MAILING OF NOTICE OF MEDICARE BENEFITS AND INFORMATION DESCRIBING PARTICIPATING PHYSICIAN PROGRAM.

SEC. 223. MAILING OF NOTICE OF MEDICARE BENEFITS AND INFORMATION DESCRIBING PARTICIPATING PHYSICIAN PROGRAM. (a) Distribution of Notices.—Title XVIII is amended by inserting after section 1803 the following new section: “notice of medicare benefits “Sec. 1804. The Secretary shall prepare (in consultation with groups representing the elderly and with health insurers) and provide for distribution of a notice containing— “(1) a clear, simple explanation of the benefits available under this title and the major categories of health care for which benefits are not available under this title, “(2) the limitations on payment (including deductibles and coinsurance amounts) that are imposed under this title, and “(3) a description of the limited benefits for long-term care services available under this title and generally available under State plans approved under title XIX. Such notice shall be mailed annually to individuals entitled to benefits under part A or part B of this title and when an individual applies for benefits under part A or enrolls under part B. “. (b) Distribution of Information Describing Participating Physician Program.— Section 1842(h)(5) (42 U.S.C. 1395u(h)(5)) is amended— (1) by inserting “through an annual mailing” after “under this part”, (2) by striking the last sentence, (3) by inserting “(A)” after “(5)”, and (4) by adding at the end the following new subparagraph: “(B) The annual notice provided under subparagraph (A) shall include— “(i) a description of the participation program, “(ii) an explanation of the advantages to beneficiaries of obtaining covered services through a participating physician or supplier, “(iii) an explanation of the assistance offered by carriers in obtaining the names of participating physicians and suppliers, and “(iv) the toll-free telephone number under paragraph (2)(A) for inquiries concerning the program and for requests for free copies of appropriate directories.”. (c) Revision of Explanation of Medicare Benefits.—Section 1842(h)(7) (42 U.S.C. 1395u(h)(7)) is amended— (1) in subparagraph (A)— (A) by inserting “prominent” before “reminder”, and (B) by striking “), and” and inserting “and a clear statement of any amounts charged for the particular items or services on the claim involved above the amount recognized under this part),”; (2) in subparagraph (B), by striking the period at the end and inserting “, and”, and 102 STAT. 748 (3) by adding at the end the following new subparagraph: “(C) shall include (i) an offer of assistance to such an individual in obtaining the names of participating physicians of appropriate specialty and (ii) an offer to provide a free copy of the appropriate participating physician directory.”. (d) Effective Dates.— (1) The Secretary of Health and Human Services shall first distribute the notice required by the amendment made by subsection (a) not later than January 31, 1989. (2) The amendments made by subsection (b) shall apply to annual notices beginning with 1989. (3) The amendments made by subsection (c) shall first apply to explanations of benefits provided for items and services furnished on or after January 1, 1989.