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Public Law 107-105
107th Congress
An Act
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. <<NOTE: Dec. 27,
2001 - [H.R. 3323]>>
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress <<NOTE: Administrative
Simplification Compliance Act.>> assembled,
SECTION 1. <<NOTE: 42 USC 1305 note.>> SHORT TITLE.
This Act may be cited as the ``Administrative Simplification
Compliance Act''.
SEC. 2. <<NOTE: 42 USC 1320d-4 note.>> EXTENSION OF DEADLINE FOR COVERED
ENTITIES 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 section 162.900 of title 45, Code of
Federal Regulations, 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 Secretary of Health and Human Services
a plan of how the person will come into compliance with the
requirements described in such paragraph not later than October
16, 2003. Such plan shall be 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
implementation strategy for achieving compliance.
(C) Whether the person plans to use or might use a
contractor or other vendor to assist the person in
achieving compliance.
(D) A timeframe for testing that begins not later
than April 16, 2003.
(3) Electronic submission.--Plans described in paragraph (2)
may be submitted electronically.
(4) Model form.--Not later than March 31, 2002, the
Secretary of Health and Human Services shall promulgate a model
form that persons may use in drafting a plan described in
paragraph (2). The promulgation of such form shall be made
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without regard to chapter 35 of title 44, United States Code
(commonly known as the ``Paperwork Reduction Act'').
(5) Analysis of plans; reports on solutions.--
(A) Analysis of plans.--
(i) Furnishing of plans.--Subject to
subparagraph (D), the Secretary of Health and
Human Services shall furnish the National
Committee on Vital and Health Statistics with a
sample of the plans submitted under paragraph (2)
for analysis by such Committee.
(ii) Analysis.--The National Committee on
Vital and Health Statistics shall analyze the
sample of the plans furnished under clause (i).
(B) Reports on solutions.--The National Committee on
Vital and Health Statistics shall regularly publish, and
widely disseminate to the public, reports containing
effective solutions to compliance problems identified in
the plans analyzed under subparagraph (A). Such reports
shall not relate specifically to any one plan but shall
be written for the purpose of assisting the maximum
number of persons to come into compliance by addressing
the most common or challenging problems encountered by
persons submitting such plans.
(C) Consultation.--In carrying out this paragraph,
the National Committee on 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.
(D) Protection of confidential information.--
(i) In general.--The Secretary of Health and
Human Services shall ensure that any material
provided under subparagraph (A) to the National
Committee on Vital and Health Statistics or any
organization described in subparagraph (C) is
redacted so as to prevent the disclosure of any--
(I) trade secrets;
(II) commercial or financial
information that is privileged or
confidential; and
(III) other information the
disclosure of which would constitute a
clearly unwarranted invasion of personal
privacy.
(ii) Construction.--Nothing in clause (i)
shall be construed to affect the application of
section 552 of title 5, United States Code
(commonly known as the ``Freedom of Information
Act''), including the exceptions from disclosure
provided under subsection (b) of such section.
(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 requirements of subparts
I through R of part 162 of title 45, Code of Federal
Regulations, on or after October 16, 2002, the person
may be excluded at
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the discretion of the Secretary of Health and Human
Services 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 section 1128A of
the Social Security Act (42 U.S.C. 1320a-7a) (other than
the first and second sentences of subsection (a) and
subsection (b)) shall apply to an exclusion under this
paragraph in the same manner as such provisions apply
with respect to an exclusion or proceeding under section
1128A(a) of such Act.
(C) Construction.--The availability of an exclusion
under this paragraph shall not be construed 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 applicable
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, deadline for
a small health plan to comply with the requirements of
subparts I through R of part 162 of title 45, Code of
Federal Regulations; or
(B) as modifying--
(i) the April 14, 2003, deadline for a health
care provider, a health plan (other than a small
health plan), or a health care clearinghouse to
comply with the requirements of subpart E of part
164 of title 45, Code of Federal Regulations; or
(ii) the April 14, 2004, deadline for a small
health plan to comply with the requirements of
such subpart.
