Page:United States Statutes at Large Volume 122.djvu/2601

 12 2 STA T . 2 578PUBLIC LA W 11 0– 275 —J UL Y 15, 2008 Subti t leE—Prov i s io n s R el a tin g to Part DPARTI— I M PR OV I NG P H ARMA CY ACC ES S SEC.17 1. PROM P T P AY ME N T B Y PRESCR I PTION D R UG P L ANS AND MA – PD PLANS UNDER PART D. (a)PROMPT P AY M EN T B Y PRE SC R I PTION D R UG P L ANS .—Section1860 D – 1 2 ( b )o f t h e Socia l Sec ur it yA ct( 4 2 U .S. C . 1 395w –112(b)) i s a m en d ed by addin g at the end the following new p aragraph

‘(4) PROMPT PAYMENT O F CLEAN CLAIMS.— ‘‘(A) PROMPT PAYMENT.— ‘‘(i) I N GENERAL.— E ach contract entered into with a PDP sponsor under this part with respect to a prescription drug plan offered by such sponsor shall pro v ide that payment shall be issued , mailed, or other - wise transmitted with respect to all clean claims sub- mitted by pharmacies (other than pharmacies that dis- pense drugs by mail order only or are located in, or contract with, a long-term care facility) under this part within the applicable number of calendar days after the date on which the claim is received. ‘‘(ii) CLEAN CLAIM D EFINED.—In this paragraph, the term ‘clean claim ’ means a claim that has no defect or impropriety (including any lac k of any re q uired substantiating documentation) or particular cir- cumstance requiring special treatment that prevents timely payment from being made on the claim under this part. ‘‘(iii) DATE OF RECEIPT OF CLAIM.—In this para- graph, a claim is considered to have been received— ‘‘(I) with respect to claims submitted electroni- cally, on the date on which the claim is transferred and ‘‘(II) with respect to claims submitted other- wise, on the 5th day after the postmark date of the claim or the date specified in the time stamp of the transmission. ‘‘( B ) APPLICABLE NUMBER OF CALENDAR DAYS DEFINED.—In this paragraph, the term ‘applicable number of calendar days’ means— ‘‘(i) with respect to claims submitted electronically, 14 days; and ‘‘(ii) with respect to claims submitted otherwise, 30 days. ‘‘(C) INTEREST PAYMENT.— ‘‘(i) IN GENERAL.—Sub j ect to clause (ii), if payment is not issued, mailed, or otherwise transmitted within the applicable number of calendar days (as defined in subparagraph (B)) after a clean claim is received, the PDP sponsor shall pay interest to the pharmacy that submitted the claim at a rate equal to the weighted average of interest on 3-month marketable T reasury securities determined for such period, increased by 0.1 percentage point for the period begin- ning on the day after the required payment date and ending on the date on which payment is made (as

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