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[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3137 Introduced in House (IH)]

103d CONGRESS
  2d Session
                                H. R. 3137

To amend the Social Security Act to improve the exchange of information 
relating to health care services, to provide for measurement of health 
                 care quality, and for other purposes.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           September 27, 1993

Mr. Hobson (for himself and Mr. Sawyer) introduced the following bill; 
 which was referred jointly to the Committees on Energy and Commerce, 
Ways and Means, Armed Services, Veterans' Affairs, Education and Labor, 
                   and Post Office and Civil Service

                            August 16, 1994

Additional sponsors: Mr. Santorum, Mr. Zimmer, Mr. Torres, Mr. Andrews 
 of Texas, Mr. Emerson, Mr. Gillmor, Mrs. Byrne, Mr. Lewis of Florida, 
Mr. Petri, Mr. Doolittle, Mr. Frost, Mr. Oxley, Mr. Kasich, Mr. Thomas 
of California, Mr. Calvert, Mr. Stokes, Mr. Brown of Ohio, Mr. Portman, 
      Mr. Clinger, Ms. Pryce of Ohio, Mr. Pombo, and Mr. Gingrich

_______________________________________________________________________

                                 A BILL

 
To amend the Social Security Act to improve the exchange of information 
relating to health care services, to provide for measurement of health 
                 care quality, 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 ``Health Care Information 
Modernization and Security Act of 1993''.

SEC. 2. ESTABLISHMENT OF HEALTH CARE DATA INTERCHANGE SYSTEM.

    (a) In General.--The Social Security Act (42 U.S.C. 301 et seq.) is 
amended by adding at the end the following new title:

            ``TITLE XXI--HEALTH CARE DATA INTERCHANGE SYSTEM

                        ``health care data panel

    ``Sec. 2101. (a) Establishment.--There is established a panel to be 
known as the Health Care Data Panel (referred to in this section as the 
`Panel').
    ``(b) Membership.--
            ``(1) In general.--The Panel shall be composed of the 
        following members:
                    ``(A) The Secretary (or his or her designee).
                    ``(B) The Secretary of Defense (or his or her 
                designee).
                    ``(C) The Secretary of Veterans Affairs (or his or 
                her designee).
                    ``(D) A representative of the Agency for Health 
                Care Policy and Research.
                    ``(E) A representative of the National Institute of 
                Standards and Technology.
                    ``(F) A representative of the National 
                Telecommunication and Information Administration.
                    ``(G) Six additional Federal officers determined 
                appropriate by the Secretary.
            ``(2) Chairperson.--The Secretary shall be the Chairperson 
        of the Panel.
    ``(c) Meetings.--
            ``(1) In general.--Except as provided in paragraph (2), the 
        Panel shall meet at the call of the Chairperson.
            ``(2) Initial and subsequent meetings.--The Panel shall 
        hold a meeting not later than 30 days after the date of the 
        enactment of this section and at least annually thereafter.
            ``(3) Quorum.--A majority of the members of the Panel shall 
        constitute a quorum, but a lesser number of members may hold 
        hearings.
    ``(d) Powers of the Panel.--
            ``(1) Hearings.--The Panel may hold such hearings, sit and 
        act at such times and places, take such testimony, and receive 
        such evidence as the Panel considers advisable to carry out the 
        purposes of this section.
            ``(2) Information from federal agencies.--The Panel may 
        secure directly from any Federal department or agency such 
        information as the Panel considers necessary to carry out the 
        provisions of this section. Upon request of the Chairperson of 
        the Panel, the head of such department or agency shall furnish 
        such information to the Panel.
            ``(3) Postal services.--The Panel may use the United States 
        mails in the same manner and under the same conditions as other 
        departments and agencies of the Federal Government.
            ``(4) Gifts.--The Panel may accept, use, and dispose of 
        gifts or donations of services or property.
    ``(e) Panel Personnel Matters.--
            ``(1) Compensation of members.--Members of the Panel shall 
        serve without compensation in addition to that received for 
        their services as officers or employees of the Federal 
        Government.
            ``(2) Staff.--
                    ``(A) Detail of government employees.--Upon the 
                request of the Chairperson any Federal Government 
                employee may be detailed to the Panel without 
                reimbursement, and such detail shall be without 
                interruption or loss of civil service status or 
                privilege.
                    ``(B) Contracts.--The Chairperson may enter into 
                contracts or other arrangements that may be necessary 
                for the Panel to perform its duties.
                    ``(C) Internal organization.--The Chairperson may 
                prescribe such rules as the Chairperson determines 
                necessary with respect to the internal organization of 
                the Panel.
    ``(f) Duties of the Panel.--
            ``(1) In general.--The Panel shall, in consultation with 
        the Health Informatics Commission established under section 
        2102, develop proposed regulations for the implementation and 
        ongoing operation of an integrated electronic health care data 
        interchange system which are based on the operating 
        requirements for the system established, selected, or developed 
        by the Panel under paragraphs (1) through (7) of subsection 
        (i). Such proposed regulations shall ensure--
                    ``(A) the integration of all participants in the 
                health care system (as defined in subsection (l)(1));
                    ``(B) the use of uniform processes which will 
                permit participants in the health care system to 
                communicate electronically for the submission and 
                receipt of health care data;
                    ``(C) the privacy of individuals who are patients 
                receiving health care services and the confidentiality 
                of information in the data interchange system;
                    ``(D) that the data in the system is verifiable, 
                timely, accurate, reliable, useful, complete, relevant, 
                time and date stamped, and comparable; and
                    ``(E) an overall reduction in the administrative 
                burdens and costs of the health care system, an overall 
                increase in the productivity, effectiveness, and 
                efficiency of the system, and an overall increase in 
                the quality of care furnished by the system.
            ``(2) Timing for development and submission of proposed 
        regulations.--Not later than 30 days after the date on which 
        the Panel is required to establish, select, or develop any of 
        the operating requirements for the system as set forth in 
        paragraphs (1) through (7) of subsection (i), the Panel shall 
        submit to the Office of Management and Budget (referred to in 
        this section as the `OMB') the proposed regulations developed 
        by the Panel under paragraph (1) which relate to such operating 
        requirements.
    ``(g) Implementation of the Regulatory Proposals Developed by the 
Panel.--
            ``(1) Promulgation of regulations.--
                    ``(A) In general.--OMB shall promulgate regulations 
                based on the proposed regulations submitted under 
                paragraph (1) within 90 days after the date such 
                proposed regulations are submitted.
                    ``(B) Regulations not based on
            ``(2) Applicability.--
                    ``(A) In general.--The regulations promulgated by 
                OMB shall apply to any health care program administered 
                by the Department of Health and Human Services, the 
                Department of Defense, and the Department of Veterans 
                Affairs and any participants in the health care system 
                affected by such programs.
                    ``(B) Special rule regarding the medicare 
                program.--The Secretary may incorporate the 
                capabilities of the common working file used in the 
                medicare program under title XVIII into a uniform 
                working file system developed and operated according to 
                regulations promulgated under subparagraph (A).
            ``(3) Compliance with regulations.--
                    ``(A) In general.--Except as provided in 
                subparagraph (B), not later than 1 year after the date 
                on which any regulations are promulgated by OMB, the 
