[Congressional Bills 103th Congress]
[From the U.S. Government Publishing Office]
[H.R. 2261 Introduced in House (IH)]
103d CONGRESS
1st Session
H. R. 2261
To contain the rate of growth in health care costs and enhance the
quality of health care by improving and making more efficient the
provision of medical and health insurance information, and for other
purposes.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
May 25, 1993
Mr. Thomas of California (for himself, Mrs. Johnson of Connecticut, Mr.
Grandy, and Mr. McCrery) introduced the following bill; which was
referred jointly to the Committees on Energy and Commerce, Ways and
Means, Education and Labor, and Veterans' Affairs
_______________________________________________________________________
A BILL
To contain the rate of growth in health care costs and enhance the
quality of health care by improving and making more efficient the
provision of medical and health insurance information, and for other
purposes.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. TABLE OF CONTENTS.
The table of contents of this Act is as follows:
Sec. 1. Table of contents.
Sec. 2. Definitions.
TITLE I--STANDARDIZATION OF CLAIMS PROCESSING
Sec. 101. Adoption of data elements, uniform claims, and uniform
electronic transmission standards.
Sec. 102. Application of standards.
Sec. 103. Periodic review and revision of standards.
TITLE II--ELECTRONIC MEDICAL DATA STANDARDS
Sec. 201. Medical data standards for hospitals and other providers.
Sec. 202. Application of electronic data standards to certain
hospitals.
Sec. 203. Electronic transmission to Federal agencies.
Sec. 204. Limitation on data requirements where standards in effect.
Sec. 205. Advisory commission.
TITLE III--DEVELOPMENT AND DISTRIBUTION OF COMPARATIVE VALUE
INFORMATION
Sec. 301. State comparative value information programs for health care
purchasing.
Sec. 302. Federal implementation.
Sec. 303. Comparative value information concerning Federal programs.
Sec. 304. Development of model systems.
TITLE IV--ADDITIONAL STANDARDS AND REQUIREMENTS; RESEARCH AND
DEMONSTRATIONS
Sec. 401. Standards relating to use of medicare and medicaid magnetized
health benefit cards; secondary payor data
bank.
Sec. 402. Preemption of State quill pen laws.
Sec. 403. Use of standard identification numbers.
Sec. 404. Coordination of benefit standards.
Sec. 405. Research and demonstrations.
SEC. 2. DEFINITIONS.
For purposes of this Act:
(1) Health benefit plan.--The term ``health benefit plan''
means any hospital or medical expense incurred policy or
certificate, hospital or medical service plan contract, or
health maintenance subscriber contract, or a multiple employer
welfare arrangement or employee benefit plan (as defined under
the Employee Retirement Income Security Act of 1974) which
provides benefits with respect to health care services. The
term includes the medicare program (under title XVIII of the
Social Security Act), medicare supplemental health insurance,
and a State medicaid plan (approved under title XIX of such
Act). The term does not include--
(A) coverage only for accident, dental, vision,
disability income, or long-term care insurance, or any
combination thereof,
(B) coverage issued as a supplement to liability
insurance,
(C) worker's compensation or similar insurance, or
(D) automobile medical-payment insurance,
or any combination thereof.
(2) Secretary.--The term ``Secretary'' means the Secretary
of Health and Human Services.
(3) State.--The term ``State'' means any of the several
States, the District of Columbia, the Commonwealth of Puerto
Rico, the Virgin Islands, Guam, and American Samoa.
TITLE I--STANDARDIZATION OF CLAIMS PROCESSING
SEC. 101. ADOPTION OF DATA ELEMENTS, UNIFORM CLAIMS, AND UNIFORM
ELECTRONIC TRANSMISSION STANDARDS.
(a) In General.--The Secretary of Health and Human Services shall
adopt standards relating to each of the following:
(1) Data elements for use in paper and electronic claims
processing under health benefit plans, as well as for use in
utilization review and management of care (including data
fields, formats, and medical nomenclature, and including plan
benefit and insurance information).
(2) Uniform claims forms (including uniform procedure and
billing codes for uses with such forms and including
information on other health benefit plans that may be liable
for benefits).
(3) Uniform electronic transmission of the data elements
(for purposes of billing and utilization review).
