,,ii #aafth ,,congress #ast ,session ,s4 #abfj ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,may #a1 #bjai ,ms4 ,smith 7for herself and ,mr4 ,cassidy7 introduced the following bill2 which was read twice and referred to the ,committee on ,health1 ,education1 ,labor1 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 care4 #a4 ,short title ,this ,act may be cited as the ,reducing ,administrative ,costs and ,burdens in ,health ,care ,act of #bjai4 #b4 ,reducing administrative costs and burdens in health care ,title ,,ii of the ,public ,health ,service ,act 7#db ,u4,s4,c4 #bjb et seq47 is amended by adding at the end the following3 ,e ,reducing administrative costs and burdens in health care #bha4 ,eliminating unnecessary administrative burdens and costs 7a7 ,reducing administrative burdens and costs ,the ,secretary1 in consultation with providers of health services1 health care suppliers of services1 health care payers1 health professional societies1 health vendors and developers1 health care standard development organizations and operating rule entities1 health care quality organizations1 health care accreditation organizations1 public health entities1 ,states1 patients1 and other appropriate entities1 shall1 in accordance with subsection 7b7-- 7#a7 establish a goal of reducing unnecessary costs and administrative burdens across the health care system1 including the ,medicare program under title ,,xviii of the ,social ,security ,act1 the ,medicaid program under title ,,xix of such ,act1 and the private health insurance market1 by at least half over a period of #aj years from the date of enactment of this section2 7#b7 develop strategies and benchmarks for meeting the goal established under paragraph 7#a72 7#c7 develop recommendations for meeting the goal established under paragraph 7#a72 and 7#d7 take action to reduce unnecessary costs and administrative burdens based on recommendations identified in this subsection4 7b7 ,strategies1 recommendations1 and actions 7#a7 ,in general ,to achieve the goal established under subsection 7a77#a71 the ,secretary1 in consultation with the entities described in such subsection1 shall not later than #a year after the date of enactment of this section1 develop strategies and recommendations and take actions to meet such goal in accordance with this subsection4 ,no strategies1 recommendation1 or action shall undermine the quality of patient care or patient health outcomes4 7#b7 ,strategies ,the strategies developed under paragraph 7#a7 shall address unnecessary costs and administrative burdens4 ,such strategies shall include broad public comment and shall prioritize-- 7,a7 recommendations identified as a result of efforts undertaken to implement section #cjja2 7,b7 recommendations and best practices identified as a result of efforts undertaken under this part2 7,c7 a review of regulations1 rules1 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 patients1 providers1 payers1 and other stakeholders across the health care system2 and 7,d7 feedback from stakeholders in rural or frontier areas on how to reduce unnecessary costs and administrative burdens on the health care system in those areas4 7#c7 ,recommendations ,the recommendations developed under paragraph 7#a7 shall include-- 7,a7 actions that improve the standardization and automation of administrative transactions2 7,b7 actions that integrate clinical and administrative functions2 7,c7 actions that improve patient care and reduce unnecessary costs and administrative burdens borne by patients1 their families1 and other caretakers2 7,d7 actions that advance the development and adoption of open application programming interfaces and other emerging technologies to increase transparency and interoperability1 empower patients1 and facilitate better integration of clinical and administrative functions2 7,e7 actions to be taken by the ,secretary and actions that need to be taken by other entities2 and 7,f7 other areas1 as the ,secretary determines appropriate1 to reduce unnecessary costs and administrative burdens required of health care providers4 7#d7 ,consistency ,any improvements in electronic processes proposed by the ,secretary under this section should leverage existing information technology definitions under ,federal ,law4 ,specifically1 any electronic processes should not be construed to include a facsimile1 a proprietary payer portal that does not meet standards specified by the ,secretary1 or an electronic form image4 7#e7 ,actions ,the ,secretary shall take action to achieve the goal established under subsection 7a77#a71 and1 not later than #a year after the date of enactment of this section1 and biennially thereafter1 submit to ,congress and make publically available1 a report describing the actions taken by the ,secretary pursuant to goals1 strategies1 and recommendations described in this subsection4 7#f7 ,,faca ,the ,federal ,advisory ,committee ,act 7#e ,u4,s4,c4 ,app47 shall not apply to the development of the goal1 strategies1 recommendations1 or actions described in this section4 7#g7 ,rule of construction ,nothing in this subsection shall be construed to authorize1 or be used by1 the ,federal ,government to inhibit or otherwise restrain efforts made to reduce waste1 fraud1 and abuse across the health care system4 #bhb4 ,grants to ,states to develop and implement recommendations to accelerate ,state innovation to reduce health care administrative costs 7a7 ,grants 7#a7 ,in general ,not later than #f months after the date of enactment of this section1 the ,secretary shall award grants to at least #ae ,states1 and one coordinating entity designated as