                persons described in paragraph (2)(A) shall be required 
                to comply with such regulations.
                    ``(B) Comprehensive quality measurement data.--Not 
                later than 2 years after the date on which any 
                regulations are promulgated by OMB relating to 
                standards, conventions, and requirements for 
                comprehensive quality measurement data (as described in 
                subsection (i)(1)(E)(iv)), the persons described in 
                paragraph (2)(A) shall be required to comply with such 
                regulations.
    ``(h) Modifications.--The Panel shall continuously monitor the 
implementation of the regulations promulgated by OMB under paragraph 
(1) of subsection (g) and shall submit to OMB any proposed 
modifications to such regulations determined appropriate by the Panel. 
The requirements of subsection (g) shall apply to any such proposed 
modifications in the same manner as such requirements apply to the 
proposed regulations initially submitted by the Panel.
    ``(i) Operating Standards, Conventions, Requirements, and 
Procedures for the Data Interchange System.--
            ``(1) Selection and establishment of data and transaction 
        standards, conventions, and requirements for the data 
        interchange system.--
                    ``(A) In general.--The Panel, in consultation with 
                the American National Standards Institute (referred to 
                in this section as `ANSI'), shall select and establish 
                data and transaction standards, conventions, and 
                requirements that permit the electronic interchange of 
                any health care data the Panel determines necessary for 
                the efficient and effective administration of the 
                health care system.
                    ``(B) Minimum requirements.--The data and 
                transaction standards, conventions, and requirements 
                selected and established by the Panel under this 
                paragraph shall, at a minimum--
                            ``(i) ensure that the data interchange 
                        system shall have the capability to comply with 
                        such standards, conventions, and requirements; 
                        and
                            ``(ii) be based on any standards that are 
                        in use and generally accepted on the date of 
                        the enactment of this Act or that are 
                        recommended by nationally recognized standard 
                        setting groups, including ANSI, the National 
                        Uniform Billing Committee, the Uniform Claim 
                        Form Task Force, the National Committee for 
                        Prescription Drug Programs, and the Healthcare 
                        Informatics Standards Planning Panel.
                    ``(C) Applicability.--The proposed regulations 
                developed by the Panel shall provide that--
                            ``(i) any participant in the health care 
                        system who has the capability to interchange 
                        data through a uniform working file developed 
                        by the Panel under paragraph (2) shall be 
                        required to transmit and receive such data 
                        using the standards, conventions, and 
                        requirements developed by the Panel under this 
                        paragraph; and
                            ``(ii) any participant in the health care 
                        system who does not have such capability shall 
                        be required to transmit and receive data 
                        through a health care information clearinghouse 
                        or a health care value added network that is 
                        certified under the procedure established 
                        pursuant to subsection (k).
                    ``(D) Additional requirements.--
                            ``(i) In general.--The proposed regulations 
                        developed by the Panel shall provide that no 
                        participant in the health care system shall be 
                        permitted to establish data requirements in 
                        addition to such standards, conventions, and 
                        requirements established by the Panel and 
                        included in regulations promulgated by OMB--
                                    ``(I) unless two or more 
                                participants voluntarily establish such 
                                additional requirements and the 
                                requirements meet all of the privacy 
                                and confidentiality standards developed 
                                by the Panel under this section and 
                                included in any regulations promulgated 
                                by OMB under subsection (g); or
                                    ``(II) a waiver is granted under 
                                clause (ii) to establish such 
                                additional requirements.
                            ``(ii) Conditions for waivers.--
                                    ``(I) In general.--The proposed 
                                regulations developed by the Panel 
                                shall provide that any participant in 
                                the health care system may request a 
                                waiver to establish additional data 
                                requirements.
                                    ``(II) Consideration of waiver 
                                requests.--The proposed regulations 
                                developed by the Panel shall provide 
                                that no waiver shall be granted under 
                                this clause unless the entity granting 
                                such waiver considers the value of the 
                                additional data to be exchanged for 
                                research or other purposes determined 
                                appropriate by the Panel, the 
                                administrative cost of the additional 
                                data requirements, the burden of the 
                                additional data requirements, and the 
                                burden of the timing of the imposition 
                                the additional data requirements.
                                    ``(III) Certain requests for 
                                waivers.--The proposed regulations 
                                developed by the Panel shall provide 
                                that if a participant in the health 
                                care system attempts to impose 
                                additional data requirements on any 
                                other such participant, the participant 
                                on which such requirements are being 
                                imposed may contact the Secretary. The 
                                Panel shall develop a procedure under 
                                which any participant in the health 
