Title: Reducing Administrative Costs and Burdens in Health Care Act of 2018
Policy area: Health

Summary:
Reducing Administrative Costs and Burdens in Health Care Act of 2018
This bill requires the Department of Health and Human Services to take a series of actions to reduce unnecessary costs and administrative burdens in the health care system, including a grant program for states to establish commissions targeting such costs.

[Congressional Bills 115th Congress]
[From the U.S. Government Publishing Office]
[S. 3434 Introduced in Senate (IS)]

<DOC>






115th CONGRESS
  2d Session
                                S. 3434

To amend the Public Health Service Act to provide for grants to enable 
   States to carry out activities to reduce administrative costs and 
                        burdens in health care.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                           September 12, 2018

Ms. Smith (for herself and Mr. Cassidy) introduced the following bill; 
     which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
To amend the Public Health Service Act to provide for grants to enable 
   States to carry out activities to reduce administrative costs and 
                        burdens in health care.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Reducing Administrative Costs and 
Burdens in Health Care Act of 2018''.

SEC. 2. REDUCING ADMINISTRATIVE COSTS AND BURDENS IN HEALTH CARE.

    Title II of the Public Health Service Act (42 U.S.C. 202 et seq.) 
is amended by adding at the end the following:

   ``PART E--REDUCING ADMINISTRATIVE COSTS AND BURDENS IN HEALTH CARE

``SEC. 281. ELIMINATING UNNECESSARY ADMINISTRATIVE BURDENS AND COSTS.

    ``(a) Reducing Administrative Burdens and Costs.--The Secretary, in 
consultation with providers of health services, health care suppliers 
of services, health care payers, health professional societies, health 
vendors and developers, health care quality organizations, health care 
accreditation organizations, public health entities, States, patients, 
and other appropriate entities, shall, in accordance with subsection 
(b)--
            ``(1) establish a goal of reducing unnecessary costs and 
        administrative burdens across the health care system, including 
        the Medicare program under title XVIII of the Social Security 
        Act, the Medicaid program under title XIX of such Act, and the 
        private health insurance market, by at least half over a period 
        of 10 years from the date of enactment of this section;
            ``(2) develop strategies and benchmarks for meeting the 
        goal established under paragraph (1);
            ``(3) develop recommendations for meeting the goal 
        established under paragraph (1); and
            ``(4) take action to reduce unnecessary costs and 
        administrative burdens based on recommendations identified in 
        this subsection.
    ``(b) Strategies, Recommendations, and Actions.--
            ``(1) In general.--To achieve the goal established under 
        subsection (a)(1), the Secretary, in consultation with the 
        entities described in such subsection, shall not later than 1 
        year after the date of enactment of this section, develop 
        strategies and recommendations and take actions to meet such 
        goal in accordance with this subsection. No strategies, 
        recommendation, or action shall undermine the quality of 
        patient care or patient health outcomes.
            ``(2) Strategies.--The strategies developed under paragraph 
        (1) shall address unnecessary costs and administrative burdens. 
        Such strategies shall include broad public comment and shall 
        prioritize--
                    ``(A) recommendations identified as a result of 
                efforts undertaken to implement section 3001;
                    ``(B) recommendations and best practices identified 
                as a results of efforts undertaken under this part;
                    ``(C) a review of regulations, rules, and 
                requirements of the Department of Health and Human 
                Services that could be modified or eliminated to reduce 
                unnecessary costs and administrative burden imposed on 
                patients, providers, payers, and other stakeholders 
                across the health care system; and
                    ``(D) feedback from stakeholders in rural or 
                frontier areas on how to reduce unnecessary costs and 
                administrative burdens on the health care system in 
                those areas.
            ``(3) Recommendations.--The recommendations developed under 
        paragraph (1) shall include--
                    ``(A) actions that improve the standardization and 
                automation of administrative transactions;
                    ``(B) actions that integrate clinical and 
                administrative functions within electronic health 
                records;
                    ``(C) actions that improve patient care and reduce 
                unnecessary costs and administrative burdens borne by 
                patients, their families, and other caretakers;
                    ``(D) actions that advance the development and 
                adoption of open application programming interfaces to 
                increase transparency and interoperability, empower 
                patients, and facilitate better integration of clinical 
                and administrative functions;
                    ``(E) actions to be taken by the Secretary and 
                actions that need to be taken by other entities; and
                    ``(F) other areas, as the Secretary determines 
                appropriate, to reduce unnecessary costs and 
                administrative burdens required of health care 
                providers.
            ``(4) Actions.--The Secretary shall take action to achieve 
        the goal established under section (a)(1), and, not later than 
        __ days after the date of enactment of this section, submit to 
        Congress and make publically available, a report describing the 
        actions taken by the Secretary pursuant to goals, strategies, 
        and recommendations described in this subsection.
            ``(5) FACA.--The Federal Advisory Committee Act (5 U.S.C. 
        App.) shall not apply to the development of the goal, 
        strategies, recommendations, or actions described in this 
        section.
            ``(6) Rule of construction.--Nothing in this subsection 
        shall be construed to authorize, or be used by, the Federal 
        Government to inhibit or otherwise restrain efforts made to 
        reduce waste, fraud, and abuse across the health care system.

