Sec. 2007. Automatic escalation to external review under a Medicare part D drug management program for at-risk beneficiaries

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Section 1860D–4(c)(5) of the Social Security Act ( 42 U.S.C. 1395ww–10(c)(5) ) is amended— in subparagraph (B), in each of clauses (ii)(III) and (iii)(IV), by striking and the option of an automatic escalation to external review and inserting , including notice that if on reconsideration a PDP sponsor affirms its denial, in whole or in part, the case shall be automatically forwarded to the independent, outside entity contracted with the Secretary for review and resolution ; and in subparagraph (E), by striking and the option and all that follows and inserting the following: and if on reconsideration a PDP sponsor affirms its denial, in whole or in part, the case shall be automatically forwarded to the independent, outside entity contracted with the Secretary for review and resolution. .

The amendments made by subsection

(a)shall apply beginning not later January 1, 2021.

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42 USC 1395ww–10(c)(5)

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Sec. 2007

Automatic escalation to external review under a Medicare part D drug management program for at-risk beneficiaries

Cite42 USC 1395ww–10(c)(5)

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