I

103D CONGRESS

2D SESSION H. R. 3909

To amend title XVII of the Public Health Service Act to authorize the

Secretary of Health and Human Services to make grants to establish

and develop telemedicine projects for rural areas, to establish a health

care data interchange system, and for other purposes.

IN THE HOUSE OF REPRESENTATIVES

FEBRUARY 24, 1994

Mr. LAROCCO introduced the following bill; which was referred jointly to the

Committees on Energy and Commerce, Ways and Means, Armed Services, Veterans’ Affairs, Post Office and Civil Service, Natural Resources,

and Education and Labor

A BILL

To amend title XVII of the Public Health Service Act to

authorize the Secretary of Health and Human Services

to make grants to establish and develop telemedicine

projects for rural areas, to establish a health care data

interchange system, and for other purposes.

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled,
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1 TITLE I—PROMOTION OF

2 TELEMEDICINE PROJECTS

3 FOR RURAL AREAS

4 SECTION 101. GRANTS TO RURAL HEALTH CARE PROVID5 ERS AND RURAL HEALTH CARE NETWORKS

6 TO ESTABLISH AND DEVELOP TELEMEDICINE

7 PROJECTS.

8 Title XVII of the Public Health Service Act (42

9 U.S.C. 300u et seq.) is amended—

10 (1) by striking the title heading and inserting

11 the following:

12 ‘‘TITLE XVII—HEALTH INFORMA13 TION, HEALTH PROMOTION,

14 AND PROMOTION OF

15 TELEMEDICINE PROJECTS

16 ‘‘PART A—HEALTH INFORMATION AND HEALTH

17 PROMOTION’’; and

18 (2) by adding at the end the following:

19 ‘‘PART B—PROMOTION OF TELEMEDICINE

20 PROJECTS FOR RURAL AREAS

21 ‘‘SEC. 1711. PURPOSES.

22 ‘‘The purposes of this part are as follows:

23 ‘‘(1) To support the establishment and develop24 ment of telemedicine projects that use telecommuni25 cations technologies and other technologies to in-
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1 crease the quality and accessibility of health care in

2 rural areas and to reduce the costs of such care.

3 Such technologies may include—

4 ‘‘(A) testbed networks for linking health

5 care providers, medical schools, medical librar6 ies, and universities to enable health care pro7 viders and researchers to share medical images

8 and to develop computer-based records;

9 ‘‘(B) software and visualization technology

10 for visualizing the human anatomy and analyz11 ing diagnostic images and records;

12 ‘‘(C) virtual reality technology for simulat13 ing surgical and medical procedures;

14 ‘‘(D) collaborative technology to allow geo15 graphically remote health care providers to pro16 vide real-time treatment to patients;

17 ‘‘(E) interactive technologies to allow

18 health care providers to monitor, evaluate, and

19 treat patients in nonclinical settings;

20 ‘‘(F) database technology to provide health

21 care providers with access to relevant medical

22 information and literature; and

23 ‘‘(G) database technology for storing,

24 accessing, and transmitting patients’ medical
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1 records while protecting the accuracy and pri2 vacy of such records.

3 ‘‘(2) To encourage the use of the telecommuni4 cations technologies and other technologies described

5 in paragraph (1)—

6 ‘‘(A) to permit rural health care providers

7 to maintain contact with itinerant staff and re8 mote specialists;

9 ‘‘(B) to permit patients in rural areas to

10 receive health care locally whenever possible;

11 ‘‘(C) to reduce the costs of health care in

12 rural areas by reducing the costs of paperwork;

13 ‘‘(D) to improve coordination and effi14 ciency in the provision of health care in rural

15 areas; and

16 ‘‘(E) to provide rural health care providers

17 with access to equipment, specialists, and con18 tinuing education programs that may not be

19 otherwise available in rural areas.

20 ‘‘(3) To demonstrate the effectiveness of tele21 communications technologies and other technologies

22 in improving the quality and accessibility of health

23 care in rural areas and reducing the costs of such

24 care.
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1 ‘‘SEC. 1712. GRANTS FOR ESTABLISHMENT OF

2 TELEMEDICINE PROJECTS.

3 ‘‘(a) IN GENERAL.—The Secretary may make grants

4 under this section to rural health care providers and rural

5 health care networks for the establishment, and initial de6 velopment and operation, of telemedicine projects that are

7 consistent with the purposes of this part.

8 ‘‘(b) APPLICATIONS.—

9 ‘‘(1) SUBMISSION.—To apply for a grant under

10 this section for any fiscal year, a rural health care

11 provider or a rural health care network shall submit

12 an application to the Secretary in accordance with

13 the procedures established by the Secretary. The

14 Secretary shall establish a deadline for the submis15 sion of applications under this paragraph for each

16 fiscal year.

17 ‘‘(2) CRITERIA FOR APPROVAL.—The Secretary

18 may not approve an application submitted under

19 paragraph (1) unless the application includes assur20 ances satisfactory to the Secretary that funds re21 ceived under this section will be used for 1 or more

22 of the following purposes:

23 ‘‘(A) To develop or acquire, through lease

24 or purchase, computer hardware, computer soft25 ware, audio equipment, video equipment, com26 puter network equipment, telecommunications
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1 transmission facilities, telecommunications ter2 minal equipment, interactive video equipment,

3 data terminal equipment, or other facilities or

4 equipment consistent with the purposes of this

5 part.

6 ‘‘(B) To develop or acquire instructional

7 programming consistent with the purposes of

8 this part.

9 ‘‘(C) To receive technical assistance or in10 struction with respect to the development or use

11 of such facilities, equipment, or instructional

12 programming.

13 ‘‘(D) Such other purposes as may be ap14 proved by the Secretary consistent with the

15 purposes of this part.

16 ‘‘(3) PETITIONS FOR RECONSIDERATION AND

17 REAPPLICATIONS.—

18 ‘‘(A) IN GENERAL.—With respect to an ap19 plication submitted under paragraph (1) that is

20 disapproved under this subsection, the applicant

21 may submit to the Secretary—

22 ‘‘(i) a petition for reconsideration of

23 the application; and

24 ‘‘(ii) an application that conforms to

25 the requirements of this subsection.
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1 ‘‘(B) DEADLINES.—The Secretary shall es2 tablish a deadline for the submission of peti3 tions for reconsideration and reapplications

4 under this paragraph for each fiscal year. The

5 Secretary shall approve or disapprove each such

6 petition and reapplication before the termi7 nation of the 60-day period beginning on the

8 date of such submission.

9 ‘‘(c) PREFERENCES IN AWARDING GRANTS.—

10 ‘‘(1) IN GENERAL.—In awarding grants under

11 this section, the Secretary shall give preference to

12 applicants that are not using any of the tele13 communications technologies or other technologies

14 described in section 1711(1) at the time the appli15 cant submits an application under subsection (b).

