(2) FORM
OF
INQUIRY.—Each clearinghouse
shall be capable of accepting inquiries under this
subsection in a variety of electronic and other forms,
including—
(A) through electronic transmission of in-
formation on the uniform health claims card (in
a manner similar to that for verification of
credit card purchases),
(B) through the use of a touch-tone tele-
phone line, and
(C) through the use of a computer modem.
The clearinghouse shall also provide, for an addi-
tional fee, for the acceptance of inquiries in a
nonelectronic form.
(3) FORM OF RESPONSE.—Each clearinghouse
shall be capable of responding to such inquiries
under this subsection in a variety of electronic and
other forms, including—
(A) through modem transmission of infor-
mation,
(B) through computer synthesized voice
communication, and
(C) through transmission of information to
a facsimile (fax) machine.
The clearinghouse shall also provide, for an addi-
tional fee, for the response to inquiries in a
nonelectronic form.
(4) LIMITATION
ON
FEES.—A clearinghouse
may not impose a fee for the acceptance or response
to an inquiry under this subsection except where the
acceptance or response is in a nonelectronic form.
(e) CLEARINGHOUSE REQUIRED FUNCTIONS RELAT-
ING TO RECEIPT AND PROCESSING OF CLAIMS FOR BENE-
FITS.—
(1) PROCESSING OF CLAIMS.—
(A) IN GENERAL.—As set forth in its con-
tract with the Secretary, each clearinghouse
serving residents of an area shall—
(i) receive claims for benefits under
health benefit plans for such residents;
(ii) process the claims to determine if
they are clean claims (as defined in section
301(c)(1));
(iii) if a claim is not a clean claim, no-
tify the person submitting the claim (I)
that payment is not authorized for the
claim, (II) of the reasons for the denial,
and (III) concerning the process available
for the appeal of such determination; and
(iv) if a claim is a clean claim—
(I) notify the person submitting
the claim that payment may be made
for the claim and the amount that is
payable under the plan and the
amount that is payable by the bene-
ficiary as cost-sharing with respect to
the provider and service, and
(II) notify the plan (or plans) lia-
ble for payment with respect to the
claim, of the submission and approval
of the claim (and provide the plan
with such additional information with
respect to the person submitting the
claim and the services under the claim
as may be required for payment to be
made on the claim).
(B) INTER-CLEARINGHOUSE VERIFICATION
PROCESS.—In addition, in the case of a service
furnished to an individual assigned to another
clearinghouse—
(i) the clearinghouse serving the pro-
vider shall forward claims described in sub-
paragraph (A) on behalf of the provider to
the clearinghouse serving the individual for
processing, and
(ii) the clearinghouse serving the indi-
vidual shall respond to the claim through
the clearinghouse serving the provider.
The Secretary may provide for such inter-clear-
inghouse electronic network as may expedite ac-
tivities under this subparagraph.
(2) FORM OF CLAIM.—Each clearinghouse shall
be capable of accepting claims under this subsection
in an electronic form, including through electronic
modem transmission. Each clearinghouse also shall
provide, for an additional fee, for the acceptance of
claims submitted on a uniform nonelectronic claims
form.
(3) PROCESSING
OF
CLAIM.—For each claim
submitted by health service provider for care fur-
nished to an individual, the clearinghouse shall de-
termine—
(A) if the claim is in proper form and the
individual is covered under a health benefit
plan,
(B) if so, whether under such plan the in-
dividual is entitled to benefits with respect to
that provider and that care, and
(C) any preconditions, such as prior au-
thorization, that may exist for payment to be
made for such care and, to the extent specified
by the Secretary, whether such preconditions
have been met.
(4) RESPONSE.—Each clearinghouse shall be
capable of responding to such inquiries in a variety
of electronic forms, including—
(A) through modem transmission of infor-
mation, and
(B) through transmission of information to
a facsimile (fax) machine.
The clearinghouse also shall provide, for an addi-
tional fee, for the response to claims in a
nonelectronic form.
(f) OPTIONAL PAYMENT FUNCTIONS.—
(1) IN
GENERAL.—Under a contractual ar-
rangement between a health benefit plan and a
clearinghouse, each clearinghouse may make pay-
ment of cleans claims received by the clearinghouse
for beneficiaries under the plan in return for pay-
ment from the plan. Any such contract shall be
made only on commercially reasonable terms, includ-
ing (if appropriate for non-Federal health plans) the
provision of a bonds or other assurances of payment
(i) the identity of the individual (using
the Social Security account number of the
individual or, in the case of an infant or
other individual to whom such a number
has not been issued, such a Social Security
account number of a parent or guardian or
other number as the Secretary shall speci-
fy), and
(ii) the health claims clearinghouse to
which the individual is assigned under sec-
tion 303(c).