                                care system contacting the Secretary 
                                under the preceding sentence shall 
                                remain anonymous. The Secretary shall 
                                notify the participant imposing the 
                                additional data requirements that such 
                                requirements may not be imposed on any 
                                other participant unless such other 
                                participant voluntarily agrees to such 
                                requirements or a waiver is obtained 
                                under this clause.
                    ``(E) Timetable for standards, conventions, and 
                requirements.--
                            ``(i) Initial Standards, conventions, and 
                        requirements relating to financial and 
                        administrative transactions.--Not later than 9 
                        months after the date of the enactment of this 
                        section, the Panel shall develop data and 
                        transaction standards, conventions, and 
                        requirements for the following items relating 
                        to the financing and administration of health 
                        care:
                                    ``(I) Enrollment.
                                    ``(II) Eligibility.
                                    ``(III) Payment and remittance 
                                advice.
                                    ``(IV) Claims.
                                    ``(V) Claims status.
                                    ``(VI) Coordination of benefits.
                                    ``(VII) Crossover billing.
                                    ``(VIII) First report of injury.
                                    ``(IX) Standardized claim 
                                attachments.
                            ``(ii) Other standards, conventions, and 
                        requirements relating to financial and 
                        administrative transactions.--Not later than 9 
                        months after the date of the enactment of this 
                        section, the Panel shall develop data and 
                        transaction standards, conventions, and 
                        requirements for items relating to the 
                        financing and administration of health care 
                        delivery that are not described in clause (i).
                            ``(iii) Standards, conventions, and 
                        requirements relating to initial quality 
                        measurement indicators.--Not later than 12 
                        months after the date of the enactment of this 
                        section, the Panel shall develop data and 
                        transaction standards, conventions, and 
                        requirements for participants in the health 
                        care system to transmit data derived from the 
                        financial and administrative transactions data 
                        described in clause (i) on quality measurement, 
                        utilization monitoring, risk assessment, 
                        patient satisfaction, outcomes, and access.
                            ``(iv) Standards, conventions, and 
                        requirements relating to comprehensive quality 
                        measurement data.--Not later than 24 months 
                        after the date of the enactment of this 
                        section, the Panel shall develop standards, 
                        conventions, and requirements for participants 
                        in the health care system to transmit 
                        comprehensive data collected at the site of 
                        care on quality measurement, utilization 
                        monitoring, risk assessment, patient 
                        satisfaction, outcomes, and access.
                            ``(v) Standards, conventions, and 
                        requirements relating to data on patient care 
                        records.--Not later than 36 months after the 
                        date of the enactment of this section, the 
                        Panel shall develop standards, conventions, and 
                        requirements related to the inclusion of data 
                        from patient care records into the health care 
                        data interchange system, including standards, 
                        conventions, and requirements on the 
                        identification of the origin of any data from 
                        such records that is included in such system.
                    ``(F) Data and transaction standards, conventions, 
                and requirements for the centers for disease control 
                and prevention.--Not later than 36 months after the 
                date of the enactment of this section, the Panel, in 
                collaboration with the Centers for Disease Control and 
                Prevention (referred to in this section as the `CDCP') 
                and in consultation with State departments of health, 
                shall develop data and transaction standards, 
                conventions, and requirements for the electronic 
                interchange of data on vital health statistics 
                collected by CDCP or the States or any other such data 
                as CDCP determines appropriate.
                    ``(G) Waivers of compliance.--
                            ``(i) Financial and administrative 
                        transactions.--The proposed regulations 
                        developed by the Panel shall provide that any 
                        of the data and transaction standards, 
                        conventions, and requirements relating to 
                        financial and administrative transactions 
                        developed by the Panel under subparagraph 
                        (E)(i) may be waived until January 1, 1995 for 
                        a health care provider that--
                                    ``(I) does not have access to a 
                                health care information clearinghouse 
                                or a health care value added network, 
                                is in the process of developing a 
                                system that complies with such 
                                standards, conventions, and 
                                requirements, and executes an agreement 
                                with the appropriate regulatory entity 
                                that such provider will meet such 
                                standards, conventions, and 
                                requirements by a specified date (not 
                                later than January 1, 1995); or
                                    ``(II) is a small rural hospital 
                                (as defined by the Panel and included 
                                in regulations promulgated by OMB under 
                                subsection (g)).
                            ``(ii) Advanced quality measurement data.--
                        The proposed regulations developed by the Panel 
