[Congressional Bills 106th Congress]
[From the U.S. Government Publishing Office]
[H.R. 5622 Introduced in House (IH)]







106th CONGRESS
  2d Session
                                H. R. 5622

  To establish a commission to create a comprehensive strategy for an 
  integrated, advanced informational infrastructure for the medicare 
                    program, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                            November 2, 2000

 Mr. Horn (for himself and Mr. Calvert) introduced the following bill; 
which was referred to the Committee on Ways and Means, and in addition 
     to the Committee on Commerce, 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 establish a commission to create a comprehensive strategy for an 
  integrated, advanced informational infrastructure for the medicare 
                    program, and for other purposes.

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

SECTION 1. SHORT TITLE; PURPOSE.

    (a) Short Title.--This Act may be cited as the ``Medicare Program 
Infrastructure Investment Act of 2000''.
    (b) Purpose.--The purpose of this Act is to design a strategy for 
the implementation of an advanced informational infrastructure for the 
administration of parts A and B of the medicare program in coordination 
with the Administrator of the Health Care Financing Administration and 
the Chief Information Office of the Health Care Financing 
Administration.

SEC. 2. ESTABLISHMENT OF THE HEALTH CARE INFRASTRUCTURE COMMISSION.

    (a) Establishment.--There is established within the Department of 
Health and Human Services a Health Care Infrastructure Advisory 
Commission (in this section referred to as the ``Commission'').
    (b) Duties.--The Commission shall carry out the following duties:
            (1) In conjunction with the Administrator and Chief 
        Information Officer of the Health Care Financing 
        Administration, the Commission shall develop a strategy to 
        create an advanced informational infrastructure for the 
        administration of the medicare program under parts A and B of 
        title XVIII of the Social Security Act, including claims 
        processing by medicare carriers and fiscal intermediaries and 
        beneficiary information functions.
            (2) 18 months after the date all of the members of the 
        Commission are appointed under subsection (c)(2), the 
        Commission shall submit to Congress (and publish in the Federal 
        Register) an initial report that describes a strategic plan to 
        implement an advanced information structure for parts A and B 
        of the medicare program, including a cost estimate and schedule 
        for the plan, that--
                    (A) complies with all existing Federal financial 
                management and information technology laws;
                    (B) provides immediate, point-of-service 
                information on covered items and services under the 
                program to each beneficiary, provider of services, 
                physician, and supplier;
                    (C) ensures that strict security measures are 
                integral to and designed into the system that--
                            (i) protect the privacy of patients and the 
                        confidentiality of personally identifiable 
                        health insurance data used or maintained under 
                        the system in a manner consistent with privacy 
                        regulations promulgated by the Secretary under 
                        the Health Insurance Portability and 
                        Accountability Act of 1996;
                            (ii) guard system integrity in a manner 
                        consistent with security regulations 
                        promulgated by the Secretary under such Act; 
                        and
                            (iii) apply to any network service provider 
                        used in connection with the system;
                    (D) immediately notifies each provider of services, 
                physician, 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 of services, physician, or supplier 
                        may develop a claim under such system;
                    (E) allows for proper completion and resubmission 
                of each claim identified as incomplete or invalid under 
                subparagraph (D);
                    (F) allows for immediate automatic processing of 
                clean claims and subsequent payment in accordance with 
                the provisions of sections 1816(c)(2)(B)(i) and 
                1842(c)(2)(B)(i) of the Social Security Act (42 U.S.C. 
                1395h(c)(2)(B)(i) and 1395u(c)(2)(B)(i)) so that a 
                provider of services, physician, or supplier may 
                immediately provide the beneficiary with a written 
                explanation of medical benefits, including an 
                explanation of costs and coverage to any beneficiary 
under parts A and B at the point of care;
                    (G) allows for electronic payment of claims to each 
                provider of services, physician, and supplier, 
                including payment through electronic funds transfer, 
                for each claim for which payment is not made on a 
                periodic interim payment basis under section 1815(e)(2) 
                of such Act (42 U.S.C. 1395g(e)(2)) for items and 
                services furnished under part A;
                    (H) complies with all applicable transactions 
                standards adopted by the Secretary under the Health 
                Insurance Portability and Accountability Act of 1996;
                    (I) provides for system specifications that are 
                flexible, modular in nature, scalable, and performance-
                based; and
                    (J) is designed to be used, or easily adapted for 
                use, in other health insurance programs administered by 
                a department or agency of the United States.
            (3) Not later than one year after the date the Commission 
        submits the initial report under paragraph (2), the Commission 
        shall submit to Congress (and shall publish in the Federal 
        Register) a final report on the Secretary's progress in 
        developing an advanced informational system.
            (4) Each report required under this subsection--
