42 U.S.C. § 1320d–7: Effect on State law

Summary

Federal rules and the standards made under sections 1320d–1 through 1320d–3 override any conflicting state law. That includes state rules that force medical or health plan records (like billing) to stay on paper instead of electronic. But state law can still stand if the Secretary finds it is needed to prevent fraud or abuse, to allow proper state regulation of insurance and health plans, for state reporting on health care delivery or costs, for other state purposes, or if it concerns controlled substances. Also, rules about the privacy of identifiable health information remain in effect subject to section 264(c)(2) of the Health Insurance Portability and Accountability Act of 1996. Nothing here stops state requirements for reporting disease, injury, child abuse, birth, or death, public health surveillance or intervention, or state demands that health plans supply information for audits, program monitoring, or licensure.

Title 42, §1320d–7

The Public Health and Welfare, Source: USLM XML via OLRC

(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 1320d–1 through 1320d–3 of this title, 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 1320d–1 through 1320d–3 of this title, 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.

Editorial Notes

References in Text

section 264(c)(2) of the Health Insurance Portability and Accountability Act of 1996, referred to in subsec. (a)(2)(B), is section 264(c)(2) of Pub. L. 104–191, which is set out as a note under section 1320d–2 of this title.

§1320d–7 Effect on State Law

Summary

Title 42, §1320d–7

Notes & Related Subsidiaries

Editorial Notes

References in Text

Citations & Metadata