This may or may not be cleared up. Bring a Weegie Board to decipher and maybe you can clear the matter up for me. Let's do a before and after. Before, the original red flag on the proposed legislation. The after, from what I believe to be from the Current Bill. I have to comment on the use of the term "ADMINISTRATIVE SIMPLIFICATION", touching and eye opening. .
_____________________________________________________________
Before:
Correcting the Record on ObamaCare's Access to Individuals' Bank Accounts
From Justin Quinn, About.com Guide August 20, 2009
Nevertheless, the language is unclear enough to create fear and loathing that is legitimate. Recalling that this is falling under the category of "Definition of Services" and "Medical and Other Services" in Medicare, it raises the questioned about why this language was included at all. There's really only one reason that makes sense. Consults every five years are going to be required (mandatory) if patients want to receive Medicare reimbursement for associated services, and when end-of-life decisions become imminent, more consultations will be required if reimbursements are to be made regarding end-of-life treatment. It may not mean "death panels," but the language is obscure enough to raise the question about the participatory nature of the consults. The bottom line: if they're not mandatory, why are these consults included in the bill at all?
Back to the bank account stuff.
This article at CNN.com uses the news network's so-called "truth-squad" to dispel the notion that the House bill provides the federal government with real-time access to the bank accounts of "individuals." Their verdict (False. The provision cited doesn't affect individuals, but companies involved in medical billing.),is reckless in its misinformation.
For the sake of clarity, it is important to note that this part of the bill updates Title XI of the Social Security Act, and once again cite the page number, section and subsection of the ObamaCare plan that spells this out. It is called "Administrative Simplification" (Section 163) and Subsection 1173A of this measure, "Standardize Electronic Transactions" has a provision (a)(2)(B) that ensures that this new governmental power:
"be authoritative, permitting no additions or constraints for electronic transactions ..." (C) "be comprehensive, efficient and robust, requiring minimal augmentation by paper transactions or clarification by further communications;" and, finally, (D) enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card;" ... (E) "enable, where feasible, near real-time adjudication of claims ..." (Emphasis added)
According to President Barack Obama, there are several versions of the bill now in existence. If this is indeed the case, (so far, I've only been able to find and read one) it is possible that this language has been clarified to strike out all references to the individual. As it stands, however, the language in the current version of the House bill clearly indicates that the authority of the government pertains to "individuals" not providers, physicians or insurers.
In fact, this is so clearly defined in the bill, that on page 64, the language for "operating rules" (which regulate the "using and processing [of] transactions") is changed in a related section to add the phrase "on behalf of an individual." Combine the two, and you have the government paying for services on behalf of an individual from the individual's account.
The most disturbing aspect of this part of the bill, as I've mentioned before is the lack of language outlining any sort of authorization on the part of the individual.
In my previous post (linked to above), I mentioned that the Democrats and Obama would scoff off any notion of the federal government dipping into individual's accounts without permission. This is indeed what has happened. If the bill had some sort of measure in it that explicitly describes the authorization process, perhaps conservatives wouldn't feel quite so paranoid about what this legislation has in store for them.
Correcting the Record on ObamaCare's Access to Individuals' Bank Accounts
--------------------------------------------------------------------------------------
Current Bill:
111TH CONGRESS
1ST SESSION H. R. 3200
3 SEC. 163. ADMINISTRATIVE SIMPLIFICATION.
4 (a) STANDARDIZING ELECTRONIC ADMINISTRATIVE
5 TRANSACTIONS.—
6 (1) IN GENERAL.—Part C of title XI of the So7
cial Security Act (42 U.S.C. 1320d et seq.) is
8 amended by inserting after section 1173 the fol9
lowing new section:
10 ‘‘SEC. 1173A. STANDARDIZE ELECTRONIC ADMINISTRATIVE
11 TRANSACTIONS.
12 ‘‘(a) STANDARDS FOR FINANCIAL AND ADMINISTRA13
TIVE TRANSACTIONS.—
14 ‘‘(1) IN GENERAL.—The Secretary shall adopt
15 and regularly update standards consistent with the
16 goals described in paragraph (2).