``SEC. 282. GRANTS TO STATES TO DEVELOP RECOMMENDATIONS.

    ``(a) In General.--The Secretary shall award grants to at least 15 
States to enable such States to establish and administer private-public 
multi-stakeholder commissions for the purpose of reducing health care 
administrative costs and burden. Not less than 3 of such grants shall 
be awarded to States that are primarily rural, frontier, or a 
combination thereof, in nature.
    ``(b) Application.--
            ``(1) In general.--To be eligible to receive a grant under 
        subsection (a) a State shall submit to the Secretary an 
        application at such time, in such manner, and containing such 
        information as the Secretary may reasonably require, including 
        the information described in paragraph (2).
            ``(2) Required information.--In addition to any additional 
        information required by the Secretary under this subsection, an 
        application shall include a description of--
                    ``(A) the size and composition of the commission to 
                be established under the grant, including the 
                stakeholders represented and the degree to which the 
                commission reflects important geographic and population 
                characteristics of the State;
                    ``(B) the relationship of the commission to the 
                State official responsible for coordinating and 
                implementing the recommendations resulting from the 
                commission, and the role and responsibilities of the 
                State with respect to the commission, including any 
                participation, review, oversight, implementation or 
                other related functions;
                    ``(C) the history and experience of the State in 
                addressing health care administrative costs, and any 
                experience similar to the purpose of the commission to 
                improve health care administrative processes and the 
                exchange of health care administrative data;
                    ``(D) the resources and expertise that will be made 
                available to the commission by commission members or 
                other possible sources, and how Federal funds will be 
                used to leverage and complement these resources;
                    ``(E) the governance structure and procedures that 
                the commission will follow to make the required 
                recommendations;
                    ``(F) the proposed objectives relating to the 
                simplification of administrative transactions, 
                increased standardization, and the efficiency and 
                effectiveness of the transmission of health 
                information;
                    ``(G) potential cost savings and other improvements 
                in meeting the objectives described in subparagraph 
                (F);
                    ``(H) the method or methods by which the 
                recommendations described in subsection (c) will be 
                reviewed, adopted, implemented, and updated as needed; 
                and
                    ``(I) the method or methods by which impacts and 
                progress toward administrative simplification goals or 
                objectives, including administrative cost savings and 
                return on investment, will be measured and reported.
    ``(c) Multi-Stakeholder Commission.--
            ``(1) In general.--Not later than 90 days after the date on 
        which a grant is awarded to a State under this section, the 
        State official described in subsection (b)(2)(B), insurance 
        commissioner, or other appropriate State official shall convene 
        a multi-stakeholder commission, in accordance with this 
        subsection.
            ``(2) Membership.--The commission convened under paragraph 
        (1) shall include representatives from health plans, health 
        care providers, health vendors, relevant State agencies, health 
        care standard development organizations, relevant professional 
        and trade associations, patients, and other entities determined 
        appropriate by the State.
            ``(3) Recommendations.--Not later than one year after the 
