II 

109TH CONGRESS 

1ST SESSION S. 1223 

To amend the Public Health Service Act to improve the quality and efficiency 

of health care delivery through improvements in health care information 

technology, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JUNE 9, 2005 

Mr. DODD introduced the following bill; which was read twice and referred to 

the Committee on Health, Education, Labor, and Pensions 

A BILL 

To amend the Public Health Service Act to improve the 

quality and efficiency of health care delivery through 

improvements in health care information technology, and 

for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

4 This Act may be cited as the ‘‘Information Tech5 nology for Health Care Quality Act’’. 
2 

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1 SEC. 2. AMENDMENT TO THE PUBLIC HEALTH SERVICE 

2 ACT. 

3 The Public Health Service Act (42 U.S.C. 201 et 

4 seq.) is amended by adding at the end thereof the fol5 lowing: 

6 ‘‘TITLE XXIX—HEALTH CARE 

7 INFORMATION TECHNOLOGY 

8 ‘‘SEC. 2901. DEFINITIONS. 

9 ‘‘In this title: 

10 ‘‘(1) COVERAGE AREA.—The term ‘coverage 

11 area’ means the boundaries of a local health infor12 mation infrastructure. 

13 ‘‘(2) DIRECTOR.—The term ‘Director’ means 

14 the Director of the Office of Health Information 

15 Technology. 

16 ‘‘(3) HEALTH CARE PROVIDER.—The term 

17 ‘health care provider’ means a hospital, skilled nurs18 ing facility, home health entity, health care clinic, 

19 community health center, group practice (as defined 

20 in section 1877(h)(4) of the Social Security Act, in21 cluding practices with only 1 physician), and any 

22 other facility or clinician determined appropriate by 

23 the Director. 

24 ‘‘(4) HEALTH INFORMATION TECHNOLOGY.— 

25 The term ‘health information technology’ means a 

26 computerized system that— 
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1 ‘‘(A) is consistent with the standards de2 veloped pursuant to section 2903; 

3 ‘‘(B) permits the secure electronic trans4 mission of information to other health care pro5 viders and public health entities; and 

6 ‘‘(C) includes— 

7 ‘‘(i) an electronic health record 

8 (EHR) that provides access in real-time to 

9 the patient’s complete medical record; 

10 ‘‘(ii) a personal health record (PHR) 

11 through which an individual (and anyone 

12 authorized by such individual) can main13 tain and manage their health information; 

14 ‘‘(iii) computerized provider order 

15 entry (CPOE) technology that permits the 

16 electronic ordering of diagnostic and treat17 ment services, including prescription drugs; 

18 ‘‘(iv) decision support to assist physi19 cians in making clinical decisions by pro20 viding electronic alerts and reminders to 

21 improve compliance with best practices, 

22 promote regular screenings and other pre23 ventive practices, and facilitate diagnoses 

24 and treatments; 
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1 ‘‘(v) error notification procedures so 

2 that a warning is generated if an order is 

3 entered that is likely to lead to a signifi4 cant adverse outcome for the patient; and 

5 ‘‘(vi) tools to allow for the collection, 

6 analysis, and reporting of data on adverse 

7 events, near misses, and the quality of care 

8 provided to the patient. 

9 ‘‘(5) LOCAL HEALTH INFORMATION INFRA10 STRUCTURES.—The term ‘local health information 

11 infrastructure’ means an independent organization 

12 of health care entities established for the purpose of 

13 linking health information systems to electronically 

14 share information. A local health information infra15 structure may not be a single business entity. 

16 ‘‘(6) OFFICE.—The term ‘Office’ means the Of17 fice of Health Information Technology established 

18 under section 2902. 

19 ‘‘SEC. 2902. OFFICE OF HEALTH INFORMATION TECH20 NOLOGY. 

21 ‘‘(a) ESTABLISHMENT.—There is established within 

22 the executive office of the President an Office of Health 

23 Information Technology. The Office shall be headed by a 

24 Director to be appointed by the President. The Director 

25 shall report directly to the President. 
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1 ‘‘(b) PURPOSE.—It shall be the purpose of the Office 

2 to— 

3 ‘‘(1) improve the quality and increase the effi4 ciency of health care delivery through the use of 

5 health information technology; 

6 ‘‘(2) provide national leadership relating to, and 

7 encourage the adoption of, health information tech8 nology; 

9 ‘‘(3) direct all health information technology ac10 tivities within the Federal Government; and 

11 ‘‘(4) facilitate the interaction between the Fed12 eral Government and the private sector relating to 

13 health information technology development and use. 