16 ‘‘(2) PREFERENCES AMONG NETWORKS.—Ex17 cept as provided in paragraph (4), in awarding

18 grants under this section to rural health care net19 works, the Secretary shall give preference to net20 works that demonstrate, through the membership of

21 the network, broad geographic representation of

22 rural areas in the State or States in which the net23 work intends to establish and develop a project with

24 funds received under this section.
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1 ‘‘(d) GRANTS RESERVED FOR HEALTH CARE PRO2 VIDERS AND SMALL HEALTH CARE NETWORKS.—At least

3 40 percent of the grants made by the Secretary under this

4 section shall be made to rural health care providers or

5 rural health care networks with 10 or fewer members.

6 ‘‘SEC. 1713. GRANTS FOR DEVELOPMENT OF ADVANCED

7 TELEMEDICINE PROJECTS.

8 ‘‘(a) IN GENERAL.—The Secretary may make grants

9 under this section to applicant groups consisting of 2 or

10 more rural health care networks for the purposes of elec11 tronically linking existing telemedicine projects established

12 by such networks and further developing such linked

13 projects in a manner that is consistent with the purposes

14 of this part.

15 ‘‘(b) APPLICATIONS.—

16 ‘‘(1) SUBMISSION.—To apply for a grant under

17 this section for any fiscal year, a group consisting of

18 2 or more rural health care networks shall submit

19 an application to the Secretary in accordance with

20 the procedures established by the Secretary. The

21 Secretary shall establish a deadline for the submis22 sion of applications under this paragraph for each

23 fiscal year.

24 ‘‘(2) CRITERIA FOR APPROVAL.—The Secretary

25 may not approve an application submitted by a
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1 group under paragraph (1) unless the application in2 cludes assurances satisfactory to the Secretary

3 that—

4 ‘‘(A) the group, through the membership

5 of the networks that are part of the group,

6 broadly geographically represents rural areas in

7 the State or States in which the group intends

8 to link and develop telemedicine projects with

9 funds received under this section; and

10 ‘‘(B) funds received under this section will

11 be used for 1 or more of the following purposes:

12 ‘‘(i) To develop or acquire, through

13 lease or purchase, computer hardware,

14 computer software, audio equipment, video

15 equipment, computer network equipment,

16 telecommunications transmission facilities,

17 telecommunications terminal equipment,

18 interactive video equipment, data terminal

19 equipment, or other facilities or equipment

20 consistent with the purposes of this part.

21 ‘‘(ii) To develop or acquire instruc22 tional programming consistent with the

23 purposes of this part.

24 ‘‘(iii) To receive technical assistance

25 or instruction with respect to the develop-
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1 ment or use of such facilities, equipment,

2 or instructional programming.

3 ‘‘(iv) Such other purposes as may be

4 approved by the Secretary consistent with

5 the purposes of this part.

6 ‘‘(3) PETITIONS FOR RECONSIDERATION AND

7 REAPPLICATIONS.—

8 ‘‘(A) IN GENERAL.—With respect to an ap9 plication submitted under paragraph (1) that is

10 disapproved under this subsection, the applicant

11 may submit to the Secretary—

12 ‘‘(i) a petition for reconsideration of

13 the application; and

14 ‘‘(ii) an application that conforms to

15 the requirements of this subsection.

16 ‘‘(B) DEADLINES.—The Secretary shall es17 tablish a deadline for the submission of peti18 tions for reconsideration and reapplications

19 under this paragraph for each fiscal year. The

20 Secretary shall approve or disapprove each such

21 petition and reapplication before the termi22 nation of the 60-day period beginning on the

23 date of such submission.
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1 ‘‘(c) PREFERENCE IN AWARDING GRANTS.—In

2 awarding grants under this section, the Secretary shall

3 give preference to groups that—

4 ‘‘(1) demonstrate that each of the rural health

5 care networks that is a part of the group was cre6 ated more than 1 year before the date on which the

7 application was submitted by the group; and

8 ‘‘(2) provide assurances satisfactory to the Sec9 retary that the group will use funds received under

10 this section to provide a broad range of health care

11 and educational services through the telemedicine

12 projects linked and developed using such funds.

13 ‘‘SEC. 1714. REVIEW AND SANCTIONS.

14 ‘‘The Secretary shall review at least annually the

15 compliance of a person receiving a grant under this part

16 with the provisions of this part. The Secretary shall estab17 lish a procedure for determining whether such a person

18 has failed to comply substantially within the provisions of

19 this part and the sanctions to be imposed for any such

20 noncompliance.

21 ‘‘SEC. 1715. ANNUAL REPORT.

22 ‘‘The Secretary shall include in the annual report

23 under section 1705 a description of the activities carried

24 out under this part.
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1 ‘‘SEC. 1716. REGULATIONS.

2 ‘‘The Secretary may issue any regulations necessary

3 to carry out this part.

4 ‘‘SEC. 1717. DEFINITIONS.

5 ‘‘For purposes of this part:

6 ‘‘(1) COMPUTER NETWORK EQUIPMENT.—The

7 term ‘computer network equipment’ means computer

8 hardware and software, terminals, signal conversion

9 equipment including both modulators and

10 demodulators, or related devices, used to commu11 nicate with other computers to process and exchange

12 data through a telecommunications network in which

13 signals are generated, modified, prepared for trans14 mission, or received, via telecommunications terminal

15 equipment and telecommunications transmission

16 facilities.

17 ‘‘(2) DATA TERMINAL EQUIPMENT.—The term

18 ‘data terminal equipment’ means equipment that

19 converts user information into data signals for

20 transmission, or reconverts the received data signals

21 into user information, and is normally found on the

22 terminal of a circuit and on the premises of the end

23 user.

24 ‘‘(3) FIBER OPTIC CABLE.—The term ‘fiber

25 optic cable’ means a bundle of optical transmission

26 elements or waveguides usually consisting of fiber
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1 core and fiber cladding that can guide a lightwave

2 and that are incorporated into an assembly of

3 materials that provide tensile strength and external

4 protection.

5 ‘‘(4) HEALTH CARE PROVIDER.—The term

6 ‘health care provider’ means a person who is li7 censed, certified, registered, or otherwise authorized

8 by law to provide health care in the ordinary course

9 of business or practice of a profession.

10 ‘‘(5) INTERACTIVE VIDEO EQUIPMENT.—The

11 term ‘interactive video equipment’ means equipment

12 used to produce and prepare for transmission audio

13 and visual signals from at least 2 distant locations

14 in order that individuals at such locations can ver15 bally and visually communicate with each other.

16 Such equipment includes monitors, other display de17 vices, cameras or other recording devices, audio pick18 up devices, and related equipment.

19 ‘‘(6) RURAL AREA.—The term ‘rural area’ has

20 the meaning given such term in section

21 1866(d)(2)(D) of the Social Security Act.