                        shall provide that any of the data and 
                        transaction standards, conventions, and 
                        requirements relating to advanced quality 
                        measurement data developed by the Panel under 
                        subparagraph (E)(iv) may be waived until 
                        January 1, 1998 for a health care provider 
                        that--
                                    ``(I) does not have access to a 
                                health care information clearinghouse 
                                or a health care value added network, 
                                is in the process of developing a 
                                system that complies with such 
                                standards, conventions, and 
                                requirements, and executes an agreement 
                                with the appropriate regulatory entity 
                                that such provider will meet such 
                                standards and requirements by a 
                                specified date (not later than January 
                                1, 1998); or
                                    ``(II) agrees to obtain from such 
                                provider's records the data elements 
                                that are needed to meet the standards 
                                and requirements developed under 
                                subparagraph (E)(iv) and agrees to 
                                subject the provider's data transfer 
                                process to a quality assurance program 
                                that is satisfactory to the appropriate 
                                regulatory entity.
            ``(2) Standards for operation of a uniform working file.--
                    ``(A) In general.--Not later than 24 months after 
                the date of the enactment of this section the Panel 
                shall establish standards for the development and 
                operation of a uniform working file system that is 
                national in scope. Such standards shall ensure--
                            ``(i) that all participants in the health 
                        care system may be linked electronically 
                        (directly or indirectly) to the uniform working 
                        file system;
                            ``(ii) that any privacy and confidentiality 
                        standards established by the Panel under 
                        paragraph (5) are satisfied;
                            ``(iii) that the uniform working file 
                        system improves the efficiency and 
                        effectiveness of the administration of the 
                        health care system, including health care 
                        quality measurement;
                            ``(iv) the interoperability of the uniform 
                        working file system by--
                                    ``(I) supporting the data and 
                                transaction standards, conventions, and 
                                requirements selected and established 
                                by the Panel; and
                                    ``(II) making use of such 
                                standards, conventions, and 
                                requirements; and
                            ``(v) the support of any other requirements 
                        selected or established by the Panel.
            ``(3) Code sets for system.--
                    ``(A) In general.--Not later than 9 months after 
                the date of the enactment of this section the Panel 
                shall select and establish code sets that are 
                maintained by private and public entities as the 
                Panel's official code sets for use in a national 
                uniform working file system. The proposed regulations 
                developed by the Panel shall provide that any changes 
                or updates to such code sets that are established or 
                requested by the private or public entity which 
                maintains the code set--
                            ``(i) shall preserve the informational 
                        value of data retained either within the 
                        uniform working file system or within the 
                        information systems of parties making use of 
                        the data and transactions standards, 
                        conventions, and requirements;
                            ``(ii) shall include instructions on how 
                        existing data containing such codes is to be 
                        converted or translated so as to preserve its 
                        value;
                            ``(iii) shall be incorporated into the 
                        official code set in such a manner as to 
                        minimize the disruption to the national uniform 
                        working file system and minimize the cost to 
                        all entities within the system for 
                        reprogramming to accommodate such changes or 
                        updates; and
                            ``(iv) shall be implemented--
                                    ``(I) only after at least 90 days 
                                advance notice has been provided to 
                                participants in the health care system; 
                                and
                                    ``(II) no more frequently than on 
                                an annual basis.
            ``(4) Establishment of unique identifiers.--
                    ``(A) In general.--Not later than 9 months after 
                the date of the enactment of this section the Panel 
                shall develop unique identifiers for each participant 
                in the health care system.
                    ``(B) Special rules.--
                            ``(i) Individuals.--Each individual shall 
                        have a unique identifier developed by the 
                        Panel.
                            ``(ii) Health care benefit plans or 
                        providers.--In developing unique identifiers 
                        for each health insurance plan or provider, the 
                        Panel shall take into account multiple uses for 
                        such identifiers and shall consider multiple 
                        physical locations and specialty 
                        classifications for providers. The unique 
                        identifiers for health insurance plans or 
                        providers may be based on the system used under 
                        title XVIII on the date of the enactment of 
                        this section.
            ``(5) Privacy and confidentiality standards.--
                    ``(A) In general.--Not later than 9 months after 
                the date of the enactment of this section the Panel, 
                after taking into consideration the Insurance 
                Information and Privacy Protection Model Act of the 
                National Association of Insurance Commissioners, other 
                model legislation, and international guidelines, shall 
