from health plans, health care providers, health ven-
dors, relevant State agencies, health care standard 
development organizations, and operating rule enti-
ties, relevant professional and trade associations, pa-
tients, and other entities determined appropriate by 
the State. 
‘‘(3) RECOMMENDATIONS.—Not later than one 
year after the date on which a grant is awarded to 
a State under this section, the commission shall 
make recommendations and plans, consistent with 
the application submitted by the State under sub-
section (b), and intended to meet the objectives de-
fined in the application. Such recommendations shall 
comply with, and build upon, all relevant Federal re-
quirements and regulations, and may include— 
‘‘(A) common, uniform specifications, best 
practices, and conventions, for the efficient, ef-
fective exchange of administrative transactions 
adopted pursuant to the Health Insurance Port-
ability and Accountability Act of 1996 (Public 
Law 104–191); 
‘‘(B) the development of streamlined busi-
ness processes for the exchange and use of 
health care administrative data; and 
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‘‘(C) specifications, incentives, require-
ments, tools, mechanisms, and resources to im-
prove— 
‘‘(i) the access, exchange, and use of 
health care administrative information 
through electronic means; 
‘‘(ii) the implementation of utilization 
management protocols; and 
‘‘(iii) compliance with Federal and 
State laws. 
‘‘(d) USE
OF FUNDS
FOR IMPLEMENTATION.—A 
State may use amounts received under a grant under this 
section for one or more of the following: 
‘‘(1) The development, implementation, and 
best use of shared data infrastructure that supports 
the electronic transmission of administrative data. 
‘‘(2) The development and provision of training 
and educational materials, forums, and activities as 
well as technical assistance to effectively implement, 
use, and benefit from electronic health care trans-
actions and operating rules. 
‘‘(3) To accelerate the early adoption and im-
plementation of administrative transactions and op-
erating rules designated by the Secretary and that 
have been adopted pursuant to the Health Insurance 
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Portability and Accountability Act of 1996 (Public 
Law 104–191), including transactions and operating 
rules described in section 1173(a)(2) of the Social 
Security Act. 
‘‘(4) To accelerate the early adoption and im-
plementation of additional or updated administrative 
transactions, operating rules, and related data ex-
change standards that are being considered for 
adoption under the Health Insurance Portability and 
Accountability Act of 1996 or are adopted pursuant 
to such Act, or as designated by the Secretary, in-
cluding the electronic claim attachment. 
‘‘(5) To conduct pilot projects to test ap-
proaches to implement and use the electronic health 
care transactions and operating rules in practice 
under a variety of different settings. With respect to 
the electronic attachment transaction, priority shall 
be given to pilot projects that test and evaluate 
methods and mechanisms to most effectively incor-
porate patient health data from electronic health 
records and other electronic sources with the elec-
tronic attachment transaction. 
‘‘(6) To assess barriers to the adoption, imple-
mentation, and effective use of electronic health care 
transactions and operating rules, as well as to ex-
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plore, identify, and plan options, approaches, and re-
sources to address barriers and make improvements. 
‘‘(7) The facilitation of public and private ini-
tiatives to reduce administrative costs and accelerate 
the adoption, implementation, and effective use of 
electronic health care transactions and operating 
rules for State programs. 
‘‘(8) Developing, testing, implementing, and as-
sessing additional data exchange specifications, oper-
ating rules, incentives, requirements, tools, mecha-
nisms, and resources to accelerate the adoption and 
effective use of the transactions and operating rules. 
‘‘(9) Ongoing needs assessments and planning 
related to the development and implementation of 
administrative simplification initiatives. 
‘‘(e) COORDINATING ENTITY.— 
‘‘(1) FUNCTIONS.—Not later than 6 months 
after the date of enactment of this section, the Sec-
retary shall designate a coordinating entity under 
this subsection for the purpose of— 
‘‘(A) providing technical assistance to 
States relating to the simplification of adminis-
trative transactions and operating rules, in-
creased standardization, and the efficiency and 
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effectiveness of the transmission of health care 
information; 
‘‘(B) evaluating pilot projects and other ef-
forts conducted under this section for impact 
and best practices to inform broader national 
use; 
‘‘(C) using consistent evaluation meth-
odologies to compare return on investment 
across efforts conducted under this section; 
‘‘(D) 
compiling, 
synthesizing, 
dissemi-
nating, and adopting lessons learned to promote 
the adoption of electronic health care trans-
actions and operating rules across the health 
care system; and 
‘‘(E) making recommendations to the Sec-
retary and the National Committee on Vital 
and Health Statistics regarding the national 
adoption of efforts conducted under this sec-
tion. 
