§1395b–9 Provisions relating to administration

Summary

Creates a center inside the Centers for Medicare & Medicaid Services (CMS) to run Medicare parts C and D. The center must be led by a director who reports to the CMS Administrator. The center must manage parts C and D, give required notices and information, and do any other tasks the Secretary assigns. The Secretary must make sure the center is doing these jobs by January 1, 2008. The Secretary can hire management staff, including people with private-sector experience in negotiating with health plans. New hires must show top skill in at least one area such as health care contracts, benefit plan design, actuarial work, contract compliance, consumer education, or other specialized areas the Secretary sets. Pay is set by the Secretary but cannot be higher than the top rate for the Senior Executive Service under 5 U.S.C. 5382(b). The Secretary must also appoint a Medicare Beneficiary Ombudsman inside HHS to help people with Medicare. The Ombudsman must take complaints and information requests from people in parts A or B, help them gather information and appeal decisions, help with problems from leaving a Medicare Advantage plan, help with income-related premium adjustments, and send yearly reports to Congress and the Secretary with activities and recommendations. The Ombudsman should work with state health insurance counseling programs. By December 13, 2017, the Secretary must also provide a pharmaceutical and technology ombudsman in CMS to handle complaints from manufacturers about coverage, coding, or payment; that ombudsman follows the same assistance rules. For fiscal years 2021 through 2030, the Secretary must transfer $2,000,000 each year (from the Hospital Insurance and Supplementary Medical Insurance Trust Funds in a mix the Secretary decides) to the CMS Program Management Account, available until spent.