Sec. 5. Improvements to dispute resolution for claims and appeals under Medicare Advantage Dual Special Needs Plans

203 words·~1 min read·/bill/113/hr/4484/ih/section-5

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Section 1859(f)(3) of the Social Security Act ( 42 U.S.C. 1395w–28(f)(3) ), as amended by section 2(b), is further amended by adding at the end the following new subparagraph: For plan years beginning after December 31, 2015, coverage under this title and title XIX of an individual enrolled under such respective title shall continue during any determination, reconsideration, or appeals proceeding described in section 1852(g), with respect to such individual. . Not later than December 31, 2015, the Secretary of Health and Human Services shall establish a streamlined process for dispute resolution for claims and appeals, with respect items and services furnished to special needs individuals described in section 1859(b)(6)(B)(ii) of the Social Security Act (42 U.S.C. 1395w–28(b)(6)(B)(ii)), to align such process under the Medicare program under title XVIII of the Social Security Act with such process under the Medicaid program under title XIX of such Act.

Such streamlined process shall take into account various State requirements and promote a pathway that would be the most beneficial for individuals entitled to benefits under part A of title XVIII of such Act or enrolled under part B of such Act and to individuals enrolled under a State plan under title XIX of such Act.

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42 USC 1395w–28(f)(3)
42 USC 1395w–28(b)(6)(B)(ii)

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Sec. 5

Improvements to dispute resolution for claims and appeals under Medicare Advantage Dual Special Needs Plans

Cite42 USC 1395w–28(f)(3)

Cite42 USC 1395w–28(b)(6)(B)(ii)

Cites 2Cited by 0 across 0 sources