§1395b–9 Provisions Relating to Administration

Summary

Create a center inside the Centers for Medicare & Medicaid Services to run Medicare Advantage (Part C) and the prescription drug program (Part D). The center must have a director who reports to the CMS Administrator. The center must handle Parts C and D, give required notices and information, and do other tasks the Secretary assigns. The center had to be up and running by January 1, 2008. The Secretary may hire management staff for CMS, including people with private-sector experience negotiating with health plans. Hired staff must show strong skill in areas like health care contract review and negotiation, benefit plan design, actuarial work, contract compliance, consumer education, or other special management skills. Pay is set based on skill, experience, and performance but cannot be higher than the top basic pay rate for the Senior Executive Service under 5 U.S.C. 5382(b). The Secretary must appoint a Medicare Beneficiary Ombudsman to take complaints from Medicare Part A and B people, help them collect information and appeal decisions, help with MA plan disenrollment problems, assist with income-related premium issues, work with counseling programs, and send yearly reports to Congress and the Secretary. The Ombudsman must not push for higher payments or new coverage, but may point out problems. Within 12 months after December 13, 2016, CMS must also have a pharmaceutical and technology ombudsman to handle coverage, coding, or payment complaints from makers of drugs, devices, diagnostics, or biotech products; that ombudsman is subject to the same restriction about advocating payment or coverage increases. Finally, $2,000,000 must be transferred each fiscal year from 2021 through 2030 from the two Medicare trust funds to the CMS Program Management Account to help carry out beneficiary enrollment simplification; these amounts remain available until spent.