SEC. 1175. Requirements
Title[ Title II\Subtitle F\Sec. 262 Contents
Sec. 1175. (a) Conduct <<NOTE: 42 USC 1320d-4.>> of Transactions
by Plans.--
``(1) In general.--If a person desires to conduct a
transaction referred to in section 1173(a)(1) with a health plan
as a standard transaction--
``(A) the health plan may not refuse to conduct such
transaction as a standard transaction;
``(B) the insurance plan may not delay such
transaction, or otherwise adversely affect, or attempt
to adversely affect, the person or the transaction on
the ground that the transaction is a standard
transaction; and
``(C) the information transmitted and received in
connection with the transaction shall be in the form of
standard data elements of health information.
``(2) Satisfaction of requirements.--A health plan may
satisfy the requirements under paragraph (1) by--
``(A) directly transmitting and receiving standard
data elements of health information; or
``(B) submitting nonstandard data elements to a
health care clearinghouse for processing into standard
data elements and transmission by the health care
clearinghouse, and receiving standard data elements
through the health care clearinghouse.
``(3) Timetable for compliance.--Paragraph (1) shall not be
construed to require a health plan to comply with any standard,
implementation specification, or modification to a standard or
specification adopted or established by the Secretary under
sections 1172 through 1174 at any time prior to the date on
which the plan is required to comply with the standard or
specification under subsection (b).
``(b) Compliance With Standards.--
``(1) Initial compliance.--
``(A) In general.--Not later than 24 months after
the date on which an initial standard or implementation
specification is adopted or established under sections
1172 and 1173, each person to whom the standard or
implementation specification applies shall comply with
the standard or specification.
``(B) Special rule for small health plans.--In the
case of a small health plan, paragraph (1) shall be
applied by substituting `36 months' for `24 months'. For
purposes of this subsection, the Secretary shall
determine the plans that qualify as small health plans.
``(2) Compliance with modified standards.--If the Secretary
adopts a modification to a standard or implementation
specification under this part, each person to whom the standard
or implementation specification applies shall comply with the
modified standard or implementation specification at such time
as the Secretary determines appropriate, taking into account the
time needed to comply due to the nature and extent of the
modification. The time determined appropriate under the
preceding sentence may not be earlier than the last day of the
180-day period beginning on the date such modification is
adopted. The Secretary may extend the time for compliance for
small health plans, if the Secretary determines that such
extension is appropriate.
``(3) Construction.--Nothing in this subsection shall be
construed to prohibit any person from complying with a standard
or specification by--
``(A) submitting nonstandard data elements to a
health care clearinghouse for processing into standard
data elements and transmission by the health care
clearing-
house; or
``(B) receiving standard data elements through a
health care clearinghouse.
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