Medicare Advantage and Prescription Drug Accountability Act of 2004

Bill: 108-hr-4903
Sponsor: Rep. Brown, Sherrod [D-OH-13]
Introduced: 2004-07-22 in the House
Policy area: Health
Subjects: Auditing
Coinsurance
Commerce
Congress
Congressional reporting requirements
Consumer education
Cost accounting
Drugs
Federal employees
Finance and Financial Sector
Financial statements
Government Operations and Politics
Government contractors
Government employees' health insurance
Government paperwork
Health insurance
Inspectors general
Insurance premiums
Investments
Legislation
Managed care
Medical economics
Medical fees
Medicare
Medigap
Physicians
Prescription pricing
Profit
Social Welfare

Summary:
action_date: 2004-07-22
text: 
Medicare Advantage and Prescription Drug Accountability Act of 2004 - Amends part C (Medicare+Choice) of title XVIII (Medicare) of the Social Security Act (SSA) to: (1) require the contract with a Medicare Advantage (MA) organization to provide for a minimum loss ratio and a maximum administrative cost ratio both to be established by the Secretary of Health and Human Services (HHS); and (2) provide for the audit of administrative costs and compliance with the Federal Acquisition Regulation. 
 
Applies all the requirements of this Act, with appropriate adaptations, to contracts with prescription drug sponsors and prescription drug plans under part D (Voluntary Prescription Drug Benefit Program) of SSA title XVIII. 
 
Amends part C of SSA title XVIII to require each MA organization to provide annually to the Secretary information on each MA plan it offers to establish financial transparency, including a functional listing of the organization's administrative costs, profits, and investment income. 
 
Provides that an election to enroll with an MA plan shall not be effective unless the election form is signed by the individual and specifically acknowledges: (1) that premiums, cost sharing requirements, and benefits under the plan may change at the beginning of each 12-month contract period; (2) the individual may lose coverage of the individual's physician or other provider at the beginning of each such period; (3) the plan may be terminated at the beginning of any such period; and (4) premiums and benefits under the plan may vary based on the county or other MA area in which the plan is offered.
 
Directs the Secretary to transmit to Congress annual Medicare Advantage accountability and prescription drug reports that include, among other things, a detailed analysis of geographic variation in cost-sharing and premiums.
 
Requires the HHS Inspector General to audit periodically a representative sample of determinations made by the Secretary regarding MA plans that provide for an actuarially equivalent level of benefits to ensure that the Secretary is only approving plans with benefits that are actuarially equivalent.
 
Directs the Secretary to report to Congress a comparison of the average benefit payments, administrative costs, profits, and investment income for MA plans with corresponding aspects of the fee-for-service programs under Medicare parts A (Hospital Insurance) and B (Supplementary Medical Insurance) and for group and individual Medicare supplemental policies.


Legislative actions:
action_date: 2004-08-03
text: Referred to the Subcommittee on Health.
action_date: 2004-07-22
text: Referred to the Subcommittee on Health, for a period to be subsequently determined by the Chairman.
action_date: 2004-07-22
text: 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 consideration of such provisions as fall within the jurisdiction of the committee concerned.
action_date: 2004-07-22
text: 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 consideration of such provisions as fall within the jurisdiction of the committee concerned.
action_date: 2004-07-22
text: 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 consideration of such provisions as fall within the jurisdiction of the committee concerned.
action_date: 2004-07-22
text: Introduced in House
action_date: 2004-07-22
text: Introduced in House