II 109th CONGRESS 2d Session S. 2247 IN THE SENATE OF THE UNITED STATES February 6, 2006 Mr. Reid (for Mr. Obama) introduced the following bill; which was read twice and referred to the Committee on Homeland Security and Governmental Affairs A BILL To promote greater use of information technology in the Federal Employees Health Benefits Program under chapter 89 of title 5, United States Code, to increase efficiency and reduce costs.

1.

Short title

This Act may be cited as the Federal Employees Health Benefits Program Efficiency Act of 2006.

2.

Federal Employees Health Benefits Program information technology efficiency

(a)

In general

Not later than 4 years after the date of enactment of this Act, each carrier entering into a contract under section 8902 of title 5, United States Code, to offer a health benefits plan shall implement an electronic system for efficient and effective adjudication of all medical claims. (b)

Adjudication

In adjudicating claims under chapter 89 of title 5, United States Code, using the system described under subsection (a), each carrier shall ensure that such claims— (1)may be submitted through the Internet; (2)are adjudicated with an accuracy of at least 99 percent; (3)may be denied instantaneously if the information provided is incorrect or incomplete or for other nonmedical reasons, with opportunity for resolution of such denials, through the Internet; and (4)shall be submitted using the privacy safeguards necessary to protect the personal and medical information of patients from inappropriate use. (c)

Fraud

Each carrier entering into a contract under section 8902 of title 5, United States Code, shall use the system described under subsection (a) to monitor for fraud and abuse as part of the adjudication of claims described under this section. (d)

Waivers

(1)

In general

The Office of Personnel Management may provide 1 or more waivers to the requirement of subsection (a), if the carrier— (A)is unable to meet the requirement despite good faith effort; or (B)the lack of participation by the carrier in the Federal Employees Health Benefits Program would significantly compromise access to health care. (2)

Limitation on waivers

No waiver under paragraph (1) may be in effect after 6 years after the date of enactment of this Act. (e)

Technical assistance

The Office of Personnel Management may provide technical assistance, including equipment, computer software, and guidance to carry out this Act. (f)

Report

(1)

Notice

The Office of Personnel Management shall provide notice to the Government Accountability Office of the implementation of this Act. (2)

Report

Not later than 5 years after receipt of notice under paragraph (1), the Government Accountability Office shall submit a report to Congress on— (A)compliance with this Act; (B)obstacles to compliance with this Act; and (C)cost savings resulting from this Act.