provided for under subsection 7e71 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 ,states4 ,not less than #c of such grants shall be awarded to ,states that are primarily rural1 frontier1 or a combination thereof1 in nature4 7#b7 ,entities ,for purposes of this section1 the term ,state means a ,state1 a ,state designated entity1 or a multi-,state collaborative 7as defined by the ,secretary74 7#c7 ,priority ,in awarding grants under this section1 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 rules4 7b7 ,application 7#a7 ,in general ,to be eligible to receive a grant under subsection 7a7 a ,state shall submit to the ,secretary an application in such a manner and containing such information as the ,secretary may reasonably require1 including the information described in paragraph 7#b74 7#b7 ,required information ,in addition to any additional information required by the ,secretary under this subsection1 an application shall include a description of-- 7,a7 the size and composition of the commission to be established under the grant1 including the stakeholders represented and the degree to which the commission reflects important geographic and population characteristics of the ,state2 7,b7 the relationship of the commission to the ,state official responsible for coordinating and implementing the recommendations resulting from the commission1 and the role and responsibilities of the ,state with respect to the commission1 including any participation1 review1 oversight1 implementation or other related functions2 7,c7 the history and experience of the ,state in addressing health care administrative costs1 and any experience similar to the purpose of the commission to improve health care administrative processes and the exchange of health care administrative data2 7,d7 the resources and expertise that will be made available to the commission by commission members or other possible sources1 and how ,federal funds will be used to leverage and complement these resources2 7,e7 the governance structure and procedures that the commission will follow to make1 implement1 and pilot recommendations2 7,f7 the proposed objectives relating to the simplification of administrative transactions and operating rules1 increased standardization1 and the efficiency and effectiveness of the transmission of health information2 7,g7 potential cost savings and other improvements in meeting the objectives described in subparagraph 7,f72 and 7,h7 the method or methods by which the recommendations described in subsection 7c7 will be reviewed1 tested1 adopted1 implemented1 and updated as needed4 7c7 ,multi-,stakeholder commission 7#a7 ,in general ,not later than #ij days after the date on which a grant is awarded to a ,state under this section1 the ,state official described in subsection 7b77#b77;,b71 the ,state insurance commissioner1 or other appropriate ,state official shall convene a multi-stakeholder commission1 in accordance with this subsection4 7#b7 ,membership ,the commission convened under paragraph 7#a7 shall include representatives from health plans1 health care providers1 health vendors1 relevant ,state agencies1 health care standard development organizations1 and operating rule entities1 relevant professional and trade associations1 patients1 and other entities determined appropriate by the ,state4 7#c7 ,recommendations ,not later than one year after the date on which a grant is awarded to a ,state under this section1 the commission shall make recommendations and plans1 consistent with the application submitted by the ,state under subsection 7b71 and intended to meet the objectives defined in the application4 ,such recommendations shall comply with1 and build upon1 all relevant ,federal requirements and regulations1 and may include-- 7,a7 common1 uniform specifications1 best practices1 and conventions1 for the efficient1 effective exchange of administrative transactions adopted pursuant to the ,health ,insurance ,portability and ,accountability ,act of #aiif 7,public ,law #ajd-aia72 7,b7 the development of streamlined business processes for the exchange and use of health care administrative data2 and 7,c7 specifications1 incentives1 requirements1 tools1 mechanisms1 and resources to improve-- 7i7 the access1 exchange1 and use of health care administrative information through electronic means2 7ii7 the implementation of utilization management protocols2 and 7iii7 compliance with ,federal and ,state laws4 7d7 ,use of funds for implementation ,a ,state may use amounts received under a grant under this section for one or more of the following3 7#a7 ,the development1 implementation1 and best use of shared data infrastructure that supports the electronic transmission of administrative data4 7#b7 ,the development and provision of training and educational materials1 forums1 and activities as well as technical assistance to effectively implement1 use1 and benefit from electronic health care transactions and operating rules4 7#c7 ,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 #aiif 7,public ,law #ajd-aia71 including transactions and operating rules described in section #aagc7;a77#b7 of the ,social ,security ,act4 7#d7 ,to accelerate the early adoption and implementation of additional or updated administrative transactions1 operating rules1 and related data exchange standards that are being considered for adoption under the ,health ,insurance ,portability and ,accountability ,act of #aiif or are adopted pursuant to such ,act1 or as designated by the ,secretary1 including the electronic claim attachment4 7#e7 ,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 settings4 ,with respect