[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3323 Engrossed in House (EH)]


  1st Session

                               H. R. 3323

_______________________________________________________________________

                                 AN ACT

     To ensure that covered entities comply with the standards for 
electronic health care transactions and code sets adopted under part C 
    of title XI of the Social Security Act, and for other purposes.
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
107th CONGRESS
  1st Session
                                H. R. 3323

_______________________________________________________________________

                                 AN ACT


 
     To ensure that covered entities comply with the standards for 
electronic health care transactions and code sets adopted under part C 
    of title XI of the Social Security Act, 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 ``Administrative Simplification 
Compliance Act''.

SEC. 2. EXTENSION OF DEADLINE FOR COVERED ENTITIES SUBMITTING 
              COMPLIANCE PLANS.

    (a) In General.--
            (1) Extension.--Subject to paragraph (2), notwithstanding 
        section 1175(b)(1)(A) of the Social Security Act (42 U.S.C. 
        1320d-4(b)(1)(A)) and section 162.900 of title 45, Code of 
        Federal Regulations, a health care provider, health plan (other 
        than a small health plan), or a health care clearinghouse shall 
        not be considered to be in noncompliance with the applicable 
        requirements of subparts I through R of part 162 of title 45, 
        Code of Federal Regulations, before October 16, 2003.
            (2) Condition.--Paragraph (1) shall apply to a person 
        described in such paragraph only if, before October 16, 2002, 
        the person submits to the Secretary of Health and Human 
        Services a plan of how the person will come into compliance 
        with the requirements described in such paragraph not later 
        than October 16, 2003. Such plan shall be a summary of the 
        following:
                    (A) An analysis reflecting the extent to which, and 
                the reasons why, the person is not in compliance.
                    (B) A budget, schedule, work plan, and 
                implementation strategy for achieving compliance.
                    (C) Whether the person plans to use or might use a 
                contractor or other vendor to assist the person in 
                achieving compliance.
                    (D) A timeframe for testing that begins not later 
                than April 16, 2003.
            (3) Electronic submission.--Plans described in paragraph 
        (2) may be submitted electronically.
            (4) Model form.--Not later than March 31, 2002, the 
        Secretary of Health and Human Services shall promulgate a model 
        form that persons may use in drafting a plan described in 
        paragraph (2). The promulgation of such form shall be made 
        without regard to chapter 35 of title 44, United States Code 
        (commonly known as the ``Paperwork Reduction Act'').
            (5) Analysis of plans; reports on solutions.--
                    (A) Analysis of plans.--
                            (i) Furnishing of plans.--Subject to 
                        subparagraph (D), the Secretary of Health and 
                        Human Services shall furnish the National 
                        Committee on Vital and Health Statistics with a 
                        sample of the plans submitted under paragraph 
                        (2) for analysis by such Committee.
                            (ii) Analysis.--The National Committee on 
                        Vital and Health Statistics shall analyze the 
                        sample of the plans furnished under clause (i).
                    (B) Reports on solutions.--The National Committee 
                on Vital and Health Statistics shall regularly publish, 
                and widely disseminate to the public, reports 
                containing effective solutions to compliance problems 
                identified in the plans analyzed under subparagraph 
                (A). Such reports shall not relate specifically to any 
                one plan but shall be written for the purpose of 
                assisting the maximum number of persons to come into 
                compliance by addressing the most common or challenging 
                problems encountered by persons submitting such plans.
                    (C) Consultation.--In carrying out this paragraph, 
                the National Committee on Vital and Health Statistics 
                shall consult with each organization--
                            (i) described in section 1172(c)(3)(B) of 
                        the Social Security Act (42 U.S.C. 1320d-
                        1(c)(3)(B)); or
                            (ii) designated by the Secretary of Health 
                        and Human Services under section 162.910(a) of 
                        title 45, Code of Federal Regulations.
                    (D) Protection of confidential information.--
                            (i) In general.--The Secretary of Health 
                        and Human Services shall ensure that any 
                        material provided under subparagraph (A) to the 
                        National Committee on Vital and Health 
                        Statistics or any organization described in 
                        subparagraph (C) is redacted so as to prevent 
                        the disclosure of any--
                                    (I) trade secrets;
                                    (II) commercial or financial 
                                information that is privileged or 
                                confidential; and
                                    (III) other information the 
                                disclosure of which would constitute a 
                                clearly unwarranted invasion of 
                                personal privacy.
                            (ii) Construction.--Nothing in clause (i) 
                        shall be construed to affect the application of 
                        section 552 of title 5, United States Code 
                        (commonly known as the ``Freedom of Information 
                        Act''), including the exceptions from 
                        disclosure provided under subsection (b) of 
                        such section.
            (6) Enforcement through exclusion from participation in 
        medicare.--
                    (A) In general.--In the case of a person described 
                in paragraph (1) who fails to submit a plan in 