        date on which a grant is awarded to a State under this section, 
        the commission shall make recommendations and plans, consistent 
        with the application submitted by the State under subsection 
        (b), and intended to meet the objectives defined in the 
        application. Such recommendations shall comply with, and build 
        upon, all relevant Federal requirements and regulations, and 
        may include--
                    ``(A) common, uniform specifications, best 
                practices, and conventions, for the efficient, 
                effective exchange of administrative transactions 
                adopted pursuant to the Health Insurance Portability 
                and Accountability Act of 1996 (Public Law 104-191);
                    ``(B) the development of streamlined business 
                processes for the exchange and use of health care 
                administrative data; and
                    ``(C) specifications, incentives, requirements, 
                tools, mechanisms, and resources to improve--
                            ``(i) the access, exchange, and use of 
                        health care administrative information through 
                        electronic means;
                            ``(ii) the credentialing of physicians, 
                        hospitals, or other health care providers or 
                        suppliers within a health plan's network;
                            ``(iii) the implementation of utilization 
                        management protocols; and
                            ``(iv) compliance with Federal and State 
                        laws.
    ``(d) Additional Use of Funds.--A State may also use amounts 
received under a grant under this section to support--
            ``(1) the development, implementation, and best use of 
        shared data infrastructure that supports the electronic 
        transmission of administrative data;
            ``(2) the provision of technical support and education to 
        community stakeholders to improve the adoption and use of key 
        electronic health care transactions;
            ``(3) the facilitation of public and private initiatives 
        aimed at reducing administrative costs for State programs; and
            ``(4) ongoing needs assessments and planning related to the 
        development and implementation of administrative simplification 
        initiatives.
    ``(e) Period and Amount.--A grant awarded to a State under this 
section shall be for a period of 5 years and shall not exceed 
$50,000,000 for such 5-year period.
    ``(f) Reports.--
            ``(1) States.--Not later than 1 year after the end of the 
        5-year grant period, a State receiving a grant under this 
        section shall submit to the Secretary a report on the outcomes, 
        including total savings, achieved by the State in implementing 
        the recommendations described in subsection (c)(3).
            ``(2) Secretary.--Not later than 6 months after the State 
        submits a report under paragraph (1), the Secretary, in 
        consultation with National Committee on Vital and Health 
        Statistics, shall submit to the Committee on Health, Education, 
        Labor, and Pensions of the Senate and the Committee on Energy 
        and Commerce of the House of Representatives, a report on the 
        outcomes achieved by the States under the grants under this 
        section.
            ``(3) GAO.--Not later than 6 months after the date on which 
        the Secretary submits the report under paragraph (2), the 
        Comptroller General of the United States shall conduct a study, 
        and submit to the Committee on Health, Education, Labor, and 
        Pensions of the Senate and the Committee on Energy and Commerce 
        of the House of Representatives, a report on the outcomes of 
        the activities carried out under the recommendations under this 
        section which shall contain a list of best practices and 
        recommendations to States concerning administrative 
        simplification.
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $200,000,000 for the 5-fiscal-
year period beginning with fiscal year 2020.

``SEC. 283. GRANTS TO ACCELERATE STATE INNOVATION AND ADOPTION OF 
              STANDARDS TO REDUCE ADMINISTRATIVE COSTS.

