Bill Explanation: H.R. 1038

This bill aims to change a part of the Social Security Act (specifically, title XVIII) related to Medicare. It focuses on prescription drug plan sponsors and MA-PD organizations that operate under the Medicare program. These organizations would be prohibited from reducing the payment on a clean claim submitted by a pharmacy in a retroactive manner.

The bill was introduced by Mr. GRIFFITH, with support from several other representatives, and referred to the Committees on Energy and Commerce, and Ways and Means, for consideration.

Overall, this bill seeks to improve transparency and accuracy in Medicare Part D spending by preventing prescription drug plan sponsors and MA-PD organizations from reducing payment on clean claims submitted by pharmacies retroactively.

The specific details of the amendment, which will be added to Section 1860D–12(b)(4)(A) of the Social Security Act, are provided in the text of the bill.

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