137
(A) the effect of such systems on the cost
of health care within the State,
(B) the impact of such systems on the ac-
cess of individuals to health care within the
State, and
(C) the effect of such systems on the qual-
ity of health care provided within such State;
and
(2) to the extent that such report does not pro-
vide information on no-fault systems operated by
States as alternative dispute resolution systems pur-
suant to this part, an analysis of the feasibility and
desirability of establishing a system under which
medical malpractice liability claims shall be resolved
on a no-fault basis.
Subtitle B—Other Requirements
and Programs
SEC. 441. FACILITATING DEVELOPMENT AND USE OF
MEDICAL PRACTICE GUIDELINES.
(a) INCREASE IN AUTHORIZATION OF APPROPRIA-
TIONS.—Section 1142(i)(1) of the Social Security Act (42
U.S.C. 1320b–12(i)(1)) is amended by striking subpara-
graphs (D) and (E) and inserting the following:
‘‘(D) $158,000,000 for fiscal year 1995 (of
which $10,000,000 shall be used for sanction-
138
ing practice guidelines for purposes of an af-
firmative defense in medical malpractice liabil-
ity actions);
‘‘(E) $200,000,000 for fiscal year 1996 (of
which $20,000,000 shall be used for sanction-
ing practice guidelines for purposes of an af-
firmative defense in medical malpractice liabil-
ity actions); and
‘‘(F) $20,000,000 for fiscal year 1997, to
be used for sanctioning practice guidelines for
purposes of an affirmative defense in medical
malpractice liability actions.’’.
(b) CONSIDERATION
OF MALPRACTICE LIABILITY
DATA IN DEVELOPING AND UPDATING GUIDELINES.—
Section 1142(c)(5) of such Act (42 U.S.C. 1320b–
12(c)(5)) is amended by striking ‘‘claims data’’ and all
that follows through ‘‘patients’’ and inserting the follow-
ing: ‘‘claims data, data on clinical and functional status
of patients, and data on medical malpractice liability ac-
tions’’.
(c) DEVELOPMENT
OF
REPORTING
FORMS
FOR
STATE ADR SYSTEMS.—The Secretary, in consultation
with the Administrator for Health Care Policy and Re-
search, shall develop a standard reporting form to be used
by State alternative dispute resolution systems in trans-
139
mitting information to the Administrator pursuant to sec-
tion 431(a)(6) on disputes resolved under such systems.
(d) STUDY OF EFFECT OF GUIDELINES ON MEDICAL
MALPRACTICE.—
(1) STUDY.—The Secretary shall conduct a
study of the effect of the use of the medical practice
guidelines developed by the Administrator for Health
Care Policy and Research on the incidence of and
the costs associated with medical malpractice.
(2) REPORTS.—(A) Not later than 1 year after
the date of the enactment of this Act, the Secretary
shall submit an interim report to Congress describ-
ing the availability and use of medical practice
guidelines and the aggregate costs associated with
medical malpractice.
(B) Not later than 5 years after the date of the
enactment of this Act, the Secretary shall submit a
report to Congress on the study conducted under
paragraph (1), together with recommendations re-
garding expanding the use of medical practice guide-
lines for determining the liability of health care pro-
fessionals and health care providers for medical mal-
practice.
140
SEC. 442. PERMITTING STATE PROFESSIONAL SOCIETIES
TO PARTICIPATE IN DISCIPLINARY ACTIVI-
TIES.
(a) ROLE OF PROFESSIONAL SOCIETIES.—Notwith-
standing any other provision of State or Federal law, a
State agency responsible for the conduct of disciplinary
actions for a type of health care practitioner may enter
into agreements with State or county professional societies
of such type of health care practitioner to permit such so-
cieties to participate in the licensing of such health care
practitioner, and to review any health care malpractice ac-
tion, health care malpractice claim or allegation, or other
information concerning the practice patterns of any such
health care practitioner. Any such agreement shall comply
with subsection (b).
(b) REQUIREMENTS OF AGREEMENTS.—Any agree-
ment entered into under subsection (a) for licensing activi-
ties or the review of any health care malpractice action,
health care malpractice claim or allegation, or other infor-
mation concerning the practice patterns of a health care
practitioner shall provide that—
(1) the health care professional society conducts
such activities or review as expeditiously as possible;
(2) after the completion of such review, such so-
ciety shall report its findings to the State agency
with which it entered into such agreement;
141
(3) the conduct of such activities or review and
the reporting of such findings be conducted in a
manner which assures the preservation of confiden-
tiality of health care information and of the review
process; and
(4) no individual affiliated with such society is
liable for any damages or injury directly caused by
the individual’s actions in conducting such activities
or review.
(c) AGREEMENTS NOT MANDATORY.—Nothing in
this section may be construed to require a State to enter
into agreements with societies described in subsection (a)
to conduct the activities described in such subsection.
(d) EFFECTIVE DATE.—This section shall take effect
2 years after the date of the enactment of this Act.
TITLE V—ADMINISTRATIVE
COST SAVINGS
Subtitle A—Standardization of
Claims Processing
SEC. 
501. 
ADOPTION 
OF 
DATA 
ELEMENTS, 
UNIFORM
CLAIMS, AND UNIFORM ELECTRONIC TRANS-
MISSION STANDARDS.
(a) IN GENERAL.—The Secretary of Health and
Human Services (in this title referred to as the ‘‘Sec-
142
retary’’) shall adopt standards relating to each of the fol-
lowing:
(1) Data elements for use in paper and elec-
tronic claims processing under health benefit plans,
as well as for use in utilization review and manage-
ment of care (including data fields, formats, and
medical nomenclature, and including plan benefit
and insurance information).
(2) Uniform claims forms (including uniform
procedure and billing codes for uses with such forms
and including information on other health benefit
plans that may be liable for benefits).
(3) Uniform electronic transmission of the data
elements (for purposes of billing and utilization re-
view).
Standards under paragraph (3) relating to electronic
transmission of data elements for claims for services shall
supersede (to the extent specified in such standards) the
standards adopted under paragraph (2) relating to the
submission of paper claims for such services.
(b) USE OF TASK FORCES.—In adopting standards
under this section—
(1) the Secretary shall take into account the
recommendations of current taskforces, including at
least the Workgroup on Electronic Data Inter-
143
change, National Uniform Billing Committee, the
Uniform Claim Task Force, and the Computer-based
Patient Record Institute;
(2) the Secretary shall consult with the Na-
tional Association of Insurance Commissioners (and,
with respect to standards under subsection (a)(3),
the American National Standards Institute); and
(3) the Secretary shall, to the maximum extent
practicable, seek to make the standards consistent
with any uniform clinical data sets which have been
adopted and are widely recognized.
(c) DEADLINES
FOR PROMULGATION.—The Sec-
retary shall promulgate the standards under—
(1) subsection (a)(1) relating to claims process-
ing data, by not later than 12 months after the date
of the enactment of this Act;
(2) subsection (a)(2) (relating to uniform
claims forms) by not later than 12 months after the
date of the enactment of this Act; and
(3)(A) subsection (a)(3) relating to trans-
mission of information concerning hospital and phy-
sicians services, by not later than 24 months after
the date of the enactment of this Act, and