22 ‘‘(7) RURAL HEALTH CARE NETWORK.—The

23 term ‘rural health care network’ means a group of

24 rural health care providers that have entered into a

25 formal relationship with each other or with health
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1 care providers in an area that is not a rural area for

2 the purpose of improving the delivery of health care

3 in a rural area, or for the purpose of improving the

4 access of their patients to the services of a

5 telemedicine project.

6 ‘‘(8) RURAL HEALTH CARE PROVIDER.—The

7 term ‘rural health care provider’ means a health

8 care provider who provides health care in a rural

9 area.

10 ‘‘(9) TELECOMMUNICATIONS TERMINAL EQUIP11 MENT.—The term ‘telecommunications terminal

12 equipment’ means the assembly of telecommuni13 cations equipment at the end of a circuit, normally

14 located on the premises of the end user, that inter15 faces with telecommunications transmission facilities

16 and that is used to modify, convert, encode, or oth17 erwise prepare signals to be transmitted via such

18 telecommunications equipment or that is used to

19 modify, reconvert, or carry signals received from

20 such facilities, the purpose of which is to accomplish

21 the goal for which the circuit was established.

22 ‘‘(10) TELECOMMUNICATIONS TRANSMISSION

23 FACILITIES.—The term ‘telecommunications trans24 mission facilities’ means facilities that transmit, re25 ceive, or carry data between telecommunications ter-
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1 minal equipment at each end of a telecommuni2 cations circuit or path. Such facilities include micro3 wave antennae, relay stations and towers, other tele4 communications antennae, fiber optic cables and re5 peaters, coaxial cables, communication satellite

6 ground station complexes, copper cable electronic

7 equipment associated with telecommunications trans8 missions, and similar items as defined by the

9 Secretary.

10 ‘‘SEC. 1718. AUTHORIZATION OF APPROPRIATIONS.

11 ‘‘There are authorized to be appropriated to carry out

12 this part such sums as may be necessary for each of the

13 fiscal years 1995 through 1998.’’.

14 TITLE II—HEALTH CARE DATA

15 INTERCHANGE SYSTEM

16 SEC. 201. ESTABLISHMENT OF HEALTH CARE DATA INTER17 CHANGE SYSTEM.

18 (a) IN GENERAL.—In accordance with the procedures

19 provided in this title, there shall be established a health

20 care data interchange system the purpose of which is to

21 make health care data available on a uniform basis to all

22 participants in the health care system.

23 (b) GENERAL REQUIREMENTS FOR SYSTEM.—The

24 system described in subsection (a) shall ensure—
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1 (1) the integration of all participants in the

2 health care system;

3 (2) the use of uniform processes which will per4 mit participants in the health care system to com5 municate electronically for the submission and re6 ceipt of health care data;

7 (3) the privacy of individuals who are patients

8 receiving health care services and the confidentiality

9 of information in the data interchange system;

10 (4) that the data in the system is verifiable,

11 timely, accurate, reliable, useful, complete, relevant,

12 time and date stamped, and comparable; and

13 (5) an overall reduction in the administrative

14 burdens and costs of the health care system, an

15 overall increase in the productivity, effectiveness,

16 and efficiency of the system, and an overall increase

17 in the quality of care furnished by the system.

18 (c) GENERAL IMPLEMENTATION.—The system de19 scribed in subsection (a) shall be implemented through—

20 (1) the development of proposed regulations as

21 provided under section 202 by the Health Care Data

22 Panel established under section 213 (referred to in

23 this title as the ‘‘Panel’’); and

24 (2) the development of final regulations through

25 the Office of Management and Budget (referred to
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1 in this title as ‘‘OMB’’) as provided under section

2 203.

3 SEC. 202. DEVELOPMENT OF PROPOSED REGULATIONS BY

4 PANEL.

5 (a) IN GENERAL.—The Panel shall, in consultation

6 with the National Health Informatics Commission estab7 lished under section 214, develop proposed regulations for

8 the implementation and ongoing operation of an inte9 grated electronic health care data interchange system that

10 are based on the operating standards, conventions, re11 quirements, and procedures for the system established, se12 lected, or developed by the Panel under sections 204

13 through 210.

14 (b) REQUIREMENTS RELATING TO PROPOSED REGU15 LATIONS.—The proposed regulations developed under sub16 section (a) shall—

17 (1) be submitted to OMB not later than 30

18 days after the date on which the Panel is required

19 to establish, select, or develop any of such operating

20 standards, conventions, requirements, and proce21 dures for the system; and

22 (2) provide that the general requirements for

23 the system referred to in section 201(b) are met.

24 (c) MODIFICATIONS.—The Panel shall continuously

25 monitor the implementation of the regulations promul-
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1 gated by OMB under section 203 and shall submit to

2 OMB any proposed modifications to such regulations de3 termined appropriate by the Panel. The requirements of

4 section 203 shall apply to any such proposed modifications

5 in the same manner as such requirements apply to the

6 proposed regulations initially submitted by the Panel.

7 SEC. 203. PROMULGATION AND IMPLEMENTATION OF PRO8 POSED REGULATIONS BY OMB.

9 (a) PROMULGATION OF REGULATIONS.—OMB shall

10 promulgate regulations based on the proposed regulations

11 submitted under section 202 within 90 days after the date

12 such proposed regulations are submitted.

13 (b) APPLICABILITY.—

14 (1) IN GENERAL.—The regulations promulgated

15 by OMB shall apply to all participants in the health

16 care system.

17 (2) SPECIAL RULE REGARDING THE MEDICARE

18 PROGRAM.—The Secretary may incorporate the ca19 pabilities of the common working file used in the

20 medicare program under title XVIII of the Social

21 Security Act into a uniform working file system de22 veloped and operated according to the regulations

23 referred to in subsection (a).

24 (c) COMPLIANCE WITH REGULATIONS.—
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1 (1) IN GENERAL.—Not later than 1 year after

2 the date on which any regulations (other than the

3 regulations described in paragraph (2)) are promul4 gated by OMB, all participants in the health care

5 system shall be required to comply with such regula6 tions.

7 (2) COMPREHENSIVE QUALITY MEASUREMENT

8 DATA.—Not later than 2 years after the date on

9 which any regulations relating to standards, conven10 tions, and requirements for comprehensive quality

11 measurement data (as described in subsection

12 204(e)(3)) are promulgated by OMB, all partici13 pants in the health care system shall be required to

14 comply with such regulations.

