Federal Employees Health Benefits Program Efficiency Act of 2006

Federal Employees Health Benefits Program Efficiency Act of 2006 - Directs each carrier entering into a contract under the Federal Employees Health Benefits Program to offer a health benefits plan to implement an electronic system for efficient and effective adjudication of all medical claims. Requires that such system be used to monitor for fraud and abuse as part of such adjudication.

[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 2247 Introduced in Senate (IS)]








109th CONGRESS
  2d Session
                                S. 2247

    To promote greater use of information technology in the Federal 
 Employees Health Benefits Program under chapter 89 of title 5, United 
         States Code, to increase efficiency and reduce costs.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                            February 6, 2006

Mr. Reid (for Mr. Obama) introduced the following bill; which was read 
     twice and referred to the Committee on Homeland Security and 
                          Governmental Affairs

_______________________________________________________________________

                                 A BILL


 
    To promote greater use of information technology in the Federal 
 Employees Health Benefits Program under chapter 89 of title 5, United 
         States Code, to increase efficiency and reduce costs.

    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 ``Federal Employees Health Benefits 
Program Efficiency Act of 2006''.

SEC. 2. FEDERAL EMPLOYEES HEALTH BENEFITS PROGRAM INFORMATION 
              TECHNOLOGY EFFICIENCY.

    (a) In General.--Not later than 4 years after the date of enactment 
of this Act, each carrier entering into a contract under section 8902 
of title 5, United States Code, to offer a health benefits plan shall 
implement an electronic system for efficient and effective adjudication 
of all medical claims.
    (b) Adjudication.--In adjudicating claims under chapter 89 of title 
5, United States Code, using the system described under subsection (a), 
each carrier shall ensure that such claims--
            (1) may be submitted through the Internet;
            (2) are adjudicated with an accuracy of at least 99 
        percent;
            (3) may be denied instantaneously if the information 
        provided is incorrect or incomplete or for other nonmedical 
        reasons, with opportunity for resolution of such denials, 
        through the Internet; and
            (4) shall be submitted using the privacy safeguards 
        necessary to protect the personal and medical information of 
        patients from inappropriate use.
    (c) Fraud.--Each carrier entering into a contract under section 
8902 of title 5, United States Code, shall use the system described 
under subsection (a) to monitor for fraud and abuse as part of the 
adjudication of claims described under this section.
    (d) Waivers.--
            (1) In general.--The Office of Personnel Management may 
        provide 1 or more waivers to the requirement of subsection (a), 
        if the carrier--
                    (A) is unable to meet the requirement despite good 
                faith effort; or
                    (B) the lack of participation by the carrier in the 
                Federal Employees Health Benefits Program would 
                significantly compromise access to health care.
            (2) Limitation on waivers.--No waiver under paragraph (1) 
        may be in effect after 6 years after the date of enactment of 
        this Act.
    (e) Technical Assistance.--The Office of Personnel Management may 
provide technical assistance, including equipment, computer software, 
and guidance to carry out this Act.
    (f) Report.--
            (1) Notice.--The Office of Personnel Management shall 
        provide notice to the Government Accountability Office of the 
        implementation of this Act.
            (2) Report.--Not later than 5 years after receipt of notice 
        under paragraph (1), the Government Accountability Office shall 
        submit a report to Congress on--
                    (A) compliance with this Act;
                    (B) obstacles to compliance with this Act; and
                    (C) cost savings resulting from this Act.
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