
From the U.S. Code Online via GPO Access
[wais.access.gpo.gov]
[Laws in effect as of January 23, 2000]
[Document affected by Public Law 107-105 Section 2]
[CITE: 42USC1320d-4]

 
                 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-4. Requirements


(a) Conduct of transactions by plans

                           (1) In general

        If a person desires to conduct a transaction referred to in 
    section 1320d-2(a)(1) of this title 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 1320d-1 through 1320d-3 of this 
    title at any time prior to the date on which the plan is required to 
    comply with the standard or specification under subsection (b) of 
    this section.

(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 1320d-1 and 1320d-2 of this title, 
        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 clearinghouse; or
            (B) receiving standard data elements through a health care 
        clearinghouse.

(Aug. 14, 1935, ch. 531, title XI, Sec. 1175, as added Pub. L. 104-191, 
title II, Sec. 262(a), Aug. 21, 1996, 110 Stat. 2027.)