15 SEC. 204. SELECTION AND ESTABLISHMENT OF DATA AND

16 TRANSACTION STANDARDS, CONVENTIONS,

17 AND REQUIREMENTS FOR THE DATA INTER18 CHANGE SYSTEM.

19 (a) IN GENERAL.—The Panel, in consultation with

20 the American National Standards Institute (referred to in

21 this title as ‘‘ANSI’’), shall select and establish data and

22 transaction standards, conventions, and requirements that

23 permit the electronic interchange of any health care data

24 the Panel determines necessary for the efficient and effec25 tive administration of the health care system.
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1 (b) MINIMUM REQUIREMENTS.—The data and trans2 action standards, conventions, and requirements selected

3 and established by the Panel under this section shall, at

4 a minimum—

5 (1) ensure that the data interchange system

6 shall have the capability to comply with such stand7 ards, conventions, and requirements; and

8 (2) be based on any standards that are in use

9 and generally accepted on the date of the enactment

10 of this title or that are recommended by nationally

11 recognized standard setting groups, including ANSI,

12 the National Uniform Billing Committee, the Uni13 form Claim Form Task Force, the National Commit14 tee for Prescription Drug Programs, and the

15 Healthcare Informatics Standards Planning Panel.

16 (c) APPLICABILITY.—The proposed regulations devel17 oped by the Panel shall provide that—

18 (1) any participant in the health care system

19 who has the capability to interchange data through

20 a uniform working file developed by the Panel under

21 section 205 shall be required to transmit and receive

22 such data using the standards, conventions, and re23 quirements developed by the Panel under this sec24 tion; and
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1 (2) any participant in the health care system

2 who does not have such capability shall be required

3 to transmit and receive data through a health care

4 information clearinghouse or a health care value5 added network that is certified under the procedure

6 established pursuant to section 211.

7 (d) ADDITIONAL REQUIREMENTS.—

8 (1) IN GENERAL.—The proposed regulations

9 developed by the Panel shall provide that no partici10 pant in the health care system shall be permitted to

11 establish data requirements in addition to such

12 standards, conventions, and requirements established

13 by the Panel and included in regulations promul14 gated by OMB—

15 (A) unless 2 or more participants volun16 tarily establish such additional requirements

17 and the requirements meet all of the privacy

18 and confidentiality standards developed by the

19 Panel under this title and included in any regu20 lations promulgated by OMB; or

21 (B) unless a waiver is granted under para22 graph (2) to establish such additional require23 ments.

24 (2) CONDITIONS FOR WAIVERS.—
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1 (A) IN GENERAL.—The proposed regula2 tions developed by the Panel shall provide that

3 any participant in the health care system may

4 request a waiver to establish additional data re5 quirements.

6 (B) CONSIDERATION OF WAIVER RE7 QUESTS.—The proposed regulations developed

8 by the Panel shall provide that no waiver shall

9 be granted under this paragraph unless the en10 tity granting such waiver considers the value of

11 the additional data to be exchanged for re12 search or other purposes determined appro13 priate by the Panel, the administrative cost of

14 the additional data requirements, the burden of

15 the additional data requirements, and the bur16 den of the timing of the imposition of the addi17 tional data requirements.

18 (C) CERTAIN REQUESTS FOR WAIVERS.—

19 The proposed regulations developed by the

20 Panel shall provide that if a participant in the

21 health care system attempts to impose addi22 tional data requirements on any other such par23 ticipant, the participant on which such require24 ments are being imposed may contact the Sec25 retary. The Panel shall develop a procedure
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1 under which any participant in the health care

2 system contacting the Secretary under the pre3 ceding sentence shall remain anonymous. The

4 Secretary shall notify the participant imposing

5 the additional data requirements that such re6 quirements may not be imposed on any other

7 participant unless such other participant volun8 tarily agrees to such requirements or a waiver

9 is obtained under this paragraph.

10 (e) TIMETABLE FOR STANDARDS, CONVENTIONS,

11 AND REQUIREMENTS.—

12 (1) STANDARDS, CONVENTIONS, AND REQUIRE13 MENTS RELATING TO FINANCIAL AND ADMINISTRA14 TIVE TRANSACTIONS.—Not later than 9 months

15 after the date of the enactment of this title, the

16 Panel shall develop data and transaction standards,

17 conventions, and requirements for the following

18 items relating to the financing and administration of

19 health care:

20 (A) Enrollment.

21 (B) Eligibility.

22 (C) Payment and remittance advice.

23 (D) Claims.

24 (E) Claims status.

25 (F) Coordination of benefits.
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1 (G) Crossover billing.

2 (H) First report of injury.

3 (I) Standardized claim attachments.

4 (J) Any other items relating to the financ5 ing and administration of health care delivery.

6 (2) STANDARDS, CONVENTIONS, AND REQUIRE7 MENTS RELATING TO INITIAL QUALITY MEASURE8 MENT INDICATORS.—Not later than 12 months after

9 the date of the enactment of this title, the Panel

10 shall develop data and transaction standards, con11 ventions, and requirements for participants in the

12 health care system to transmit data derived from the

13 financial and administrative transactions data de14 scribed in paragraph (1) on quality measurement,

15 utilization monitoring, risk assessment, patient satis16 faction, outcomes, and access.

17 (3) STANDARDS, CONVENTIONS, AND REQUIRE18 MENTS RELATING TO COMPREHENSIVE QUALITY

19 MEASUREMENT DATA.—Not later than 24 months

20 after the date of the enactment of this title, the

21 Panel shall develop standards, conventions, and re22 quirements for participants in the health care sys23 tem to transmit comprehensive data collected at the

24 site of care on quality measurement, utilization mon-
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1 itoring, risk assessment, patient satisfaction, out2 comes, and access.

3 (4) STANDARDS, CONVENTIONS, AND REQUIRE4 MENTS RELATING TO DATA ON PATIENT CARE

5 RECORDS.—Not later than 36 months after the date

6 of the enactment of this title, the Panel shall develop

7 standards, conventions, and requirements related to

8 the inclusion of data from patient care records into

9 the health care data interchange system, including

10 standards, conventions, and requirements on the

11 identification of the origin of any data from such

12 records that is included in such system.

13 (5) STANDARDS, CONVENTIONS, AND REQUIRE14 MENTS FOR THE CENTERS FOR DISEASE CONTROL

15 AND PREVENTION.—Not later than 36 months after

16 the date of the enactment of this title, the Panel, in

17 collaboration with the Centers for Disease Control

18 and Prevention (referred to in this title as the

19 ‘‘CDCP’’) and in consultation with State depart20 ments of health, shall develop standards, conven21 tions, and requirements for the electronic inter22 change of data on vital health statistics collected by

23 CDCP or the States or any other such data as

24 CDCP determines appropriate.

25 (f) WAIVERS OF COMPLIANCE.—
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1 (1) FINANCIAL AND ADMINISTRATIVE TRANS2 ACTIONS.—The proposed regulations developed by

3 the Panel shall provide that any of the data and

4 transaction standards, conventions, and require5 ments relating to financial and administrative trans6 actions developed by the Panel under subsection

7 (e)(1) may be waived until January 1, 1995, for a

8 health care provider that—

9 (A) does not have access to a health care

10 information clearinghouse or a health care

11 value-added network, is in the process of devel12 oping a system that complies with such stand13 ards, conventions, and requirements, and

14 executes an agreement with the appropriate

15 regulatory entity that such provider will meet

16 such standards, conventions, and requirements

17 by a specified date (not later than January 1,

18 1995); or

19 (B) is a small rural hospital (as defined by

20 the Panel and included in regulations promul21 gated by OMB).

