[Congressional Bills 116th Congress]
[From the U.S. Government Publishing Office]
[S. 1260 Introduced in Senate (IS)]
<DOC>
116th CONGRESS
1st Session
S. 1260
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
May 1, 2019
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 2019''.
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 standard development organizations
and operating rule entities, 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 result 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;
``(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 and
other emerging technologies 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) Consistency.--Any improvements in electronic
processes proposed by the Secretary under this section should
leverage existing information technology definitions under
Federal Law. Specifically, any electronic processes should not
be construed to include a facsimile, a proprietary payer portal
that does not meet standards specified by the Secretary, or an
electronic form image.
``(5) Actions.--The Secretary shall take action to achieve
the goal established under subsection (a)(1), and, not later
than 1 year after the date of enactment of this section, and
biennially thereafter, 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.
``(6) 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.
``(7) 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 AND IMPLEMENT RECOMMENDATIONS
TO ACCELERATE STATE INNOVATION TO REDUCE HEALTH CARE
ADMINISTRATIVE COSTS.
``(a) Grants.--
``(1) In general.--Not later than 6 months after the date
of enactment of this section, the Secretary shall award grants
to at least 15 States, and one coordinating entity designated
as provided for under subsection (e), to enable such States to
establish and administer private-public multi-stakeholder
commissions for the purpose of reducing health care
administrative costs and burden within and across States. Not
less than 3 of such grants shall be awarded to States that are
primarily rural, frontier, or a combination thereof, in nature.
``(2) Entities.--For purposes of this section, the term
`State' means a State, a State designated entity, or a multi-
State collaborative (as defined by the Secretary).
``(3) Priority.--In awarding grants under this section, the
Secretary shall give priority to applications submitted by
States that propose to carry out a pilot program or support the
adoption of electronic health care transactions and operating
rules.
``(b) Application.--
``(1) In general.--To be eligible to receive a grant under
subsection (a) a State shall submit to the Secretary an
application in such a 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, implement, and
pilot recommendations;
``(F) the proposed objectives relating to the
simplification of administrative transactions and
operating rules, 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); and
``(H) the method or methods by which the
recommendations described in subsection (c) will be
reviewed, tested, adopted, implemented, and updated as
needed.
``(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), the State
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, and operating rule
entities, 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 implementation of utilization
management protocols; and
``(iii) compliance with Federal and State
laws.
``(d) Use of Funds for Implementation.--A State may use amounts
received under a grant under this section for one or more of the
following:
``(1) The development, implementation, and best use of
shared data infrastructure that supports the electronic
transmission of administrative data.
``(2) The development and provision of training and
educational materials, forums, and activities as well as
technical assistance to effectively implement, use, and benefit
from electronic health care transactions and operating rules.
``(3) To accelerate the early adoption and implementation
of administrative transactions and operating rules 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 and operating
rules described in section 1173(a)(2) of the Social Security
Act.
``(4) To accelerate the early adoption and implementation
of additional or updated administrative transactions, operating
rules, 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.
``(5) To conduct pilot projects to test approaches to
implement and use the electronic health care transactions and
operating rules 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.
``(6) To assess barriers to the adoption, implementation,
and effective use of electronic health care transactions and
operating rules, as well as to explore, identify, and plan
options, approaches, and resources to address barriers and make
improvements.
``(7) The facilitation of public and private initiatives to
reduce administrative costs and accelerate the adoption,
implementation, and effective use of electronic health care
transactions and operating rules for State programs.
``(8) Developing, testing, implementing, and assessing
additional data exchange specifications, operating rules,
incentives, requirements, tools, mechanisms, and resources to
accelerate the adoption and effective use of the transactions
and operating rules.
``(9) Ongoing needs assessments and planning related to the
development and implementation of administrative simplification
initiatives.
