HR 287 IH

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.

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

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 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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