II

106TH CONGRESS

2D SESSION S. 2312

To amend title XVIII of the Social Security Act to provide for a moratorium

on the mandatory delay of payment of claims submitted under part

B of the medicare program and to establish an advanced informational

infrastructure for the administration of Federal health benefits programs.

IN THE SENATE OF THE UNITED STATES

MARCH 29, 2000

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

to the Committee on Finance

A BILL

To amend title XVIII of the Social Security Act to provide

for a moratorium on the mandatory delay of payment

of claims submitted under part B of the medicare program and to establish an advanced informational infrastructure for the administration of Federal health benefits programs.

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; TABLE OF CONTENTS.

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

5 ‘‘Health Care Infrastructure Investment Act of 2000’’.
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1 (b) TABLE OF CONTENTS.—The table of contents of

2 this Act is as follows:

Sec. 1. Short title; table of contents.

Sec. 2. Moratorium on delayed payments under contracts that provide for the

disbursement of funds.

Sec. 3. Establishment of the Health Care Infrastructure Commission.

Sec. 4. Study and final recommendations; timetable for implementation of advanced informational infrastructure.

Sec. 5. Application of advanced informational infrastructure to the FEHBP.

Sec. 6. Authorization of appropriations.

3 SEC. 2. MORATORIUM ON DELAYED PAYMENTS UNDER

4 CONTRACTS THAT PROVIDE FOR THE DIS5 BURSEMENT OF FUNDS.

6 (a) MORATORIUM.—Section 1842(c)(3) (42 U.S.C.

7 1395u(c)(3)) is repealed.

8 (b) EFFECTIVE DATE.—The amendment made by

9 subsection (a) shall take effect on the date of enactment

10 of this Act.

11 SEC. 3. ESTABLISHMENT OF THE HEALTH CARE INFRA12 STRUCTURE COMMISSION.

13 (a) ESTABLISHMENT.—There is established within

14 the Department of Health and Human Services a Health

15 Care Infrastructure Commission (in this section referred

16 to as the ‘‘Commission’’) to coordinate the expertise and

17 programs within and among departments and agencies of

18 the Federal Government for the purposes of designing and

19 implementing an advanced informational infrastructure

20 for the administration of Federal health benefits pro21 grams.
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1 (b) DUTIES.—The Commission shall—

2 (1) establish an advanced informational infra3 structure for the administration of Federal health

4 benefits programs which consists of an immediate

5 claim, administration, payment resolution, and data

6 collection system (in this section referred to as the

7 ‘‘system’’) that is initially for use by carriers to

8 process claims submitted by providers and suppliers

9 under part B of the medicare program under title

10 XVIII of the Social Security Act (42 U.S.C. 1395j

11 et seq.) after conducting the study under section

12 4(a)(1);

13 (2) implement such system in accordance with

14 the final recommendations published under sub15 section (a)(2) of section 4 and the timetable set

16 forth under subsection (b) of such section; and

17 (3) carry out such other matters as the Sec18 retary of Health and Human Services (in this sec19 tion referred to as the ‘‘Secretary’’), in consultation

20 with the other members of the Commission, may

21 prescribe.

22 (c) MEMBERSHIP.—

23 (1) NUMBER AND APPOINTMENT.—The Com24 mission shall be composed of 7 members as follows:
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1 (A) The Secretary, who shall be the chair2 person of the Commission.

3 (B) One shall be appointed from the Na4 tional Aeronautics and Space Administration by

5 the Administrator.

6 (C) One shall be appointed from the De7 fense Advanced Research Projects Agency by

8 the Director.

9 (D) One shall be appointed from the Na10 tional Science Foundation by the Director.

11 (E) One shall be appointed from the Office

12 of Science and Technology Policy by the Direc13 tor.

14 (F) One shall be appointed from the De15 partment of Veterans Affairs by the Secretary.

16 (G) One shall be appointed from the Office

17 of Management and Budget by the Director.

18 (2) REQUIREMENTS.—Each of the members ap19 pointed under subparagraphs (B) through (G) of

20 paragraph (1) shall—

21 (A) have been appointed as an officer or

22 employee of the agency by the President by and

23 with the advice and consent of the Senate; and

24 (B) be an expert in advanced information

25 technology.
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1 (3) DEADLINE FOR INITIAL APPOINTMENT.—

2 The members of the Commission shall be appointed

3 by not later than 3 months after the date of enact4 ment of this Act.