22 (2) COMPREHENSIVE QUALITY MEASUREMENT

23 DATA.—The proposed regulations developed by the

24 Panel shall provide that any of the data and trans25 action standards, conventions, and requirements re-
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1 lating to comprehensive quality measurement data

2 developed by the Panel under subsection (e)(3) may

3 be waived until January 1, 1998, for a health care

4 provider that—

5 (A) does not have access to a health care

6 information clearinghouse or a health care

7 value-added network, is in the process of devel8 oping a system that complies with such stand9 ards, conventions, and requirements, and

10 executes an agreement with the appropriate

11 regulatory entity that such provider will meet

12 such standards and requirements by a specified

13 date (not later than January 1, 1998); or

14 (B) agrees to obtain from such provider’s

15 records the data elements that are needed to

16 meet the standards and requirements developed

17 under subsection (e)(3) and agrees to subject

18 the provider’s data transfer process to a quality

19 assurance program that is satisfactory to the

20 appropriate regulatory entity.

21 SEC. 205. STANDARDS FOR OPERATION OF A UNIFORM

22 WORKING FILE.

23 Not later than 24 months after the date of the enact24 ment of this title the Panel shall establish standards for

25 the development and operation of a uniform working file
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1 system that is national in scope. Such standards shall en2 sure—

3 (1) that all participants in the health care sys4 tem may be linked electronically (directly or indi5 rectly) to the uniform working file system;

6 (2) that any privacy and confidentiality stand7 ards established by the Panel under section 208 are

8 satisfied;

9 (3) that the uniform working file system im10 proves the efficiency and effectiveness of the admin11 istration of the health care system, including health

12 care quality measurement;

13 (4) the interoperability of the uniform working

14 file system by—

15 (A) supporting the data and transaction

16 standards, conventions, and requirements se17 lected and established by the Panel; and

18 (B) making use of such standards, conven19 tions, and requirements; and

20 (5) the support of any other requirements se21 lected or established by the Panel.

22 SEC. 206. CODE SETS FOR SYSTEM.

23 Not later than 9 months after the date of the enact24 ment of this title, the Panel shall select and establish code

25 sets that are maintained by private and public entities as
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1 the Panel’s official code sets for use in a national uniform

2 working file system. The proposed regulations developed

3 by the Panel shall provide that any changes or updates

4 to such code sets that are established or requested by the

5 private or public entity which maintains the code set—

6 (1) shall preserve the informational value of

7 data retained either within the uniform working file

8 system or within the information systems of parties

9 making use of the data and transactions standards,

10 conventions, and requirements;

11 (2) shall include instructions on how existing

12 data containing such codes is to be converted or

13 translated so as to preserve its value;

14 (3) shall be incorporated into the official code

15 set in such a manner as to minimize the disruption

16 to the national uniform working file system and min17 imize the cost to all entities within the system for

18 reprogramming to accommodate such changes or up19 dates; and

20 (4) shall be implemented—

21 (A) only after at least 90 days advance no22 tice has been provided to participants in the

23 health care system; and

24 (B) no more frequently than on an annual

25 basis.
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1 SEC. 207. ESTABLISHMENT OF UNIQUE IDENTIFIERS.

2 (a) IN GENERAL.—Not later than 9 months after the

3 date of the enactment of this title, the Panel shall develop

4 unique identifiers for each participant in the health care

5 system.

6 (b) SPECIAL RULES.—

7 (1) INDIVIDUALS.—Each individual shall have a

8 unique identifier developed by the Panel.

9 (2) HEALTH PLANS OR PROVIDERS.—In devel10 oping unique identifiers for each health plan or pro11 vider, the Panel shall take into account multiple uses

12 for such identifiers and shall consider multiple phys13 ical locations and specialty classifications for provid14 ers. The unique identifiers for health plans or pro15 viders may be based on the system used under title

16 XVIII of the Social Security Act on the date of the

17 enactment of this title.

18 SEC. 208. PRIVACY AND CONFIDENTIALITY STANDARDS.

19 (a) IN GENERAL.—Not later than 9 months after the

20 date of the enactment of this title, the Panel, after taking

21 into consideration the Insurance Information and Privacy

22 Protection Model Act of the National Association of Insur23 ance Commissioners, other model legislation, and inter24 national guidelines, shall develop requirements that pro25 tect the privacy of participants in the health care system
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1 and ensure the confidentiality of information in the data

2 interchange system.

3 (b) PRINCIPLES CONSIDERED.—In developing the re4 quirements referred to in subsection (a), the Panel shall

5 take into consideration the following principles:

6 (1) Information relating to an identifiable or

7 identified individual should be collected only to the

8 extent necessary to carry out the purpose for which

9 the information is collected.

10 (2) Information relating to an identifiable or

11 identified individual collected for a particular pur12 pose should generally not be used for another pur13 pose without the individual’s informed consent un14 less the pooling of information renders an individ15 ual’s data unidentifiable.

16 (3) Information relating to an identifiable or

17 identified individual should be disposed of when no

18 longer necessary to carry out the purpose for which

19 it was collected, unless the pooling of information

20 renders an individual’s data unidentifiable.

21 (4) Methods to ensure the verifiability, timeli22 ness, accuracy, reliability, utility, completeness, rel23 evance, and comparability of information relating to

24 an identifiable or identified individual should be

25 instituted.
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1 (5) An individual should be notified in advance

2 of the collection of information relating to such indi3 vidual with regard to—

4 (A) whether the furnishing of information

5 is mandatory or voluntary;

6 (B) the recordkeeping practices with re7 spect to any information provided; and

8 (C) the uses to be made of any information

9 provided.

10 (6) If informed consent is necessary for the in11 tended primary or secondary use of information re12 lating to an identifiable or identified individual, the

13 individual should be provided the opportunity to re14 ject such uses at the time the information is col15 lected, except where such uses are necessary to com16 ply with law.

17 (7) An individual should be permitted to inspect

18 and correct any information which concerns such in19 dividual and should be able to obtain information on

20 how such information is being used.

