text: SECTION 1. SHORT TITLE.
  
      This Act may be cited as the ``Administrative Simplification 
  Compliance Act''.
  
  SEC. 2. EXTENSION OF DEADLINE FOR COVERED ENTITIES SUBMITTING 
                COMPLIANCE PLANS.
  
      (a) In General.--
          (1) Extension.--Subject to paragraph (2), notwithstanding 
      section 1175(b)(1)(A) of the Social Security Act (42 U.S.C. 1320d-
      4(b)(1)(A)) and section 162.900 of title 45, Code of Federal 
      Regulations, a health care provider, health plan (other than a 
      small health plan), or a health care clearinghouse shall not be 
      considered to be in noncompliance with the applicable requirements 
      of subparts I through R of part 162 of title 45, Code of Federal 
      Regulations, before October 16, 2003.
          (2) Condition.--Paragraph (1) shall apply to a person described 
      in such paragraph only if, before October 16, 2002, the person 
      submits to the Secretary of Health and Human Services a plan of how 
      the person will come into compliance with the requirements 
      described in such paragraph not later than October 16, 2003. Such 
      plan shall be a summary of the following:
              (A) An analysis reflecting the extent to which, and the 
          reasons why, the person is not in compliance.
              (B) A budget, schedule, work plan, and implementation 
          strategy for achieving compliance.
              (C) Whether the person plans to use or might use a 
          contractor or other vendor to assist the person in achieving 
          compliance.
              (D) A timeframe for testing that begins not later than 
          April 16, 2003.
          (3) Electronic submission.--Plans described in paragraph (2) 
      may be submitted electronically.
          (4) Model form.--Not later than March 31, 2002, the Secretary 
      of Health and Human Services shall promulgate a model form that 
      persons may use in drafting a plan described in paragraph (2). The 
      promulgation of such form shall be made without regard to chapter 
      35 of title 44, United States Code (commonly known as the 
      ``Paperwork Reduction Act'').
          (5) Analysis of plans; reports on solutions.--
              (A) Analysis of plans.--
                  (i) Furnishing of plans.--Subject to subparagraph (D), 
              the Secretary of Health and Human Services shall furnish 
              the National Committee on Vital and Health Statistics with 
              a sample of the plans submitted under paragraph (2) for 
              analysis by such Committee.
                  (ii) Analysis.--The National Committee on Vital and 
              Health Statistics shall analyze the sample of the plans 
              furnished under clause (i).
              (B) Reports on solutions.--The National Committee on Vital 
          and Health Statistics shall regularly publish, and widely 
          disseminate to the public, reports containing effective 
          solutions to compliance problems identified in the plans 
          analyzed under subparagraph (A). Such reports shall not relate 
          specifically to any one plan but shall be written for the 
          purpose of assisting the maximum number of persons to come into 
          compliance by addressing the most common or challenging 
          problems encountered by persons submitting such plans.
              (C) Consultation.--In carrying out this paragraph, the 
          National Committee on Vital and Health Statistics shall consult 
          with each organization--
                  (i) described in section 1172(c)(3)(B) of the Social 
              Security Act (42 U.S.C. 1320d-1(c)(3)(B)); or
                  (ii) designated by the Secretary of Health and Human 
              Services under section 162.910(a) of title 45, Code of 
              Federal Regulations.
              (D) Protection of confidential information.--
                  (i) In general.--The Secretary of Health and Human 
              Services shall ensure that any material provided under 
              subparagraph (A) to the National Committee on Vital and 
              Health Statistics or any organization described in 
              subparagraph (C) is redacted so as to prevent the 
              disclosure of any--
  
                      (I) trade secrets;
                      (II) commercial or financial information that is 
                  privileged or confidential; and
                      (III) other information the disclosure of which 
                  would constitute a clearly unwarranted invasion of 
                  personal privacy.
  
