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Title 42, The Public Health and WelfareRelease 119-110

§1395w–154 Improved Medicare Prescription Drug Plan and Ma–pd Plan Complaint System

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

Last updated Sep 22, 2026|Official source

Summary

The Secretary must create and keep a simple, easy-to-use complaint system for Medicare Advantage drug plans and standalone prescription drug plans. It must collect complaints sent any way (phone, letter, email, or other) from people and from places like HHS regional offices, the Medicare Beneficiary Ombudsman, and contractors. Complaints must be kept until they are resolved. The system must be able to spot big problems, start actions to fix them, watch progress, and help improve plan quality. The Secretary must also make a model online complaint form and put it on the front page of Medicare.gov and the Medicare Beneficiary Ombudsman website. Each year the Secretary must report to Congress about how many complaints there were, what kinds, where they happened, how fast they were handled, and how they were resolved. MA–PD plan: a Medicare Advantage plan that includes drug coverage. Prescription drug plan: a standalone Medicare drug plan. Secretary: the Secretary of Health and Human Services. System: the complaint system described above.

Full Legal Text

Title 42, §1395w–154

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

(a)In general
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)Model electronic complaint form
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)Annual reports by the Secretary
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)Definitions
In this section: (1) MA–PD plan
(2)Prescription drug plan
The term “prescription drug plan” has the meaning given such term in section 1395w–151(a)(14) of this title.
(3)Secretary
The term “Secretary” means the Secretary of Health and Human Services.
(4)System
The term “system” means the plan complaint system developed and maintained under subsection (a).

Legislative History

Notes & Related Subsidiaries

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.

Reference

Citations & Metadata

Citation

42 U.S.C. § 1395w–154

Title 42, The Public Health and Welfare

Last Updated

Sep 22, 2026

Release point: 119-110