I
107TH CONGRESS
1ST SESSION
H. R. 287
To amend title XXVII of the Public Health Service Act, title I of the
Employee Retirement Income Security Act of 1974, the Internal Revenue
Code of 1986, and title XVIII of the Social Security Act to require
that group and individual health insurance coverage, group health plans,
and Medicare+Choice organizations provide prompt payment of claims.
IN THE HOUSE OF REPRESENTATIVES
JANUARY 30, 2001
Mrs. MCCARTHY of New York (for herself and Mr. KING) introduced the fol-
lowing bill; which was referred to the Committee on Energy and Com-
merce, and in addition to the Committees on Ways and Means, and Edu-
cation and the Workforce, for a period to be subsequently determined by
the Speaker, in each case for consideration of such provisions as fall with-
in the jurisdiction of the committee concerned
A BILL
To amend title XXVII of the Public Health Service Act,
title I of the Employee Retirement Income Security Act
of 1974, the Internal Revenue Code of 1986, and title
XVIII of the Social Security Act to require that group
and individual health insurance coverage, group health
plans, 
and 
Medicare+Choice 
organizations 
provide
prompt payment of claims.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
(as added by section 262 of the Health Insurance
Portability and Accountability Act of 1996).’’.
(2) ERISA AMENDMENTS.—(A) Subpart B of
part 7 of subtitle B of title I of the Employee Re-
tirement Income Security Act of 1974 is amended by
adding at the end the following new section:
‘‘SEC. 714. STANDARD RELATING TO PROMPT PAYMENT OF
CLAIMS.
‘‘A group health plan, and a health insurance issuer
offering group health insurance coverage, shall—
‘‘(1) pay the claim to a participant or bene-
ficiary, or make a payment to a health care provider,
within 15 business days of the date of the claim or
bill for services rendered (in the case of a claim or
bill transmitted electronically) or within 30 business
days of such date for other claims or bills submitted
in writing; and
‘‘(2) shall accept as a clean claim a claim that
is submitted consistent with the standards adopted
under part C of title XI of the Social Security Act
(as added by section 262 of the Health Insurance
Portability and Accountability Act of 1996).’’.
(B) Section 732(a) of such Act (29 U.S.C.
1191a(a)) is amended by striking ‘‘section 711’’ and
inserting ‘‘sections 711 and 714’’.
(C) The table of contents in section 1 of such
Act is amended by inserting after the item relating
to section 713 the following new item:
‘‘Sec. 714. Standard relating to prompt payment of claims.’’.
(3) 
INTERNAL
REVENUE
CODE
AMEND-
MENTS.—
(A) IN GENERAL.—Subchapter B of chap-
ter 100 of the Internal Revenue Code of 1986
is amended—
(i) in the table of sections, by insert-
ing after the item relating to section 9812
the following new item:
‘‘Sec. 9813. Standard relating to prompt payment of claims.’’;
and
(ii) by inserting after section 9812 the
following:
‘‘SEC. 9813. STANDARD RELATING TO PROMPT PAYMENT OF
CLAIMS.
‘‘A group health plan shall—
‘‘(1) pay the claim to a participant or bene-
ficiary, or make a payment to a health care provider,
within 15 business days of the date of the claim or
bill for services rendered (in the case of a claim or
bill transmitted electronically) or within 30 business
days of such date for other claims or bills submitted
in writing; and
‘‘(2) shall accept as a clean claim a claim that
is submitted consistent with the standards adopted
under part C of title XI of the Social Security Act
(as added by section 262 of the Health Insurance
Portability and Accountability Act of 1996).’’.
(B) CONFORMING
AMENDMENT.—Section
4980D(d)(1) of such Code is amended by strik-
ing ‘‘section 9811’’ and inserting ‘‘sections
9811 and 9813’’.
(b) INDIVIDUAL HEALTH INSURANCE.—Part B of
title XXVII of the Public Health Service Act is amended
by inserting after section 2752 the following new section:
‘‘SEC. 2753. STANDARD RELATING PATIENT FREEDOM OF
CHOICE.
‘‘The provisions of section 2707 shall apply to health
insurance coverage offered by a health insurance issuer
in the individual market in the same manner as they apply
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
AND
GROUP
HEALTH INSURANCE COVERAGE.—Subject to para-
graph (3), the amendments made by subsection (a)
apply with respect to group health plans for plan
years beginning on or after January 1, 2002.
(2) INDIVIDUAL
HEALTH
INSURANCE
COV-
ERAGE.—The amendment made by subsection (b)
apply with respect to health insurance coverage of-
fered, sold, issued, renewed, in effect, or operated in
the individual market on or after such date.
(3) COLLECTIVE BARGAINING EXCEPTION.—In
the case of a group health plan maintained pursuant
to 1 or more collective bargaining agreements be-
tween employee representatives and 1 or more em-
ployers ratified before the date of enactment of this
Act, the amendments made subsection (a) shall not
apply to plan years beginning before the later of—
(A) the date on which the last collective
bargaining agreements relating to the plan ter-
minates (determined without regard to any ex-
tension thereof agreed to after the date of en-
actment of this Act), or
(B) January 1, 2002.
For purposes of subparagraph (A), any plan amend-
ment made pursuant to a collective bargaining
agreement relating to the plan which amends the
plan solely to conform to any requirement added by
subsection (a) shall not be treated as a termination
of such collective bargaining agreement.
(d) COORDINATION OF ADMINISTRATION.—The Sec-
retary of Labor, the Secretary of the Treasury, and the
Secretary of Health and Human Services shall ensure,
through the execution of an interagency memorandum of
understanding among such Secretaries, that—
(1) regulations, rulings, and interpretations
issued by such Secretaries relating to the same mat-
ter over which two or more such Secretaries have re-
sponsibility under the provisions of this Act (and the
amendments made thereby) are administered so as
to have the same effect at all times; and
(2) coordination of policies relating to enforcing
the same requirements through such Secretaries in
order to have a coordinated enforcement strategy
that avoids duplication of enforcement efforts and
assigns priorities in enforcement.
SEC. 3. PROMPT PAYMENT BY MEDICARE+CHOICE ORGANI-
ZATIONS IN ALL LINES OF BUSINESS.
(a) IN GENERAL.—Section 1857(f)(1) of the Social
Security Act (42 U.S.C. 1395w–27(f)(1)) is amended by
inserting ‘‘and to individuals enrolled with the organiza-
tion through other lines of business (including private
health benefits coverage)’’ after ‘‘to enrollees pursuant to
the contract’’.
(b) EFFECTIVE DATE.—The amendment made by
subsection (a) shall apply to contract years beginning on
or after January 1, 2002.
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