,i  #aacth ,,congress  #b;d ,session    
,h4 ,r4 #diih  ,,in ,,the ,,house ,,of  
,,representatives  ,june #bf1 #bjad ,ms4
 ,de,lauro introduced the following     
bill2 which was referred to the         
,committee on ,ways and ,means1 and in  
addition to the ,committee on ,energy   
and ,commerce1 for a period to be       
subsequently determined by the ,speaker1
 in each case for consideration of such 
provisions as fall within the           
jurisdiction of the committee concerned 
,a ,,bill  ,to enhance beneficiary and  
provider protections and improve        
transparency in the ,medicare ,advantage
 market1 and for other purposes4  #a4   
,short title ,this ,act may be cited as 
the ,medicare ,advantage ,participant   
,bill of ,rights ,act of #bjad4  #b4    
,limitation on removal of ,medicare     
,advantage providers by ,,ma            
organizations  7a7 ,limitation ,section 
#aheb7;d7 of the ,social ,security ,act 
7#db ,u4,s4,c4 #aciew-#bb7;d77 is       
amended by adding at the end the        

following3  7#g7 ,limitation on removal 
of providers from ,,ma plans by ,,ma    
organizations  7,a7 ,removal of         
providers with cause ,beginning with    
plan year #bjae1 except as provided in  
subparagraph 7,c71 an ,,ma organization 
offering an ,,ma plan may only remove a 
provider of services or a supplier from 
a network of such plan if the           
organization has cause to remove such   
provider or supplier4  7,b7 ,cause to   
remove providers  7i7 ,in ,general ,an  
,,ma organization offering an ,,ma plan 
has cause to remove a provider of       
services or a supplier from a network of
 such plan if the ,secretary determines 
that the provider or supplier is--  7,i7
 medically negligent2  7,,ii7 in        
violation of any legal or contractual   
requirement applicable to the provider  
or supplier acting within the lawful    
scope of practice1 including any        
participation or other requirement      
applicable to such provider or supplier 
under this title or under any           

contractual term for such plan2 or      
7,,iii7 otherwise unfit to furnish items
 and services in accordance with        
requirements of this title4  7ii7       
,consideration of cost to ,,ma          
organizations ,for purposes of          
subparagraph 7,a71 cost to an ,,ma      
organization offering an ,,ma plan due  
to the participation of a provider of   
services or supplier in a network of    
such plan does not constitute cause for 
the ,,ma organization to remove such    
provider or supplier from the network1  
and such cost may not be considered as a
 factor in favor of a determination that
 such organization has cause to remove  
the provider4  7,c7 ,exception ,with    
respect to each upcoming plan year1     
beginning with plan year #bjae1 an ,,ma 
organization offering an ,,ma plan may  
only remove a provider of services or   
supplier from a network of such plan for
 reasons not specified in subparagraph  
7,b77i7 before the date that is #fj days
 before the first day of the annual     

coordinated election period for such    
plan year under section #ahea7;e77#c74  
7,d7 ,notice and appeal process  7i7 ,in
 ,general ,any removal of a provider of 
services or supplier from a network of  
an ,,ma plan may occur only after the   
completion of a fair notice and appeal  
process that the ,secretary shall       
establish by regulation4 ,such process  
shall require the ,,ma organization to  
provide to such provider or supplier and
 to the ,secretary an explanation of the
 reason or reasons for the removal4     
7ii7 ,application  7,i7 ,application of 
new process ,in the case of a removal of
 a provider of services or supplier from
 a network of an ,,ma plan occurring on 
or after the effective date published in
 a final rule for such fair notice and  
appeal process1 such process shall apply
 in lieu of the process for the         
termination or suspension of a provider 
contract under section #dbb4bjb7;a7 of  
title #db1 ,code of ,federal            
,regulations4  7,,ii7 ,continuation of  

old process ,in the case of a removal of
 a provider of services or supplier from
 a network of an ,,ma plan occurring    
before such effective date1 the process 
for the termination or suspension of a  
provider contract under section         
#dbb4bjb7;a7 of title #db1 ,code of     
,federal ,regulations1 shall apply4     
7,e7 ,participant notice and protection 
7i7 ,notice to participants of provider 
removal ,not less than #fj days before  
the date on which a provider of services
 or supplier is removed from a network  
of an ,,ma plan1 the ,,ma organization  
offering such plan shall provide        
notification of the removal to each     
individual enrolled in such plan        
receiving items or services from the    
provider or supplier during the plan    
year in effect on the date of removal or
 during the previous plan year4 ,such   
notification shall include--  7,i7 the  
names and telephone numbers of          
in-network providers of services and    
suppliers offering items and services   