14 ‘‘(c) DUTIES AND RESPONSIBILITIES.—The Office 

15 shall be responsible for the following: 

16 ‘‘(1) NATIONAL STRATEGY.—The Office shall 

17 develop a national strategy for improving the quality 

18 and enhancing the efficiency of health care through 

19 the improved use of health information technology 

20 and the creation of a National Health Information 

21 Infrastructure. 

22 ‘‘(2) FEDERAL LEADERSHIP.—The Office 

23 shall— 
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1 ‘‘(A) serve as the principle advisor to the 

2 President concerning health information tech3 nology; 

4 ‘‘(B) direct all health information tech5 nology activity within the Federal Government, 

6 including approving or disapproving agency 

7 policies submitted under paragraph (3); 

8 ‘‘(C) work with public and private health 

9 information technology stakeholders to imple10 ment the national strategy described in para11 graph (1); and 

12 ‘‘(D) ensure that health information tech13 nology is utilized as fully as practicable in car14 rying out health surveillance efforts. 

15 ‘‘(3) AGENCY POLICIES.— 

16 ‘‘(A) IN GENERAL.—The Office shall, in 

17 accordance with this paragraph, approve or dis18 approve the policies of Federal departments or 

19 agencies with respect to any policy proposed to 

20 be implemented by such agency or department 

21 that would significantly affect that agency or 

22 department’s use of health information tech23 nology. 

24 ‘‘(B) SUBMISSION OF PROPOSAL.—The 

25 head of any Federal Government agency or de-
7 

•S 1223 IS 

1 partment that desires to implement any policy 

2 with respect to such agency or department that 

3 would significantly affect that agency or depart4 ment’s use of health information technology 

5 shall submit an implementation proposal to the 

6 Office at least 60 days prior to the proposed 

7 date of the implementation of such policy. 

8 ‘‘(C) APPROVAL OR DISAPPROVAL.—Not 

9 later than 60 days after the date on which a 

10 proposal is received under subparagraph (B), 

11 the Office shall determine whether to approve 

12 the implementation of such proposal. In making 

13 such determination, the Office shall consider 

14 whether the proposal is consistent with the na15 tional strategy described in paragraph (1). If 

16 the Office fails to make a determination within 

17 such 60-day period, such proposal shall be 

18 deemed to be approved. 

19 ‘‘(D) FAILURE TO APPROVE.—Except as 

20 otherwise provided for by law, a proposal sub21 mitted under subparagraph (B) may not be im22 plemented unless such proposal is approved or 

23 deemed to be approved under subparagraph 

24 (C). 

25 ‘‘(4) COORDINATION.—The Office shall— 
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1 ‘‘(A) encourage the development and adop2 tion of clinical, messaging, and decision support 

3 health information data standards, pursuant to 

4 the requirements of section 2903; 

5 ‘‘(B) ensure the maintenance and imple6 mentation of the data standards described in 

7 subparagraph (A); 

8 ‘‘(C) oversee and coordinate the health in9 formation technology efforts of the Federal 

10 Government; 

11 ‘‘(D) ensure the compliance of the Federal 

12 Government with federally adopted health infor13 mation technology data standards; 

14 ‘‘(E) ensure that the Federal Government 

15 consults and collaborates on decision making 

16 with respect to health information technology 

17 with the private sector and other interested par18 ties; and 

19 ‘‘(F) in consultation with private sector, 

20 adopt certification and testing criteria to deter21 mine if electronic health information systems 

22 interoperate. 

23 ‘‘(5) COMMUNICATION.—The Office shall—
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1 ‘‘(A) act as the point of contact for the 

2 private sector with respect to the use of health 

3 information technology; and 

4 ‘‘(B) work with the private sector to collect 

5 and disseminate best health information tech6 nology practices. 

7 ‘‘(6) EVALUATION AND DISSEMINATION.—The 

8 Office shall coordinate with the Agency for Health 

9 Research and Quality and other Federal agencies 

10 to— 

11 ‘‘(A) evaluate and disseminate information 

12 relating to evidence of the costs and benefits of 

13 health information technology and to whom 

14 those costs and benefits accrue; 

15 ‘‘(B) evaluate and disseminate information 

16 on the impact of health information technology 

17 on the quality and efficiency of patient care; 

18 and 

19 ‘‘(C) review Federal payment structures 

20 and differentials for health care providers that 

21 utilize health information technology systems. 

22 ‘‘(7) TECHNICAL ASSISTANCE.—The Office 

23 shall utilize existing private sector quality improve24 ment organizations to— 
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1 ‘‘(A) promote the adoption of health infor2 mation technology among healthcare providers; 

3 and 

4 ‘‘(B) provide technical assistance con5 cerning the implementation of health informa6 tion technology to healthcare providers. 