Standards under paragraph (3) relating to electronic transmission of
data elements for claims for services shall supersede (to the extent
specified in such standards) the standards adopted under paragraph (2)
relating to the submission of paper claims for such services. Standards
under paragraph (3) shall include protections to assure the
confidentiality of patient-specific information and to protect against
the unauthorized use and disclosure of information.
(b) Use of Task Forces.--In adopting standards under this section--
(1) the Secretary shall take into account the
recommendations of current task forces, including at least the
Workgroup on Electronic Data Interchange, National Uniform
Billing Committee, the Uniform Claim Task Force, and the
Computer-based Patient Record Institute;
(2) the Secretary shall consult with the National
Association of Insurance Commissioners (and, with respect to
standards under subsection (a)(3), the American National
Standards Institute); and
(3) the Secretary shall, to the maximum extent practicable,
seek to make the standards consistent with any uniform clinical
data sets which have been adopted and are widely recognized.
(c) Deadlines for Promulgation.--The Secretary shall promulgate the
standards under--
(1) subsection (a)(1) relating to claims processing data,
by not later than 12 months after the date of the enactment of
this Act;
(2) subsection (a)(2) (relating to uniform claims forms) by
not later than 12 months after the date of the enactment of
this Act; and
(3)(A) subsection (a)(3) relating to transmission of
information concerning hospital and physicians services, by not
later than 24 months after the date of the enactment of this
Act, and
(B) subsection (a)(3) relating to transmission of
information on other services, by such later date as the
Secretary may determine it to be feasible.
(d) Report to Congress.--Not later than 3 years after the date of
the enactment of this Act, the Secretary shall report to Congress
recommendations regarding restructuring the medicare peer review
quality assurance program given the availability of hospital data in
electronic form.
SEC. 102. APPLICATION OF STANDARDS.
(a) In General.--If the Secretary determines, at the end of the 2-
year period beginning on the date that standards are adopted under
section 101 with respect to classes of services, that a significant
number of claims for benefits for such services under health benefit
plans are not being submitted in accordance with such standards, the
Secretary may require, after notice in the Federal Register of not less
than 6 months, that all providers of such services must submit claims
to health benefit plans in accordance with such standards. The
Secretary may waive the application of such a requirement in such cases
as the Secretary finds that the imposition of the requirement would not
be economically practicable.
(b) Significant Number.--The Secretary shall make an affirmative
determination described in subsection (a) for a class of services only
if the Secretary finds that there would be a significant, measurable
additional gain in efficiencies in the health care system that would be
obtained by imposing the requirement described in such paragraph with
respect to such services.
(c) Application of Requirement.--
(1) In general.--If the Secretary imposes the requirement
under subsection (a)--
(A) in the case of a requirement that imposes the
standards relating to electronic transmission of claims
for a class of services, each health care provider that
furnishes such services for which benefits are payable
under a health benefit plan shall transmit
electronically and directly to the plan on behalf of
the beneficiary involved a claim for such services in
accordance with such standards;
(B) any health benefit plan may reject any claim
subject to the standards adopted under section 101 but
which is not submitted in accordance with such
standards;
(C) it is unlawful for a health benefit plan (i) to
reject any such claim on the basis of the form in which
it is submitted if it is submitted in accordance with
such standards or (ii) to require, for the purpose of
utilization review or as a condition of providing
benefits under the plan, a provider to transmit medical
data elements that are inconsistent with the standards
established under section 101(a)(1); and
(D) the Secretary may impose a civil money penalty
on any provider that knowingly and repeatedly submits
claims in violation of such standards or on any health
benefit plan (other than a health benefit plan
described in paragraph (2)) that knowingly and
repeatedly rejects claims in violation of subparagraph
(B), in an amount not to exceed $100 for each such
claim.
The provisions of section 1128A of the Social Security Act
(other than the first sentence of subsection (a) and other than
subsection (b)) shall apply to a civil money penalty under
subparagraph (D) in the same manner as such provisions apply to
a penalty or proceeding under section 1128A(a) of such Act.
(2) Plans subject to effective state regulation.--A plan
described in this paragraph is a health benefit plan--
(A) that is subject to regulation by a State, and
(B) with respect to which the Secretary finds
that--
(i) the State provides for application of
the standards established under section 101,
and
(ii) the State regulatory program provides
for the appropriate and effective enforcement
of such standards.
