I
107TH CONGRESS
1ST SESSION
H. R. 3323
To ensure that covered entities comply with the standards for electronic
health care transactions and code sets adopted under part C of title
XI of the Social Security Act, and for other purposes.
IN THE HOUSE OF REPRESENTATIVES
NOVEMBER 16, 2001
Mr. HOBSON (for himself, Mr. SAWYER, Mr. STARK, Ms. PRYCE of Ohio, Mr.
GILLMOR, Mr. BURR of North Carolina, Mr. BLUNT, Mrs. JOHNSON of
Connecticut, Mr. UPTON, Mr. THOMAS, Mr. MCDERMOTT, Mr. BACHUS,
Mr. RANGEL, Mr. TIBERI, Mr. OSE, Mr. REGULA, Mr. LATOURETTE,
Mr. GREENWOOD, Mr. WHITFIELD, Mrs. THURMAN, Mr. STRICKLAND,
Mr. PORTMAN, and Mr. BECERRA) introduced the following bill; which
was referred to the Committee on Energy and Commerce, and in addition
to the Committee on Ways and Means, for a period to be subsequently
determined by the Speaker, in each case for consideration of such provi-
sions as fall within the jurisdiction of the committee concerned
A BILL
To ensure that covered entities comply with the standards
for electronic health care transactions and code sets
adopted under part C of title XI of the Social Security
Act, and for other purposes.
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled,
SECTION 1. EXTENSION OF DEADLINE FOR COVERED ENTI-
TIES SUBMITTING COMPLIANCE PLANS.
(a) IN GENERAL.—
(1) EXTENSION.—Subject to paragraph (2),
notwithstanding section 1175(b)(1)(A) of the Social
Security Act (42 U.S.C. 1320d–4(b)(1)(A)) and sec-
tion 162.900 of title 45, Code of Federal Regula-
tions, a health care provider, health plan (other than
a small health plan), or a health care clearinghouse
shall not be considered to be in noncompliance with
the applicable requirements of subparts I through R
of part 162 of title 45, Code of Federal Regulations,
before October 16, 2003.
(2) CONDITION.—Paragraph (1) shall apply to
a person described in such paragraph only if, before
October 16, 2002, the person submits to the Sec-
retary of Health and Human Services a plan detail-
ing how the person will come into compliance with
the requirements described in such paragraph not
later than October 16, 2003. Such plan shall include
a summary of the following:
(A) An analysis reflecting the extent to
which, and the reasons why, the person is not
in compliance.
(B) A budget, schedule, work plan, and im-
plementation strategy for achieving compliance.
Vital and Health Statistics shall consult
with each organization—
(I) 
described 
in 
section
1172(c)(3)(B) of the Social Security
Act (42 U.S.C. 1320d–1(c)(3)(B)); or
(II) designated by the Secretary
of Health and Human Services under
section 162.910(a) of title 45, Code of
Federal Regulations.
(iii) FURNISHING OF PLANS.—Subject
to subparagraph (C), the Secretary of
Health and Human Services shall furnish
the National Committee on Vital and
Health Statistics with all of the compliance
plans submitted under paragraph (2), from
which such committee shall select the sam-
ple for analysis.
(B) REPORTS
ON
SOLUTIONS.—The Na-
tional Committee on Vital and Health Statistics
shall regularly publish, and widely disseminate
to the public, reports containing effective solu-
tions to compliance problems identified in the
compliance plans analyzed under subparagraph
(A). Such reports shall not relate specifically to
any one plan but shall be written for the pur-
pose of assisting the maximum number of per-
sons to come into compliance by addressing the
most common or challenging problems encoun-
tered by persons submitting such plans.
(C) PROTECTION
OF
CONFIDENTIAL
IN-
FORMATION.—The Secretary of Health and
Human Services shall ensure that any material
provided under subparagraph (A) to the Na-
tional Committee on Vital and Health Statistics
or any organization described in subparagraph
(A)(ii) is redacted so as to prevent the disclo-
sure of any—
(i) trade secrets;
(ii) commercial or financial informa-
tion that is privileged or confidential; and
(iii) other information the disclosure
of which would constitute a clearly unwar-
ranted invasion of personal privacy.