7 ‘‘(8) FEDERAL REIMBURSEMENT.— 

8 ‘‘(A) IN GENERAL.—Not later than 6 

9 months after the date of enactment of this title, 

10 the Office shall make recommendations to the 

11 President and the Secretary of Health and 

12 Human Service on changes to Federal reim13 bursement and payment structures that would 

14 encourage the adoption of information tech15 nology (IT) to improve health care quality and 

16 safety. 

17 ‘‘(B) PLAN.—Not later than 90 days after 

18 receiving recommendations under subparagraph 

19 (A), the Secretary shall provide to the relevant 

20 Committees of Congress a report that provides, 

21 with respect to each recommendation, a plan for 

22 the implementation, or an explanation as to 

23 why implementation is inadvisable, of such rec24 ommendations. The Office shall continue to 

25 monitor federally funded and supported infor-
11 

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1 mation technology and quality initiatives (includ2 ing the initiatives authorized in this title), and 

3 periodically update recommendations to the 

4 President and the Secretary. 

5 ‘‘(d) RESOURCES.—The President shall make avail6 able to the Office, the resources, both financial and other7 wise, necessary to enable the Director to carry out the pur8 poses of, and perform the duties and responsibilities of 

9 the Office under, this section. 

10 ‘‘(e) DETAIL OF FEDERAL EMPLOYEES.—Upon the 

11 request of the Director, the head of any Federal agency 

12 is authorized to detail, without reimbursement from the 

13 Office, any of the personnel of such agency to the Office 

14 to assist it in carrying out its duties under this section. 

15 Any such detail shall not interrupt or otherwise affect the 

16 civil service status or privileges of the Federal employee. 

17 ‘‘SEC. 2903. PROMOTING THE INTEROPERABILITY OF 

18 HEALTH CARE INFORMATION TECHNOLOGY 

19 SYSTEMS. 

20 ‘‘(a) DEVELOPMENT, AND FEDERAL GOVERNMENT

21 ADOPTION, OF STANDARDS.— 

22 ‘‘(1) ADOPTION.— 

23 ‘‘(A) IN GENERAL.—Not later than 2 years 

24 after the date of the enactment of this title, the 

25 Director, in collaboration with the Consolidated 
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1 Health Informatics Initiative (or a successor or2 ganization to such Initiative), shall provide for 

3 the adoption by the Federal Government of na4 tional data and communication health informa5 tion technology standards that promote the effi6 cient exchange of data between varieties of pro7 vider health information technology systems. In 

8 carrying out the preceding sentence, the Direc9 tor may adopt existing standards. Except as 

10 otherwise provided for in this title, standards 

11 adopted under this section shall be voluntary 

12 for private sector entities. 

13 ‘‘(B) GRANTS OR CONTRACTS.—The Direc14 tor may utilize grants or contracts to provide 

15 for the private sector development of standards 

16 for adoption by the Federal Government under 

17 subparagraph (A). 

18 ‘‘(C) DEFINITION.—In this paragraph, the 

19 term ‘provide for’ means that the Director shall 

20 promulgate, and each Federal agency or depart21 ment shall adopt, regulations to ensure that 

22 each such agency or department complies with 

23 the requirements of subsection (b). 
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1 ‘‘(2) REQUIREMENTS.—The standards devel2 oped and adopted under paragraph (1) shall be de3 signed to— 

4 ‘‘(A) enable health information technology 

5 to be used for the collection and use of clinically 

6 specific data; 

7 ‘‘(B) promote the interoperability of health 

8 care information across health care settings; 

9 ‘‘(C) facilitate clinical decision support 

10 through the use of health information tech11 nology; and 

12 ‘‘(D) ensure the privacy and confidentiality 

13 of medical records. 

14 ‘‘(3) PUBLIC PRIVATE PARTNERSHIP.—Con15 sistent with activities being carried out on the date 

16 of enactment of this title, including the Consolidated 

17 Health Informatics Initiative (or a successor organi18 zation to such Initiative), health information tech19 nology standards shall be adopted by the Director 

20 under paragraph (1) at the conclusion of a collabo21 rative process that includes consultation between the 

22 Federal Government and private sector health care 

23 and information technology stakeholders. 

24 ‘‘(4) PRIVACY AND SECURITY.—The regulations 

25 promulgated by the Secretary under part C of title 
14 

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1 XI of the Social Security Act (42 U.S.C. 1320d et 

2 seq.) and sections 261, 262, 263, and 264 of the 

3 Health Insurance Portability and Accountability Act 

4 of 1996 (42 U.S.C. 1320d–2 note) with respect to 

5 the privacy, confidentiality, and security of health 

6 information shall apply to the implementation of 

7 programs and activities under this title. 

