II 

109TH CONGRESS 

1ST SESSION S. 1418 

To enhance the adoption of a nationwide interoperable health information 

technology system and to improve the quality and reduce the costs 

of health care in the United States. 

IN THE SENATE OF THE UNITED STATES 

JULY 18, 2005 

Mr. ENZI (for himself, Mr. KENNEDY, Mr. FRIST, Mrs. CLINTON, Mr. ALEXANDER, Mr. DODD, Mr. BURR, Mr. HARKIN, Mr. ISAKSON, Ms. MIKULSKI, Mr. DEWINE, Mr. JEFFORDS, Mr. ROBERTS, Mr. BINGAMAN, Mrs. 

MURRAY, Mr. HAGEL, Mr. MARTINEZ, Mr. TALENT, Mr. OBAMA, Mr. 

BOND, and Mr. NELSON of Florida) introduced the following bill; which 

was read twice and referred to the Committee on Health, Education, 

Labor, and Pensions 

A BILL 

To enhance the adoption of a nationwide interoperable health 

information technology system and to improve the quality 

and reduce the costs of health care in the United States. 

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 ‘‘Wired for Health Care 

5 Quality Act’’. 
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1 SEC. 2. IMPROVING HEALTH CARE, QUALITY, SAFETY, AND 

2 EFFICIENCY. 

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

4 seq.) is amended by adding at the end the following: 

5 ‘‘TITLE XXIX—HEALTH 

6 INFORMATION TECHNOLOGY 

7 ‘‘SEC. 2901. DEFINITIONS. 

8 ‘‘In this title: 

9 ‘‘(1) HEALTH CARE PROVIDER.—The term 

10 ‘health care provider’ means a hospital, skilled nurs11 ing facility, home health entity, health care clinic, 

12 federally qualified health center, group practice (as 

13 defined in section 1877(h)(4) of the Social Security 

14 Act), a pharmacist, a pharmacy, a laboratory, a phy15 sician (as defined in section 1861(r) of the Social 

16 Security Act), a health facility operated by or pursu17 ant to a contract with the Indian Health Service, a 

18 rural health clinic, and any other category of facility 

19 or clinician determined appropriate by the Secretary. 

20 ‘‘(2) HEALTH INFORMATION.—The term ‘health 

21 information’ has the meaning given such term in 

22 section 1171(4) of the Social Security Act. 

23 ‘‘(3) HEALTH INSURANCE PLAN.—The term 

24 ‘health insurance plan’ means— 

25 ‘‘(A) a health insurance issuer (as defined 

26 in section 2791(b)(2)); 
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1 ‘‘(B) a group health plan (as defined in 

2 section 2791(a)(1)); and 

3 ‘‘(C) a health maintenance organization 

4 (as defined in section 2791(b)(3)). 

5 ‘‘(4) LABORATORY.—The term ‘laboratory’ has 

6 the meaning given that term in section 353. 

7 ‘‘(5) PHARMACIST.—The term ‘pharmacist’ has 

8 the meaning given that term in section 804 of the 

9 Federal Food, Drug, and Cosmetic Act. 

10 ‘‘(6) QUALIFIED HEALTH INFORMATION TECH11 NOLOGY.—The term ‘qualified health information 

12 technology’ means a computerized system (including 

13 hardware, software, and training) that— 

14 ‘‘(A) protects the privacy and security of 

15 health information; 

16 ‘‘(B) maintains and provides permitted ac17 cess to health information in an electronic for18 mat; 

19 ‘‘(C) incorporates decision support to re20 duce medical errors and enhance health care 

21 quality; 

22 ‘‘(D) complies with the standards adopted 

23 by the Federal Government under section 2903; 

24 and 
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1 ‘‘(E) allows for the reporting of quality 

2 measures under section 2908. 

3 ‘‘(7) STATE.—The term ‘State’ means each of 

4 the several States, the District of Columbia, Puerto 

5 Rico, the Virgin Islands, Guam, American Samoa, 

6 and the Northern Mariana Islands. 

7 ‘‘SEC. 2902. OFFICE OF THE NATIONAL COORDINATOR OF 

8 HEALTH INFORMATION TECHNOLOGY. 

9 ‘‘(a) OFFICE OF NATIONAL HEALTH INFORMATION

10 TECHNOLOGY.—There is established within the Office of 

11 the Secretary an Office of the National Coordinator of 

12 Health Information Technology (referred to in this section 

13 as the ‘Office’). The Office shall be headed by a National 

14 Coordinator who shall be appointed by the President, in 

15 consultation with the Secretary, and shall report directly 

16 to the Secretary. 

17 ‘‘(b) PURPOSE.—It shall be the purpose of the Office 

18 to carry out programs and activities to develop a nation19 wide interoperable health information technology infra20 structure that— 

21 ‘‘(1) ensures that patients’ health information 

22 is secure and protected; 

23 ‘‘(2) improves health care quality, reduces med24 ical errors, and advances the delivery of patient-cen25 tered medical care; 
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1 ‘‘(3) reduces health care costs resulting from 

2 inefficiency, medical errors, inappropriate care, and 

3 incomplete information; 

4 ‘‘(4) ensures that appropriate information to 

5 help guide medical decisions is available at the time 

6 and place of care; 

7 ‘‘(5) promotes a more effective marketplace, 

8 greater competition, and increased choice through 

9 the wider availability of accurate information on 

10 health care costs, quality, and outcomes; 

11 ‘‘(6) improves the coordination of care and in12 formation among hospitals, laboratories, physician 

13 offices, and other entities through an effective infra14 structure for the secure and authorized exchange of 

15 health care information; 

16 ‘‘(7) improves public health reporting and facili17 tates the early identification and rapid response to 

18 public health threats and emergencies, including bio19 terror events and infectious disease outbreaks; 

20 ‘‘(8) facilitates health research; and 

21 ‘‘(9) promotes prevention of chronic diseases. 

22 ‘‘(c) DUTIES OF THE NATIONAL COORDINATOR.— 

23 The National Coordinator shall— 
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1 ‘‘(1) serve as a member of the public-private 

2 American Health Information Collaborative estab3 lished under section 2903; 

4 ‘‘(2) serve as the principal advisor to the Sec5 retary concerning the development, application, and 

6 use of health information technology, and coordinate 

7 and oversee the health information technology pro8 grams of the Department; 

9 ‘‘(3) facilitate the adoption of a nationwide, 

10 interoperable system for the electronic exchange of 

11 health information; 

12 ‘‘(4) ensure the adoption and implementation of 

13 standards for the electronic exchange of health infor14 mation to reduce cost and improve health care qual15 ity; 

16 ‘‘(5) ensure that health information technology 

17 policy and programs of the Department are coordi18 nated with those of relevant executive branch agen19 cies (including Federal commissions) with a goal of 

20 avoiding duplication of efforts and of helping to en21 sure that each agency undertakes health information 

22 technology activities primarily within the areas of its 

23 greatest expertise and technical capability; 

24 ‘‘(6) to the extent permitted by law, coordinate 

25 outreach and consultation by the relevant executive 
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1 branch agencies (including Federal commissions) 

2 with public and private parties of interest, including 

3 consumers, payers, employers, hospitals and other 

4 health care providers, physicians, community health 

5 centers, laboratories, vendors and other stake6 holders; 

7 ‘‘(7) advise the President regarding specific 

8 Federal health information technology programs; 

9 and 

10 ‘‘(8) submit the reports described under section 

11 2903(i) (excluding paragraph (4) of such section). 

