42 U.S. Code § 1395b–9 - Provisions relating to administration
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(a) Coordinated administration of medicare prescription drug and Medicare Advantage programs
(1) In general
There is within the Centers for Medicare & Medicaid Services a center to carry out the duties described in paragraph (3).
Such center shall be headed by a director who shall report directly to the Administrator of the Centers for Medicare & Medicaid Services.
The duties described in this paragraph are the following:
(B) The provision of notice and information under section 1395b–2 of this title.
(b) Employment of management staff
(1) In general
The Secretary may employ, within the Centers for Medicare & Medicaid Services, such individuals as management staff as the Secretary determines to be appropriate. With respect to the administration of parts C and D of this subchapter, such individuals shall include individuals with private sector expertise in negotiations with health benefits plans.
To 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:
(3) Rates of payment
(A) Performance-related pay
Subject to subparagraph (B), the Secretary shall establish the rate of pay for an individual employed under paragraph (1). Such rate shall take into account expertise, experience, and performance.
(c) Medicare Beneficiary Ombudsman
(1) In general
The Secretary shall appoint within the Department of Health and Human Services a Medicare Beneficiary Ombudsman who shall have expertise and experience in the fields of health care and education of (and assistance to) individuals entitled to benefits under this subchapter.
The Medicare Beneficiary Ombudsman shall—
(A) receive complaints, grievances, and requests for information submitted by individuals entitled to benefits under part A of this subchapter or enrolled under part B of this subchapter, 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 of this subchapter; 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
To the extent possible, the Ombudsman shall work with health insurance counseling programs (receiving funding under section 1395b–4 of this title) to facilitate the provision of information to individuals entitled to benefits under part A of this subchapter or enrolled under part B of this subchapter, or both regarding MA plans and changes to those plans. Nothing in this paragraph shall preclude further collaboration between the Ombudsman and such programs.
 So in original. A closing parenthesis probably should precede the semicolon.
Source(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.)
2003—Subsec. (b). Pub. L. 108–173, § 900(b), added subsec. (b).
Subsec. (c). Pub. L. 108–173, § 923(a), added subsec. (c).
Deadline for Appointment
Pub. L. 108–173, title IX, § 923(b),Dec. 8, 2003, 117 Stat. 2394, provided that: “By not later than 1 year after the date of the enactment of this Act [Dec. 8, 2003], the Secretary [of Health and Human Services] shall appoint the Medicare Beneficiary Ombudsman under section 1808(c) of the Social Security Act [42 U.S.C. 1395b–9 (c)], as added by subsection (a).”
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