I
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. AN-
DREWS 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 Representa-
tives of the United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ‘‘Health Care Informa-
tion Modernization and Security Act of 1993’’.
SEC. 2. ESTABLISHMENT OF HEALTH CARE DATA INTER-
CHANGE 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 estab-
lished 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 com-
posed of the following members:
‘‘(A) The Secretary (or his or her des-
ignee).
‘‘(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 In-
stitute of Standards and Technology.
‘‘(F) A representative of the National Tele-
communication and Information Administra-
tion.
‘‘(G) Six additional Federal officers deter-
mined appropriate by the Secretary.
‘‘(2) CHAIRPERSON.—The Secretary shall be
the Chairperson of the Panel.
‘‘(c) MEETINGS.—
‘‘(1) IN GENERAL.—Except as provided in para-
graph (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
AGEN-
CIES.—The Panel may secure directly from any Fed-
eral 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 ad-
dition to that received for their services as officers
or employees of the Federal Government.
‘‘(2) STAFF.—
‘‘(A) DETAIL
OF
GOVERNMENT
EMPLOY-
EES.—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 con-
sultation with the Health Informatics Commission
established under section 2102, develop proposed
regulations for the implementation and ongoing op-
eration 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 regula-
tions 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 sys-
tem to communicate electronically for the sub-
mission and receipt of health care data;
‘‘(C) the privacy of individuals who are pa-
tients receiving health care services and the
confidentiality of information in the data inter-
change system;
‘‘(D) that the data in the system is verifi-
able, timely, accurate, reliable, useful, complete,
relevant, time and date stamped, and com-
parable; and
‘‘(E) an overall reduction in the adminis-
trative burdens and costs of the health care sys-
tem, an overall increase in the productivity, ef-
fectiveness, and efficiency of the system, and an
overall increase in the quality of care furnished
by the system.
‘‘(2) TIMING FOR DEVELOPMENT AND SUBMIS-
SION OF PROPOSED REGULATIONS.—Not later than
30 days after the date on which the Panel is re-
quired to establish, select, or develop any of the op-
erating 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 PRO-
POSALS DEVELOPED BY THE PANEL.—
‘‘(1) PROMULGATION OF REGULATIONS.—
‘‘(A) IN
GENERAL.—OMB shall promul-
gate regulations based on the proposed regula-
tions 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 pro-
mulgated 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 MED-
ICARE
PROGRAM.—The Secretary may incor-
porate the capabilities of the common working
file used in the medicare program under title
XVIII into a uniform working file system devel-
oped and operated according to regulations pro-
mulgated 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 promul-
gated by OMB, the persons described in para-
graph (2)(A) shall be required to comply with
such regulations.
‘‘(B) COMPREHENSIVE QUALITY MEASURE-
MENT 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 meas-
urement data (as described in subsection
(i)(1)(E)(iv)), the persons described in para-
graph (2)(A) shall be required to comply with
such regulations.
‘‘(h) MODIFICATIONS.—The Panel shall continuously
monitor the implementation of the regulations promul-
gated 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 re-
quirements of subsection (g) shall apply to any such pro-
posed modifications in the same manner as such require-
ments apply to the proposed regulations initially submit-
ted by the Panel.
‘‘(i) OPERATING STANDARDS, CONVENTIONS, RE-
QUIREMENTS, AND PROCEDURES FOR THE DATA INTER-
CHANGE SYSTEM.—
‘‘(1) SELECTION
AND
ESTABLISHMENT
OF
DATA
AND
TRANSACTION
STANDARDS, 
CONVEN-
TIONS, AND REQUIREMENTS FOR THE DATA INTER-
CHANGE SYSTEM.—
‘‘(A) IN
GENERAL.—The Panel, in con-
sultation 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 mini-
mum—
‘‘(i) ensure that the data interchange
system shall have the capability to comply
with such standards, conventions, and re-
quirements; 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 regu-
lations developed by the Panel shall provide
that—
‘‘(i) any participant in the health care
system who has the capability to inter-
change data through a uniform working
file developed by the Panel under para-
graph (2) shall be required to transmit and
receive such data using the standards, con-
ventions, and requirements developed by
the Panel under this paragraph; and
‘‘(ii) any participant in the health
care system who does not have such capa-
bility shall be required to transmit and re-
ceive data through a health care informa-
tion clearinghouse or a health care value
added network that is certified under the
procedure established pursuant to sub-
section (k).
‘‘(D) ADDITIONAL REQUIREMENTS.—
‘‘(i) IN GENERAL.—The proposed reg-
ulations developed by the Panel shall pro-
vide that no participant in the health care
system shall be permitted to establish data
requirements in addition to such stand-
ards, conventions, and requirements estab-
lished by the Panel and included in regula-
tions promulgated by OMB—
‘‘(I) unless two or more partici-
pants voluntarily establish such addi-
tional requirements and the require-
ments meet all of the privacy and con-
fidentiality 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 re-
quirements.