12 ‘‘(d) DETAIL OF FEDERAL EMPLOYEES.— 

13 ‘‘(1) IN GENERAL.—Upon the request of the 

14 National Coordinator, the head of any Federal agen15 cy is authorized to detail, with or without reimburse16 ment from the Office, any of the personnel of such 

17 agency to the Office to assist it in carrying out its 

18 duties under this section. 

19 ‘‘(2) EFFECT OF DETAIL.—Any detail of per20 sonnel under paragraph (1) shall— 

21 ‘‘(A) not interrupt or otherwise affect the 

22 civil service status or privileges of the Federal 

23 employee; and 
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1 ‘‘(B) be in addition to any other staff of 

2 the Department employed by the National Co3 ordinator. 

4 ‘‘(3) ACCEPTANCE OF DETAILEES.—Notwith5 standing any other provision of law, the Office may 

6 accept detailed personnel from other Federal agen7 cies without regard to whether the agency described 

8 under paragraph (1) is reimbursed. 

9 ‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec10 tion shall be construed to require the duplication of Fed11 eral efforts with respect to the establishment of the Office, 

12 regardless of whether such efforts were carried out prior 

13 to or after the enactment of this title. 

14 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There 

15 are authorized to be appropriated such sums as may be 

16 necessary to carry out the activities of the Office under 

17 this section for each of fiscal years 2006 through 2010. 

18 ‘‘SEC. 2903. AMERICAN HEALTH INFORMATION COLLABO19 RATIVE. 

20 ‘‘(a) PURPOSE.—The Secretary shall establish the 

21 public-private American Health Information Collaborative 

22 (referred to in this section as the ‘Collaborative’) to— 

23 ‘‘(1) advise the Secretary and recommend spe24 cific actions to achieve a nationwide interoperable 

25 health information technology infrastructure; 
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1 ‘‘(2) serve as a forum for the participation of 

2 a broad range of stakeholders to provide input on 

3 achieving the interoperability of health information 

4 technology; and 

5 ‘‘(3) recommend standards (including content, 

6 communication, and security standards) for the elec7 tronic exchange of health information for adoption 

8 by the Federal Government and voluntary adoption 

9 by private entities. 

10 ‘‘(b) COMPOSITION.— 

11 ‘‘(1) IN GENERAL.—The Collaborative shall be 

12 composed of— 

13 ‘‘(A) the Secretary, who shall serve as the 

14 chairperson of the Collaborative; 

15 ‘‘(B) the Secretary of Defense, or his or 

16 her designee; 

17 ‘‘(C) the Secretary of Veterans Affairs, or 

18 his or her designee; 

19 ‘‘(D) the Secretary of Commerce, or his or 

20 her designee; 

21 ‘‘(E) the National Coordinator for Health 

22 Information Technology; 

23 ‘‘(F) representatives of other relevant Fed24 eral agencies, as determined appropriate by the 

25 Secretary; and 
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1 ‘‘(G) representatives from each of the fol2 lowing categories to be appointed by the Sec3 retary from nominations submitted by the pub4 lic— 

5 ‘‘(i) consumer and patient organiza6 tions; 

7 ‘‘(ii) experts in health information pri8 vacy and security; 

9 ‘‘(iii) health care providers; 

10 ‘‘(iv) health insurance plans or other 

11 third party payors; 

12 ‘‘(v) standards development organiza13 tions; 

14 ‘‘(vi) information technology vendors; 

15 ‘‘(vii) purchasers or employers; and 

16 ‘‘(viii) State or local government agen17 cies or Indian tribe or tribal organizations. 

18 ‘‘(2) CONSIDERATIONS.—In appointing mem19 bers under paragraph (1)(G), the Secretary shall se20 lect individuals with expertise in— 

21 ‘‘(A) health information privacy; 

22 ‘‘(B) health information security; 

23 ‘‘(C) health care quality and patient safety, 

24 including those individuals with experience in 
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1 utilizing health information technology to im2 prove health care quality and patient safety; 

3 ‘‘(D) data exchange; and 

4 ‘‘(E) developing health information tech5 nology standards and new health information 

6 technology. 

7 ‘‘(3) TERMS.—Members appointed under para8 graph (1)(G) shall serve for 2 year terms, except 

9 that any member appointed to fill a vacancy for an 

10 unexpired term shall be appointed for the remainder 

11 of such term. A member may serve for not to exceed 

12 180 days after the expiration of such member’s term 

13 or until a successor has been appointed. 

14 ‘‘(c) RECOMMENDATIONS AND POLICIES.—The Col15 laborative shall make recommendations to identify uni16 form national policies for adoption by the Federal Govern17 ment and voluntary adoption by private entities to support 

18 the widespread adoption of health information technology, 

19 including— 

20 ‘‘(1) protection of health information through 

21 privacy and security practices; 

22 ‘‘(2) measures to prevent unauthorized access 

23 to health information; 

24 ‘‘(3) methods to facilitate secure patient access 

25 to health information; 
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1 ‘‘(4) the ongoing harmonization of industry2 wide health information technology standards; 

3 ‘‘(5) recommendations for a nationwide inter4 operable health information technology infrastruc5 ture; 

6 ‘‘(6) the identification and prioritization of spe7 cific use cases for which heath information tech8 nology is valuable, beneficial, and feasible; 

9 ‘‘(7) recommendations for the establishment of 

10 an entity to ensure the continuation of the functions 

11 of the Collaborative; and 

12 ‘‘(8) other policies determined to be necessary 

13 by the Collaborative. 

14 ‘‘(d) STANDARDS.— 

15 ‘‘(1) EXISTING STANDARDS.—The standards 

16 adopted by the Consolidated Health Informatics Ini17 tiative shall be deemed to have been recommended 

18 by the Collaborative under this section. 

19 ‘‘(2) FIRST YEAR REVIEW.—Not later than 1 

20 year after the date of enactment of this title, the 

21 Collaborative shall— 

22 ‘‘(A) review existing standards (including 

23 content, communication, and security stand24 ards) for the electronic exchange of health in-
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1 formation, including such standards adopted by 

2 the Secretary under paragraph (2)(A); 

3 ‘‘(B) identify deficiencies and omissions in 

4 such existing standards; and 

5 ‘‘(C) identify duplication and overlap in 

6 such existing standards; 

7 and recommend modifications to such standards as 

8 necessary. 

9 ‘‘(3) ONGOING REVIEW.—Beginning 1 year 

10 after the date of enactment of this title, and annu11 ally thereafter, the Collaborative shall— 

12 ‘‘(A) review existing standards (including 

13 content, communication, and security stand14 ards) for the electronic exchange of health in15 formation, including such standards adopted by 

16 the Secretary under paragraph (2)(A); 

17 ‘‘(B) identify deficiencies and omissions in 

18 such existing standards; and 

19 ‘‘(C) identify duplication and overlap in 

20 such existing standards; 

21 and recommend modifications to such standards as 

22 necessary. 