(B) USE
OF
ELECTRONIC
READ-AND-
WRITE CARDS.—The Secretary may provide for
cards in a electronic form that permit informa-
tion on the card to be readily changed. Such in-
formation may include information relating to
the health coverage status of the individual and
the medical history of the individual.
(3) 
ADDITIONAL
INFORMATION.—The 
card
shall include such additional information, in elec-
tronic or other form, as the Secretary may require
to carry out the purposes of this subtitle. In addi-
tion, the health benefit plan issuing the card may in-
clude such additional information on the card as the
plan desires, subject to such limitations as the Sec-
retary may provide.
(4) ASSURING CONFIDENTIALITY OF INFORMA-
TION.—In establishing standards under this sub-
section, the Secretary shall include a requirement
that, to the greatest extent possible, information on
an individual’s medical condition or medical history
shall be treated in a confidential manner.
(b) UNIFORM CLAIMS DATA SET.—
(1) IN GENERAL.—The Secretary shall establish
standards with respect to the type and form of sub-
stantiating documentation that—
(A) health claims clearinghouse may re-
quire in order for a claim for benefits to be ac-
cepted for processing, and
(B) claims for benefits under such plans
may be required to provide in order to be treat-
ed as clean claims and to obtain payment.
(2) SCOPE
OF
DATA
SET.—The standards
under this subsection are intended to cover substan-
tially most claims that are filed under health benefit
plans. Such data set need not include all elements
that may potentially be required to be reported
under utilization review provisions of plans.
(3) CONSISTENCY WITH ELECTRONIC MEDICAL
RECORDS.—In establishing standards under this
subsection, the Secretary shall assure that the
standards—
(A) are consistent with standards being de-
veloped for the maintenance of electronic medi-
cal records, and
(B) would permit data elements from such
medical records to be the elements which are
transmitted for purposes of electronic submis-
sion of claims.
(4) UNIFORM, UNIQUE PROVIDER IDENTIFICA-
TION CODES.—In establishing standards under this
subsection, the Secretary shall provide for a unique
identifier for each health service provider (as defined
in section 302(a)(3)) that submits claims for pay-
ment to health benefit plans.
(5) UNIFORM
DIAGNOSTIC
AND
PROCEDURE
CODES.—In establishing standards under this sub-
section, the Secretary shall develop a single, uniform
coding system for diagnostic and procedure codes.
(c) FREE SOFTWARE TO PROVIDERS.—The Secretary
shall provide for the development, and shall make available
without charge to health service providers, such computer
software as will enable the providers—
(1) to make inquiries, and receive responses,
electronically respecting the eligibility and benefits of
an individual under health benefit plans,
(2) to submit claims and to receive verification
of claims status electronically, and
(3) in the case of hospitals to submit uniform
reports.
(d) ADJUSTMENTS FOR RURAL PROVIDERS.—In es-
tablishing standards under this section, the Secretary shall
provide for such exceptions and adjustments as are nec-
essary to take into account the circumstances faced by
health service providers in rural areas and the need to en-
sure the availability of health services to individuals resid-
ing in such areas.
(e) DEADLINE.—The Secretary shall first provide for
the standards for uniform health claims cards under sub-
section (a) and for the standards for uniform claims data
set under subsection (b) and shall develop (and make
available) the software under subsection (c) by not later
than 18 months after the date of the enactment of this
Act.
SEC. 305. EXCISE TAX ON PREMIUMS RECEIVED ON GROUP
HEALTH PLANS WHICH DO NOT MEET CER-
TAIN REQUIREMENTS.
(a) IN GENERAL.—Chapter 47 of the Internal Reve-
nue Code of 1986 (relating to taxes on group health plans)
is amended by adding at the end thereof the following new
section:
‘‘SEC. 5000A. FAILURE TO SATISFY CERTAIN STANDARDS
FOR GROUP HEALTH PLANS.
‘‘(a) IN GENERAL.—
‘‘(1) TAX.—In the case of any group health
plan, there is hereby imposed a tax on the failure of
such person to meet at any time during any taxable
year the applicable requirements of section 301 of
the Rural Health Care Access Improvement Act of
1993.
‘‘(2) DETERMINATION
OF
VIOLATIONS.—The
Secretary of Health and Human Services shall de-
termine whether any person meets the requirements
of such section.
