From: Subject: P.L. 104-191 Date: Wed, 29 Oct 2008 08:55:34 -0400 MIME-Version: 1.0 Content-Type: multipart/related; type="text/html"; boundary="----=_NextPart_000_0000_01C939A4.1ACFDE20" X-MimeOLE: Produced By Microsoft MimeOLE V6.00.2900.5579 This is a multi-part message in MIME format. ------=_NextPart_000_0000_01C939A4.1ACFDE20 Content-Type: text/html; charset="Windows-1252" Content-Transfer-Encoding: quoted-printable Content-Location: http://aspe.hhs.gov/admnsimp/pl104191.htm P.L. 104-191

[TABLE OF=20 CONTENTS]

[SUMMARY]

Skip to=20 Main Content

PUBLIC LAW 104-191

AUG. 21, 1996

HEALTH INSURANCE PORTABILITY AND ACCOUNTABILITY ACT = OF=20 1996

Public Law 104-191
104th Congress

An Act

To amend the Internal Revenue Code of 1986 to improve portability and = continuity of health insurance coverage in the group and individual = markets, to=20 combat waste, fraud, and abuse in health insurance and health care = delivery, to=20 promote the use of medical savings accounts, to improve access to = long-term care=20 services and coverage, to simplify the administration of health = insurance, and=20 for other purposes.

Be it enacted by the Senate and House of Representatives of the = United States=20 of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

(a) SHORT TITLE.--This Act may be cited as the = "Health=20 Insurance Portability and Accountability Act of 1996".

(b) TABLE OF CONTENTS.--The table of contents of = this Act is=20 as follows:

Sec. 1. Short title; table of contents.

TITLE I--HEALTH CARE ACCESS, PORTABILITY, AND=20 RENEWABILITY

...

TITLE II--PREVENTING HEALTH CARE FRAUD AND ABUSE; = ADMINISTRATIVE=20 SIMPLIFICATION; MEDICAL LIABILITY REFORM

...

Subtitle F--Administrative=20 Simplification

Skip to=20 Main Content

Sec. = 261. Purpose.=20

Sec. = 262.=20 Administrative simplification.

"Part C--Administrative Simplification

Skip to=20 Main Content

"Sec. = 1171.=20 Definitions.=20

"Sec. = 1172.=20 General requirements for adoption of standards.=20

"Sec. = 1173.=20 Standards for information transactions and data elements.=20

"Sec. = 1174.=20 Timetables for adoption of standards.=20

"Sec. = 1175.=20 Requirements.=20

"Sec. = 1176.=20 General penalty for failure to comply with requirements and = standards.=20

"Sec. = 1177.=20 Wrongful disclosure of individually identifiable health = information.=20

"Sec. = 1178.=20 Effect on State law.=20

"Sec. = 1179.=20 Processing payment transactions.".

Sec. 263. = Changes in=20 membership and duties of National Committee on Vital and Health = Statistics.=20

Sec. 264.=20 Recommendations with respect to privacy of certain health information. =

...

Subtitle F--Administrative Simplification

SEC. 261. PURPOSE.

It is the purpose of this subtitle to improve the Medicare program = under=20 title XVIII of the Social Security Act, the medicaid program under title = XIX of=20 such Act, and the efficiency and effectiveness of the health care = system, by=20 encouraging the development of a health information system through the=20 establishment of standards and requirements for the electronic = transmission of=20 certain health information.

SEC. 262. ADMINISTRATIVE SIMPLIFICATION.

(a) IN GENERAL.--Title XI (42 U.S.C. 1301 et seq.) is amended by = adding at=20 the end the following:

"PART C--ADMINISTRATIVE = SIMPLIFICATION

"DEFINITIONS

"SEC. 1171. For purposes of this part:

"(1) CODE SET.--The term 'code set' means any set of codes used for = encoding=20 data elements, such as tables of terms, medical concepts, medical = diagnostic=20 codes, or medical procedure codes.

"(2) HEALTH CARE CLEARINGHOUSE.--The term 'health care clearinghouse' = means a=20 public or private entity that processes or facilitates the processing of = nonstandard data elements of health information into standard data = elements.

"(3) HEALTH CARE PROVIDER.--The term 'health care provider' includes = a=20 provider of services (as defined in section 1861(u)), a provider of = medical or=20 other health services (as defined in section 1861(s)), and any other = person=20 furnishing health care services or supplies.

"(4) HEALTH INFORMATION.--The term 'health information' means any=20 information, whether oral or recorded in any form or medium, that--

"(A) is created or received by a health care provider, health plan, = public=20 health authority, employer, life insurer, school or university, or = health care=20 clearinghouse; and

"(B) relates to the past, present, or future physical or mental = health or=20 condition of an individual, the provision of health care to an = individual, or=20 the past, present, or future payment for the provision of health care to = an=20 individual.

"(5) HEALTH PLAN.--The term 'health plan' means an individual or = group plan=20 that provides, or pays the cost of, medical care (as such term is = defined in=20 section 2791 of the Public Health Service Act). Such term includes the=20 following, and any combination thereof:

"(A) A group health plan (as defined in section 2791(a) of the Public = Health=20 Service Act), but only if the plan--

"(i) has 50 or more participants (as defined in section 3(7) of the = Employee=20 Retirement Income Security Act of 1974); or

"(ii) is administered by an entity other than the employer who = established=20 and maintains the plan.

"(B) A health insurance issuer (as defined in section 2791(b) of the = Public=20 Health Service Act).

"(C) A health maintenance organization (as defined in section 2791(b) = of the=20 Public Health Service Act).

"(D) Part A or part B of the Medicare program under title XVIII.

"(E) The medicaid program under title XIX.

"(F) A Medicare supplemental policy (as defined in section = 1882(g)(1)).

"(G) A long-term care policy, including a nursing home fixed = indemnity policy=20 (unless the Secretary determines that such a policy does not provide=20 sufficiently comprehensive coverage of a benefit so that the policy = should be=20 treated as a health plan).

"(H) An employee welfare benefit plan or any other arrangement which = is=20 established or maintained for the purpose of offering or providing = health=20 benefits to the employees of 2 or more employers.

"(I) The health care program for active military personnel under = title 10,=20 United States Code.

"(J) The veterans health care program under chapter 17 of title 38, = United=20 States Code.

"(K) The Civilian Health and Medical Program of the Uniformed = Services=20 (CHAMPUS), as defined in section 1072(4) of title 10, United States = Code.

"(L) The Indian health service program under the Indian Health Care=20 Improvement Act (25 U.S.C. 1601 et seq.).

"(M) The Federal Employees Health Benefit Plan under chapter 89 of = title 5,=20 United States Code.

"(6) INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.--The term = 'individually=20 identifiable health information' means any information, including = demographic=20 information collected from an individual, that--

"(A) is created or received by a health care provider, health plan, = employer,=20 or health care clearinghouse; and

"(i) identifies the individual; or

"(ii) with respect to which there is a reasonable basis to believe = that the=20 information can be used to identify the individual.

"(7) STANDARD.--The term 'standard', when used with reference to a = data=20 element of health information or a transaction referred to in section=20 1173(a)(1), means any such data element or transaction that meets each = of the=20 standards and implementation specifications adopted or established by = the=20 Secretary with respect to the data element or transaction under sections = 1172=20 through 1174.