23 ‘‘(4) LIMITATION.—The standards described in 

24 this section shall be consistent with any standards 
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1 developed pursuant to the Health Insurance Port2 ability and Accountability Act of 1996. 

3 ‘‘(e) FEDERAL ACTION.—Not later than 60 days 

4 after the issuance of a recommendation from the Collabo5 rative under subsection (d)(2), the Secretary of Health 

6 and Human Services, the Secretary of Veterans Affairs, 

7 and the Secretary of Defense, in collaboration with rep8 resentatives of other relevant Federal agencies, as deter9 mined appropriate by the Secretary, shall jointly review 

10 such recommendations. The Secretary shall provide for the 

11 adoption by the Federal Government of any standard or 

12 standards contained in such recommendation. 

13 ‘‘(f) COORDINATION OF FEDERAL SPENDING.—Not 

14 later than 1 year after the adoption by the Federal Gov15 ernment of a recommendation as provided for in sub16 section (e), and in compliance with chapter 113 of title 

17 40, United States Code, no Federal agency shall expend 

18 Federal funds for the purchase of any form of health in19 formation technology or health information technology 

20 system for clinical care or for the electronic retrieval, stor21 age, or exchange of health information that is not con22 sistent with applicable standards adopted by the Federal 

23 Government under subsection (e). 

24 ‘‘(g) COORDINATION OF FEDERAL DATA COLLEC25 TION.—Not later than 3 years after the adoption by the 
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1 Federal Government of a recommendation as provided for 

2 in subsection (e), all Federal agencies collecting health 

3 data for the purposes of surveillance, epidemiology, ad4 verse event reporting, research, or for other purposes de5 termined appropriate by the Secretary shall comply with 

6 standards adopted under subsection (e). 

7 ‘‘(h) VOLUNTARY ADOPTION.—Any standards adopt8 ed by the Federal Government under subsection (e) shall 

9 be voluntary with respect to private entities. 

10 ‘‘(i) REPORTS.—The Secretary shall submit to the 

11 Committee on Health, Education, Labor, and Pensions 

12 and the Committee on Finance of the Senate and the 

13 Committee on Energy and Commerce and the Committee 

14 on Ways and Means of the House of Representatives, on 

15 an annual basis, a report that— 

16 ‘‘(1) describes the specific actions that have 

17 been taken by the Federal Government and private 

18 entities to facilitate the adoption of an interoperable 

19 nationwide system for the electronic exchange of 

20 health information; 

21 ‘‘(2) describes barriers to the adoption of such 

22 a nationwide system; 

23 ‘‘(3) contains recommendations to achieve full 

24 implementation of such a nationwide system; and 
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1 ‘‘(4) contains a plan and progress toward the 

2 establishment of an entity to ensure the continuation 

3 of the functions of the Collaborative. 

4 ‘‘(j) APPLICATION OF FACA.—The Federal Advisory 

5 Committee Act (5 U.S.C. App.) shall apply to the Collabo6 rative, except that the term provided for under section 

7 14(a)(2) shall be 5 years. 

8 ‘‘(k) RULE OF CONSTRUCTION.—Nothing in this sec9 tion shall be construed to require the duplication of Fed10 eral efforts with respect to the establishment of the Col11 laborative, regardless of whether such efforts were carried 

12 out prior to or after the enactment of this title. 

13 ‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—There 

14 are authorized to be appropriated such sums as may be 

15 necessary to carry out this section for each of fiscal years 

16 2006 through 2010. 

17 ‘‘SEC. 2904. IMPLEMENTATION AND CERTIFICATION OF 

18 HEALTH INFORMATION STANDARDS. 

19 ‘‘(a) IMPLEMENTATION.— 

20 ‘‘(1) IN GENERAL.—The Secretary, based upon 

21 the recommendations of the Collaborative, shall de22 velop criteria to ensure uniform and consistent im23 plementation of any standards for the electronic ex24 change of health information voluntarily adopted by 
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1 private entities in technical conformance with such 

2 standards adopted under this title. 

3 ‘‘(2) IMPLEMENTATION ASSISTANCE.—The Sec4 retary may recognize a private entity or entities to 

5 assist private entities in the implementation of the 

6 standards adopted under this title using the criteria 

7 developed by the Secretary under this section. 

8 ‘‘(b) CERTIFICATION.— 

9 ‘‘(1) IN GENERAL.—The Secretary, based upon 

10 the recommendations of the Collaborative, shall de11 velop criteria to ensure and certify that hardware, 

12 software, and support services that claim to be in 

13 compliance with any standard for the electronic ex14 change of health information adopted under this title 

15 have established and maintained such compliance in 

16 technical conformance with such standards. 

17 ‘‘(2) CERTIFICATION ASSISTANCE.—The Sec18 retary may recognize a private entity or entities to 

19 assist in the certification described under paragraph 

20 (1) using the criteria developed by the Secretary 

21 under this section. 

22 ‘‘(c) DELEGATION AUTHORITY.—The Secretary, 

23 through consultation with the Collaborative, may delegate 

24 the development of the criteria under subsections (a) and 

25 (b) to a private entity. 
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1 ‘‘SEC. 2905. GRANTS TO FACILITATE THE WIDESPREAD 

2 ADOPTION OF INTEROPERABLE HEALTH IN3 FORMATION TECHNOLOGY. 

4 ‘‘(a) COMPETITIVE GRANTS TO FACILITATE THE

5 WIDESPREAD ADOPTION OF HEALTH INFORMATION

6 TECHNOLOGY.— 

7 ‘‘(1) IN GENERAL.—The Secretary may award 

8 competitive grants to eligible entities to facilitate the 

9 purchase and enhance the utilization of qualified 

10 health information technology systems to improve 

11 the quality and efficiency of health care. 

12 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

13 grant under paragraph (1) an entity shall— 

14 ‘‘(A) submit to the Secretary an applica15 tion at such time, in such manner, and con16 taining such information as the Secretary may 

17 require; 

18 ‘‘(B) submit to the Secretary a strategic 

19 plan for the implementation of data sharing 

20 and interoperability measures; 

21 ‘‘(C) be a— 

22 ‘‘(i) not for profit hospital; 

23 ‘‘(ii) group practice (including a single 

24 physician); or 

25 ‘‘(iii) another health care provider not 

26 described in clause (i) or (ii); 
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1 ‘‘(D) adopt the standards adopted by the 

2 Federal Government under section 2903; 

3 ‘‘(E) require that health care providers re4 ceiving such grants implement the measurement 

5 system adopted under section 2908 and report 

6 to the Secretary on such measures; 

7 ‘‘(F) demonstrate significant financial 

8 need; and 

9 ‘‘(G) provide matching funds in accordance 

10 with paragraph (4). 

11 ‘‘(3) USE OF FUNDS.—Amounts received under 

12 a grant under this subsection shall be used to facili13 tate the purchase and enhance the utilization of 

14 qualified health information technology systems. 

15 ‘‘(4) MATCHING REQUIREMENT.—To be eligible 

16 for a grant under this subsection an entity shall con17 tribute non-Federal contributions to the costs of car18 rying out the activities for which the grant is award19 ed in an amount equal to $1 for each $3 of Federal 

20 funds provided under the grant. 