                develop requirements which protect the privacy of 
                participants in the health care system and ensure the 
                confidentiality of information in the data interchange 
                system.
                    ``(B) Principles considered.--In developing the 
                requirements referred to in subparagraph (A), the Panel 
                shall take into consideration the following principles:
                            ``(i) Information relating to an 
                        identifiable or identified individual should be 
                        collected only to the extent necessary to carry 
                        out the purpose for which the information is 
                        collected.
                            ``(ii) Information relating to an 
                        identifiable or identified individual collected 
                        for a particular purpose should generally not 
                        be used for another purpose without the 
                        individual's informed consent unless the 
                        pooling of information renders an individual's 
                        data unidentifiable.
                            ``(iii) Information relating to an 
                        identifiable or identified individual should be 
                        disposed of when no longer necessary to carry 
                        out the purpose for which it was collected, 
                        unless the pooling of information renders an 
                        individual's data unidentifiable.
                            ``(iv) Methods to ensure the verifiability, 
                        timeliness, accuracy, reliability, utility, 
                        completeness, relevance, and comparability of 
                        information relating to an identifiable or 
                        identified individual should be instituted.
                            ``(v) An individual should be notified in 
                        advance of the collection of information 
                        relating to such individual with regard to--
                                    ``(I) whether the furnishing of 
                                information is mandatory or voluntary;
                                    ``(II) the recordkeeping practices 
                                with respect to any information 
                                provided; and
                                    ``(III) the uses to be made of any 
                                information provided.
                            ``(vi) If informed consent is necessary for 
                        the intended primary or secondary use of 
                        information relating to an identifiable or 
                        identified individual, the individual should be 
                        provided the opportunity to reject such uses at 
                        the time the information is collected, except 
                        where such uses are necessary to comply with 
                        law.
                            ``(vii) An individual should be permitted 
                        to inspect and correct any information which 
                        concerns such individual and should be able to 
                        obtain information on how such information is 
                        being used.
            ``(6) Transfer of information between health benefit 
        plans.--Not later than 9 months after the date of the enactment 
        of this section, the Panel shall develop rules and procedures--
                    ``(A) for determining the financial liability of 
                health benefit plans when health care benefits are 
                payable under two or more health benefit plans; and
                    ``(B) concerning the transfer among health benefit 
                plans of appropriate official data sets needed to carry 
                out the coordination of benefits, the sequential 
                processing of claims, and other health data as 
                determined necessary by the Panel for individuals who 
                have more than one health care benefit plan, according 
                to the priorities established under the rules and 
                procedures established under subparagraph (A).
            ``(7) Fines and penalties for failure to comply.--
                    ``(A) Compliance with standards for privacy and 
                confidentiality.--Not later than 9 months after the 
                date of the enactment of this section the Panel shall 
                develop civil fines and penalties, as determined 
                appropriate by the Panel, to enforce any of the 
                requirements developed by the Panel under paragraph (5) 
                relating to privacy and confidentiality. The civil 
                penalties developed by the Panel under this 
                subparagraph shall not be less than $1,000 for each 
                violation.
                    ``(B) Compliance with other requirements.--
                            ``(i) In general.--Not later than 9 months 
                        after the date of the enactment of this section 
                        the Panel shall develop civil fines and 
                        penalties, as determined appropriate by the 
                        Panel, to enforce any of the requirements 
                        developed by this Panel under this section 
                        other than the requirements related to privacy 
                        and confidentiality. The civil fines and 
                        penalties developed by the Panel under this 
                        subparagraph shall not exceed $100 for each 
                        violation.
                            ``(ii) Limitations.--
                                    ``(I) Penalties not to apply where 
                                noncompliance not discovered exercising 
                                reasonable diligence.--No civil fine or 
                                penalty developed by the Panel under 
                                this subparagraph shall be imposed if 
                                it is established that the person 
                                liable for the fine or penalty did not 
                                know, and by exercising reasonable 
                                diligence would not have known, that 
                                such person failed to comply with any 
                                of the requirements described in clause 
                                (i).
                                    ``(II) Penalties not to apply to 
                                compliance failures corrected within 30 
                                days.--No civil fine or penalty 
                                developed by the Panel under this 
                                subparagraph shall be imposed if--
                                            ``(aa) the failure to 
                                        comply was due to reasonable 
                                        cause and not to willful 
                                        neglect, and
                                            ``(bb) the failure to 
                                        comply is corrected during the 
                                        30-day period beginning on the 
                                        1st date the person liable for 
