109TH CONGRESS

1ST SESSION S. 1418

AN ACT

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 INFORMA6 TION TECHNOLOGY AND

7 QUALITY

8 ‘‘SEC. 2901. DEFINITIONS.

9 ‘‘In this title:

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

11 ‘health care provider’ means a hospital, skilled nurs12 ing facility, home health entity, health care clinic,

13 federally qualified health center, group practice (as

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

15 Act), a pharmacist, a pharmacy, a laboratory, a phy16 sician (as defined in section 1861(r) of the Social

17 Security Act), a practitioner (as defined in section

18 1842(b)(18)(CC) of the Social Security Act), a

19 health facility operated by or pursuant to a contract

20 with the Indian Health Service, a rural health clinic,

21 and any other category of facility or clinician deter22 mined appropriate by the Secretary.

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

24 information’ has the meaning given such term in

25 section 1171(4) of the Social Security Act.
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1 ‘‘(3) HEALTH INSURANCE PLAN.—The term

2 ‘health insurance plan’ means—

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

4 in section 2791(b)(2));

5 ‘‘(B) a group health plan (as defined in

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

7 ‘‘(C) a health maintenance organization

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

9 ‘‘(4) INDIVIDUALLY IDENTIFIABLE HEALTH IN10 FORMATION.—The term ‘individually identifiable

11 health information’ has the meaning given such term

12 in section 1171 of the Social Security Act.

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

14 the meaning given that term in section 353.

15 ‘‘(6) PHARMACIST.—The term ‘pharmacist’ has

16 the meaning given that term in section 804 of the

17 Federal Food, Drug, and Cosmetic Act.

18 ‘‘(7) QUALIFIED HEALTH INFORMATION TECH19 NOLOGY.—The term ‘qualified health information

20 technology’ means a computerized system (including

21 hardware and software) that—

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

23 health information;
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1 ‘‘(B) maintains and provides permitted ac2 cess to health information in an electronic for3 mat;

4 ‘‘(C) incorporates decision support to re5 duce medical errors and enhance health care

6 quality;

7 ‘‘(D) complies with the standards adopted

8 by the Federal Government under section 2903;

9 and

10 ‘‘(E) allows for the reporting of quality

11 measures under section 2907.

12 ‘‘(8) STATE.—The term ‘State’ means each of

13 the several States, the District of Columbia, Puerto

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

15 and the Northern Mariana Islands.

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

17 HEALTH INFORMATION TECHNOLOGY.

18 ‘‘(a) OFFICE OF NATIONAL HEALTH INFORMATION

19 TECHNOLOGY.—There is established within the Office of

20 the Secretary an Office of the National Coordinator of

21 Health Information Technology (referred to in this section

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

23 Coordinator who shall be appointed by the Secretary and

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

2 to coordinate with relevant Federal agencies and private

3 entities and oversee programs and activities to develop a

4 nationwide interoperable health information technology in5 frastructure that—

6 ‘‘(1) ensures that patients’ individually identifi7 able health information is secure and protected;

8 ‘‘(2) improves health care quality, reduces med9 ical errors, and advances the delivery of patient-cen10 tered medical care;

11 ‘‘(3) reduces health care costs resulting from

12 inefficiency, medical errors, inappropriate care, and

13 incomplete information;

14 ‘‘(4) ensures that appropriate information to

15 help guide medical decisions is available at the time

16 and place of care;

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

18 greater competition, and increased choice through

19 the wider availability of accurate information on

20 health care costs, quality, and outcomes;

21 ‘‘(6) improves the coordination of care and in22 formation among hospitals, laboratories, physician

23 offices, and other entities through an effective infra24 structure for the secure and authorized exchange of

25 health care information;
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1 ‘‘(7) improves public health reporting and facili2 tates the early identification and rapid response to

3 public health threats and emergencies, including bio4 terror events and infectious disease outbreaks;

5 ‘‘(8) facilitates health research; and

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

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

8 The National Coordinator shall—

9 ‘‘(1) serve as the principal advisor to the Sec10 retary concerning the development, application, and

11 use of health information technology, and coordinate

12 and oversee the health information technology pro13 grams of the Department;

14 ‘‘(2) facilitate the adoption of a nationwide,

15 interoperable system for the electronic exchange of

16 health information;

17 ‘‘(3) ensure the adoption and implementation of

18 standards for the electronic exchange of health infor19 mation to reduce cost and improve health care qual20 ity;

21 ‘‘(4) ensure that health information technology

22 policy and programs of the Department are coordi23 nated with those of relevant executive branch agen24 cies (including Federal commissions) with a goal of

