{"identifier":"/us/usc/t42/s1320d","title":42,"num":"\u00a7\u202f1320d.","heading":"Definitions","text":"\u00a7\u202f1320d.\nDefinitions\nFor purposes of this part:\n(1)\nCode set\nThe term \u201ccode set\u201d means any set of codes used for encoding data elements, such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes.\n(2)\nHealth care clearinghouse\nThe term \u201chealth care clearinghouse\u201d means a public or private entity that processes or facilitates the processing of nonstandard data elements of health information into standard data elements.\n(3)\nHealth care provider\nThe term \u201chealth care provider\u201d includes a provider of services (as defined in\nsection 1395x(u) of this title\nsection 1395x(s) of this title\n(4)\nHealth information\nThe term \u201chealth information\u201d means any information, whether oral or recorded in any form or medium, that\u2014\n(A) is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and\n(B) relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual.\n(5)\nHealth plan\nThe term \u201chealth plan\u201d means an individual or group plan that provides, or pays the cost of, medical care (as such term is defined in\n(A) A group health plan (as defined in\n(i) has 50 or more participants (as defined in\nsection 1002(7) of title 29\n(ii) is administered by an entity other than the employer who established and maintains the plan.\n(B) A health insurance issuer (as defined in\nsection 300gg\u201391(b) of this title\n(C) A health maintenance organization (as defined in\nsection 300gg\u201391(b) of this title\n(D) Parts\n1\n1 So in original. Probably should be \u201cPart\u201d.\n(E) The medicaid program under subchapter XIX.\n(F) A Medicare supplemental policy (as defined in\nsection 1395ss(g)(1) of this title\n(G) A long-term care policy, including a nursing home fixed indemnity policy (unless the Secretary determines that such a policy does not provide sufficiently comprehensive coverage of a benefit so that the policy should be treated as a health plan).\n(H) An employee welfare benefit plan or any other arrangement which is established or maintained for the purpose of offering or providing health benefits to the employees of 2 or more employers.\n(I) The health care program for active military personnel under title 10.\n(J) The veterans health care program under chapter 17 of title 38.\n(K) The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), as defined in\nsection 1072(4) of title 10\n(L) The Indian health service program under the Indian Health Care Improvement Act (\n25 U.S.C. 1601\n(M) The Federal Employees Health Benefit Plan under chapter 89 of title 5.\n(6)\nIndividually identifiable health information\nThe term \u201cindividually identifiable health information\u201d means any information, including demographic information collected from an individual, that\u2014\n(A) is created or received by a health care provider, health plan, employer, or health care clearinghouse; and\n(B) relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual, and\u2014\n(i) identifies the individual; or\n(ii) with respect to which there is a reasonable basis to believe that the information can be used to identify the individual.\n(7)\nStandard\nThe term \u201cstandard\u201d, when used with reference to a data element of health information or a transaction referred to in\nsection 1320d\u20132(a)(1) of this title\n(8)\nStandard setting organization\nThe term \u201cstandard setting organization\u201d means a standard setting organization accredited by the American National Standards Institute, including the National Council for Prescription Drug Programs, that develops standards for information transactions, data elements, or any other standard that is necessary to, or will facilitate, the implementation of this part.\n(9)\nOperating rules\nThe term \u201coperating rules\u201d means the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications as adopted for purposes of this part.","url":"https://projectusc.org/usc/t42/s1320d.html","content":[{"t":"sec","id":"/us/usc/t42/s1320d","children":[{"t":"num","text":"\u00a7\u202f1320d."},{"t":"heading","text":"Definitions","tail":"\n"},{"t":"chapeau","text":"For purposes of this part:"},{"t":"para","id":"/us/usc/t42/s1320d/1","children":[{"t":"num","text":"(1)"},{"t":"heading","text":"Code set"},{"t":"content","children":[{"t":"p","text":"The term \u201ccode set\u201d means any set of codes used for encoding data elements, such as tables of terms, medical concepts, medical diagnostic codes, or medical procedure codes.