SEC. 1172. General requirements for adoption of standards
Title[ Title II\Subtitle F\Sec. 262 Contents
Sec. 1172. (a) Applicability.--Any <<NOTE: 42 USC 1320d-1.>>
standard adopted under this part shall apply, in whole or in part, to
the following persons:
``(1) A health plan.
``(2) A health care clearinghouse.
``(3) A health care provider who transmits any health
information in electronic form in connection with a transaction
referred to in section 1173(a)(1).
``(b) Reduction of Costs.--Any standard adopted under this part
shall be consistent with the objective of reducing the administrative
costs of providing and paying for health care.
``(c) Role of Standard Setting Organizations.--
``(1) In general.--Except as provided in paragraph (2), any
standard adopted under this part shall be a standard that has
been developed, adopted, or modified by a standard setting
organization.
``(2) Special rules.--
``(A) Different standards.--The Secretary may adopt
a standard that is different from any standard
developed, adopted, or modified by a standard setting
organization, if--
``(i) the different standard will
substantially reduce administrative costs to
health care providers and health plans compared to
the alternatives; and
``(ii) the standard is promulgated in
accordance with the rulemaking procedures of
subchapter III of chapter 5 of title 5, United
States Code.
``(B) No standard by standard setting
organization.--If no standard setting organization has
developed, adopted, or modified any standard relating to
a standard that the Secretary is authorized or required
to adopt under this part--
``(i) paragraph (1) shall not apply; and
``(ii) subsection (f) shall apply.
``(3) Consultation requirement.--
``(A) In general.--A standard may not be adopted
under this part unless--
``(i) in the case of a standard that has been
developed, adopted, or modified by a standard
setting organization, the organization consulted
with each of the organizations described in
subparagraph (B) in the course of such
development, adoption, or modification; and
``(ii) in the case of any other standard, the
Secretary, in complying with the requirements of
subsection (f), consulted with each of the
organizations described in subparagraph (B) before
adopting the standard.
``(B) Organizations described.--The organizations
referred to in subparagraph (A) are the following:
``(i) The National Uniform Billing Committee.
``(ii) The National Uniform Claim Committee.
``(iii) The Workgroup for Electronic Data
Interchange.
``(iv) The American Dental Association.
``(d) Implementation Specifications.--The Secretary shall establish
specifications for implementing each of the standards adopted under this
part.
``(e) Protection of Trade Secrets.--Except as otherwise required by
law, a standard adopted under this part shall not require disclosure of
trade secrets or confidential commercial information by a person
required to comply with this part.
``(f) Assistance to the Secretary.--In complying with the
requirements of this part, the Secretary shall rely on the
recommendations of the National Committee on Vital and Health Statistics
established under section 306(k) of the Public Health Service Act (42
U.S.C. 242k(k)), and shall consult with appropriate Federal and State
agencies <<NOTE: Federal Register, publication.>> and private
organizations. The Secretary shall publish in the Federal Register any
recommendation of the National Committee on Vital and Health Statistics
regarding the adoption of a standard under this part.
``(g) Application to Modifications of Standards.--This section shall
apply to a modification to a standard (including an addition to a
standard) adopted under section 1174(b) in the same manner as it applies
to an initial standard adopted under section 1174(a).
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