‘‘(3) SUNSET.—
‘‘(A) IN GENERAL.—No tax may be im-
posed under this subsection for—
‘‘(i) a violation of section 301(a)(1) of
the Rural Health Care Access Improve-
ment Act of 1993 with respect to individ-
uals who first become entitled to benefits
under the group health plan on or after
the sunset date (as defined in subpara-
graph (B));
‘‘(ii) a failure to provide under section
301(a)(2) of such Act information on or
after the sunset date; and
‘‘(iii) a failure to accept under section
301(a)(3) of such Act a determination of a
health claims clearinghouse made on or
after the sunset date.
‘‘(B) SUNSET
DATE.—For purposes of
subparagraph (A), the term ‘sunset date’ means
the date that is 63 months after the date of the
enactment of this section.
‘‘(b) AMOUNT OF TAX.—
‘‘(1) IN GENERAL.—The amount of tax imposed
by subsection (a) by reason of 1 or more failures
during a taxable year shall be equal to 25 percent
of the gross premiums received during such taxable
year with respect to all group health plans issued by
the person on whom such tax is imposed.
‘‘(2) GROSS PREMIUMS.—For purposes of para-
graph (1), gross premiums shall include any consid-
eration received with respect to any group health
plan.
‘‘(3) CONTROLLED GROUPS.—For purposes of
paragraph (1)—
‘‘(A) CONTROLLED
GROUP
OF
CORPORA-
TIONS.—All corporations which are members of
the same controlled group of corporations shall
be treated as 1 person. For purposes of the pre-
ceding sentence, the term ‘controlled group of
corporations’ has the meaning given to such
term by section 1563(a), except that—
‘‘(i) ‘more than 50 percent’ shall be
substituted for ‘at least 80 percent’ each
place it appears in section 1563(a)(1), and
‘‘(ii) the determination shall be made
without regard to subsections (a)(4) and
(e)(3)(C) of section 1563.
‘‘(B) PARTNERSHIPS, PROPRIETORSHIPS,
ETC., WHICH ARE UNDER COMMON CONTROL.—
Under regulations prescribed by the Secretary,
all trades or business (whether or not incor-
porated) which are under common control shall
be treated as 1 person. The regulations pre-
scribed under this subparagraph shall be based
on principles similar to the principles which
apply in the case of subparagraph (A).
‘‘(c) LIMITATION ON TAX.—
‘‘(1) TAX NOT TO APPLY WHERE FAILURE NOT
DISCOVERED
EXERCISING
REASONABLE
DILI-
GENCE.—No tax shall be imposed by subsection (a)
with respect to any failure for which it is established
to the satisfaction of the Secretary that the person
on whom the tax is imposed did not know, and exer-
cising reasonable diligence would not have known,
that such failure existed.
‘‘(2) TAX
NOT
TO
APPLY
WHERE
FAILURES
CORRECTED WITHIN 30 DAYS.—No tax shall be im-
posed by subsection (a) with respect to any failure
if—
‘‘(A) such failure was due to reasonable
cause and not to willful neglect, and
‘‘(B) such failure is corrected during the
30-day period beginning on the 1st date any of
the persons on whom the tax is imposed knew,
or exercising reasonable diligence would have
known, that such failure existed.
‘‘(3) WAIVER BY SECRETARY.—In the case of a
failure which is due to reasonable cause and not to
willful neglect, the Secretary may waive part or all
of the tax imposed by subsection (a) to the extent
that the payment of such tax would be excessive rel-
ative to the failure involved.
‘‘(d) GROUP HEALTH PLAN DEFINED.—For pur-
poses of this section, the term ‘group health plan’ has the
meaning given such term in section 5000(b)(1).’’.
(b) NONDEDUCTIBILITY OF TAX.—Paragraph (6) of
section 275(a) of such Code (relating to nondeductibility
of certain taxes) is amended by inserting ‘‘47,’’ after
‘‘46,’’.
(c) CLERICAL AMENDMENTS.—The table of sections
for such chapter 47 is amended by adding at the end
thereof the following new item:
‘‘Sec. 5000A. Failure to satisfy certain standards for group health
plans.’’.
(d) EFFECTIVE DATES.—
(1) IN GENERAL.—The amendments made by
subsections (a) and (c) shall take effect on the date
of the enactment of this Act.
(2) NONDEDUCTIBILITY OF TAX.—The amend-
ment made by subsection (b) shall apply to taxable
years beginning after December 31, 1994.
SEC. 306. APPLICATION OF REQUIREMENTS TO MEDICARE
AND MEDICAID PROGRAMS.
(a) APPLICATION
TO MEDICARE PROGRAM.—The
Secretary shall provide, in regulations promulgated to
carry out title XVIII of the Social Security Act, that iden-
tification cards issued under that title and the claims proc-
ess provided under that title are modified to the extent
required to conform to the requirements of section 304
for health benefits plans as of the applicable effective
dates under this subtitle, so that hospitals, and other pro-
viders of services, as well as physicians and other providers
of medical and other services need not maintain a separate
billing system in order to submit claims under the medi-
care program.