21 ‘‘(5) PREFERENCE IN AWARDING GRANTS.—In 

22 awarding grants under this subsection the Secretary 

23 shall give preference to— 
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1 ‘‘(A) eligible entities that are located in 

2 rural, frontier, and other underserved areas as 

3 determined by the Secretary; and 

4 ‘‘(B) eligible entities that will link, to the 

5 extent practicable, the qualified health informa6 tion system to local or regional health informa7 tion networks. 

8 ‘‘(b) COMPETITIVE GRANTS TO STATES FOR THE DE9 VELOPMENT OF STATE LOAN PROGRAMS TO FACILITATE

10 THE WIDESPREAD ADOPTION OF HEALTH INFORMATION

11 TECHNOLOGY.— 

12 ‘‘(1) IN GENERAL.—The Secretary may award 

13 competitive grants to States for the establishment of 

14 State programs for loans to health care providers to 

15 facilitate the purchase and enhance the utilization of 

16 qualified health information technology. 

17 ‘‘(2) ESTABLISHMENT OF FUND.—To be eligi18 ble to receive a competitive grant under this sub19 section, a State shall establish a qualified health in20 formation technology loan fund (referred to in this 

21 subsection as a ‘State loan fund’) and comply with 

22 the other requirements contained in this section. A 

23 grant to a State under this subsection shall be de24 posited in the State loan fund established by the 

25 State. No funds authorized by other provisions of 
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1 this title to be used for other purposes specified in 

2 this title shall be deposited in any State loan fund. 

3 ‘‘(3) ELIGIBILITY.—To be eligible to receive a 

4 grant under paragraph (1) a State shall— 

5 ‘‘(A) submit to the Secretary an applica6 tion at such time, in such manner, and con7 taining such information as the Secretary may 

8 require; 

9 ‘‘(B) submit to the Secretary a strategic 

10 plan in accordance with paragraph (4); 

11 ‘‘(C) establish a qualified health informa12 tion technology loan fund in accordance with 

13 paragraph (2); 

14 ‘‘(D) require that health care providers re15 ceiving such loans— 

16 ‘‘(i) link, to the extent practicable, the 

17 qualified health information system to a 

18 local or regional health information net19 work; and 

20 ‘‘(ii) consult with the Center for Best 

21 Practices established in section 914(d) to 

22 access the knowledge and experience of ex23 isting initiatives regarding the successful 

24 implementation and effective use of health 

25 information technology; 
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1 ‘‘(E) require that health care providers re2 ceiving such loans adopt the standards adopted 

3 by the Federal Government under section 

4 2903(d); 

5 ‘‘(F) require that health care providers re6 ceiving such loans implement the measurement 

7 system adopted under section 2908 and report 

8 to the Secretary on such measures; and 

9 ‘‘(G) provide matching funds in accordance 

10 with paragraph (8). 

11 ‘‘(4) STRATEGIC PLAN.— 

12 ‘‘(A) IN GENERAL.—A State that receives 

13 a grant under this subsection shall annually 

14 prepare a strategic plan that identifies the in15 tended uses of amounts available to the State 

16 loan fund of the State. 

17 ‘‘(B) CONTENTS.—A strategic plan under 

18 subparagraph (A) shall include— 

19 ‘‘(i) a list of the projects to be as20 sisted through the State loan fund in the 

21 first fiscal year that begins after the date 

22 on which the plan is submitted; 

23 ‘‘(ii) a description of the criteria and 

24 methods established for the distribution of 

25 funds from the State loan fund; and 
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1 ‘‘(iii) a description of the financial 

2 status of the State loan fund and the 

3 short-term and long-term goals of the 

4 State loan fund. 

5 ‘‘(5) USE OF FUNDS.— 

6 ‘‘(A) IN GENERAL.—Amounts deposited in 

7 a State loan fund, including loan repayments 

8 and interest earned on such amounts, shall be 

9 used only for awarding loans or loan guaran10 tees, or as a source of reserve and security for 

11 leveraged loans, the proceeds of which are de12 posited in the State loan fund established under 

13 paragraph (1). Loans under this section may be 

14 used by a health care provider to facilitate the 

15 purchase and enhance the utilization of quali16 fied health information technology. 

17 ‘‘(B) LIMITATION.—Amounts received by a 

18 State under this subsection may not be used— 

19 ‘‘(i) for the purchase or other acquisi20 tion of any health information technology 

21 system that is not a qualified health infor22 mation technology system; 

23 ‘‘(ii) to conduct activities for which 

24 Federal funds are expended under this 
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1 title, or the amendments made by the 

2 Wired for Health Care Quality Act; or 

3 ‘‘(iii) for any purpose other than mak4 ing loans to eligible entities under this sec5 tion. 

6 ‘‘(6) TYPES OF ASSISTANCE.—Except as other7 wise limited by applicable State law, amounts depos8 ited into a State loan fund under this subsection 

9 may only be used for the following: 

10 ‘‘(A) To award loans that comply with the 

11 following: 

12 ‘‘(i) The interest rate for each loan 

13 shall be less than or equal to the market 

14 interest rate. 

15 ‘‘(ii) The principal and interest pay16 ments on each loan shall commence not 

17 later than 1 year after the loan was award18 ed, and each loan shall be fully amortized 

19 not later than 10 years after the date of 

20 the loan. 

21 ‘‘(iii) The State loan fund shall be 

22 credited with all payments of principal and 

23 interest on each loan awarded from the 

24 fund. 
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1 ‘‘(B) To guarantee, or purchase insurance 

2 for, a local obligation (all of the proceeds of 

3 which finance a project eligible for assistance 

4 under this subsection) if the guarantee or pur5 chase would improve credit market access or re6 duce the interest rate applicable to the obliga7 tion involved. 

8 ‘‘(C) As a source of revenue or security for 

9 the payment of principal and interest on rev10 enue or general obligation bonds issued by the 

11 State if the proceeds of the sale of the bonds 

12 will be deposited into the State loan fund. 

13 ‘‘(D) To earn interest on the amounts de14 posited into the State loan fund. 

15 ‘‘(7) ADMINISTRATION OF STATE LOAN

16 FUNDS.— 

17 ‘‘(A) COMBINED FINANCIAL ADMINISTRA18 TION.—A State may (as a convenience and to 

19 avoid unnecessary administrative costs) com20 bine, in accordance with State law, the financial 

21 administration of a State loan fund established 

22 under this subsection with the financial admin23 istration of any other revolving fund established 

24 by the State if otherwise not prohibited by the 
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1 law under which the State loan fund was estab2 lished. 

3 ‘‘(B) COST OF ADMINISTERING FUND.— 

4 Each State may annually use not to exceed 4 

5 percent of the funds provided to the State 

6 under a grant under this subsection to pay the 

7 reasonable costs of the administration of the 

8 programs under this section, including the re9 covery of reasonable costs expended to establish 

10 a State loan fund which are incurred after the 

11 date of enactment of this title. 

12 ‘‘(C) GUIDANCE AND REGULATIONS.—The 

13 Secretary shall publish guidance and promul14 gate regulations as may be necessary to carry 

15 out the provisions of this subsection, includ16 ing— 

17 ‘‘(i) provisions to ensure that each 

18 State commits and expends funds allotted 

19 to the State under this subsection as effi20 ciently as possible in accordance with this 

21 title and applicable State laws; and 

22 ‘‘(ii) guidance to prevent waste, fraud, 

23 and abuse. 