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1320d/2","children":[{"t":"num","text":"(2)"},{"t":"heading","text":"Health care clearinghouse"},{"t":"content","children":[{"t":"p","text":"The term \u201chealth care clearinghouse\u201d means a public or private entity that processes or facilitates the processing of nonstandard data elements of health information into standard data elements.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1320d/3","children":[{"t":"num","text":"(3)"},{"t":"heading","text":"Health care provider"},{"t":"content","children":[{"t":"p","text":"The term \u201chealth care provider\u201d includes a provider of services (as defined in ","children":[{"t":"ref","text":"section 1395x(u) of this title","href":"/us/usc/t42/s1395x/u","tail":"), a provider of medical or other health services (as defined in "},{"t":"ref","text":"section 1395x(s) of this title","href":"/us/usc/t42/s1395x/s","tail":"), and any other person furnishing health care services or supplies."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1320d/4","children":[{"t":"num","text":"(4)"},{"t":"heading","text":"Health information"},{"t":"chapeau","text":"The term \u201chealth information\u201d means any information, whether oral or recorded in any form or medium, that\u2014"},{"t":"subpara","id":"/us/usc/t42/s1320d/4/A","children":[{"t":"num","text":"(A)"},{"t":"content","text":" is created or received by a health care provider, health plan, public health authority, employer, life insurer, school or university, or health care clearinghouse; and","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1320d/4/B","children":[{"t":"num","text":"(B)"},{"t":"content","text":" relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1320d/5","children":[{"t":"num","text":"(5)"},{"t":"heading","text":"Health plan"},{"t":"chapeau","text":"The term \u201chealth plan\u201d means an individual or group plan that provides, or pays the cost of, medical care (as such term is defined in ","children":[{"t":"ref","text":"section 300gg\u201391 of this title","href":"/us/usc/t42/s300gg\u201391","tail":"). Such term includes the following, and any combination thereof:"}]},{"t":"subpara","id":"/us/usc/t42/s1320d/5/A","children":[{"t":"num","text":"(A)"},{"t":"chapeau","text":" A group health plan (as defined in ","children":[{"t":"ref","text":"section 300gg\u201391(a) of this title","href":"/us/usc/t42/s300gg\u201391/a","tail":"), but only if the plan\u2014"}]},{"t":"clause","id":"/us/usc/t42/s1320d/5/A/i","children":[{"t":"num","text":"(i)"},{"t":"content","text":" has 50 or more participants (as defined in ","children":[{"t":"ref","text":"section 1002(7) of title 29","href":"/us/usc/t29/s1002/7","tail":"); or"}],"tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1320d/5/A/ii","children":[{"t":"num","text":"(ii)"},{"t":"content","text":" is administered by an entity other than the employer who established and maintains the plan.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1320d/5/B","children":[{"t":"num","text":"(B)"},{"t":"content","text":" A health insurance issuer (as defined in ","children":[{"t":"ref","text":"section 300gg\u201391(b) of this title","href":"/us/usc/t42/s300gg\u201391/b","tail":")."}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1320d/5/C","children":[{"t":"num","text":"(C)"},{"t":"content","text":" A health maintenance organization (as defined in ","children":[{"t":"ref","text":"section 300gg\u201391(b) of this title","href":"/us/usc/t42/s300gg\u201391/b","tail":")."}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1320d/5/D","children":[{"t":"num","text":"(D)"},{"t":"content","text":" Parts\u202f","children":[{"t":"ref","text":"1"},{"t":"num","text":"1","tail":"\u202fSo in original. Probably should be \u201cPart\u201d."},{"t":"text","text":"\u202fSo in original. Probably should be \u201cPart\u201d.","tail":" A, B, C, or D of the Medicare program under subchapter XVIII."}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1320d/5/E","children":[{"t":"num","text":"(E)"},{"t":"content","text":" The medicaid program under subchapter XIX.","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1320d/5/F","children":[{"t":"num","text":"(F)"},{"t":"content","text":" A Medicare supplemental policy (as defined in ","children":[{"t":"ref","text":"section 1395ss(g)(1) of this title","href":"/us/usc/t42/s1395ss/g/1","tail":")."