                                        the fine or penalty knew, or by 
                                        exercising reasonable diligence 
                                        would have known, that the 
                                        failure to comply occurred.
                                    ``(III) Waiver.--In the case of a 
                                failure to comply which is due to 
                                reasonable cause and not to willful 
                                neglect, any civil fine or penalty 
                                developed by the Panel under this 
                                subparagraph may be waived to the 
                                extent that the payment of such fine or 
                                penalty would be excessive relative to 
                                the compliance failure involved.
    ``(j) Reports to the Congress.--
            ``(1) Legislative proposal on certain criminal fines and 
        penalties.--Not later than 12 months after the date of the 
        enactment of this section the Panel shall submit to the 
        Congress a legislative proposal relating to any criminal fines 
        and penalties determined appropriate by the Panel to enforce 
        any of the requirements developed by the Panel under paragraph 
        (5) relating to privacy and confidentiality.
            ``(2) Annual reports.--
                    ``(A) In general.--The Panel shall annually prepare 
                and submit to Congress a report on--
                            ``(i) the status of the data interchange 
                        system, including the system's ability to 
                        provide data on cost, quality, and patient 
                        satisfaction;
                            ``(ii) the savings and costs of 
                        implementing the data interchange system; and
                            ``(iii) any legislative recommendations 
                        related to the data interchange system.
                    ``(B) Availability to the public.--Any information 
                in the report submitted to Congress under subparagraph 
                (A) shall be made available to the public unless such 
                information may not be disclosed by law.
    ``(k) Oversight of Uniform Working File, Health Care Information 
Clearinghouses, and Value Added Networks.--
            ``(1) Periodic reviews.--Not later than 9 months after the 
        date of the enactment of this section the Secretary shall 
        establish a procedure for the periodic review of business 
        practices, performance, and fees with respect to the uniform 
        working file and each health care information clearinghouse and 
        value added network to ensure that such entities are not taking 
        unfair advantage of participants in the health care system 
        through the application of any regulations promulgated by OMB 
        under subsection (g).
            ``(2) Certification procedure.--Not later than 12 months 
        after the date of the enactment of this section the Panel shall 
        establish a certification procedure for the uniform working 
        file, health care information clearinghouses, and value added 
        networks. The requirements for certification shall include--
                    ``(A) adherence to the data and transaction 
                standards and requirements and the privacy and 
                confidentiality standards included in any regulations 
                promulgated by OMB under subsection (g);
                    ``(B) making public standardized indicators of 
                performance such as accessibility, transaction 
                responsiveness, administrative efficiency, reliability, 
                dependability, and any other indicators determined 
                appropriate by the Secretary; and
                    ``(C) any other requirements determined appropriate 
                by the Secretary.
    ``(l) Definitions.--For purposes of this section:
            ``(1) Participant in the health care system.--
                    ``(A) In general.--The term `participant in the 
                health care system' means any Federal health care 
                program, State, administrator, employee welfare benefit 
                plan, health insurance plan, insurer, or provider.
                    ``(B) Administrator.--The term `administrator' has 
                the meaning given that term in section 3(16)(A) of the 
                Employee Retirement Income Security Act of 1974.
                    ``(C) Employee welfare benefit plan.--The term 
                `employee welfare benefit plan' has the meaning given 
                that term in section 3(1) of the Employee Retirement 
                Income Security Act of 1974.
                    ``(D) Health insurance plan.--The term `health 
                insurance plan' means any contract or arrangement under 
                which an entity bears all or part of the cost of 
                providing health care items and services, including a 
                hospital or medical expense incurred policy or 
                certificate, hospital or medical service plan contract, 
                or health maintenance subscriber contract (including 
                any self-insured health insurance plan).
                    ``(E) Insurer.--The term `insurer' means any entity 
                that offers a health insurance plan under which such 
                entity is at risk for all or part of the cost of 
                benefits under the plan, and includes any agent of such 
                entity.
                    ``(F) Provider.--The term `provider' means a 
                physician, hospital, pharmacy, laboratory, or other 
                person licensed or otherwise authorized under 
                applicable State laws to furnish health care items or 
                services.
                    ``(H) State.--The term `State' has the meaning 
                given to such term by section 1101(a)(1).
            ``(2) Health care information clearinghouse.--The term 
        `health care information clearinghouse' means a public or 
        private entity that--
                    ``(A) processes data that cannot be sent directly 
                due to lack of proper formatting or editing; and
                    ``(B) facilitates the translation of data to the 
                standardized data set and code sets between persons who 
                normally would send or receive the transaction;
        but does not store information processed beyond the time 
        required to complete its task and communicate the information.
            ``(3) Health care value added network.--The term `health 
        care value added network' means any entity that provides 
        additional services beyond the transmission of data or value, 
        such as the storage of electronic data or value and the 
        transfer of such data or value between health care entities.
            ``(4) Code sets.--The term `code sets' means any codes used 
        for supplying specific data in a uniform data set, including 
        tables of terms, medical diagnostic codes, medical procedure 
        codes, identification numbers, and any code sets of the 
        National Uniform Billing Committee, the Health Care Financing 
        Administration, or ANSI.

