SEC. 1173. Standards for information transactions and data elements
Title[ Title II\Subtitle F\Sec. 262 Contents
Sec. 1173. (a) Standards <<NOTE: 42 USC 1320d-2.>> To Enable
Electronic Exchange.--
``(1) In general.--The Secretary shall adopt standards for
transactions, and data elements for such transactions, to enable
health information to be exchanged electronically, that are
appropriate for--
``(A) the financial and administrative transactions
described in paragraph (2); and
``(B) other financial and administrative
transactions determined appropriate by the Secretary,
consistent with the goals of improving the operation of
the health care system and reducing administrative
costs.
``(2) Transactions.--The transactions referred to in
paragraph (1)(A) are transactions with respect to the following:
``(A) Health claims or equivalent encounter
information.
``(B) Health claims attachments.
``(C) Enrollment and disenrollment in a health plan.
``(D) Eligibility for a health plan.
``(E) Health care payment and remittance advice.
``(F) Health plan premium payments.
``(G) First report of injury.
``(H) Health claim status.
``(I) Referral certification and authorization.
``(3) Accommodation of specific providers.--The
standards adopted by the Secretary under paragraph (1) shall
accommodate the needs of different types of health care
providers.
``(b) Unique Health Identifiers.--
``(1) In general.--The Secretary shall adopt standards
providing for a standard unique health identifier for each
individual, employer, health plan, and health care provider for
use in the health care system. In carrying out the preceding
sentence for each health plan and health care provider, the
Secretary shall take into account multiple uses for identifiers
and multiple locations and specialty classifications for health
care providers.
``(2) Use of identifiers.--The standards adopted under
paragraph (1) shall specify the purposes for which a unique
health identifier may be used.
``(c) Code Sets.--
``(1) In general.--The Secretary shall adopt standards
that--
``(A) select code sets for appropriate data elements
for the transactions referred to in subsection (a)(1)
from among the code sets that have been developed by
private and public entities; or
``(B) establish code sets for such data elements if
no code sets for the data elements have been developed.
``(2) Distribution.--The Secretary shall establish efficient
and low-cost procedures for distribution (including electronic
distribution) of code sets and modifications made to such code
sets under section 1174(b).
``(d) Security Standards for Health Information.--
``(1) Security standards.--The Secretary shall adopt
security standards that--
``(A) take into account--
``(i) the technical capabilities of record
systems used to maintain health information;
``(ii) the costs of security measures;
``(iii) the need for training persons who have
access to health information;
``(iv) the value of audit trails in
computerized record systems; and
``(v) the needs and capabilities of small
health care providers and rural health care
providers (as such providers are defined by the
Secretary); and
``(B) ensure that a health care clearinghouse, if it
is part of a larger organization, has policies and
security procedures which isolate the activities of the
health care clearinghouse with respect to processing
information in a manner that prevents unauthorized
access to such information by such larger organization.
``(2) Safeguards.--Each person described in section 1172(a)
who maintains or transmits health information shall maintain
reasonable and appropriate administrative, technical, and
physical safeguards--
``(A) to ensure the integrity and confidentiality of
the information;
``(B) to protect against any reasonably
anticipated--
``(i) threats or hazards to the security or
integrity of the information; and
``(ii) unauthorized uses or disclosures of the
information; and
``(C) otherwise to ensure compliance with this part
by the officers and employees of such person.
``(e) Electronic Signature.--
``(1) Standards.--The Secretary, in coordination with the
Secretary of Commerce, shall adopt standards specifying
procedures for the electronic transmission and authentication of
signatures with respect to the transactions referred to in
subsection (a)(1).
``(2) Effect of compliance.--Compliance with the standards
adopted under paragraph (1) shall be deemed to satisfy Federal
and State statutory requirements for written signatures with
respect to the transactions referred to in subsection (a)(1).
``(f) Transfer of Information Among Health Plans.--The Secretary
shall adopt standards for transferring among health plans appropriate
standard data elements needed for the coordination of benefits, the
sequential processing of claims, and other data elements for individuals
who have more than one health plan.
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