21 SEC. 209. TRANSFER OF INFORMATION BETWEEN HEALTH

22 PLANS.

23 Not later than 9 months after the date of the enact24 ment of this title, the Panel shall develop rules and proce25 dures—
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•HR 3909 IH

1 (1) for determining the financial liability of

2 health plans when health care benefits are payable

3 under two or more health plans; and

4 (2) concerning the transfer among health plans

5 of appropriate official data sets needed to carry out

6 the coordination of benefits, the sequential process7 ing of claims, and other health data as determined

8 necessary by the Panel for individuals who have

9 more than 1 health plan, according to the priorities

10 established under the rules and procedures estab11 lished under paragraph (1).

12 SEC. 210. FINES AND PENALTIES FOR FAILURE TO COMPLY.

13 (a) DEVELOPMENT BY THE PANEL.—

14 (1) COMPLIANCE WITH STANDARDS FOR PRI15 VACY AND CONFIDENTIALITY.—Not later than 9

16 months after the date of the enactment of this title,

17 the Panel shall develop civil fines and penalties, as

18 determined appropriate by the Panel, to enforce any

19 of the requirements developed by the Panel under

20 section 208 relating to privacy and confidentiality.

21 The civil fines and penalties developed by the Panel

22 under this paragraph shall not be less than $1,000

23 for each violation.

24 (2) COMPLIANCE WITH OTHER REQUIRE25 MENTS.—
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1 (A) IN GENERAL.—Not later than 9

2 months after the date of the enactment of this

3 title, the Panel shall develop civil fines and pen4 alties, as determined appropriate by the Panel,

5 to enforce any of the requirements developed by

6 the Panel under this title other than the re7 quirements related to privacy and confidential8 ity. The civil fines and penalties developed by

9 the Panel under this paragraph shall not exceed

10 $100 for each violation.

11 (B) LIMITATIONS.—

12 (i) PENALTIES NOT TO APPLY WHERE

13 NONCOMPLIANCE NOT DISCOVERED EXER14 CISING REASONABLE DILIGENCE.—No civil

15 fine or penalty developed by the Panel

16 under this paragraph shall be imposed if it

17 is established that the person liable for the

18 fine or penalty did not know, and by exer19 cising reasonable diligence would not have

20 known, that such person failed to comply

21 with any of the requirements described in

22 subparagraph (A).

23 (ii) PENALTIES NOT TO APPLY TO

24 COMPLIANCE FAILURES CORRECTED WITH25 IN 30 DAYS.—No civil fine or penalty devel-
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•HR 3909 IH

1 oped by the Panel under this paragraph

2 shall be imposed if—

3 (I) the failure to comply was due

4 to reasonable cause and not to willful

5 neglect, and

6 (II) the failure to comply is cor7 rected during the 30-day period begin8 ning on the 1st date the person liable

9 for the fine or penalty knew, or by ex10 ercising reasonable diligence would

11 have known, that the failure to com12 ply occurred.

13 (iii) WAIVER.—In the case of a failure

14 to comply which is due to reasonable cause

15 and not to willful neglect, any civil fine or

16 penalty developed by the Panel under this

17 paragraph may be waived to the extent

18 that the payment of such fine or penalty

19 would be excessive relative to the compli20 ance failure involved.

21 (b) LEGISLATIVE PROPOSAL ON CERTAIN CRIMINAL

22 FINES AND PENALTIES.—Not later than 12 months after

23 the date of the enactment of this title, the Panel shall sub24 mit to Congress a legislative proposal relating to any

25 criminal fines and penalties determined appropriate by the
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1 Panel to enforce any of the requirements developed by the

2 Panel under section 208 relating to privacy and

3 confidentiality.

4 SEC. 211. OVERSIGHT OF UNIFORM WORKING FILE,

5 HEALTH CARE INFORMATION CLEARING6 HOUSES, AND VALUE-ADDED NETWORKS.

7 (a) PERIODIC REVIEWS.—Not later than 9 months

8 after the date of the enactment of this title, the Secretary

9 shall establish a procedure for the periodic review of busi10 ness practices, performance, and fees with respect to the

11 uniform working file and each health care information

12 clearinghouse and value-added network to ensure that

13 such entities are not taking unfair advantage of partici14 pants in the health care system through the application

15 of any regulations promulgated by OMB.

16 (b) CERTIFICATION PROCEDURE.—Not later than 12

17 months after the date of the enactment of this title, the

18 Panel shall establish a certification procedure for the uni19 form working file, health care information clearinghouses,

20 and value-added networks. The requirements for certifi21 cation shall include—

22 (1) adherence to the data and transaction

23 standards and requirements and the privacy and

24 confidentiality standards included in any regulations

25 promulgated by OMB;
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1 (2) making public standardized indicators of

2 performance such as accessibility, transaction re3 sponsiveness, administrative efficiency, reliability,

4 dependability, and any other indicators determined

5 appropriate by the Secretary; and

6 (3) any other requirements determined appro7 priate by the Secretary.

8 SEC. 212. ANNUAL REPORTS TO CONGRESS.

9 (a) IN GENERAL.—The Panel shall annually prepare

10 and submit to Congress a report on—

11 (1) the status of the data interchange system,

12 including the system’s ability to provide data on

13 cost, quality, and patient satisfaction;

14 (2) the savings and costs of implementing the

15 data interchange system; and

16 (3) any legislative recommendations related to

17 the data interchange system.

18 (b) AVAILABILITY TO THE PUBLIC.—Any informa19 tion in the report submitted to Congress under subsection

20 (a) shall be made available to the public unless such infor21 mation may not be disclosed by law.

22 SEC. 213. HEALTH CARE DATA PANEL.

23 (a) ESTABLISHMENT.—There is established a panel

24 to be known as the Health Care Data Panel.

25 (b) MEMBERSHIP.—
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1 (1) IN GENERAL.—The Panel shall be composed

2 of the following members:

3 (A) The Secretary.

4 (B) The Secretary of Defense.

5 (C) The Secretary of Veterans Affairs.

6 (D) A representative of the Agency for

7 Health Care Policy and Research.

8 (E) A representative of the National Insti9 tute of Standards and Technology.

10 (F) A representative of the National Tele11 communication and Information Administra12 tion.

13 (G) 6 additional Federal officers deter14 mined appropriate by the Secretary.

15 (2) CHAIR.—The Secretary shall be the Chair

16 of the Panel.

17 (c) MEETINGS.—

18 (1) IN GENERAL.—Except as provided in para19 graph (2), the Panel shall meet at the call of the

20 Chair.

21 (2) INITIAL AND SUBSEQUENT MEETINGS.—

22 The Panel shall hold a meeting not later than 30

23 days after the date of the enactment of this section

24 and at least annually thereafter.
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1 (3) QUORUM.—A majority of the members of

2 the Panel shall constitute a quorum, but a lesser

3 number of members may hold hearings.

4 (d) POWERS OF THE PANEL.—

5 (1) HEARINGS.—The Panel may hold such

6 hearings, sit and act at such times and places, take

7 such testimony, and receive such evidence as the

8 Panel considers advisable to carry out the purposes

9 of this section.

