§1395b–9 Provisions Relating to Administration

Summary

Create a new center inside the Centers for Medicare & Medicaid Services (CMS) to run Medicare Parts C and D. A director will lead the center and report to the CMS Administrator. The center must manage Parts C and D, send required notices and information under section 1395b–2, and do other tasks the Secretary assigns. The center had to be in place by January 1, 2008. The Secretary may hire management staff, including people with private-sector experience negotiating with health plans. Hires must have strong skills in at least one area like health care contract work, benefit plan design, actuarial science, contract compliance, consumer education, or other special skills the Secretary names. The Secretary sets pay based on skill, experience, and performance, but pay cannot be higher than the top Senior Executive Service basic rate under section 5382(b) of title 5. The Secretary must also appoint a Medicare Beneficiary Ombudsman in HHS who has health-care and beneficiary-help experience. The Ombudsman will take complaints from Part A and B people, help them gather information and appeal decisions, help with problems from leaving a Medicare Advantage plan, help with income-related premium adjustment information under section 1395r(i)(4)(C), and send annual reports to Congress and the Secretary with recommendations. The Ombudsman should work with health insurance counseling programs under section 1395b–4. Not later than 12 months after December 13, 2016, the Secretary must create a pharmaceutical and technology ombudsman at CMS to take complaints from manufacturers about coverage, coding, or payment for their products and to provide the same kinds of help described above. For fiscal years 2021 through 2030, the Secretary must transfer $2,000,000 each year from the Federal Hospital Insurance Trust Fund and the Federal Supplementary Medical Insurance Trust Fund (in proportions the Secretary decides) to the CMS Program Management Account. Those funds remain available until spent.