,,ii #aai? ,,congress #a/ ,session ,s4 #bhgi ,,9 ,,! ,,s5ate ,,( ,,! ,,unit$ ,,/ates ,septemb] #ah 7legislative day1 ,septemb] #af71 #bjbe,ms4 ,cortez ,ma/o 7= h]self & ,mrs4 ,blackburn7 introduc$ ! foll[+ bill2 :i* 0 read twice & ref]r$ to ! ,committee on ,f9ance ,a ,,bill ,to am5d title ,,xviii ( ! ,social ,security ,act to apply improv$ prompt paym5t requirem5ts to ,m$ic>e ,advantage organizations4 #a4 ,%ort title ,?is ,act may be cit$ z ! ,m$ic>e ,advantage ,prompt ,pay ,act4 #b4 ,application ( improv$ prompt paym5t requirem5ts to ,m$ic>e ,advantage organizations 7a7 ,requirem5ts 7#a7 ,9 g5]al ,section #aheg ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#bg7 is am5d$-- 7,a7 9 subsection 7f71 by /rik+ p>agraph 7#a7 & ins]t+ ! foll[+3 7#a7 ,requirem5ts 7,a7 ,items & s]vices furni%$ by 9-network & out-(-network provid]s ( s]vices & suppli]s 7i7 ,9 g5]al ,a contract "u ?is "p betwe5 ! ,secret>y & a ,m$ic>e ,advantage organization (f]+ a ,m$ic>e ,advantage plan %all require ! organization to provide prompt paym5t = n less ?an #ie p]c5t ( clean claims submitt$ to ! organization1 ) respect to cov]$ items or s]vices furni%$ to enrollees by a provid] ( s]vices or suppli]1 )9 ! applicable numb] ( cal5d> days aft] ! date ( initial receipt ( su* clean claim1 reg>dless ( :e!r su* items or s]vices are furni%$ "u a contract betwe5 ! organization & ! provid] ( s]vices or suppli]4 7ii7 ,applicable numb] ( cal5d> days ,9 clause 7i71 ! t]m applicable numb] ( cal5d> days means-- 7,i7 9 ! case ( a claim submitt$ electronically1 by a provid] ( s]vices or suppli] = items or s]vices furni%$ "u a contract betwe5 ! organization & ! provid] ( s]vices or suppli]1 #ad days2 & 7,,ii7 9 ! case ( a claim n describ$ 9 subclause 7,i71 #cj days4 7,b7 ,clean claim def9$ ,9 ?is p>agraph1 ! t]m clean claim means a claim t-- 7i7 has a complete data set1 ) respect to ! ,,ub-#jd or ,,cms #aejj =m1 z applicable 7or successor to su* applicable =m7 = all entries id5tifi$ z m&atory entries by ! ,national ,uni=m ,bill+ ,committee2 & 7ii7 9 ! case ( a claim submitt$ electronically1 is complet$ 9 accordance ) ! applicable /&>ds & data elem5ts adopt$ "u section #aagc7;a74 7,c7 ,rebuttable presumption = receipt ( claim 7i7 ,9 g5]al ,= purposes ( ?is p>agraph1 !re %all be a rebuttable presumption t a claim has be5 receiv$ by an ,,ma organization-- 7,i7 9 ! case ( a claim submitt$ electronically1 on ! date v]ifi$ 9 ! heal? c>e claim /atus reque/ & response transaction t is = su* claim & meets applicable /&>ds & data elem5ts adopt$ "u section #aagc7;a7 = su* electronic reque/s & responses2 & 7,,ii7 9 ! case ( a claim submitt$ o!rwise1 on ! fif? bus9ess day aft] ! po/m>k date ( ! claim or ! date specifi$ 9 ! "t /amp ( ! transmission4 7ii7 ,bus9ess day def9$ ,9 clause 7i77,,ii71 ! t]m bus9ess day means any