[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4401 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 4401

   To amend title XVIII of the Social Security Act to provide for a 
moratorium on the mandatory delay of payment of claims submitted under 
      part B of the Medicare Program and to establish an advanced 
 informational infrastructure for the administration of Federal health 
                           benefits programs.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 9, 2000

Mr. Horn (for himself, and Mr. Calvert) introduced the following bill; 
which was referred to the Committee on Commerce, and in addition to the 
Committee on Ways and Means, and Government Reform, 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 title XVIII of the Social Security Act to provide for a 
moratorium on the mandatory delay of payment of claims submitted under 
      part B of the Medicare Program and to establish an advanced 
 informational infrastructure for the administration of Federal health 
                           benefits programs.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Health Care 
Infrastructure Investment Act of 2000''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Moratorium on delayed payments under contracts that provide for 
                            the disbursement of funds.
Sec. 3. Establishment of the Health Care Infrastructure Commission.
Sec. 4. Study and final recommendations; timetable for implementation 
                            of advanced informational infrastructure.
Sec. 5. Application of advanced informational infrastructure to the 
                            FEHBP.
Sec. 6. Authorization of appropriations.

SEC. 2. MORATORIUM ON DELAYED PAYMENTS UNDER CONTRACTS THAT PROVIDE FOR 
              THE DISBURSEMENT OF FUNDS.

    Section 1842(c) of the Social Security Act (42 U.S.C. 1395u(c)) is 
amended by striking paragraph (3).

SEC. 3. ESTABLISHMENT OF THE HEALTH CARE INFRASTRUCTURE COMMISSION.

    (a) Establishment.--There is established within the Department of 
Health and Human Services a Health Care Infrastructure Commission (in 
this section referred to as the ``Commission'') to coordinate the 
expertise and programs within and among departments and agencies of the 
Federal Government for the purposes of designing and implementing an 
advanced informational infrastructure for the administration of Federal 
health benefits programs.
    (b) Duties.--The Commission shall--
            (1) establish an advanced informational infrastructure for 
        the administration of Federal health benefits programs which 
        consists of an immediate claim, administration, payment 
        resolution, and data collection system (in this section 
        referred to as the ``system'') that is initially for use by 
        carriers to process claims submitted by providers and suppliers 
        under part B of the medicare program under title XVIII of the 
        Social Security Act (42 U.S.C. 1395j et seq.) after conducting 
        the study under section 4(a)(1);
            (2) implement such system in accordance with the final 
        recommendations published under subsection (a)(2) of section 4 
        and the timetable set forth under subsection (b) of such 
        section; and
            (3) carry out such other matters as the Secretary of Health 
        and Human Services (in this section referred to as the 
        ``Secretary''), in consultation with the other members of the 
        Commission, may prescribe.
    (c) Membership.--
            (1) Number and appointment.--The Commission shall be 
        composed of 7 members as follows:
                    (A) The Secretary, who shall be the chairperson of 
                the Commission.
                    (B) One shall be appointed from the National 
                Aeronautics and Space Administration by the 
                Administrator.
                    (C) One shall be appointed from the Defense 
                Advanced Research Projects Agency by the Director.
                    (D) One shall be appointed from the National 
                Science Foundation by the Director.
                    (E) One shall be appointed from the Office of 
                Science and Technology Policy by the Director.
                    (F) One shall be appointed from the Department of 
                Veterans Affairs by the Secretary.
                    (G) One shall be appointed from the Office of 
                Management and Budget by the Director.
            (2) Requirements.--Each of the members appointed under 
        subparagraphs (B) through (G) of paragraph (1) shall--
                    (A) have been appointed as an officer or employee 
                of the agency by the President by and with the advice 
                and consent of the Senate; and
                    (B) be an expert in advanced information 
                technology.
            (3) Deadline for initial appointment.--The members of the 
        Commission shall be appointed  by not later than 3 months after 
the date of enactment of this Act.
    (d) Meetings.--
            (1) In general.--The Commission shall meet at the call of 
        the chairperson, except that it shall meet--
                    (A) not less than 4 times each year; or
                    (B) on the written request of a majority of its 
                members.
            (2) Quorum.--A majority of the members of the Commission 
        shall constitute a quorum, but a lesser number of members may 
        hold hearings.
    (e) Compensation.--Each member of the Commission shall serve 
without compensation in addition to that received for the services of 
such member as an officer or employee of the United States.
    (f) Staff.--
            (1) In general.--The chairperson of the Commission may, 
        without regard to the civil service laws and regulations, 
        appoint and terminate an executive director and such other 
        additional personnel as may be necessary to enable the 
        Commission to perform its duties.
            (2) Compensation.--The chairperson of the Commission may 
        fix the compensation of the executive director and other 
        personnel without regard to the provisions of chapter 51 and 
        subchapter III of chapter 53 of title 5, United States Code, 
        relating to classification of positions and General Schedule 
        pay rates, except that the rate of pay for the executive 
        director and other personnel may not exceed the rate payable 
        for level V of the Executive Schedule under section 5316 of 
        such title.
            (3) Detail of government employees.--Any Federal Government 
        employee may be detailed to the Commission without 
        reimbursement, and such detail shall be without interruption or 
        loss of civil service status or privilege.
    (g) Procurement of Temporary and Intermittent Services.--The 
chairperson of the Commission may procure temporary and intermittent 
services under section 3109(b) of title 5, United States Code, at rates 
for individuals which do not exceed the daily equivalent of the annual 
rate of basic pay prescribed for level V of the Executive Schedule 
under section 5316 of such title.
    (h) Termination.--The Commission shall terminate on the date on 
which the system is fully implemented under section 4(b)(3).

