[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4028 Introduced in House (IH)]

103d CONGRESS
  2d Session
                                H. R. 4028

    To empower the Department of Health and Human Services to issue 
 advisory opinions on whether certain arrangements for the delivery of 
 health care services and supplies are in compliance with statutes and 
rules establishing acceptable health care billing and payment practices 
   and with statutes and rules defining health care fraud and abuse.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             March 11, 1994

Mr. Hoagland (for himself, Mr. Porter, Mr. Brewster, and Mr. Thomas of 
 California) introduced the following bill; which was referred jointly 
      to the Committees on Ways and Means and Energy and Commerce

_______________________________________________________________________

                                 A BILL


 
    To empower the Department of Health and Human Services to issue 
 advisory opinions on whether certain arrangements for the delivery of 
 health care services and supplies are in compliance with statutes and 
rules establishing acceptable health care billing and payment practices 
   and with statutes and rules defining health care fraud and abuse.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; REFERENCES IN ACT.

    (a) Short Title.--This Act may be cited as the ``Health Care Fraud 
and Abuse Advisory Opinion Act of 1994''.
    (b) References in Act.--Except as otherwise specifically provided, 
whenever an amendment herein is expressed in terms of an amendment to, 
or repeal of a section or other provision, the reference shall be 
considered to be made to that section or other provision of the Social 
Security Act.

SEC. 2. AUTHORIZING THE SECRETARY OF HEALTH AND HUMAN SERVICES TO ISSUE 
              ADVISORY OPINIONS UNDER TITLE XI.

    (a) Authorization.--Title XI, section 1128 (42 U.S.C. 1320a-7) is 
amended by the addition of the following new paragraph:
    ``(j) The Secretary shall issue advisory opinions as provided in 
this section.
            ``(1) Matters subject to advisory opinions.--The Secretary 
        shall issue advisory opinions as to the following matters:
                    ``(i) What constitutes prohibited remuneration 
                within the meaning of section 1320a-7b(b) of title 42, 
                United States Code.
                    ``(ii) Whether an arrangement or proposed 
                arrangement satisfies the criteria set forth in section 
                1320a-7b(b)(3) of title 42, United States Code as 
                amended for activities which do not result in 
                prohibited remuneration.
                    ``(iii) Whether an arrangement or proposed 
                arrangement satisfies the criteria which the Secretary 
                has established, or shall establish by regulation for 
                activities which do not result in prohibited 
                remuneration.
                    ``(iv) What constitutes an inducement to reduce or 
                limit services to individuals entitled to benefits 
                under part A or part B of title XVIII or title XIX 
                within the meaning of section 1320a-7a(b) of title 42, 
                United States Code.
                    ``(v) Whether an arrangement, activity or proposed 
                arrangement or proposed activity violates any other 
                provision of the Act.
            ``(2) Matters not subject to advisory opinions.--Such 
        advisory opinions shall not address the following matters:
                    ``(i) Whether the fair market value shall be, or 
                was paid or received for any goods, services or 
                property.
                    ``(ii) Whether an individual is a bona fide 
                employee within the requirements of section 3121(d)(2) 
                of title 26, United States Code.
            ``(3) Effect of advisory opinions.--
                    ``(i) Each advisory opinion issued by the Secretary 
                shall be binding as to the Secretary and the party or 
                parties requesting the opinion.
                    ``(ii) The failure of a party to seek an advisory 
                opinion may not be introduced into evidence to prove 
                that the party intended to violate the provisions of 
                sections 1320a-7, 1320a-7(a), or 1320a-7(b) of title 
                42, United States Code.
            ``(4) Regulations.--The Secretary within one hundred and 
        eighty days of the date of enactment, shall issue regulations 
        establishing a system for the issuance of advisory opinions. 
        Such regulations shall provide for--
                    ``(i) the procedure to be followed by a party 
                applying for an advisory opinion;
                    ``(ii) the procedure to be followed by the 
                Secretary in responding to a request for an advisory 
                opinion;
                    ``(iii) the interval in which the Secretary shall 
                respond;
                    ``(iv) the reasonable fee to be charged to the 
                party requesting an advisory opinion; and
                    ``(v) the manner in which advisory opinions will be 
                made available to the public.
            ``(5) Interval for issuance of advisory opinions.--Under no 
        circumstances shall the interval in which the Secretary shall 
        respond to a party requesting an advisory opinion exceed 30 
        days.''.

SEC. 3. AUTHORIZING THE SECRETARY OF HEALTH AND HUMAN SERVICES TO ISSUE 
              ADVISORY OPINIONS UNDER TITLE XVIII.

    (a) Authorization.--Title XVIII, section 1877 (42 U.S.C. 1395nn) is 
amended by the addition of the following new paragraph:
    ``(i)(1) Advisory Opinions.--The Secretary shall issue advisory 
opinions on whether an arrangement or proposed arrangement will result 
in a prohibited referral within the meaning of section 1395nn of title 
42, United States Code, as amended.
    ``(2) Effect of Advisory Opinions.--
            ``(i) Each advisory opinion issued by the Secretary shall 
        be binding as to the Secretary and the party or parties 
        requesting the opinion.
            ``(ii) The failure of a party to seek an advisory opinion 
        may not be introduced into evidence to prove that the party 
        intended to violate the provisions of section 1395nn of title 
        42, United States Code.
    ``(3) Regulations.--The Secretary within one hundred and eighty 
days of the date of enactment, shall issue regulations establishing a 
system for the issuance of advisory opinions. Such regulations shall 
provide for--
            ``(i) the procedure to be followed by a party applying for 
        an advisory opinion;
            ``(ii) the procedure to be followed by the Secretary in 
        responding to a request for an advisory opinion;
            ``(iii) the interval in which the Secretary shall respond;
            ``(iv) the reasonable fee to be charged to the party 
        requesting an advisory opinion; and
            ``(v) the manner in which advisory opinions will be made 
        available to the public.
    ``(4) Interval for Issuance of Advisory Opinions.--Under no 
circumstances shall the interval in which the Secretary shall respond 
to a party requesting an advisory opinion exceed thirty days.''.

SEC. 4. EFFECTIVE DATE.

    Unless otherwise specified herein, the Health Care Fraud and Abuse 
Advisory Opinion Act of 1994 shall be effective upon enactment.

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