Title: Stop Excessive Narcotics in our Retirement Communities Protection Act of 2018
Policy area: Health

Summary:
Stop Excessive Narcotics in our Retirement Communities Protection Act or the SENIOR Communities Protection Act
This bill authorizes the suspension of payments to a pharmacy under the Medicare prescription drug benefit and Medicare Advantage prescription drug plans pending the investigation of a credible allegation of fraud by the pharmacy. A fraud hotline tip, without other evidence, may not be considered a credible allegation of fraud.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5676 Introduced in House (IH)]

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115th CONGRESS
  2d Session
                                H. R. 5676

   To amend title XVIII of the Social Security Act to authorize the 
 suspension of payments by Medicare prescription drug plans and MA-PD 
   plans pending investigations of credible allegations of fraud by 
                              pharmacies.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 3, 2018

 Mr. MacArthur (for himself, Mr. Collins of New York, Mr. Schweikert, 
Ms. Kuster of New Hampshire, Mr. Blumenauer, and Mr. Tonko) 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 authorize the 
 suspension of payments by Medicare prescription drug plans and MA-PD 
   plans pending investigations of credible allegations of fraud by 
                              pharmacies.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Stop Excessive Narcotics in our 
Retirement Communities Protection Act'' or the ``SENIOR Communities 
Protection Act''.

SEC. 2. SUSPENSION OF PAYMENTS BY MEDICARE PRESCRIPTION DRUG PLANS AND 
              MA-PD PLANS PENDING INVESTIGATIONS OF CREDIBLE 
              ALLEGATIONS OF FRAUD BY PHARMACIES.

    (a) In General.--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:
            ``(7) Suspension of payments pending investigation of 
        credible allegations of fraud by pharmacies.--
                    ``(A) In general.--The provisions of section 
                1862(o) shall apply with respect to a PDP sponsor with 
                a contract under this part, a pharmacy, and payments to 
                such pharmacy under this part in the same manner as 
                such provisions apply with respect to the Secretary, a 
                provider of services or supplier, and payments to such 
                provider of services or supplier under this title.
                    ``(B) Rule of construction.--Nothing in this 
                paragraph shall be construed as limiting the authority 
                of a PDP sponsor to conduct postpayment review.''.
    (b) Application to MA-PD Plans.--Section 1857(f)(3) of the Social 
Security Act (42 U.S.C. 1395w-27(f)(3)) is amended by adding at the end 
the following new subparagraph:
                    ``(D) Suspension of payments pending investigation 
                of credible allegations of fraud by pharmacies.--
                Section 1860D-12(b)(7).''.
    (c) Conforming Amendment.--Section 1862(o)(3) of the Social 
Security Act (42 U.S.C. 1395y(o)(3)) is amended by inserting ``, 
section 1860D-12(b)(7) (including as applied pursuant to section 
1857(f)(3)(D)),'' after ``this subsection''.
    (d) Clarification Relating to Credible Allegation of Fraud.--
Section 1862(o) of the Social Security Act (42 U.S.C. 1395y(o)) is 
amended by adding at the end the following new paragraph:
            ``(4) Credible allegation of fraud.--In carrying out this 
        subsection, section 1860D-12(b)(7) (including as applied 
        pursuant to section 1857(f)(3)(D)), and section 1903(i)(2)(C), 
        a fraud hotline tip (as defined by the Secretary) without 
        further evidence shall not be treated as sufficient evidence 
        for a credible allegation of fraud.''.
    (e) Effective Date.--The amendments made by this section shall 
apply with respect to plan years beginning on or after January 1, 2020.
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