HR 5622 IH

To establish a commission to create a comprehensive strategy for an integrated, advanced informational infrastructure for the medicare program, and for other purposes.

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

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 Representatives 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 informational infrastructure for the administration of parts A and B of the medicare program in coordination with the Administrator of the Health Care Financing Administration and the Chief Information Office of the Health Care Financing Administration.

SEC. 2. ESTABLISHMENT OF THE HEALTH CARE INFRASTRUCTURE 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 Financing Administration, the Commission shall develop 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 beneficiary 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 report 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 financial management and information technology laws;

(B) provides immediate, point-of-service information 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 manner consistent with security regulations promulgated by the Secretary under such Act; and

(iii) apply to any network service provider used in connection with the system;

(D) immediately notifies each provider of services, physician, or supplier of any incomplete or invalid claim, including--

(i) the identification of any missing information;

(ii) the identification of any coding errors; 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 resubmission of each claim identified as incomplete or invalid under subparagraph (D);

(F) allows for immediate automatic processing 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 supplier 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 supplier, including payment through electronic funds transfer, for each claim for which payment is not made on a periodic interim payment basis under section 1815(e)(2) of such Act (42 U.S.C. 1395g(e)(2)) for items and services furnished under part A;

(H) complies with all applicable transactions standards adopted by the Secretary under the Health Insurance Portability and Accountability 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 adapted 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 paragraph (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 respect to the subject matter of the report.

(c) MEMBERSHIP-

(1) COMPOSITION- The Commission shall be composed of 13 voting members appointed in accordance 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 member.

(D) The Secretary shall appoint one member 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 members who represent information technology providers, one who represents medicare information technology providers and one who represent health industry information technology providers.

(F) The Secretary shall appoint two members 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 chairperson 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 knowledgeable in advanced information technology, financial management, or electronic billing procedures associated 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 Commission who is a full-time officer or employee of the United States may not receive additional pay, allowances, or benefits 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 sections 5702 and 5703 of title 5, United States Code.

(f) STAFF-

(1) IN GENERAL- The chairperson of the Commission 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 executive 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 executive 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 interruption or loss of civil service status or privilege.

(g) PROCUREMENT OF TEMPORARY AND INTERMITTENT 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 necessary 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 `Administrator' 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 implementation under subsection (b), the Secretary shall submit to Congress a report on the progress of the Health Care Financing Administration on implementing a modernized 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 Secretary shall fully implement a modernized advanced, integrated 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 following new paragraph:

`(4) INTERACTIVE TRANSACTIONS- If the Secretary adopts a batch standard for a transaction under paragraph (1) that involves a health care provider, 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 immediately complete the transaction at the point of service.'.

END