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H.R. 5676 (115th): Stop Excessive Narcotics in our Retirement Communities Protection Act of 2018


The text of the bill below is as of Jun 20, 2018 (Referred to Senate Committee). The bill was not enacted into law.

Summary of this bill

Source: Republican Policy Committee

H.R. 5676 allows Medicare Advantage and Prescription Drug Plans to suspend payments to a provider or supplier pending an investigation of a credible allegation of fraud against the provider or supplier. This is similar to the authority the Secretary of the Department of Health and Human Services (HHS) already has for Medicare Fee-for-Service.


IIB

115th CONGRESS

2d Session

H. R. 5676

IN THE SENATE OF THE UNITED STATES

June 20, 2018

Received; read twice and referred to the Committee on Finance

AN ACT

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.

1.

Short title

This Act may be cited as the Stop Excessive Narcotics in our Retirement Communities Protection Act of 2018 or the SENIOR Communities Protection Act of 2018.

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.

Passed the House of Representatives June 19, 2018.

Karen L. Haas,

Clerk