25 avoiding duplication of efforts and of helping to en-
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1 sure that each agency undertakes health information

2 technology activities primarily within the areas of its

3 greatest expertise and technical capability;

4 ‘‘(5) to the extent permitted by law, coordinate

5 outreach and consultation by the relevant executive

6 branch agencies (including Federal commissions)

7 with public and private parties of interest, including

8 consumers, payers, employers, hospitals and other

9 health care providers, physicians, community health

10 centers, laboratories, vendors and other stake11 holders;

12 ‘‘(6) advise the President regarding specific

13 Federal health information technology programs;

14 and

15 ‘‘(7) prepare the reports described under sec16 tion 2903(i) (excluding paragraph (4) of such sec17 tion).

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

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

20 National Coordinator, the head of any Federal agen21 cy is authorized to detail, with or without reimburse22 ment from the Office, any of the personnel of such

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

24 duties under this section.
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1 ‘‘(2) EFFECT OF DETAIL.—Any detail of per2 sonnel under paragraph (1) shall—

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

4 civil service status or privileges of the Federal

5 employee; and

6 ‘‘(B) be in addition to any other staff of

7 the Department employed by the National Co8 ordinator.

9 ‘‘(3) ACCEPTANCE OF DETAILEES.—Notwith10 standing any other provision of law, the Office may

11 accept detailed personnel from other Federal agen12 cies without regard to whether the agency described

13 under paragraph (1) is reimbursed.

14 ‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec15 tion shall be construed to require the duplication of Fed16 eral efforts with respect to the establishment of the Office,

17 regardless of whether such efforts were carried out prior

18 to or after the enactment of this title.

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

20 are authorized to be appropriated to carry out this section,

21 $5,000,000 for fiscal year 2006, $5,000,000 for fiscal year

22 2007, and such sums as may be necessary for each of fis23 cal years 2008 through 2010.
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1 ‘‘SEC. 2903. AMERICAN HEALTH INFORMATION COLLABO2 RATIVE.

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

4 public-private American Health Information Collaborative

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

6 ‘‘(1) advise the Secretary and recommend spe7 cific actions to achieve a nationwide interoperable

8 health information technology infrastructure;

9 ‘‘(2) serve as a forum for the participation of

10 a broad range of stakeholders to provide input on

11 achieving the interoperability of health information

12 technology; and

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

14 communication, and security standards) for the elec15 tronic exchange of health information (including for

16 the reporting of quality data under section 2907) for

17 adoption by the Federal Government and voluntary

18 adoption by private entities.

19 ‘‘(b) COMPOSITION.—

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

21 composed of members of the public and private sec22 tors to be appointed by the Secretary, including rep23 resentatives from—

24 ‘‘(A) consumer or patient organizations;

25 ‘‘(B) organizations with expertise in pri26 vacy and security;
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1 ‘‘(C) health care providers;

2 ‘‘(D) health insurance plans or other third

3 party payors;

4 ‘‘(E) information technology vendors; and

5 ‘‘(F) purchasers or employers.

6 ‘‘(2) PARTICIPATION.—In appointing members

7 under paragraph (1), and in developing the proce8 dures for conducting the activities of the Collabo9 rative, the Secretary shall ensure a balance among

10 various sectors of the health care system so that no

11 single sector unduly influences the recommendations

12 of the Collaborative.

13 ‘‘(3) TERMS.—Members appointed under para14 graph (1) shall serve for 2 year terms, except that

15 any member appointed to fill a vacancy for an unex16 pired term shall be appointed for the remainder of

17 such term. A member may serve for not to exceed

18 180 days after the expiration of such member’s term

19 or until a successor has been appointed.

20 ‘‘(4) OUTSIDE INVOLVEMENT.—With respect to

21 the functions of the Collaborative, the Secretary

22 shall ensure an adequate opportunity for the partici23 pation of outside advisors, including individuals with

24 expertise in—

25 ‘‘(A) health information privacy;
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1 ‘‘(B) health information security;

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

3 including individuals with expertise in utilizing

4 health information technology to improve health

5 care quality and patient safety;

6 ‘‘(D) data exchange; and

7 ‘‘(E) developing health information tech8 nology standards and new health information

9 technology.