SEC. 4. STUDY AND FINAL RECOMMENDATIONS; TIMETABLE FOR IMPLEMENTATION 
              OF ADVANCED INFORMATIONAL INFRASTRUCTURE.

    (a) Study and Final Recommendations.--
            (1) Study.--The Commission shall conduct a study during the 
        3-year period beginning on the date of enactment of this Act on 
        the design and construction of an immediate claim, 
        administration, payment resolution, and data collection system 
        (in this section referred to as the ``system'') that--
                    (A) immediately advises each provider and supplier 
                of coverage determinations;
                    (B) immediately notifies each provider or supplier 
                of any incomplete or invalid claim, including--
                            (i) the identification of any missing 
                        information;
                            (ii) the identification of any coding 
                        errors; and
                            (iii) information detailing how the 
                        provider or supplier may develop a claim under 
                        such system;
                    (C) allows for proper completion and resubmission 
                of each claim identified as incomplete or invalid under 
                subparagraph (B);
                    (D) allows for immediate automatic processing of 
                clean claims (as defined in section 1842(c)(2)(B)(i) of 
                the Social Security Act (42 U.S.C. 1395u(c)(2)(B)(i)) 
                so that a provider or supplier may provide a written 
                explanation of medical benefits, including an 
                explanation of costs and coverage to any beneficiary 
                under part B of the medicare program under title XVIII 
                of the Social Security Act (42 U.S.C. 1395j et seq.) at 
                the point of care; and
                    (E) allows for electronic payment of claims to each 
                provider and supplier, including payment through 
                electronic funds transfer, for each claim for which 
                payment is not made on a periodic interim payment basis 
                under such part.
            (2) Final recommendations.--
                    (A) Publication.--Not later than 3 years after the 
                date of enactment of this Act, the chairperson of the 
                Commission shall publish in the Federal Register final 
                recommendations that reflect input from each interested 
                party, including providers and suppliers, insurance 
                companies, and health benefits management concerns 
                using a process similar to the process used for 
                developing standards under section 1172(c) of the 
                Social Security Act (42 U.S.C. 1320d-1(c)).
                    (B) Considerations.--In developing the final 
                recommendations to be published under subparagraph (A), 
                the Commission shall--
                            (i) make every effort to design system 
                        specifications that are flexible, scalable, and 
                        performance-based; and
                            (ii) ensure that strict security measures--
                                    (I) guard system integrity;
                                    (II) protect the privacy of 
                                patients and the confidentiality of 
                                personally identifiable health 
                                insurance data used or maintained under 
                                the system; and
                                    (III) apply to any network service 
                                provider used in connection with the 
                                system.
    (b) Timetable.--The timetable set forth under this subsection is as 
follows:
            (1) Initial implementation.--Not later than 5 years after 
        the date of enactment of this Act, the system shall support--
                    (A) 50 percent of queries regarding coverage 
                determinations;
                    (B) 30 percent of determinations regarding 
                incomplete or invalid claims; and
                    (C) immediate processing at the point of care of 40 
                percent of clean claims submitted by providers and 
                suppliers under part B of the medicare program.
            (2) Intermediate implementation.--Not later than 7 years 
        after the date of enactment of this Act, the system shall 
        support--
                    (A) 70 percent of queries regarding coverage 
                determinations;
                    (B) 50 percent of determinations regarding 
                incomplete or invalid claims; and
                    (C) immediate processing at the point of care of 60 
                percent of clean claims submitted by providers and 
                suppliers under part B of the medicare program.
            (3) Full implementation.--Not later than 10 years after the 
        date of enactment of this Act, the system shall support--
                    (A) 90 percent of queries regarding coverage 
                determinations;
                    (B) 60 percent of determinations regarding 
                incomplete or invalid claims; and
                    (C) immediate processing at the point of care of 40 
                percent of the total number of claims submitted by 
                providers and suppliers under part B of the medicare 
                program.