that are the same or similar to the     
items and services offered by the       
removed provider or supplier2  7,,ii7   
information regarding the options       
available to an individual enrolled in  
such plan to request the continuation of
 medical treatment or therapy with the  
removed provider or supplier2 and       
7,,iii7 one or more customer service    
telephone numbers that an individual    
enrolled in such plan may access to     
obtain information regarding changes to 
the network of the plan4  7ii7 ,annual  
notice of change ,in addition to        
providing the notification of removal as
 required under clause 7i71 the ,,ma    
organization offering such ,,ma plan    
shall include such notification in the  
annual notice of change for the ,,ma    
plan for the upcoming plan year4  7iii7 
,continuity of care ,in any case in     
which a provider of services or supplier
 is removed from a network of an ,,ma   
plan1 such plan shall ensure that the   
removal satisfies the continuity of care

 requirements under paragraph 7#a77;,a7 
with respect to each individual enrolled
 in such plan receiving items or        
services from the provider or supplier  
during the plan year in effect on the   
date of removal or during the previous  
plan year4  7,f7 ,rule of construction  
,nothing in this paragraph shall be     
construed as affecting the ability of a 
provider of services or supplier to     
decline to participate in a network of  
an ,,ma plan4  7#h7 ,transparency in    
measures used by ,,ma organizations to  
establish or modify provider networks   
7,a7 ,in ,general ,beginning with plan  
year #bjaf1 an ,,ma organization        
offering an ,,ma plan shall include the 
information described in subparagraph   
7,b7--  7i7 in the annual bid           
information submitted by the ,,ma       
organization with respect to the ,,ma   
plan under section #ahed2 and  7ii7 on  
the ,internet ,web site for the ,,ma    
plan4  7,b7 ,information described ,the 
information described in this           

subparagraph is the following3  7i7     
,information regarding the measures used
 by the ,,ma organization to establish  
or modify the provider network of the   
,,ma plan1 including measures of the    
quality and efficiency of providers4    
,such information shall include the     
specifications1 methodology1 and sample 
size of such measures4  7ii7 ,other     
information related to the establishment
 or modification of such provider       
network that the ,secretary determines  
appropriate4  7,c7 ,limitation ,the     
information described in subparagraph   
7,b7 shall not include any individually 
identifiable information of any provider
 or supplier of services4  4  7b7       
,enforcement  7#a7 ,sanctions for       
noncompliance ,section #aheg7;g77#a7 of 
the ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#bg7;g77#a77 is        
amended--  7,a7 in subparagraph 7,j71 by
 striking or2  7,b7 by redesignating    
subparagraph 7,k7 as subparagraph 7,l72 
7,c7 by inserting after subparagraph    

7,j7 the following new subparagraph3    
7,k7 fails to comply with sections      
#aheb7;d77#g7 or #aheb7;d77#h72 or  2   
and  7,d7 in subparagraph 7,l7 7as so   
redesignated71 by striking through 7,j7 
and inserting through 7,k74  7#b7       
,sanctions not applicable to part ,d    
,title ,,xviii of the ,social ,security 
,act is amended--  7,a7 in section      
#ahfj;,d-#ab7;b77#c77;,e7 7#db ,u4,s4,c4
 #aciew-#aab7;b77#c77;,e771 by striking 
paragraph 7#a77;,f7 and inserting       
paragraphs 7#a77;,f7 and 7#a77,k72 and  
7,b7 in section #ahid7;e77#f77;,b7 7#db 
,u4,s4,c4 #acie;eee7e77#f77;,b771 by    
inserting 7other than paragraph 7#a77,k7
 of such section7 after #aheg7;g77#a74  
7c7 ,network access adequacy standards  
,beginning with plan year #bjae1 in     
applying the network access adequacy    
standards pursuant to section           
#aheb7;d77#a7 of the ,social ,security  
,act 7#db ,u4,s4,c4 #aciew-#bb7;d77#a771
 the ,secretary of ,health and ,human   
,services shall seek input from patient 

advocacy groups1 providers of services  
and suppliers1 and ,,ma plans under part
 ,c of title ,,xviii of such ,act4  7d7 
,medicare ,advantage ,plan ,compare     
,tool ,not later than ,september #cj1   
#bjae1 the ,secretary of ,health and    
,human ,services shall take such        
measures as are necessary to ensure that
 the ,medicare ,advantage ,compare ,tool
 takes into account the preferences and 
utilization needs of such individuals4