II 

109TH CONGRESS 

2D SESSION S. 2247 

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. 

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 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Federal Employees 

5 Health Benefits Program Efficiency Act of 2006’’. 
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1 SEC. 2. FEDERAL EMPLOYEES HEALTH BENEFITS PRO2 GRAM INFORMATION TECHNOLOGY EFFI3 CIENCY. 

4 (a) IN GENERAL.—Not later than 4 years after the 

5 date of enactment of this Act, each carrier entering into 

6 a contract under section 8902 of title 5, United States 

7 Code, to offer a health benefits plan shall implement an 

8 electronic system for efficient and effective adjudication 

9 of all medical claims. 

10 (b) ADJUDICATION.—In adjudicating claims under 

11 chapter 89 of title 5, United States Code, using the system 

12 described under subsection (a), each carrier shall ensure 

13 that such claims— 

14 (1) may be submitted through the Internet; 

15 (2) are adjudicated with an accuracy of at least 

16 99 percent; 

17 (3) may be denied instantaneously if the infor18 mation provided is incorrect or incomplete or for 

19 other nonmedical reasons, with opportunity for reso20 lution of such denials, through the Internet; and 

21 (4) shall be submitted using the privacy safe22 guards necessary to protect the personal and medical 

23 information of patients from inappropriate use. 

24 (c) FRAUD.—Each carrier entering into a contract 

25 under section 8902 of title 5, United States Code, shall 

26 use the system described under subsection (a) to monitor 
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1 for fraud and abuse as part of the adjudication of claims 

2 described under this section. 

3 (d) WAIVERS.— 

4 (1) IN GENERAL.—The Office of Personnel 

5 Management may provide 1 or more waivers to the 

6 requirement of subsection (a), if the carrier— 

7 (A) is unable to meet the requirement de8 spite good faith effort; or 

9 (B) the lack of participation by the carrier 

10 in the Federal Employees Health Benefits Pro11 gram would significantly compromise access to 

12 health care. 

13 (2) LIMITATION ON WAIVERS.—No waiver 

14 under paragraph (1) may be in effect after 6 years 

15 after the date of enactment of this Act. 

16 (e) TECHNICAL ASSISTANCE.—The Office of Per17 sonnel Management may provide technical assistance, in18 cluding equipment, computer software, and guidance to 

19 carry out this Act. 

20 (f) REPORT.— 

21 (1) NOTICE.—The Office of Personnel Manage22 ment shall provide notice to the Government Ac23 countability Office of the implementation of this Act. 

24 (2) REPORT.—Not later than 5 years after re25 ceipt of notice under paragraph (1), the Government 
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1 Accountability Office shall submit a report to Con2 gress on— 

3 (A) compliance with this Act; 

4 (B) obstacles to compliance with this Act; 

5 and 

6 (C) cost savings resulting from this Act. 

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