BBA Law

H.R.2015

Balanced Budget Act of 1997 (Enrolled as Agreed to or Passed by Both House and Senate)

SEC. 4753. MODIFICATION OF MMIS REQUIREMENTS.

(a) IN GENERAL- Section 1903(r) (42 U.S.C. 1396b(r)) is amended--

(1) by striking all that precedes paragraph (5) and inserting the following:

`(r)(1) In order to receive payments under subsection (a) for use of automated data systems in administration of the State plan under this title, a State must have in operation mechanized claims processing and information retrieval systems that meet the requirements of this subsection and that the Secretary has found--

`(A) are adequate to provide efficient, economical, and effective administration of such State plan;

`(B) are compatible with the claims processing and information retrieval systems used in the administration of title XVIII, and for this purpose--

`(i) have a uniform identification coding system for providers, other payees, and beneficiaries under this title or title XVIII;

`(ii) provide liaison between States and carriers and intermediaries with agreements under title XVIII to facilitate timely exchange of appropriate data; and

`(iii) provide for exchange of data between the States and the Secretary with respect to persons sanctioned under this title or title XVIII;

`(C) are capable of providing accurate and timely data;

`(D) are complying with the applicable provisions of part C of title XI;

`(E) are designed to receive provider claims in standard formats to the extent specified by the Secretary; and

`(F) effective for claims filed on or after January 1, 1999, provide for electronic transmission of claims data in the format specified by the Secretary and consistent with the Medicaid Statistical Information System (MSIS) (including detailed individual enrollee encounter data and other information that the Secretary may find necessary).';

(2) in paragraph (5)--

(A) by striking subparagraph (B);

(B) by striking all that precedes clause (i) and inserting the following:

`(2) In order to meet the requirements of this paragraph, mechanized claims processing and information retrieval systems must meet the following requirements:';

(C) in clause (iii), by striking `under paragraph (6)'; and

(D) by redesignating clauses (i) through (iii) as paragraphs (A) through (C); and

(3) by striking paragraphs (6), (7), and (8).

(b) CONFORMING AMENDMENTS- Section 1902(a)(25)(A)(ii) (42 U.S.C. 1396a(a)(25)(A)(ii)) is amended by striking all that follows `shall' and inserting the following: `be integrated with, and be monitored as a part of the Secretary's review of, the State's mechanized claims processing and information retrieval systems required under section 1903(r);'.

(c) EFFECTIVE DATE- Except as otherwise specifically provided, the amendments made by this section shall take effect on January 1, 1998.