I
106TH CONGRESS
2D SESSION
H. R. 4401
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 HOUSE OF REPRESENTATIVES
MAY 9, 2000
Mr. HORN (for himself, and Mr. CALVERT) introduced the following bill; which
was referred to the Committee on Commerce, and in addition to the Com-
mittee on Ways and Means, and Government Reform, 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 con-
cerned
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 Pro-
gram and to establish an advanced informational infra-
structure for the administration of Federal health bene-
fits programs.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; TABLE OF CONTENTS.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Health Care Infrastructure Investment Act of 2000’’.
(b) TABLE OF CONTENTS.—The table of contents of
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 ad-
vanced informational infrastructure.
Sec. 5. Application of advanced informational infrastructure to the FEHBP.
Sec. 6. Authorization of appropriations.
SEC. 2. MORATORIUM ON DELAYED PAYMENTS UNDER
CONTRACTS THAT PROVIDE FOR THE DIS-
BURSEMENT OF FUNDS.
Section 1842(c) of the Social Security Act (42 U.S.C.
1395u(c)) is amended by striking paragraph (3).
SEC. 3. ESTABLISHMENT OF THE HEALTH CARE INFRA-
STRUCTURE COMMISSION.
(a) ESTABLISHMENT.—There is established within
the Department of Health and Human Services a Health
Care Infrastructure Commission (in this section referred
to as the ‘‘Commission’’) to coordinate the expertise and
programs within and among departments and agencies of
the Federal Government for the purposes of designing and
implementing an advanced informational infrastructure
for the administration of Federal health benefits pro-
grams.
(b) DUTIES.—The Commission shall—
(1) establish an advanced informational infra-
structure for the administration of Federal health
benefits programs which consists of an immediate
claim, administration, payment resolution, and data
collection system (in this section referred to as the
‘‘system’’) that is initially for use by carriers to
process claims submitted by providers and suppliers
under part B of the medicare program under title
XVIII of the Social Security Act (42 U.S.C. 1395j
et seq.) after conducting the study under section
4(a)(1);
(2) implement such system in accordance with
the final recommendations published under sub-
section (a)(2) of section 4 and the timetable set
forth under subsection (b) of such section; and
(3) carry out such other matters as the Sec-
retary of Health and Human Services (in this sec-
tion referred to as the ‘‘Secretary’’), in consultation
with the other members of the Commission, may
prescribe.
(c) MEMBERSHIP.—
(1) NUMBER AND APPOINTMENT.—The Com-
mission shall be composed of 7 members as follows:
(A) The Secretary, who shall be the chair-
person of the Commission.
(B) One shall be appointed from the Na-
tional Aeronautics and Space Administration by
the Administrator.
(C) One shall be appointed from the De-
fense Advanced Research Projects Agency by
the Director.
(D) One shall be appointed from the Na-
tional Science Foundation by the Director.
(E) One shall be appointed from the Office
of Science and Technology Policy by the Direc-
tor.
(F) One shall be appointed from the De-
partment of Veterans Affairs by the Secretary.
(G) One shall be appointed from the Office
of Management and Budget by the Director.
(2) REQUIREMENTS.—Each of the members ap-
pointed under subparagraphs (B) through (G) of
paragraph (1) shall—
(A) have been appointed as an officer or
employee of the agency by the President by and
with the advice and consent of the Senate; and
(B) be an expert in advanced information
technology.
(3) DEADLINE FOR INITIAL APPOINTMENT.—
The members of the Commission shall be appointed
by not later than 3 months after the date of enact-
ment of this Act.
(d) MEETINGS.—
(1) IN GENERAL.—The Commission shall meet
at the call of the chairperson, except that it shall
meet—
(A) not less than 4 times each year; or
(B) on the written request of a majority of
its members.
(2) QUORUM.—A majority of the members of
the Commission shall constitute a quorum, but a
lesser number of members may hold hearings.
(e) COMPENSATION.—Each member of the Commis-
sion shall serve without compensation in addition to that
received for the services of such member as an officer or
employee of the United States.
(f) STAFF.—
(1) IN GENERAL.—The chairperson of the Com-
mission may, without regard to the civil service laws
and regulations, appoint and terminate an executive
director and such other additional personnel as may
be necessary to enable the Commission to perform
its duties.
(2) COMPENSATION.—The chairperson of the
Commission may fix the compensation of the execu-
tive director and other personnel without regard to
the provisions of chapter 51 and subchapter III of
chapter 53 of title 5, United States Code, relating
to classification of positions and General Schedule
pay rates, except that the rate of pay for the execu-
tive director and other personnel may not exceed the
rate payable for level V of the Executive Schedule
under section 5316 of such title.
(3) DETAIL
OF
GOVERNMENT
EMPLOYEES.—
Any Federal Government employee may be detailed
to the Commission without reimbursement, and such
detail shall be without interruption or loss of civil
service status or privilege.
(g) PROCUREMENT OF TEMPORARY AND INTERMIT-
TENT SERVICES.—The chairperson of the Commission
may procure temporary and intermittent services under
section 3109(b) of title 5, United States Code, at rates
for individuals which do not exceed the daily equivalent
of the annual rate of basic pay prescribed for level V of
the Executive Schedule under section 5316 of such title.
(h) TERMINATION.—The Commission shall terminate
on the date on which the system is fully implemented
under section 4(b)(3).
SEC. 4. STUDY AND FINAL RECOMMENDATIONS; TIME-
TABLE FOR IMPLEMENTATION OF ADVANCED
INFORMATIONAL INFRASTRUCTURE.