24 ‘‘(D) PRIVATE SECTOR CONTRIBUTIONS.— 
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1 ‘‘(i) IN GENERAL.—A State loan fund 

2 established under this subsection may ac3 cept contributions from private sector enti4 ties, except that such entities may not 

5 specify the recipient or recipients of any 

6 loan issued under this subsection. 

7 ‘‘(ii) AVAILABILITY OF INFORMA8 TION.—A State shall make publically avail9 able the identity of, and amount contrib10 uted by, any private sector entity under 

11 clause (i) and may issue letters of com12 mendation or make other awards (that 

13 have no financial value) to any such entity. 

14 ‘‘(8) MATCHING REQUIREMENTS.— 

15 ‘‘(A) IN GENERAL.—The Secretary may 

16 not make a grant under paragraph (1) to a 

17 State unless the State agrees to make available 

18 (directly or through donations from public or 

19 private entities) non-Federal contributions in 

20 cash toward the costs of the State program to 

21 be implemented under the grant in an amount 

22 equal to not less than $1 for each $1 of Federal 

23 funds provided under the grant. 

24 ‘‘(B) DETERMINATION OF AMOUNT OF

25 NON-FEDERAL CONTRIBUTION.—In determining 
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1 the amount of non-Federal contributions that a 

2 State has provided pursuant to subparagraph 

3 (A), the Secretary may not include any 

4 amounts provided to the State by the Federal 

5 Government. 

6 ‘‘(9) PREFERENCE IN AWARDING GRANTS.— 

7 The Secretary may give a preference in awarding 

8 grants under this subsection to States that adopt 

9 value-based purchasing programs to improve health 

10 care quality. 

11 ‘‘(10) REPORTS.—The Secretary shall annually 

12 submit to the Committee on Health, Education, 

13 Labor, and Pensions and the Committee on Finance 

14 of the Senate, and the Committee on Energy and 

15 Commerce and the Committee on Ways and Means 

16 of the House of Representatives, a report summa17 rizing the reports received by the Secretary from 

18 each State that receives a grant under this sub19 section. 

20 ‘‘(c) GRANTS FOR THE IMPLEMENTATION OF RE21 GIONAL OR LOCAL HEALTH INFORMATION TECHNOLOGY

22 PLANS.— 

23 ‘‘(1) IN GENERAL.—The Secretary may award 

24 competitive grants to eligible entities to implement 

25 regional or local health information plans to improve 
29 

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1 health care quality and efficiency through the elec2 tronic exchange of health information pursuant to 

3 the standards, protocols, and other requirements 

4 adopted by the Secretary under sections 2903 and 

5 2908. 

6 ‘‘(2) ELIGIBILITY.—To be eligible to receive a 

7 grant under paragraph (1) an entity shall— 

8 ‘‘(A) demonstrate financial need to the 

9 Secretary; 

10 ‘‘(B) demonstrate that one of its principal 

11 missions or purposes is to use information tech12 nology to improve health care quality and effi13 ciency; 

14 ‘‘(C) adopt bylaws, memoranda of under15 standing, or other charter documents that dem16 onstrate that the governance structure and de17 cisionmaking processes of such entity allow for 

18 participation on an ongoing basis by multiple 

19 stakeholders within a community, including— 

20 ‘‘(i) physicians (as defined in section 

21 1861(r) of the Social Security Act), includ22 ing physicians that provide services to low 

23 income and underserved populations; 
30 

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1 ‘‘(ii) hospitals (including hospitals 

2 that provide services to low income and un3 derserved populations); 

4 ‘‘(iii) pharmacists or pharmacies; 

5 ‘‘(iv) health insurance plans; 

6 ‘‘(v) health centers (as defined in sec7 tion 330(b)) and Federally qualified health 

8 centers (as defined in section 1861(aa)(4) 

9 of the Social Security Act); 

10 ‘‘(vi) rural health clinics (as defined in 

11 section 1861(aa) of the Social Security 

12 Act); 

13 ‘‘(vii) patient or consumer organiza14 tions; 

15 ‘‘(viii) employers; and 

16 ‘‘(ix) any other health care providers 

17 or other entities, as determined appro18 priate by the Secretary; 

19 ‘‘(D) adopt nondiscrimination and conflict 

20 of interest policies that demonstrate a commit21 ment to open, fair, and nondiscriminatory par22 ticipation in the health information plan by all 

23 stakeholders; 

24 ‘‘(E) adopt the standards adopted by the 

25 Secretary under section 2903; 
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1 ‘‘(F) require that health care providers re2 ceiving such loans implement the measurement 

3 system adopted under section 2908 and report 

4 to the Secretary on such measures; 

5 ‘‘(G) facilitate the electronic exchange of 

6 health information within the local or regional 

7 area and among local and regional areas; 

8 ‘‘(H) prepare and submit to the Secretary 

9 an application in accordance with paragraph 

10 (3); and 

11 ‘‘(I) agree to provide matching funds in ac12 cordance with paragraph (5). 

13 ‘‘(3) APPLICATION.— 

14 ‘‘(A) IN GENERAL.—To be eligible to re15 ceive a grant under paragraph (1), an entity 

16 shall submit to the Secretary an application at 

17 such time, in such manner, and containing such 

18 information as the Secretary may require. 

19 ‘‘(B) REQUIRED INFORMATION.—At a 

20 minimum, an application submitted under this 

21 paragraph shall include— 

22 ‘‘(i) clearly identified short-term and 

23 long-term objectives of the regional or local 

24 health information plan; 
32 

•S 1418 IS

1 ‘‘(ii) a technology plan that complies 

2 with the standards adopted under section 

3 2903 and that includes a descriptive and 

4 reasoned estimate of costs of the hardware, 

5 software, training, and consulting services 

6 necessary to implement the regional or 

7 local health information plan; 

8 ‘‘(iii) a strategy that includes initia9 tives to improve health care quality and ef10 ficiency, including the use and reporting of 

11 health care quality measures adopted 

12 under section 2908; 

13 ‘‘(iv) a plan that describes provisions 

14 to encourage the implementation of the 

15 electronic exchange of health information 

16 by all physicians, including single physician 

17 practices and small physician groups par18 ticipating in the health information plan; 

19 ‘‘(v) a plan to ensure the privacy and 

20 security of personal health information 

21 that is consistent with Federal and State 

22 law; 

23 ‘‘(vi) a governance plan that defines 

24 the manner in which the stakeholders shall 
33 

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1 jointly make policy and operational deci2 sions on an ongoing basis; and 

3 ‘‘(vii) a financial or business plan that 

4 describes— 

5 ‘‘(I) the sustainability of the 

6 plan; 

7 ‘‘(II) the financial costs and ben8 efits of the plan; and 

9 ‘‘(III) the entities to which such 

10 costs and benefits will accrue. 

11 ‘‘(4) USE OF FUNDS.—Amounts received under 

12 a grant under paragraph (1) shall be used to estab13 lish and implement a regional or local health infor14 mation plan in accordance with this subsection. 

