§ 1320d–1. General requirements for adoption of standards

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Any standard adopted under this part shall apply, in whole or in part, to the following persons: A health plan. A health care clearinghouse. 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 . Any standard adopted under this part shall be consistent with the objective of reducing the administrative costs of providing and paying for health care. 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.

The Secretary may adopt a standard that is different from any standard developed, adopted, or modified by a standard setting organization, if— the different standard will substantially reduce administrative costs to health care providers and health plans compared to the alternatives; and the standard is promulgated in accordance with the rulemaking procedures of subchapter III of chapter 5 of title 5. 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— paragraph

(1)shall not apply; and subsection

(f)shall apply. A standard may not be adopted under this part unless— 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 in the case of any other standard, the Secretary, in complying with the requirements of subsection (f), consulted with each of the organizations described in subparagraph

(B)before adopting the standard. The organizations referred to in subparagraph

(A)are the following: The National Uniform Billing Committee. The National Uniform Claim Committee. The Workgroup for Electronic Data Interchange. The American Dental Association. The Secretary shall establish specifications for implementing each of the standards adopted under this part. 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. 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. 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, § 1172, as added Pub. L. 104–191, title II, § 262(a) , Aug. 21, 1996 , 110 Stat. 2023 .)

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statutes-at-large

Public Law 107–105
To ensure that covered entities comply with the standards for electronic health care transactions and code sets adopted under part C of title XI of the Social Security Act, and for other purposes

3 references not yet in our index

Pub. L. 104-191
110 Stat. 2023
Pub. L. 97-248

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§ 1320d–1

General requirements for adoption of standards

Fed. Reg.×29

Stat.×1

Pub. L.Pub. L. 104-191

Stat.110 Stat. 2023

Pub. L.Pub. L. 97-248

Cites 3Cited by 30 across 2 sources