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U.S. Code as of:
01/19/04
Section 1395b-9. Provisions relating to administration
(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).
(2) Director
Such center shall be headed by a director who shall report
directly to the Administrator of the Centers for Medicare &
Medicaid Services.
(3) Duties
The duties described in this paragraph are the following:
(A) The administration of parts C and D of this subchapter.
(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
The Secretary shall ensure that the center is carrying out the
duties described in paragraph (3) by not later than January 1,
2008.
(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.
(2) Eligibility
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:
(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
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.
(B) Limitation
In no case may the rate of compensation determined under
subparagraph (A) exceed the highest rate of basic pay for the
Senior Executive Service under section 5382(b) of title 5.
(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.
(2) Duties
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
(iii) assistance to such individuals in presenting
information under section 1395r(i)(4)(C) of this title
(relating to income-related premium adjustment; )1(! 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.
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