(6) ENFORCEMENT THROUGH EXCLUSION FROM
PARTICIPATION IN MEDICARE.—
(A) IN GENERAL.—In the case of a person
described in paragraph (1) who fails to submit
a plan in accordance with paragraph (2), and
who is not in compliance with the applicable re-
quirements of subparts I through R of part 162
of title 45, Code of Federal Regulations, on or
after October 16, 2002, the person is subject
to exclusion from participation (including under
part C or as a contractor under sections 1816,
1842, and 1893) in title XVIII of the Social
Security Act (42 U.S.C. 1395 et seq.).
(B) PROCEDURE.—The provisions of sec-
tion 1128A of the Social Security Act (42
U.S.C. 1320a–7a) (other than the first and sec-
ond sentences of subsection (a) and subsection
(b)) shall apply to an exclusion under this para-
graph in the same manner as such provisions
apply with respect to an exclusion or proceeding
under section 1128A(a).
(C) CONSTRUCTION.—The availability of a
exclusion under this paragraph shall not be con-
strued to affect the imposition of penalties
under section 1176 of the Social Security Act
(42 U.S.C. 1320d–5).
(D) NONAPPLICABILITY
TO
COMPLYING
PERSONS.—The exclusion under subparagraph
(A) shall not apply to a person who—
(i) submits a plan in accordance with
paragraph (2); or
(ii) who is in compliance with the ap-
plicable 
requirements 
of 
subparts 
I
through R of part 162 of title 45, Code of
Federal Regulations, on or before October
16, 2002.
(b) SPECIAL RULES.—
(1) RULES
OF
CONSTRUCTION.—Nothing in
this section shall be construed—
(A) as modifying the October 16, 2003,
date for compliance of small health plans with
subparts I through R of part 162 of title 45,
Code of Federal Regulations; or
(B) as modifying—
(i) the April 14, 2003, date for com-
pliance of a health care provider, a health
plan (other than a small health plan), or a
health care clearinghouse with subpart E
of part 164 of title 45, Code of Federal
Regulations; or
(ii) the April 14, 2004, date for com-
pliance of a small health plan with subpart
E of part 164 of title 45, Code of Federal
Regulations.
(2) APPLICABILITY OF PRIVACY REQUIREMENTS
TO CERTAIN TRANSACTIONS PRIOR TO STANDARDS
COMPLIANCE DATE.—
(A) IN
GENERAL.—Notwithstanding any
other provision of law, during the period that
begins on April 14, 2003, and ends on October
16, 2003, a health care provider or, subject to
subparagraph (C), a health care clearinghouse,
that transmits any health information in elec-
tronic form in connection with a transaction de-
scribed in subparagraph (B) shall comply with
the requirements of subpart E of part 164 of
title 45, Code of Federal Regulations, without
regard to whether the transmission meets the
standards required by part 162 of such title.
(B) 
TRANSACTIONS
DESCRIBED.—The
transactions described in this subparagraph are
the following:
(i) A health care claims or equivalent
encounter information transaction.
(ii) A health care payment and remit-
tance advice transaction.
(iii) A coordination of benefits trans-
action.
(iv) A health care claim status trans-
action.
(v) An enrollment and disenrollment
in a health plan transaction.
(vi) An eligibility for a health plan
transaction.
(vii) A health plan premium payments
transaction.
(viii) A referral certification and au-
thorization transaction.
(C) 
APPLICATION
TO
HEALTH
CARE
CLEARINGHOUSES.—For purposes of this para-
graph, during the period described in subpara-
graph (A), an entity that would otherwise meet
the definition of health care clearinghouse that
processes or facilitates the processing of infor-
mation in connection with a transaction de-
scribed in subparagraph (B) shall be deemed to
be a health care clearinghouse notwithstanding
that the entity does not process or facilitate the
processing of such information into any stand-
ard formats required by part 162 of title 45,
Code of Federal Regulations.
(c) DEFINITIONS.—In this section—