42 USC 1320d-1 - General requirements for adoption of standards

U.S Code last checked for updates: May 03, 2024

§ 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

(c)

Role of standard setting organizations

(1)

In general

(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) 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), 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

(e)

Protection of trade secrets

(f)

Assistance to Secretary

(g)

Application to modifications of standards

(Aug. 14, 1935, ch. 531, title XI, § 1172, as added Pub. L. 104–191, title II, § 262(a), Aug. 21, 1996, 110 Stat. 2023.)

cite as: 42 USC 1320d-1