Summary: H.R.5400 — 108th Congress (2003-2004)All Information (Except Text)

There is one summary for H.R.5400. Bill summaries are authored by CRS.

Shown Here:
Introduced in House (11/19/2004)

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.