I
106TH CONGRESS
2D SESSION
H. R. 5622
To establish a commission to create a comprehensive strategy for an inte-
grated, advanced informational infrastructure for the medicare program,
and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
NOVEMBER 2, 2000
Mr. HORN (for himself and Mr. CALVERT) introduced the following bill; which
was referred to the Committee on Ways and Means, and in addition to
the Committee on Commerce, 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 concerned
A BILL
To establish a commission to create a comprehensive strategy
for an integrated, advanced informational infrastructure
for the medicare program, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE; PURPOSE.
(a) SHORT TITLE.—This Act may be cited as the
‘‘Medicare Program Infrastructure Investment Act of
2000’’.
(b) PURPOSE.—The purpose of this Act is to design
a strategy for the implementation of an advanced informa-
tional infrastructure for the administration of parts A and
B of the medicare program in coordination with the Ad-
ministrator of the Health Care Financing Administration
and the Chief Information Office of the Health Care Fi-
nancing Administration.
SEC. 2. 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 Advisory Commission (in this section
referred to as the ‘‘Commission’’).
(b) DUTIES.—The Commission shall carry out the
following duties:
(1) In conjunction with the Administrator and
Chief Information Officer of the Health Care Fi-
nancing Administration, the Commission shall de-
velop a strategy to create an advanced informational
infrastructure for the administration of the medicare
program under parts A and B of title XVIII of the
Social Security Act, including claims processing by
medicare carriers and fiscal intermediaries and bene-
ficiary information functions.
(2) 18 months after the date all of the members
of the Commission are appointed under subsection
(c)(2), the Commission shall submit to Congress
(and publish in the Federal Register) an initial re-
port that describes a strategic plan to implement an
advanced information structure for parts A and B of
the medicare program, including a cost estimate and
schedule for the plan, that—
(A) complies with all existing Federal fi-
nancial management and information tech-
nology laws;
(B) provides immediate, point-of-service in-
formation on covered items and services under
the program to each beneficiary, provider of
services, physician, and supplier;
(C) ensures that strict security measures
are integral to and designed into the system
that—
(i) protect the privacy of patients and
the confidentiality of personally identifiable
health insurance data used or maintained
under the system in a manner consistent
with privacy regulations promulgated by
the Secretary under the Health Insurance
Portability and Accountability Act of 1996;
(ii) guard system integrity in a man-
ner consistent with security regulations
promulgated by the Secretary under such
Act; and
(iii) apply to any network service pro-
vider used in connection with the system;
(D) immediately notifies each provider of
services, physician, or supplier of any incom-
plete 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 of services, physician, or supplier
may develop a claim under such system;
(E) allows for proper completion and re-
submission of each claim identified as incom-
plete or invalid under subparagraph (D);
(F) allows for immediate automatic proc-
essing of clean claims and subsequent payment
in accordance with the provisions of sections
1816(c)(2)(B)(i) and 1842(c)(2)(B)(i) of the
Social 
Security 
Act 
(42 
U.S.C.
1395h(c)(2)(B)(i) and 1395u(c)(2)(B)(i)) so
that a provider of services, physician, or sup-
plier may immediately provide the beneficiary
with a written explanation of medical benefits,
including an explanation of costs and coverage
to any beneficiary under parts A and B at the
point of care;
(G) allows for electronic payment of claims
to each provider of services, physician, and sup-
plier, including payment through electronic
funds transfer, for each claim for which pay-
ment is not made on a periodic interim pay-
ment basis under section 1815(e)(2) of such
Act (42 U.S.C. 1395g(e)(2)) for items and serv-
ices furnished under part A;
(H) complies with all applicable trans-
actions standards adopted by the Secretary
under the Health Insurance Portability and Ac-
countability Act of 1996;
(I) provides for system specifications that
are flexible, modular in nature, scalable, and
performance-based; and
(J) is designed to be used, or easily adapt-
ed for use, in other health insurance programs
administered by a department or agency of the
United States.
(3) Not later than one year after the date the
Commission submits the initial report under para-
graph (2), the Commission shall submit to Congress
(and shall publish in the Federal Register) a final
report on the Secretary’s progress in developing an
advanced informational system.
(4) 
Each 
report 
required 
under 
this
subsection—
(A) shall include those recommendations,
findings, and conclusions of the Commission
that receive the approval of at least a majority
of the members of the Commission; and
(B) shall include dissenting or additional
views of members of the Commission with re-
spect to the subject matter of the report.
(c) MEMBERSHIP.—
(1) COMPOSITION.—The Commission shall be
composed of 13 voting members appointed in accord-
ance with paragraph (2) and two ex officio voting
members designated under paragraph (3).
