,i  #aaeth ,,congress  #b;d ,session    
,h4 ,r4 #gcdj  ,,in ,,the ,,house ,,of  
,,representatives  ,december #ai1 #bjah 
,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 ,bill of       
,rights ,act of #bjah4  #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 #bjai1 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 network   
mid-year1 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 #bjai1 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 written
 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 at the       
minimum--  7,i7 the names and telephone 
numbers of available 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 #bjai1 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 ,medicare ,advantage ,plan ,compare 
,tool ,not later than one year after the
 date of enactment of this ,act1 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  
#c4 ,network adequacy  7a7 ,in ,general 
,section #aheb7;d7 of the ,social       
,security ,act 7#db ,u4,s4,c4           
#aciew-#bb7;d771 as amended by section  
#b1 is amended by adding at the end the 
following3  7#i7 ,network adequacy      
requirements ,beginning in plan year    
#bjai1 notwithstanding any other        
provision of law1 the following shall   
apply3 7,a7 ,provider availability ,when
 establishing a plan network1 a         
,medicare ,advantage organization       
offering an ,,ma plan shall1 among other
 factors determined by the ,secretary1  
consider the following3  7i7 ,the       
anticipated enrollment in the plan4     
7ii7 ,the expected types of services    
provided and utilization of services by 
enrollees under the plan4  7iii7 ,the   
number and types of providers needed to 
provide such services4  7iv7 ,the number
 of network providers who are not       
accepting new patients4  7v7 ,the       

location of providers and enrollees4    
7vi7 ,the full-time equivalent          
availability of a provider to provide   
such services4  7,b7 ,provision of care 
in a timely manner ,a ,medicare         
,advantage organization offering an ,,ma
 plan shall ensure that providers are   
able to provide services in a timely    
manner1 as defined by the ,secretary1   
under the plan4  7,c7 ,application of   
network access adequacy standards ,in   
applying the network access adequacy    
standards pursuant to paragraph 7#a71   
the ,secretary shall seek input from    
patient advocacy groups1 providers of   
services and suppliers1 and ,,ma plans  
under this part4  7,d7 ,certification   
,each plan year1 a ,medicare ,advantage 
organization shall certify to the       
,secretary1 with respect to each ,,ma   
plan offered by the organization1 that  
the providers1 including specialists and
 subspecialists1 in the plan network are
 able to provide the services required  
under the organization's contract with  

the ,secretary under section #aheg with 
respect to the offering of such plan and
 to meet the needs of the enrollees     
within the plan service area during the 
year4  7,e7 ,annual reporting ,each plan
 year1 a ,medicare ,advantage           
organization shall report to the        
,secretary the following with respect to
 each ,,ma plan offered by the          
organization3  7i7 ,average wait time   
,the average wait time for primary and  
specialty care for enrollees under the  
plan4  7ii7 ,utilization of out of      
network providers ,the utilization of   
out-of-network providers under the plan4
  7iii7 ,average cost per patient ,the  
average annual spending per patient for 
primary and specialty care for enrollees
 under the plan4  7,f7 ,certification   
,in advance of the annual1 coordinated  
election period under section           
#ahea7;e77#c71 a ,medicare ,advantage   
organization shall certify to the       
,secretary the accuracy of provider     
directories for each plan offered by the

 organization4  7,g7 ,network review    
,the ,secretary shall ensure that the   
network of each ,,ma plan offered by a  
,medicare ,advantage organization meets 
the network adequacy guidelines         
established under this paragraph and    
under section #dbb4aab7;a77#d7 of title 
#db1 ,code of ,federal ,regulations 7or 
any successor regulation to such        
section7 at least once every #c years or
 when a material change in network      
occurs4  4  7b7 ,enforcement ,section   
#aheg7;g77#a77,k7 of the ,social        
,security ,act 7#db ,u4,s4,c4           
#aciew-#bg7;g77#a77,k771 as added by    
section #b7;b71 is amended by striking  
or #aheb7;d77#h7 and inserting 1        
#aheb7;d77#h71 or #aheb7;d77#i74