View all text of Subchapter XVIII [§ 1395 - § 1395lll]
§ 1395b–9. Provisions relating to administration
(a) Coordinated administration of medicare prescription drug and Medicare Advantage programs
(1) In general
(2) Director
(3) DutiesThe duties described in this paragraph are the following:
(A) The administration of parts C and D.
(B) The provision of notice and information under section 1395b–2 of this title.
(C) Such other duties as the Secretary may specify.
(4) Deadline
(b) Employment of management staff
(1) In general
(2) EligibilityTo be eligible for employment under paragraph (1) an individual shall be required to have demonstrated, by their education and experience (either in the public or private sector), superior expertise in at least one of the following areas:
(A) The review, negotiation, and administration of health care contracts.
(B) The design of health care benefit plans.
(C) Actuarial sciences.
(D) Compliance with health plan contracts.
(E) Consumer education and decision making.
(F) Any other area specified by the Secretary that requires specialized management or other expertise.
(3) Rates of payment
(A) Performance-related pay
(B) Limitation
(c) Medicare Beneficiary Ombudsman
(1) In general
(2) DutiesThe Medicare Beneficiary Ombudsman shall—
(A) receive complaints, grievances, and requests for information submitted by individuals entitled to benefits under part A or enrolled under part B, or both, with respect to any aspect of the medicare program;
(B) provide assistance with respect to complaints, grievances, and requests referred to in subparagraph (A), including—
(i) assistance in collecting relevant information for such individuals, to seek an appeal of a decision or determination made by a fiscal intermediary, carrier, MA organization, or the Secretary;
(ii) assistance to such individuals with any problems arising from disenrollment from an MA plan under part C; and
(iii) assistance to such individuals in presenting information under section 1395r(i)(4)(C) of this title (relating to income-related premium adjustment; 1
1 So in original. A closing parenthesis probably should precede the semicolon.
and(C) submit annual reports to Congress and the Secretary that describe the activities of the Office and that include such recommendations for improvement in the administration of this subchapter as the Ombudsman determines appropriate.
The Ombudsman shall not serve as an advocate for any increases in payments or new coverage of services, but may identify issues and problems in payment or coverage policies.
(3) Working with health insurance counseling programs
(d) Pharmaceutical and technology ombudsman
(1) In generalNot later than 12 months after December 13, 2016, the Secretary shall provide for a pharmaceutical and technology ombudsman within the Centers for Medicare & Medicaid Services who shall receive and respond to complaints, grievances, and requests that—
(A) are from entities that manufacture pharmaceutical, biotechnology, medical device, or diagnostic products that are covered or for which coverage is being sought under this subchapter; and
(B) are with respect to coverage, coding, or payment under this subchapter for such products.
(2) Application
(e) Funding for implementation of beneficiary enrollment simplification
(Aug. 14, 1935, ch. 531, title XVIII, § 1808, as added and amended Pub. L. 108–173, title IX, §§ 900(a), (b), 923(a), Dec. 8, 2003, 117 Stat. 2369, 2393; Pub. L. 114–255, div. A, title IV, § 4010, Dec. 13, 2016, 130 Stat. 1185; Pub. L. 116–260, div. CC, title I, § 120(b), Dec. 27, 2020, 134 Stat. 2955.)