II

106TH CONGRESS

2D SESSION S. 2708

To establish a Patients Before Paperwork Medicare Red Tape Reduction

Commission to study the proliferation of paperwork under the medicare

program.

IN THE SENATE OF THE UNITED STATES

JUNE 8, 2000

Mr. ASHCROFT introduced the following bill; which was read twice and

referred to the Committee on Finance

A BILL

To establish a Patients Before Paperwork Medicare Red

Tape Reduction Commission to study the proliferation

of paperwork under the medicare program.

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 ‘‘Patients Before Paper5 work Medicare Red Tape Reduction Act of 2000’’.

6 SEC. 2. FINDINGS.

7 Congress makes the following findings:

8 (1) Regulations promulgated by the Health

9 Care Financing Administration to administer the
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1 medicare program under title XVIII of the Social

2 Security Act are 3 times as long as the regulations

3 relating to the Internal Revenue Code of 1986.

4 (2) During the Administration of President

5 Clinton, more than a quarter of the 110,000 pages

6 of medicare regulations and paperwork have been

7 added.

8 (3) According to American Medical Association

9 Immediate Past President Dr. Nancy W. Dickey, for

10 most doctors, ‘‘the biggest challenge is getting

11 through mountains of medicare paperwork’’.

12 (4) According to the Wall Street Journal,

13 Allina, a nonprofit Minnesota organization serving

14 35,000 medicare beneficiaries, expects to spend

15 $2,000,000 annually in paperwork-related burdens.

16 (5) Medicare paperwork burdens have forced in17 creasing numbers of medicare beneficiaries to resort

18 to the use of ‘‘insurance claim service’’ firms that

19 charge from $20 to $75 an hour.

20 (6) The Health Care Financing Administration

21 uses 23 different forms in the administration of the

22 medicare program.

23 (7) In 1998, the average processing time for

24 appeals of claims denied under part A of the medi-
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1 care program was 310 days and the average appeal

2 time was 524 days under part B of such program.

3 SEC. 3. PATIENTS BEFORE PAPERWORK MEDICARE RED

4 TAPE REDUCTION COMMISSION.

5 (a) ESTABLISHMENT.—There is established a com6 mission to be known as the Patients Before Paperwork

7 Medicare Red Tape Reduction Commission (in this section

8 referred to as the ‘‘Commission’’).

9 (b) DUTIES OF THE COMMISSION.—The Commission

10 shall—

11 (1) review existing paperwork burdens and re12 lated regulations under the medicare program under

13 title XVIII of the Social Security Act (42 U.S.C.

14 1395 et seq.), with the goal of reducing the paper15 work burdens under such program;

16 (2) analyze whether existing and proposed pa17 perwork requirements and related regulations have

18 proven benefits, including a positive health benefit

19 for medicare beneficiaries;

20 (3) make recommendations regarding methods

21 to streamline and to simplify the coding method for

22 items and services for which reimbursement is pro23 vided under the medicare program;

24 (4) make recommendations regarding the facili25 tation of electronic filing of claims for reimburse-
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1 ment and the elimination of paperwork under the

2 medicare program;

3 (5) develop a standard form that will minimize

4 any duplication of data and that facilitates the cre5 ation of an electronic system that relies on less pa6 perwork than the current system;

7 (6) determine the effect of the paperwork re8 quirements under the medicare program on relation9 ships between doctors and patients; and

10 (7) review and analyze such other matters relat11 ing to paperwork reduction under the medicare pro12 gram as the Commission deems appropriate.

13 (c) MEMBERSHIP.—

14 (1) NUMBER AND APPOINTMENT.—

15 (A) IN GENERAL.—Subject to subpara16 graph (B), the Commission shall be composed

17 of 11 members, of whom—

18 (i) 3 shall be appointed by the Presi19 dent, of whom not more than 2 shall be of

20 the same political party;

21 (ii) 3 shall be appointed by the Major22 ity Leader of the Senate, in consultation

23 with the Minority Leader of the Senate, of

24 whom not more than 2 shall be of the

25 same political party;
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1 (iii) 3 shall be appointed by the

2 Speaker of the House of Representatives,

3 in consultation with the Minority Leader of

4 the House of Representatives, of whom not

5 more than 2 shall be of the same political

6 party;

7 (iv) 1, who shall serve as Chairperson

8 of the Commission, appointed jointly by

9 the President, Majority Leader of the Sen10 ate, and the Speaker of the House of Rep11 resentatives; and

12 (v) 1, who shall be the Secretary of

13 Health and Human Services or the Admin14 istrator of the Health Care Financing Ad15 ministration, as determined by the Presi16 dent.

17 (B) MEMBERSHIP.—

18 (i) IN GENERAL.—Each member ap19 pointed under this paragraph, except for

20 the member described in subparagraph

21 (A)(v), shall be—

22 (I) a health care provider, in23 surer, or expert familiar with the

24 medicare program; or

25 (II) a medicare beneficiary.
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1 (ii) INCLUSION OF PRACTICING PHYSI2 CIANS.—At least 1 member appointed

3 under this paragraph shall be a practicing

4 physician.

5 (2) DEADLINE FOR APPOINTMENT.—Members

6 of the Commission shall be appointed by not later

7 than August 1, 2000.

8 (3) TERMS OF APPOINTMENT.—The term of

9 any appointment under paragraph (1) to the Com10 mission shall be for the life of the Commission.

11 (4) MEETINGS.—The Commission shall meet at

12 the call of its Chairperson or a majority of its mem13 bers.