8 ‘‘(5) PILOT TESTS.—To the extent practical, 

9 the Director shall pilot test the health information 

10 technology data standards developed under para11 graph (1) prior to their implementation under this 

12 section. 

13 ‘‘(6) DISSEMINATION.— 

14 ‘‘(A) IN GENERAL.—The Director shall en15 sure that the standards adopted under para16 graph (1) are widely disseminated to interested 

17 stakeholders. 

18 ‘‘(B) LICENSING.—To facilitate the dis19 semination and implementation of the stand20 ards developed and adopted under paragraph 

21 (1), the Director may license such standards, or 

22 utilize other means, to ensure the widespread 

23 use of such standards. 

24 ‘‘(b) IMPLEMENTATION OF STANDARDS.— 
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1 ‘‘(1) PURCHASE OF SYSTEMS BY THE SEC2 RETARY.—Effective beginning on the date that is 1 

3 year after the adoption of the technology standards 

4 pursuant to subsection (a), the Secretary shall not 

5 purchase any health care information technology 

6 system unless such system is in compliance with the 

7 standards adopted under subsection (a), nor shall 

8 the Director approve any proposal pursuant to sec9 tion 2902(c)(3) unless such proposal utilizes systems 

10 that are in compliance with the standards adopted 

11 under subsection (a). 

12 ‘‘(2) RECIPIENTS OF FEDERAL FUNDS.—Effec13 tive on the date described in paragraph (1), no ap14 propriated funds may be used to purchase a health 

15 care information technology system unless such sys16 tem is in compliance with applicable standards 

17 adopted under subsection (a). 

18 ‘‘(c) MODIFICATION OF STANDARDS.—The Director 

19 shall provide for ongoing oversight of the health informa20 tion technology standards developed under subsection (a) 

21 to— 

22 ‘‘(1) identify gaps or other shortcomings in 

23 such standards; and 
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1 ‘‘(2) modify such standards when determined 

2 appropriate or develop additional standards, in col3 laboration with standard setting organizations. 

4 ‘‘SEC. 2904. LOAN GUARANTEES FOR THE ADOPTION OF 

5 HEALTH INFORMATION TECHNOLOGY. 

6 ‘‘(a) IN GENERAL.—The Director shall guarantee 

7 payment of the principal of and the interest on loans made 

8 to eligible entities to enable such entities— 

9 ‘‘(1) to implement local health information in10 frastructures to facilitate the development of inter11 operability across health care settings to improve 

12 quality and efficiency; or 

13 ‘‘(2) to facilitate the purchase and adoption of 

14 health information technology to improve quality and 

15 efficiency. 

16 ‘‘(b) ELIGIBILITY.—To be eligible to receive a loan 

17 guarantee under subsection (a) an entity shall— 

18 ‘‘(1) with respect to an entity desiring a loan 

19 guarantee— 

20 ‘‘(A) under subsection (a)(1), be a coalition 

21 of entities that represent an independent con22 sortium of health care stakeholders within a 

23 community that— 

24 ‘‘(i) includes— 
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1 ‘‘(I) physicians (as defined in 

2 section 1881(r)(1) of the Social Secu3 rity Act); 

4 ‘‘(II) hospitals; and 

5 ‘‘(III) group health plans or 

6 other health insurance issuers (as 

7 such terms are defined in section 

8 2791); and 

9 ‘‘(ii) may include any other health 

10 care providers; or 

11 ‘‘(B) under subsection (a)(2) be a health 

12 care provider; 

13 ‘‘(2) to the extent practicable, adopt the na14 tional health information technology standards 

15 adopted under section 2903; 

16 ‘‘(3) provide assurances that the entity shall 

17 submit to the Director regular reports on the activi18 ties carried out under the loan guarantee, includ19 ing— 

20 ‘‘(A) a description of the financial costs 

21 and benefits of the project involved and of the 

22 entities to which such costs and benefits accrue; 

23 ‘‘(B) a description of the impact of the 

24 project on health care quality and safety; and 
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1 ‘‘(C) a description of any reduction in du2 plicative or unnecessary care as a result of the 

3 project involved; 

4 ‘‘(4) provide assurances that not later than 30 

5 days after the development of the standard quality 

6 measures pursuant to section 2906, the entity shall 

7 submit to the Director regular reports on such meas8 ures, including provider level data and analysis of 

9 the impact of information technology on such meas10 ures; and 

11 ‘‘(5) prepare and submit to the Director an ap12 plication at such time, in such manner, and con13 taining such information as the Director may re14 quire. 

