Medical and Health Insurance Information Reform Act of 1992

Medical and Health Insurance Information Reform Act of 1992 - Adds a new title XXII, Medical And Health Insurance Information Reform, to the Social Security Act (SSA). Requires the Secretary of Health and Human Services, in order to assure the availability of comparative value information to health care purchasers, to determine whether each State is developing and implementing a health care value information program. Enumerates the criteria for State programs.

Provides that if the Secretary finds that a State has not developed or implemented a health care value information program that comports with such criteria, the Secretary must take necessary actions to implement a comparable program in the State. Allows fees to be charged for the informational materials provided pursuant to such program.

Directs the head of any Federal agency with responsibility for the provision of health insurance or health care services to develop and make comparative value information available to States, health care providers, and consumers.

Directs the Secretary to promulgate requirements for health insurers to furnish periodically to the Secretary, on a sample basis, health care data relevant to health care services research. Requires the Secretary to make available, under the Freedom of Information Act, all Medicare (SSA title XVIII) claims records, without regard to the consent of the physician or other individual who furnished the item or service in question. Maintains in force Privacy Act protections against the release of information that identifies Medicare beneficiaries.

Applies this new requirement for release of records only to information received after the enactment of this Act.

Directs the Secretary, directly or through grant or contract, to develop model systems: (1) for gathering health care cost, quality, and outcomes data; and (2) for analyzing such data in a manner that would allow valid comparisons among providers and among health plans. Requires the Secretary to support and evaluate experiments with different approaches to achieve the most cost-effective method. Provides that, when appropriate, the Secretary may establish standards for data gathering in order to facilitate analysis and comparisons across the nation. Authorizes appropriations.

Authorizes the Secretary to make grants to States to enable them to plan and initiate implementation of their health care information programs. Authorizes appropriations.

Nullifies any State law which requires medical or health insurance records (including billing information) to be kept in written, rather than electronic, form.

Directs the Secretary, after taking into consideration the Insurance Information and Privacy Protection Model Act of the National Association of Insurance Commissioners (NAIC), to promulgate requirements concerning health insurance information privacy and confidentiality. Includes among such requirements that information identifying individuals shall not be redisclosed (with such limited exceptions as the Secretary may provide) except to the extent necessary to carry out the purpose for which the information was collected. Requires the Secretary to take into consideration specified principles concerning information that identifies individuals when promulgating such requirements.

Directs the Secretary to determine whether problems relating to standards for the electronic receipt and transmission of health insurance information cause significant administrative costs. Requires the Secretary, if such costs are generated, to promulgate standards for the electronic receipt and transmission of claims, payment, eligibility, and enrollment information (including privacy and confidentiality protection requirements).

Directs the Secretary to determine whether problems relating to the receipt and transmission of health insurance eligibility verification cause significant administrative costs. Requires the Secretary, if such costs are generated, to promulgate requirements for the receipt and transmission of health insurance eligibility verification.

Directs the Secretary to determine whether the proportion of health insurance claims and payment information received and transmitted by paper will continue to cause significant administrative costs. Directs the Secretary, if such costs are generated, to require a specified proportion of (or all of) such information to be received and transmitted electronically (with such exceptions as the Secretary might specify).

Directs the Secretary to promulgate requirements for the format and content of basic claim forms under health insurance plans.

Directs the Secretary to determine whether the variety of information requested by health insurers (in addition to information requested in basic claims forms) causes administrative costs disproportionate to the benefits derived. Requires the Secretary, if such costs are generated, to publish recommendations concerning what additional information should be allowed to be requested and in what format.

Directs the Secretary, after consulting with the NAIC, to promulgate rules for determining the relative liability of insurers and the priority of payment when several health insurance policies cover the same individual.

Directs the Secretary to determine whether problems relating to the transfer of information among health insurers that cover the same individual cause significant mistaken payments or administrative costs. Requires the Secretary, if such payments or costs are generated, to promulgate requirements concerning the transfer among insurers (and annual updating) of information (which may include requirements for the use of unique identifiers, and for the listing of all individuals covered under a health insurance plan).

Directs the Secretary to determine, for each State, whether there were in effect State requirements substantially the same as those enumerated below and whether the State effectively enforced them. Applies the requirements enumerated below to administrators of self-insured employee plans.

Provides for Federal backup authority to be effective in a State (with respect to a section) only if the Secretary makes a negative finding with respect to certain requirements or if the State does not provide sufficient information to enable the Secretary to make the determination.

Requires health insurers (in States that do not have an equivalent program) to: (1) meet the Federal requirements concerning the protection of privacy and confidentiality; (2) use social security numbers for their beneficiaries and Medicare unique identifiers for each provider that furnishes items and services; (3) meet the standards and requirements (if any) concerning the receipt and transmission of health insurance information; (4) meet the requirements concerning the form and content of health insurance claim forms; (5) follow the rules determining the priority of payment when several health insurance policies cover the same individual; and (6) meet the requirements (if any) concerning the furnishing of information among insurers.

Requires the Secretary, after consulting with the American National Standards Institute (ANSI) and others, to promulgate requirements for hospitals concerning electronic medical data. Specifies the data sets to be included in such requirements.

Permits the Secretary, after consulting with ANSI and others, to promulgate requirements for health care entities other than hospitals concerning electronic medical data.

Requires hospitals that participate in the Medicare program to maintain an electronic patient care information system that meets certain data set requirements promulgated by the Secretary for hospitals, and to transmit data electronically to the Secretary, peer review organizations, carriers, and intermediaries, from the appropriate data sets. Permits waivers of such requirements for hospitals in the process of developing an electronic patient care information system, for small rural hospitals, and for certain hospitals that agree to subject their data transfer processes to specified quality assurance procedures.

Permits Federal agencies to require electronic transmission of data elements utilized for certain agency health care or research programs.

Amends the Internal Revenue Code to subject insurers to an excise tax for any failure to comply with requirements under SSA new title XXII respecting health insurance. Specifies the amount of such tax for administrators of self-insured employee welfare benefit plans and other insurers. Provides that the excise tax generally shall not apply if the violation could not have been discovered through the exercise of reasonable diligence, or if the violation was corrected within 30 days after it had been discovered. Gives the Secretary authority to waive the tax if the violations were due to reasonable cause and not willful neglect, to the extent payment of the tax would be excessive relative to the failure involved.

Authorizes the Secretary to make grants to: (1) community organizations or coalitions of health care providers, insurers, and purchasers to establish, and document the efficacy of, communication links between the information systems of health insurers and of health care providers; and (2) public and private non-profit entities for the development of regional- and community- based clinical information systems, and for the development and testing of certain ambulatory care data sets. Authorizes appropriations.