(a) STUDY AND FINAL RECOMMENDATIONS.—
(1) STUDY.—The Commission shall conduct a
study during the 3-year period beginning on the date
of enactment of this Act on the design and construc-
tion of an immediate claim, administration, payment
resolution, and data collection system (in this section
referred to as the ‘‘system’’) that—
(A) immediately advises each provider and
supplier of coverage determinations;
(B) immediately notifies each provider or
supplier of any incomplete or invalid claim,
including—
(i) the identification of any missing
information;
(ii) the identification of any coding er-
rors; and
(iii) information detailing how the
provider or supplier may develop a claim
under such system;
(C) allows for proper completion and re-
submission of each claim identified as incom-
plete or invalid under subparagraph (B);
(D) allows for immediate automatic proc-
essing of clean claims (as defined in section
1842(c)(2)(B)(i) of the Social Security Act (42
U.S.C. 1395u(c)(2)(B)(i)) so that a provider or
supplier may provide a written explanation of
medical benefits, including an explanation of
costs and coverage to any beneficiary under
part B of the medicare program under title
XVIII of the Social Security Act (42 U.S.C.
1395j et seq.) at the point of care; and
(E) allows for electronic payment of claims
to each provider and supplier, including pay-
ment through electronic funds transfer, for each
claim for which payment is not made on a peri-
odic interim payment basis under such part.
(2) FINAL RECOMMENDATIONS.—
(A) PUBLICATION.—Not later than 3 years
after the date of enactment of this Act, the
chairperson of the Commission shall publish in
the Federal Register final recommendations
that reflect input from each interested party,
including providers and suppliers, insurance
companies, and health benefits management
concerns using a process similar to the process
used for developing standards under section
1172(c) of the Social Security Act (42 U.S.C.
1320d–1(c)).
(B) CONSIDERATIONS.—In developing the
final recommendations to be published under
subparagraph (A), the Commission shall—
(i) make every effort to design system
specifications that are flexible, scalable,
and performance-based; and
(ii) 
ensure 
that 
strict 
security
measures—
(I) guard system integrity;
(II) protect the privacy of pa-
tients and the confidentiality of per-
sonally identifiable health insurance
data used or maintained under the
system; and
(III) apply to any network serv-
ice provider used in connection with
the system.
(b) TIMETABLE.—The timetable set forth under this
subsection is as follows:
(1) INITIAL IMPLEMENTATION.—Not later than
5 years after the date of enactment of this Act, the
system shall support—
(A) 50 percent of queries regarding cov-
erage determinations;
(B) 30 percent of determinations regarding
incomplete or invalid claims; and
(C) immediate processing at the point of
care of 40 percent of clean claims submitted by
providers and suppliers under part B of the
medicare program.
(2) 
INTERMEDIATE
IMPLEMENTATION.—Not
later than 7 years after the date of enactment of
this Act, the system shall support—
(A) 70 percent of queries regarding cov-
erage determinations;
(B) 50 percent of determinations regarding
incomplete or invalid claims; and
(C) immediate processing at the point of
care of 60 percent of clean claims submitted by
providers and suppliers under part B of the
medicare program.
(3) FULL IMPLEMENTATION.—Not later than
10 years after the date of enactment of this Act, the
system shall support—
(A) 90 percent of queries regarding cov-
erage determinations;
(B) 60 percent of determinations regarding
incomplete or invalid claims; and
(C) immediate processing at the point of
care of 40 percent of the total number of claims
submitted by providers and suppliers under
part B of the medicare program.
SEC. 5. APPLICATION OF ADVANCED INFORMATIONAL IN-
FRASTRUCTURE TO THE FEHBP.
(a) IN GENERAL.—The Office of Personnel Manage-
ment (in this section referred to as the ‘‘Office’’) shall—
(1) adapt the immediate claim, administration,
payment resolution, and data collection system es-
tablished under section 3 (in this section referred to
as the ‘‘system’’) for use under the Federal employ-
ees health benefits program under chapter 89 of title
5, United States Code; and
(2) require that carriers (as defined in section
8901(7) of such Code) participating in such pro-
gram use the system to satisfy certain minimum re-
quirements for claim submission, processing, and
payment in accordance with the timetable set forth
in subsection (b).
(b) TIMETABLE.—The timetable set forth in this sub-
section is as follows:
(1) INITIAL IMPLEMENTATION.—Not later than
5 years after the date of enactment of this Act, the
Office shall require that carriers use the system to
process not less than—
(A) 50 percent of queries regarding cov-
erage determinations;
(B) 30 percent of determinations of incom-
plete or invalid claims; and
(C) immediate processing at the point of
care of 10 percent of the total number of
claims.
(2) 
INTERMEDIATE
IMPLEMENTATION.—Not
later than 7 years after the date of enactment of
this Act, the Office shall require that carriers use
the system to support not less than—
(A) 70 percent of queries regarding cov-
erage determinations;
(B) 50 percent of determinations regarding
incomplete or invalid claims; and
(C) immediate processing at the point of
care of 20 percent of the total number of
claims.
(3) FULL IMPLEMENTATION.—Not later than
10 years after the date of enactment of this Act, the
Office shall require that carriers use the system to
support not less than—
(A) 90 percent of queries regarding cov-
erage determinations;
(B) 60 percent of determinations of incom-
plete or invalid claims; and
(C) immediate processing of 35 percent of
the total number of claims.
SEC. 6. AUTHORIZATION OF APPROPRIATIONS.
(a) IN GENERAL.—There are appropriated to the
Health Care Infrastructure Commission established under
section 3, out of any funds in the Treasury that are not
otherwise appropriated, such sums as may be necessary
to carry out the provisions of this Act.
(b) AVAILABILITY.—Any sums appropriated under
subsection (a) shall remain available until the termination
of the Health Care Infrastructure Commission under sec-
tion 3(h).
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