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







107th CONGRESS
  1st Session
                                H. R. 3323

     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.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 16, 2001

Mr. Hobson (for himself, Mr. Sawyer, Mr. Stark, Ms. Pryce of Ohio, Mr. 
    Gillmor, Mr. Burr of North Carolina, Mr. Blunt, Mrs. Johnson of 
  Connecticut, Mr. Upton, Mr. Thomas, Mr. McDermott, Mr. Bachus, Mr. 
Rangel, Mr. Tiberi, Mr. Ose, Mr. Regula, Mr. LaTourette, Mr. Greenwood, 
   Mr. Whitfield, Mrs. Thurman, Mr. Strickland, Mr. Portman, and Mr. 
   Becerra) 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 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. 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 detailing how the person will come into 
        compliance with the requirements described in such paragraph 
        not later than October 16, 2003. Such plan shall include 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 specific period of 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) In general.--The National Committee on 
                        Vital and Health Statistics shall analyze a 
                        representative sample of the compliance plans 
                        submitted under paragraph (2).
                            (ii) Consultation.--In carrying out such 
                        analysis, 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.
                            (iii) Furnishing of plans.--Subject to 
                        subparagraph (C), the Secretary of Health and 
                        Human Services shall furnish the National 
                        Committee on Vital and Health Statistics with 
                        all of the compliance plans submitted under 
                        paragraph (2), from which such committee shall 
                        select the sample for analysis.
                    (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 compliance 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) Protection of confidential information.--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 (A)(ii) 
                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.
            (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 is subject to 
exclusion 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).
                    (C) Construction.--The availability of a 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, date for 
                compliance of small health plans with subparts I 
                through R of part 162 of title 45, Code of Federal 
                Regulations; or
                    (B) as modifying--
                            (i) the April 14, 2003, date for compliance 
                        of a health care provider, a health plan (other 
                        than a small health plan), or a health care 
                        clearinghouse with subpart E of part 164 of 
                        title 45, Code of Federal Regulations; or
                            (ii) the April 14, 2004, date for 
                        compliance of a small health plan with subpart 
                        E of part 164 of title 45, Code of Federal 
                        Regulations.
            (2) Applicability of privacy requirements to certain 
        transactions prior to standards compliance date.--
                    (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 (C), a health 
                care clearinghouse, that transmits any health 
                information in electronic form in connection with a 
                transaction described in subparagraph (B) 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) 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) Application to health care clearinghouses.--For 
                purposes of this paragraph, during the period described 
                in subparagraph (A), an entity that would otherwise 
                meet the definition of health care clearinghouse that 
                processes or facilitates the processing of information 
                in connection with a transaction described in 
                subparagraph (B) shall be deemed to be a health care 
                clearinghouse notwithstanding that the entity does not 
                process or facilitate the processing of such 
                information into any standard formats required by part 
                162 of title 45, Code of Federal Regulations.
    (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. 2. ESTABLISHMENT OF MEDICARE ADMINISTRATIVE FEE FOR SUBMISSION OF 
              PAPER CLAIMS.

    (a) Imposition of Fee.--Notwithstanding any other provision of law, 
the Secretary of Health and Human Services shall establish (in the form 
of a separate fee or reduction of payment otherwise made under the 
medicare program under title XVIII of the Social Security Act) an 
administrative fee of $1 for the submission of a claim in a paper or 
non-electronic form for items or services for which payment is sought 
under such title.
    (b) Exception Authority.--The Secretary--
            (1) shall waive the imposition of a fee under subsection 
        (a) in cases in which--
                    (A) there is no method available for the submission 
                of claims other than in a written form; or
                    (B) the person submitting the claim is a small 
                provider of services or supplier; and
            (2) may waive the imposition of such a fee in such unusual 
        cases as the Secretary finds appropriate.
    (c) Effective Date.--Subsection (a) applies to claims submitted on 
or after October 16, 2003.
    (d) Use of Fees.--Amounts equivalent to the fees collected under 
this section are hereby appropriated, and shall remain available until 
expended, to the Secretary of Health and Human Services for technical 
assistance and enforcement activities related to subparts I through R 
of part 162 of title 45, Code of Federal Regulations.
    (e) Definition.--For purposes of this section, the term ``small 
provider of services or supplier'' means--
            (1) an institutional provider of services (as defined in 
        section 1861(u) of the Social Security Act (42 U.S.C. 
        1395x(u))) with fewer than 25 full-time equivalent employees; 
        or
            (2) a physician, practitioner, or supplier with fewer than 
        10 full-time equivalent employees.

SEC. 3. 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. 4. 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.
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