Clean CLAIMS Act

[Congressional Bills 118th Congress]
[From the U.S. Government Publishing Office]
[H.R. 8283 Introduced in House (IH)]

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118th CONGRESS
  2d Session
                                H. R. 8283

     To amend title XI of the Social Security Act to provide for a 
  demonstration project to support automatic claim submissions under 
                   Medicare, and for other purposes.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                              May 7, 2024

Mr. Schweikert introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
     To amend title XI of the Social Security Act to provide for a 
  demonstration project to support automatic claim submissions under 
                   Medicare, and for other purposes.

    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 ``Clean Commitment to Leveraging 
Artificial Intelligence to Improve Medicare Sustainability Act'' or the 
``Clean CLAIMS Act''.

SEC. 2. DEMONSTRATION PROJECT TO SUPPORT AUTOMATIC CLEAN CLAIM 
              SUBMISSIONS UNDER MEDICARE.

    Section 1115 of the Social Security Act (42 U.S.C. 1315) is amended 
by adding at the end following new subsection:
    ``(g)(1) The Secretary shall enter into an agreement with a MAC 
submitting an application under the jurisdiction of the MAC for the 
purpose of conducting a demonstration project under this subsection.
    ``(2) An agreement to conduct a demonstration project under this 
subsection shall--
            ``(A) require the demonstration project to begin on the 
        date that is the sooner of 1 year after the date of the 
        enactment of this subsection or the first day on which the 
        Secretary has sufficiently educated the physicians described in 
        subparagraph (B), and end 3 years after the appropriate date;
            ``(B) require the MAC to identify and contract with no less 
        than 500 physicians (as defined in 1861(r)) with National 
        Provider Identifiers or Tax Identification Numbers to 
        voluntarily participate in the demonstration project for the 
        purpose of carrying out subparagraph (D);
            ``(C) provide for the education and training of providers 
        described in subparagraph (B) on how the platform described in 
        subparagraph (D) operates; and
            ``(D) provide for a point of care clean claims processing 
        platform for physicians that leverages artificially intelligent 
        technologies that is capable of automatically--
                    ``(i) creating claims under part B of title XVIII 
                after live audio recording a patient-physician 
                encounter;
                    ``(ii) submitting claims described in clause (i) to 
                the Secretary for reimbursement under such parts (as 
                appropriate);
                    ``(iii) applying the appropriate payer guidelines; 
                and
                    ``(iv) populates the required corresponding medical 
                record documentation to support the items and services 
                billed via the clean claim submitted pursuant to clause 
                (ii).
    ``(3) The Secretary shall, within 6 months after the date of the 
enactment of this subsection, publish a request for proposal for the 
purpose of contracting with an entity with a service platform with the 
capabilities to perform the activities for the demonstration described 
in paragraph (2)(D).
    ``(4) Notwithstanding title XVIII, an individual enrolled under 
part B of title XVIII who receives care for a claim which is submitted 
under this demonstration project may not be responsible for any cost 
sharing for items and services furnished by a physicians described in 
subparagraph (B) during the demonstration project for items and 
services billed incorrectly or not covered under part B.
    ``(5) Any claim which is submitted under this demonstration project 
shall be exempt from the Medicare Fee for Service Recovery Audit 
Program.
    ``(6) Not later than 1 year after the date on which the 
demonstration project begins pursuant to paragraph (2)(A), the 
Secretary shall submit to Congress a report that--
            ``(A) analyzes the data collected from the claims submitted 
        pursuant to paragraph (2)(D);
            ``(B) evaluates feedback submitted by physicians described 
        in paragraph (2)(B);
            ``(C) recommends any improvements of the demonstration 
        project with respect, including how to scale the project; and
            ``(D) any other information the Secretary determines 
        appropriate.
    ``(7) In this subsection:
            ``(A) The term `jurisdiction' means the defined geographic 
        area in which a MAC processes claims submitted under part B of 
        title XVIII.
            ``(B) The term `MAC' has the meaning given such term in 
        section 1874A(a)(3).''.
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