``(e) Coordinating Entity.--
``(1) Functions.--Not later than 6 months after the date of
enactment of this section, the Secretary shall designate a
coordinating entity under this subsection for the purpose of--
``(A) providing technical assistance to States
relating to the simplification of administrative
transactions and operating rules, increased
standardization, and the efficiency and effectiveness
of the transmission of health care information;
``(B) evaluating pilot projects and other efforts
conducted under this section for impact and best
practices to inform broader national use;
``(C) using consistent evaluation methodologies to
compare return on investment across efforts conducted
under this section;
``(D) compiling, synthesizing, disseminating, and
adopting lessons learned to promote the adoption of
electronic health care transactions and operating rules
across the health care system; and
``(E) making recommendations to the Secretary and
the National Committee on Vital and Health Statistics
regarding the national adoption of efforts conducted
under this section.
``(2) Eligibility.--The entity designated under paragraph
(1) shall be a qualified nonprofit entity that--
``(A) focuses its mission on administrative
simplification;
``(B) has demonstrated experience using a multi-
stakeholder and consensus-based process for the
development of common, uniform specifications,
operating rules, best practices, and conventions, for
the efficient, effective exchange of administrative
transactions that includes representation by or
participation from health plans, health care providers,
vendors, States, relevant Federal agencies, and other
health care standard development organizations;
``(C) has demonstrated experience providing
technical assistance to health plans, health care
providers, vendors, and States relating to the
simplification of administrative transactions and
operating rules, increased standardization, and the
efficiency and effectiveness of the transmission of
health care information;
``(D) has demonstrated experience evaluating and
measuring the adoption and return on investment of
administrative transactions and operating rules;
``(E) has demonstrated experience gathering,
synthesizing, and adopting common, uniform
specifications, operating rules, best practices, and
conventions for national use based on lessons learned
to promote the adoption of electronic health care
transactions and operating rules across the health care
system;
``(F) has a public set of guiding principles that
ensure processes are open and transparent, and supports
nondiscrimination and conflict of interest policies
that demonstrate a commitment to open, fair, and
nondiscriminatory practices;
``(G) builds on the transaction standards issued
under Health Insurance Portability and Accountability
Act of 1996; and
``(H) allows for public review and updates of
common, uniform specifications, operating rules, best
practices, and conventions to support administrative
simplification.
``(f) 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. A grant awarded to the coordinating
entity designated by the Secretary under subsection (e) shall be for a
period of 5 years and shall not exceed $15,000,000 for such 5-year
period.
``(g) Reports.--
``(1) States.--Not later than 1 year after receiving a
grant under this section, and biennially thereafter, a State
shall submit to the Secretary a report on the outcomes
experienced by the State under the grant.
``(2) Coordinating entity.--Not later than 1 year after
receiving a grant under this section, and at least biennially
thereafter, the coordinating entity shall submit to the
Secretary and the National Committee on Vital and Health
Statistics a report of evaluations conducted under the grant
under this section and recommendations regarding the national
adoption of efforts conducted under this section.
``(3) Secretary.--Not later than 6 months after the date on
which the States and coordinating entity submit the report
required under paragraphs (1) and (2), 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.
``(4) GAO.--Not later than 6 months after the date on which
the Secretary submits the final report under paragraph (3), 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 this section which shall
contain a list of best practices and recommendations to States
concerning administrative simplification.
``(h) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $250,000,000 for the 5-fiscal-
year period beginning with fiscal year 2020.''.
<all>
Reducing Administrative Costs and Burdens in Health Care Act of 2019
#1260 | S Congress #116
Policy Area: Health
Subjects: Administrative law and regulatory proceduresCongressional oversightDepartment of Health and Human ServicesGovernment studies and investigationsHealth care costs and insuranceHealth care coverage and accessHealth care qualityHealth information and medical recordsHealth programs administration and fundingHealth technology, devices, suppliesMedicaidMedicarePublic-private cooperationRural conditions and developmentState and local government operations
Last Action: Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (5/1/2019)
Bill Text Source: Congress.gov
Summary and Impacts
Original Text