                accordance with paragraph (2), and who is not in 
                compliance with the applicable requirements of subparts 
                I through R of part 162 of title 45, Code of Federal 
                Regulations, on or after October 16, 2002, the person 
                may be excluded at the discretion of the Secretary of 
                Health and Human Services from participation (including 
                under part C or as a contractor under sections 1816, 
                1842, and 1893) in title XVIII of the Social Security 
                Act (42 U.S.C. 1395 et seq.).
                    (B) Procedure.--The provisions of section 1128A of 
                the Social Security Act (42 U.S.C. 1320a-7a) (other 
                than the first and second sentences of subsection (a) 
                and subsection (b)) shall apply to an exclusion under 
                this paragraph in the same manner as such provisions 
                apply with respect to an exclusion or proceeding under 
                section 1128A(a) of such Act.
                    (C) Construction.--The availability of an exclusion 
                under this paragraph shall not be construed to affect 
                the imposition of penalties under section 1176 of the 
                Social Security Act (42 U.S.C. 1320d-5).
                    (D) Nonapplicability to complying persons.--The 
                exclusion under subparagraph (A) shall not apply to a 
                person who--
                            (i) submits a plan in accordance with 
                        paragraph (2); or
                            (ii) who is in compliance with the 
                        applicable requirements of subparts I through R 
                        of part 162 of title 45, Code of Federal 
                        Regulations, on or before October 16, 2002.
    (b) Special Rules.--
            (1) Rules of construction.--Nothing in this section shall 
        be construed--
                    (A) as modifying the October 16, 2003, deadline for 
                a small health plan to comply with the requirements of 
                subparts I through R of part 162 of title 45, Code of 
                Federal Regulations; or
                    (B) as modifying--
                            (i) the April 14, 2003, deadline for a 
                        health care provider, a health plan (other than 
                        a small health plan), or a health care 
                        clearinghouse to comply with the requirements 
                        of subpart E of part 164 of title 45, Code of 
                        Federal Regulations; or
                            (ii) the April 14, 2004, deadline for a 
                        small health plan to comply with the 
                        requirements of such subpart.
            (2) Applicability of privacy standards before compliance 
        deadline for information transaction standards.--
                    (A) In general.--Notwithstanding any other 
                provision of law, during the period that begins on 
                April 14, 2003, and ends on October 16, 2003, a health 
                care provider or, subject to subparagraph (B), a health 
                care clearinghouse, that transmits any health 
                information in electronic form in connection with a 
                transaction described in subparagraph (C) shall comply 
                with the requirements of subpart E of part 164 of title 
                45, Code of Federal Regulations, without regard to 
                whether the transmission meets the standards required 
                by part 162 of such title.
                    (B) Application to health care clearinghouses.--For 
                purposes of this paragraph, during the period described 
                in subparagraph (A), an entity that processes or 
                facilitates the processing of information in connection 
                with a transaction described in subparagraph (C) and 
                that otherwise would be treated as a health care 
                clearinghouse shall be treated as a health care 
                clearinghouse without regard to whether the processing 
                or facilitation produces (or is required to produce) 
                standard data elements or a standard transaction as 
                required by part 162 of title 45, Code of Federal 
                Regulations.
                    (C) Transactions described.--The transactions 
                described in this subparagraph are the following:
                            (i) A health care claims or equivalent 
                        encounter information transaction.
                            (ii) A health care payment and remittance 
                        advice transaction.
                            (iii) A coordination of benefits 
                        transaction.
                            (iv) A health care claim status 
                        transaction.
                            (v) An enrollment and disenrollment in a 
                        health plan transaction.
                            (vi) An eligibility for a health plan 
                        transaction.
                            (vii) A health plan premium payments 
                        transaction.
                            (viii) A referral certification and 
                        authorization transaction.
    (c) Definitions.--In this section--
            (1) the terms ``health care provider'', ``health plan'', 
        and ``health care clearinghouse'' have the meaning given those 
        terms in section 1171 of the Social Security Act (42 U.S.C. 
        1320d) and section 160.103 of title 45, Code of Federal 
        Regulations;
            (2) the terms ``small health plan'' and ``transaction'' 
        have the meaning given those terms in section 160.103 of title 
        45, Code of Federal Regulations; and
            (3) the terms ``health care claims or equivalent encounter 
        information transaction'', ``health care payment and remittance 
        advice transaction'', ``coordination of benefits transaction'', 
        ``health care claim status transaction'', ``enrollment and 
        disenrollment in a health plan transaction'', ``eligibility for 
        a health plan transaction'', ``health plan premium payments 
        transaction'', and ``referral certification and authorization 
        transaction'' have the meanings given those terms in sections 
        162.1101, 162.1601, 162.1801, 162.1401, 162.1501, 162.1201, 
        162.1701, and 162.1301 of title 45, Code of Federal 
        Regulations, respectively.