(2) IN GENERAL.—Not later than 90 days after
the date of the enactment of this Act, members of
the Commission shall be appointed as follows:
(A) The Director of the Defense Advanced
Research Projects Agency shall appoint one
member.
(B) The Director of the National Science
Foundation shall appoint one member.
(C) The Director of the Office of Science
and Technology Policy shall appoint one mem-
ber.
(D) The Secretary shall appoint one mem-
ber who represents each of the following:
(i) Physicians and other health care
practitioners.
(ii) Hospitals.
(iii) Skilled nursing facilities.
(iv) Home health agencies.
(v) Suppliers of durable medical
equipment.
(vi) Fiscal intermediaries and carriers.
(E) The Secretary shall appoint two mem-
bers who represent information technology pro-
viders, one who represents medicare informa-
tion technology providers and one who represent
health industry information technology pro-
viders.
(F) The Secretary shall appoint two mem-
bers who represent medicare beneficiaries.
(3) EX OFFICIO MEMBERS.—The following shall
serve as ex officio members of the Commission:
(A) The Secretary, who shall be the chair-
person of the Commission.
(B) The Chief Financial Officer of the
Health Care Financing Administration.
(4) QUALIFICATIONS.—Each of the members
appointed under paragraph (2) shall be knowledge-
able in advanced information technology, financial
management, or electronic billing procedures associ-
ated with health care benefit programs. One of the
members appointed under paragraph (2)(F) shall
have expertise in health information privacy.
(d) MEETINGS.—
(1) IN GENERAL.—The Commission shall meet
at the call of the chairperson, except that it shall
meet—
(A) not less than four 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 who is a full-time officer or employee of the United
States may not receive additional pay, allowances, or bene-
fits by reason of their service on the Commission. Each
member of the Commission shall receive travel expenses
and per diem in lieu of subsistence in accordance with sec-
tions 5702 and 5703 of title 5, United States Code.
(f) STAFF.—
(1) IN GENERAL.—The chairperson of the Com-
mission may, without regard to the civil service laws
and regulations, appoint 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.—
Upon request of the chairperson, the head of any
Federal department or agency may detail to the
Commission, without reimbursement, basis, any of
the personnel of that department or agency to the
Commission to assist it in carrying out its duties
under this Act. Such detail shall be without inter-
ruption 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 that is 60 days after the date the Commission
submits to Congress the final report under subsection
(b)(3).
(i) AUTHORIZATION OF APPROPRIATIONS.—
(1) IN GENERAL.—There are authorized to be
appropriated out of any funds in the Treasury not
otherwise appropriated, such sums as may be nec-
essary for the Commission to carry out its duties
under this section.
(2) AVAILABILITY.—Any sums appropriated
under paragraph (1) shall remain available until the
termination of the Commission under subsection (h).
(j) DEFINITIONS.—In this section:
(1) SECRETARY.—The term ‘‘Secretary’’ means
the Secretary of Health and Human Services.
(2) ADMINISTRATOR.—The term ‘‘Adminis-
trator’’ means the Administrator of the Health Care
Financing Administration.
(k) APPLICABILITY OF FACA.—The provisions of the
Federal Advisory Committee Act (5 U.S.C. App.) shall
apply to the Commission.
SEC. 3. IMPLEMENTATION OF SYSTEM.
(a) ANNUAL REPORTS ON IMPLEMENTATION.—Not
later than 6 months after the Commission publishes in the
Federal Register the final report required under section
2(b)(3) and annually thereafter until the date of final im-
plementation under subsection (b), the Secretary shall
submit to Congress a report on the progress of the Health
Care Financing Administration on implementing a mod-
ernized advanced, integrated informational infrastructure
for the administration of parts A and B of the medicare
program.
(b) FINAL IMPLEMENTATION.—Not later than 10
years after the date of the enactment of this Act, the Sec-
retary shall fully implement a modernized advanced, inte-
grated informational infrastructure for the administration
of parts A and B of the medicare program.
SEC. 4. ADMINISTRATIVE SIMPLIFICATION.
Section 1173(a) of the Social Security Act (42 U.S.C.
1320d–2(a)) is amended by adding at the end the fol-
lowing new paragraph:
‘‘(4) INTERACTIVE TRANSACTIONS.—If the Sec-
retary adopts a batch standard for a transaction
under paragraph (1) that involves a health care pro-
vider, not later than 24 months after the adoption
of the batch standard, the Secretary shall also adopt
an interactive standard that is compatible with the
batch standard so that the provider may imme-
diately complete the transaction at the point of serv-
ice.’’.
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