15 ‘‘(5) MATCHING REQUIREMENT.— 

16 ‘‘(A) IN GENERAL.—The Secretary may 

17 not make a grant under this subsection to an 

18 entity unless the entity agrees that, with re19 spect to the costs to be incurred by the entity 

20 in carrying out the infrastructure program for 

21 which the grant was awarded, the entity will 

22 make available (directly or through donations 

23 from public or private entities) non-Federal 

24 contributions toward such costs in an amount 

25 equal to not less than 50 percent of such costs 
34 

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1 ($1 for each $2 of Federal funds provided 

2 under the grant). 

3 ‘‘(B) DETERMINATION OF AMOUNT CON4 TRIBUTED.—Non-Federal contributions re5 quired under subparagraph (A) may be in cash 

6 or in kind, fairly evaluated, including equip7 ment, technology, or services. Amounts provided 

8 by the Federal Government, or services assisted 

9 or subsidized to any significant extent by the 

10 Federal Government, may not be included in 

11 determining the amount of such non-Federal 

12 contributions. 

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

14 on which the first grant is awarded under this section, 

15 and annually thereafter during the grant period, an entity 

16 that receives a grant under this section shall submit to 

17 the Secretary a report on the activities carried out under 

18 the grant involved. Each such report shall include— 

19 ‘‘(1) a description of the financial costs and 

20 benefits of the project involved and of the entities to 

21 which such costs and benefits accrue; 

22 ‘‘(2) an analysis of the impact of the project on 

23 health care quality and safety; 
35 

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1 ‘‘(3) a description of any reduction in duplica2 tive or unnecessary care as a result of the project in3 volved; 

4 ‘‘(4) a description of the efforts of recipients 

5 under this section to facilitate secure patient access 

6 to health information; and 

7 ‘‘(5) other information as required by the Sec8 retary. 

9 ‘‘(e) AUTHORIZATION OF APPROPRIATIONS.— 

10 ‘‘(1) IN GENERAL.—For the purpose of car11 rying out this section, there is authorized to be ap12 propriated $125,000,000 for fiscal year 2006, 

13 $150,000,000 for fiscal year 2007, and such sums 

14 as may be necessary for each of fiscal years 2008 

15 through 2010. 

16 ‘‘(2) AVAILABILITY.—Amounts appropriated 

17 under paragraph (1) shall remain available through 

18 fiscal year 2010. 

19 ‘‘SEC. 2906. DEMONSTRATION PROGRAM TO INTEGRATE IN20 FORMATION TECHNOLOGY INTO CLINICAL 

21 EDUCATION. 

22 ‘‘(a) IN GENERAL.—The Secretary may award grants 

23 under this section to carry out demonstration projects to 

24 develop academic curricula integrating qualified health in25 formation technology systems in the clinical education of 
36 

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1 health professionals. Such awards shall be made on a com2 petitive basis and pursuant to peer review. 

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

4 under subsection (a), an entity shall— 

5 ‘‘(1) submit to the Secretary an application at 

6 such time, in such manner, and containing such in7 formation as the Secretary may require; 

8 ‘‘(2) submit to the Secretary a strategic plan 

9 for integrating qualified health information tech10 nology in the clinical education of health profes11 sionals and for ensuring the consistent utilization of 

12 decision support software to reduce medical errors 

13 and enhance health care quality; 

14 ‘‘(3) be— 

15 ‘‘(A) a health professions school; 

16 ‘‘(B) a school of nursing; or 

17 ‘‘(C) a graduate medical education pro18 gram; 

19 ‘‘(4) provide for the collection of data regarding 

20 the effectiveness of the demonstration project to be 

21 funded under the grant in improving the safety of 

22 patients, the efficiency of health care delivery, and 

23 in increasing the likelihood that graduates of the 

24 grantee will adopt and incorporate health informa-
37 

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1 tion technology in the delivery of health care serv2 ices; and 

3 ‘‘(5) provide matching funds in accordance with 

4 subsection (c). 

5 ‘‘(c) USE OF FUNDS.— 

6 ‘‘(1) IN GENERAL.—With respect to a grant 

7 under subsection (a), an eligible entity shall— 

8 ‘‘(A) use grant funds in collaboration with 

9 2 or more disciplines; and 

10 ‘‘(B) use grant funds to integrate qualified 

11 health information technology into community12 based clinical education. 

13 ‘‘(2) LIMITATION.—An eligible entity shall not 

14 use amounts received under a grant under sub15 section (a) to purchase hardware, software, or serv16 ices. 

17 ‘‘(d) MATCHING FUNDS.— 

18 ‘‘(1) IN GENERAL.—The Secretary may award 

19 a grant to an entity under this section only if the 

20 entity agrees to make available non-Federal con21 tributions toward the costs of the program to be 

22 funded under the grant in an amount that is not 

23 less than $1 for each $2 of Federal funds provided 

24 under the grant. 
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1 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB2 UTED.—Non-Federal contributions under paragraph 

3 (1) may be in cash or in kind, fairly evaluated, in4 cluding equipment or services. Amounts provided by 

5 the Federal Government, or services assisted or sub6 sidized to any significant extent by the Federal Gov7 ernment, may not be included in determining the 

8 amount of such contributions. 

9 ‘‘(e) EVALUATION.—The Secretary shall take such 

10 action as may be necessary to evaluate the projects funded 

11 under this section and publish, make available, and dis12 seminate the results of such evaluations on as wide a basis 

13 as is practicable. 

14 ‘‘(f) REPORTS.—Not later than 1 year after the date 

15 of enactment of this title, and annually thereafter, the Sec16 retary shall submit to the Committee on Health, Edu17 cation, Labor, and Pensions and the Committee on Fi18 nance of the Senate, and the Committee on Energy and 

19 Commerce and the Committee on Ways and Means of the 

20 House of Representatives a report that— 

21 ‘‘(1) describes the specific projects established 

22 under this section; and 

23 ‘‘(2) contains recommendations for Congress 

24 based on the evaluation conducted under subsection 

25 (e). 
39 

•S 1418 IS

1 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There 

2 is authorized to be appropriated to carry out this section, 

3 $5,000,000 for fiscal year 2007, and such sums as may 

4 be necessary for each of fiscal years 2008 through 2010. 

5 ‘‘(h) SUNSET.—This section shall not apply after 

6 September 30, 2010. 

7 ‘‘SEC. 2907. LICENSURE AND THE ELECTRONIC EXCHANGE 

8 OF HEALTH INFORMATION. 

9 ‘‘(a) IN GENERAL.—The Secretary shall carry out, 

10 or contract with a private entity to carry out, a study that 

11 examines— 

12 ‘‘(1) the variation among State laws that relate 

13 to the licensure, registration, and certification of 

14 medical professionals; and 

15 ‘‘(2) how such variation among State laws im16 pacts the secure electronic exchange of health infor17 mation— 

18 ‘‘(A) among the States; and 

19 ‘‘(B) between the States and the Federal 

20 Government. 

21 ‘‘(b) REPORT AND RECOMMENDATIONS.—Not later 

22 than 1 year after the date of enactment of this title, the 

23 Secretary shall publish a report that— 

24 ‘‘(1) describes the results of the study carried 

25 out under subsection (a); and 
40 

•S 1418 IS

1 ‘‘(2) makes recommendations to States regard2 ing the harmonization of State laws based on the re3 sults of such study. 

4 ‘‘SEC. 2908. QUALITY MEASUREMENT SYSTEMS. 

