[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1472 Introduced in House (IH)]







105th CONGRESS
  1st Session
                                H. R. 1472

 To amend the Employee Retirement Income Security Act of 1974 and the 
 Public Health Service Act to require group health plans and group and 
 individual health insurance coverage to pay interest on clean claims 
                   that are not paid within 30 days.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 29, 1997

 Mr. Ackerman introduced the following bill; which was referred to the 
 Committee on Commerce, and in addition to the Committee on Education 
 and the Workforce, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
 To amend the Employee Retirement Income Security Act of 1974 and the 
 Public Health Service Act to require group health plans and group and 
 individual health insurance coverage to pay interest on clean claims 
                   that are not paid within 30 days.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Insurance Claim Prompt 
Payment Act of 1997''.

SEC. 2. PROMPT PAYMENT OF PROVIDER CLAIMS.

    (a) Group Health Plans.--
            (1) Public health service act amendments.--Subpart 2 of 
        part A of title XXVII of the Public Health Service Act (as 
        added by section 604(a) of the Newborns' and Mothers' Health 
        Protection Act of 1996 and amended by section 703(a) of the 
        Mental Health Parity Act of 1996) is amended by adding at the 
        end the following new section:

``SEC. 2706. STANDARDS RELATING TO PROMPT PAYMENT OF PROVIDER CLAIMS.

    ``(a) In General.--To the extent that a group health plan, or a 
health insurance issuer offering group health insurance coverage, fails 
to provide for the issue, mailing, or transmission of payment for a 
clean claim within 30 calendar days after the date the plan or issuer 
receives a clean claim, the plan or issuer shall provide for payment of 
interest on the unpaid balance at the rate of interest and for the same 
period specified in section 1842(c)(2)(C) of the Social Security Act 
for purposes of part B of title XVIII of such Act.
    ``(b) Contract Limitations.--No provision of a contract between a 
group health plan and a provider of health services, or between a 
health insurance issuer and a provider of health services in relation 
to provision of items and services in connection with group health 
insurance coverage by the issuer, shall be given effect to the extent 
it prevents the application of subsection (a). Such a provision may be 
given effect to the extent it--
            ``(1) requires payment to be made more promptly than as 
        provided in subsection (a),
            ``(2) provides for a higher interest rate than that 
        provided under subsection (a), or
            ``(3) otherwise provides for greater sanctions or remedies 
        in the case of a failure by a plan or issuer to make prompt 
        payment on claims under the plan or under the health insurance 
        coverage involved.
    ``(c) Clean Claim Defined.--For purposes of this section, the term 
`clean claim' means a claim that has no defect or impropriety 
(including any lack of any required substantiating documentation) or 
particular circumstance requiring special treatment that prevents 
timely payment from being made on the claim under the group health plan 
or health insurance coverage involved.''.
            (2) ERISA amendments.--(A) Subpart B of part 7 of subtitle 
        B of title I of the Employee Retirement Income Security Act of 
        1974 (as added by section 603(a) of the Newborns' and Mothers' 
        Health Protection Act of 1996 and amended by section 702(a) of 
        the Mental Health Parity Act of 1996) is amended by adding at 
        the end the following new section:

``SEC. 713. STANDARDS RELATING TO PROMPT PAYMENT OF PROVIDER CLAIMS.

    ``(a) In General.--To the extent that a group health plan, or a 
health insurance issuer offering group health insurance coverage, fails 
to provide for the issue, mailing, or transmission of payment for a 
clean claim within 30 calendar days after the date the plan or issuer 
receives a clean claim, the plan or issuer shall provide for payment of 
interest on the unpaid balance at the rate of interest and for the same 
period specified in section 1842(c)(2)(C) of the Social Security Act 
for purposes of part B of title XVIII of such Act.
    ``(b) Contract Limitations.--No provision of a contract between a 
group health plan and a provider of health services, or between a 
health insurance issuer and a provider of health services in relation 
to provision of items and services in connection with group health 
insurance coverage by the issuer, shall be given effect to the extent 
it prevents the application of subsection (a). Such a provision may be 
given effect to the extent it--
            ``(1) requires payment to be made more promptly than as 
        provided in subsection (a),
            ``(2) provides for a higher interest rate than that 
        provided under subsection (a), or
            ``(3) otherwise provides for greater sanctions or remedies 
        in the case of a failure by a plan or issuer to make prompt 
        payment on claims under the plan or under the health insurance 
        coverage involved.
    ``(c) Clean Claim Defined.--For purposes of this section, the term 
`clean claim' means a claim that has no defect or impropriety 
(including any lack of any required substantiating documentation) or 
particular circumstance requiring special treatment that prevents 
timely payment from being made on the claim under the group health plan 
or health insurance coverage involved.''.
            (B) Section 732(a) of such Act (29 U.S.C. 1191a(a)), as 
        amended by section 603(b)(2) of Public Law 104-204, is amended 
        by striking ``section 711'' and inserting ``sections 711 and 
        713''.
            (C) The table of contents in section 1 of such Act is 
        amended by inserting after the item relating to section 712 the 
        following new item:

``Sec. 713. Standards relating to prompt payment of provider claims.''.
    (b) Individual Health Insurance.--Part B of title XXVII of the 
Public Health Service Act (as added by section 605(a) of the Newborn's 
and Mother's Health Protection Act of 1996) is amended by inserting 
after section 2751 the following new section:

``SEC. 2752. STANDARDS RELATING TO PROMPT PAYMENT OF PROVIDER CLAIMS.

    ``The provisions of section 2706 shall apply to health insurance 
coverage offered by a health insurance issuer in the individual market 
in the same manner as it applies to health insurance coverage offered 
by a health insurance issuer in connection with a group health plan in 
the small or large group market.''.
    (c) Effective Dates.--The amendments made by this section shall 
apply with respect to payment for items and services furnished on or 
after the date this is 1 year after the date of the enactment of this 
Act.
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