(d) Treatment of Rejections.--If a plan rejects a claim pursuant to
subsection (c)(1), the plan shall permit the person submitting the
claim a reasonable opportunity to resubmit the claim on a form or in an
electronic manner that meets the requirements for acceptance of the
claim under such subsection.
SEC. 103. PERIODIC REVIEW AND REVISION OF STANDARDS.
(a) In General.--The Secretary shall--
(1) provide for the ongoing receipt and review of comments
and suggestions for changes in the standards adopted and
promulgated under section 101;
(2) establish a schedule for the periodic review of such
standards; and
(3) based upon such comments, suggestions, and review,
revise such standards and promulgate such revisions.
(b) Application of Revised Standards.--If the Secretary under
subsection (a) revises the standards described in 101, then, in the
case of any claim for benefits submitted under a health benefit plan
more than the minimum period (of not less than 6 months specified by
the Secretary) after the date the revision is promulgated under
subsection (a)(3), such standards shall apply under section 102 instead
of the standards previously promulgated.
TITLE II--ELECTRONIC MEDICAL DATA STANDARDS
SEC. 201. MEDICAL DATA STANDARDS FOR HOSPITALS AND OTHER PROVIDERS.
(a) Promulgation of Hospital Data Standards.--
(1) In general.--Between July 1, 1994, and January 1, 1995,
the Secretary shall promulgate standards described in
subsection (b) for hospitals concerning electronic medical
data.
(2) Revision.--The Secretary may from time to time revise
the standards promulgated under this subsection.
(b) Contents of Data Standards.--The standards promulgated under
subsection (a) shall include at least the following:
(1) A definition of a standard set of data elements for use
by utilization and quality control peer review organizations.
(2) A definition of the set of comprehensive data elements,
which set shall include for hospitals the standard set of data
elements defined under paragraph (1).
(3) Standards for an electronic patient care information
system with data obtained at the point of care, including
standards to protect against the unauthorized use and
disclosure of information.
(4) A specification of, and manner of presentation of, the
individual data elements of the sets and system under this
subsection.
(5) Standards concerning the transmission of electronic
medical data.
(6) Standards relating to confidentiality of patient-
specific information.
The standards under this section shall be consistent with standards for
data elements established under section 101.
(c) Optional Data Standards for Other Providers.--
(1) In general.--The Secretary may promulgate standards
described in paragraph (2) concerning electronic medical data
for providers that are not hospitals. The Secretary may from
time to time revise the standards promulgated under this
subsection.
(2) Contents of data standards.--The standards promulgated
under paragraph (1) for non-hospital providers may include
standards comparable to the standards described in paragraphs
(2), (4), and (5) of subsection (b) for hospitals.
(d) Consultation.--In promulgating and revising standards under
this section, the Secretary shall--
(1) consult with the American National Standards Institute,
hospitals, with the advisory commission established under
section 205, and with other affected providers, health benefit
plans, and other interested parties, and
(2) take into consideration, in developing standards under
subsection (b)(1), the data set used by the utilization and
quality control peer review program under part B of title XI of
the Social Security Act.
SEC. 202. APPLICATION OF ELECTRONIC DATA STANDARDS TO CERTAIN
HOSPITALS.
(a) Medicare Requirement for Sharing of Hospital Information.--As
of January 1, 1996, subject to paragraph (2), each hospital, as a
requirement of each participation agreement under section 1866 of the
Social Security Act, shall--
(1) maintain clinical data included in the set of
comprehensive data elements under section 201(b)(2) in
electronic form on all inpatients,
(2) upon request of the Secretary or of a utilization and
quality control peer review organization (with which the
Secretary has entered into a contract under part B of title XI
of such Act), transmit electronically the data set, and
(3) upon request of the Secretary, or of a fiscal
intermediary or carrier, transmit electronically any data (with
respect to a claim) from such data set,
in accordance with the standards promulgated under section 201(a).
(b) Waiver Authority.--Until January 1, 2000:
(1) The Secretary may waive the application of the
requirements of subsection (a) for a hospital that is a small
rural hospital, for such period as the hospital demonstrates
compliance with such requirements would constitute an undue
financial hardship.