5 (d) MEETINGS.—

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

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

8 meet—

9 (A) not less than 4 times each year; or

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

11 its members.

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

13 the Commission shall constitute a quorum, but a

14 lesser number of members may hold hearings.

15 (e) COMPENSATION.—Each member of the Commis16 sion shall serve without compensation in addition to that

17 received for the services of such member as an officer or

18 employee of the United States.

19 (f) STAFF.—

20 (1) IN GENERAL.—The chairperson of the Com21 mission may, without regard to the civil service laws

22 and regulations, appoint and terminate an executive

23 director and such other additional personnel as may

24 be necessary to enable the Commission to perform

25 its duties.
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1 (2) COMPENSATION.—The chairperson of the

2 Commission may fix the compensation of the execu3 tive director and other personnel without regard to

4 the provisions of chapter 51 and subchapter III of

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

6 to classification of positions and General Schedule

7 pay rates, except that the rate of pay for the execu8 tive director and other personnel may not exceed the

9 rate payable for level V of the Executive Schedule

10 under section 5316 of such title.

11 (3) DETAIL OF GOVERNMENT EMPLOYEES.—

12 Any Federal Government employee may be detailed

13 to the Commission without reimbursement, and such

14 detail shall be without interruption or loss of civil

15 service status or privilege.

16 (g) PROCUREMENT OF TEMPORARY AND INTERMIT17 TENT SERVICES.—The chairperson of the Commission

18 may procure temporary and intermittent services under

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

20 for individuals which do not exceed the daily equivalent

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

22 the Executive Schedule under section 5316 of such title.

23 (h) TERMINATION.—The Commission shall terminate

24 on the date on which the system is fully implemented

25 under section 4(b)(3).
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1 SEC. 4. STUDY AND FINAL RECOMMENDATIONS; TIME2 TABLE FOR IMPLEMENTATION OF ADVANCED

3 INFORMATIONAL INFRASTRUCTURE.

4 (a) STUDY AND FINAL RECOMMENDATIONS.—

5 (1) STUDY.—The Commission shall conduct a

6 study during the 3-year period beginning on the date

7 of enactment of this Act on the design and construc8 tion of an immediate claim, administration, payment

9 resolution, and data collection system (in this section

10 referred to as the ‘‘system’’) that—

11 (A) immediately advises each provider and

12 supplier of coverage determinations;

13 (B) immediately notifies each provider or

14 supplier of any incomplete or invalid claim,

15 including—

16 (i) the identification of any missing

17 information;

18 (ii) the identification of any coding er19 rors; and

20 (iii) information detailing how the

21 provider or supplier may develop a claim

22 under such system;

23 (C) allows for proper completion and re24 submission of each claim identified as incom25 plete or invalid under subparagraph (B);
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1 (D) allows for immediate automatic proc2 essing of clean claims (as defined in section

3 1842(c)(2)(B)(i) of the Social Security Act (42

4 U.S.C. 1395u(c)(2)(B)(i)) so that a provider or

5 supplier may provide a written explanation of

6 medical benefits, including an explanation of

7 costs and coverage to any beneficiary under

8 part B of the medicare program under title

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

10 1395j et seq.) at the point of care; and

11 (E) allows for electronic payment of claims

12 to each provider and supplier, including pay13 ment through electronic funds transfer, for each

14 claim for which payment is not made on a peri15 odic interim payment basis under such part.

16 (2) FINAL RECOMMENDATIONS.—

17 (A) PUBLICATION.—Not later than 3 years

18 after the date of enactment of this Act, the

19 chairperson of the Commission shall publish in

20 the Federal Register final recommendations

21 that reflect input from each interested party,

22 including providers and suppliers, insurance

23 companies, and health benefits management

24 concerns using a process similar to the process

25 used for developing standards under section
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1 1172(c) of the Social Security Act (42 U.S.C.

2 1320d–1(c)).

