‘‘(B) define the data elements to be con-
tained in a uniform electronic claims data set to 
be used with respect to such claims. 
‘‘(2) SCOPE OF INFORMATION.— 
‘‘(A) ENSURING
ACCOUNTABILITY
FOR 
CLAIMS SUBMITTED ELECTRONICALLY.—In es-
tablishing standards under this section, the Sec-
retary, in consultation with appropriate agen-
cies, shall include such methods of ensuring 
provider responsibility and accountability for 
claims submitted electronically that are de-
signed to control fraud and abuse in the sub-
mission of such claims. 
‘‘(B) COMPONENTS.—In establishing such 
standards the Secretary shall— 
‘‘(i) with respect to data elements, de-
fine data fields, formats, and medical no-
menclature, and plan benefit and insurance 
information; 
‘‘(ii) develop a single, uniform coding 
system for diagnostic and procedure codes; 
and 
‘‘(iii) provide for standards for the 
uniform electronic transmission of such 
elements. 
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‘‘(3) COORDINATION
WITH
STANDARDS
FOR 
ELECTRONIC
MEDICAL
RECORDS.—In establishing 
standards under this subsection, the Secretary shall 
assure that— 
‘‘(A) the development of such standards is 
coordinated with the development of the stand-
ards for electronic medical records under sec-
tion 2253, and 
‘‘(B) the coding of data elements under the 
uniform electronic claims data set and the cod-
ing of the same elements in the uniform hos-
pital clinical data set are consistent. 
‘‘(4) USE
OF
TASK
FORCES.—In adopting 
standards under this subsection— 
‘‘(A) the Secretary shall take into account 
the recommendations of current task forces; 
and 
‘‘(B) the Secretary shall provide that the 
electronic transmission standards are con-
sistent, to the extent practicable, with the appli-
cable standards established by the Accredited 
Standards Committee X–12 of the American 
National Standards Institute. 
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‘‘(5) UNIFORM, UNIQUE PROVIDER IDENTIFICA-
TION CODES.—In establishing standards under this 
subsection— 
‘‘(A) the Secretary shall provide for a 
unique identifier code for each health service 
provider that furnishes services for which a 
claim may be submitted under this title or 
under an AmeriCare supplemental plan, and 
‘‘(B) in the case of a provider that has a 
unique identifier issued for purposes of title 
XVIII, the code provided under subparagraph 
(A) shall be the same as such unique identifier. 
‘‘(6) WEBSITE AVAILABILITY TO PROVIDERS.— 
The Secretary shall establish and maintain a website 
that will enable health service providers, without 
charge, to submit claims and to receive verification 
of claims status electronically. 
‘‘(7) STANDARDS
FOR
PAPER
CLAIMS.—The 
standards shall provide for a uniform paper claims 
form which is consistent with data elements required 
for the submission of claims electronically. 
‘‘(8) STANDARDS
FOR
CLAIMS
FOR
CLINICAL 
LABORATORY TESTS.—The standards shall provide 
that claims for clinical laboratory tests for which 
benefits are provided under this title or under an 
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AmeriCare supplemental plan shall be submitted di-
rectly by the person or entity that performed (or su-
pervised the performance of) the tests to the plan in 
a manner consistent with (and subject to such excep-
tions as are provided under) the requirement for di-
rect submission of such claims under title XVIII. 
‘‘(9) DEADLINE.—The Secretary shall first pro-
vide for the standards for the uniform claims under 
this subsection (and shall develop and make avail-
able the software under paragraph (6)) by not later 
than 1 year after the date of the enactment of this 
title. 
‘‘(d) USE UNDER THIS TITLE AND MEDICARE AND 
MEDICAID PROGRAMS.— 
‘‘(1) REQUIREMENT FOR PROVIDERS.—In the 
case of a health service provider that submits a 
claim for services furnished under this title in viola-
tion of subsection (a)(1), no payment shall be made 
under this title for such services. 
‘‘(2) REQUIREMENTS OF MEDICARE ADMINIS-
TRATIVE
CONTRACTORS
UNDER
MEDICARE
PRO-
GRAM.—The Secretary shall provide, in regulations 
promulgated to carry out this title, that the claims 
process provided under this title conforms to the 
standards established under subsection (c). 
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‘‘(3) REQUIREMENTS
OF
STATE
MEDICAID 
PLANS.—As a condition for the approval of State 
plans under the medicaid program, effective as of 
the effective date specified in subsection (a)(3), each 
such plan shall provide, in accordance with regula-
tions of the Secretary, that the claims process pro-
vided under the plan is modified to the extent re-
quired to conform to the standards established under 
subsection (c). 
‘‘SEC. 2253. ELECTRONIC MEDICAL RECORDS AND REPORT-
ING. 