5 ‘‘(a) IN GENERAL.—The Secretary of Health and 

6 Human Services, the Secretary of Veterans Affairs, the 

7 Secretary of Defense, and representatives of other relevant 

8 Federal agencies, as determined appropriate by the Sec9 retary, (referred to in the section as the ‘Secretaries’) shall 

10 jointly develop a quality measurement system for the pur11 pose of measuring the quality of care patients receive. 

12 ‘‘(b) REQUIREMENTS.—The Secretaries shall ensure 

13 that the quality measurement system developed under sub14 section (a) comply with the following: 

15 ‘‘(1) MEASURES.— 

16 ‘‘(A) IN GENERAL.—Subject to subpara17 graph (B), the Secretaries shall select measures 

18 of quality to be used by the Secretaries under 

19 the systems. 

20 ‘‘(B) REQUIREMENTS.—In selecting the 

21 measures to be used under each system pursu22 ant to subparagraph (A), the Secretaries shall, 

23 to the extent feasible, ensure that— 

24 ‘‘(i) such measures are evidence 

25 based, reliable and valid; 
41 

•S 1418 IS

1 ‘‘(ii) such measures include measures 

2 of process, structure, patient experience, 

3 efficiency, and equity; and 

4 ‘‘(iii) such measures include measures 

5 of overuse, underuse, and misuse of health 

6 care items and services. 

7 ‘‘(2) PRIORITIES.—In developing the system 

8 under subsection (a), the Secretaries shall ensure 

9 that priority is given to— 

10 ‘‘(A) measures with the greatest potential 

11 impact for improving the quality and efficiency 

12 of care provided under Federal programs; 

13 ‘‘(B) measures that may be rapidly imple14 mented by group health plans, health insurance 

15 issuers, physicians, hospitals, nursing homes, 

16 long-term care providers, and other providers; 

17 and 

18 ‘‘(C) measures which may inform health 

19 care decisions made by consumers and patients. 

20 ‘‘(3) WEIGHTS OF MEASURES.—The Secretaries 

21 shall assign weights to the measures used by the 

22 Secretaries under each system established under 

23 subsection (a). 

24 ‘‘(4) RISK ADJUSTMENT.—The Secretaries shall 

25 establish procedures to account for differences in pa-
42 

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1 tient health status, patient characteristics, and geo2 graphic location. To the extent practicable, such pro3 cedures shall recognize existing procedures. 

4 ‘‘(5) MAINTENANCE.—The Secretaries shall, as 

5 determined appropriate, but in no case more often 

6 than once during each 12-month period, update the 

7 quality measurement systems developed under sub8 section (a), including through— 

9 ‘‘(A) the addition of more accurate and 

10 precise measures under the systems and the re11 tirement of existing outdated measures under 

12 the systems; and 

13 ‘‘(B) the refinement of the weights as14 signed to measures under the systems. 

15 ‘‘(c) REQUIRED CONSIDERATIONS IN DEVELOPING

16 AND UPDATING THE SYSTEMS.—In developing and updat17 ing the quality measurement systems under this section, 

18 the Secretaries shall— 

19 ‘‘(1) consult with, and take into account the 

20 recommendations of, the entity that the Secretaries 

21 has an arrangement with under subsection (e); 

22 ‘‘(2) consult with representatives of health care 

23 providers, consumers, employers, and other individ24 uals and groups that are interested in the quality of 

25 health care; and 
43 

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1 ‘‘(3) take into account— 

2 ‘‘(A) any demonstration or pilot program 

3 conducted by the Secretaries relating to meas4 uring and rewarding quality and efficiency of 

5 care; 

6 ‘‘(B) any existing activities conducted by 

7 the Secretaries relating to measuring and re8 warding quality and efficiency; 

9 ‘‘(C) any existing activities conducted by 

10 private entities including health insurance plans 

11 and payors; and 

12 ‘‘(D) the report by the Institute of Medi13 cine of the National Academy of Sciences under 

14 section 238(b) of the Medicare Prescription 

15 Drug, Improvement, and Modernization Act of 

16 2003. 

17 ‘‘(d) REQUIRED CONSIDERATIONS IN IMPLEMENTING

18 THE SYSTEMS.—In implementing the quality measure19 ment systems under this section, the Secretaries shall take 

20 into account the recommendations of public-private enti21 ties— 

22 ‘‘(1) that are established to examine issues of 

23 data collection and reporting, including the feasi24 bility of collecting and reporting data on measures; 

25 and 
44 

•S 1418 IS

1 ‘‘(2) that involve representatives of health care 

2 providers, consumers, employers, and other individ3 uals and groups that are interested in quality of 

4 care. 

5 ‘‘(e) ARRANGEMENT WITH AN ENTITY TO PROVIDE

6 ADVICE AND RECOMMENDATIONS.— 

7 ‘‘(1) ARRANGEMENT.—On and after July 1, 

8 2006, the Secretaries shall have in place an arrange9 ment with an entity that meets the requirements de10 scribed in paragraph (2) under which such entity 

11 provides the Secretaries with advice on, and rec12 ommendations with respect to, the development and 

13 updating of the quality measurement systems under 

14 this section, including the assigning of weights to 

15 the measures under subsection (b)(2). 

16 ‘‘(2) REQUIREMENTS DESCRIBED.—The re17 quirements described in this paragraph are the fol18 lowing: 

19 ‘‘(A) The entity is a private nonprofit enti20 ty governed by an executive director and a 

21 board. 

22 ‘‘(B) The members of the entity include 

23 representatives of— 

24 ‘‘(i) health insurance plans and pro25 viders with experience in the care of indi-
45 

•S 1418 IS

1 viduals with multiple complex chronic con2 ditions or groups representing such health 

3 insurance plans and providers; 

4 ‘‘(ii) groups representing patients and 

5 consumers; 

6 ‘‘(iii) purchasers and employers or 

7 groups representing purchasers or employ8 ers; 

9 ‘‘(iv) organizations that focus on qual10 ity improvement as well as the measure11 ment and reporting of quality measures; 

12 ‘‘(v) State government health pro13 grams; 

14 ‘‘(vi) individuals or entities skilled in 

15 the conduct and interpretation of bio16 medical, health services, and health eco17 nomics research and with expertise in out18 comes and effectiveness research and tech19 nology assessment; and 

20 ‘‘(vii) individuals or entities involved 

21 in the development and establishment of 

22 standards and certification for health in23 formation technology systems and clinical 

24 data. 
46 

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1 ‘‘(C) The membership of the entity is rep2 resentative of individuals with experience with 

3 urban health care issues and individuals with 

4 experience with rural and frontier health care 

5 issues. 

6 ‘‘(D) If the entity requires a fee for mem7 bership, the entity shall provide assurances to 

8 the Secretaries that such fees are not a sub9 stantial barrier to participation in the entity’s 

10 activities related to the arrangement with the 

11 Secretaries. 

12 ‘‘(E) The entity— 

13 ‘‘(i) permits any member described in 

14 subparagraph (B) to vote on matters of 

15 the entity related to the arrangement with 

16 the Secretary under paragraph (1); and 

17 ‘‘(ii) ensures that member voting pro18 vides a balance among disparate stake19 holders, so that no member organization 

20 described in subparagraph (B) unduly in21 fluences the outcome. 

