I 
111TH CONGRESS 
1ST SESSION H. R. 3089 
To amend title XVIII of the Social Security Act to provide for standardized 
marketing requirements under the Medicare Advantage program and 
the Medicare Prescription Drug program and to provide for State certifi-
cation prior to waiver of licensure requirements under the Medicare 
Prescription Drug program, and for other purposes. 
IN THE HOUSE OF REPRESENTATIVES 
JUNE 26, 2009 
Ms. CASTOR of Florida (for herself and Ms. SCHAKOWSKY) introduced the fol-
lowing bill; which was referred to the Committee on Ways and Means, 
and in addition to the Committee on Energy and Commerce, for a period 
to be subsequently determined by the Speaker, in each case for consider-
ation 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 standardized marketing requirements under the Medi-
care Advantage program and the Medicare Prescription 
Drug program and to provide for State certification prior 
to waiver of licensure requirements under the Medicare 
Prescription Drug program, 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 ‘‘Accountability and 
Transparency in Medicare Marketing Act of 2009’’. 
SEC. 
2. 
STANDARDIZED 
MARKETING 
REQUIREMENTS 
UNDER THE MEDICARE ADVANTAGE AND 
MEDICARE PRESCRIPTION DRUG PROGRAMS. 
(a) MEDICARE ADVANTAGE PROGRAM.— 
(1) IN GENERAL.—Section 1856 of the Social 
Security Act (42 U.S.C. 1395w–26) is amended— 
(A) in subsection (b)(1), by inserting ‘‘or 
subsection (c)’’ after ‘‘subsection (a)’’; and 
(B) by adding at the end the following new 
subsection: 
‘‘(c) STANDARDIZED MARKETING REQUIREMENTS.— 
‘‘(1) DEVELOPMENT BY THE NAIC.— 
‘‘(A) 
REQUIREMENTS.—The 
Secretary 
shall request the National Association of Insur-
ance Commissioners (in this subsection referred 
to as the ‘NAIC’) to— 
‘‘(i) develop standardized marketing 
requirements for Medicare Advantage or-
ganizations with respect to Medicare Ad-
vantage plans and PDP sponsors with re-
spect to prescription drug plans under part 
D; and 
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‘‘(ii) submit a report containing such 
requirements to the Secretary by not later 
than the date that is 9 months after the 
date of enactment of this subsection. 
‘‘(B) PROHIBITED ACTIVITIES.—Such re-
quirements shall include prohibitions on the 
prohibited 
activities 
described 
in 
section 
1851(j)(1). 
‘‘(C) LIMITATIONS.—Such requirements 
shall establish limitations that include at least 
the limitations described in section 1851(j)(2), 
except for those relating to compensation. 
‘‘(D) ELECTION
FORM.—Such require-
ments may prohibit a Medicare Advantage or-
ganization or a PDP sponsor (or an agent of 
such an organization or sponsor) from com-
pleting any portion of any election form used to 
carry out elections under section 1851 or 
1860D–1 on behalf of any individual. 
‘‘(E) AGENT
AND
BROKER
COMMISSIONS 
AND COMPENSATION.—Such requirements shall 
establish standards— 
‘‘(i) for fair and appropriate commis-
sions for agents and brokers of Medicare 
Advantage organizations and PDP spon-
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sors, including a prohibition on extra bo-
nuses or incentives; 
‘‘(ii) for the disclosure of such com-
missions; and 
‘‘(iii) for the use of compensation for 
agents and brokers other than such com-
missions. 
Such standards shall ensure that the use of 
compensation creates incentives for agents and 
brokers to enroll individuals in the Medicare 
Advantage plan that is intended to best meet 
their health care needs. 
‘‘(F) CERTAIN
CONDUCT
OF
AGENTS.— 
Such requirements shall address the conduct of 
agents engaged in on-site promotion at a facil-
ity of an organization with which the Medicare 
Advantage organization or PDP sponsor has a 
co-branding relationship. 
‘‘(G) OTHER STANDARDS.—Such require-
ments may establish such other standards relat-
ing to unfair trade practices and marketing 
under Medicare Advantage plans and prescrip-
tion drug plans under part D as the NAIC de-
termines appropriate. 
‘‘(2) IMPLEMENTATION OF REQUIREMENTS.— 
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retary shall ensure that such regulations take 
effect beginning with the first open enrollment 
period beginning 12 months after the date of 
enactment of this subsection. 
‘‘(C) CONSULTATION.—In establishing re-
quirements under this subsection, the NAIC or 
Secretary (as the case may be) shall consult 
with a working group composed of representa-
tives of Medicare Advantage organizations and 
PDP sponsors, consumer groups, and other 
qualified individuals. Such representatives shall 
be selected in a manner so as to insure bal-
anced representation among the interested 
groups. 
‘‘(3) STATE
REPORTING
OF
VIOLATIONS
OF 
STANDARDIZED
MARKETING
REQUIREMENTS.—The 
Secretary shall request that States report any viola-
tions of the standardized marketing requirements 
under the regulations under subparagraph (A) or 
(B) of paragraph (2) to national and regional offices 
of the Centers for Medicare & Medicaid Services. 