14 (5) QUORUM.—A quorum shall consist of a ma15 jority of the members of the Commission, except

16 that 3 members may conduct a hearing under sub17 section (e)(1).

18 (6) VACANCIES.—A vacancy on the Commission

19 shall be filled in the same manner in which the origi20 nal appointment was made not later than 30 days

21 after the Commission is given notice of the vacancy

22 and shall not affect the power of the remaining

23 members to execute the duties of the Commission.

24 (7) COMPENSATION.—Members of the Commis25 sion shall receive no additional pay, allowances, or
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1 benefits by reason of their service on the Commis2 sion.

3 (8) EXPENSES.—Each member of the Commis4 sion shall receive travel expenses and per diem in

5 lieu of subsistence in accordance with sections 5702

6 and 5703 of title 5, United States Code.

7 (d) STAFF AND SUPPORT SERVICES.—

8 (1) EXECUTIVE DIRECTOR.—

9 (A) APPOINTMENT.—The Chairperson

10 shall appoint an executive director of the Com11 mission.

12 (B) COMPENSATION.—The executive direc13 tor shall be paid the rate of basic pay for level

14 V of the Executive Schedule.

15 (2) STAFF.—With the approval of the Commis16 sion, the executive director may appoint such per17 sonnel as the executive director considers appro18 priate.

19 (3) APPLICABILITY OF CIVIL SERVICE LAWS.—

20 The staff of the Commission shall be appointed with21 out regard to the provisions of title 5, United States

22 Code, governing appointments in the competitive

23 service, and shall be paid without regard to the pro24 visions of chapter 51 and subchapter III of chapter
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1 53 of such title (relating to classification and Gen2 eral Schedule pay rates).

3 (4) EXPERTS AND CONSULTANTS.—With the

4 approval of the Commission, the executive director

5 may procure temporary and intermittent services

6 under section 3109(b) of title 5, United States Code.

7 (5) PHYSICAL FACILITIES.—The Administrator

8 of General Services shall locate suitable office space

9 for the operation of the Commission. The facilities

10 shall serve as the headquarters of the Commission

11 and shall include all necessary equipment and

12 incidentals required for the proper functioning of the

13 Commission.

14 (e) POWERS OF COMMISSION.—

15 (1) HEARINGS AND OTHER ACTIVITIES.—For

16 the purpose of carrying out its duties, the Commis17 sion may hold such hearings and undertake such

18 other activities as the Commission determines to be

19 necessary to carry out its duties.

20 (2) STUDIES BY GAO.—Upon the request of the

21 Commission, the Comptroller General of the United

22 States shall conduct such studies or investigations as

23 the Commission determines to be necessary to carry

24 out its duties.
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1 (3) COST ESTIMATES BY CONGRESSIONAL

2 BUDGET OFFICE AND OFFICE OF THE CHIEF ACTU3 ARY OF HCFA.—

4 (A) The Director of the Congressional

5 Budget Office or the Chief Actuary of the

6 Health Care Financing Administration shall

7 provide to the Commission, upon the request of

8 the Commission, such cost estimates as the

9 Commission determines to be necessary to carry

10 out its duties.

11 (B) The Commission shall reimburse the

12 Director of the Congressional Budget Office for

13 expenses relating to the employment in the of14 fice of the Director of such additional staff as

15 may be necessary for the Director to comply

16 with requests by the Commission under sub17 paragraph (A).

18 (4) DETAIL OF FEDERAL EMPLOYEES.—Upon

19 the request of the Commission, the head of any Fed20 eral agency is authorized to detail, without reim21 bursement, any of the personnel of such agency to

22 the Commission to assist the Commission in car23 rying out its duties. Any such detail shall not inter24 rupt or otherwise affect the civil service status or

25 privileges of the Federal employee.
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1 (5) TECHNICAL ASSISTANCE.—Upon the re2 quest of the Commission, the head of a Federal

3 agency shall provide such technical assistance to the

4 Commission as the Commission determines to be

5 necessary to carry out its duties.

6 (6) USE OF MAILS.—The Commission may use

7 the United States mails in the same manner and

8 under the same conditions as Federal agencies and

9 shall, for purposes of the frank, be considered a

10 commission of Congress as described in section 3215

11 of title 39, United States Code.

12 (7) OBTAINING INFORMATION.—The Commis13 sion may secure directly from any Federal agency

14 information necessary to enable it to carry out its

15 duties, if the information may be disclosed under

16 section 552 of title 5, United States Code. Upon re17 quest of the Chairperson of the Commission, the

18 head of such agency shall furnish such information

19 to the Commission.

20 (8) ADMINISTRATIVE SUPPORT SERVICES.—

21 Upon the request of the Commission, the Adminis22 trator of General Services shall provide to the Com23 mission on a reimbursable basis such administrative

24 support services as the Commission may request.
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1 (9) PRINTING.—For purposes of costs relating

2 to printing and binding, including the cost of per3 sonnel detailed from the Government Printing Of4 fice, the Commission shall be deemed to be a com5 mittee of Congress.

6 (f) REPORT.—Not later than 1 year after the date

7 on which the final member of the Commission is appointed

8 under subsection (c), the Commission shall submit a re9 port to the President and Congress which shall contain

10 a detailed statement of only those recommendations, find11 ings, and conclusions of the Commission that receive the

12 approval of at least a majority of the members of the Com13 mission.

14 (g) TERMINATION.—The Commission shall terminate

15 30 days after the date of submission of the report required

16 under subsection (f).

17 (h) AUTHORIZATION OF APPROPRIATIONS.—There

18 are authorized to be appropriated $500,000 to carry out

19 this section.

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