(2) The Secretary may waive the application of the
requirements of subsection (a) for a hospital that is in the
process of developing a system to provide the required data set
and executes agreements with its fiscal intermediary and its
utilization and quality control peer review organization that
the hospital will meet the requirements of subsection (a) by a
specified date (not later than January 1, 2000).
(3) The Secretary may waive the application of the
requirement of subsection (a)(1) for a hospital that agrees to
obtain from its records the data elements that are needed to
meet the requirements of paragraphs (2) and (3) of subsection
(a) and agrees to subject its data transfer process to a
quality assurance program specified by the Secretary.
(c) Application to Hospitals of the Department of Veterans
Affairs.--
(1) In general.--The Secretary of Veterans Affairs shall
provide that each hospital of the Department of Veterans
Affairs shall comply with the requirements of subsection (a) in
the same manner as such requirements would apply to the
hospital if it were participating in the Medicare program.
(2) Waiver.--Such Secretary may waive the application of
such requirements to a hospital in the same manner as the
Secretary of Health and Human Services may waive under
subsection (b) the application of the requirements of
subsection (a).
SEC. 203. ELECTRONIC TRANSMISSION TO FEDERAL AGENCIES.
(a) In General.--Effective January 1, 2000, if a provider is
required under a Federal program to transmit a data element that is
subject to a presentation or transmission standard (as defined in
subsection (b)), the head of the Federal agency responsible for such
program (if not otherwise authorized) is authorized to require the
provider to present and transmit the data element electronically in
accordance with such a standard.
(b) Presentation or Transmission Standard Defined.--In subsection
(a), the term ``presentation or transmission standard'' means a
standard, promulgated under subsection (b) or (c) of section 201,
described in paragraph (4) or (5) of section 201(b).
SEC. 204. LIMITATION ON DATA REQUIREMENTS WHERE STANDARDS IN EFFECT.
(a) In General.--If standards with respect to data elements are
promulgated under section 201 with respect to a class of provider, a
health benefit plan may not require, for the purpose of utilization
review or as a condition of providing benefits under the plan, that a
provider in the class--
(1) provide any data element not in the set of
comprehensive data elements specified under such standards, or
(2) transmit or present any such data element in a manner
inconsistent with the applicable standards for such
transmission or presentation.
(b) Compliance.--
(1) In general.--The Secretary may impose a civil money
penalty on any health benefit plan (other than a health benefit
plan described in paragraph (2)) that fails to comply with
subsection (a) in an amount not to exceed $100 for each such
failure. The provisions of section 1128A of the Social Security
Act (other than the first sentence of subsection (a) and other
than subsection (b)) shall apply to a civil money penalty under
this paragraph in the same manner as such provisions apply to a
penalty or proceeding under section 1128A(a) of such Act.
(2) Plans subject to effective state regulation.--A plan
described in this paragraph is a health benefit plan that is
subject to regulation by a State, if the Secretary finds that--
(A) the State provides for application of the
requirement of subsection (a), and
(B) the State regulatory program provides for the
appropriate and effective enforcement of such
requirement with respect to such plans.
SEC. 205. ADVISORY COMMISSION.
(a) In General.--The Secretary shall establish an advisory
commission including hospital executives, hospital data base managers,
physicians, health services researchers, and technical experts in
collection and use of data and operation of data systems. Such
commission shall include, as ex officio members, a representative of
the Director of the National Institutes of Health, the Administrator
for Health Care Policy and Research, the Secretary of Veterans Affairs,
and the Director of the Centers for Disease Control.
(b) Functions.--The advisory commission shall monitor and advise
the Secretary concerning--
(1) the standards established under this title, and
(2) operational concerns about the implementation of such
standards under this part.
(c) Staff.--From the amounts appropriated under subsection (d), the
Secretary shall provide sufficient staff to assist the advisory
commission in its activities under this section.
(d) Authorization of Appropriations.--There are authorized to be
appropriated $2,000,000 for each of fiscal years 1994 through 1999 to
carry out this section.
TITLE III--DEVELOPMENT AND DISTRIBUTION OF COMPARATIVE VALUE
INFORMATION
SEC. 301. STATE COMPARATIVE VALUE INFORMATION PROGRAMS FOR HEALTH CARE
PURCHASING.