17 ‘‘(2) GOALS FOR FINANCIAL AND ADMINISTRA18
TIVE TRANSACTIONS.—The goals for standards
19 under paragraph (1) are that such standards shall—
20 ‘‘(A) be unique with no conflicting or re21
dundant standards;
22 ‘‘(B) be authoritative, permitting no addi23
tions or constraints for electronic transactions,
24 including companion guides;
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58
•HR 3200 IH
1 ‘‘(C) be comprehensive, efficient and ro2
bust, requiring minimal augmentation by paper
3 transactions or clarification by further commu4
nications;
5 ‘‘(D) enable the real-time (or near real6
time) determination of an individual’s financial
7 responsibility at the point of service and, to the
8 extent possible, prior to service, including
9 whether the individual is eligible for a specific
10 service with a specific physician at a specific fa11
cility, which may include utilization of a ma12
chine-readable health plan beneficiary identi13
fication card;
14 ‘‘(E) enable, where feasible, near real-time
15 adjudication of claims;
16 ‘‘(F) provide for timely acknowledgment,
17 response, and status reporting applicable to any
18 electronic transaction deemed appropriate by
19 the Secretary;
20 ‘‘(G) describe all data elements (such as
21 reason and remark codes) in unambiguous
22 terms, not permit optional fields, require that
23 data elements be either required or conditioned
24 upon set values in other fields, and prohibit ad25
ditional conditions; and
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59
•HR 3200 IH
1 ‘‘(H) harmonize all common data elements
2 across administrative and clinical transaction
3 standards.
4 ‘‘(3) TIME FOR ADOPTION.—Not later than 2
5 years after the date of implementation of the X12
6 Version 5010 transaction standards implemented
7 under this part, the Secretary shall adopt standards
8 under this section.
9 ‘‘(4) REQUIREMENTS FOR SPECIFIC STAND10
ARDS.—The standards under this section shall be
11 developed, adopted and enforced so as to—
12 ‘‘(A) clarify, refine, complete, and expand,
13 as needed, the standards required under section
14 1173;
15 ‘‘(B) require paper versions of standard16
ized transactions to comply with the same
17 standards as to data content such that a fully
18 compliant, equivalent electronic transaction can
19 be populated from the data from a paper
20 version;
21 ‘‘(C) enable electronic funds transfers, in
22 order to allow automated reconciliation with the
23 related health care payment and remittance ad24
vice;
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60
•HR 3200 IH
1 ‘‘(D) require timely and transparent claim
2 and denial management processes, including
3 tracking, adjudication, and appeal processing;
4 ‘‘(E) require the use of a standard elec5
tronic transaction with which health care pro6
viders may quickly and efficiently enroll with a
7 health plan to conduct the other electronic
8 transactions provided for in this part; and
9 ‘‘(F) provide for other requirements relat10
ing to administrative simplification as identified
11 by the Secretary, in consultation with stake12
holders.
13 ‘‘(5) BUILDING ON EXISTING STANDARDS.—In
14 developing the standards under this section, the Sec15
retary shall build upon existing and planned stand16
ards.
17 ‘‘(6) IMPLEMENTATION AND ENFORCEMENT.—
18 Not later than 6 months after the date of the enact19
ment of this section, the Secretary shall submit to
20 the appropriate committees of Congress a plan for
21 the implementation and enforcement, by not later
22 than 5 years after such date of enactment, of the
23 standards under this section. Such plan shall in24
clude—
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61
•HR 3200 IH
1 ‘‘(A) a process and timeframe with mile2
stones for developing the complete set of stand3
ards;
4 ‘‘(B) an expedited upgrade program for
5 continually developing and approving additions
6 and modifications to the standards as often as
7 annually to improve their quality and extend
8 their functionality to meet evolving require9
ments in health care;
10 ‘‘(C) programs to provide incentives for,
11 and ease the burden of, implementation for cer12
tain health care providers, with special consid13
eration given to such providers serving rural or
14 underserved areas and ensure coordination with
15 standards, implementation specifications, and
16 certification criteria being adopted under the
17 HITECH Act;
18 ‘‘(D) programs to provide incentives for,
19 and ease the burden of, health care providers
20 who volunteer to participate in the process of
21 setting standards for electronic transactions;
22 ‘‘(E) an estimate of total funds needed to
23 ensure timely completion of the implementation
24 plan; and
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62
•HR 3200 IH
1 ‘‘(F) an enforcement process that includes
2 timely investigation of complaints, random au3
dits to ensure compliance, civil monetary and
4 programmatic penalties for non-compliance con5
sistent with existing laws and regulations, and
6 a fair and reasonable appeals process building
7 off of enforcement provisions under this part.
