I
105TH CONGRESS
2D SESSION
H. R. 4413
To amend the Public Health Service Act, the Employee Retirement Income
Security Act of 1974, and the Internal Revenue Code of 1986 to assure
prompt payment of participating providers under health plans.
IN THE HOUSE OF REPRESENTATIVES
AUGUST 5, 1998
Mr. MCDERMOTT introduced the following bill; which was referred to the
Committee on Commerce, and in addition to the Committees on Edu-
cation and the Workforce, and Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
A BILL
To amend the Public Health Service Act, the Employee Re-
tirement Income Security Act of 1974, and the Internal
Revenue Code of 1986 to assure prompt payment of
participating providers under health plans.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Participating Provider
Prompt Payment Act of 1998’’.
SEC. 2. ASSURING PROMPT PAYMENT UNDER HEALTH
PLANS.
(a) GROUP HEALTH PLANS.—
(1) PUBLIC
HEALTH
SERVICE
ACT
AMEND-
MENTS.—Subpart 2 of part A of title XXVII of the
Public Health Service Act is amended by adding at
the end the following new section:
‘‘SEC. 2706. STANDARDS RELATING TO PROMPT PAYMENT.
‘‘A group health plan, and a health insurance issuer
offering group health insurance coverage, shall provide
prompt payment (consistent with the standards applied to
Medicare+Choice plans under section 1857(f) of the So-
cial Security Act) to claims submitted for covered items
and services that are not furnished by a nonparticipating
provider (or in the case of a plan or coverage that is a
private fee-for-service plan of the type described in section
1859(b)(2) of such Act, if the claim is submitted to the
plan or issuer by a participant, beneficiary, or enrollee).’’.
(2) ERISA AMENDMENTS.—
(A) IN GENERAL.—Subpart B of part 7 of
subtitle B of title I of the Employee Retirement
Income Security Act of 1974 is amended by
adding at the end the following new section:
‘‘SEC. 713. STANDARDS RELATING TO PROMPT PAYMENT.
‘‘A group health plan, and a health insurance issuer
offering group health insurance coverage, shall provide
prompt payment (consistent with the standards applied to
Medicare+Choice plans under section 1857(f) of the So-
cial Security Act) to claims submitted for covered items
and services that are not furnished by a nonparticipating
provider (or in the case of a plan or coverage that is a
private fee-for-service plan of the type described in section
1859(b)(2) of such Act, if the claim is submitted to the
plan or issuer by a participant, beneficiary, or enrollee).’’.
(B) CLERICAL AMENDMENT.—The table of
contents in section 1 of the Employee Retire-
ment Income Security Act of 1974 is amended
by inserting after the item relating to section
712 the following new item:
‘‘Sec. 713. Standards relating to prompt payment.’’.
(3) 
INTERNAL
REVENUE
CODE
AMEND-
MENTS.—
(A) IN GENERAL.—Subchapter B of chap-
ter 100 of the Internal Revenue Code of 1986
(relating to other requirements) is amended by
adding at the end the following new section:
‘‘SEC. 9813. STANDARDS RELATING TO PROMPT PAYMENT.
‘‘A group health plan shall provide prompt payment
(consistent 
with 
the 
standards 
applied 
to
Medicare+Choice plans under section 1857(f) of the So-
cial Security Act) to claims submitted for covered items
and services that are not furnished by a nonparticipating
provider (or in the case of a plan that is a private fee-
for-service plan of the type described in section 1859(b)(2)
of such Act, if the claim is submitted to the plan by a
participant or beneficiary).’’.
(B) CLERICAL AMENDMENT.—The table of
sections of such subchapter of such chapter is
amended by adding at the end the following
new item:
‘‘Sec. 9813. Standards relating to prompt payment.’’
(b) INDIVIDUAL HEALTH INSURANCE.—Part B of
title XXVII of the Public Health Service Act is amended
by inserting after section 2751 the following new section:
‘‘SEC. 2752. STANDARDS RELATING TO PROMPT PAYMENT.
‘‘The provisions of section 2706 shall apply to health
insurance coverage offered by a health insurance issuer
in the individual market in the same manner as it applies
to health insurance coverage offered by a health insurance
issuer in connection with a group health plan in the small
or large group market.’’.
(c) EFFECTIVE DATES.—
(1) GROUP HEALTH PLANS.—The amendments
made by subsection (a) shall apply with respect to
group health plans (and health insurance coverage
offered in connection with such plans) for plan years
beginning on or after January 1, 1999.