(a) Purpose.--In order to assure the availability of comparative
value information to purchasers of health care in each State, the
Secretary shall determine whether each State is developing and
implementing a health care value information program that meets the
criteria and schedule set forth in subsection (b).
(b) Criteria and Schedule for State Programs.--The criteria and
schedule for a State health care value information program in this
subsection shall be specified by the Secretary as follows:
(1) The State begins promptly after enactment of this Act
to develop (directly or through contractual or other
arrangements with one or more States, coalitions of health
insurance purchasers, other entities, or any combination of
such arrangements) information systems regarding comparative
health values.
(2) The information contained in such systems covers at
least the average prices of common health care services (as
defined in subsection (d)) and health insurance plans, and,
where available, measures of the variability of these prices
within a State or other market areas.
(3) The information described in paragraph (2) is made
available within the State beginning not later than 1 year
after the date of the enactment of this Act, and is revised as
frequently as reasonably necessary, but at intervals of no
greater than 1 year.
(4) Not later than 6 years after the date of the enactment
of this Act the State has developed information systems that
provide comparative costs, quality, and outcomes data with
respect to health insurance plans and hospitals and made the
information broadly available within the relevant market areas.
Nothing in this section shall preclude a State from providing
additional information, such as information on prices and benefits of
different health benefit plans, available.
(c) Grants to States for the Development of State Programs.--
(1) Grant authority.--The Secretary may make grants to each
State to enable such State to plan the development of its
health care value information program and, if necessary, to
initiate the implementation of such program. Each State seeking
such a grant shall submit an application therefore, containing
such information as the Secretary finds necessary to assure
that the State is likely to develop and implement a program in
accordance with the criteria and schedule in subsection (b).
(2) Offset authority.--If, at any time within the 3-year
period following the receipt by a State of a grant under this
subsection, the Secretary is required by section 302 to
implement a health care information program in the State, the
Secretary may recover the amount of the grant under this
subsection by offset against any other amount payable to the
State under the Social Security Act. The amount of the offset
shall be made available (from the appropriation account with
respect to which the offset was taken) to the Secretary to
carry out such section.
(3) Authorization of appropriations.--There are authorized
to be appropriated such sums as are necessary to make grants
under this subsection, to remain available until expended.
(d) Common Health Care Services Defined.--In this section, the term
``common health care services'' includes such procedures as the
Secretary may specify and any additional health care services which a
State may wish to include in its comparative value information program.
SEC. 302. FEDERAL IMPLEMENTATION.
(a) In General.--If the Secretary finds, at any time, that a State
has failed to develop or to continue to implement a health care value
information program in accordance with the criteria and schedule in
section 301(b), the Secretary shall take the actions necessary,
directly or through grants or contract, to implement a comparable
program in the State.
(b) Fees.--Fees may be charged by the Secretary for the information
materials provided pursuant to a program under this section. Any
amounts so collected shall be deposited in the appropriation account
from which the Secretary's costs of providing such materials were met,
and shall remain available for such purposes until expended.
SEC. 303. COMPARATIVE VALUE INFORMATION CONCERNING FEDERAL PROGRAMS.
(a) Development.--The head of each Federal agency with
responsibility for the provision of health insurance or of health care
services to individuals shall promptly develop health care value
information relating to each program that such head administers and
covering the same types of data that a State program meeting the
criteria of section 301(b) would provide.
(b) Dissemination of Information.--Such information shall be made
generally available to States and to providers and consumers of health
care services.
SEC. 304. DEVELOPMENT OF MODEL SYSTEMS.
(a) In General.--The Secretary shall, directly or through grant or
contract, develop model systems to facilitate--
(1) the gathering of data on health care cost, quality, and
outcome described in section 301(b)(4), and
(2) analyzing such data in a manner that will permit the
valid comparison of such data among providers and among health
plans.
(b) Experimentation.--The Secretary shall support experimentation
with different approaches to achieve the objectives of subsection (a)
in the most cost effective manner (relative to the accuracy and
timeliness of the data secured) and shall evaluate the various methods
to determine their relative success.
