point of care, for use by utilization and quality
control peer review organizations with respect
to physician care.
(C) A specification of, and manner of pres-
entation of, the individual data elements of the
sets under this paragraph.
(D) Standards concerning the electronic
transmission of such data sets.
(E) Standards relating to confidentiality of
health information reported under this section,
which include the physical security of electronic
data 
and 
the 
use 
of 
keys, 
passwords,
encryption, and other means to ensure the pro-
tection of the confidentiality and privacy of
electronic data.
(F) Standards to ensure the suitability of
electronic data as evidence in a court of law.
(3) COORDINATION WITH STANDARDS FOR UNI-
FORM ELECTRONIC CLAIMS DATA SET.—In establish-
ing standards under this subsection, the Secretary
shall ensure that—
(A) the development of the standards is co-
ordinated with the development of the stand-
ards for the uniform electronic claims data set
under section 203;
(B) the coding of the same data elements
under the uniform hospital clinical data set, the
uniform patient information data set, and the
uniform electronic claims data set is consistent;
and
(C) the standards under this subsection
are consistent, to the maximum extent prac-
ticable, with other standards existing at the
time the standards under this subsection are es-
tablished, including any standard set by the
American National Standards Institute.
(4) CONSULTATION.—in establishing standards
under this subsection, the Secretary shall—
(A) consult with the American National
Standards Institute, health care providers,
health benefit plan sponsors, and other inter-
ested parties; and
(B) take into consideration the data set
used by the utilization and quality control peer
review program under part B of title XI of the
Social Security Act.
(5) DEADLINES.—The Secretary shall promul-
gate standards described in paragraph (2) concern-
ing the uniform hospital clinical data set prior to the
expiration of the 1-year period beginning on the date
of the enactment of this Act. The Secretary shall
promulgate standards described in paragraph (2)
concerning the uniform patient information clinical
data set prior to January 1, 2001.
(b) REQUIREMENT
FOR APPLICATION
OF ELEC-
TRONIC RECORDS STANDARDS TO HOSPITALS.—
(1) AS
CONDITION
OF
MEDICARE
PARTICIPA-
TION.—As of January 1, 2001, each hospital, as a
requirement of each participation agreement under
section 1866 of the Social Security Act, shall, in ac-
cordance with the standards promulgated under sub-
section (a)(1)—
(A) maintain clinical data included in the
uniform hospital clinical data set under sub-
section (a)(2)(A) in electronic form on all inpa-
tients;
(B) upon request of the Secretary or of a
utilization and quality control peer review orga-
nization (with which the Secretary has entered
into a contract under part B of title XI of such
Act), transmit electronically data requested
from such data set; and
(C) upon request of the Secretary, or of a
fiscal intermediary or carrier, transmit elec-
tronically any data (with respect to a claim)
from such data set.
(2) APPLICATION
OF
PRESENTATION
AND
TRANSMISSION STANDARDS TO ELECTRONIC TRANS-
MISSION TO FEDERAL AGENCIES.—Effective Janu-
ary 1, 2001, if a hospital is required under a Fed-
eral program to transmit a data element included in
the uniform hospital clinical data set that is subject
to a standard, promulgated under subsection (a)(1),
described in subparagraph (C) or (D) of subsection
(a)(2), the head of the Federal agency responsible
for such program (if not otherwise authorized) is au-
thorized to require the provider to present and
transmit the data element electronically in accord-
ance with such a standard.
(c) LIMITATION ON DATA REQUIREMENTS WHERE
STANDARDS IN EFFECT.—
(1) IN
GENERAL.—On or after January 1,
2001, a health benefit plan sponsor may not require,
for the purpose of utilization review or as a condi-
tion of providing benefits or making payments under
the plan provided, that a hospital—
(A) provide any data element not in the
uniform hospital clinical data set specified
under the standards promulgated under sub-
section (a); or
(B) transmit or present any such data ele-
ment in a manner inconsistent with such stand-
ards applicable to such transmission or presen-
tation.