                    (A) shall include those recommendations, findings, 
                and conclusions of the Commission that receive the 
                approval of at least a majority of the members of the 
                Commission; and
                    (B) shall include dissenting or additional views of 
                members of the Commission with respect to the subject 
                matter of the report.
    (c) Membership.--
            (1) Composition.--The Commission shall be composed of 13 
        voting members appointed in accordance with paragraph (2) and 
        two ex officio voting members designated under paragraph (3).
            (2) In general.--Not later than 90 days after the date of 
        the enactment of this Act, members of the Commission shall be 
        appointed as follows:
                    (A) The Director of the Defense Advanced Research 
                Projects Agency shall appoint one member.
                    (B) The Director of the National Science Foundation 
                shall appoint one member.
                    (C) The Director of the Office of Science and 
                Technology Policy shall appoint one member.
                    (D) The Secretary shall appoint one member who 
                represents each of the following:
                            (i) Physicians and other health care 
                        practitioners.
                            (ii) Hospitals.
                            (iii) Skilled nursing facilities.
                            (iv) Home health agencies.
                            (v) Suppliers of durable medical equipment.
                            (vi) Fiscal intermediaries and carriers.
                    (E) The Secretary shall appoint two members who 
                represent information technology providers, one who 
                represents medicare information technology providers 
                and one who represent health industry information 
                technology providers.
                    (F) The Secretary shall appoint two members who 
                represent medicare beneficiaries.
            (3) Ex officio members.--The following shall serve as ex 
        officio members of the Commission:
                    (A) The Secretary, who shall be the chairperson of 
                the Commission.
                    (B) The Chief Financial Officer of the Health Care 
                Financing Administration.
            (4) Qualifications.--Each of the members appointed under 
        paragraph (2) shall be knowledgeable in advanced information 
        technology, financial management, or electronic billing 
        procedures associated with health care benefit programs. One of 
        the members appointed under paragraph (2)(F) shall have 
        expertise in health information privacy.
    (d) Meetings.--
            (1) In general.--The Commission shall meet at the call of 
        the chairperson, except that it shall meet--
                    (A) not less than four 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 who is a full-time 
officer or employee of the United States may not receive additional 
pay, allowances, or benefits by reason of their service on the 
Commission. Each member of the Commission shall receive travel 
expenses  and per diem in lieu of subsistence in accordance with 
sections 5702 and 5703 of title 5, United States Code.
    (f) Staff.--
            (1) In general.--The chairperson of the Commission may, 
        without regard to the civil service laws and regulations, 
        appoint 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.--Upon request of the 
        chairperson, the head of any Federal department or agency may 
        detail to the Commission, without reimbursement, basis, any of 
        the personnel of that department or agency to the Commission to 
        assist it in carrying out its duties under this Act. 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 that 
is 60 days after the date the Commission submits to Congress the final 
report under subsection (b)(3).
    (i) Authorization of Appropriations.--
            (1) In general.--There are authorized to be appropriated 
        out of any funds in the Treasury not otherwise appropriated, 
        such sums as may be necessary for the Commission to carry out 
        its duties under this section.
            (2) Availability.--Any sums appropriated under paragraph 
        (1) shall remain available until the termination of the 
        Commission under subsection (h).
    (j) Definitions.--In this section:
            (1) Secretary.--The term ``Secretary'' means the Secretary 
        of Health and Human Services.
            (2) Administrator.--The term ``Administrator'' means the 
        Administrator of the Health Care Financing Administration.
    (k) Applicability of FACA.--The provisions of the Federal Advisory 
Committee Act (5 U.S.C. App.) shall apply to the Commission.

SEC. 3. IMPLEMENTATION OF SYSTEM.

    (a) Annual Reports on Implementation.--Not later than 6 months 
after the Commission publishes in the Federal Register the final report 
required under section 2(b)(3) and annually thereafter until the date 
of final implementation under subsection (b), the Secretary shall 
submit to Congress a report on the progress of the Health Care 
Financing Administration on implementing a modernized advanced, 
integrated informational infrastructure for the administration of parts 
A and B of the medicare program.
    (b) Final Implementation.--Not later than 10 years after the date 
of the enactment of this Act, the Secretary shall fully implement a 
modernized advanced, integrated informational infrastructure for the 
administration of parts A and B of the medicare program.

SEC. 4. ADMINISTRATIVE SIMPLIFICATION.

    Section 1173(a) of the Social Security Act (42 U.S.C. 1320d-2(a)) 
is amended by adding at the end the following new paragraph:
            ``(4) Interactive transactions.--If the Secretary adopts a 
        batch standard for a transaction under paragraph (1) that 
        involves a health care provider, not later than 24 months after 
        the adoption of the batch standard, the Secretary shall also 
        adopt an interactive standard that is compatible with the batch 
        standard so that the provider may immediately complete the 
        transaction at the point of service.''.
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