10 ‘‘(c) RECOMMENDATIONS AND POLICIES.—Not later

11 than 1 year after the date of enactment of this title, and

12 annually thereafter, the Collaborative shall recommend to

13 the Secretary uniform national policies for adoption by the

14 Federal Government and voluntary adoption by private en15 tities to support the widespread adoption of health infor16 mation technology, including—

17 ‘‘(1) protection of individually identifiable

18 health information through privacy and security

19 practices;

20 ‘‘(2) measures to prevent unauthorized access

21 to health information, including unauthorized access

22 through the use of certain peer-to-peer file-sharing

23 applications;
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1 ‘‘(3) methods to notify patients if their individ2 ually identifiable health information is wrongfully

3 disclosed;

4 ‘‘(4) methods to facilitate secure patient access

5 to health information;

6 ‘‘(5) fostering the public understanding of

7 health information technology;

8 ‘‘(6) the ongoing harmonization of industry9 wide health information technology standards;

10 ‘‘(7) recommendations for a nationwide inter11 operable health information technology infrastruc12 ture;

13 ‘‘(8) the identification and prioritization of spe14 cific use cases for which health information tech15 nology is valuable, beneficial, and feasible;

16 ‘‘(9) recommendations for the establishment of

17 an entity to ensure the continuation of the functions

18 of the Collaborative; and

19 ‘‘(10) other policies (including recommendations

20 for incorporating health information technology into

21 the provision of care and the organization of the

22 health care workplace) determined to be necessary

23 by the Collaborative.

24 ‘‘(d) STANDARDS.—
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1 ‘‘(1) EXISTING STANDARDS.—The standards

2 adopted by the Consolidated Health Informatics Ini3 tiative shall be deemed to have been recommended

4 by the Collaborative under this section.

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

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

7 Collaborative shall—

8 ‘‘(A) review existing standards (including

9 content, communication, and security stand10 ards) for the electronic exchange of health in11 formation;

12 ‘‘(B) identify deficiencies and omissions in

13 such existing standards; and

14 ‘‘(C) identify duplication and overlap in

15 such existing standards;

16 and recommend new standards and modifications to

17 such existing standards as necessary.

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

19 after the date of enactment of this title, and annu20 ally thereafter, the Collaborative shall—

21 ‘‘(A) review existing standards (including

22 content, communication, and security stand23 ards) for the electronic exchange of health in24 formation;
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1 ‘‘(B) identify deficiencies and omissions in

2 such existing standards; and

3 ‘‘(C) identify duplication and overlap in

4 such existing standards;

5 and recommend new standards and modifications to

6 such existing standards as necessary.

7 ‘‘(4) LIMITATION.—The standards and time8 frame for adoption described in this section shall be

9 consistent with any standards developed pursuant to

10 the Health Insurance Portability and Accountability

11 Act of 1996.

12 ‘‘(e) FEDERAL ACTION.—Not later than 90 days

13 after the issuance of a recommendation from the Collabo14 rative under subsection (d)(2), the Secretary of Health

15 and Human Services, the Secretary of Veterans Affairs,

16 and the Secretary of Defense, in collaboration with rep17 resentatives of other relevant Federal agencies, as deter18 mined appropriate by the Secretary, shall jointly review

19 such recommendations. If appropriate, the Secretary shall

20 provide for the adoption by the Federal Government of

21 any standard or standards contained in such recommenda22 tion.

23 ‘‘(f) COORDINATION OF FEDERAL SPENDING.—

24 ‘‘(1) IN GENERAL.—Not later than 1 year after

25 the adoption by the Federal Government of a rec-
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1 ommendation as provided for in subsection (e), and

2 in compliance with chapter 113 of title 40, United

3 States Code, no Federal agency shall expend Federal

4 funds for the purchase of any new health informa5 tion technology or health information technology sys6 tem for clinical care or for the electronic retrieval,

7 storage, or exchange of health information that is

8 not consistent with applicable standards adopted by

9 the Federal Government under subsection (e).

10 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in

11 paragraph (1) shall be construed to restrict the pur12 chase of minor (as determined by the Secretary)

13 hardware or software components in order to mod14 ify, correct a deficiency in, or extend the life of exist15 ing hardware or software.

16 ‘‘(g) COORDINATION OF FEDERAL DATA COLLEC17 TION.—Not later than 3 years after the adoption by the

18 Federal Government of a recommendation as provided for

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

20 data for the purposes of quality reporting, surveillance, ep21 idemiology, adverse event reporting, research, or for other

22 purposes determined appropriate by the Secretary, shall

23 comply with standards adopted under subsection (e).

24 ‘‘(h) VOLUNTARY ADOPTION.—
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1 ‘‘(1) IN GENERAL.—Any standards adopted by

2 the Federal Government under subsection (e) shall

3 be voluntary with respect to private entities.