‘‘(a) 
STANDARDS
FOR
ELECTRONIC
MEDICAL 
RECORDS.— 
‘‘(1) PROMULGATION OF STANDARDS.— 
‘‘(A) IN GENERAL.—Not later than Janu-
ary 1, 2009, the Secretary shall promulgate 
standards described in paragraph (2) for hos-
pitals and other health care providers con-
cerning electronic medical records. Such stand-
ards shall include the standards established 
under part C of title XI. 
‘‘(B) REVISION.—The Secretary may from 
time to time revise the standards promulgated 
under this paragraph. 
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‘‘(2) CONTENTS OF STANDARDS.—The stand-
ards promulgated under paragraph (1) shall include 
at least the following: 
‘‘(A) A definition of a uniform provider 
clinical data set, including a definition of the 
set of comprehensive data elements, for use by 
utilization and quality control peer review orga-
nizations. 
‘‘(B) Standards for an electronic patient 
care information system with data obtained at 
the point of care. 
‘‘(C) A specification of, and manner of 
presentation of, the individual data elements of 
the set and system under this paragraph. 
‘‘(D) Standards concerning the trans-
mission of electronic medical data. 
‘‘(E) Standards relating to confidentiality 
of patient-specific information, which include 
the physical security of electronic data and the 
use of keys, passwords, encryption, and other 
means to ensure the protection of the confiden-
tiality and privacy of electronic data. 
‘‘(3) COORDINATION
WITH
STANDARDS
FOR 
UNIFORM ELECTRONIC CLAIMS DATA SET.—In es-
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tablishing standards under this subsection, the Sec-
retary shall assure that— 
‘‘(A) the development of such standards is 
coordinated with the development of the stand-
ards for the uniform electronic claims data set 
under subsection (b), and 
‘‘(B) the coding of data elements under the 
uniform provider clinical data set and the cod-
ing of the same elements under the uniform 
electronic claims data set are consistent. 
‘‘(4) CONSULTATION.—In establishing stand-
ards under this subsection, the Secretary shall— 
‘‘(A) consult with the American National 
Standards Institute, hospitals and other health 
care providers, health benefit plans, and other 
interested parties, and 
‘‘(B) take into consideration, in developing 
standards under paragraph (2)(A), the data set 
used by the utilization and quality control peer 
review program under part B of title XI. 
‘‘(b) REQUIREMENT
FOR APPLICATION
OF ELEC-
TRONIC RECORDS STANDARDS.— 
‘‘(1) AS CONDITION OF MEDICARE, MEDICAID, 
SCHIP, AND AMERICARE PARTICIPATION.—Effective 
January 1, 2010, each hospital or other institutional 
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or noninstitutional health care provider, as a re-
quirement of each participation agreement under 
this title, title XVIII, title XIX, and title XXI, shall, 
in accordance with the standards promulgated under 
subsection (a)(1)— 
‘‘(A) maintain clinical data included in the 
uniform provider clinical data set under sub-
section (a)(2)(A) in electronic form on all pa-
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), trans-
mit 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, 2009, if a hospital or other health care pro-
vider is required under a Federal program to trans-
mit a data element that is subject to a standard, 
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promulgated under subsection (a)(1), described in 
subparagraph (C) or (D) of subsection (a)(2), the 
head of the Federal agency responsible for such pro-
gram (if not otherwise authorized) is authorized to 
require the provider to present and transmit the 
data element electronically in accordance with such 
a standard. 
‘‘(c) LIMITATION ON DATA REQUIREMENTS WHERE 
STANDARDS IN EFFECT.— 
‘‘(1) IN
GENERAL.—On or after January 1, 
2009, the Secretary under this title or under title 
XVIII (including any carrier or fiscal intermediary 
or any utilization and quality control peer review or-
ganization) and an AmeriCare supplemental plan 
may not require, for the purpose of utilization review 
or as a condition of providing benefits or making 
payments under this title, title XVIII, or the plan, 
that a hospital or other health care provider— 
‘‘(A) provide any data element not in the 
uniform provider clinical data set specified 
under the standards promulgated under sub-
section (a), or 
‘‘(B) transmit or present any such data 
element in a manner inconsistent with such 
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standards applicable to such transmission or 
presentation. 
‘‘(2) COMPLIANCE.—The Secretary may impose 
a civil money penalty on any AmeriCare supple-
mental plan that fails to comply with paragraph (1) 
in an amount not to exceed $100 for each such fail-
ure. The provisions of section 1128A of the Social 
Security Act (other than the first sentence of sub-
section (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 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, 
2009, each such plan may not require that a hos-
pital or other health care provider, 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 provider clinical data set specified 
under the standards promulgated under sub-
section (a), or 
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‘‘(B) transmit or present any such data 
element in a manner inconsistent with such 
standards applicable to such transmission or 
presentation. 
‘‘(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 shall 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 
title, 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 indi-
vidual) that serves the functional equivalent of a sig-
nature. The regulations may provide for such excep-
tions to paragraph (1) as the Secretary determines 
to be necessary to prevent fraud and abuse, to pre-
vent the illegal distribution of controlled substances, 
and in such other cases as the Secretary deems ap-
propriate. 
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