    ``(a) In General.--The Secretary shall award grants to States or 
State-designated entities, including States with multi-stakeholder 
commissions under section 282(c), as well as other multi-State 
collaboratives, to fund activities and improvements that--
            ``(1) accelerate the early adoption and implementation of 
        administrative transactions designated by the Secretary and 
        that have been adopted pursuant to the Health Insurance 
        Portability and Accountability Act of 1996 (Public Law 104-
        191), including transactions described in section 1173(a)(2) of 
        the Social Security Act;
            ``(2) accelerate the early adoption and implementation of 
        additional administrative transactions and related data 
        exchange standards that are being considered for adoption under 
        the Health Insurance Portability and Accountability Act of 1996 
        or are adopted pursuant to such Act, or as designated by the 
        Secretary, including the electronic claim attachment; and
            ``(3) to compile, synthesize, and disseminate lessons 
        learned to promote the adoption of the transactions described 
        in paragraph (1) across the health care system.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a) a State, or State designated entity (including a State 
with a commission established under section 282(c), State Medicaid 
agency, or multi-State collaborative, as further defined by the 
Secretary), shall submit to the Secretary an application at such time, 
in such manner, and containing such information as the Secretary may 
reasonably require.
    ``(c) Prioritization.--In awarding grants under this section, the 
Secretary shall give priority to--
            ``(1) applications submitted by eligible entities located 
        in States, or across multiple States, that are composed 
        primarily of rural or frontier areas;
            ``(2) applications submitted by multi-State collaboratives 
        that, as determined by the Secretary, may have the greatest 
        chance of successfully carrying out the activities described in 
        subsection (a); and
            ``(3) applications submitted by entities that propose to 
        carry out a pilot program, as described in subsection (d)(3).
    ``(d) Activities.--A State shall use amounts received under a grant 
under this section for one or more of the following:
            ``(1) Needs assessments and planning.--Grant funds may be 
        used to determine possible barriers to the adoption, 
        implementation, and effective use of the transactions described 
        in subsection (a)(1) in section 1, as well as to explore, 
        identify, and plan options, approaches, and resources to 
        address barriers and make improvements.
            ``(2) Education, training, and technical assistance.--Grant 
        funds may be used to develop and make available training and 
        educational materials, forums, and activities as well as 
        technical assistance to effectively implement, use, and benefit 
        from the transactions described in subsection (a)(1).
            ``(3) Pilot program.--Grant funds may be used for pilot 
        projects to test approaches to implement and use the 
        transactions described in subsection (a)(1) in practice under a 
        variety of different settings. With respect to the electronic 
        attachment transaction, priority shall be given to pilot 
        projects that test and evaluate methods and mechanisms to most 
        effectively incorporate patient health data from electronic 
        health records and other electronic sources with the electronic 
        attachment transaction. All such pilot projects shall include 
        plans to be evaluated for impacts and best practices and for 
        reporting findings for broader Statewide and national use.
            ``(4) Adoption and use.--Grant funds may be used to 
        accelerate the adoption, implementation, and effective use of 
        the transactions described in subsection (a)(1) across State 
        programs.
            ``(5) Specifications, incentives, requirements, tools, 
        mechanisms, and resources.--Grant funds may be used for 
        developing, testing, implementing, and assessing additional 
        data exchange specifications, incentives, requirements, tools, 
        mechanisms and resources to accelerate the adoption and 
        effective use of the transactions described in subsection 
        (a)(1).
    ``(e) Reports.--
            ``(1) States.--Not later than 1 year after the end of the 
        5-year grant period, an entity receiving a grant under this 
        section shall submit to the Secretary a report on the outcomes, 
        including total savings, achieved by the State in implementing 
        the recommendations described in subsection (d).
            ``(2) Secretary.--Not later than 6 months after the entity 
        submits a report under paragraph (1), the Secretary, in 
        consultation with National Committee on Vital and Health 
        Statistics, shall submit to the Committee on Health, Education, 
        Labor, and Pensions of the Senate and the Committee on Energy 
        and Commerce of the House of Representatives, a report on the 
        outcomes achieved under the grants under this section.
            ``(3) GAO.--Not later than 6 months after the date on which 
        the Secretary submits the report under paragraph (2), the 
        Comptroller General of the United States shall conduct a study, 
        and submit to the Committee on Health, Education, Labor, and 
        Pensions of the Senate and the Committee on Energy and Commerce 
        of the House of Representatives, a report on the outcomes of 
        the activities carried out under the recommendations under this 
        section which shall contain a list of best practices and 
        recommendations to States concerning administrative 
        simplification.
    ``(f) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $50,000,000 for the 5-fiscal-
year period beginning with fiscal year 2020.''.
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