‘‘(2) 
ELIGIBILITY.—The 
entity 
designated 
under paragraph (1) shall be a qualified nonprofit 
entity that— 
‘‘(A) focuses its mission on administrative 
simplification; 
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‘‘(B) has demonstrated experience using a 
multi-stakeholder and consensus-based process 
for the development of common, uniform speci-
fications, operating rules, best practices, and 
conventions, for the efficient, effective exchange 
of administrative transactions that includes rep-
resentation by or participation from health 
plans, health care providers, vendors, States, 
relevant Federal agencies, and other health care 
standard development organizations; 
‘‘(C) has demonstrated experience pro-
viding technical assistance to health plans, 
health care providers, vendors, and States relat-
ing to the simplification of administrative trans-
actions and operating rules, increased standard-
ization, and the efficiency and effectiveness of 
the transmission of health care information; 
‘‘(D) has demonstrated experience evalu-
ating and measuring the adoption and return 
on investment of administrative transactions 
and operating rules; 
‘‘(E) has demonstrated experience gath-
ering, synthesizing, and adopting common, uni-
form specifications, operating rules, best prac-
tices, and conventions for national use based on 
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lessons learned to promote the adoption of elec-
tronic health care transactions and operating 
rules across the health care system; 
‘‘(F) has a public set of guiding principles 
that ensure processes are open and transparent, 
and supports nondiscrimination and conflict of 
interest policies that demonstrate a commit-
ment to open, fair, and nondiscriminatory prac-
tices; 
‘‘(G) builds on the transaction standards 
issued under Health Insurance Portability and 
Accountability Act of 1996; and 
‘‘(H) allows for public review and updates 
of common, uniform specifications, operating 
rules, best practices, and conventions to support 
administrative simplification. 
‘‘(f) PERIOD AND AMOUNT.—A grant awarded to a 
State under this section shall be for a period of 5 years 
and shall not exceed $50,000,000 for such 5-year period. 
A grant awarded to the coordinating entity designated by 
the Secretary under subsection (e) shall be for a period 
of 5 years and shall not exceed $15,000,000 for such 5- 
year period. 
‘‘(g) REPORTS.— 
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‘‘(1) STATES.—Not later than 1 year after re-
ceiving a grant under this section, and biennially 
thereafter, a State shall submit to the Secretary a 
report on the outcomes experienced by the State 
under the grant. 
‘‘(2) COORDINATING ENTITY.—Not later than 1 
year after receiving a grant under this section, and 
at least biennially thereafter, the coordinating entity 
shall submit to the Secretary and the National Com-
mittee on Vital and Health Statistics a report of 
evaluations conducted under the grant under this 
section and recommendations regarding the national 
adoption of efforts conducted under this section. 
‘‘(3) SECRETARY.—Not later than 6 months 
after the date on which the States and coordinating 
entity submit the report required under paragraphs 
(1) and (2), the Secretary, in consultation with Na-
tional Committee on Vital and Health Statistics, 
shall submit to the Committee on Health, Edu-
cation, Labor, and Pensions of the Senate and the 
Committee on Energy and Commerce of the House 
of Representatives, a report on the outcomes 
achieved under the grants under this section. 
‘‘(4) GAO.—Not later than 6 months after the 
date on which the Secretary submits the final report 
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under paragraph (3), the Comptroller General of the 
United States shall conduct a study, and submit to 
the Committee on Health, Education, Labor, and 
Pensions of the Senate and the Committee on En-
ergy and Commerce of the House of Representa-
tives, a report on the outcomes of the activities car-
ried out under this section which shall contain a list 
of best practices and recommendations to States 
concerning administrative simplification. 
‘‘(h) AUTHORIZATION OF APPROPRIATIONS.—There 
is authorized to be appropriated to carry out this section 
$250,000,000 for the 5-fiscal-year period beginning with 
fiscal year 2020.’’. 
Æ 
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