15 ‘‘(c) USE OF FUNDS.—Amounts received under a 

16 loan guarantee under subsection (a) shall be used—

17 ‘‘(1) with respect to a loan guarantee described 

18 in subsection (a)(1)—

19 ‘‘(A) to develop a plan for the implementa20 tion of a local health information infrastructure 

21 under this section; 

22 ‘‘(B) to establish systems for the sharing 

23 of data in accordance with the national health 

24 information technology standards developed 

25 under section 2903; 
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1 ‘‘(C) to purchase directly related inte2 grated hardware and software to establish an 

3 interoperable health information technology sys4 tem that is capable of linking to a local health 

5 care information infrastructure; and 

6 ‘‘(D) to train staff, maintain health infor7 mation technology systems, and maintain ade8 quate security and privacy protocols; 

9 ‘‘(2) with respect to a loan guarantee described 

10 in subsection (a)(2)— 

11 ‘‘(A) to develop a plan for the purchase 

12 and installation of health information tech13 nology; 

14 ‘‘(B) to purchase directly related inte15 grated hardware and software to establish an 

16 interoperable health information technology sys17 tem that is capable of linking to a national or 

18 local health care information infrastructure; 

19 and 

20 ‘‘(C) to train staff, maintain health infor21 mation technology systems, and maintain ade22 quate security and privacy protocols; and 

23 ‘‘(3) to carry out any other activities deter24 mined appropriate by the Director. 
20 

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1 ‘‘(d) SPECIAL CONSIDERATIONS FOR CERTAIN ENTI2 TIES.—In awarding loan guarantees under this section, 

3 the Director shall give special consideration to eligible en4 tities that— 

5 ‘‘(1) provide service to low-income and under6 served populations; and 

7 ‘‘(2) agree to electronically submit the informa8 tion described in paragraphs (3) and (4) of sub9 section (b) on a daily basis. 

10 ‘‘(e) SPECIAL CONSIDERATIONS FOR LOCAL HEALTH

11 INFORMATION INFRASTRUCTURES.—In awarding loan 

12 guarantees under this section to local health information 

13 infrastructures, the Director shall give special consider14 ation to eligible entities that— 

15 ‘‘(1) include at least 50 percent of the patients 

16 living in the designated coverage area; 

17 ‘‘(2) incorporate public health surveillance and 

18 reporting into the overall architecture of the pro19 posed infrastructure; and 

20 ‘‘(3) link local health information infrastruc21 tures. 

22 ‘‘(f) AREAS OF SPECIFIC INTEREST.—In awarding 

23 loan guarantees under this section, the Director shall in24 clude— 
21 

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1 ‘‘(1) entities with a coverage area that includes 

2 an entire State; and 

3 ‘‘(2) entities with a multi-state coverage area. 

4 ‘‘(g) ADMINISTRATIVE PROVISIONS.— 

5 ‘‘(1) AGGREGATE AMOUNT.— 

6 ‘‘(A) IN GENERAL.—Except as provided in 

7 subparagraph (B), the aggregate amount of 

8 principal of loans guaranteed under subsection 

9 (a) with respect to an eligible entity may not 

10 exceed $5,000,000. In any 12-month period the 

11 amount disbursed to an eligible entity under 

12 this section (by a lender under a guaranteed 

13 loan) may not exceed $5,000,000. 

14 ‘‘(B) EXCEPTION.—The cumulative total 

15 of the principal of the loans outstanding at any 

16 time to which guarantees have been issued 

17 under subsection (a) may not exceed such limi18 tations as may be specified in appropriation 

19 Acts. 

20 ‘‘(2) PROTECTION OF FEDERAL GOVERN21 MENT.— 

22 ‘‘(A) IN GENERAL.—The Director may not 

23 approve an application for a loan guarantee 

24 under this section unless the Director deter25 mines that— 
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1 ‘‘(i) the terms, conditions, security (if 

2 any), and schedule and amount of repay3 ments with respect to the loan are suffi4 cient to protect the financial interests of 

5 the United States and are otherwise rea6 sonable, including a determination that the 

7 rate of interest does not exceed such per8 cent per annum on the principal obligation 

9 outstanding as the Director determines to 

10 be reasonable, taking into account the 

11 range of interest rates prevailing in the 

12 private market for loans with similar ma13 turities, terms, conditions, and security 

14 and the risks assumed by the United 

15 States; and 

16 ‘‘(ii) the loan would not be available 

17 on reasonable terms and conditions with18 out the enactment of this section. 