(2) Applicability of privacy standards before compliance
deadline for information transaction standards.--
(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 (B), a health care
clearinghouse, that transmits any health information in
electronic form in connection with a transaction
described in subparagraph (C) 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) Application to health care clearinghouses.--For
purposes of this paragraph, during the period described
in subparagraph (A), an entity that processes or
facilitates the processing of information in connection
with a transaction described in subparagraph (C) and
that otherwise would be treated as a health care
clearinghouse shall be
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treated as a health care clearinghouse without regard to
whether the processing or facilitation produces (or is
required to produce) standard data elements or a
standard transaction as required by part 162 of title
45, Code of Federal Regulations.
(C) 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 remittance
advice transaction.
(iii) A coordination of benefits transaction.
(iv) A health care claim status transaction.
(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
authorization transaction.
(c) Definitions.--In this section--
(1) the terms ``health care provider'', ``health plan'', and
``health care clearinghouse'' have the meaning given those terms
in section 1171 of the Social Security Act (42 U.S.C. 1320d) and
section 160.103 of title 45, Code of Federal Regulations;
(2) the terms ``small health plan'' and ``transaction'' have
the meaning given those terms in section 160.103 of title 45,
Code of Federal Regulations; and
(3) the terms ``health care claims or equivalent encounter
information transaction'', ``health care payment and remittance
advice transaction'', ``coordination of benefits transaction'',
``health care claim status transaction'', ``enrollment and
disenrollment in a health plan transaction'', ``eligibility for
a health plan transaction'', ``health plan premium payments
transaction'', and ``referral certification and authorization
transaction'' have the meanings given those terms in sections
162.1101, 162.1601, 162.1801, 162.1401, 162.1501, 162.1201,
162.1701, and 162.1301 of title 45, Code of Federal Regulations,
respectively.
SEC. 3. REQUIRING ELECTRONIC SUBMISSION OF MEDICARE CLAIMS.
(a) In General.--Section 1862 of the Social Security Act (42 U.S.C.
1395y) is amended--
(1) in subsection (a)--
(A) by striking ``or'' at the end of paragraph (20);
(B) by striking the period at the end of paragraph
(21) and inserting ``; or''; and
(C) by inserting after paragraph (21) the following
new paragraph:
``(22) subject to subsection (h), for which a claim is
submitted other than in an electronic form specified by the
Secretary.''; and
(2) by inserting after subsection (g) the following new
subsection:
``(h)(1) The Secretary--
``(A) shall waive the application of subsection (a)(22) in
cases in which--
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``(i) there is no method available for the
submission of claims in an electronic form; or
``(ii) the entity submitting the claim is a small
provider of services or supplier; and
``(B) may waive the application of such subsection in such
unusual cases as the Secretary finds appropriate.
``(2) For purposes of this subsection, the term `small provider of
services or supplier' means--
``(A) a provider of services with fewer than 25 full-time
equivalent employees; or
``(B) a physician, practitioner, facility, or supplier
(other than provider of services) with fewer than 10 full-time
equivalent employees.''.
(b) Effective <<NOTE: 42 USC 1395y note.>> Date.--The amendments
made by subsection (a) shall apply to claims submitted on or after
October 16, 2003.
SEC. 4. CLARIFICATION WITH RESPECT TO APPLICABILITY OF ADMINISTRATIVE
SIMPLIFICATION REQUIREMENTS TO MEDICARE+CHOICE
ORGANIZATIONS.
Section 1171(5)(D) of the Social Security Act (42 U.S.C.
1320d(5)(D)) is amended by striking ``Part A or part B'' and inserting
``Parts A, B, or C''.
SEC. 5. AUTHORIZATION OF APPROPRIATIONS FOR IMPLEMENTATION OF
REGULATIONS.
(a) In General.--Subject to subsection (b), and in addition to any
other amounts that may be authorized to be appropriated, there are
authorized to be appropriated a total of $44,200,000, for--
(1) technical assistance, education and outreach, and
enforcement activities related to subparts I through R of part
162 of title 45, Code of Federal Regulations; and
(2) adopting the standards required to be adopted under
section 1173 of the Social Security Act (42 U.S.C. 1320d-2).
(b) Reductions.--
(1) Model form 14 days late.--If the Secretary fails to
promulgate the model form described in section 1(a)(4) by the
date that is 14 days after the deadline described in such
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