8 ‘‘(b) LIMITATIONS ON USE OF DATA.—Nothing in
9 this section shall be construed to permit the use of infor10
mation collected under this section in a manner that would
11 adversely affect any individual.
12 ‘‘(c) PROTECTION OF DATA.—The Secretary shall en13
sure (through the promulgation of regulations or other14
wise) that all data collected pursuant to subsection (a)
15 are—
16 ‘‘(1) used and disclosed in a manner that meets
17 the HIPAA privacy and security law (as defined in
18 section 3009(a)(2) of the Public Health Service
19 Act), including any privacy or security standard
20 adopted under section 3004 of such Act; and
21 ‘‘(2) protected from all inappropriate internal
22 use by any entity that collects, stores, or receives the
23 data, including use of such data in determinations of
24 eligibility (or continued eligibility) in health plans,
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63
•HR 3200 IH
1 and from other inappropriate uses, as defined by the
2 Secretary.’’.
3 (2) DEFINITIONS.—Section 1171 of such Act
4 (42 U.S.C. 1320d) is amended—
5 (A) in paragraph (7), by striking ‘‘with
6 reference to’’ and all that follows and inserting
7 ‘‘with reference to a transaction or data ele8
ment of health information in section 1173
9 means implementation specifications, certifi10
cation criteria, operating rules, messaging for11
mats, codes, and code sets adopted or estab12
lished by the Secretary for the electronic ex13
change and use of information’’; and
14 (B) by adding at the end the following new
15 paragraph:
16 ‘‘(9) OPERATING RULES.—The term ‘operating
17 rules’ means business rules for using and processing
18 transactions. Operating rules should address the fol19
lowing:
20 ‘‘(A) Requirements for data content using
21 available and established national standards.
22 ‘‘(B) Infrastructure requirements that es23
tablish best practices for streamlining data flow
24 to yield timely execution of transactions.
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64
•HR 3200 IH
1 ‘‘(C) Policies defining the transaction re2
lated rights and responsibilities for entities that
3 are transmitting or receiving data.’’.
4 (3) CONFORMING AMENDMENT.—Section
5 1179(a) of such Act (42 U.S.C. 1320d–8(a)) is
6 amended, in the matter before paragraph (1)—
7 (A) by inserting ‘‘on behalf of an indi8
vidual’’ after ‘‘1978)’’; and
9 (B) by inserting ‘‘on behalf of an indi10
vidual’’ after ‘‘for a financial institution.’’
11 (b) STANDARDS FOR CLAIMS ATTACHMENTS AND
12 COORDINATION OF BENEFITS .—
13 (1) STANDARD FOR HEALTH CLAIMS ATTACH14
MENTS.—Not later than 1 year after the date of the
15 enactment of this Act, the Secretary of Health and
16 Human Services shall promulgate a final rule to es17
tablish a standard for health claims attachment
18 transaction described in section 1173(a)(2)(B) of the
19 Social Security Act (42 U.S.C. 1320d–2(a)(2)(B))
20 and coordination of benefits.
21 (2) REVISION IN PROCESSING PAYMENT TRANS22
ACTIONS BY FINANCIAL INSTITUTIONS.—
23 (A) IN GENERAL.—Section 1179 of the So24
cial Security Act (42 U.S.C. 1320d–8) is
25 amended, in the matter before paragraph (1)—
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65
•HR 3200 IH
1 (i) by striking ‘‘or is engaged’’ and in2
serting ‘‘and is engaged’’; and
3 (ii) by inserting ‘‘(other than as a
4 business associate for a covered entity)’’
5 after ‘‘for a financial institution’’.
6 (B) EFFECTIVE DATE.—The amendments
7 made by paragraph (1) shall apply to trans8
actions occurring on or after such date (not
9 later than 6 months after the date of the enact10
ment of this Act) as the Secretary of Health
11 and Human Services shall specify.