SEC. 3. REQUIRING ELECTRONIC SUBMISSION OF MEDICARE CLAIMS.

    (a) In General.--Section 1862 of the Social Security Act (42 U.S.C. 
1395y) is amended--
            (1) in subsection (a)--
                    (A) by striking ``or'' at the end of paragraph 
                (20);
                    (B) by striking the period at the end of paragraph 
                (21) and inserting ``; or''; and
                    (C) by inserting after paragraph (21) the following 
                new paragraph:
            ``(22) subject to subsection (h), for which a claim is 
        submitted other than in an electronic form specified by the 
        Secretary.''; and
            (2) by inserting after subsection (g) the following new 
        subsection:
    ``(h)(1) The Secretary--
            ``(A) shall waive the application of subsection (a)(22) in 
        cases in which--
                    ``(i) there is no method available for the 
                submission of claims in an electronic form; or
                    ``(ii) the entity submitting the claim is a small 
                provider of services or supplier; and
            ``(B) may waive the application of such subsection in such 
        unusual cases as the Secretary finds appropriate.
    ``(2) For purposes of this subsection, the term `small provider of 
services or supplier' means--
            ``(A) a provider of services with fewer than 25 full-time 
        equivalent employees; or
            ``(B) a physician, practitioner, facility, or supplier 
        (other than provider of services) with fewer than 10 full-time 
        equivalent employees.''.
    (b) Effective Date.--The amendments made by subsection (a) shall 
apply to claims submitted on or after October 16, 2003.

SEC. 4. CLARIFICATION WITH RESPECT TO APPLICABILITY OF ADMINISTRATIVE 
              SIMPLIFICATION REQUIREMENTS TO MEDICARE+CHOICE 
              ORGANIZATIONS.

    Section 1171(5)(D) of the Social Security Act (42 U.S.C. 
1320d(5)(D)) is amended by striking ``Part A or part B'' and inserting 
``Parts A, B, or C''.

SEC. 5. AUTHORIZATION OF APPROPRIATIONS FOR IMPLEMENTATION OF 
              REGULATIONS.

    (a) In General.--Subject to subsection (b), and in addition to any 
other amounts that may be authorized to be appropriated, there are 
authorized to be appropriated a total of $44,200,000, for--
            (1) technical assistance, education and outreach, and 
        enforcement activities related to subparts I through R of part 
        162 of title 45, Code of Federal Regulations; and
            (2) adopting the standards required to be adopted under 
        section 1173 of the Social Security Act (42 U.S.C. 1320d-2).
    (b) Reductions.--
            (1) Model form 14 days late.--If the Secretary fails to 
        promulgate the model form described in section 1(a)(4) by the 
        date that is 14 days after the deadline described in such 
        section, the amount referred to in subsection (a) shall be 
        reduced by 25 percent.
            (2) Model form 30 days late.--If the Secretary fails to 
        promulgate the model form described in section 1(a)(4) by the 
        date that is 30 days after the deadline described in such 
        section, the amount referred to in subsection (a) shall be 
        reduced by 50 percent.
            (3) Model form 45 days late.--If the Secretary fails to 
        promulgate the model form described in section 1(a)(4) by the 
        date that is 45 days after the deadline described in such 
        section, the amount referred to in subsection (a) shall be 
        reduced by 75 percent.
            (4) Model form 60 days late.--If the Secretary fails to 
        promulgate the model form described in section 1(a)(4) by the 
        date that is 60 days after the deadline described in such 
        section, the amount referred to in subsection (a) shall be 
        reduced by 100 percent.

            Passed the House of Representatives December 4, 2001.

            Attest:

                                                                 Clerk.