19 ‘‘(B) RECOVERY.— 

20 ‘‘(i) IN GENERAL.—The United States 

21 shall be entitled to recover from the appli22 cant for a loan guarantee under this sec23 tion the amount of any payment made pur24 suant to such loan guarantee, unless the 

25 Director for good cause waives such right 
23 

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1 of recovery, and, upon making any such 

2 payment, the United States shall be sub3 rogated to all of the rights of the recipient 

4 of the payments with respect to which the 

5 loan was made. 

6 ‘‘(ii) MODIFICATION OF TERMS.—Any 

7 terms and conditions applicable to a loan 

8 guarantee under this section may be modi9 fied by the Director to the extent the Di10 rector determines it to be consistent with 

11 the financial interest of the United States. 

12 ‘‘(3) DEFAULTS.—The Director may take such 

13 action as the Director deems appropriate to protect 

14 the interest of the United States in the event of a 

15 default on a loan guaranteed under this section, in16 cluding taking possession of, holding, and using real 

17 property pledged as security for such a loan guar18 antee. 

19 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.— 

20 ‘‘(1) IN GENERAL.—There is authorized to be 

21 appropriated to carry out this section, $250,000,000 

22 for each of fiscal years 2006 through 2011. 

23 ‘‘(2) AVAILABILITY.—Amounts appropriated 

24 under subparagraph (A) shall remain available for 

25 obligation until expended. 
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1 ‘‘SEC. 2905. GRANTS FOR THE PURCHASE OF HEALTH IN2 FORMATION TECHNOLOGY. 

3 ‘‘(a) IN GENERAL.—The Director may award com4 petitive grants to eligible entities— 

5 ‘‘(1) to implement local health information in6 frastructures to facilitate the development of inter7 operability across health care settings; or 

8 ‘‘(2) to facilitate the purchase and adoption of 

9 health information technology. 

10 ‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 

11 under section (a) an entity shall— 

12 ‘‘(1) demonstrate financial need to the Director; 

13 ‘‘(2) with respect to an entity desiring a 

14 grant— 

15 ‘‘(A) under subsection (a)(1), represent an 

16 independent consortium of health care stake17 holders within a community that— 

18 ‘‘(i) includes— 

19 ‘‘(I) physicians (as defined in 

20 section 1881(r)(1) of the Social Secu21 rity Act); 

22 ‘‘(II) hospitals; and 

23 ‘‘(III) group health plans or 

24 other health insurance issuers (as 

25 such terms are defined in section 

26 2791); and 
25 

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1 ‘‘(ii) may include any other health 

2 care providers; or 

3 ‘‘(B) under subsection (a)(2) be a health 

4 care provider that provides health care services 

5 to low-income and underserved populations; 

6 ‘‘(3) adopt the national health information tech7 nology standards developed under section 2903; 

8 ‘‘(4) provide assurances that the entity shall 

9 submit to the Director regular reports on the activi10 ties carried out under the loan guarantee, includ11 ing— 

12 ‘‘(A) a description of the financial costs 

13 and benefits of the project involved and of the 

14 entities to which such costs and benefits accrue; 

15 ‘‘(B) a description of the impact of the 

16 project on health care quality and safety; and 

17 ‘‘(C) a description of any reduction in du18 plicative or unnecessary care as a result of the 

19 project involved; 

20 ‘‘(5) provide assurances that not later than 30 

21 days after the development of the standard quality 

22 measures pursuant to section 2906, the entity shall 

23 submit to the Director regular reports on such meas24 ures, including provider level data and analysis of 
26 

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1 the impact of information technology on such meas2 ures; 

3 ‘‘(6) prepare and submit to the Director an ap4 plication at such time, in such manner, and con5 taining such information as the Director may re6 quire; and 

7 ‘‘(7) agree to provide matching funds in accord8 ance with subsection (g). 

9 ‘‘(c) USE OF FUNDS.—Amounts received under a 

10 grant under subsection (a) shall be used to— 

11 ‘‘(1) with respect to a grant described in sub12 section (a)(1)— 

13 ‘‘(A) to develop a plan for the implementa14 tion of a local health information infrastructure 

15 under this section; 

16 ‘‘(B) to establish systems for the sharing 

17 of data in accordance with the national health 

18 information technology standards developed 

19 under section 2903; 

20 ‘‘(C) to implement, enhance, or upgrade a 

21 comprehensive, electronic health information 

22 technology system; and 

23 ‘‘(D) to maintain adequate security and 

24 privacy protocols; 
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1 ‘‘(2) with respect to a grant described in sub2 section (a)(2)— 

3 ‘‘(A) to develop a plan for the purchase 

4 and installation of health information tech5 nology; 

6 ‘‘(B) to purchase directly related inte7 grated hardware and software to establish an 

8 interoperable health information technology sys9 tem that is capable of linking to a national or 

10 local health care information infrastructure; 

11 and 

12 ‘‘(C) to train staff, maintain health infor13 mation technology systems, and maintain ade14 quate security and privacy protocols; 

15 ‘‘(3) maintain adequate security and privacy 

16 protocols; and 

17 ‘‘(4) to carry out any other activities deter18 mined appropriate by the Director. 

