[Congressional Bills 105th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4413 Introduced in House (IH)]







105th CONGRESS
  2d Session
                                H. R. 4413

To amend the Public Health Service Act, the Employee Retirement Income 
 Security Act of 1974, and the Internal Revenue Code of 1986 to assure 
     prompt payment of participating providers under health plans.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             August 5, 1998

Mr. McDermott introduced the following bill; which was referred to the 
 Committee on Commerce, and in addition to the Committees on Education 
and the Workforce, and Ways and Means, 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 Public Health Service Act, the Employee Retirement Income 
 Security Act of 1974, and the Internal Revenue Code of 1986 to assure 
     prompt payment of participating providers under health plans.

    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 ``Participating Provider Prompt 
Payment Act of 1998''.

SEC. 2. ASSURING PROMPT PAYMENT UNDER HEALTH PLANS.

    (a) Group Health Plans.--
            (1) Public health service act amendments.--Subpart 2 of 
        part A of title XXVII of the Public Health Service Act is 
        amended by adding at the end the following new section:

``SEC. 2706. STANDARDS RELATING TO PROMPT PAYMENT.

    ``A group health plan, and a health insurance issuer offering group 
health insurance coverage, shall provide prompt payment (consistent 
with the standards applied to Medicare+Choice plans under section 
1857(f) of the Social Security Act) to claims submitted for covered 
items and services that are not furnished by a nonparticipating 
provider (or in the case of a plan or coverage that is a private fee-
for-service plan of the type described in section 1859(b)(2) of such 
Act, if the claim is submitted to the plan or issuer by a participant, 
beneficiary, or enrollee).''.
            (2) ERISA amendments.--
                    (A) In general.--Subpart B of part 7 of subtitle B 
                of title I of the Employee Retirement Income Security 
                Act of 1974 is amended by adding at the end the 
                following new section:

``SEC. 713. STANDARDS RELATING TO PROMPT PAYMENT.

    ``A group health plan, and a health insurance issuer offering group 
health insurance coverage, shall provide prompt payment (consistent 
with the standards applied to Medicare+Choice plans under section 
1857(f) of the Social Security Act) to claims submitted for covered 
items and services that are not furnished by a nonparticipating 
provider (or in the case of a plan or coverage that is a private fee-
for-service plan of the type described in section 1859(b)(2) of such 
Act, if the claim is submitted to the plan or issuer by a participant, 
beneficiary, or enrollee).''.
                    (B) Clerical amendment.--The table of contents in 
                section 1 of the Employee Retirement Income Security 
                Act of 1974 is amended by inserting after the item 
                relating to section 712 the following new item:

``Sec. 713. Standards relating to prompt payment.''.
            (3) Internal revenue code amendments.--
                    (A) In general.--Subchapter B of chapter 100 of the 
                Internal Revenue Code of 1986 (relating to other 
                requirements) is amended by adding at the end the 
                following new section:

``SEC. 9813. STANDARDS RELATING TO PROMPT PAYMENT.

    ``A group health plan shall provide prompt payment (consistent with 
the standards applied to Medicare+Choice plans under section 1857(f) of 
the Social Security Act) to claims submitted for covered items and 
services that are not furnished by a nonparticipating provider (or in 
the case of a plan that is a private fee-for-service plan of the type 
described in section 1859(b)(2) of such Act, if the claim is submitted 
to the plan by a participant or beneficiary).''.
                    (B) Clerical amendment.--The table of sections of 
                such subchapter of such chapter is amended by adding at 
                the end the following new item:


                              ``Sec. 9813. Standards relating to prompt 
                                        payment.''
    (b) Individual Health Insurance.--Part B of title XXVII of the 
Public Health Service Act is amended by inserting after section 2751 
the following new section:

``SEC. 2752. STANDARDS RELATING TO PROMPT PAYMENT.

    ``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.--
            (1) Group health plans.--The amendments made by subsection 
        (a) shall apply with respect to group health plans (and health 
        insurance coverage offered in connection with such plans) for 
        plan years beginning on or after January 1, 1999.
            (2) Individual market.--The amendment made by subsection 
        (b) shall apply with respect to health insurance coverage 
        offered, sold, issued, renewed, in effect, or operated in the 
        individual market on or after such date.
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