‘‘(II) CONSIDERATION OF WAIV-
ER REQUESTS.—The proposed regula-
tions developed by the Panel shall pro-
vide that no waiver shall be granted
under this clause unless the entity
granting such waiver considers the
value of the additional data to be ex-
changed for research or other pur-
poses determined appropriate by the
Panel, the administrative cost of the
additional data requirements, the bur-
den of the additional data require-
ments, 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 sys-
tem contacting the Secretary under
the preceding sentence shall remain
anonymous. The Secretary shall notify
the participant imposing the addi-
tional data requirements that such re-
quirements may not be imposed on
any other participant unless such
other participant voluntarily agrees to
such requirements or a waiver is ob-
tained under this clause.
‘‘(E) TIMETABLE FOR STANDARDS, CON-
VENTIONS, AND REQUIREMENTS.—
‘‘(i) INITIAL
STANDARDS, CONVEN-
TIONS, AND REQUIREMENTS RELATING TO
FINANCIAL
AND
ADMINISTRATIVE
TRANS-
ACTIONS.—Not later than 9 months after
the date of the enactment of this section,
the Panel shall develop data and trans-
action standards, conventions, and require-
ments 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 attach-
ments.
‘‘(ii) OTHER
STANDARDS, CONVEN-
TIONS, AND REQUIREMENTS RELATING TO
FINANCIAL
AND
ADMINISTRATIVE
TRANS-
ACTIONS.—Not later than 9 months after
the date of the enactment of this section,
the Panel shall develop data and trans-
action standards, conventions, and require-
ments 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 stand-
ards, conventions, and requirements for
participants in the health care system to
transmit data derived from the financial
and administrative transactions data de-
scribed in clause (i) on quality measure-
ment, utilization monitoring, risk assess-
ment, patient satisfaction, outcomes, and
access.
‘‘(iv) STANDARDS, CONVENTIONS, AND
REQUIREMENTS
RELATING
TO
COM-
PREHENSIVE
QUALITY
MEASUREMENT
DATA.—Not later than 24 months after
the date of the enactment of this section,
the Panel shall develop standards, conven-
tions, and requirements for participants in
the health care system to transmit com-
prehensive data collected at the site of care
on quality measurement, utilization mon-
itoring, risk assessment, patient satisfac-
tion, 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 pa-
tient care records into the health care data
interchange system, including standards,
conventions, and requirements on the iden-
tification of the origin of any data from
such records that is included in such sys-
tem.
‘‘(F) DATA
AND
TRANSACTION
STAND-
ARDS, 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 subpara-
graph (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 sys-
tem that complies with such stand-
ards, conventions, and requirements,
and executes an agreement with the
appropriate regulatory entity that
such provider will meet such stand-
ards, 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
MEASURE-
MENT
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 devel-
oped 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 sys-
tem that complies with such stand-
ards, conventions, and requirements,
and executes an agreement with the
appropriate regulatory entity that
such provider will meet such stand-
ards 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 pro-
gram that is satisfactory to the appro-
priate regulatory entity.
‘‘(2) STANDARDS FOR OPERATION OF A UNI-
FORM 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 confiden-
tiality standards established by the Panel
under paragraph (5) are satisfied;
‘‘(iii) that the uniform working file
system improves the efficiency and effec-
tiveness of the administration of the health
care system, including health care quality
measurement;
‘‘(iv) the interoperability of the uni-
form working file system by—
‘‘(I) supporting the data and
transaction standards, conventions,
and requirements selected and estab-
lished by the Panel; and
‘‘(II) making use of such stand-
ards, conventions, and requirements;
and
‘‘(v) the support of any other require-
ments 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 of-
ficial code set in such a manner as to mini-
mize 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
IDENTIFI-
ERS.—
‘‘(A) IN
GENERAL.—Not later than 9
months after the date of the enactment of this
section the Panel shall develop unique identifi-
ers for each participant in the health care sys-
tem.
‘‘(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 ac-
count 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 STAND-
ARDS.—
‘‘(A) IN
GENERAL.—Not later than 9
months after the date of the enactment of this
section the Panel, after taking into consider-
ation the Insurance Information and Privacy
Protection Model Act of the National Associa-
tion 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 devel-
oping the requirements referred to in subpara-
graph (A), the Panel shall take into consider-
ation the following principles:
‘‘(i) Information relating to an identi-
fiable or identified individual should be col-
lected only to the extent necessary to carry
out the purpose for which the information
is collected.
‘‘(ii) Information relating to an identi-
fiable 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 individ-
ual’s data unidentifiable.
‘‘(iii) Information relating to an iden-
tifiable or identified individual should be
disposed of when no longer necessary to
carry out the purpose for which it was col-
lected, unless the pooling of information
renders an individual’s data unidentifiable.
‘‘(iv) Methods to ensure the verifi-
ability, timeliness, accuracy, reliability,
utility, completeness, relevance, and com-
parability 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 in-
formation is mandatory or voluntary;
‘‘(II) the recordkeeping practices
with respect to any information pro-
vided; 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 col-
lected, except where such uses are nec-
essary to comply with law.