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.pdf
_____________________________________________________________
Before:
Correcting the Record on ObamaCare's Access to Individuals' Bank Accounts
From Justin Quinn, About.com Guide August 20, 2009
Nevertheless, the language is unclear enough to create fear and loathing that is legitimate. Recalling that this is falling under the category of "Definition of Services" and "Medical and Other Services" in Medicare, it raises the questioned about why this language was included at all. There's really only one reason that makes sense. Consults every five years are going to be required (mandatory) if patients want to receive Medicare reimbursement for associated services, and when end-of-life decisions become imminent, more consultations will be required if reimbursements are to be made regarding end-of-life treatment. It may not mean "death panels," but the language is obscure enough to raise the question about the participatory nature of the consults. The bottom line: if they're not mandatory, why are these consults included in the bill at all?
Back to the bank account stuff.
This article at CNN.com uses the news network's so-called "truth-squad" to dispel the notion that the House bill provides the federal government with real-time access to the bank accounts of "individuals." Their verdict (False. The provision cited doesn't affect individuals, but companies involved in medical billing.),is reckless in its misinformation.
For the sake of clarity, it is important to note that this part of the bill updates Title XI of the Social Security Act, and once again cite the page number, section and subsection of the ObamaCare plan that spells this out. It is called "Administrative Simplification" (Section 163) and Subsection 1173A of this measure, "Standardize Electronic Transactions" has a provision (a)(2)(B) that ensures that this new governmental power:
"be authoritative, permitting no additions or constraints for electronic transactions ..." (C) "be comprehensive, efficient and robust, requiring minimal augmentation by paper transactions or clarification by further communications;" and, finally, (D) enable the real-time (or near real-time) determination of an individual’s financial responsibility at the point of service and, to the extent possible, prior to service, including whether the individual is eligible for a specific service with a specific physician at a specific facility, which may include utilization of a machine-readable health plan beneficiary identification card;" ... (E) "enable, where feasible, near real-time adjudication of claims ..." (Emphasis added)
According to President Barack Obama, there are several versions of the bill now in existence. If this is indeed the case, (so far, I've only been able to find and read one) it is possible that this language has been clarified to strike out all references to the individual. As it stands, however, the language in the current version of the House bill clearly indicates that the authority of the government pertains to "individuals" not providers, physicians or insurers.
In fact, this is so clearly defined in the bill, that on page 64, the language for "operating rules" (which regulate the "using and processing [of] transactions") is changed in a related section to add the phrase "on behalf of an individual." Combine the two, and you have the government paying for services on behalf of an individual from the individual's account.
The most disturbing aspect of this part of the bill, as I've mentioned before is the lack of language outlining any sort of authorization on the part of the individual.
In my previous post (linked to above), I mentioned that the Democrats and Obama would scoff off any notion of the federal government dipping into individual's accounts without permission. This is indeed what has happened. If the bill had some sort of measure in it that explicitly describes the authorization process, perhaps conservatives wouldn't feel quite so paranoid about what this legislation has in store for them.
Correcting the Record on ObamaCare's Access to Individuals' Bank Accounts
--------------------------------------------------------------------------------------
Current Bill:
111TH CONGRESS
1ST SESSION H. R. 3200
3 SEC. 163. ADMINISTRATIVE SIMPLIFICATION.
4 (a) STANDARDIZING ELECTRONIC ADMINISTRATIVE
5 TRANSACTIONS.—
6 (1) IN GENERAL.—Part C of title XI of the So7
cial Security Act (42 U.S.C. 1320d et seq.) is
8 amended by inserting after section 1173 the fol9
lowing new section:
10 ‘‘SEC. 1173A. STANDARDIZE ELECTRONIC ADMINISTRATIVE
11 TRANSACTIONS.
12 ‘‘(a) STANDARDS FOR FINANCIAL AND ADMINISTRA13
TIVE TRANSACTIONS.—
14 ‘‘(1) IN GENERAL.—The Secretary shall adopt
15 and regularly update standards consistent with the
16 goals described in paragraph (2).
