I

103D CONGRESS

1ST SESSION H. R. 2991

To establish a Uniform Claim Commission, to require the use of a universal

claim form to submit claims under certain Federal programs that provide

for payments for health care services, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

AUGUST 6, 1993

Mr. RAMSTAD introduced the following bill; which was referred to the

Committee on Energy and Commerce

A BILL

To establish a Uniform Claim Commission, to require the

use of a universal claim form to submit claims under

certain Federal programs that provide for payments for

health care services, 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.

4 This Act may be cited as the ‘‘Health Care Adminis5 trative Simplification Act of 1993’’.

6 SEC. 2. ESTABLISHMENT.

7 There is established a commission to be known as the

8 Uniform Claim Commission.
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1 SEC. 3. DUTY.

2 The Commission shall develop a universal paper

3 claims processing form containing standard data elements

4 for use by all health service providers that furnish services

5 for which a claim may be submitted under a Federal pro6 gram that provides for payments for health care services.

7 The Commission shall develop such form in a manner that

8 will permit the form to serve as a model for claims process9 ing forms used in the private sector.

10 SEC. 4. MEMBERSHIP.

11 (a) NUMBER AND APPOINTMENT.—The Commission

12 shall be composed of 17 members appointed by the direc13 tor of the Office of Technology Assessment not later than

14 120 days after the date of the enactment of this Act. The

15 members of the Commission shall be appointed from

16 among individuals with expertise in health care claims ad17 ministration, enrollment and eligibility administration,

18 health care financial management, health care reimburse19 ment, and other related fields. The Commission shall in20 clude individuals from various geographic areas of the

21 United States, representatives from public and private

22 health benefit plans involved in payment under such plans,

23 administrators of such plans, and health service providers.

24 (b) TERMS.—Each member shall be appointed for the

25 life of the Commission.
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1 (c) VACANCIES.—A vacancy in the Commission shall

2 be filled not later than 30 days after the date of the cre3 ation of the vacancy in the manner in which the original

4 appointment was made.

5 (d) COMPENSATION.—

6 (1) RATES OF PAY.—Except as provided in

7 paragraph (2), members of the Commission shall

8 serve without pay.

9 (2) TRAVEL EXPENSES.—Each member of the

10 Commission shall receive travel expenses, including

11 per diem in lieu of subsistence, in accordance with

12 sections 5702 and 5703 of title 5, United States

13 Code.

14 (e) QUORUM.—11 members of the Commission shall

15 constitute a quorum, but a lesser number may hold hear16 ings, take testimony, or receive evidence.

17 (f) CHAIRPERSON.—The chairperson of the Commis18 sion shall be elected by a majority vote of the members

19 of the Commission.

20 (g) MEETINGS.—The Commission shall meet at the

21 call of the chairperson of the Commission.

22 SEC. 5. STAFF AND SUPPORT SERVICES.

23 (a) DIRECTOR.—The Commission shall have a direc24 tor appointed by the Commission and paid at a rate not
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1 to exceed the maximum rate of basic pay payable for GS–

2 9 of the General Schedule.

3 (b) STAFF.—The Commission may appoint and fix

4 the pay of additional personnel as it considers appropriate,

5 except that—

6 (1) not more than 2 individuals may be ap7 pointed under this subsection; and

8 (2) an individual so appointed may not receive

9 pay in excess of the maximum rate of basic pay pay10 able for GS–7 of the General Schedule.

11 (c) APPLICABILITY OF CERTAIN CIVIL SERVICE

12 LAWS.—The director and staff of the Commission may be

13 appointed without regard to the provisions of title 5,

14 United States Code, governing appointments in the com15 petitive service, and may be paid without regard to the

16 provisions of chapter 51 and subchapter III of chapter 53

17 of that title relating to classification and General Schedule

18 pay rates, except as provided in subsections (a) and (b).

19 (d) STAFF OF FEDERAL AGENCIES.—Upon request

20 of the Commission, the head of any Federal agency may

21 detail, on a nonreimbursable basis, any of the personnel

22 of the agency to the Commission to assist it in carrying

23 out its duties under this Act.

24 (e) EXPERTS AND CONSULTANTS.—The Commission

25 may procure temporary and intermittent services under
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1 section 3109(b) of title 5, United States Code, but at rates

2 for individuals not to exceed the daily equivalent of the

3 maximum annual rate of basic pay payable for GS–12 of

4 the General Schedule.

5 (f) ADMINISTRATIVE SUPPORT SERVICES.—The Ad6 ministrator of General Services shall provide to the Com7 mission on a reimbursable basis such administrative sup8 port services necessary for the Commission to carry out

9 its responsibilities under this Act.

10 SEC. 6. POWERS.

11 (a) HEARINGS AND SESSIONS.—The Commission

12 may, for the purpose of carrying out this Act, hold hear13 ings, sit and act at times and places, take testimony, and

14 receive evidence as the Commission considers appropriate.

15 The Commission may administer oaths or affirmations to

16 witnesses appearing before it.

17 (b) DELEGATION OF AUTHORITY.—Any member or

18 agent of the Commission may, if authorized by the Com19 mission, take any action that the Commission is author20 ized to take by this section.

