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[107th Congress Public Law 105]
[From the U.S. Government Printing Office]

<DOC>
[DOCID: f:publ105.107]

[[Page 115 STAT. 1003]]

Public Law 107-105
107th Congress

                                 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. <<NOTE: Dec. 27, 
                         2001 -  [H.R. 3323]>> 

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress <<NOTE: Administrative 
Simplification Compliance Act.>> assembled,

SECTION 1. <<NOTE: 42 USC 1305 note.>> SHORT TITLE.

    This Act may be cited as the ``Administrative Simplification 
Compliance Act''.

SEC. 2. <<NOTE: 42 USC 1320d-4 note.>> 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

[[Page 115 STAT. 1004]]

        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

[[Page 115 STAT. 1005]]

                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

[[Page 115 STAT. 1006]]

                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--

[[Page 115 STAT. 1007]]

                    ``(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 <<NOTE: 42 USC 1395y note.>> 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,

[[Page 115 STAT. 1008]]

        the amount referred to in subsection (a) shall be reduced by 100 
        percent.

    Approved December 27, 2001.

LEGISLATIVE HISTORY--H.R. 3323 (S. 1684):
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CONGRESSIONAL RECORD, Vol. 147 (2001):
            Dec. 4, considered and passed House.
            Dec. 12, considered and passed Senate.

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