19 ‘‘(d) SPECIAL CONSIDERATIONS FOR CERTAIN ENTI20 TIES.—In awarding grants under this section, the Direc21 tor shall give special consideration to eligible entities 

22 that— 

23 ‘‘(1) provide service to low-income and under24 served populations; and 
28 

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1 ‘‘(2) agree to electronically submit the informa2 tion described in paragraphs (4) and (5) of sub3 section (b). 

4 ‘‘(e) SPECIAL CONSIDERATIONS FOR LOCAL HEALTH

5 INFORMATION INFRASTRUCTURES.—In awarding grants 

6 under this section to local health information infrastruc7 tures, the Director shall give special consideration to eligi8 ble entities that— 

9 ‘‘(1) include at least 50 percent of the patients 

10 living in the designated coverage area; 

11 ‘‘(2) incorporate public health surveillance and 

12 reporting into the overall architecture of the pro13 posed infrastructure; and 

14 ‘‘(3) link local health information infrastruc15 tures; 

16 ‘‘(f) AREAS OF SPECIFIC INTEREST.—In awarding 

17 grants under this section, the Director shall include— 

18 ‘‘(1) entities with a coverage area that includes 

19 an entire State; and 

20 ‘‘(2) entities with a multi-state coverage area. 

21 ‘‘(g) MATCHING REQUIREMENT.— 

22 ‘‘(1) IN GENERAL.—The Director may not 

23 make a grant under this section to an entity unless 

24 the entity agrees that, with respect to the costs to 

25 be incurred by the entity in carrying out the infra-
29 

•S 1223 IS 

1 structure program for which the grant was awarded, 

2 the entity will make available (directly or through 

3 donations from public or private entities) non-Fed4 eral contributions toward such costs in an amount 

5 equal to not less than 20 percent of such costs ($1 

6 for each $5 of Federal funds provided under the 

7 grant). 

8 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB9 UTED.—Non-Federal contributions required under 

10 paragraph (1) may be in cash or in kind, fairly eval11 uated, including equipment, technology, or services. 

12 Amounts provided by the Federal Government, or 

13 services assisted or subsidized to any significant ex14 tent by the Federal Government, may not be in15 cluded in determining the amount of such non-Fed16 eral contributions. 

17 ‘‘(h) AUTHORIZATION OF APPROPRIATIONS.— 

18 ‘‘(1) IN GENERAL.—There is authorized to be 

19 appropriated to carry out this section, $250,000,000 

20 for each of fiscal years 2006 through 2011. 

21 ‘‘(2) AVAILABILITY.—Amounts appropriated 

22 under paragraph (1) shall remain available for obli23 gation until expended.’’. 
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•S 1223 IS 

1 SEC. 3. STANDARDIZED MEASURES OF QUALITY HEALTH 

2 CARE AND DATA COLLECTION. 

3 Title XXIX of the Public Health Service Act, as 

4 added by section 2, is amended by adding at the end the 

5 following: 

6 ‘‘SEC. 2906. STANDARDIZED MEASURES OF QUALITY 

7 HEALTH CARE. 

8 ‘‘(a) IN GENERAL.— 

9 ‘‘(1) COLLABORATION.—The Secretary of 

10 Health and Human Services, the Secretary of De11 fense, and the Secretary of Veterans Affairs (re12 ferred to in this section as the ‘Secretaries’), in con13 sultation with the Quality Interagency Coordination 

14 Taskforce (as established by Executive Order on 

15 March 13, 1998), the Institute of Medicine, the 

16 Joint Commission on Accreditation of Healthcare 

17 Organizations, the National Committee for Quality 

18 Assurance, the American Health Quality Associa19 tion, the National Quality Forum, the Medicare Pay20 ment Advisory Committee, and other individuals and 

21 organizations determined appropriate by the Secre22 taries, shall establish uniform health care quality 

23 measures to assess the effectiveness, timeliness, pa24 tient-centeredness, efficiency, equity, and safety of 

25 care delivered across all federally supported health 

26 delivery programs. 
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•S 1223 IS 

1 ‘‘(2) DEVELOPMENT OF MEASURES.—Not later 

2 than 18 months after the date of enactment of this 

3 title, the Secretaries shall develop standardized sets 

4 of quality measures for each of the 20 priority areas 

5 for improvement in health care quality as identified 

6 by the Institute of Medicine in their report entitled 

7 ‘Priority Areas for National Action’ in 2003, or 

8 other such areas as identified by the Secretaries in 

9 order to assist beneficiaries in making informed 

10 choices about health plans or care delivery systems. 

