[Congressional Bills 107th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3323 Enrolled Bill (ENR)]
H.R.3323
One Hundred Seventh Congress
of the
United States of America
AT THE FIRST SESSION
Begun and held at the City of Washington on Wednesday,
the third day of January, two thousand and one
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.
Speaker of the House of Representatives.
Vice President of the United States and
President of the Senate.