(c) Standards.--When the Secretary considers it appropriate, the
Secretary may establish standards for the collection and reporting of
data on health care cost, quality and outcomes in order to facilitate
analysis and comparisons among States and nationally.
(e) Report.--By not later than 3 years after the date of the
enactment of this Act, the Secretary shall report to the Congress and
the States on the models developed, and experiments conducted, under
this section.
(e) Authorization of Appropriations.--There are authorized to be
appropriated such sums as are necessary for each fiscal year beginning
with fiscal year 1993 to enable the Secretary to carry out this
section, including evaluation of the different approaches tested under
subsection (b) and their relative cost effectiveness.
TITLE IV--ADDITIONAL STANDARDS AND REQUIREMENTS; RESEARCH AND
DEMONSTRATIONS
SEC. 401. STANDARDS RELATING TO USE OF MEDICARE AND MEDICAID MAGNETIZED
HEALTH BENEFIT CARDS; SECONDARY PAYOR DATA BANK.
(a) Magnetized Identification Cards Under Medicare Program.--The
Secretary shall adopt standards relating to the design and use of
magnetized medicare identification cards in order to assist health care
providers providing medicare covered services to individuals--
(1) in determining whether individuals are eligible for
benefits under the medicare program, and
(2) in billing the medicare program for such services
provided to eligible individuals.
Such cards shall be designed to be compatible with machines currently
employed to transmit information on credit cards. Such cards also shall
be designed to be able to be used with respect to the provision of
benefits under medicare supplemental policies.
(b) Adoption Under Medicaid Plans.--
(1) In general.--The Secretary shall take such steps as may
be necessary to encourage and assist States to design and use
magnetized medicaid identification cards that meet such
standards, for use under their medicaid plans.
(2) Limitation on mmis funds.--In applying section
1903(a)(3) of the Social Security Act, the Secretary may
determine that Federal financial participation is not available
under that section to a State which has provided for a
magnetized card system that is inconsistent with the standards
adopted under subsection (a).
(c) Medicare and Medicaid Secondary Payor Data Bank.--The Secretary
shall establish a medicare and medicaid information system which is
designed to provide information on those group health plans and other
health benefit plans that are primary payors to the medicare program
and medicaid program under section 1862(b) or section 1905(a)(25) of
the Social Security Act.
(d) Authorization of Appropriations.--There are authorized to be
appropriated, in equal proportions from the Federal Hospital Insurance
Trust Fund and from the Federal Supplementary Medical Insurance Trust
Fund, a total of $25,000,000 to carry out subsections (a) and (c),
including the issuance of magnetized cards to medicare beneficiaries.
SEC. 402. PREEMPTION OF STATE QUILL PEN LAWS.
(a) In General.--Effective January 1, 1994, no effect shall be
given to any provision of State law that requires medical or health
insurance records (including billing information) to be maintained in
written, rather than electronic form.
(b) Secretarial Authority.--The Secretary of Health and Human
Services may issue regulations to carry out subsection (a). Such
regulations may provide for such exceptions to subsection (a) as the
Secretary determines to be necessary to prevent fraud and abuse, with
respect to controlled substances, and in such other cases as the
Secretary deems appropriate.
SEC. 403. USE OF STANDARD IDENTIFICATION NUMBERS.
(a) In General.--Effective January 1, 1994, each health benefit
plan shall--
(1) for each of its beneficiaries that has a social
security account number, use that number as the personal
identifier for claims processing and related purposes, and
(2) for each provider that has a unique identifier for
purposes of title XVIII of the Social Security Act and that
furnishes health care items or services to a beneficiary under
the plan, use that identifier as the identifier of that
provider for claims processing and related purposes.
(b) Compliance.--
(1) In general.--The Secretary may impose a civil money
penalty on any health benefit plan (other than a health benefit
plan described in paragraph (2)) that fails to comply with
standards established under subsection (a) in an amount not to
exceed $100 for each such failure. The provisions of section
1128A of the Social Security Act (other than the first sentence
of subsection (a) and other than subsection (b)) shall apply to
a civil money penalty under this paragraph in the same manner
as such provisions apply to a penalty or proceeding under
section 1128A(a) of such Act.