10 (2) INFORMATION FROM FEDERAL AGENCIES.—

11 The Panel may secure directly from any Federal de12 partment or agency such information as the Panel

13 considers necessary to carry out the provisions of

14 this section. Upon request of the Chair of the Panel,

15 the head of such department or agency shall furnish

16 such information to the Panel.

17 (3) POSTAL SERVICES.—The Panel may use the

18 United States mails in the same manner and under

19 the same conditions as other departments and agen20 cies of the Federal Government.

21 (4) GIFTS.—The Panel may accept, use, and

22 dispose of gifts or donations of services or property.

23 (e) PANEL PERSONNEL MATTERS.—

24 (1) COMPENSATION OF MEMBERS.—Members of

25 the Panel shall serve without compensation in addi-
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•HR 3909 IH

1 tion to that received for their services as officers or

2 employees of the Federal Government.

3 (2) STAFF.—

4 (A) DETAIL OF GOVERNMENT EMPLOY5 EES.—Upon the request of the Chair, any Fed6 eral Government employee may be detailed to

7 the Panel without reimbursement, and such de8 tail shall be without interruption or loss of civil

9 service status or privilege.

10 (B) CONTRACTS.—The Chair may enter

11 into contracts or other arrangements that may

12 be necessary for the Panel to perform its

13 duties.

14 (C) INTERNAL ORGANIZATION.—The Chair

15 may prescribe such rules as the Chair deter16 mines necessary with respect to the internal or17 ganization of the Panel.

18 SEC. 214. NATIONAL HEALTH INFORMATICS COMMISSION.

19 (a) APPOINTMENT.—The Panel shall provide for ap20 pointment of a National Health Informatics Commission

21 (referred to in this section as the ‘‘Commission’’) to advise

22 the Panel on its activities.

23 (b) MEMBERSHIP.—
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1 (1) IN GENERAL.—The Commission shall con2 sist of 15 members. The Panel shall designate 1

3 member of the Commission as the Chair.

4 (2) EXPERTISE.—Members of the Commission

5 shall be individuals who—

6 (A) represent different professions and dif7 ferent geographic areas, including urban and

8 rural areas;

9 (B) represent Federal or State government

10 health programs;

11 (C) represent applicable standard-setting

12 groups, including the National Uniform Billing

13 Committee, the Uniform Claim Form Task

14 Force, American National Standards Institute,

15 and the Healthcare Informatics Standards

16 Planning Panel;

17 (D) represent consumers of health care

18 services; and

19 (E) have expertise in—

20 (i) electronic data interchange of

21 health care information and computerized

22 information systems associated with the

23 operation and administration of matters

24 relating to health care;
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•HR 3909 IH

1 (ii) the provision and financing of

2 health care;

3 (iii) conducting and interpreting

4 health economics research;

5 (iv) research and development of tech6 nological and scientific advances in health

7 care;

8 (v) health care eligibility, enrollment,

9 and claims administration;

10 (vi) health care financial management;

11 (vii) health care reimbursement; or

12 (viii) health care outcomes research.

13 (3) TERMS.—The Chair shall serve on the Com14 mission at the pleasure of the Panel. Each other

15 member of the Commission shall be appointed for a

16 term of 5 years, except with respect to the members

17 first appointed—

18 (A) 3 members shall be appointed for a

19 term of 1 year;

20 (B) 3 members shall be appointed for

21 terms of 2 years;

22 (C) 3 members shall be appointed for

23 terms of 3 years;

24 (D) 3 members shall be appointed for

25 terms of 4 years; and
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•HR 3909 IH

1 (E) 2 members shall be appointed for

2 terms of 5 years.

3 (4) VACANCIES.—

4 (A) IN GENERAL.—A vacancy on the Com5 mission shall be filled in the manner in which

6 the original appointment was made and shall be

7 subject to any conditions which applied with re8 spect to the original appointment.

9 (B) FILLING UNEXPIRED TERM.—An indi10 vidual chosen to fill a vacancy shall be ap11 pointed for the unexpired term of the member

12 replaced.

13 (C) EXPIRATION OF TERMS.—The term of

14 any member shall not expire before the date on

15 which the member’s successor takes office.

16 (c) MEETINGS.—

17 (1) IN GENERAL.—Except as provided in para18 graph (2), the Commission shall meet at the call of

19 the Chair.

20 (2) INITIAL MEETING.—No later than 30 days

21 after the date on which all members of the Commis22 sion have been appointed, the Commission shall hold

23 its first meeting.
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1 (3) QUORUM.—A majority of the members of

2 the Commission shall constitute a quorum, but a

3 lesser number of members may hold hearings.

4 (d) DUTIES.—

5 (1) IN GENERAL.—Not later than 60 days prior

6 to any date on which the Panel is required to select,

7 establish, or develop any requirements relating to

8 the data interchange system, the Commission shall

9 make recommendations to the Panel with respect to

10 the issues relating to such requirements.

11 (2) ADDITIONAL STUDIES AND PROJECTS.—As

12 directed by the Panel, the Commission shall under13 take such studies and projects as the Panel may

14 deem necessary.

15 (e) POWERS OF THE COMMISSION.—

16 (1) HEARINGS.—The Commission may hold

17 such hearings, sit and act at such times and places,

18 take such testimony, and receive such evidence as

19 the Commission considers advisable to carry out the

20 purposes of this section.

21 (2) INFORMATION FROM FEDERAL AGENCIES.—

22 The Commission may secure directly from any Fed23 eral department or agency such information as the

24 Commission considers necessary to carry out the

25 provisions of this section. Upon request of the Chair,
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1 the head of such department or agency shall furnish

2 such information to the Commission.

3 (3) POSTAL SERVICES.—The Commission may

4 use the United States mails in the same manner and

5 under the same conditions as other departments and

6 agencies of the Federal Government.

7 (4) GIFTS.—The Commission may accept, use,

8 and dispose of gifts or donations of services or prop9 erty.

10 (f) COMMISSION PERSONNEL MATTERS.—

11 (1) COMPENSATION OF MEMBERS.—Each mem12 ber of the Commission who is not an officer or em13 ployee of the Federal Government shall be com14 pensated at a rate equal to the daily equivalent of

15 the annual rate of basic pay prescribed for level IV

16 of the Executive Schedule under section 5315 of title

17 5, United States Code, for each day (including travel

18 time) during which such member is engaged in the

19 performance of the duties of the Commission. All

20 members of the Commission who are officers or em21 ployees of the United States shall serve without com22 pensation in addition to that received for their serv23 ices as officers or employees of the United States.

