PAID Act Introduced in the U.S. Senate

On June 26, 2019, Senators Tim Scott (R-SC) and Ben Cardin (D-MD) introduced Senate Bill 1989 into the U.S. Senate. Section one of this bill states the Act may be cited as the Provide Accurate Information Directly (PAID Act). The PAID Act’s Senate introduction comes on the heels of the bill’s introduction into the U.S. House of Representatives as H.R. 1375 earlier this year by Representatives Ron Kind (D-WI) and Guy Bilirakis (R-FL). 

Identical to the House version, Senate Bill 1989 proposes that the Centers for Medicare and Medicaid (CMS) expand its Section 111 Query Process to identify whether an individual is, or during the preceding three-year (3) period, was enrolled in Medicare Part C (Medicare Advantage) and/or Medicare Part D (Prescription Drugs) plan, and provide the name and address of each plan identified during the preceding three year (3) period. As with the House bill, Senate Bill 1989 does not require CMS to also return information on an individual’s Medicaid enrollment which was previously included in a prior version of the PAID Act introduced in the last Congressional session.

In the bigger picture, the PAID Act aims to address current challenges claims payers have in determining Part C and Part D enrollment with identifying potential reimbursement claims. This problem is particularly pressing in the Part C context as Medicare Advantage Plans have become more aggressive in asserting recovery claims over the past several years, including obtaining several favorable court decisions finding that Part C plans have private cause action rights allowing them to sue claims payers for “double damages.” While in a nascent state, by comparison, there is evidence of increased recovery efforts on the Part D side. On this note, CMS recently amended its Part D manual to encourage Part D providers to identify and pursue secondary payer reimbursement. Click here to review our recent article about CMS’ updates to its Medicare Prescription Drug Benefit Manual.   

Senate Bill 1989 has been referred to the Senate Committee on Finance. On the House side, H.R. 1375 is currently pending before Committee on Energy and Commerce and the Committee on Ways and Means’ Subcommittee on Health.

By Kate Riordan

Courtesy of ISO Claims Partners Blog

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