[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.