(b) APPLICATION TO STATE MEDICAID PLANS.—As
a condition for the approval of State plans under title XIX
of the Social Security Act, effective as of the applicable
effective dates under this subtitle, each such plan shall
provide, in accordance with regulations of the Secretary,
that identification cards issued under the plan and the
claims process provided under the plan are modified to the
extent required to conform to the requirements of section
304 for health benefits plans, so that hospitals, and other
providers of services, as well as physicians and other pro-
viders of medical and other services need not maintain a
separate billing system in order to submit claims under
the medicaid program.
Subtitle B—Other Provisions
SEC. 311. TELECOMMUNICATIONS DEMONSTRATION PRO-
GRAM FOR TRAUMA CARE IN RURAL AREAS.
Section 1204 of the Public Health Service Area (42
U.S.C. 300d-3) is amended—
(1) by redesignating subsection (c) as sub-
section (d); and
(2) by inserting after subsection (b) the follow-
ing new subsection:
‘‘(c) DEMONSTRATION PROGRAM REGARDING TELE-
COMMUNICATIONS.—
‘‘(1) LINKAGES
FOR
RURAL
FACILITIES.—
Projects under subsection (a)(1) shall include dem-
onstration projects to establish telecommunications
between rural medical facilities and medical facilities
that have expertise or equipment that can be utilized
by the rural facilities through the telecommuni-
cations.
‘‘(2) MODES OF COMMUNICATIONS.—The Sec-
retary shall ensure that the telecommunications
technologies demonstrated under paragraph (1) in-
clude interactive video telecommunications, static
video imaging transmitted through the telephone
system, and facsimiles transmitted through such sys-
tem.’’.
SEC. 312. PRIMARY CARE NURSING CLINICS IN RURAL
AREAS.
Part C of title VII of the Public Health Service Act
(42 U.S.C. 293j et seq.) is amended—
(1) by redesignating section 752 as section 753;
and
(2) by inserting after section 751 the following
new section:
‘‘Subpart VII—Provision of Primary Care Services in
Rural Areas
‘‘SEC. 752. PROVISION OF PRIMARY CARE SERVICES IN
RURAL AREAS.
‘‘(a) AUTHORIZATION TO USE AMOUNTS.—The Sec-
retary may use not to exceed $5,000,000, out of amounts
appropriated to carry out programs under this part, in
each of the fiscal years 1994 through 1996 to award
grants to public or private schools of nursing for the estab-
lishment of clinics that shall be administered by such
schools.
‘‘(b) APPLICATION.—A school desiring to receive a
grant under subsection (a) shall prepare and submit to
the Secretary, an application at such time, in such form,
and containing such information as the Secretary may re-
quire.
‘‘(c) USE
OF GRANTS.—Amounts received under
grants awarded under subsection (a) shall be used to—
‘‘(1) establish clinics, to be run and staffed by
the faculty and students of such grantee school, to
provide primary care services in medically under-
served rural areas or in areas on or within 50 miles
of Indian country (as defined in section 1151 of title
18, United States Code);
‘‘(2) provide for all aspects of clinical training
program development, faculty enhancement and stu-
dent scholarships in a manner that would benefit the
clinic established under paragraph (1); and
‘‘(3) carry out any other activities determined
appropriate by the Secretary.
‘‘(d) DESIGN.—The clinics established under sub-
section (c)(1) shall be designed to provide nursing stu-
dents with a structured clinical experience that is similar
in nature to that provided by residency training programs
for physicians.’’.
SEC. 313. IDENTIFICATION, ASSESSMENT, AND REDUCTION
OF PAPERWORK BURDEN ASSOCIATED WITH
HEALTH CARE SERVICES.
Section 3505 of title 44, United States Code, is
amended—
(1) by striking ‘‘and’’ at the end of paragraph
(5);
(2) by striking the period at the end of para-
graph (6) and inserting ‘‘; and’’; and
(3) by adding at the end the following:
‘‘(7) within 6 months after the date of the en-
actment of the Rural Health Care Access Improve-
ment Act of 1993, in consultation with the Secretary
of Health and Human Services, shall—
‘‘(A) identify, inventory, and assess the
burden of federally conducted or sponsored in-
formation collection requests associated with
the delivery of health care services; and
‘‘(B) for each of the fiscal years 1994,
1995, 1996, 1997, 1998, and 1999, establish a
goal for reducing the burden described in sub-
paragraph (A) existing at the end of the preced-
ing fiscal year by not less than 5 percent
through more effective use of information re-
sources management, regulatory flexibility, and
other means.’’.
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