"(8) STANDARD SETTING ORGANIZATION.--The term 'standard setting = organization'=20 means a standard setting organization accredited by the American = National=20 Standards Institute, including the National Council for Prescription = Drug=20 Programs, that develops standards for information transactions, data = elements,=20 or any other standard that is necessary to, or will facilitate, the=20 implementation of this part.

"GENERAL REQUIREMENTS FOR ADOPTION OF=20 STANDARDS

"SEC. 1172. (a) APPLICABILITY.--Any standard adopted under = this part=20 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=20 electronic form in connection with a transaction referred to in section=20 1173(a)(1).

"(b) REDUCTION OF COSTS.--Any standard adopted under this part shall = be=20 consistent with the objective of reducing the administrative costs of = providing=20 and paying for health care.

"(c) ROLE OF STANDARD SETTING ORGANIZATIONS.--

"(1) IN GENERAL.--Except as provided in paragraph (2), any standard = adopted=20 under this part shall be a standard that has been developed, adopted, or = modified by a standard setting organization.

"(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=20 setting organization, if--

"(i) the different standard will substantially reduce administrative = costs to=20 health care providers and health plans compared to the alternatives; = and

"(ii) the standard is promulgated in accordance with the rulemaking=20 procedures of subchapter III of chapter 5 of title 5, United States = Code.

"(B) NO STANDARD BY STANDARD SETTING ORGANIZATION.--If no standard = setting=20 organization has developed, adopted, or modified any standard relating = to a=20 standard that the Secretary is authorized or required to adopt under = this=20 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=20 by a standard setting organization, the organization consulted with each = of the=20 organizations described in subparagraph (B) in the course of such = development,=20 adoption, or modification; and

"(ii) in the case of any other standard, the Secretary, in complying = with the=20 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=20 (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.--The Secretary shall = establish

specifications for implementing each of the standards adopted under = this

part.

"(e) PROTECTION OF TRADE SECRETS.--Except as otherwise required by = law, a=20 standard adopted under this part shall not require disclosure of trade = secrets=20 or confidential commercial information by a person required to comply = with this=20 part.

"(f) ASSISTANCE TO THE SECRETARY.--In complying with the requirements = of this=20 part, the Secretary shall rely on the recommendations of the National = Committee=20 on Vital and Health Statistics established under section 306(k) of the = Public=20 Health Service Act (42 U.S.C. 242k(k)), and shall consult with = appropriate=20 Federal and State agencies and private organizations. The Secretary = shall=20 publish in the Federal Register any recommendation of the National = Committee on=20 Vital and Health Statistics regarding the adoption of a standard under = this=20 part.

(g) APPLICATION TO MODIFICATIONS OF STANDARDS.--This section shall = apply to a=20 modification to a standard (including an addition to a standard) adopted = under=20 section 1174(b) in the same manner as it applies to an initial standard = adopted=20 under section 1174(a).

"STANDARDS FOR INFORMATION TRANSACTIONS = AND DATA=20 ELEMENTS

"SEC. 1173. (a) STANDARDS TO ENABLE ELECTRONIC EXCHANGE.--

"(1) IN GENERAL.--The Secretary shall adopt standards for = transactions, and=20 data elements for such transactions, to enable health information to be=20 exchanged electronically, that are appropriate for--

"(A) the financial and administrative transactions described in = paragraph=20 (2); and

"(B) other financial and administrative transactions determined = appropriate=20 by the Secretary, consistent with the goals of improving the operation = of the=20 health care system and reducing administrative costs.

"(2) TRANSACTIONS.--The transactions referred to in paragraph (1)(A) = are=20 transactions with respect to the following:

"(A) Health claims or equivalent encounter information.

"(B) Health claims attachments.

"(C) Enrollment and disenrollment in a health plan.

"(D) Eligibility for a health plan.

"(E) Health care payment and remittance advice.

"(F) Health plan premium payments.

"(G) First report of injury.

"(H) Health claim status.

"(I) Referral certification and authorization.

"(3) ACCOMMODATION OF SPECIFIC PROVIDERS.--The standards adopted by = the=20 Secretary under paragraph (1) shall accommodate the needs of different = types of=20 health care providers.

(b) UNIQUE HEALTH IDENTIFIERS.--

"(1) IN GENERAL.--The Secretary shall adopt standards providing for a = standard unique health identifier for each individual, employer, health = plan,=20 and health care provider for use in the health care system. In carrying = out the=20 preceding sentence for each health plan and health care provider, the = Secretary=20 shall take into account multiple uses for identifiers and multiple = locations and=20 specialty classifications for health care providers.

"(2) USE OF IDENTIFIERS.--The standards adopted under paragraph (1) = shall=20 specify the purposes for which a unique health identifier may be = used.

"(1) IN GENERAL.--The Secretary shall adopt standards that--

"(A) select code sets for appropriate data elements for the = transactions=20 referred to in subsection (a)(1) from among the code sets that have been = developed by private and public entities; or

"(B) establish code sets for such data elements if no code sets for = the data=20 elements have been developed.

"(2) DISTRIBUTION.--The Secretary shall establish efficient and = low-cost=20 procedures for distribution (including electronic distribution) of code = sets and=20 modifications made to such code sets under section 1174(b).

(d) SECURITY STANDARDS FOR HEALTH INFORMATION.--

"(1) SECURITY STANDARDS.--The Secretary shall adopt security = standards=20 that--

"(A) take into account--

"(i) the technical capabilities of record systems used to maintain = health=20 information;

"(ii) the costs of security measures;

"(iii) the need for training persons who have access to health=20 information;

"(iv) the value of audit trails in computerized record systems; = and

"(v) the needs and capabilities of small health care providers and = rural=20 health care providers (as such providers are defined by the Secretary); = and

"(B) ensure that a health care clearinghouse, if it is part of a = larger=20 organization, has policies and security procedures which isolate the = activities=20 of the health care clearinghouse with respect to processing information = in a=20 manner that prevents unauthorized access to such information by such = larger=20 organization.

"(2) SAFEGUARDS.--Each person described in section 1172(a) who = maintains or=20 transmits health information shall maintain reasonable and appropriate=20 administrative, technical, and physical safeguards--

"(A) to ensure the integrity and confidentiality of the = information;

"(B) to protect against any reasonably anticipated--

"(i) threats or hazards to the security or integrity of the = information;=20 and

"(ii) unauthorized uses or disclosures of the information; and

"(C) otherwise to ensure compliance with this part by the officers = and=20 employees of such person.

(e) ELECTRONIC SIGNATURE.--

"(1) STANDARDS.--The Secretary, in coordination with the Secretary of = Commerce, shall adopt standards specifying procedures for the electronic = transmission and authentication of signatures with respect to the = transactions=20 referred to in subsection (a)(1).

"(2) EFFECT OF COMPLIANCE.--Compliance with the standards adopted = under=20 paragraph (1) shall be deemed to satisfy Federal and State statutory=20 requirements for written signatures with respect to the transactions = referred to=20 in subsection (a)(1).

(f) TRANSFER OF INFORMATION AMONG HEALTH PLANS.--The Secretary shall = adopt=20 standards for transferring among health plans appropriate standard data = elements=20 needed for the coordination of benefits, the sequential processing of = claims,=20 and other data elements for individuals who have more than one health = plan.

