,,ii #aaith ,,congress #ast ,session ,s4 #bhgi ,,in ,,the ,,senate ,,of ,,the ,,united ,,states ,september #ah 7legislative day1 ,september #af71 #bjbe,ms4 ,cortez ,masto 7for herself and ,mrs4 ,blackburn7 introduced the following bill2 which was read twice and referred to the ,committee on ,finance ,a ,,bill ,to amend title ,,xviii of the ,social ,security ,act to apply improved prompt payment requirements to ,medicare ,advantage organizations4 #a4 ,short title ,this ,act may be cited as the ,medicare ,advantage ,prompt ,pay ,act4 #b4 ,application of improved prompt payment requirements to ,medicare ,advantage organizations 7a7 ,requirements 7#a7 ,in general ,section #aheg of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7 is amended-- 7,a7 in subsection 7f71 by striking paragraph 7#a7 and inserting the following3 7#a7 ,requirements 7,a7 ,items and services furnished by in-network and out-of-network providers of services and suppliers 7i7 ,in general ,a contract under this part between the ,secretary and a ,medicare ,advantage organization offering a ,medicare ,advantage plan shall require the organization to provide prompt payment for not less than #ie percent of clean claims submitted to the organization1 with respect to covered items or services furnished to enrollees by a provider of services or supplier1 within the applicable number of calendar days after the date of initial receipt of such clean claim1 regardless of whether such items or services are furnished under a contract between the organization and the provider of services or supplier4 7ii7 ,applicable number of calendar days ,in clause 7i71 the term applicable number of calendar days means-- 7,i7 in the case of a claim submitted electronically1 by a provider of services or supplier for items or services furnished under a contract between the organization and the provider of services or supplier1 #ad days2 and 7,,ii7 in the case of a claim not described in subclause 7,i71 #cj days4 7,b7 ,clean claim defined ,in this paragraph1 the term clean claim means a claim that-- 7i7 has a complete data set1 with respect to the ,,ub-#jd or ,,cms #aejj form1 as applicable 7or successor to such applicable form7 for all entries identified as mandatory entries by the ,national ,uniform ,billing ,committee2 and 7ii7 in the case of a claim submitted electronically1 is completed in accordance with the applicable standards and data elements adopted under section #aagc7;a74 7,c7 ,rebuttable presumption for receipt of claim 7i7 ,in general ,for purposes of this paragraph1 there shall be a rebuttable presumption that a claim has been received by an ,,ma organization-- 7,i7 in the case of a claim submitted electronically1 on the date verified in the health care claim status request and response transaction that is for such claim and meets applicable standards and data elements adopted under section #aagc7;a7 for such electronic requests and responses2 and 7,,ii7 in the case of a claim submitted otherwise1 on the fifth business day after the postmark date of the claim or the date specified in the time stamp of the transmission4 7ii7 ,business day defined ,in clause 7i77,,ii71 the term business day means any day other than ,saturday1 ,sunday1 or a legal public holiday described in section #fajc of title #e1 ,united ,states ,code4 7,d7 ,interest applied for clean claims not promptly paid ,if payment for such covered items or services is not issued1 mailed1 or otherwise transmitted to the provider of services or supplier for such claims that are clean claims1 in accordance with subparagraph 7,a71 by not later than the deadline for such payment under such subparagraph1 the ,,ma organization shall pay the provider of services or supplier interest at the rate used for purposes of section #cijb7;a7 of title #ca1 ,united ,states ,code 7relating to interest penalties for failure to make prompt payments7 for the period beginning on the day after such required payment date and ending on the date on which payment is made4 2 and 7,b7 in subsection 7g7-- 7i7 by redesignating paragraph 7#d7 as paragraph 7#e72 7ii7 by inserting after paragraph 7#c7 the following new paragraph3 7#d7 ,application of civil money penalties to prompt pay violations ,if the ,secretary determines that an ,,ma organization with a contract under this section is not in compliance with subsection 7f77#a71 the ,secretary shall provide1 in addition to any other remedies authorized by law1 for civil money penalties of not more than #be1jjj for each such determination4 ,in making a determination under the previous sentence1 the ,secretary may take into account information collected pursuant to section #ahea7;d77#d77;,d77v74 2 and 7iii7 in paragraph 7#e71 as redesignated by clause 7i71 by striking or 7#c7 and inserting 1 7#c71 or 7#d74 7#b7 ,effective date ,the amendments made by this subsection shall apply with respect to items and services furnished on or after ,january #a1 #bjbg1 and contract years beginning on or after such date4 7b7 ,provision of information regarding compliance with prompt payment requirements ,section #ahea7;d77#d77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7;d77#d77;,d77 is amended-- 7#a7 in clause 7iii71 by striking and at the end2 7#b7 in clause 7iv71 by striking the period and inserting 1 and2 and 7#c7 by adding at the end the following new clause3 7v7 information regarding compliance of the plan with the prompt payment requirements under section #aheg7;f77#a71 including1 with respect to the most recent #ab-month period for which data are available-- 7,i7 the number and percent of submitted claims for which payment was made by the plan2 7,,ii7 the number and percent of submitted claims-- 7aa7 that were for items or services furnished by a provider of services or supplier under a contract between the organization offering the plan and the provider of services or supplier2 and 7bb7 that were for items or services not furnished under such a contract2 7,,iii7 the number and percent of submitted claims described in each of items 7aa7 and 7bb7 of subclause 7,,ii7 for which payment was made by the plan by the deadline required pursuant to section #aheg7;f77#a77;,a72 7,,iv7 the number and percent of submitted claims described in each of items 7aa7 and 7bb7 of subclause 7,,ii7 for which interest was paid by the plan pursuant to section #aheg7;f77#a77;,d72 and 7,v7 the total amount of interest paid by the plan pursuant to such section4 4