day o!r ?an ,saturday1 ,sunday1 or a legal public holiday describ$ 9 section #fajc ( title #e1 ,unit$ ,/ates ,code4 7,d7 ,int]e/ appli$ = clean claims n promptly paid ,if paym5t = su* cov]$ items or s]vices is n issu$1 mail$1 or o!rwise transmitt$ to ! provid] ( s]vices or suppli] = su* claims t are clean claims1 9 accordance ) subp>agraph 7,a71 by n lat] ?an ! deadl9e = su* paym5t "u su* subp>agraph1 ! ,,ma organization %all pay ! provid] ( s]vices or suppli] int]e/ at ! rate us$ = purposes ( section #cijb7;a7 ( title #ca1 ,unit$ ,/ates ,code 7relat+ to int]e/ p5alties = failure to make prompt paym5ts7 = ! p]iod beg9n+ on ! day aft] su* requir$ paym5t date & end+ on ! date on :i* paym5t is made4 2 & 7,b7 9 subsection 7g7-- 7i7 by r$esignat+ p>agraph 7#d7 z p>agraph 7#e72 7ii7 by ins]t+ aft] p>agraph 7#c7 ! foll[+ new p>agraph3 7#d7 ,application ( civil money p5alties to prompt pay violations ,if ! ,secret>y det]m9es t an ,,ma organization ) a contract "u ?is section is n 9 compliance ) subsection 7f77#a71 ! ,secret>y %all provide1 9 addition to any o!r rem$ies au?oriz$ by law1 = civil money p5alties ( n m ?an #be1jjj = ea* su* det]m9ation4 ,9 mak+ a det]m9ation "u ! previ\s s5t5ce1 ! ,secret>y may take into acc\nt in=mation collect$ pursuant to section #ahea7;d77#d77;,d77v74 2 & 7iii7 9 p>agraph 7#e71 z r$esignat$ by clause 7i71 by /rik+ or 7#c7 & ins]t+ 1 7#c71 or 7#d74 7#b7 ,effective date ,! am5dm5ts made by ?is subsection %all apply ) respect to items & s]vices furni%$ on or aft] ,janu>y #a1 #bjbg1 & contract ye>s beg9n+ on or aft] su* date4 7b7 ,provision ( in=mation reg>d+ compliance ) prompt paym5t requirem5ts ,section #ahea7;d77#d77;,d7 ( ! ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#ba7;d77#d77;,d77 is am5d$-- 7#a7 9 clause 7iii71 by /rik+ & at ! end2 7#b7 9 clause 7iv71 by /rik+ ! p]iod & ins]t+ 1 &2 & 7#c7 by add+ at ! end ! foll[+ new clause3 7v7 in=mation reg>d+ compliance ( ! plan ) ! prompt paym5t requirem5ts "u section #aheg7;f77#a71 includ+1 ) respect to ! mo/ rec5t #ab-mon? p]iod = :i* data are available-- 7,i7 ! numb] & p]c5t ( submitt$ claims = :i* paym5t 0 made by ! plan2 7,,ii7 ! numb] & p]c5t ( submitt$ claims-- 7aa7 t 7 = items or s]vices furni%$ by a provid] ( s]vices or suppli] "u a contract betwe5 ! organization (f]+ ! plan & ! provid] ( s]vices or suppli]2 & 7bb7 t 7 = items or s]vices n furni%$ "u su* a contract2 7,,iii7 ! numb] & p]c5t ( submitt$ claims describ$ 9 ea* ( items 7aa7 & 7bb7 ( subclause 7,,ii7 = :i* paym5t 0 made by ! plan by ! deadl9e requir$ pursuant to section #aheg7;f77#a77;,a72 7,,iv7 ! numb] & p]c5t ( submitt$ claims describ$ 9 ea* ( items 7aa7 & 7bb7 ( subclause 7,,ii7 = :i* int]e/ 0 paid by ! plan pursuant to section #aheg7;f77#a77;,d72 & 7,v7 ! total am\nt ( int]e/ paid by ! plan pursuant to su* section4 4