"TIMETABLES FOR ADOPTION OF = STANDARDS

"SEC. 1174. (a) INITIAL STANDARDS.--The Secretary shall carry = out=20 section 1173 not later than 18 months after the date of the enactment of = the=20 Health Insurance Portability and Accountability Act of 1996, except that = standards relating to claims attachments shall be adopted not later than = 30=20 months after such date.

"(b) ADDITIONS AND MODIFICATIONS TO STANDARDS.--

"(1) IN GENERAL.--Except as provided in paragraph (2), the Secretary = shall=20 review the standards adopted under section 1173, and shall adopt = modifications=20 to the standards (including additions to the standards), as determined=20 appropriate, but not more frequently than once every 12 months. Any = addition or=20 modification to a standard shall be completed in a manner which = minimizes the=20 disruption and cost of compliance.

"(2) SPECIAL RULES.--

"(A) FIRST 12-MONTH PERIOD.--Except with respect to additions and=20 modifications to code sets under subparagraph (B), the Secretary may not = adopt=20 any modification to a standard adopted under this part during the = 12-month=20 period beginning on the date the standard is initially adopted, unless = the=20 Secretary determines that the modification is necessary in order to = permit=20 compliance with the standard.

"(B) ADDITIONS AND MODIFICATIONS TO CODE SETS.--

"(i) IN GENERAL.--The Secretary shall ensure that procedures exist = for the=20 routine maintenance, testing, enhancement, and expansion of code = sets.

"(ii) Additional rules.--If a code set is modified under this = subsection, the=20 modified code set shall include instructions on how data elements of = health=20 information that were encoded prior to the modification may be converted = or=20 translated so as to preserve the informational value of the data = elements that=20 existed before the modification. Any modification to a code set under = this=20 subsection shall be implemented in a manner that minimizes the = disruption and=20 cost of complying with such modification.

"REQUIREMENTS

"SEC. 1175. (a) CONDUCT OF TRANSACTIONS BY PLANS.--

"(1) IN GENERAL.--If a person desires to conduct a transaction = referred to in=20 section 1173(a)(1) with a health plan as a standard transaction--

"(A) the health plan may not refuse to conduct such transaction as a = standard=20 transaction;

"(B) the insurance plan may not delay such transaction, or otherwise=20 adversely affect, or attempt to adversely affect, the person or the = transaction=20 on the ground that the transaction is a standard transaction; and

"(C) the information transmitted and received in connection with the=20 transaction shall be in the form of standard data elements of health=20 information.

"(2) SATISFACTION OF REQUIREMENTS.--A health plan may satisfy the=20 requirements under paragraph (1) by--

"(A) directly transmitting and receiving standard data elements of = health=20 information; or

"(B) submitting nonstandard data elements to a health care = clearinghouse for=20 processing into standard data elements and transmission by the health = care=20 clearinghouse, and receiving standard data elements through the health = care=20 clearinghouse.

"(3) TIMETABLE FOR COMPLIANCE.--Paragraph (1) shall not be construed = to=20 require a health plan to comply with any standard, implementation = specification,=20 or modification to a standard or specification adopted or established by = the=20 Secretary under sections 1172 through 1174 at any time prior to the date = on=20 which the plan is required to comply with the standard or specification = under=20 subsection (b).

"(b) COMPLIANCE WITH STANDARDS.--

"(1) INITIAL COMPLIANCE.--

"(A) IN GENERAL.--Not later than 24 months after the date on which an = initial=20 standard or implementation specification is adopted or established under = sections 1172 and 1173, each person to whom the standard or = implementation=20 specification applies shall comply with the standard or = specification.

"(B) SPECIAL RULE FOR SMALL HEALTH PLANS.--In the case of a small = health=20 plan, paragraph (1) shall be applied by substituting '36 months' for '24 = months'. For purposes of this subsection, the Secretary shall determine = the=20 plans that qualify as small health plans.

"(2) COMPLIANCE WITH MODIFIED STANDARDS.--If the Secretary adopts a=20 modification to a standard or implementation specification under this = part, each=20 person to whom the standard or implementation specification applies = shall comply=20 with the modified standard or implementation specification at such time = as the=20 Secretary determines appropriate, taking into account the time needed to = comply=20 due to the nature and extent of the modification. The time determined=20 appropriate under the preceding sentence may not be earlier than the = last day of=20 the 180-day period beginning on the date such modification is adopted. = The=20 Secretary may extend the time for compliance for small health plans, if = the=20 Secretary determines that such extension is appropriate.

"(3) CONSTRUCTION.--Nothing in this subsection shall be construed to = prohibit=20 any person from complying with a standard or specification by--

"(A) submitting nonstandard data elements to a health care = clearinghouse for=20 processing into standard data elements and transmission by the health = care=20 clearinghouse; or

"(B) receiving standard data elements through a health care=20 clearinghouse.

"GENERAL PENALTY FOR FAILURE TO COMPLY = WITH=20 REQUIREMENTS AND STANDARDS

"SEC. 1176. (a) GENERAL PENALTY.--

"(1) IN GENERAL.--Except as provided in subsection (b), the Secretary = shall=20 impose on any person who violates a provision of this part a penalty of = not more=20 than $100 for each such violation, except that the total amount imposed = on the=20 person for all violations of an identical requirement or prohibition = during a=20 calendar year may not exceed $25,000.

"(2) PROCEDURES.--The provisions of section 1128A (other than = subsections (a)=20 and (b) and the second sentence of subsection (f)) shall apply to the = imposition=20 of a civil money penalty under this subsection in the same manner as = such=20 provisions apply to the imposition of a penalty under such section = 1128A.

"(b) LIMITATIONS.--

"(1) OFFENSES OTHERWISE PUNISHABLE.--A penalty may not be imposed = under=20 subsection (a) with respect to an act if the act constitutes an offense=20 punishable under section 1177.

"(2) NONCOMPLIANCE NOT DISCOVERED.--A penalty may not be imposed = under=20 subsection (a) with respect to a provision of this part if it is = established to=20 the satisfaction of the Secretary that the person liable for the penalty = did not=20 know, and by exercising reasonable diligence would not have known, that = such=20 person violated the provision.

"(3) FAILURES DUE TO REASONABLE CAUSE.--

"(A) IN GENERAL.--Except as provided in subparagraph (B), a penalty = may not=20 be imposed under subsection (a) if--

"(i) the failure to comply was due to reasonable cause and not to = willful=20 neglect; and

"(ii) the failure to comply is corrected during the 30-day period = beginning=20 on the first date the person liable for the penalty knew, or by = exercising=20 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=20 extended as determined appropriate by the Secretary based on the nature = and=20 extent of the failure to comply.

"(ii) ASSISTANCE.--If the Secretary determines that a person failed = to comply=20 because the person was unable to comply, the Secretary may provide = technical=20 assistance to the person during the period described in subparagraph = (A)(ii).=20 Such assistance shall be provided in any manner determined appropriate = by the=20 Secretary.

"(4) REDUCTION.--In the case of a failure to comply which is due to=20 reasonable cause and not to willful neglect, any penalty under = subsection (a)=20 that is not entirely waived under paragraph (3) may be waived to the = extent that=20 the payment of such penalty would be excessive relative to the = compliance=20 failure involved.

