107TH CONGRESS 1ST SESSION S. 1684 …

107TH CONGRESS
   1ST SESSION
                     S. 1684

                     AN ACT
To provide a 1-year extension of the date for compliance
   by certain covered entities with the administrative sim-
   plification standards for electronic transactions and code
   sets issued in accordance with the Health Insurance
   Portability and Accountability Act of 1996.

 1      Be it enacted by the Senate and House of Representa-
 2 tives of the United States of America in Congress assembled,
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 1   SECTION 1. 1-YEAR EXTENSION OF DATE FOR COMPLIANCE

 2                   BY CERTAIN COVERED ENTITIES WITH AD-

 3                   MINISTRATIVE SIMPLIFICATION STANDARDS

 4                   FOR ELECTRONIC TRANSACTIONS AND CODE

 5                   SETS.

 6       (a)       IN      GENERAL.--Notwithstanding       section
 7 1175(b)(1)(A) of the Social Security Act (42 U.S.C.
 8 1320d­4(b)(1)(A)) and section 162.900 of title 45 of the
 9 Code of Federal Regulations--
10                (1) a health care provider shall not be consid-
11       ered to be in noncompliance with the applicable re-
12       quirements of subparts I through N of part 162 of
13       title 45 of the Code of Federal Regulations before
14       October 16, 2003; and
15                (2) a health plan (other than a small health
16       plan) or a health care clearinghouse shall not be
17       considered to be in noncompliance with the applica-
18       ble requirements of subparts I through R of part
19       162 of title 45 of the Code of Federal Regulations
20       before October 16, 2003.
21       (b) SPECIAL RULES.--
22                (1) RULES    OF       CONSTRUCTION.--Nothing   in
23       this section shall be construed--
24                      (A) as modifying the October 16, 2003,
25                date for compliance of small health plans with


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 1                subparts I through R of part 162 of title 45 of
 2                the Code of Federal Regulations; or
 3                    (B) as modifying--
 4                         (i) the April 14, 2003, date for com-
 5                    pliance of a health care provider, a health
 6                    plan (other than a small health plan), or a
 7                    health care clearinghouse with subpart E
 8                    of part 164 of title 45 of the Code of Fed-
 9                    eral Regulations; or
10                         (ii) the April 14, 2004, date for com-
11                    pliance of a small health plan with subpart
12                    E of part 164 of title 45 of the Code of
13                    Federal Regulations.
14                (2) APPLICABILITY   OF PRIVACY REQUIREMENTS

15       TO CERTAIN TRANSACTIONS PRIOR TO STANDARDS

16       COMPLIANCE DATE.--

17                    (A) IN   GENERAL.--Notwithstanding      any
18                other provision of law, during the period that
19                begins on April 14, 2003, and ends on October
20                16, 2003, a health care provider or, subject to
21                subparagraph (C), a health care clearinghouse,
22                that transmits any health information in elec-
23                tronic form in connection with a transaction de-
24                scribed in subparagraph (B) shall comply with
25                the then applicable requirements of subpart E


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 1                of part 164 of title 45 of the Code of Federal
 2                Regulations without regard to section 164.106
 3                of subpart A of such part or to whether the
 4                transmission meets any standard formats re-
 5                quired by part 162 of title 45 of the Code of
 6                Federal Regulations.
 7                     (B)       TRANSACTIONS      DESCRIBED.--The

 8                transactions described in this subparagraph are
 9                the following:
10                           (i) A health care claims or equivalent
11                     encounter information transaction.
12                           (ii) A health care payment and remit-
13                     tance advice transaction.
14                           (iii) A coordination of benefits trans-
15                     action.
16                           (iv) A health care claim status trans-
17                     action.
18                           (v) An enrollment and disenrollment
19                     in a health plan transaction.
20                           (vi) An eligibility for a health plan
21                     transaction.
22                           (vii) A health plan premium payments
23                     transaction.
24                           (viii) A referral certification and au-
25                     thorization transaction.


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 1                          (ix) A transaction with respect to a
 2                    first report of injury.
 3                          (x) A transaction with respect to
 4                    health claims attachments.
 5                    (C)    APPLICATION        TO   HEALTH   CARE

 6                CLEARINGHOUSES.--For      purposes of this para-
 7                graph, during the period described in subpara-
 8                graph (A), an entity that would otherwise meet
 9                the definition of health care clearinghouse that
10                processes or facilitates the processing of infor-
11                mation in connection with a transaction de-
12                scribed in subparagraph (B) shall be deemed to
13                be a health care clearinghouse notwithstanding
14                that the entity does not process or facilitate the
15                processing of such information into any stand-
16                ard formats required by part 162 of title 45 of
17                the Code of Federal Regulations.
18       (c) DEFINITIONS.--In this section--
19                (1) the terms ``health care provider'', ``health
20       plan'', and ``health care clearinghouse'' have the
21       meaning given those terms in section 1171 of the
22       Social Security Act (42 U.S.C. 1320d) and section
23       160.103 of part 160 of title 45 of the Code of Fed-
24       eral Regulations;




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 1                (2) the terms ``small health plan'' and ``trans-
 2       action'' have the meaning given those terms in sec-
 3       tion 160.103 of part 160 of title 45 of the Code of
 4       Federal Regulations; and
 5                (3) the terms ``health care claims or equivalent
 6       encounter information transaction'', ``health care
 7       payment and remittance advice transaction'', ``co-
 8       ordination of benefits transaction'', ``health care
 9       claim       status    transaction'',   ``enrollment   and
10       disenrollment in a health plan transaction'', ``eligi-
11       bility for a health plan transaction'', ``health plan
12       premium payments transaction'', and ``referral cer-
13       tification and authorization transaction'' have the
14       meanings given those terms in sections 162.1101,
15       162.1601,         162.1801,      162.1401,     162.1501,
16       162.1201, 162.1701, and 162.1301 of part 162 of
17       title 45 of the Code of Federal Regulations, respec-
18       tively.
         Passed the Senate November 27, 2001.
         Attest:




                                                      Secretary.




      S 1684 ES
107TH CONGRESS
   1ST SESSION     S. 1684
                AN ACT
To provide a 1-year extension of the date for com-
  pliance by certain covered entities with the ad-
  ministrative simplification standards for elec-
  tronic transactions and code sets issued in ac-
  cordance with the Health Insurance Portability
  and Accountability Act of 1996.