(2) COMPLIANCE.—The Secretary may impose
a civil money penalty on any health benefit plan
sponsor that fails to comply with paragraph (1) in
an amount not to exceed $100 for each such failure.
The provisions of section 1128A of the Social Secu-
rity Act (other than the first sentence of subsection
(a) and other than subsection (b)) shall apply to a
civil money penalty under this paragraph in the
same manner as such provisions apply to a penalty
or proceeding under section 1128A(a) of such Act.
(3) APPLICATION TO MEDICARE PROGRAM.—Ef-
fective as of January 1, 2001, neither the Secretary,
nor any carrier or fiscal intermediary, nor any utili-
zation and quality control peer review organization
may require, for the purpose of utilization review or
as a condition of providing benefits or making pay-
ments under the medicare program, that a hos-
pital—
(A) provide any data element not in the
uniform hospital clinical data set specified
under the standards promulgated under sub-
section (a); or
(B) transmit or present any such data ele-
ment in a manner inconsistent with such stand-
ards applicable to such transmission or presen-
tation.
(4) APPLICATION TO MEDICAID PROGRAM.—As
a condition for the approval of State plans under the
medicaid program and in accordance with regula-
tions of the Secretary, effective as of January 1,
2001, each such plan may not require that a hos-
pital, for the purpose of utilization review or as a
condition of providing benefits or making payments
under the plan—
(A) provide any data element not in the
uniform hospital clinical data set specified
under the standards promulgated under sub-
section (a), or
(B) transmit or present any such data ele-
ment in a manner inconsistent with such stand-
ards applicable to such transmission or presen-
tation.
(d) PREEMPTION OF STATE QUILL PEN LAWS.—
(1) IN GENERAL.—Any provision of State law
that requires medical or health insurance records
(including billing information) to be maintained in
written, rather than electronic, form is deemed to be
satisfied if the records are maintained in an elec-
tronic form that meets standards established by the
Secretary under paragraph (2).
(2) SECRETARIAL AUTHORITY.—Not later than
1 year after the date of the enactment of this Act,
the Secretary shall issue regulations to carry out
paragraph (1). The regulations shall provide for an
electronic substitute that is in the form of a unique
identifier (assigned to each authorized individual)
that serves the functional equivalent of a signature.
The regulations may provide for such exceptions to
paragraph (1) as the Secretary determines to be nec-
essary to prevent fraud and abuse, to prevent the il-
legal distribution of controlled substances, and in
such other cases as the Secretary deems appropriate.
(3) EFFECTIVE
DATE.—Paragraph (1) shall
take effect on the first day of the first month that
begins more than 30 days after the date the Sec-
retary issues the regulations referred to in para-
graph (2).
SEC. 205. UNIFORM HOSPITAL COST REPORTING.
Each hospital, as a requirement under a participation
agreement under section 1866(a) of the Social Security
Act for each cost reporting period beginning during or
after fiscal year 1996, shall provide for the reporting of
information to the Secretary with respect to any hospital
care provided in a uniform manner consistent with stand-
ards established by the Secretary to carry out section
4007(c) of the Omnibus Budget Reconciliation Act of
1987 and in an electronic form consistent with standards
established by the Secretary.
SEC. 206. USE OF TASK FORCES.
In adopting standards under this title, the Sec-
retary—
(1) shall take into account the recommenda-
tions of—
(A) current task forces, including at least
the Workgroup on Electronic Data Interchange,
National Uniform Billing Committee, the Uni-
form Claim Task Force, and the Computer-
based Patient Record Institute; and
(B) national organizations representing
health care financial managers; and
(2) shall provide that electronic transmission
standards are consistent, to the extent practicable,
with the applicable standards established by the Ac-
credited Standards Committee X–12 of the Amer-
ican National Standards Institute.
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