to the electronic attachment transaction1 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 transaction4 7#f7 ,to assess barriers to the adoption1 implementation1 and effective use of electronic health care transactions and operating rules1 as well as to explore1 identify1 and plan options1 approaches1 and resources to address barriers and make improvements4 7#g7 ,the facilitation of public and private initiatives to reduce administrative costs and accelerate the adoption1 implementation1 and effective use of electronic health care transactions and operating rules for ,state programs4 7#h7 ,developing1 testing1 implementing1 and assessing additional data exchange specifications1 operating rules1 incentives1 requirements1 tools1 mechanisms1 and resources to accelerate the adoption and effective use of the transactions and operating rules4 7#i7 ,ongoing needs assessments and planning related to the development and implementation of administrative simplification initiatives4 7e7 ,coordinating entity 7#a7 ,functions ,not later than #f months after the date of enactment of this section1 the ,secretary shall designate a coordinating entity under this subsection for the purpose of-- 7,a7 providing technical assistance to ,states relating to the simplification of administrative transactions and operating rules1 increased standardization1 and the efficiency and effectiveness of the transmission of health care information2 7,b7 evaluating pilot projects and other efforts conducted under this section for impact and best practices to inform broader national use2 7,c7 using consistent evaluation methodologies to compare return on investment across efforts conducted under this section2 7,d7 compiling1 synthesizing1 disseminating1 and adopting lessons learned to promote the adoption of electronic health care transactions and operating rules across the health care system2 and 7,e7 making recommendations to the ,secretary and the ,national ,committee on ,vital and ,health ,statistics regarding the national adoption of efforts conducted under this section4 7#b7 ,eligibility ,the entity designated under paragraph 7#a7 shall be a qualified nonprofit entity that-- 7,a7 focuses its mission on administrative simplification2 7,b7 has demonstrated experience using a multi-stakeholder and consensus-based process for the development of common1 uniform specifications1 operating rules1 best practices1 and conventions1 for the efficient1 effective exchange of administrative transactions that includes representation by or participation from health plans1 health care providers1 vendors1 ,states1 relevant ,federal agencies1 and other health care standard development organizations2 7,c7 has demonstrated experience providing technical assistance to health plans1 health care providers1 vendors1 and ,states relating to the simplification of administrative transactions and operating rules1 increased standardization1 and the efficiency and effectiveness of the transmission of health care information2 7,d7 has demonstrated experience evaluating and measuring the adoption and return on investment of administrative transactions and operating rules2 7,e7 has demonstrated experience gathering1 synthesizing1 and adopting common1 uniform specifications1 operating rules1 best practices1 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 system2 7,f7 has a public set of guiding principles that ensure processes are open and transparent1 and supports nondiscrimination and conflict of interest policies that demonstrate a commitment to open1 fair1 and nondiscriminatory practices2 7,g7 builds on the transaction standards issued under ,health ,insurance ,portability and ,accountability ,act of #aiif2 and 7,h7 allows for public review and updates of common1 uniform specifications1 operating rules1 best practices1 and conventions to support administrative simplification4 7f7 ,period and amount ,a grant awarded to a ,state under this section shall be for a period of #e years and shall not exceed #ej1jjj1jjj for such #e-year period4 ,a grant awarded to the coordinating entity designated by the ,secretary under subsection 7e7 shall be for a period of #e years and shall not exceed #ae1jjj1jjj for such #e-year period4 7g7 ,reports 7#a7 ,states ,not later than #a year after receiving a grant under this section1 and biennially thereafter1 a ,state shall submit to the ,secretary a report on the outcomes experienced by the ,state under the grant4 7#b7 ,coordinating entity ,not later than #a year after receiving a grant under this section1 and at least biennially thereafter1 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 section4 7#c7 ,secretary ,not later than #f months after the date on which the ,states and coordinating entity submit the report required under paragraphs 7#a7 and 7#b71 the ,secretary1 in consultation with ,national ,committee on ,vital and ,health ,statistics1 shall submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 a report on the outcomes achieved under the grants under this section4 7#d7 ,,gao ,not later than #f months after the date on which the ,secretary submits the final report under paragraph 7#c71 the ,comptroller ,general of the ,united ,states shall conduct a study1 and submit to the ,committee on ,health1 ,education1 ,labor1 and ,pensions of the ,senate and the ,committee on ,energy and ,commerce of the ,house of ,representatives1 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 simplification4 7h7 ,authorization of appropriations ,there is authorized to be appropriated to carry out this section1 #bej1jjj1jjj for the #e-;fiscal-year period beginning with fiscal year #bjbj4 4