« PreviousContinue »
(A) the health plan may not refuse to conduct such transaction as a standard transaction;
(B) the insurance plan may not delay such transaction, or otherwise adversely affect, or attempt to adversely affect, the person or the transaction on the ground that the transaction is a standard transaction; and
(C) the information transmitted and received in connection with the transaction shall be in the form of standard data elements of health information.
(2) SATISFACTION OF REQUIREMENTS.-A health plan may satisfy the requirements under paragraph (1) by
(A) directly transmitting and receiving standard data elements of health information; or
(B) submitting nonstandard data elements to a health care clearinghouse for processing into standard data elements and transmission by the health care clearinghouse, and receiving standard data elements through the health care clearinghouse.
(3) TIMETABLE FOR COMPLIANCE.-Paragraph (1) shall not be construed to require a health plan to comply with any standard, implementation specification, or modification to a standard or specification adopted or established by the Secretary under sections 1172 through 1174 at any time prior to the date on which the plan is required to comply with the standard or specification under subsection (b).
(b) COMPLIANCE WITH STANDARDS.
(1) INITIAL COMPLIANCE.—
(A) IN GENERAL.-Not later than 24 months after the date on which an initial standard or implementation specification is adopted or established under sections 1172 and 1173, each person to whom the standard or implementation specification applies shall comply with the standard or specification.
(B) SPECIAL RULE FOR SMALL HEALTH PLANS.-In the case of a small health plan, paragraph (1) shall be applied by substituting "36 months" for "24 months". For purposes of this subsection, the Secretary shall determine the plans that qualify as small health plans.
(2) COMPLIANCE WITH MODIFIED STANDARDS.-If the Secretary adopts a modification to a standard or implementation specification under this part, each person to whom the standard or implementation specification applies shall comply with the modified standard or implementation specification at such time as the Secretary determines appropriate, taking into account the time needed to comply due to the nature and extent of the modification. The time determined appropriate under the preceding sentence may not be earlier than the last day of the 180-day period beginning on the date such modification is adopted. The Secretary may extend the time for compliance for small health plans, if the Secretary determines that such extension is appropriate.
(3) CONSTRUCTION.-Nothing in this subsection shall be construed to prohibit any person from complying with a standard or specification by
(A) submitting nonstandard data elements to a health care clearinghouse for processing into standard data ele
ments and transmission by the health care clearinghouse;
(B) receiving standard data elements through a health care clearinghouse.
GENERAL PENALTY FOR FAILURE TO COMPLY WITH REQUIREMENTS AND STANDARDS
SEC. 1176. [42 U.S.C. 1320d-5] (a) GENERAL PENALTY.—
(1) IN GENERAL.-Except as provided in subsection (b), the Secretary shall impose on any person who violates a provision of this part a penalty of not more than $100 for each such violation, except that the total amount imposed on the person for all violations of an identical requirement or prohibition during a calendar year may not exceed $25,000.
(2) PROCEDURES.-The provisions of section 1128A (other than subsections (a) and (b) and the second sentence of subsection (f)) shall apply to the imposition of a civil money penalty under this subsection in the same manner as such provisions apply to the imposition of a penalty under such section 1128A.
(1) OFFENSES OTHERWISE PUNISHABLE.-A penalty may not be imposed under subsection (a) with respect to an act if the act constitutes an offense punishable under section 1177.
(2) NONCOMPLIANCE NOT DISCOVERED.—A penalty may not be imposed under subsection (a) with respect to a provision of this part if it is established to the satisfaction of the Secretary that the person liable for the penalty did not know, and by exercising reasonable diligence would not have known, that such person violated the provision.
(3) FAILURES DUE TO REASONABLE CAUSE.
(A) IN GENERAL.-Except as provided in subparagraph (B), a penalty may not be imposed under subsection (a)
(i) the failure to comply was due to reasonable cause and not to willful neglect; and
(ii) the failure to comply is corrected during the 30day period beginning on the first date the person liable for the penalty knew, or by exercising reasonable diligence would have known, that the failure to comply occurred.
(B) EXTENSION OF PERIOD.—
(i) NO PENALTY.-The period referred to in subparagraph (A)(ii) may be extended as determined appropriate by the Secretary based on the nature and extent of the failure to comply.
(ii) ASSISTANCE.-If the Secretary determines that a person failed to comply because the person was unable to comply, the Secretary may provide technical assistance to the person during the period described in subparagraph (A)(ii). Such assistance shall be provided in
any manner determined appropriate by the Secretary. (4) REDUCTION.-In the case of a failure to comply which is due to reasonable cause and not to willful neglect, any penalty under subsection (a) that is not entirely waived under paragraph (3) may be waived to the extent that the payment of
such penalty would be excessive relative to the compliance failure involved.
WRONGFUL DISCLOSURE OF INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION
SEC. 1177. [42 U.S.C. 1320d-6] (a) OFFENSE.-A person who knowingly and in violation of this part
(1) uses or causes to be used a unique health identifier;
(2) obtains individually identifiable health information relating to an individual; or
(3) discloses individually identifiable health information to another person,
shall be punished as provided in subsection (b).