SEC. 5. APPLICATION OF ADVANCED INFORMATIONAL INFRASTRUCTURE TO THE 
              FEHBP.

    (a) In General.--The Office of Personnel Management (in this 
section referred to as the ``Office'') shall--
            (1) adapt the immediate claim, administration, payment 
        resolution, and data collection system established under 
        section 3 (in this section referred to as the ``system'') for 
        use under the Federal employees health benefits program under 
        chapter 89 of title 5, United States Code; and
            (2) require that carriers (as defined in section 8901(7) of 
        such Code) participating in such program use the system to 
        satisfy certain minimum requirements for claim submission, 
        processing, and payment in accordance with the timetable set 
        forth in subsection (b).
    (b) Timetable.--The timetable set forth in this subsection is as 
follows:
            (1) Initial implementation.--Not later than 5 years after 
        the date of enactment of this Act, the Office shall require 
        that carriers use the system to process not less than--
                    (A) 50 percent of queries regarding coverage 
                determinations;
                    (B) 30 percent of determinations of incomplete or 
                invalid claims; and
                    (C) immediate processing at the point of care of 10 
                percent of the total number of claims.
            (2) Intermediate implementation.--Not later than 7 years 
        after the date of enactment of this Act, the Office shall 
        require that carriers use the system to support not less than--
                    (A) 70 percent of queries regarding coverage 
                determinations;
                    (B) 50 percent of determinations regarding 
                incomplete or invalid claims; and
                    (C) immediate processing at the point of care of 20 
                percent of the total number of claims.
            (3) Full implementation.--Not later than 10 years after the 
        date of enactment of this Act, the Office shall require that 
        carriers use the system to support not less than--
                    (A) 90 percent of queries regarding coverage 
                determinations;
                    (B) 60 percent of determinations of incomplete or 
                invalid claims; and
                    (C) immediate processing of 35 percent of the total 
                number of claims.

SEC. 6. AUTHORIZATION OF APPROPRIATIONS.

    (a) In General.--There are appropriated to the Health Care 
Infrastructure Commission established under section 3, out of any funds 
in the Treasury that are not otherwise appropriated, such sums as may 
be necessary to carry out the provisions of this Act.
    (b) Availability.--Any sums appropriated under subsection (a) shall 
remain available until the termination of the Health Care 
Infrastructure Commission under section 3(h).
                                 <all>