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U.S. Code as of:
01/19/04
Section 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.
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