"WRONGFUL DISCLOSURE OF INDIVIDUALLY = IDENTIFIABLE=20 HEALTH INFORMATION

"SEC. 1177. (a) OFFENSE.--A person who knowingly and in = violation of=20 this part--

"(1) uses or causes to be used a unique health identifier;

"(2) obtains individually identifiable health information relating to = an=20 individual; or

"(3) discloses individually identifiable health information to = another=20 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=20 both;

"(2) if the offense is committed under false pretenses, be fined not = more=20 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=20 individually identifiable health information for commercial advantage, = personal=20 gain, or malicious harm, be fined not more than $250,000, imprisoned not = more=20 than 10 years, or both.

"EFFECT ON STATE LAW

"SEC. 1178. (a) GENERAL EFFECT.--

"(1) GENERAL RULE.--Except as provided in paragraph (2), a provision = or=20 requirement under this part, or a standard or implementation = specification=20 adopted or established under sections 1172 through 1174, shall supersede = any=20 contrary provision of State law, including a provision of State law that = requires medical or health plan records (including billing information) = to be=20 maintained or transmitted in written rather than electronic form.

"(2) EXCEPTIONS.--A provision or requirement under this part, or a = standard=20 or implementation specification adopted or established under sections = 1172=20 through 1174, shall not supersede a contrary provision of State law, if = the=20 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=20 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=20 Accountability Act of 1996, relates to the privacy of individually = identifiable=20 health information.

"(b) PUBLIC HEALTH.--Nothing in this part shall be construed to = invalidate or=20 limit the authority, power, or procedures established under any law = providing=20 for the reporting of disease or injury, child abuse, birth, or death, = public=20 health surveillance, or public health investigation or intervention.

"(c) STATE REGULATORY REPORTING.--Nothing in this part shall limit = the=20 ability of a State to require a health plan to report, or to provide = access to,=20 information for management audits, financial audits, program monitoring = and=20 evaluation, facility licensure or certification, or individual licensure = or=20 certification.

"PROCESSING PAYMENT TRANSACTIONS BY = FINANCIAL=20 INSTITUTIONS

"SEC. 1179. To the extent that an entity is engaged in = activities of a=20 financial institution (as defined in section 1101 of the Right to = Financial=20 Privacy Act of 1978), or is engaged in authorizing, processing, = clearing,=20 settling, billing,

transferring, reconciling, or collecting payments, for a financial=20 institution, this part, and any standard adopted under this part, shall = not=20 apply to the entity with respect to such activities, including the=20 following:

"(1) The use or disclosure of information by the entity for = authorizing,=20 processing, clearing, settling, billing, transferring, reconciling or=20 collecting, a payment for, or related to, health plan premiums or health = care,=20 where such payment is made by any means, including a credit, debit, or = other=20 payment card, an account, check, or electronic funds transfer.

"(2) The request for, or the use or disclosure of, information by the = entity=20 with respect to a payment described in paragraph (1)--

"(A) for transferring receivables;

"(B) for auditing;

"(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=20 transactions, payment card, account, check, or electronic funds = transfer;

"(E) for reporting to consumer reporting agencies; or

"(F) for complying with--

"(i) a civil or criminal subpoena; or

"(ii) a Federal or State law regulating the entity.".

(b) CONFORMING AMENDMENTS.--

(1) REQUIREMENT FOR MEDICARE PROVIDERS.--Section 1866(a)(1) (42 = U.S.C.=20 1395cc(a)(1)) is amended--

(A) by striking ``and" at the end of subparagraph (P);

(B) by striking the period at the end of subparagraph (Q) and = inserting ";=20 and"; and

"(R) to contract only with a health care clearinghouse (as defined in = section=20 1171) that meets each standard and implementation specification adopted = or=20 established under part C of title XI on or after the date on which the = health=20 care clearinghouse is required to comply with the standard or=20 specification.".

(2) TITLE HEADING.--Title XI (42 U.S.C. 1301 et seq.) is amended by = striking=20 the title heading and inserting the following:

"TITLE XI--GENERAL PROVISIONS, PEER REVIEW, AND = ADMINISTRATIVE=20 SIMPLIFICATION".

SEC. 263. CHANGES IN MEMBERSHIP AND DUTIES OF NATIONAL COMMITTEE ON VITAL AND = HEALTH=20 STATISTICS.

Section 306(k) of the Public Health Service Act (42 U.S.C. = 242k(k))

is amended--

(1) in paragraph (1), by striking "16" and inserting "18";

(2) by amending paragraph (2) to read as follows:

"(2) The members of the Committee shall be appointed from among = persons who=20 have distinguished themselves in the fields of health statistics, = electronic=20 interchange of health care information, privacy and security of = electronic=20 information, population-based public health, purchasing or financing = health care=20 services, integrated computerized health information systems, health = services=20 research, consumer interests in health information, health data = standards,=20 epidemiology, and the provision of health services. Members of the = Committee=20 shall be appointed for terms of 4 years.";

(3) by redesignating paragraphs (3) through (5) as paragraphs (4) = through=20 (6), respectively, and inserting after paragraph (2) the following:

"(3) Of the members of the Committee--

"(A) 1 shall be appointed, not later than 60 days after the date of = the=20 enactment of the Health Insurance Portability and Accountability Act of = 1996, by=20 the Speaker of the House of Representatives after consultation with the = Minority=20 Leader of the House of Representatives;

"(B) 1 shall be appointed, not later than 60 days after the date of = the=20 enactment of the Health Insurance Portability and Accountability Act of = 1996, by=20 the President pro tempore of the Senate after consultation with the = Minority=20 Leader of the Senate; and

"(C) 16 shall be appointed by the Secretary.";

(4) by amending paragraph (5) (as so redesignated) to read as = follows:

"(5) The Committee--

"(A) shall assist and advise the Secretary--

"(i) to delineate statistical problems bearing on health and health = services=20 which are of national or international interest;

"(ii) to stimulate studies of such problems by other organizations = and=20 agencies whenever possible or to make investigations of such problems = through=20 subcommittees;

"(iii) to determine, approve, and revise the terms, definitions,=20 classifications, and guidelines for assessing health status and health = services,=20 their distribution and costs, for use (I) within the Department of = Health and=20 Human Services, (II) by all programs administered or funded by the = Secretary,=20 including the Federal-State-local cooperative health statistics system = referred=20 to in subsection (e), and (III) to the extent possible as determined by = the head=20 of the agency involved, by the Department of Veterans Affairs, the = Department of=20 Defense, and other Federal agencies concerned with health and health=20 services;

"(iv) with respect to the design of and approval of health = statistical and=20 health information systems concerned with the collection, processing, = and=20 tabulation of health statistics within the Department of Health and = Human=20 Services, with respect to the Cooperative Health Statistics System = established=20 under subsection (e), and with respect to the standardized means for the = collection of health information and statistics to be established by the = Secretary under subsection (j)(1);

"(v) to review and comment on findings and proposals developed by = other=20 organizations and agencies and to make recommendations for their = adoption or=20 implementation by local, State, national, or international agencies;

"(vi) to cooperate with national committees of other countries and = with the=20 World Health Organization and other national agencies in the studies of = problems=20 of mutual interest;