                  (ii) Construction.--Nothing in clause (i) shall be 
              construed to affect the application of section 552 of title 
              5, United States Code (commonly known as the ``Freedom of 
              Information Act''), including the exceptions from 
              disclosure provided under subsection (b) of such section.
          (6) Enforcement through exclusion from participation in 
      medicare.--
              (A) In general.--In the case of a person described in 
          paragraph (1) who fails to submit a plan in accordance with 
          paragraph (2), and who is not in compliance with the applicable 
          requirements of subparts I through R of part 162 of title 45, 
          Code of Federal Regulations, on or after October 16, 2002, the 
          person may be excluded at the discretion of the Secretary of 
          Health and Human Services from participation (including under 
          part C or as a contractor under sections 1816, 1842, and 1893) 
          in title XVIII of the Social Security Act (42 U.S.C. 1395 et 
          seq.).
              (B) Procedure.--The provisions of section 1128A of the 
          Social Security Act (42 U.S.C. 1320a-7a) (other than the first 
          and second sentences of subsection (a) and subsection (b)) 
          shall apply to an exclusion under this paragraph in the same 
          manner as such provisions apply with respect to an exclusion or 
          proceeding under section 1128A(a) of such Act.
              (C) Construction.--The availability of an exclusion under 
          this paragraph shall not be construed to affect the imposition 
          of penalties under section 1176 of the Social Security Act (42 
          U.S.C. 1320d-5).
              (D) Nonapplicability to complying persons.--The exclusion 
          under subparagraph (A) shall not apply to a person who--
                  (i) submits a plan in accordance with paragraph (2); or
                  (ii) who is in compliance with the applicable 
              requirements of subparts I through R of part 162 of title 
              45, Code of Federal Regulations, on or before October 16, 
              2002.
      (b) Special Rules.--
          (1) Rules of construction.--Nothing in this section shall be 
      construed--
              (A) as modifying the October 16, 2003, deadline for a small 
          health plan to comply with the requirements of subparts I 
          through R of part 162 of title 45, Code of Federal Regulations; 
          or
              (B) as modifying--
                  (i) the April 14, 2003, deadline for a health care 
              provider, a health plan (other than a small health plan), 
              or a health care clearinghouse to comply with the 
              requirements of subpart E of part 164 of title 45, Code of 
              Federal Regulations; or
                  (ii) the April 14, 2004, deadline for a small health 
              plan to comply with the requirements of such subpart.
          (2) Applicability of privacy standards before compliance 
      deadline for information transaction standards.--
              (A) In general.--Notwithstanding any other provision of 
          law, during the period that begins on April 14, 2003, and ends 
          on October 16, 2003, a health care provider or, subject to 
          subparagraph (B), a health care clearinghouse, that transmits 
          any health information in electronic form in connection with a 
          transaction described in subparagraph (C) shall comply with the 
          requirements of subpart E of part 164 of title 45, Code of 
          Federal Regulations, without regard to whether the transmission 
          meets the standards required by part 162 of such title.
              (B) Application to health care clearinghouses.--For 
          purposes of this paragraph, during the period described in 
          subparagraph (A), an entity that processes or facilitates the 
          processing of information in connection with a transaction 
          described in subparagraph (C) and that otherwise would be 
          treated as a health care clearinghouse shall be treated as a 
          health care clearinghouse without regard to whether the 
          processing or facilitation produces (or is required to produce) 
          standard data elements or a standard transaction as required by 
          part 162 of title 45, Code of Federal Regulations.
              (C) Transactions described.--The transactions described in 
          this subparagraph are the following:
                  (i) A health care claims or equivalent encounter 
              information transaction.
                  (ii) A health care payment and remittance advice 
              transaction.
                  (iii) A coordination of benefits transaction.
                  (iv) A health care claim status transaction.
                  (v) An enrollment and disenrollment in a health plan 
              transaction.
                  (vi) An eligibility for a health plan transaction.
                  (vii) A health plan premium payments transaction.
                  (viii) A referral certification and authorization 
              transaction.
      (c) Definitions.--In this section--
          (1) the terms ``health care provider'', ``health plan'', and 
      ``health care clearinghouse'' have the meaning given those terms in 
      section 1171 of the Social Security Act (42 U.S.C. 1320d) and 
      section 160.103 of title 45, Code of Federal Regulations;
          (2) the terms ``small health plan'' and ``transaction'' have 
      the meaning given those terms in section 160.103 of title 45, Code 
      of Federal Regulations; and
          (3) the terms ``health care claims or equivalent encounter 
      information transaction'', ``health care payment and remittance 
      advice transaction'', ``coordination of benefits transaction'', 
      ``health care claim status transaction'', ``enrollment and 
      disenrollment in a health plan transaction'', ``eligibility for a 
      health plan transaction'', ``health plan premium payments 
      transaction'', and ``referral certification and authorization 
      transaction'' have the meanings given those terms in sections 
      162.1101, 162.1601, 162.1801, 162.1401, 162.1501, 162.1201, 
      162.1701, and 162.1301 of title 45, Code of Federal Regulations, 
      respectively.
  
  SEC. 3. REQUIRING ELECTRONIC SUBMISSION OF MEDICARE CLAIMS.
  