11 The selection of appropriate quality indicators under 

12 this subsection shall include the evaluation criteria 

13 formulated by clinical professionals, consumers, and 

14 data collection experts. 

15 ‘‘(3) PILOT TESTING.—Each federally sup16 ported health delivery program may conduct a pilot 

17 test of the quality measures developed under para18 graph (2) that shall include a collection of patient19 level data and a public release of comparative per20 formance reports. 

21 ‘‘(b) PUBLIC REPORTING REQUIREMENTS.—The 

22 Secretaries, working collaboratively, shall establish public 

23 reporting requirements for clinicians, institutional pro24 viders, and health plans in each of the federally supported 

25 health delivery program described in subsection (a). Such 
32 

•S 1223 IS 

1 requirements shall provide that the entities described in 

2 the preceding sentence shall report to the appropriate Sec3 retary on the measures developed under subsection (a). 

4 ‘‘(c) FULL IMPLEMENTATION.—The Secretaries, 

5 working collaboratively, shall implement all sets of quality 

6 measures and reporting systems developed under sub7 sections (a) and (b) by not later than the date that is 1 

8 year after the date on which the measures are developed 

9 under subsection (a)(2). 

10 ‘‘(d) REPORTS.—Not later than 1 year after the date 

11 of enactment of this title, and annually thereafter, the Sec12 retary shall— 

13 ‘‘(1) submit to Congress a report that details 

14 the collaborative efforts carried out under subsection 

15 (a), the progress made on standardizing quality indi16 cators throughout the Federal Government, and the 

17 state of quality measurement for priority areas that 

18 links data to the report submitted under paragraph 

19 (2) for the year involved; and 

20 ‘‘(2) submit to Congress a report that details 

21 areas of clinical care requiring further research nec22 essary to establish effective clinical treatments that 

23 will serve as a basis for additional quality indicators. 

24 ‘‘(e) COMPARATIVE QUALITY REPORTS.—Beginning 

25 not later than 3 years after the date of enactment of this 
33 

•S 1223 IS 

1 title, in order to make comparative quality information 

2 available to health care consumers, including members of 

3 health disparity populations, health professionals, public 

4 health officials, researchers, and other appropriate individ5 uals and entities, the Secretaries shall provide for the pool6 ing, analysis, and dissemination of quality measures col7 lected under this section. Nothing in this section shall be 

8 construed as modifying the privacy standards under the 

9 Health Insurance Portability and Accountability Act of 

10 1996 (Public Law 104–191). 

11 ‘‘(f) ONGOING EVALUATION OF USE.—The Secretary 

12 of Health and Human Services shall ensure the ongoing 

13 evaluation of the use of the health care quality measures 

14 established under this section. 

15 ‘‘(g) EVALUATION AND REGULATIONS.— 

16 ‘‘(1) EVALUATION.— 

17 ‘‘(A) IN GENERAL.—The Secretary shall, 

18 directly or indirectly through a contract with 

19 another entity, conduct an evaluation of the col20 laborative efforts of the Secretaries to establish 

21 uniform health care quality measures and re22 porting requirements for federally supported 

23 health care delivery programs as required under 

24 this section. 
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•S 1223 IS 

1 ‘‘(B) REPORT.—Not later than 1 year 

2 after the date of enactment of this title, the 

3 Secretary of Health and Human Services shall 

4 submit a report to the appropriate committees 

5 of Congress concerning the results of the eval6 uation under subparagraph (A). 

7 ‘‘(2) REGULATIONS.— 

8 ‘‘(A) PROPOSED.—Not later than 6 

9 months after the date on which the report is 

10 submitted under paragraph (1)(B), the Sec11 retary shall publish proposed regulations re12 garding the application of the uniform health 

13 care quality measures and reporting require14 ments described in this section to federally sup15 ported health delivery programs. 

16 ‘‘(B) FINAL REGULATIONS.—Not later 

17 than 1 year after the date on which the report 

18 is submitted under paragraph (1)(B), the Sec19 retary shall publish final regulations regarding 

20 the uniform health care quality measures and 

21 reporting requirements described in this section. 

22 ‘‘(h) DEFINITIONS.—In this section, the term ‘feder23 ally supported health delivery program’ means a program 

24 that is funded by the Federal Government under which 
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1 health care items or services are delivered directly to pa2 tients.’’. 

Æ