"(vii) to issue an annual report on the state of the Nation's health, = its=20 health services, their costs and distributions, and to make proposals = for=20 improvement of the Nation's health statistics and health information = systems;=20 and

"(viii) in complying with the requirements imposed on the Secretary = under=20 part C of title XI of the Social Security Act;

"(B) shall study the issues related to the adoption of uniform data = standards=20 for patient medical record information and the electronic exchange of = such=20 information;

"(C) shall report to the Secretary not later than 4 years after the = date of=20 the enactment of the Health Insurance Portability and Accountability Act = of 1996=20 recommendations and legislative proposals for such standards and = electronic=20 exchange; and

"(D) shall be responsible generally for advising the Secretary and = the=20 Congress on the status of the implementation of part C of title XI of = the Social=20 Security Act."; and

(5) by adding at the end the following:

"(7) Not later than 1 year after the date of the enactment of the = Health=20 Insurance Portability and Accountability Act of 1996, and annually = thereafter,=20 the Committee shall submit to the Congress, and make public, a report = regarding=20 the implementation of part C of title XI of the Social Security Act. = Such report=20 shall address the following subjects, to the extent that the Committee=20 determines appropriate:

"(A) The extent to which persons required to comply with part C of = title XI=20 of the Social Security Act are cooperating in implementing the standards = adopted=20 under such part.

"(B) The extent to which such entities are meeting the security = standards=20 adopted under such part and the types of penalties assessed for = noncompliance=20 with such standards.

"(C) Whether the Federal and State Governments are receiving = information of=20 sufficient quality to meet their responsibilities under such part.

"(D) Any problems that exist with respect to implementation of such = part.

"(E) The extent to which timetables under such part are being = met.".

SEC. 264. RECOMMENDATIONS WITH RESPECT TO PRIVACY = OF CERTAIN=20 HEALTH INFORMATION.

(a) IN GENERAL.--Not later than the date that is 12 months after the = date of=20 the enactment of this Act, the Secretary of Health and Human Services = shall=20 submit to the Committee on Labor and Human Resources and the Committee = on=20 Finance of the Senate and the Committee on Commerce and the Committee on = Ways=20 and Means of the House of Representatives detailed recommendations on = standards=20 with respect to the privacy of individually identifiable health = information.

(b) SUBJECTS FOR RECOMMENDATIONS.--The recommendations under = subsection (a)=20 shall address at least the following:

(1) The rights that an individual who is a subject of individually=20 identifiable health information should have.

(2) The procedures that should be established for the exercise of = such=20 rights.

(3) The uses and disclosures of such information that should be = authorized or=20 required.

(1) IN GENERAL.--If legislation governing standards with respect to = the=20 privacy of individually identifiable health information transmitted in=20 connection with the transactions described in section 1173(a) of the = Social=20 Security Act (as added by section 262) is not enacted by the date that = is 36=20 months after the date of the enactment of this Act, the Secretary of = Health and=20 Human Services shall promulgate final regulations containing such = standards not=20 later than the date that is 42 months after the date of the enactment of = this=20 Act. Such regulations shall address at least the subjects described in=20 subsection (b).

(2) PREEMPTION.--A regulation promulgated under paragraph (1) shall = not=20 supercede a contrary provision of State law, if the provision of State = law=20 imposes requirements, standards, or implementation specifications that = are more=20 stringent than the requirements, standards, or implementation = specifications=20 imposed under the regulation.

(d) CONSULTATION.--In carrying out this section, the Secretary of = Health and=20 Human Services shall consult with--

(1) the National Committee on Vital and Health Statistics established = under=20 section 306(k) of the Public Health Service Act (42 U.S.C. 242k(k)); = and

(2) the Attorney General.

...


Go = Back	Adminstrative = Simplification	NCVHS	Data=20 Council	Department of=20 Health & Human Services

Comments/suggestions and other questions about HIPAA should be = directed=20 to the Web=20 Master.

