SEC. 262. ADMINISTRATIVE SIMPLIFICATION
Title[ Title II\Subtitle F\Sec. 262 Contents
(a) In General.--Title XI (42 U.S.C. 1301 et seq.) is amended by
adding at the end the following:
``Part C--Administrative Simplification
``definitions
Sec. 1171. For <<NOTE: 42 USC 1320d.>> purposes of this part:
``(1) Code set.--The term `code set' means any set of codes
used for encoding data elements, such as tables of terms,
medical concepts, medical diagnostic codes, or medical procedure
codes.
``(2) Health care clearinghouse.--The term `health care
clearinghouse' means a public or private entity that processes
or facilitates the processing of nonstandard data elements of
health information into standard data elements.
``(3) Health care provider.--The term `health care provider'
includes a provider of services (as defined in section 1861(u)),
a provider of medical or other health services (as defined in
section 1861(s)), and any other person furnishing health care
services or supplies.
``(4) Health information.--The term `health information'
means any information, whether oral or recorded in any form or
medium, that--
``(A) is created or received by a health care
provider, health plan, public health authority,
employer, life insurer, school or university, or health
care clearinghouse; and
``(B) relates to the past, present, or future
physical or mental health or condition of an individual,
the provision of health care to an individual, or the
past, present, or future payment for the provision of
health care to an individual.
``(5) Health plan.--The term `health plan' means an
individual or group plan that provides, or pays the cost of,
medical care (as such term is defined in section 2791 of the
Public Health Service Act). Such term includes the following,
and any combination thereof:
``(A) A group health plan (as defined in section
2791(a) of the Public Health Service Act), but only if
the plan--
``(i) has 50 or more participants (as defined
in section 3(7) of the Employee Retirement Income
Security Act of 1974); or
``(ii) is administered by an entity other than
the employer who established and maintains the
plan.
``(B) A health insurance issuer (as defined in
section 2791(b) of the Public Health Service Act).
``(C) A health maintenance organization (as defined
in section 2791(b) of the Public Health Service Act).
``(D) Part A or part B of the Medicare program under
title XVIII.
``(E) The medicaid program under title XIX.
``(F) A Medicare supplemental policy (as defined in
section 1882(g)(1)).
``(G) A long-term care policy, including a nursing
home fixed indemnity policy (unless the Secretary
determines that such a policy does not provide
sufficiently comprehensive coverage of a benefit so that
the policy should be treated as a health plan).
``(H) An employee welfare benefit plan or any other
arrangement which is established or maintained for the
purpose of offering or providing health benefits to the
employees of 2 or more employers.
``(I) The health care program for active military
personnel under title 10, United States Code.
``(J) The veterans health care program under chapter
17 of title 38, United States Code.
``(K) The Civilian Health and Medical Program of the
Uniformed Services (CHAMPUS), as defined in section
1072(4) of title 10, United States Code.
``(L) The Indian health service program under the
Indian Health Care Improvement Act (25 U.S.C. 1601 et
seq.).
``(M) The Federal Employees Health Benefit Plan
under chapter 89 of title 5, United States Code.
``(6) Individually identifiable health information.--The
term `individually identifiable health information' means any
information, including demographic information collected from an
individual, that--
``(A) is created or received by a health care
provider, health plan, employer, or health care
clearinghouse; and
``(B) relates to the past, present, or future
physical or mental health or condition of an individual,
the provision of health care to an individual, or the
past, present, or future payment for the provision of
health care to an individual, and--
``(i) identifies the individual; or
``(ii) with respect to which there is a
reasonable basis to believe that the information
can be used to identify the individual.
``(7) Standard.--The term `standard', when used with
reference to a data element of health information or a
transaction referred to in section 1173(a)(1), means any such
data element or transaction that meets each of the standards and
implementation specifications adopted or established by the
Secretary with respect to the data element or transaction under
sections 1172 through 1174.
``(8) Standard setting organization.--The term `standard
setting organization' means a standard setting organization
accredited by the American National Standards Institute,
including the National Council for Prescription Drug Programs,
that develops standards for information transactions, data
elements, or any other standard that is necessary to, or will
facilitate, the implementation of this part.
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