24 (2) TRAVEL EXPENSES.—The members of the

25 Commission shall be allowed travel expenses, includ-
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1 ing per diem in lieu of subsistence, at rates author2 ized for employees of agencies under subchapter I of

3 chapter 57 of title 5, United States Code, while

4 away from their homes or regular places of business

5 in the performance of services for the Commission.

6 (3) STAFF.—

7 (A) IN GENERAL.—The Chair may, with8 out regard to civil service laws and regulations,

9 appoint and terminate such personnel as may

10 be necessary to enable the Commission to per11 form its duties.

12 (B) COMPENSATION.—The Chair may fix

13 the compensation of personnel without regard

14 to the provisions of chapter 51 and subchapter

15 III of chapter 53 of title 5, United States Code,

16 relating to classification of positions and Gen17 eral Schedule pay rates, except that the rate of

18 pay for the personnel may not exceed the rate

19 payable for level V of the Executive Schedule

20 under section 5316 of such title.

21 (C) DETAIL OF GOVERNMENT EMPLOY22 EES.—Any Federal Government employee may

23 be detailed to the Commission without reim24 bursement, and such detail shall be without
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1 interruption or loss of civil service status or

2 privilege.

3 (D) PROCUREMENT OF TEMPORARY AND

4 INTERMITTENT SERVICES.—The Chair may

5 procure temporary and intermittent services

6 under section 3109(b) of title 5, United States

7 Code, at rates for individuals which do not ex8 ceed the daily equivalent of the annual rate of

9 basic pay prescribed for level V of the Executive

10 Schedule under section 5316 of such title.

11 (E) CONTRACTS.—The Chair may enter

12 into contracts or other arrangements that may

13 be necessary for the Commission to perform its

14 duties.

15 (F) INTERNAL ORGANIZATION.—The Chair

16 may prescribe such rules as the Chair deter17 mines necessary with respect to the internal or18 ganization of the Commission. The Commission

19 shall create such committees (composed of

20 Commission members and others as appointed

21 by the Chair) as necessary to enable the Com22 mission to meet its responsibilities and func23 tions.

24 (g) REPORTS.—The Commission shall submit to the

25 Panel such reports as may be requested by the Panel on
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1 each study or project conducted by the Commission. Such

2 reports shall contain such information as requested by the

3 Panel.

4 (h) TERMINATION OF COMMISSION.—The Commis5 sion shall terminate 20 years after the date of the enact6 ment of this title.

7 (i) AUTHORIZATION OF APPROPRIATIONS.—

8 (1) IN GENERAL.—There are authorized to be

9 appropriated such sums as may be necessary to

10 carry out the purposes of this section.

11 (2) AVAILABILITY.—Any sums appropriated

12 under the authorization contained in this subsection

13 shall remain available, without fiscal year limitation,

14 until expended.

15 SEC. 215. DEFINITIONS.

16 For purposes of this title:

17 (1) ADMINISTRATOR.—The term ‘‘adminis18 trator’’ has the meaning given that term in section

19 3(16)(A) of the Employee Retirement Income Secu20 rity Act of 1974.

21 (2) CODE SETS.—The term ‘‘code sets’’ means

22 any codes used for supplying specific data in a uni23 form data set, including tables of terms, medical di24 agnostic codes, medical procedure codes, identifica25 tion numbers, and any code sets of the National
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1 Uniform Billing Committee, the Health Care Fi2 nancing Administration, or ANSI.

3 (3) EMPLOYEE WELFARE BENEFIT PLAN.—The

4 term ‘‘employee welfare benefit plan’’ has the mean5 ing given that term in section 3(1) of the Employee

6 Retirement Income Security Act of 1974.

7 (4) HEALTH CARE INFORMATION CLEARING8 HOUSE.—The term ‘‘health care information clear9 inghouse’’ means a public or private entity that—

10 (A) processes data that cannot be sent di11 rectly due to lack of proper formatting or edit12 ing; and

13 (B) facilitates the translation of data to

14 the standardized data set and code sets between

15 persons who normally would send or receive the

16 transaction;

17 but does not store information processed beyond the

18 time required to complete its task and communicate

19 the information.

20 (5) HEALTH CARE VALUE-ADDED NETWORK.—

21 The term ‘‘health care value-added network’’ means

22 any entity that provides additional services beyond

23 the transmission of data or value, such as the stor24 age of electronic data or value and the transfer of

25 such data or value between health care entities.
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1 (6) HEALTH PLAN.—the term ‘‘health plan’’

2 means an insured health plan and a self-insured

3 health plan.

4 (7) INSURED HEALTH PLAN.—

5 (A) IN GENERAL.—Except as provided in

6 subparagraph (B), the term ‘‘insured health

7 plan’’ means any hospital or medical service

8 policy or certificate, hospital or medical service

9 plan contract, or health maintenance organiza10 tion group contract offered by an insurer.

11 (B) EXCEPTION.—Such term does not in12 clude any of the following—

13 (i) coverage only for accident, dental,

14 vision, disability income, or long-term care

15 insurance, or any combination thereof,

16 (ii) medicare supplemental health in17 surance,

18 (iii) coverage issued as a supplement

19 to liability insurance,

20 (iv) worker’s compensation or similar

21 insurance,

22 (v) automobile medical-payment insur23 ance,

24 (vi) coverage for a specified disease or

25 illness, or
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1 (vii) a hospital or fixed indemnity pol2 icy (unless the Secretary determines that

3 such a policy provides sufficiently com4 prehensive coverage of a benefit so that it

5 should be treated as an insured health

6 plan),

7 or any combination thereof.

8 (8) INSURER.—The term ‘‘insurer’’ means any

9 entity that offers a health plan under which such en10 tity is at risk for all or part of the cost of benefits

11 under the plan, and includes any agent of such

12 entity.

13 (9) PARTICIPANT IN THE HEALTH CARE SYS14 TEM.—The term ‘‘participant in the health care sys15 tem’’ means any Federal health care program, State,

16 employee welfare benefit plan, health plan, adminis17 trator, insurer, or provider.

18 (10) PROVIDER.—The term ‘‘provider’’ means a

19 physician, hospital, pharmacy, laboratory, or other

20 person licensed or otherwise authorized under appli21 cable State laws to furnish health care items or serv22 ices.

23 (11) SELF-INSURED HEALTH PLAN.—The term

24 ‘‘self-insured health plan’’—
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1 (A) means an employee welfare benefit

2 plan or other arrangement insofar as the plan

3 or arrangement provides health benefits and

4 that is funded in a manner other than through

5 the purchase of 1 or more insured health plans,

6 but

7 (B) does not include any coverage or insur8 ance described in paragraph (7)(B).

9 (12) STATE.—The term ‘‘State’’ means each of

10 the several States, the District of Columbia, the

11 Commonwealth of Puerto Rico, the United States

12 Virgin Islands, Guam, American Samoa, and the

13 Commonwealth of the Northern Mariana Islands.

Æ