------=_NextPart_000_0000_01C939A4.1ACFDE20 Content-Type: image/gif Content-Transfer-Encoding: base64 Content-Location: http://aspe.hhs.gov/admnsimp/barrow.gif R0lGODlhNwA3APcAAAAAAP///////////////////////////////////wAAMwAAZgAAmQAAzP// /wAzMwAzZgAzmQAzzAAz/wBmAABmMwBmZgBmmQBmzABm/wCZAACZMwCZZgCZmQCZzACZ/wDMAADM MwDMZgDMmQDMzADM/wD/MwD/ZgD/mQD/zP///zMAMzMAZjMAmTMAzDMA/////zMzMzMzZjMzmTMz zDMz/zNmADNmMzNmZjNmmTNmzDNm/zOZADOZMzOZZjOZmTOZzDOZ/zPMADPMMzPMZjPMmTPMzDPM /zP/ADP/MzP/ZjP/mTP/zDP//2YAAGYAM2YAZmYAmWYAzGYA/////2YzM2YzZmYzmWYzzGYz/2Zm AGZmM2ZmZmZmmWZmzGZm/2aZAGaZM2aZZmaZmWaZzGaZ/2bMAGbMM2bMZmbMmWbMzGbM/2b/AGb/ M2b/Zmb/mWb/zGb//////5kAM5kAZpkAmZkAzJkA/////5kzM5kzZpkzmZkzzJkz/5lmAJlmM5lm ZplmmZlmzJlm/5mZAJmZM5mZZpmZmZmZzJmZ/5nMAJnMM5nMZpnMmZnMzJnM/5n/AJn/M5n/Zpn/ mZn/zJn//////8wAM8wAZswAmcwAzMwA/////8wzM8wzZswzmcwzzMwz/8xmAMxmM8xmZsxmmcxm zMxm/8yZAMyZM8yZZsyZmcyZzMyZ/8zMAMzMM8zMZszMmczMzMzM/8z/AMz/M8z/Zsz/mcz/zMz/ //8AM/8AZv8Amf8AzP8zAP8zM/8zZv8zmf8zzP8z//9mAP9mM/9mZv9mmf9mzP9m//+ZAP+ZM/+Z Zv+Zmf+ZzP+Z///MAP/MM//MZv/Mmf/MzP/M////M///Zv//mf//zP////////////////////// /////////////////////////////////////////////////////zMAAGYAAJkAAMwAAAAzADMz AGYzAJkzAMwzAP////////////8AAAD/AP//AAAA//8A/wD//////yH5BAEAAAAALAAAAAA3ADcA AAj+ALkI/EewoMGDCBMqXJhQ4ECGECNKNOiQy8SLGBFWlPWvosePIEOKBCmL48aOI1OqVFkSpUCO JWPKnEmzps2bL006hHmzp8+fsnK65MITqNGjQk8eXQo06c5/TKPiJKrzJVSpWGU6tZq1a1CqQ4v+ nOB15laiV8eSLRvzrNibE+KybQtWqc+4cud+bWkXLt61c92mrfk3b+C6T/0WXoxX1mLHfyHLFWyT sWW5jwtLJkuZ5uXLmzFHjtxZ5mfQmUc3Ll3yNGrNsFcj5hrT9WvVjUnPRlvbtuXQZGNP3s3T9+3c uDkTh2r8uGjkw/kmbv47NXTl0mlTt349uOzsvFuJb+/u/frequHFjwceevP5sIOB+2YvHDv6t/Jd 00/+vq9p6vuZx9p/xgX4nH3wKWabgeUh6J9nmuk1IISNSbicWoaxNSFhGZa1IYd69ZeYUYBpeGGI SJ2IYlMqrujThy6a1WKMNsFIY0k23ihYRjxCBB5HPQaZ0I83HjXUSkgmqeSSTDbp5JMhBQQAOw== ------=_NextPart_000_0000_01C939A4.1ACFDE20 Content-Type: image/gif Content-Transfer-Encoding: base64 Content-Location: http://aspe.hhs.gov/admnsimp/bad.gif R0lGODlhNgA2APcAAAAAAAAAMwAAZgAAmQAAzAAA/wAzAAAzMwAzZgAzmQAzzAAz/wBmAABmMwBm ZgBmmQBmzABm/wCZAACZMwCZZgCZmQCZzACZ/wDMAADMMwDMZgDMmQDMzADM/wD/AAD/MwD/ZgD/ mQD/zAD//zMAADMAMzMAZjMAmTMAzDMA/zMzADMzMzMzZjMzmTMzzDMz/zNmADNmMzNmZjNmmTNm zDNm/zOZADOZMzOZZjOZmTOZzDOZ/zPMADPMMzPMZjPMmTPMzDPM/zP/ADP/MzP/ZjP/mTP/zDP/ /2YAAGYAM2YAZmYAmWYAzGYA/2YzAGYzM2YzZmYzmWYzzGYz/2ZmAGZmM2ZmZmZmmWZmzGZm/2aZ AGaZM2aZZmaZmWaZzGaZ/2bMAGbMM2bMZmbMmWbMzGbM/2b/AGb/M2b/Zmb/mWb/zGb//5kAAJkA M5kAZpkAmZkAzJkA/5kzAJkzM5kzZpkzmZkzzJkz/5lmAJlmM5lmZplmmZlmzJlm/5mZAJmZM5mZ ZpmZmZmZzJmZ/5nMAJnMM5nMZpnMmZnMzJnM/5n/AJn/M5n/Zpn/mZn/zJn//8wAAMwAM8wAZswA mcwAzMwA/8wzAMwzM8wzZswzmcwzzMwz/8xmAMxmM8xmZsxmmcxmzMxm/8yZAMyZM8yZZsyZmcyZ zMyZ/8zMAMzMM8zMZszMmczMzMzM/8z/AMz/M8z/Zsz/mcz/zMz///8AAP8AM/8AZv8Amf8AzP8A //8zAP8zM/8zZv8zmf8zzP8z//9mAP9mM/9mZv9mmf9mzP9m//+ZAP+ZM/+ZZv+Zmf+ZzP+Z///M AP/MM//MZv/Mmf/MzP/M////AP//M///Zv//mf//zP///wAAAA0NDRoaGigoKDU1NUNDQ1BQUF1d XWtra3h4eIaGhpOTk6Ghoa6urru7u8nJydbW1uTk5PHx8f///wAAAAAAAAAAAAAAAAAAAAAAAAAA AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAACwAAAAANgA2AEAI/gCvXWMV CACAAw4OIFDIcKHDhhAPMJS4UOIKiQcuYjRoReC1Ax1CVpDRpUsOkyhzeDmpMoceS5aq6MgBJMfM mkB05NxpAUjPn0Bk5Gh5sQOHICRZmly5VKUlPTMSSIUJ84HUqwloAP0ZhGuFoSsvcrCAdGjKlV6q xJwZFasOHVQtddnqsy5ZCx3IfiV6YGzZlmhtCr5pU6fOClilPrjrs6tjvHj3dplxsa7QloRvXn1A UyddC1gfdzWal7RkGSsANP4p43KOGUNfx+Zs82sFHbdz496t+/aD1ihLyjCItzSHDiNbK5+xXHmO 5syft34e3UH1oTVnehkO8jjJkkpZ/jI9KXcOVSvZdXau69lu4wqww/Ylm/QsYDlx81PV4xmC1M+i wceXX5eN14l+ctl0FRQIWjKHXV2tVppkOYjVU4GCrXTTA4Tx5GFiENw1GmSmmUXZAZaBJVh62SXm 4gMPRHhXXiOWFhJtXaAmkBUHcNhTbzMFOZhgQ82kolnhoTQDSq0B0NFAVgAQknHGiSYiV3QZtpOW 6wlGRg5OfkRaSDIsmZJ9aFWhRw5fZqblm+45INSX8pX2XUn2NeWFFXGZ9BZOcPbUHmN71YlXfeDp yWYOlljxZVw0PADoluzJ6FihFYJ0aJ6A5dCJHFZJNcMVVD341lU0DGqpXipe5Fh9/52u9FIXoSqm k3kwoXdYAltZGQSFrtKHpkswLTqTiwxSRROWqz2GHJLBIpUSncYuuhNNtboF4ZVBHBUZtCheqOhM