‘‘(vii) An individual should be per-
mitted to inspect and correct any informa-
tion 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 bene-
fits are payable under two or more health bene-
fit 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 prior-
ities 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 devel-
oped by the Panel under paragraph (5) relating
to privacy and confidentiality. The civil pen-
alties developed by the Panel under this sub-
paragraph shall not be less than $1,000 for
each violation.
‘‘(B) COMPLIANCE WITH OTHER REQUIRE-
MENTS.—
‘‘(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 appro-
priate by the Panel, to enforce any of the
requirements developed by this Panel
under this section other than the require-
ments related to privacy and confidential-
ity. 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 DISCOV-
ERED EXERCISING REASONABLE DILI-
GENCE.—No civil fine or penalty de-
veloped by the Panel under this sub-
paragraph shall be imposed if it is es-
tablished 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 re-
quirements described in clause (i).
‘‘(II) PENALTIES NOT TO APPLY
TO
COMPLIANCE
FAILURES
COR-
RECTED
WITHIN
DAYS.—No civil
fine or penalty developed by the Panel
under this subparagraph shall be im-
posed 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 rea-
sonable cause and not to willful ne-
glect, any civil fine or penalty devel-
oped by the Panel under this subpara-
graph may be waived to the extent
that the payment of such fine or pen-
alty 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 leg-
islative proposal relating to any criminal fines and
penalties determined appropriate by the Panel to en-
force any of the requirements developed by the Panel
under paragraph (5) relating to privacy and con-
fidentiality.
‘‘(2) ANNUAL REPORTS.—
‘‘(A) IN GENERAL.—The Panel shall annu-
ally 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 imple-
menting 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 sec-
tion 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 net-
works. The requirements for certification shall in-
clude—
‘‘(A) adherence to the data and transaction
standards and requirements and the privacy
and confidentiality standards included in any
regulations promulgated by OMB under sub-
section (g);
‘‘(B) making public standardized indica-
tors of performance such as accessibility, trans-
action responsiveness, administrative efficiency,
reliability, dependability, and any other indica-
tors 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 SYS-
TEM.—
‘‘(A) IN GENERAL.—The term ‘participant
in the health care system’ means any Federal
health care program, State, administrator, em-
ployee welfare benefit plan, health insurance
plan, insurer, or provider.
‘‘(B) ADMINISTRATOR.—The term ‘admin-
istrator’ 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 sec-
tion 3(1) of the Employee Retirement Income
Security Act of 1974.
‘‘(D) HEALTH
INSURANCE
PLAN.—The
term ‘health insurance plan’ means any con-
tract 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 (includ-
ing 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 in-
cludes any agent of such entity.
‘‘(F) PROVIDER.—The term ‘provider’
means a physician, hospital, pharmacy, labora-
tory, or other person licensed or otherwise au-
thorized 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 CLEARING-
HOUSE.—The term ‘health care information clear-
inghouse’ means a public or private entity that—
‘‘(A) processes data that cannot be sent di-
rectly due to lack of proper formatting or edit-
ing; 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
NET-
WORK.—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 trans-
fer of such data or value between health care enti-
ties.
‘‘(4) CODE SETS.—The term ‘code sets’ means
any codes used for supplying specific data in a uni-
form data set, including tables of terms, medical di-
agnostic codes, medical procedure codes, identifica-
tion numbers, and any code sets of the National
Uniform Billing Committee, the Health Care Fi-
nancing 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 con-
sist 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 govern-
ment 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 manage-
ment;
‘‘(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 in-
dividual chosen to fill a vacancy shall be ap-
pointed 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 para-
graph (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 Commis-
sion 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 relat-
ing to the data interchange system, the Commission
shall make recommendations to the Panel with re-
spect to the issues relating to such requirements.
‘‘(2) ADDITIONAL STUDIES AND PROJECTS.—As
directed by the Panel, the Commission shall under-
take 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
AGEN-
CIES.—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 prop-
erty.
‘‘(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 com-
pensated 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 em-
ployees of the United States shall serve without com-
pensation in addition to that received for their serv-
ices as officers or employees of the United States.
‘‘(2) TRAVEL EXPENSES.—The members of the
Commission shall be allowed travel expenses, includ-
ing per diem in lieu of subsistence, at rates author-
ized 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 regula-
tions, 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 sub-
chapter III of chapter 53 of title 5, United
States Code, relating to classification of posi-
tions 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 Exec-
utive Schedule under section 5316 of such title.
‘‘(C) DETAIL
OF
GOVERNMENT
EMPLOY-
EES.—Any Federal Government employee may
be detailed to the Commission without reim-
bursement, 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 serv-
ices 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 per-
form 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 respon-
sibilities 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 Commis-
sion shall terminate 20 years after the date of the enact-
ment 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 enact-
ment of this Act.
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