17 ‘‘(2) GOALS FOR FINANCIAL AND ADMINISTRA18
TIVE TRANSACTIONS.—The goals for standards
19 under paragraph (1) are that such standards shall—
20 ‘‘(A) be unique with no conflicting or re21
dundant standards;
22 ‘‘(B) be authoritative, permitting no addi23
tions or constraints for electronic transactions,
24 including companion guides;
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58
•HR 3200 IH
1 ‘‘(C) be comprehensive, efficient and ro2
bust, requiring minimal augmentation by paper
3 transactions or clarification by further commu4
nications;
5 ‘‘(D) enable the real-time (or near real6
time) determination of an individual’s financial
7 responsibility at the point of service and, to the
8 extent possible, prior to service, including
9 whether the individual is eligible for a specific
10 service with a specific physician at a specific fa11
cility, which may include utilization of a ma12
chine-readable health plan beneficiary identi13
fication card;
14 ‘‘(E) enable, where feasible, near real-time
15 adjudication of claims;
16 ‘‘(F) provide for timely acknowledgment,
17 response, and status reporting applicable to any
18 electronic transaction deemed appropriate by
19 the Secretary;
20 ‘‘(G) describe all data elements (such as
21 reason and remark codes) in unambiguous
22 terms, not permit optional fields, require that
23 data elements be either required or conditioned
24 upon set values in other fields, and prohibit ad25
ditional conditions; and
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59
•HR 3200 IH
1 ‘‘(H) harmonize all common data elements
2 across administrative and clinical transaction
3 standards.
4 ‘‘(3) TIME FOR ADOPTION.—Not later than 2
5 years after the date of implementation of the X12
6 Version 5010 transaction standards implemented
7 under this part, the Secretary shall adopt standards
8 under this section.
9 ‘‘(4) REQUIREMENTS FOR SPECIFIC STAND10
ARDS.—The standards under this section shall be
11 developed, adopted and enforced so as to—
12 ‘‘(A) clarify, refine, complete, and expand,
13 as needed, the standards required under section
14 1173;
15 ‘‘(B) require paper versions of standard16
ized transactions to comply with the same
17 standards as to data content such that a fully
18 compliant, equivalent electronic transaction can
19 be populated from the data from a paper
20 version;
21 ‘‘(C) enable electronic funds transfers, in
22 order to allow automated reconciliation with the
23 related health care payment and remittance ad24
vice;
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60
•HR 3200 IH
1 ‘‘(D) require timely and transparent claim
2 and denial management processes, including
3 tracking, adjudication, and appeal processing;
4 ‘‘(E) require the use of a standard elec5
tronic transaction with which health care pro6
viders may quickly and efficiently enroll with a
7 health plan to conduct the other electronic
8 transactions provided for in this part; and
9 ‘‘(F) provide for other requirements relat10
ing to administrative simplification as identified
11 by the Secretary, in consultation with stake12
holders.
13 ‘‘(5) BUILDING ON EXISTING STANDARDS.—In
14 developing the standards under this section, the Sec15
retary shall build upon existing and planned stand16
ards.
17 ‘‘(6) IMPLEMENTATION AND ENFORCEMENT.—
18 Not later than 6 months after the date of the enact19
ment of this section, the Secretary shall submit to
20 the appropriate committees of Congress a plan for
21 the implementation and enforcement, by not later
22 than 5 years after such date of enactment, of the
23 standards under this section. Such plan shall in24
clude—
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61
•HR 3200 IH
1 ‘‘(A) a process and timeframe with mile2
stones for developing the complete set of stand3
ards;
4 ‘‘(B) an expedited upgrade program for
5 continually developing and approving additions
6 and modifications to the standards as often as
7 annually to improve their quality and extend
8 their functionality to meet evolving require9
ments in health care;
10 ‘‘(C) programs to provide incentives for,
11 and ease the burden of, implementation for cer12
tain health care providers, with special consid13
eration given to such providers serving rural or
14 underserved areas and ensure coordination with
15 standards, implementation specifications, and
16 certification criteria being adopted under the
17 HITECH Act;
18 ‘‘(D) programs to provide incentives for,
19 and ease the burden of, health care providers
20 who volunteer to participate in the process of
21 setting standards for electronic transactions;
22 ‘‘(E) an estimate of total funds needed to
23 ensure timely completion of the implementation
24 plan; and
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62
•HR 3200 IH
1 ‘‘(F) an enforcement process that includes
2 timely investigation of complaints, random au3
dits to ensure compliance, civil monetary and
4 programmatic penalties for non-compliance con5
sistent with existing laws and regulations, and
6 a fair and reasonable appeals process building
7 off of enforcement provisions under this part.
