12 2 STA T . 2 580PUBLIC LA W 110 – 2 7 5 —J UL Y 15 , 2008 ‘ ‘ (E) E LECTRONI CTR A N SF EROFF U N D S .—APD P spon so r s hal lpa y all c l e an cla im ss ub mi t te d electronically by elec - tronic trans f er of funds if the pharmacy so re q uests or has so requested pre v iously. I n the case w here such pay- ment is made electronically , remittance may be made by the PDP sponsor electronically as well. ‘‘( F ) PROTECTIN G T H E RIGHTS OF CLAI M ANTS.— ‘‘(i) IN GENERAL.— N othin g in this paragraph shall be construed to prohibit or limit a claim or action not covered by the sub j ect matter of this section that any individual or organi z ation has against a provider or a PDP sponsor. ‘‘(ii) ANTI-RETALIATION.— C onsistent with applicable Federal or S tate law, a PDP sponsor shall not retaliate against an individual or provider for e x er- cising a right of action under this subparagraph. ‘‘( G ) R ULE OF CONSTRUCTION.—A determination under this paragraph that a claim submitted by a pharmacy is a clean claim shall not be construed as a positive deter- mination regarding eligibility for payment under this title, nor is it an indication of government approval of, or acquiescence regarding, the claim submitted. T he deter- mination shall not relieve any party of civil or criminal liability with respect to the claim, nor does it offer a defense to any administrative, civil, or criminal action with respect to the claim. ’ ’. (b) PROM P TPA Y MENT B Y M A – PD PLANS.—Section 1857 (f) of the Social Security Act ( 42U .S.C. 1 39 5w–27) is amended by adding at the end the following new paragraph
‘‘(3) INCORPORATION OF CERTAIN PRESCRIPTION DRUG PLAN CONTRACT RE Q UIREMENTS.—The following provisions shall apply to contracts with a Medicare Advantage organization offering an MA–PD plan in the same manner as they apply to contracts with a PDP sponsor offering a prescription drug plan under part D: ‘‘(A) PROMPT PAYMENT.—Section 18 60 D–12(b)(4).’’. (c) EFFECTI V E DATE.—The amendments made by this section shall apply to plan years beginning on or after J anuary 1, 2010. SEC.172 .S UBMI SSI ON O F C LA IMS B YPH A R MACIES LOCA T E D IN OR CONTRACTIN GW ITH LONG - TERM CARE FACILITIES. (a) SUBMISSION OF CLAIMS BY PHARMACIES L OCATED IN OR CONTRACTING W ITH LONG-TERM CARE FACILITIES.— (1) SUBMISSION OF CLAIMS TO PRESCRIPTION DRUG PLANS.— Section 1860D–12(b) of the Social Security Act (42 U.S.C. 1395w–112(b)), as amended by section 171(a), is amended by adding at the end the following new paragraph: ‘‘(5) SUBMISSION OF CLAIMS BY PHARMACIES LOCATED IN OR CONTRACTING W ITH LONG-TERM CARE FACILITIES.—Each con- tract entered into with a PDP sponsor under this part with respect to a prescription drug plan offered by such sponsor shall provide that a pharmacy located in, or having a contract with, a long-term care facility shall have not less than 30 days (but not more than 90 days) to submit claims to the sponsor for reimbursement under the plan.’’. (2) SUBMISSION OF CLAIMS TO MA–PD PLANS.—Section 1857(f)(3) of the Social Security Act, as added by section 171(b), Deadlin e .42USC1395w– 2 7 n ot e. Ap pli c a b ilit y .
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