‘‘(4) REPORT.—The Secretary shall submit an 
annual report to Congress on the enforcement of the 
standardized marketing requirements under the reg-
ulations under subparagraph (A) or (B) of para-
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graph (2), together with such recommendations as 
the Secretary determines appropriate. Such report 
shall include— 
‘‘(A) a list of any alleged violations of such 
requirements reported to the Secretary by a 
State, a Medicare Advantage organization, or a 
PDP sponsor; and 
‘‘(B) the disposition of such reported viola-
tions.’’. 
(2) STATE
AUTHORITY
TO
ENFORCE
STAND-
ARDIZED MARKETING REQUIREMENTS.— 
(A) IN GENERAL.—Section 1856(b)(3) of 
the Social Security Act (42 U.S.C. 1395w– 
26(b)(3)) is amended— 
(i) by striking ‘‘or State’’ and insert-
ing ‘‘, State’’; and 
(ii) by inserting ‘‘, or State laws or 
regulations enacting the standardized mar-
keting requirements under subsection (c)’’ 
after ‘‘plan solvency’’. 
(B) NO
PREEMPTION
OF
STATE
SANC-
TIONS.—Nothing in title XVIII of the Social 
Security Act or the provisions of, or amend-
ments made by, this Act, shall be construed to 
prohibit a State from conducting a market con-
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duct examination or from imposing sanctions 
against 
Medicare 
Advantage 
organizations, 
PDP sponsors, or agents or brokers of such or-
ganizations or sponsors for violations of the 
standardized marketing requirements under 
subsection (c) of section 1856 of the Social Se-
curity Act (as added by paragraph (1)) as en-
acted by that State. 
(3) 
CONFORMING
AMENDMENT.—Section 
1851(h)(4) of the Social Security Act (42 U.S.C. 
1395w–21(h)(4)) is amended by adding at the end 
the following flush sentence: 
‘‘Beginning on the effective date of the implementa-
tion of the regulations under subparagraph (A) or 
(B) of section 1856(c)(2), each Medicare Advantage 
organization with respect to a Medicare Advantage 
plan offered by the organization (and agents of such 
organization) shall comply with the standardized 
marketing requirements under section 1856(c).’’. 
(b) MEDICARE PRESCRIPTION DRUG PROGRAM.— 
Section 1860D–4 of the Social Security Act (42 U.S.C. 
1395w–104) is amended by adding at the end the fol-
lowing new subsection: 
‘‘(m) 
STANDARDIZED
MARKETING
REQUIRE-
MENTS.—A PDP sponsor with respect to a prescription 
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drug plan offered by the sponsor (and agents of such spon-
sor) shall comply with the standardized marketing require-
ments under section 1856(c).’’. 
SEC. 3. STATE CERTIFICATION PRIOR TO WAIVER OF LI-
CENSURE REQUIREMENTS UNDER MEDICARE 
PRESCRIPTION DRUG PROGRAM. 
(a) IN GENERAL.—Section 1860D–12(c) of the So-
cial Security Act (42 U.S.C. 1395w–112(c)) is amended— 
(1) in paragraph (1)(A), by striking ‘‘In the 
case’’ and inserting ‘‘Subject to paragraph (5), in 
the case’’; and 
(2) by adding at the end the following new 
paragraph: 
‘‘(5) STATE CERTIFICATION REQUIRED.— 
‘‘(A) IN
GENERAL.—The Secretary may 
only grant a waiver under paragraph (1)(A) if 
the Secretary has received a certification from 
the State insurance commissioner that the pre-
scription drug plan has a substantially complete 
application pending in the State. 
‘‘(B) REVOCATION OF WAIVER UPON FIND-
ING
OF
FRAUD
AND
ABUSE.—The Secretary 
shall revoke a waiver granted under paragraph 
(1)(A) if the State insurance commissioner sub-
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mits a certification to the Secretary that the re-
cipient of such a waiver— 
‘‘(i) has committed fraud or abuse 
with respect to such waiver; 
‘‘(ii) has failed to make a good faith 
effort to satisfy State licensing require-
ments; or 
‘‘(iii) was determined ineligible for li-
censure by the State.’’. 
(b) EFFECTIVE DATE.—The amendments made by 
subsection (a) shall apply with respect to plan years begin-
ning on or after January 1, 2010. 
SEC. 4. NAIC RECOMMENDATIONS ON THE ESTABLISH-
MENT OF STANDARDIZED BENEFIT PACK-
AGES FOR MEDICARE ADVANTAGE PLANS 
AND PRESCRIPTION DRUG PLANS. 
Not later than 30 days after the date of enactment 
of this Act, the Secretary of Health and Human Services 
shall request the National Association of Insurance Com-
missioners to establish a committee to study and make 
recommendations to the Secretary and Congress on— 
(1) the establishment of standardized benefit 
packages for Medicare Advantage plans under part 
C of title XVIII of the Social Security Act and for 
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prescription drug plans under part D of such Act; 
and 
(2) the regulation of such plans. 
Æ 
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