Medicare Advantage and Prescription Drug Accountability Act of 2005

Bill: 109-hr-4103
Sponsor: Rep. Brown, Sherrod [D-OH-13]
Introduced: 2005-10-20 in the House
Policy area: Health
Subjects: Access to health care
Auditing
Business records
Coinsurance
Commerce
Congress
Congressional reporting requirements
Consumer complaints
Consumer education
Cost accounting
Drug industry
Drugs
Federal employees
Finance and Financial Sector
Financial statements
Government Operations and Politics
Government contractors
Government employees' health insurance
Government paperwork
Health insurance
Health maintenance organizations
Inspectors general
Insurance premiums
Investments
Legislation
Managed care
Medicaid
Medical economics
Medical fees
Medical statistics
Medicare
Medigap
Ombudsman
Physicians
Prescription pricing
Profit
Social Welfare

Summary:
action_date: 2005-10-20
text: 
Medicare Advantage and Prescription Drug Accountability Act of 2005 - Amends title XVIII (Medicare) of the Social Security Act to require the contract with an Medicare Advantage (MA) organization to provide for a minimum loss ratio (aggregate average benefits that are at least a minimum ratio of the aggregate average revenues collected under the contract) and a maximum administrative cost ratio (aggregate average administrative costs that do not exceed a maximum ratio of the aggregate average revenues collected under the contract).
 
Requires each contract with a Medicare+Choice organization to grant the Secretary of Health and Human Services the right to audit and inspect any books and records of the organization for compliance with such ratio and related administrative cost requirements.
 
Applies such requirements to contracts with prescription drug sponsors under Medicare part D (Voluntary Prescription Drug Benefit Program).
 
Prescribes requirements for financial transparency of MA plans.
 
Renders an election to enroll with an MA plan ineffective unless the election form is signed by the individual and specifically acknowledges specified plan features.
 
Applies such requirements to prescription drug plans under Medicare part D.
 
Directs the Secretary to transmit to Congress annual MA accountability and prescription drug accountability reports.
 
Requires periodic audits by the departmental Inspector General of the Secretary's determinations about the acturial equivalency of MA plans.
 

 
Requires each prescription drug plan sponsor with respect to a prescription drug plan, and each MA organization with respect to an MA-PD plan, to report annually to the Inspector General on drug claims rejections and reversals on appeal.
 
Directs the Secretary to appoint a Medicare prescription drug ombudsman. 


Legislative actions:
action_date: 2005-11-04
text: Referred to the Subcommittee on Health.
action_date: 2005-10-20
text: 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.
action_date: 2005-10-20
text: 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.
action_date: 2005-10-20
text: 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.
action_date: 2005-10-20
text: Introduced in House
action_date: 2005-10-20
text: Introduced in House