(2) Plans subject to effective state regulation.--A plan
described in this paragraph is a health benefit plan that is
subject to regulation by a State, if the Secretary finds that--
(A) the State provides for application of the
requirement of subsection (a), and
(B) the State regulatory program provides for the
appropriate and effective enforcement of such
requirement with respect to such plans.
SEC. 404. COORDINATION OF BENEFIT STANDARDS.
(a) Review of Coordination of Benefit Problems.--Between July 1,
1994, and January 1, 1995, the Secretary shall determine whether
problems relating to--
(1) the rules for determining the liability of health
benefit plans when benefits are payable under 2 or more such
plans, or
(2) the availability of information among such health
benefit plans when benefits are so payable,
cause significant administrative costs.
(b) Contingent Promulgation of Standards.--
(1) In general.--If the Secretary determines that such
problems do cause significant administrative costs that could
be significantly reduced through the implementation of
standards, the Secretary shall promulgate standards
concerning--
(A) the liability of health benefit plans when
benefits are payable under 2 or more such plans, and
(B) the transfer among health benefit plans of
appropriate information (which may include standards
for the use of unique identifiers, and for the listing
of all individuals covered under a health benefit plan)
in determining liability in cases when benefits are
payable under 2 or more such plans.
(2) Effective date.--The standards promulgated under
paragraph (1) shall become effective on a date specified by the
Secretary, which date shall be not earlier than 1 year after
the date of promulgation of the standards.
(c) Compliance.--
(1) In general.--The Secretary may impose a civil money
penalty on any health benefit plan (other than a health benefit
plan described in paragraph (2)) that fails to comply with
standards promulgated under subsection (b) in an amount not to
exceed $100 for each such failure. The provisions of section
1128A of the Social Security Act (other than the first sentence
of subsection (a) and other than subsection (b)) shall apply to
a civil money penalty under this paragraph in the same manner
as such provisions apply to a penalty or proceeding under
section 1128A(a) of such Act.
(2) Plans subject to effective state regulation.--A plan
described in this paragraph is a health benefit plan that is
subject to regulation by a State, if the Secretary finds that--
(A) the State provides for application of the
standards established under subsection (b), and
(B) the State regulatory program provides for the
appropriate and effective enforcement of such standards
with respect to such plans.
(d) Revision of Standards.--If the Secretary establishes standards
under subsection (b), the Secretary may revise such standards from time
to time and such revised standards shall be applied under subsection
(c) on or after such date (not earlier than 6 months after the date the
revision is promulgated) as the Secretary shall specify.
SEC. 405. RESEARCH AND DEMONSTRATIONS.
(a) Demonstrations and Research on Monitoring and Improving Patient
Care.--
(1) The Secretary shall provide grants to qualified
entities to demonstrate (and conduct research concerning) the
application of comprehensive information systems--
(A) in continuously monitoring patient care, and
(B) in improving patient care.
(2) To make grants under this subsection, there are
authorized to be appropriated from the Federal Hospital
Insurance Trust Fund $10,000,000 for each fiscal year
(beginning with fiscal year 1994 and ending with fiscal year
1998).
(b) Communication Links.--
(1) The Secretary may make grants to at least 2, but not
more than 5, community organizations, or coalitions of health
care providers, health benefit plans, and purchasers, to
establish and document the efficacy of communication links
between the information systems of health benefit plans and of
health care providers.
(2) To make grants under this subsection, there are
authorized to be appropriated such sums as may be necessary for
fiscal year 1994, to remain available until expended.
(c) Regional or Community Based Clinical Information Systems.--
(1) The Secretary may make grants to at least 2, but not
more than 5, public or private non-profit entities for the
development of regional or community-based clinical information
systems.
(2) To make grants under this subsection, there are
authorized to be appropriated such sums as may be necessary for
fiscal year 1994, to remain available until expended.
(d) Ambulatory Care Data Sets.--
(1) The Secretary may make grants to public or private non-
profit entities to develop and test, for electronic medical
data generated by physicians and other entities (other than
hospitals) that provide health care services--
(A) the definition of a comprehensive set of data
elements, and
(B) the specification of, and manner of
presentation of, the individual data elements of the
set under subparagraph (A).
(2) To make grants under this subsection, there are
authorized to be appropriated such sums as may be necessary for
fiscal year 1994, to remain available until expended.
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