(b) PENALTIES.-A person described in subsection (a) shall(1) be fined not more than $50,000, imprisoned not more than 1 year, or both;
(2) if the offense is committed under false pretenses, be fined not more than $100,000, imprisoned not more than 5 years, or both; and
(3) if the offense is committed with intent to sell, transfer, or use individually identifiable health information for commercial advantage, personal gain, or malicious harm, be fined not more than $250,000, imprisoned not more than 10 years, or both.
EFFECT ON STATE LAW
SEC. 1178. [42 U.S.C. 1320d-7] (a) GENERAL EFFECT.—
(1) GENERAL RULE.-Except as provided in paragraph (2), a provision or requirement under this part, or a standard or implementation specification adopted or established under sections 1172 through 1174, shall supersede any contrary provision of State law, including a provision of State law that requires medical or health plan records (including billing information) to be maintained or transmitted in written rather than electronic form.
(2) EXCEPTIONS.-A provision or requirement under this part, or a standard or implementation specification adopted or established under sections 1172 through 1174, shall not supersede a contrary provision of State law, if the provision of State law
(A) is a provision the Secretary determines
(i) is necessary
(I) to prevent fraud and abuse;
(II) to ensure appropriate State regulation of insurance and health plans;
(III) for State reporting on health care delivery or costs; or
(IV) for other purposes; or
(ii) addresses controlled substances; or
(B) subject to section 264(c)(2) of the Health Insurance Portability and Accountability Act of 1996, relates to the privacy of individually identifiable health information.
(b) PUBLIC HEALTH.-Nothing in this part shall be construed to invalidate or limit the authority, power, or procedures established under any law providing for the reporting of disease or injury, child
abuse, birth, or death, public health surveillance, or public health investigation or intervention.
(c) STATE REGULATORY REPORTING.-Nothing in this part shall limit the ability of a State to require a health plan to report, or to provide access to, information for management audits, financial audits, program monitoring and evaluation, facility licensure or certification, or individual licensure or certification.
PROCESSING PAYMENT TRANSACTIONS BY FINANCIAL INSTITUTIONS
SEC. 1179. [42 U.S.C. 1320d-8] To the extent that an entity is engaged in activities of a financial institution (as defined in section 1101 of the Right to Financial Privacy Act of 1978), or is engaged in authorizing, processing, clearing, settling, billing, transferring, reconciling, or collecting payments, for a financial institution, this part, and any standard adopted under this part, shall not apply to the entity with respect to such activities, including the following: (1) The use or disclosure of information by the entity for authorizing, processing, clearing, settling, billing, transferring, reconciling or collecting, a payment for, or related to, health plan premiums or health care, where such payment is made by any means, including a credit, debit, or other payment card, an account, check, or electronic funds transfer.
(2) The request for, or the use of disclosure of, information by the entity with respect to a payment described in paragraph (1)
(A) for transferring receivables;
(C) in connection with
(i) a customer dispute; or
(ii) an inquiry from, or to, a customer;
(D) in a communication to a customer of the entity regarding the customer's transactions, payment card, account, check, or electronic funds transfer;
(E) for reporting to consumer reporting agencies; or
(i) a civil or criminal subpoena; or
(ii) a Federal or State law regulating the entity.
TITLE XII-ADVANCES TO STATE
TABLE OF CONTENTS OF TITLE 2
Advances to State unemployment funds
ADVANCES TO STATE UNEMPLOYMENT FUNDS 3
SEC. 1201. [42 U.S.C. 1321] (a)(1) Advances shall be made to the States from the Federal unemployment account in the Unemployment Trust Fund as provided in this section, and shall be repayable, with interest to the extent provided in section 1202(b), in the manner provided in sections 901(d)(1), 903(b)(2), and 1202. An advance to a State for the payment of compensation in any 3-month period may be made if—
(A) the Governor of the State applies therefor no earlier than the first day of the month preceding the first month of such 3month period, and
(B) he furnishes to the Secretary of Labor his estimate of the amount of an advance which will be required by the State for the payment of compensation in each month of such 3-month period.
(2) In the case of any application for an advance under this section to any State for any 3-month period, the Secretary of Labor shall
(A) determine the amount (if any) which he finds will be required by such State for the payment of compensation in each month of such 3-month period, and
(B) certify to the Secretary of the Treasury the amount (not greater than the amount estimated by the Governor of the State) determined under subparagraph (A).
The aggregate of the amounts certified by the Secretary of Labor with respect to any 3-month period shall not exceed the amount which the Secretary of the Treasury reports to the Secretary of
Title XII of the Social Security Act is administered by the Department of Labor.
Regulations of the Secretary of Labor relating to Title XII are contained in chapter V, Title 20, Code of Federal Regulations.
2 This table of contents does not appear in the law.
3 See P.L. 83-591, §3302(c)(3)(this volume), with respect to advances to a State or State agen
See Vol. II, P.L. 95–521, §102(i), with respect to reporting of benefits received under the Social Security Act.
See Vol. II, P.L. 96-499, §1025, with respect to withholding certification of State unemployment laws.