      (a) In General.--Section 1862 of the Social Security Act (42 U.S.C. 
  1395y) is amended--
          (1) in subsection (a)--
              (A) by striking ``or'' at the end of paragraph (20);
              (B) by striking the period at the end of paragraph (21) and 
          inserting ``; or''; and
              (C) by inserting after paragraph (21) the following new 
          paragraph:
          ``(22) subject to subsection (h), for which a claim is 
      submitted other than in an electronic form specified by the 
      Secretary.''; and
          (2) by inserting after subsection (g) the following new 
      subsection:
      ``(h)(1) The Secretary--
          ``(A) shall waive the application of subsection (a)(22) in 
      cases in which--
              ``(i) there is no method available for the submission of 
          claims in an electronic form; or
              ``(ii) the entity submitting the claim is a small provider 
          of services or supplier; and
          ``(B) may waive the application of such subsection in such 
      unusual cases as the Secretary finds appropriate.
      ``(2) For purposes of this subsection, the term `small provider of 
  services or supplier' means--
          ``(A) a provider of services with fewer than 25 full-time 
      equivalent employees; or
          ``(B) a physician, practitioner, facility, or supplier (other 
      than provider of services) with fewer than 10 full-time equivalent 
      employees.''.
      (b) Effective Date.--The amendments made by subsection (a) shall 
  apply to claims submitted on or after October 16, 2003.
  
  SEC. 4. CLARIFICATION WITH RESPECT TO APPLICABILITY OF ADMINISTRATIVE 
                SIMPLIFICATION REQUIREMENTS TO MEDICARE+CHOICE 
                ORGANIZATIONS.
  
      Section 1171(5)(D) of the Social Security Act (42 U.S.C. 
  1320d(5)(D)) is amended by striking ``Part A or part B'' and inserting 
  ``Parts A, B, or C''.
  
  SEC. 5. AUTHORIZATION OF APPROPRIATIONS FOR IMPLEMENTATION OF 
                REGULATIONS.
  
      (a) In General.--Subject to subsection (b), and in addition to any 
  other amounts that may be authorized to be appropriated, there are 
  authorized to be appropriated a total of $44,200,000, for--
          (1) technical assistance, education and outreach, and 
      enforcement activities related to subparts I through R of part 162 
      of title 45, Code of Federal Regulations; and
          (2) adopting the standards required to be adopted under section 
      1173 of the Social Security Act (42 U.S.C. 1320d-2).
      (b) Reductions.--
          (1) Model form 14 days late.--If the Secretary fails to 
      promulgate the model form described in section 1(a)(4) by the date 
      that is 14 days after the deadline described in such section, the 
      amount referred to in subsection (a) shall be reduced by 25 
      percent.
          (2) Model form 30 days late.--If the Secretary fails to 
      promulgate the model form described in section 1(a)(4) by the date 
      that is 30 days after the deadline described in such section, the 
      amount referred to in subsection (a) shall be reduced by 50 
      percent.
          (3) Model form 45 days late.--If the Secretary fails to 
      promulgate the model form described in section 1(a)(4) by the date 
      that is 45 days after the deadline described in such section, the 
      amount referred to in subsection (a) shall be reduced by 75 
      percent.
          (4) Model form 60 days late.--If the Secretary fails to 
      promulgate the model form described in section 1(a)(4) by the date 
      that is 60 days after the deadline described in such section, the 
      amount referred to in subsection (a) shall be reduced by 100 
      percent.
  
                                 Speaker of the House of Representatives.
  
                              Vice President of the United States and    
                                                 President of the Senate.
target: Administrative Simplification Compliance Act - Extends by one year the deadlines for compliance by health care providers, health plans other than small health plans, and health care clearinghouses with the standards for electronic health care transactions and code sets adopted under part C (Administrative Simplification) of title XI of the Social Security Act (SSA) by the Secretary of Health and Human Services only if, before the current deadline, such entity submits to the Secretary a plan for compliance with such standards.Directs the Secretary to furnish the National Committee on Vital and Health Statistics with a sample of such plans for analysis for reports containing effective solutions to compliance problems identified in the plans.Provides for exclusion from participation in Medicare (SSA title XVIII) for noncompliance.Amends SSA title XVIII to require the electronic submission of Medicare claims except in certain circumstances.Amends SSA title XI part C to include the Medicare+Choice program as a health plan (thus applying administrative simplification requirements to Medicare+Choice organizations).Authorizes appropriations.
feat_title: 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.