}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1320d/5/G","children":[{"t":"num","text":"(G)"},{"t":"content","text":" A long-term care policy, including a nursing home fixed indemnity policy (unless the Secretary determines that such a policy does not provide sufficiently comprehensive coverage of a benefit so that the policy should be treated as a health plan).","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1320d/5/H","children":[{"t":"num","text":"(H)"},{"t":"content","text":" An employee welfare benefit plan or any other arrangement which is established or maintained for the purpose of offering or providing health benefits to the employees of 2 or more employers.","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1320d/5/I","children":[{"t":"num","text":"(I)"},{"t":"content","text":" The health care program for active military personnel under title 10.","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1320d/5/J","children":[{"t":"num","text":"(J)"},{"t":"content","text":" The veterans health care program under chapter 17 of title 38.","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1320d/5/K","children":[{"t":"num","text":"(K)"},{"t":"content","text":" The Civilian Health and Medical Program of the Uniformed Services (CHAMPUS), as defined in ","children":[{"t":"ref","text":"section 1072(4) of title 10","href":"/us/usc/t10/s1072/4","tail":"."}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1320d/5/L","children":[{"t":"num","text":"(L)"},{"t":"content","text":" The Indian health service program under the Indian Health Care Improvement Act (","children":[{"t":"ref","text":"25 U.S.C. 1601","href":"/us/usc/t25/s1601","tail":" et seq.)."}],"tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1320d/5/M","children":[{"t":"num","text":"(M)"},{"t":"content","text":" The Federal Employees Health Benefit Plan under chapter 89 of title 5.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1320d/6","children":[{"t":"num","text":"(6)"},{"t":"heading","text":"Individually identifiable health information"},{"t":"chapeau","text":"The term \u201cindividually identifiable health information\u201d means any information, including demographic information collected from an individual, that\u2014"},{"t":"subpara","id":"/us/usc/t42/s1320d/6/A","children":[{"t":"num","text":"(A)"},{"t":"content","text":" is created or received by a health care provider, health plan, employer, or health care clearinghouse; and","tail":"\n"}],"tail":"\n"},{"t":"subpara","id":"/us/usc/t42/s1320d/6/B","children":[{"t":"num","text":"(B)"},{"t":"chapeau","text":" relates to the past, present, or future physical or mental health or condition of an individual, the provision of health care to an individual, or the past, present, or future payment for the provision of health care to an individual, and\u2014"},{"t":"clause","id":"/us/usc/t42/s1320d/6/B/i","children":[{"t":"num","text":"(i)"},{"t":"content","text":" identifies the individual; or","tail":"\n"}],"tail":"\n"},{"t":"clause","id":"/us/usc/t42/s1320d/6/B/ii","children":[{"t":"num","text":"(ii)"},{"t":"content","text":" with respect to which there is a reasonable basis to believe that the information can be used to identify the individual.","tail":"\n"}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1320d/7","children":[{"t":"num","text":"(7)"},{"t":"heading","text":"Standard"},{"t":"content","children":[{"t":"p","text":"The term \u201cstandard\u201d, when used with reference to a data element of health information or a transaction referred to in ","children":[{"t":"ref","text":"section 1320d\u20132(a)(1) of this title","href":"/us/usc/t42/s1320d\u20132/a/1","tail":", means any such data element or transaction that meets each of the standards and implementation specifications adopted or established by the Secretary with respect to the data element or transaction under sections 1320d\u20131 through 1320d\u20133 of this title."}],"tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1320d/8","children":[{"t":"num","text":"(8)"},{"t":"heading","text":"Standard setting organization"},{"t":"content","children":[{"t":"p","text":"The term \u201cstandard setting organization\u201d means a standard setting organization accredited by the American National Standards Institute, including the National Council for Prescription Drug Programs, that develops standards for information transactions, data elements, or any other standard that is necessary to, or will facilitate, the implementation of this part.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"para","id":"/us/usc/t42/s1320d/9","children":[{"t":"num","text":"(9)"},{"t":"heading","text":"Operating rules"},{"t":"content","children":[{"t":"p","text":"The term \u201coperating rules\u201d means the necessary business rules and guidelines for the electronic exchange of information that are not defined by a standard or its implementation specifications as adopted for purposes of this part.","tail":"\n"}],"tail":"\n"}],"tail":"\n"},{"t":"text","text":"\n"},{"t":"text","text":"\n"}]}]}