I

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.

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; PURPOSE.

4 (a) SHORT TITLE.—This Act may be cited as the

5 ‘‘Medicare Program Infrastructure Investment Act of

6 2000’’.

7 (b) PURPOSE.—The purpose of this Act is to design

8 a strategy for the implementation of an advanced informa-
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1 tional infrastructure for the administration of parts A and

2 B of the medicare program in coordination with the Ad3 ministrator of the Health Care Financing Administration

4 and the Chief Information Office of the Health Care Fi5 nancing Administration.

6 SEC. 2. ESTABLISHMENT OF THE HEALTH CARE INFRA7 STRUCTURE COMMISSION.

8 (a) ESTABLISHMENT.—There is established within

9 the Department of Health and Human Services a Health

10 Care Infrastructure Advisory Commission (in this section

11 referred to as the ‘‘Commission’’).

12 (b) DUTIES.—The Commission shall carry out the

13 following duties:

14 (1) In conjunction with the Administrator and

15 Chief Information Officer of the Health Care Fi16 nancing Administration, the Commission shall de17 velop a strategy to create an advanced informational

18 infrastructure for the administration of the medicare

19 program under parts A and B of title XVIII of the

20 Social Security Act, including claims processing by

21 medicare carriers and fiscal intermediaries and bene22 ficiary information functions.

23 (2) 18 months after the date all of the members

24 of the Commission are appointed under subsection

25 (c)(2), the Commission shall submit to Congress
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1 (and publish in the Federal Register) an initial re2 port that describes a strategic plan to implement an

3 advanced information structure for parts A and B of

4 the medicare program, including a cost estimate and

5 schedule for the plan, that—

6 (A) complies with all existing Federal fi7 nancial management and information tech8 nology laws;

9 (B) provides immediate, point-of-service in10 formation on covered items and services under

11 the program to each beneficiary, provider of

12 services, physician, and supplier;

13 (C) ensures that strict security measures

14 are integral to and designed into the system

15 that—

16 (i) protect the privacy of patients and

17 the confidentiality of personally identifiable

18 health insurance data used or maintained

19 under the system in a manner consistent

20 with privacy regulations promulgated by

21 the Secretary under the Health Insurance

22 Portability and Accountability Act of 1996;

23 (ii) guard system integrity in a man24 ner consistent with security regulations
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1 promulgated by the Secretary under such

2 Act; and

3 (iii) apply to any network service pro4 vider used in connection with the system;

5 (D) immediately notifies each provider of

6 services, physician, or supplier of any incom7 plete or invalid claim, including—

8 (i) the identification of any missing

9 information;

10 (ii) the identification of any coding er11 rors; and

12 (iii) information detailing how the

13 provider of services, physician, or supplier

14 may develop a claim under such system;

15 (E) allows for proper completion and re16 submission of each claim identified as incom17 plete or invalid under subparagraph (D);

18 (F) allows for immediate automatic proc19 essing of clean claims and subsequent payment

20 in accordance with the provisions of sections

21 1816(c)(2)(B)(i) and 1842(c)(2)(B)(i) of the

22 Social Security Act (42 U.S.C.

23 1395h(c)(2)(B)(i) and 1395u(c)(2)(B)(i)) so

24 that a provider of services, physician, or sup25 plier may immediately provide the beneficiary
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1 with a written explanation of medical benefits,

2 including an explanation of costs and coverage

3 to any beneficiary under parts A and B at the

4 point of care;

5 (G) allows for electronic payment of claims

6 to each provider of services, physician, and sup7 plier, including payment through electronic

8 funds transfer, for each claim for which pay9 ment is not made on a periodic interim pay10 ment basis under section 1815(e)(2) of such

11 Act (42 U.S.C. 1395g(e)(2)) for items and serv12 ices furnished under part A;

13 (H) complies with all applicable trans14 actions standards adopted by the Secretary

15 under the Health Insurance Portability and Ac16 countability Act of 1996;

17 (I) provides for system specifications that

18 are flexible, modular in nature, scalable, and

19 performance-based; and

20 (J) is designed to be used, or easily adapt21 ed for use, in other health insurance programs

22 administered by a department or agency of the

23 United States.

24 (3) Not later than one year after the date the

25 Commission submits the initial report under para-
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1 graph (2), the Commission shall submit to Congress

2 (and shall publish in the Federal Register) a final

3 report on the Secretary’s progress in developing an

4 advanced informational system.

5 (4) Each report required under this

6 subsection—

7 (A) shall include those recommendations,

8 findings, and conclusions of the Commission

9 that receive the approval of at least a majority

10 of the members of the Commission; and

11 (B) shall include dissenting or additional

12 views of members of the Commission with re13 spect to the subject matter of the report.

14 (c) MEMBERSHIP.—

15 (1) COMPOSITION.—The Commission shall be

16 composed of 13 voting members appointed in accord17 ance with paragraph (2) and two ex officio voting

18 members designated under paragraph (3).

19 (2) IN GENERAL.—Not later than 90 days after

20 the date of the enactment of this Act, members of

21 the Commission shall be appointed as follows:

22 (A) The Director of the Defense Advanced

23 Research Projects Agency shall appoint one

24 member.
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1 (B) The Director of the National Science

2 Foundation shall appoint one member.

3 (C) The Director of the Office of Science

4 and Technology Policy shall appoint one mem5 ber.

6 (D) The Secretary shall appoint one mem7 ber who represents each of the following:

8 (i) Physicians and other health care

9 practitioners.

10 (ii) Hospitals.

11 (iii) Skilled nursing facilities.

12 (iv) Home health agencies.

13 (v) Suppliers of durable medical

14 equipment.