3 (B) CONSIDERATIONS.—In developing the

4 final recommendations to be published under

5 subparagraph (A), the Commission shall—

6 (i) make every effort to design system

7 specifications that are flexible, scalable,

8 and performance-based; and

9 (ii) ensure that strict security

10 measures—

11 (I) guard system integrity;

12 (II) protect the privacy of pa13 tients and the confidentiality of per14 sonally identifiable health insurance

15 data used or maintained under the

16 system; and

17 (III) apply to any network serv18 ice provider used in connection with

19 the system.

20 (b) TIMETABLE.—The timetable set forth under this

21 subsection is as follows:

22 (1) INITIAL IMPLEMENTATION.—Not later than

23 5 years after the date of enactment of this Act, the

24 system shall support—
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1 (A) 50 percent of queries regarding cov2 erage determinations;

3 (B) 30 percent of determinations regarding

4 incomplete or invalid claims; and

5 (C) immediate processing at the point of

6 care of 40 percent of clean claims submitted by

7 providers and suppliers under part B of the

8 medicare program.

9 (2) INTERMEDIATE IMPLEMENTATION.—Not

10 later than 7 years after the date of enactment of

11 this Act, the system shall support—

12 (A) 70 percent of queries regarding cov13 erage determinations;

14 (B) 50 percent of determinations regarding

15 incomplete or invalid claims; and

16 (C) immediate processing at the point of

17 care of 60 percent of clean claims submitted by

18 providers and suppliers under part B of the

19 medicare program.

20 (3) FULL IMPLEMENTATION.—Not later than

21 10 years after the date of enactment of this Act, the

22 system shall support—

23 (A) 90 percent of queries regarding cov24 erage determinations;
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1 (B) 60 percent of determinations regarding

2 incomplete or invalid claims; and

3 (C) immediate processing at the point of

4 care of 40 percent of the total number of claims

5 submitted by providers and suppliers under

6 part B of the medicare program.

7 SEC. 5. APPLICATION OF ADVANCED INFORMATIONAL IN8 FRASTRUCTURE TO THE FEHBP.

9 (a) IN GENERAL.—The Office of Personnel Manage10 ment (in this section referred to as the ‘‘Office’’) shall—

11 (1) adapt the immediate claim, administration,

12 payment resolution, and data collection system es13 tablished under section 3 (in this section referred to

14 as the ‘‘system’’) for use under the Federal employ15 ees health benefits program under chapter 89 of title

16 5, United States Code; and

17 (2) require that carriers (as defined in section

18 8901(7) of such Code) participating in such pro19 gram use the system to satisfy certain minimum re20 quirements for claim submission, processing, and

21 payment in accordance with the timetable set forth

22 in subsection (b).

23 (b) TIMETABLE.—The timetable set forth in this sub24 section is as follows:
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1 (1) INITIAL IMPLEMENTATION.—Not later than

2 5 years after the date of enactment of this Act, the

3 Office shall require that carriers use the system to

4 process not less than—

5 (A) 50 percent of queries regarding cov6 erage determinations;

7 (B) 30 percent of determinations of incom8 plete or invalid claims; and

9 (C) immediate processing at the point of

10 care of 10 percent of the total number of

11 claims.

12 (2) INTERMEDIATE IMPLEMENTATION.—Not

13 later than 7 years after the date of enactment of

14 this Act, the Office shall require that carriers use

15 the system to support not less than—

16 (A) 70 percent of queries regarding cov17 erage determinations;

18 (B) 50 percent of determinations regarding

19 incomplete or invalid claims; and

20 (C) immediate processing at the point of

21 care of 20 percent of the total number of

22 claims.

23 (3) FULL IMPLEMENTATION.—Not later than

24 10 years after the date of enactment of this Act, the
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1 Office shall require that carriers use the system to

2 support not less than—

3 (A) 90 percent of queries regarding cov4 erage determinations;

5 (B) 60 percent of determinations of incom6 plete or invalid claims; and

7 (C) immediate processing of 35 percent of

8 the total number of claims.

9 SEC. 6. AUTHORIZATION OF APPROPRIATIONS.

10 (a) IN GENERAL.—There are appropriated to the

11 Health Care Infrastructure Commission established under

12 section 3, out of any funds in the Treasury that are not

13 otherwise appropriated, such sums as may be necessary

14 to carry out the provisions of this Act.

15 (b) AVAILABILITY.—Any sums appropriated under

16 subsection (a) shall remain available until the termination

17 of the Health Care Infrastructure Commission under sec18 tion 3(h).

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