PAID Act Reintroduced in 116th Congress

By Kate Riordan  |  March 8, 2019

On February 26th, Congressmen Ron Kind (D-WI) and Guy Bilirakis (R-FL) reintroduced the Provide Accurate Information Directly (PAID) Act as H.R. 1375 into the U.S. House of Representatives. This bi-partisan bill was originally filed late in the last Congressional session and expired when the 115th Congress (2017-2018) ended.

The PAID Act proposes the Centers for Medicare and Medicaid (CMS) expand its Section 111 Query Process to identify whether an individual is, or during the preceding three-year (3) period, was enrolled in Medicare Part C (Medicare Advantage) and/or Medicare Part D (Prescription Drugs) plan, and provide the name and address of each plan identified during the preceding three year (3) period. Unlike the previous version, the new bill does not require CMS to also return information on an individual’s Medicaid enrollment.

The PAID Act aims to address current challenges claims payers have in determining Part C and Part D enrollment with identifying potential reimbursement claims. This problem is particularly pressing in the Part C context as Medicare Advantage Plans have become more aggressive in asserting recovery claims over the past several years, including obtaining several favorable court decisions finding that Part C plans have private cause action rights allowing them to sue claims payers for “double damages.” While in a nascent state, by comparison, there is evidence of increased recovery efforts on the Part D side. On this note, CMS recently amended its Part D manual to encourage Part D providers to identify and pursue secondary payer reimbursement. Click here to review our recent article about CMS’ updates to its Medicare Prescription Drug Benefit Manual.   

H.R. 1375 has been referred to the Committee on Energy and Commerce, and the Committee on Ways and Means. It is anticipated that a companion bill will be introduced in the Senate soon.

ISO Claims Partners will monitor this legislation for movement and provide any updates as warranted. In the interim, please contact the author at kate.riordan@verisk.com or 978.825.6010 if you have any questions.


Kate Riordan

Kate Riordan is the director of Medicare Secondary Payer (MSP) initiatives at ISO Claims Partners. She has well over five years of experience in completing Medicare Set-Asides and obtaining CMS approvals, with a concentration in California claims. Kate graduated Bowdoin College and Suffolk University Law School and is a Medicare Set-Aside Certified Consultant.