bdK0npY/udjsjN4+y1Jl4rZUbosJSBooT1iF6Fi7x0EGrmVNzWsuVhx6aIF/UulwpVGjHXecZF3A 61Nr5HZJaXuqYulsuyFx8FxwK/CYJXuTrmiydhmKl6RSiQIQyI4odtDtzGR5KxoQjsGpM6Vs6vDl lyELFAhIUwYhc837Jk0WEI3trDMZhkH9c4U8ymy1tEuufGZ4K6ko5NdDXSY1mwA4cJTMd3ZBBp5r rzQ1TD/7LHdOUF8cBM5kxQa1F/4IycxBjiW1rbbabBJORh5UyS313DrcndPdQTSOMwcVk4EQWR3k 6AXbXbjd+aIHllo341s6LrljOclA5wEy+I3n4GvHXjgZL+nwEkyAMD666ZDjPDkQM/x8udE5Ct72 ol8CYkmbT1D1xGY6PJDq4zifXrMOqqvE+lF/dw777Gy+ZAVWoct16maQn37U78GzuYIDNU92vOxf dmFJJ09Akb8et8PURU46UAz1ksY97K1OBtxbyvd+xgWY6CF/+bMCIBBHFepJJX2Q4163gEen99Xs NfND3v3YlJi3KA8mnTAM5JY2Mw1SLngl2V63TPIzw8FleXJzEQ34BJM5YHByGf402gZngBYPdmso IbQfCntGhmy1AFcwyUMOVkhFDXbAgDFE4AyRpzY9BMJn4QOE2nQiFShAAStksUIgfDczIFqtJpvz ghE9hrw6Lm50o9Oh9VrIxyvCsAsytAAN7ai4Ql7MRQoLohWNBrw4zhGJduwZ3Zzmk8TgrY8z8+Pm AKnFvyGvkFCr1+KoR70AXgUCmLxaB+BYEiPWhJBxk8r03sQ7NPLxbEJcJRGzeJdB3lFupkzAn04n ORpcRQe4xKUqgYcnIxppbL8EwouiFz23IC2ZuTRa9DbJOt8FJW6jZBw1OQSBRALRjZnMZUhOssmL sNACINSdziJHz0u6MJ1WM1kK9kqyyYNUAHWRA97HhELQ58hGKLBBqEETKhvYOFQHnMMTAK4RpcZJ 7mIYVRwTI1lDz21ubRJ90o5ScxEZsO6kJk3pSVmA0pWybgUsRU1JVzDTi6TmZQIJCAA7 ------=_NextPart_000_0000_01C939A4.1ACFDE20 Content-Type: image/gif Content-Transfer-Encoding: base64 Content-Location: http://aspe.hhs.gov/admnsimp/bnvch.gif R0lGODdhNwA3APcAAAAAAAEBAf///////////////////////////////wAAMwAAZgAAmQAAzP// /wAzMwAzZgAzmQAzzAAz/wBmAABmMwBmZgBmmQBmzABm/wCZAACZMwCZZgCZmQCZzACZ/wDMAADM MwDMZgDMmQDMzADM/wD/MwD/ZgD/mQD/zP///zMAMzMAZjMAmTMAzDMA/////zMzMzMzZjMzmTMz zDMz/zNmADNmMzNmZjNmmTNmzDNm/zOZADOZMzOZZjOZmTOZzDOZ/zPMADPMMzPMZjPMmTPMzDPM /zP/ADP/MzP/ZjP/mTP/zDP//2YAAGYAM2YAZmYAmWYAzGYA/////2YzM2YzZmYzmWYzzGYz/2Zm AGZmM2ZmZmZmmWZmzGZm/2aZAGaZM2aZZmaZmWaZzGaZ/2bMAGbMM2bMZmbMmWbMzGbM/2b/AGb/ M2b/Zmb/mWb/zGb//////5kAM5kAZpkAmZkAzJkA/////5kzM5kzZpkzmZkzzJkz/5lmAJlmM5lm ZplmmZlmzJlm/5mZAJmZM5mZZpmZmZmZzJmZ/5nMAJnMM5nMZpnMmZnMzJnM/5n/AJn/M5n/Zpn/ mZn/zJn//////8wAM8wAZswAmcwAzMwA/////8wzM8wzZswzmcwzzMwz/8xmAMxmM8xmZsxmmcxm zMxm/8yZAMyZM8yZZsyZmcyZzMyZ/8zMAMzMM8zMZszMmczMzMzM/8z/AMz/M8z/Zsz/mcz/zMz/ //8AM/8AZv8Amf8AzP8zAP8zM/8zZv8zmf8zzP8z//9mAP9mM/9mZv9mmf9mzP9m//+ZAP+ZM/+Z Zv+Zmf+ZzP+Z///MAP/MM//MZv/Mmf/MzP/M////M///Zv//mf//zP////////////////////// /////////////////////////////////////////////////////zMAAGYAAJkAAMwAAAAzADMz AGYzAJkzAMwzAP////////////8AAAD/AP//AAAA//8A/wD//////yH5BAEAAAAALAAAAAA3ADcA AAj+ALkI/EewoMGDCBMqXJhQ4ECGECNKNOiQy8SLGBFWlPWvosePIEOKBCmL48aOI1OqVFkSpUCO JWPKnEmzps2bL006hHmzp8+fsnK65MIzo9GDJV9OGAozgNOnUKNKnUo1alIuE7KelBXgYNeFATiC Nfi1YNigWLXu/MfVq0KuThmW/TeXbtKsal+yrVvXLFSLCefylYV3gk69bckqlCqWrdmCic0Sztpy a9XLTi0GDWARs9PClddGJtiXIFzOm63SjQr4X2Gih4nudctZI2cuVVf/JfgaNtPZZHE7bWxaOFXj T03jRRsaMd+oB5Gz5gJAd1nQQi1DPf2UOnKyYQv+4uYeADTz2E2jQycPHrDA8HR5Lz//ezTa7Yxj dv8e33XWs9mJdl1WqxHl2XHxFQagb5YVVNheX0nXWlW4Pbhgc7KdNplW3ZEGHUHjTZWWYcPR16B/ eLHGFXIlZQaicBY9aJeJAqKYImtskZfcXoBtKBmNzhV2418WSfdUag7i9WOAQRKIIo4eUtjScksy KKCST+4WZXkT7PeUjKRdhSFMMo6YIYBcKtgRVFhWOaaNZuHlXldCCmkdmGECKRuVq+EFQGp12mkc n26ih+KWQ6b532dOfkmZV2IaqiOjXVI6AQAGpimTgvkxeSaIbN7oJ6aOOmnjYHqmB6GlaWJqXZqR ylGGqqeqspVTnTxJpSSVs1rpnFsbYtmVrpTxCmmqq1pVJ4WBVhVpfXMlFqxY4cHIlpDUHksrcI/J t1S3CNlJmra+fqqYcm4lhGevb47W32IKrUtuuwfWm+hUz24F1L78Itvvvz5tC/DANQlM8MH5iobw wdse5XBCbz4sMWToLWwxhitlrPHGHHfs8ccghxQQAAA7 ------=_NextPart_000_0000_01C939A4.1ACFDE20 Content-Type: image/gif Content-Transfer-Encoding: base64 Content-Location: http://aspe.hhs.gov/admnsimp/bdc.gif R0lGODlhNwA3APcAAAAAAAEBAf///////////////////////////////wAAMwAAZgAAmQAAzP// /wAzMwAzZgAzmQAzzAAz/wBmAABmMwBmZgBmmQBmzABm/wCZAACZMwCZZgCZmQCZzACZ/wDMAADM MwDMZgDMmQDMzADM/wD/MwD/ZgD/mQD/zP///zMAMzMAZjMAmTMAzDMA/////zMzMzMzZjMzmTMz zDMz/zNmADNmMzNmZjNmmTNmzDNm/zOZADOZMzOZZjOZmTOZzDOZ/zPMADPMMzPMZjPMmTPMzDPM /zP/ADP/MzP/ZjP/mTP/zDP//2YAAGYAM2YAZmYAmWYAzGYA/////2YzM2YzZmYzmWYzzGYz/2Zm AGZmM2ZmZmZmmWZmzGZm/2aZAGaZM2aZZmaZmWaZzGaZ/2bMAGbMM2bMZmbMmWbMzGbM/2b/AGb/ M2b/Zmb/mWb/zGb//////5kAM5kAZpkAmZkAzJkA/////5kzM5kzZpkzmZkzzJkz/5lmAJlmM5lm ZplmmZlmzJlm/5mZAJmZM5mZZpmZmZmZzJmZ/5nMAJnMM5nMZpnMmZnMzJnM/5n/AJn/M5n/Zpn/ mZn/zJn//////8wAM8wAZswAmcwAzMwA/////8wzM8wzZswzmcwzzMwz/8xmAMxmM8xmZsxmmcxm zMxm/8yZAMyZM8yZZsyZmcyZzMyZ/8zMAMzMM8zMZszMmczMzMzM/8z/AMz/M8z/Zsz/mcz/zMz/ //8AM/8AZv8Amf8AzP8zAP8zM/8zZv8zmf8zzP8z//9mAP9mM/9mZv9mmf9mzP9m//+ZAP+ZM/+Z Zv+Zmf+ZzP+Z///MAP/MM//MZv/Mmf/MzP/M////M///Zv//mf//zP////////////////////// /////////////////////////////////////////////////////zMAAGYAAJkAAMwAAAAzADMz AGYzAJkzAMwzAP////////////8AAAD/AP//AAAA//8A/wD//////yH5BAEAAAAALAAAAAA3ADcA QAj+ALkI/EewoMGDCBMqXJhQoEBZ/2QFmEixosWLGDNalCVLYL6PDrlAlHgwABeKEA121GjyIkFZ H/N1FAkx5MgABGN+tCiyJUqJJgkKnMjln06CATg+rOkQYkykFGNW1Jkv6keoAWKmLJh0Jsd/NiPi NDjW6FWuCqmiJauUJtimETnKnUu3rt27d5e+fbg3pN+/gAMLtsmUL0myCi9u3Vr2MFeYH7+GdRxx KErFcilanog05862kuFKfGq2asWiWLOaNnly4tHHXguLFFswNlWZcS8+1fqvLFLQskfiHU68eOy+ g5MrXy6YofPn0A9ONk69+vHJvnsrBJq9JGK2HXX+YveekLvI1hUhXkRdOp9b7OnXA0Dve+LWk9xd a70uuuxRoELxxFVGJx3VlV7Y3baaZkXRl15rBb3WG3B9OUVabzGhdlJ7t/Vm1VmwIdhfgB+aFhMA 85UYoVQlUQifYrdpxIWCGrk44neJpXWhduCJaJh1QA7n42zRFWlkXMgxp+SSzR3pZJFhMSllcqH9 GOSVdA0p3JNcxvVQPhXShmNCSTFUX4szZXjjWggJSOaYE+oUnFgssVTUSkXVqV9kc1KmXVDSsaaR h6d5BtJ7a6bGmUEOnsYFAIT6p5WWYhbkIJ0UkQXoUCmNJSd/hkkKJlH56VkoTjodiGio9omnmaKm ZeGH0YyR2QfqbCTFKCBHGb0EKGRg/nbrTaRJVSisPH3Fm7CUAhssre7dpJRqqYI1FYjMrjrbsnsC sBK1CoKJ3rIhansTRsaCOx9Q+3GUKmbNjpVfqifmeW2wwPqpapW4ZoeTs2fhpFtkvPlrY6gqySvn b9YGBXCnaMZLXkTBsnmQhDyWy++5puqZbkYH44rlyCELRzKWlHapcm3Bnewyv1PGrFxAAAA7 ------=_NextPart_000_0000_01C939A4.1ACFDE20 Content-Type: image/gif Content-Transfer-Encoding: base64 Content-Location: http://aspe.hhs.gov/admnsimp/bhhs.gif R0lGODlhNwA3APcAAAAAAAEBAf///////////////////////////////wAAMwAAZgAAmQAAzP// /wAzMwAzZgAzmQAzzAAz/wBmAABmMwBmZgBmmQBmzABm/wCZAACZMwCZZgCZmQCZzACZ/wDMAADM MwDMZgDMmQDMzADM/wD/MwD/ZgD/mQD/zP///zMAMzMAZjMAmTMAzDMA/////zMzMzMzZjMzmTMz zDMz/zNmADNmMzNmZjNmmTNmzDNm/zOZADOZMzOZZjOZmTOZzDOZ/zPMADPMMzPMZjPMmTPMzDPM /zP/ADP/MzP/ZjP/mTP/zDP//2YAAGYAM2YAZmYAmWYAzGYA/////2YzM2YzZmYzmWYzzGYz/2Zm AGZmM2ZmZmZmmWZmzGZm/2aZAGaZM2aZZmaZmWaZzGaZ/2bMAGbMM2bMZmbMmWbMzGbM/2b/AGb/ M2b/Zmb/mWb/zGb//////5kAM5kAZpkAmZkAzJkA/////5kzM5kzZpkzmZkzzJkz/5lmAJlmM5lm ZplmmZlmzJlm/5mZAJmZM5mZZpmZmZmZzJmZ/5nMAJnMM5nMZpnMmZnMzJnM/5n/AJn/M5n/Zpn/ mZn/zJn//////8wAM8wAZswAmcwAzMwA/////8wzM8wzZswzmcwzzMwz/8xmAMxmM8xmZsxmmcxm zMxm/8yZAMyZM8yZZsyZmcyZzMyZ/8zMAMzMM8zMZszMmczMzMzM/8z/AMz/M8z/Zsz/mcz/zMz/ //8AM/8AZv8Amf8AzP8zAP8zM/8zZv8zmf8zzP8z//9mAP9mM/9mZv9mmf9mzP9m//+ZAP+ZM/+Z Zv+Zmf+ZzP+Z///MAP/MM//MZv/Mmf/MzP/M////M///Zv//mf//zP////////////////////// /////////////////////////////////////////////////////zMAAGYAAJkAAMwAAAAzADMz AGYzAJkzAMwzAP////////////8AAAD/AP//AAAA//8A/wD//////yH5BAEAAAAALAAAAAA3ADcA QAj+ALkI/EewoMGDCBMqXJhQoEBZ/xhInEiR4gxAXbqoMmTolSFYMzh2gdVlRsWTEh9CdMgFIsqL KGPKlAhr3z5AM6xNVPmPpcuJhg7NjNnF2r5oJWvuM8TAkNFXJne2XOnwp0RVIGXCihbN5j5rTBm8 ugloH6yhDHj6/Helrdu2gF5hfUv3bZeuWJHWrau2akS0gANT7PuwJ8vDiBMrXoxYFtXCMlUBIimY YheRMQm3/Hv1VZfKJ2d0BdvUJtTBUw1DnqgKNIOaGb+GtJk1c+q1J0fKDDn2a1gGNlWFNJRxsldr n9Pe9huYOKyPk593sWmyi8fkMzUz3s69+2KG4MP+iz+I27X5k5qtxmQKa2NUmZcxqsKOMj1nihxx np84AyTXivZV1N97+x1iFFL9HSWVY6pt9tZGe0VYlyq0dQHIaM7B8pZ9b70ioYTTITfdPp7d5dte HLr13Id1GXLUFWMR9xWLV6TYFkca0uWiTdHAAkhdY2lYU45XAPIjXTa+1ZEqNBrSFYmG3GjTkREG OJOFktFnUTSGzEAdYFbut59945Vp5j8Meqfmmt6d6aaZa7Ep53ZpMifmmMutVtllIxmy0XxaDhXm TMTJNQOgJc0wA59InYXWoCd1xBGBgOVH6YKPbfaSZMLt199GgPyWUp6aCggLZXfSZBYD70HqpKj6 nmL42j7JDdplqgxQaNaio7VKKkSpBJsKV8IWa+yxxfYGTbBPRnPsoDC5NsNYpO0IlYmtYdogsMI6 i+y3wkKzz7KpeMUsj8/+ep+jlbnIVFdnAXLgpaPWWVix3oKLrE3DHpWKuPl+C+lQI71i8CtdAZLr Ul6+8qi6yRr8rcTIjrVsb/oGC2mgDJSkkVdcvrejojw+eZRHYdl37LIBVyyuacO+PK6xxAo7MKt+ 3jqUU1POCit6EIMbDTTRvJJxuVztc7TG6qKF40fEVRSNTsAdVZtMN+92GY6S8agzmE3j6hqZb5aN kL1TOab22my37fbbcK/d4Jx0cxcQAAA7 ------=_NextPart_000_0000_01C939A4.1ACFDE20--