§1395w–154 — Title 42 The Public Health and Welfare | U.S. Code

§1395w–154 Improved Medicare prescription drug plan and MA–PD plan complaint system

Title 42 › Chapter CHAPTER 7— - SOCIAL SECURITY › Subchapter SUBCHAPTER XVIII— - HEALTH INSURANCE FOR AGED AND DISABLED › Part Part D— - Voluntary Prescription Drug Benefit Program › Subpart subpart 5— - definitions and miscellaneous provisions › § 1395w–154

Last updated Apr 6, 2026|Official source

Summary

The Secretary must set up and run a public, easy-to-use system to collect complaints about MA–PD plans and prescription drug plans. It must accept complaints by phone, mail, email, or other ways and take reports from HHS offices, the Medicare Beneficiary Ombudsman, and Medicare contractors. Complaints stay in the system until they are resolved. The system must spot serious problems, start follow-up actions, and help improve plan quality. The Secretary must make a model online complaint form and put it on the front page of Medicare.gov and the Ombudsman website. Each year the Secretary must report to Congress on how many complaints there were, the types and where they happened, how fast agencies or plans responded, and whether complaints were resolved. Definitions: MA–PD plan and prescription drug plan — meanings given elsewhere; Secretary — Secretary of Health and Human Services; system — the complaint system.

Title 42, §1395w–154

The Public Health and Welfare — Source: USLM XML via OLRC

(a)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, e-mail, 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 1395kk–1 of this title) 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)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)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)In this section:

(1)The term “MA–PD plan” has the meaning given such term in section 1395w–151(a)(9) of this title.

(2)The term “prescription drug plan” has the meaning given such term in section 1395w–151(a)(14) of this title.

(3)The term “Secretary” means the Secretary of Health and Human Services.

(4)The term “system” means the plan complaint system developed and maintained under subsection (a).

Editorial Notes

Codification Section was enacted as part of the Patient Protection and Affordable Care Act, and not as part of the Social Security Act which comprises this chapter.

§1395w–154 Improved Medicare prescription drug plan and MA–PD plan complaint system

Summary

Title 42, §1395w–154

Notes & Related Subsidiaries

Editorial Notes

Citations & Metadata