15 (vi) Fiscal intermediaries and carriers.

16 (E) The Secretary shall appoint two mem17 bers who represent information technology pro18 viders, one who represents medicare informa19 tion technology providers and one who represent

20 health industry information technology pro21 viders.

22 (F) The Secretary shall appoint two mem23 bers who represent medicare beneficiaries.

24 (3) EX OFFICIO MEMBERS.—The following shall

25 serve as ex officio members of the Commission:
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1 (A) The Secretary, who shall be the chair2 person of the Commission.

3 (B) The Chief Financial Officer of the

4 Health Care Financing Administration.

5 (4) QUALIFICATIONS.—Each of the members

6 appointed under paragraph (2) shall be knowledge7 able in advanced information technology, financial

8 management, or electronic billing procedures associ9 ated with health care benefit programs. One of the

10 members appointed under paragraph (2)(F) shall

11 have expertise in health information privacy.

12 (d) MEETINGS.—

13 (1) IN GENERAL.—The Commission shall meet

14 at the call of the chairperson, except that it shall

15 meet—

16 (A) not less than four times each year; or

17 (B) on the written request of a majority of

18 its members.

19 (2) QUORUM.—A majority of the members of

20 the Commission shall constitute a quorum, but a

21 lesser number of members may hold hearings.

22 (e) COMPENSATION.—Each member of the Commis23 sion who is a full-time officer or employee of the United

24 States may not receive additional pay, allowances, or bene25 fits by reason of their service on the Commission. Each
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1 member of the Commission shall receive travel expenses

2 and per diem in lieu of subsistence in accordance with sec3 tions 5702 and 5703 of title 5, United States Code.

4 (f) STAFF.—

5 (1) IN GENERAL.—The chairperson of the Com6 mission may, without regard to the civil service laws

7 and regulations, appoint an executive director and

8 such other additional personnel as may be necessary

9 to enable the Commission to perform its duties.

10 (2) COMPENSATION.—The chairperson of the

11 Commission may fix the compensation of the execu12 tive director and other personnel without regard to

13 the provisions of chapter 51 and subchapter III of

14 chapter 53 of title 5, United States Code, relating

15 to classification of positions and General Schedule

16 pay rates, except that the rate of pay for the execu17 tive director and other personnel may not exceed the

18 rate payable for level V of the Executive Schedule

19 under section 5316 of such title.

20 (3) DETAIL OF GOVERNMENT EMPLOYEES.—

21 Upon request of the chairperson, the head of any

22 Federal department or agency may detail to the

23 Commission, without reimbursement, basis, any of

24 the personnel of that department or agency to the

25 Commission to assist it in carrying out its duties
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1 under this Act. Such detail shall be without inter2 ruption or loss of civil service status or privilege.

3 (g) PROCUREMENT OF TEMPORARY AND INTERMIT4 TENT SERVICES.—The chairperson of the Commission

5 may procure temporary and intermittent services under

6 section 3109(b) of title 5, United States Code, at rates

7 for individuals which do not exceed the daily equivalent

8 of the annual rate of basic pay prescribed for level V of

9 the Executive Schedule under section 5316 of such title.

10 (h) TERMINATION.—The Commission shall terminate

11 on the date that is 60 days after the date the Commission

12 submits to Congress the final report under subsection

13 (b)(3).

14 (i) AUTHORIZATION OF APPROPRIATIONS.—

15 (1) IN GENERAL.—There are authorized to be

16 appropriated out of any funds in the Treasury not

17 otherwise appropriated, such sums as may be nec18 essary for the Commission to carry out its duties

19 under this section.

20 (2) AVAILABILITY.—Any sums appropriated

21 under paragraph (1) shall remain available until the

22 termination of the Commission under subsection (h).

23 (j) DEFINITIONS.—In this section:

24 (1) SECRETARY.—The term ‘‘Secretary’’ means

25 the Secretary of Health and Human Services.
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1 (2) ADMINISTRATOR.—The term ‘‘Adminis2 trator’’ means the Administrator of the Health Care

3 Financing Administration.

4 (k) APPLICABILITY OF FACA.—The provisions of the

5 Federal Advisory Committee Act (5 U.S.C. App.) shall

6 apply to the Commission.

7 SEC. 3. IMPLEMENTATION OF SYSTEM.

8 (a) ANNUAL REPORTS ON IMPLEMENTATION.—Not

9 later than 6 months after the Commission publishes in the

10 Federal Register the final report required under section

11 2(b)(3) and annually thereafter until the date of final im12 plementation under subsection (b), the Secretary shall

13 submit to Congress a report on the progress of the Health

14 Care Financing Administration on implementing a mod15 ernized advanced, integrated informational infrastructure

16 for the administration of parts A and B of the medicare

17 program.

18 (b) FINAL IMPLEMENTATION.—Not later than 10

19 years after the date of the enactment of this Act, the Sec20 retary shall fully implement a modernized advanced, inte21 grated informational infrastructure for the administration

22 of parts A and B of the medicare program.
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1 SEC. 4. ADMINISTRATIVE SIMPLIFICATION.

2 Section 1173(a) of the Social Security Act (42 U.S.C.

3 1320d–2(a)) is amended by adding at the end the fol4 lowing new paragraph:

5 ‘‘(4) INTERACTIVE TRANSACTIONS.—If the Sec6 retary adopts a batch standard for a transaction

7 under paragraph (1) that involves a health care pro8 vider, not later than 24 months after the adoption

9 of the batch standard, the Secretary shall also adopt

10 an interactive standard that is compatible with the

11 batch standard so that the provider may imme12 diately complete the transaction at the point of serv13 ice.’’.

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