legislation: 108-hr-5400

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bill_id congress bill_type bill_number title policy_area introduced_date latest_action_date latest_action_text origin_chamber sponsor_name sponsor_state sponsor_party sponsor_bioguide_id cosponsor_count summary_text update_date url
108-hr-5400 108 hr 5400 Medicare PPO Fairness Act of 2004 Health 2004-11-19 2004-12-01 Referred to the Subcommittee on Health, for a period to be subsequently determined by the Chairman. House Rep. Cardin, Benjamin L. [D-MD-3] MD D C000141 0 Medicare PPO Fairness Act of 2004 - Directs the Secretary of Health and Human Services to provide written notice to each individual who is, or has been, enrolled in the Medicare PPO Demonstration Project of the following: (1) the fact that the enrollees are, and have been, eligible for coverage of services whether the services were provided by in-network or out-of-network providers; and (2) there is a procedure for reimbursement for claims for services that should be (or have been) covered but were not covered because of their provision by an out-of-network provider. Directs the Secretary to: (1) establish a procedure for reimbursement of enrollees under the Medicare PPO Demonstration Project for claims for services furnished before January 1, 2005, that should be (or have been) covered but were not covered because of their provision by an out-of-network provider; and (2) provide for an adjustment in the capitation rates for plans under the project for months in 2005 so as to reduce payment under such rates, in the aggregate, by the aggregate amount of payments the Secretary estimates will be paid under such procedure. 2023-01-14T22:48:32Z  

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