text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Medicare Advantage Participant Bill 
  of Rights Act of 2014''.
  
  SEC. 2. LIMITATION ON REMOVAL OF MEDICARE ADVANTAGE PROVIDERS BY MA 
                ORGANIZATIONS.
  
      (a) Limitation.--Section 1852(d) of the Social Security Act (42 
  U.S.C. 1395w-22(d)) is amended by adding at the end the following:
              ``(7) Limitation on removal of providers from ma plans by 
          ma organizations.--
                      ``(A) Removal of providers with cause.--Beginning 
                  with plan year 2015, except as provided in subparagraph 
                  (C), 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 supplier.
                      ``(B) Cause to remove providers.--
                              ``(i) 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--
                                      ``(I) medically negligent;
                                      ``(II) in violation of any legal or 
                                  contractual requirement applicable to 
                                  the provider or supplier acting within 
                                  the lawful scope of practice, including 
                                  any participation or other requirement 
                                  applicable to such provider or supplier 
                                  under this title or under any 
                                  contractual term for such plan; or
                                      ``(III) otherwise unfit to furnish 
                                  items and services in accordance with 
                                  requirements of this title.
                              ``(ii) Consideration of cost to ma 
                          organizations.--For purposes of subparagraph 
                          (A), 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, and such cost may 
                          not be considered as a factor in favor of a 
                          determination that such organization has cause 
                          to remove the provider.
                      ``(C) Exception.--With respect to each upcoming 
                  plan year, beginning with plan year 2015, 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 (B)(i) 
                  before the date that is 60 days before the first day of 
                  the annual coordinated election period for such plan 
                  year under section 1851(e)(3).
                      ``(D) Notice and appeal process.--
                              ``(i) 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 
                          regulation. 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 removal.
                              ``(ii) Application.--
                                      ``(I) 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 
                                  process, such process shall apply in 
                                  lieu of the process for the termination 
                                  or suspension of a provider contract 
                                  under section 422.202(a) of title 42, 
                                  Code of Federal Regulations.
                                      ``(II) 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 date, the process for 
                                  the termination or suspension of a 
                                  provider contract under section 
                                  422.202(a) of title 42, Code of Federal 
                                  Regulations, shall apply.
                      ``(E) Participant notice and protection.--
                              ``(i) Notice to participants of provider 
                          removal.--Not less than 60 days before the date 
                          on which a provider of services or supplier is 
                          removed from a network of an MA plan, the MA 
                          organization offering such plan shall provide 
                          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 year. Such 
                          notification shall include--
                                      ``(I) the names and telephone 
                                  numbers of 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 
                                  supplier;
                                      ``(II) 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 
                                  supplier; and
                                      ``(III) 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 plan.
                              ``(ii) Annual notice of change.--In 
                          addition to providing the notification of 
                          removal as required under clause (i), 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 
                          year.
                              ``(iii) Continuity of care.--In any case in 
                          which a provider of services or supplier is 
                          removed from a network of an MA plan, such plan 
                          shall ensure that the removal satisfies the 
                          continuity of care requirements under paragraph 
                          (1)(A) 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 year.
                      ``(F) 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 plan.
              ``(8) Transparency in measures used by ma organizations to 
          establish or modify provider networks.--
                      ``(A) In general.--Beginning with plan year 2016, 
                  an MA organization offering an MA plan shall include 
                  the information described in subparagraph (B)--
                              ``(i) in the annual bid information 
                          submitted by the MA organization with respect 
                          to the MA plan under section 1854; and
                              ``(ii) on the Internet Web Site for the MA 
                          plan.
                      ``(B) Information described.--The information 
                  described in this subparagraph is the following:
                              ``(i) Information regarding the measures 
                          used by the MA organization to establish or 
                          modify the provider network of the MA plan, 
                          including measures of the quality and 
                          efficiency of providers. Such information shall 
                          include the specifications, methodology, and 
                          sample size of such measures.
                              ``(ii) Other information related to the 
                          establishment or modification of such provider 
                          network that the Secretary determines 
                          appropriate.
                      ``(C) Limitation.--The information described in 
                  subparagraph (B) shall not include any individually 
                  identifiable information of any provider or supplier of 
                  services.''.
      (b) Enforcement.--
              (1) Sanctions for noncompliance.--Section 1857(g)(1) of the 
          Social Security Act (42 U.S.C. 1395w-27(g)(1)) is amended--
                      (A) in subparagraph (J), by striking ``or'';
                      (B) by redesignating subparagraph (K) as 
                  subparagraph (L);
                      (C) by inserting after subparagraph (J) the 
                  following new subparagraph:
                      ``(K) fails to comply with sections 1852(d)(7) or 
                  1852(d)(8); or''; and
                      (D) in subparagraph (L) (as so redesignated), by 
                  striking ``through (J)'' and inserting ``through (K)''.
              (2) Sanctions not applicable to part d.--Title XVIII of the 
          Social Security Act is amended--
                      (A) in section 1860D-12(b)(3)(E) (42 U.S.C. 1395w-
                  112(b)(3)(E)), by striking ``paragraph (1)(F)'' and 
                  inserting ``paragraphs (1)(F) and (1)(K)''; and
                      (B) in section 1894(e)(6)(B) (42 U.S.C. 
                  1395eee(e)(6)(B)), by inserting ``(other than paragraph 
                  (1)(K) of such section)'' after ``1857(g)(1)''.
      (c) Network Access Adequacy Standards.--Beginning with plan year 
  2015, in applying the network access adequacy standards pursuant to 
  section 1852(d)(1) of the Social Security Act (42 U.S.C. 1395w-
  22(d)(1)), the Secretary of Health and Human Services shall seek input 
  from patient advocacy groups, providers of services and suppliers, and 
  MA plans under part C of title XVIII of such Act.
      (d) Medicare Advantage Plan Compare Tool.--Not later than September 
  30, 2015, 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 
  individuals.
target: Medicare Advantage Participant Bill of Rights Act of 2014 - Amends part C (Medicare+Choice) of title XVIII (Medicare) of the Social Security Act to require a Medicare Advantage (MA) organization to remove a service provider or a supplier from a plan network only for cause, subject to completion of a fair notice and appeals process. Lists as cause for removal: (1) medical negligence, (2) violation of any legal or contractual requirement for the provider or supplier acting within the lawful scope of practice, or (3) unfitness to furnish items and services in accordance with Medicare requirements.  Requires an MA organization offering an MA plan to include information on the measures used to establish or modify the plan's provider network: (1) in the annual bid information submitted about the MA plan, and (2) on the plan's Internet Web. Subjects to certain sanctions MA organizations with contracts which fail to meet these information requirements. Directs the Secretary of Health and Human Services (HHS) to: (1) seek input from patient advocacy groups and others in applying network access adequacy standards, and (2) take necessary measures to ensure that the Medicare Advantage Compare Tool takes into account the preferences and utilization needs of such individuals.
feat_title: Medicare Advantage Participant Bill of Rights Act of 2014