22 ‘‘(F) With respect to matters related to the 

23 arrangement with the Secretary under para24 graph (1), the entity conducts its business in an 
47 

•S 1418 IS

1 open and transparent manner and provides the 

2 opportunity for public comment. 

3 ‘‘(G) The entity operates as a voluntary 

4 consensus standards setting organization as de5 fined for purposes of section 12(d) of the Na6 tional Technology Transfer and Advancement 

7 Act of 1995 (Public Law 104–113) and Office 

8 of Management and Budget Revised Circular 

9 A–119 (published in the Federal Register on 

10 February 10, 1998). 

11 ‘‘(f) USE OF QUALITY MEASUREMENT SYSTEM.— 

12 ‘‘(1) IN GENERAL.—For purposes of activities 

13 conducted or supported by the Secretary under this 

14 Act, the Secretary shall, to the extent practicable, 

15 adopt and utilize the measurement system developed 

16 under this section. 

17 ‘‘(2) COLLABORATIVE AGREEMENTS.—With re18 spect to activities conducted or supported by the 

19 Secretary under this Act, the Secretary may estab20 lish collaborative agreements with private entities, 

21 including group health plans and health insurance 

22 issuers, providers, purchasers, consumer organiza23 tions, and entities receiving a grant under section 

24 2908, to— 
48 

•S 1418 IS

1 ‘‘(A) encourage the use of the health care 

2 quality measures adopted by the Secretary 

3 under this section; and 

4 ‘‘(B) foster uniformity between the health 

5 care quality measures utilized by private enti6 ties. 

7 ‘‘(g) DISSEMINATION OF INFORMATION.—Beginning 

8 on January 1, 2008, in order to make comparative quality 

9 information available to health care consumers, health 

10 professionals, public health officials, researchers, and 

11 other appropriate individuals and entities, the Secretary 

12 shall provide for the aggregation and analysis of quality 

13 measures collected under section 2905 and the dissemina14 tion of recommendations and best practices derived in part 

15 from such analysis. 

16 ‘‘(h) TECHNICAL ASSISTANCE.—The Secretary shall 

17 provide technical assistance to public and private entities 

18 to enable such entities to— 

19 ‘‘(1) implement and use evidence-based guide20 lines with the greatest potential to improve health 

21 care quality, efficiency, and patient safety; and 

22 ‘‘(2) establish mechanisms for the rapid dis23 semination of information regarding evidence-based 

24 guidelines with the greatest potential to improve 

25 health care quality, efficiency, and patient safety. 
49

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1 ‘‘SEC. 2909. APPLICABILITY OF PRIVACY AND SECURITY 

2 REGULATIONS. 

3 ‘‘The regulations promulgated by the Secretary under 

4 part C of title XI of the Social Security Act and sections 

5 261, 262, 263, and 264 of the Health Insurance Port6 ability and Accountability Act of 1996 with respect to the 

7 privacy, confidentiality, and security of health information 

8 shall— 

9 ‘‘(1) apply to any health information stored or 

10 transmitted in an electronic format on or after the 

11 date of enactment of this title; and 

12 ‘‘(2) apply to the implementation of standards, 

13 programs, and activities under this title. 

14 ‘‘SEC. 2910. STUDY OF REIMBURSEMENT INCENTIVES. 

15 ‘‘The Secretary shall carry out, or contract with a 

16 private entity to carry out, a study that examines methods 

17 to create efficient reimbursement incentives for improving 

18 health care quality in Federally qualified health centers, 

19 rural health clinics, and free clinics.’’. 

20 SEC. 3. HEALTH INFORMATION TECHNOLOGY RESOURCE 

21 CENTER. 

22 Section 914 of the Public Health Service Act (42 

23 U.S.C. 299b–3) is amended by adding at the end the fol24 lowing: 

25 ‘‘(d) CENTER FOR BEST PRACTICES.— 
50 

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1 ‘‘(1) IN GENERAL.—The Secretary, acting 

2 through the Director, shall develop a Center for Best 

3 Practices to provide technical assistance and develop 

4 best practices to support and accelerate efforts to 

5 adopt, implement, and effectively use interoperable 

6 health information technology in compliance with 

7 section 2903 and 2908. 

8 ‘‘(2) CENTER FOR BEST PRACTICES.— 

9 ‘‘(A) IN GENERAL.—The Center shall sup10 port activities to meet goals, including— 

11 ‘‘(i) providing for the widespread 

12 adoption of interoperable health informa13 tion technology; 

14 ‘‘(ii) providing for the establishment 

15 of regional and local health information 

16 networks to facilitate the development of 

17 interoperability across health care settings 

18 and improve the quality of health care; 

19 ‘‘(iii) the development of solutions to 

20 barriers to the exchange of electronic 

21 health information; or 

22 ‘‘(iv) other activities identified by the 

23 States, local or regional health information 

24 networks, or health care stakeholders as a 
51 

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1 focus for developing and sharing best prac2 tices. 

3 ‘‘(B) PURPOSES.—The purpose of the Cen4 ter is to— 

5 ‘‘(i) provide a forum for the exchange 

6 of knowledge and experience; 

7 ‘‘(ii) accelerate the transfer of lessons 

8 learned from existing public and private 

9 sector initiatives, including those currently 

10 receiving Federal financial support; 

11 ‘‘(iii) assemble, analyze, and widely 

12 disseminate evidence and experience re13 lated to the adoption, implementation, and 

14 effective use of interoperable health infor15 mation technology; and 

16 ‘‘(iv) assure the timely provision of 

17 technical and expert assistance from the 

18 Agency and its contractors. 

19 ‘‘(C) SUPPORT FOR ACTIVITIES.—To pro20 vide support for the activities of the Center, the 

21 Director shall modify the requirements, if nec22 essary, that apply to the National Resource 

23 Center for Health Information Technology to 

24 provide the necessary infrastructure to support 

25 the duties and activities of the Center and fa-
52 

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1 cilitate information exchange across the public 

2 and private sectors. 

3 ‘‘(3) TECHNICAL ASSISTANCE TELEPHONE

4 NUMBER OR WEBSITE.—The Secretary shall estab5 lish a toll-free telephone number or Internet website 

6 to provide health care providers and patients with a 

7 single point of contact to— 

8 ‘‘(A) learn about Federal grants and tech9 nical assistance services related to interoperable 

10 health information technology; 

11 ‘‘(B) learn about qualified health informa12 tion technology and the quality measurement 

13 system adopted by the Federal Government 

14 under sections 2903 and 2908; 

15 ‘‘(C) learn about regional and local health 

16 information networks for assistance with health 

17 information technology; and 

18 ‘‘(D) disseminate additional information 

19 determined by the Secretary. 

20 ‘‘(4) AUTHORIZATION OF APPROPRIATIONS.— 

21 There are authorized to be appropriated to carry out 

22 this subsection, such sums as may be necessary for 

23 each of fiscal years 2006 through 2010.’’. 
53 

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1 SEC. 4. REAUTHORIZATION OF INCENTIVE GRANTS RE2 GARDING TELEMEDICINE. 

3 Section 330L(b) of the Public Health Service Act (42 

4 U.S.C. 254c–18(b)) is amended by striking ‘‘2002 through 

5 2006’’ and inserting ‘‘2006 through 2010’’. 

Æ