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ACA Now

3311 - Improved Medicare PDP and MA-PD Plan Complaint System

 
Implementation Status 
Statutory Text 

Summary

Mandates development of a system to collect complaints against Part D plans and requires CMS to deliver an annual report to Congress summarizing such complaints. CMS must develop a model complaint form that must be prominently displayed on the home page for Medicare.gov.

Implementation Status

 
Summary 
Statutory Text 

In the April 15, 2011, final rule governing MA and Part D policy, CMS finalized implementation of this provision (see pp. 21470-71).

Statutory Text

 
Implementation Status 
Summary 

SEC. 3311 ø42 U.S.C. 1395w–154¿. IMPROVED MEDICARE PRESCRIPTION DRUG PLAN AND MA–PD PLAN COMPLAINT SYSTEM. (a) IN GENERAL.—The Secretary shall develop and maintain a complaint system, that is widely known and easy to use, to collect and maintain information on MA–PD plan and prescription drug plan complaints that are received (including by telephone, letter, email, or any other means) by the Secretary (including by a regional office of the Department of Health and Human Services, the Medicare Beneficiary Ombudsman, a subcontractor, a carrier, a fiscal intermediary, and a Medicare administrative contractor under section 1874A of the Social Security Act (42 U.S.C. 1395kk)) through the date on which the complaint is resolved. The system shall be able to report and initiate appropriate interventions and monitoring based on substantial complaints and to guide quality improvement. (b) MODEL ELECTRONIC COMPLAINT FORM.—The Secretary shall develop a model electronic complaint form to be used for reporting plan complaints under the system. Such form shall be prominently displayed on the front page of the Medicare.gov Internet website and on the Internet website of the Medicare Beneficiary Ombudsman. (c) ANNUAL REPORTS BY THE SECRETARY.—The Secretary shall submit to Congress annual reports on the system. Such reports shall include an analysis of the number and types of complaints reported in the system, geographic variations in such complaints, the timeliness of agency or plan responses to such complaints, and the resolution of such complaints. (d) DEFINITIONS.—In this section: (1) MA–PD PLAN.—The term ‘‘MA–PD plan’’ has the meaning given such term in section 1860D–41(a)(9) of such Act (42 U.S.C. 1395w–151(a)(9)). (2) PRESCRIPTION DRUG PLAN.—The term ‘‘prescription drug plan’’ has the meaning given such term in section 1860D– 41(a)(14) of such Act (42 U.S.C. 1395w–151(a)(14)). (3) SECRETARY.—The term ‘‘Secretary’’ means the Secretary of Health and Human Services. (4) SYSTEM.—The term ‘‘system’’ means the plan complaint system developed and maintained under subsection (a).

Browse ACA Titles

  • I-Quality, Affordable Health Care for all Americans
  • II-Role of Public Programs
  • III-Improving the Quality and Efficiency of Health Care
  • IV-Prevention of Chronic Disease and Improving Public Health
  • V-Health Care Workforce
  • VI-Transparency and Program Integrity
  • VII-Improving Access to Innovative Medical Therapies
  • VIII-Community Living Assistance Services and Supports (CLASS ACT)
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