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U.S. Code as of:
01/19/04
Section 1320d. Definitions
For 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 1395x(u) of this title), a provider of
medical or other health services (as defined in section 1395x(s)
of this title), 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 300gg-91 of this title). Such term includes
the following, and any combination thereof:
(A) A group health plan (as defined in section 300gg-91(a) of
this title), but only if the plan -
(i) has 50 or more participants (as defined in section
1002(7) of title 29); 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
300gg-91(b) of this title).
(C) A health maintenance organization (as defined in section
300gg-91(b) of this title).
(D) Parts )1(! A, B, or C of the Medicare program under
subchapter XVIII of this chapter.
(E) The medicaid program under subchapter XIX of this
chapter.
(F) A Medicare supplemental policy (as defined in section
1395ss(g)(1) of this title).
(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.
(J) The veterans health care program under chapter 17 of
title 38.
(K) The Civilian Health and Medical Program of the Uniformed
Services (CHAMPUS), as defined in section 1072(4) of title 10.
(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.
(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
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(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
1320d-2(a)(1) of this title, 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 1320d-1
through 1320d-3 of this title.
(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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