2000 
[DOCID: f:h287ih.txt]






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 
   following bill; which was referred to the Committee on Energy and 
  Commerce, and in addition to the Committees on Ways and Means, and 
Education and the Workforce, 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 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 Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Prompt Payment of Health Benefit 
Claims Act of 2001''.

SEC. 2. PROMPT PAYMENT OF HEALTH BENEFIT CLAIMS BY GROUP HEALTH PLANS 
              AND HEALTH INSURANCE ISSUERS.

    (a) Group Health Plans.--
            (1) Public health service act amendments.--Subpart 2 of 
        part A of title XXVII of the Public Health Service Act is 
        amended by adding at the end the following new section:

``SEC. 2707. 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 beneficiary, 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).''.
            (2) ERISA amendments.--(A) Subpart B of part 7 of subtitle 
        B of title I of the Employee Retirement 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 beneficiary, 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 amendments.--
                    (A) In general.--Subchapter B of chapter 100 of the 
                Internal Revenue Code of 1986 is amended--
                            (i) in the table of sections, by inserting 
                        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 beneficiary, 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 striking ``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 paragraph (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 coverage.--The amendment 
        made by subsection (b) apply with respect to health insurance 
        coverage offered, 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 between employee representatives and 1 or 
        more employers 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 terminates 
                (determined without regard to any extension thereof 
                agreed to after the date of enactment of this Act), or
                    (B) January 1, 2002.
        For purposes of subparagraph (A), any plan amendment 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 
  
5dc
      of such collective bargaining agreement.
    (d) Coordination of Administration.--The Secretary 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 matter over which two or 
        more such Secretaries have responsibility 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 ORGANIZATIONS 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 organization 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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