
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document not affected by Public Laws enacted between
  January 23, 2000 and December 4, 2001]
[CITE: 42USC1320d-1]

 
                 TITLE 42--THE PUBLIC HEALTH AND WELFARE
 
                       CHAPTER 7--SOCIAL SECURITY
 
   SUBCHAPTER XI--GENERAL PROVISIONS, PEER REVIEW, AND ADMINISTRATIVE 
                             SIMPLIFICATION
 
                  Part C--Administrative Simplification
 
Sec. 1320d-1. General requirements for adoption of standards


(a) Applicability

    Any 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 1320d-2(a)(1) of this title.

(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.

        (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) of this section 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) of this 
            section, 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 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 242k(k) of this title, and 
shall consult with appropriate Federal and State agencies 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 1320d-3(b) of this 
title in the same manner as it applies to an initial standard adopted 
under section 1320d-3(a) of this title.

(Aug. 14, 1935, ch. 531, title XI, Sec. 1172, as added Pub. L. 104-191, 
title II, Sec. 262(a), Aug. 21, 1996, 110 Stat. 2023.)


                            Prior Provisions

    A prior section 1172 of act Aug. 14, 1935, was classified to section 
1320c-21 of this title prior to the general amendment of part B of this 
subchapter by Pub. L. 97-248.

                  Section Referred to in Other Sections

    This section is referred to in sections 1320d, 1320d-2, 1320d-4, 
1320d-7 of this title.