8 ‘‘(b) LIMITATIONS ON USE OF DATA.—Nothing in
9 this section shall be construed to permit the use of infor10
mation collected under this section in a manner that would
11 adversely affect any individual.
12 ‘‘(c) PROTECTION OF DATA.—The Secretary shall en13
sure (through the promulgation of regulations or other14
wise) that all data collected pursuant to subsection (a)
15 are—
16 ‘‘(1) used and disclosed in a manner that meets
17 the HIPAA privacy and security law (as defined in
18 section 3009(a)(2) of the Public Health Service
19 Act), including any privacy or security standard
20 adopted under section 3004 of such Act; and
21 ‘‘(2) protected from all inappropriate internal
22 use by any entity that collects, stores, or receives the
23 data, including use of such data in determinations of
24 eligibility (or continued eligibility) in health plans,
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63
•HR 3200 IH
1 and from other inappropriate uses, as defined by the
2 Secretary.’’.
3 (2) DEFINITIONS.—Section 1171 of such Act
4 (42 U.S.C. 1320d) is amended—
5 (A) in paragraph (7), by striking ‘‘with
6 reference to’’ and all that follows and inserting
7 ‘‘with reference to a transaction or data ele8
ment of health information in section 1173
9 means implementation specifications, certifi10
cation criteria, operating rules, messaging for11
mats, codes, and code sets adopted or estab12
lished by the Secretary for the electronic ex13
change and use of information’’; and
14 (B) by adding at the end the following new
15 paragraph:
16 ‘‘(9) OPERATING RULES.—The term ‘operating
17 rules’ means business rules for using and processing
18 transactions. Operating rules should address the fol19
lowing:
20 ‘‘(A) Requirements for data content using
21 available and established national standards.
22 ‘‘(B) Infrastructure requirements that es23
tablish best practices for streamlining data flow
24 to yield timely execution of transactions.
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64
•HR 3200 IH
1 ‘‘(C) Policies defining the transaction re2
lated rights and responsibilities for entities that
3 are transmitting or receiving data.’’.
4 (3) CONFORMING AMENDMENT.—Section
5 1179(a) of such Act (42 U.S.C. 1320d–8(a)) is
6 amended, in the matter before paragraph (1)—
7 (A) by inserting ‘‘on behalf of an indi8
vidual’’ after ‘‘1978)’’; and
9 (B) by inserting ‘‘on behalf of an indi10
vidual’’ after ‘‘for a financial institution.’’
11 (b) STANDARDS FOR CLAIMS ATTACHMENTS AND
12 COORDINATION OF BENEFITS .—
13 (1) STANDARD FOR HEALTH CLAIMS ATTACH14
MENTS.—Not later than 1 year after the date of the
15 enactment of this Act, the Secretary of Health and
16 Human Services shall promulgate a final rule to es17
tablish a standard for health claims attachment
18 transaction described in section 1173(a)(2)(B) of the
19 Social Security Act (42 U.S.C. 1320d–2(a)(2)(B))
20 and coordination of benefits.
21 (2) REVISION IN PROCESSING PAYMENT TRANS22
ACTIONS BY FINANCIAL INSTITUTIONS.—
23 (A) IN GENERAL.—Section 1179 of the So24
cial Security Act (42 U.S.C. 1320d–8) is
25 amended, in the matter before paragraph (1)—
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65
•HR 3200 IH
1 (i) by striking ‘‘or is engaged’’ and in2
serting ‘‘and is engaged’’; and
3 (ii) by inserting ‘‘(other than as a
4 business associate for a covered entity)’’
5 after ‘‘for a financial institution’’.
6 (B) EFFECTIVE DATE.—The amendments
7 made by paragraph (1) shall apply to trans8
actions occurring on or after such date (not
9 later than 6 months after the date of the enact10
ment of this Act) as the Secretary of Health
11 and Human Services shall specify.
http://frwebgate.access.gpo.gov/cgi-bin/getdoc.cgi?dbname=111_cong_bills&docid=f:h3200ih.pdf