                ``national health informatics commission

    ``Sec. 2102. (a) Appointment.--The Health Care Data Interchange 
Panel (referred to in this section as the `Panel') shall provide for 
appointment of a National Health Informatics Commission (referred to in 
this section as the `Commission') to advise the Panel on its 
activities.
    ``(b) Membership.--
            ``(1) In general.--The Commission shall consist of 15 
        members. The Panel shall designate 1 member of the Commission 
        as the Chairperson.
            ``(2) Expertise.--Members of the Commission shall be 
        individuals who--
                    ``(A) represent different professions and different 
                geographic areas, including urban and rural areas;
                    ``(B) represent Federal or State government health 
                programs;
                    ``(C) represent applicable standard-setting groups, 
                including the National Uniform Billing Committee, the 
                Uniform Claim Form Task Force, American National 
                Standards Institute, and the Healthcare Informatics 
                Standards Planning Panel;
                    ``(D) represent consumers of health care services; 
                and
                    ``(E) have expertise in--
                            ``(i) electronic data interchange of health 
                        care information and computerized information 
                        systems associated with the operation and 
                        administration of matters relating to health 
                        care;
                            ``(ii) the provision and financing of 
                        health care;
                            ``(iii) conducting and interpreting health 
                        economics research;
                            ``(iv) research and development of 
                        technological and scientific advances in health 
                        care;
                            ``(v) health care eligibility, enrollment, 
                        and claims administration;
                            ``(vi) health care financial management;
                            ``(vii) health care reimbursement; or
                            ``(viii) health care outcomes research.
            ``(3) Terms.--The Chairperson shall serve on the Commission 
        at the pleasure of the Panel. Each other member of the 
        Commission shall be appointed for a term of 5 years, except 
        with respect to the members first appointed--
                    ``(A) 3 members shall be appointed for a term of 1 
                year;
                    ``(B) 3 members shall be appointed for terms of 2 
                years;
                    ``(C) 3 members shall be appointed for terms of 3 
                years;
                    ``(D) 3 members shall be appointed for terms of 4 
                years; and
                    ``(E) 2 members shall be appointed for terms of 5 
                years.
            ``(4) Vacancies.--
                    ``(A) In general.--A vacancy on the Commission 
                shall be filled in the manner in which the original 
                appointment was made and shall be subject to any 
                conditions which applied with respect to the original 
                appointment.
                    ``(B) Filling unexpired term.--An individual chosen 
                to fill a vacancy shall be appointed for the unexpired 
                term of the member replaced.
                    ``(C) Expiration of terms.--The term of any member 
                shall not expire before the date on which the member's 
                successor takes office.
    ``(c) Meetings.--
            ``(1) In general.--Except as provided in paragraph (2), the 
        Commission shall meet at the call of the Chairperson.
            ``(2) Initial meeting.--No later than 30 days after the 
        date on which all members of the Commission have been 
        appointed, the Commission shall hold its first meeting.
            ``(3) Quorum.--A majority of the members of the Commission 
        shall constitute a quorum, but a lesser number of members may 
        hold hearings.
    ``(d) Duties.--
            ``(1) In general.--Not later than 60 days prior to any date 
        on which the Panel is required to select, establish, or develop 
        any requirements relating to the data interchange system, the 
        Commission shall make recommendations to the Panel with respect 
        to the issues relating to such requirements.
            ``(2) Additional studies and projects.--As directed by the 
        Panel, the Commission shall undertake such studies and projects 
        as the Panel may deem necessary.
    ``(e) Powers of the Commission.--
            ``(1) Hearings.--The Commission may hold such hearings, sit 
        and act at such times and places, take such testimony, and 
        receive such evidence as the Commission considers advisable to 
        carry out the purposes of this section.
            ``(2) Information from federal agencies.--The Commission 
        may secure directly from any Federal department or agency such 
        information as the Commission considers necessary to carry out 
        the provisions of this section. Upon request of the 
        Chairperson, the head of such department or agency shall 
        furnish such information to the Commission.
            ``(3) Postal services.--The Commission may use the United 
        States mails in the same manner and under the same conditions 
        as other departments and agencies of the Federal Government.
            ``(4) Gifts.--The Commission may accept, use, and dispose 
        of gifts or donations of services or property.
    ``(f) Commission Personnel Matters.--
            ``(1) Compensation of members.--Each member of the 
        Commission who is not an officer or employee of the Federal 
        Government shall be compensated at a rate equal to the daily 
        equivalent of the annual rate of basic pay prescribed for level 
        IV of the Executive Schedule under section 5315 of title 5, 
        United States Code, for each day (including travel time) during 
        which such member is engaged in the performance of the duties 
        of the Commission. All members of the Commission who are 
        officers or employees of the United States shall serve without 
        compensation in addition to that received for their services as 
        officers or employees of the United States.
            ``(2) Travel expenses.--The members of the Commission shall 
        be allowed travel expenses, including per diem in lieu of 
        subsistence, at rates authorized for employees of agencies 
        under subchapter I of chapter 57 of title 5, United States 
        Code, while away from their homes or regular places of business 
        in the performance of services for the Commission.
            ``(3) Staff.--
                    ``(A) In general.--The Chairperson may, without 
                regard to civil service laws and regulations, appoint 
                and terminate such personnel as may be necessary to 
                enable the Commission to perform its duties.
                    ``(B) Compensation.--The Chairperson may fix the 
                compensation of personnel without regard to the 
                provisions of chapter 51 and subchapter III of chapter 
                53 of title 5, United States Code, relating to 
                classification of positions and General Schedule pay 
                rates, except that the rate of pay for the personnel 
                may not exceed the rate payable for level V of the 
                Executive Schedule under section 5316 of such title.
                    ``(C) Detail of government employees.--Any Federal 
                Government employee may be detailed to the Commission 
                without reimbursement, and such detail shall be without 
                interruption or loss of civil service status or 
                privilege.
                    ``(D) Procurement of temporary and intermittent 
                services.--The Chairperson may procure temporary and 
                intermittent services under section 3109(b) of title 5, 
                United States Code, at rates for individuals which do 
                not exceed the daily equivalent of the annual rate of 
                basic pay prescribed for level V of the Executive 
                Schedule under section 5316 of such title.
                    ``(E) Contracts.--The Chairperson may enter into 
                contracts or other arrangements that may be necessary 
                for the Commission to perform its duties.
                    ``(F) Internal organization.--The Chairperson may 
                prescribe such rules as the Chairperson determines 
                necessary with respect to the internal organization of 
                the Commission. The Commission shall create such 
                committees (composed of Commission members and others 
                as appointed by the Chairperson) as necessary to enable 
                the Commission to meet its responsibilities and 
                functions.
    ``(g) Reports.--The Commission shall submit to the Panel such 
reports as may be requested by the Panel on each study or project 
conducted by the Commission. Such reports shall contain such 
information as requested by the Panel.
    ``(h) Termination of Commission.--The Commission shall terminate 20 
years after the date of the enactment of this Act.
    ``(i) Authorization of Appropriations.--
            ``(1) In general.--There are authorized to be appropriated 
        such sums as may be necessary to carry out the purposes of this 
        section.
            ``(2) Availability.--Any sums appropriated under the 
        authorization contained in this subsection shall remain 
        available, without fiscal year limitation, until expended.''.
    (b) Effective Date.--The amendments made by subsection (a) shall be 
effective on the date of the enactment of this Act.
                                 <all>
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