21 (c) INFORMATION.—

22 (1) IN GENERAL.—The Commission may secure

23 directly from any Federal agency information nec24 essary to enable it to carry out this Act. Upon re25 quest of the Commission, the head of the Federal
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1 agency shall furnish the information to the Com2 mission.

3 (2) EXCEPTION.—Paragraph (1) shall not

4 apply to any information that the Commission is

5 prohibited to secure or request by another law.

6 (d) MAILS.—The Commission may use the United

7 States mails in the same manner and under the same con8 ditions as other Federal agencies.

9 (e) CONTRACT AUTHORITY.—The Commission may

10 contract with and compensate government and private

11 agencies or persons for supplies or services without regard

12 to section 3709 of the Revised Statutes (41 U.S.C. 5).

13 (f) PUBLICATION IN FEDERAL REGISTER.—The

14 Commission may publish a notice and request for com15 ments in the Federal Register in the same manner as a

16 Federal agency.

17 SEC. 7. PROMULGATION OF UNIFORM CLAIMS PROCESSING

18 FORM.

19 (a) DEVELOPMENT OF PRELIMINARY FORM.—The

20 Commission shall develop a preliminary version of the

21 form required to be developed under section 3 not later

22 than the expiration of the 6-month period beginning on

23 the date of the appointment of the last member of the

24 Commission to be appointed under section 4(a).
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1 (b) PUBLICATION.—The Commission shall publish a

2 copy of the preliminary version of the form required to

3 be developed under subsection (a) in the Federal Register,

4 along with a notice of the comment period established in

5 subsection (c) and a request for comments, promptly after

6 the date on which such preliminary version is completed.

7 (c) COMMENT PERIOD.—The Commission may re8 ceive comments concerning the preliminary version of the

9 form required to be developed under subsection (a) during

10 the 30-day period beginning on the date the preliminary

11 version appears in the Federal Register.

12 (d) REVISION OF FORM AND FINAL REPORT.—Not

13 later than the expiration of the 30-day period beginning

14 on the date following the closing date of the comment pe15 riod under subsection (c), the Commission shall—

16 (1) revise the preliminary version of the form

17 required to be developed under subsection (a), tak18 ing into consideration any comments received pursu19 ant to subsection (c);

20 (2) develop a final version of the form required

21 to be developed under section 3; and

22 (3) submit to the Congress, the Secretary of

23 Health and Human Services, the Secretary of De24 fense, and the Secretary of Veterans Affairs a report

25 containing—
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1 (A) a copy of the final version of the form;

2 (B) a summary of the activities of the

3 Commission; and

4 (C) any other findings, conclusions, or rec5 ommendations that the Commission determines

6 to be appropriate.

7 SEC. 8. TERMINATION.

8 The Commission shall terminate not later than the

9 expiration of the 30-day period beginning on the date on

10 which the Commission submits its report under section 7.

11 SEC. 9. PROMULGATION OF REGULATIONS CONCERNING

12 UNIFORM CLAIMS PROCESSING FORM.

13 (a) NOTICE OF REGULATIONS.—Promptly upon re14 ceipt of the report submitted under section 7(d), the Sec15 retary of Health and Human Services, the Secretary of

16 Defense, and the Secretary of Veterans Affairs each shall

17 publish in the Federal Register a notice of rulemaking in

18 which the Secretary announces the promulgation of a reg19 ulation that will—

20 (1) take effect 90 days after the date of the

21 publication of the notice; and

22 (2) require all health service providers that fur23 nish health care services for which a claim for pay24 ment may be submitted under a Federal program

25 within the jurisdiction of the Secretary to submit
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1 any such claim using the universal paper claims

2 processing form developed by the Commission under

3 section 3.

4 (b) PROMULATION AND IMPLEMENTATION OF REGU5 LATIONS.—The Secretary of Health and Human Services,

6 the Secretary of Defense, and the Secretary of Veterans

7 Affairs each shall promulgate and implement a regulation

8 described in subsection (a).

9 SEC. 10. FUNDING.

10 From funds appropriated for salaries and expenses

11 with respect to the Department of Health and Human

12 Services for fiscal year 1995, the Secretary of Health and

13 Human Services shall expend such amounts as may be

14 necessary to ensure that the Commission is able to carry

15 out its duties under this Act, except that such amounts

16 shall not exceed $500,000.

17 SEC. 11. DEFINITIONS.

18 For purposes of this Act:

19 (1) COMMISSION.—The term ‘‘Commission’’

20 means the Uniform Claims Commission established

21 by section 2.

22 (2) HEALTH SERVICE PROVIDER.—The term

23 ‘‘health service provider’’ includes a provider of serv24 ices (as defined in section 1861(u) of the Social Se25 curity Act), physician, supplier, and other person
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1 furnishing health care services but does not include

2 a Federal program that provides directly for the pro3 vision of health care services to beneficiaries.

4 SEC. 12. BUDGET COMPLIANCE.

5 Any spending authority (as defined in subparagraphs

6 (A) and (C) of section 401(c)(2) of the Congressional

7 Budget Act of 1974 (2 U.S.C. 651(c)(2)(A))) authorized

8 by this Act shall be effective only to such extent or in such

9 amounts as are provided in appropriation Acts.

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