.—Each contract 
entered into with a PDP sponsor under this 
subsection with respect to a prescription drug 
plan offered by such sponsor shall provide that 
payment shall be issued, mailed, or otherwise 
transmitted with respect to all clean claims sub-
mitted under this part within the applicable 
number of calendar days after the date on 
which the claim is received. 
‘‘(B) DEFINITIONS.—In this paragraph: 
‘‘(i) CLEAN CLAIM.—The term ‘clean 
claim’ means a claim, with respect to a 
covered part D drug, that has no apparent 
defect or impropriety (including any lack 
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of any required substantiating documenta-
tion) or particular circumstance requiring 
special treatment that prevents timely pay-
ment from being made on the claim under 
this part. 
‘‘(ii) APPLICABLE
NUMBER
OF
CAL-
ENDAR DAYS.—The term ‘applicable num-
ber of calendar days’ means— 
‘‘(I) with respect to claims sub-
mitted 
electronically, 
calendar 
days; and 
‘‘(II) with respect to claims sub-
mitted otherwise, 30 calendar days. 
‘‘(C) INTEREST PAYMENT.—If payment is 
not issued, mailed, or otherwise transmitted 
within the applicable number of calendar days 
(as defined in subparagraph (B)) after a clean 
claim is received, interest shall be paid at a rate 
used for purposes of section 3902(a) of title 31, 
United States Code (relating to interest pen-
alties for failure to make prompt payments), for 
the period beginning on the day after the re-
quired payment date and ending on the date on 
which payment is made. 
‘‘(D) PROCEDURES INVOLVING CLAIMS.— 
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‘‘(i) CLAIMS DEEMED TO BE CLEAN 
CLAIMS.— 
‘‘(I) IN GENERAL.—A claim for a 
covered part D drug shall be deemed 
to be a clean claim for purposes of 
this paragraph if the PDP sponsor in-
volved does not provide a notification 
of deficiency to the claimant by the 
10th day that begins after the date on 
which the claim is submitted. 
‘‘(II) NOTIFICATION
OF
DEFI-
CIENCY.—For purposes of subclause 
(II), the term ‘notification of defi-
ciency’ means a notification that 
specifies all defects or improprieties in 
the claim involved and that lists all 
additional information or documents 
necessary for the proper processing 
and payment of the claim. 
‘‘(ii) PAYMENT OF CLEAN PORTIONS 
OF CLAIMS.—A PDP sponsor shall, as ap-
propriate, pay any portion of a claim for a 
covered part D drug that would be a clean 
claim but for a defect or impropriety in a 
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