4 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in

5 this section shall be construed to require that a pri6 vate entity that enters into a contract with the Fed7 eral Government adopt the standards adopted by the

8 Federal Government under this section with respect

9 to activities not related to the contract.

10 ‘‘(3) LIMITATION.—Private entities that enter

11 into a contract with the Federal Government shall

12 adopt the standards adopted by the Federal Govern13 ment under this section for the purpose of activities

14 under such Federal contract.

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

16 Committee on Health, Education, Labor, and Pensions

17 and the Committee on Finance of the Senate and the

18 Committee on Energy and Commerce and the Committee

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

20 an annual basis, a report that—

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

22 been taken by the Federal Government and private

23 entities to facilitate the adoption of an interoperable

24 nationwide system for the electronic exchange of

25 health information;
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1 ‘‘(2) describes barriers to the adoption of such

2 a nationwide system;

3 ‘‘(3) contains recommendations to achieve full

4 implementation of such a nationwide system; and

5 ‘‘(4) contains a plan and progress toward the

6 establishment of an entity to ensure the continuation

7 of the functions of the Collaborative.

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

9 Committee Act (5 U.S.C. App.) shall apply to the Collabo10 rative, except that the term provided for under section

11 14(a)(2) shall be 5 years.

12 ‘‘(k) RULE OF CONSTRUCTION.—Nothing in this sec13 tion shall be construed to require the duplication of Fed14 eral efforts with respect to the establishment of the Col15 laborative, regardless of whether such efforts were carried

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

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

18 are authorized to be appropriated to carry out this section,

19 $4,000,000 for fiscal year 2006, $4,000,000 for fiscal year

20 2007, and such sums as may be necessary for each of fis21 cal years 2008 through 2010.

22 ‘‘SEC. 2904. IMPLEMENTATION AND CERTIFICATION OF

23 HEALTH INFORMATION STANDARDS.

24 ‘‘(a) IMPLEMENTATION.—
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1 ‘‘(1) IN GENERAL.—The Secretary, based upon

2 the recommendations of the Collaborative, shall de3 velop criteria to ensure uniform and consistent im4 plementation of any standards for the electronic ex5 change of health information voluntarily adopted by

6 private entities in technical conformance with such

7 standards adopted under this title.

8 ‘‘(2) IMPLEMENTATION ASSISTANCE.—The Sec9 retary may recognize a private entity or entities to

10 assist private entities in the implementation of the

11 standards adopted under this title using the criteria

12 developed by the Secretary under this section.

13 ‘‘(b) CERTIFICATION.—

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

15 the recommendations of the Collaborative, shall de16 velop criteria to ensure and certify that hardware

17 and software that claim to be in compliance with ap18 plicable standards for the electronic exchange of

19 health information adopted under this title have es20 tablished and maintained such compliance in tech21 nical conformance with such standards.

22 ‘‘(2) CERTIFICATION ASSISTANCE.—The Sec23 retary may recognize a private entity or entities to

24 assist in the certification described under paragraph
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1 (1) using the criteria developed by the Secretary

2 under this section.

3 ‘‘(c) OUTSIDE INVOLVEMENT.—The Secretary,

4 through consultation with the Collaborative, may accept

5 recommendations on the development of the criteria under

6 subsections (a) and (b) from a Federal agency or private

7 entity.

8 ‘‘SEC. 2905. GRANTS TO FACILITATE THE WIDESPREAD

9 ADOPTION OF INTEROPERABLE HEALTH IN10 FORMATION TECHNOLOGY.

11 ‘‘(a) COMPETITIVE GRANTS TO FACILITATE THE

12 WIDESPREAD ADOPTION OF HEALTH INFORMATION

13 TECHNOLOGY.—

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

15 competitive grants to eligible entities to facilitate the

16 purchase and enhance the utilization of qualified

17 health information technology systems to improve

18 the quality and efficiency of health care.

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

20 grant under paragraph (1) an entity shall—

21 ‘‘(A) submit to the Secretary an applica22 tion at such time, in such manner, and con23 taining such information as the Secretary may

24 require;
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1 ‘‘(B) submit to the Secretary a strategic

2 plan for the implementation of data sharing

3 and interoperability measures;

4 ‘‘(C) be a—

5 ‘‘(i) not for profit hospital, including a

6 federally qualified health center (as defined

7 in section 1861(aa)(4) of the Social Secu8 rity Act);

9 ‘‘(ii) individual or group practice; or

10 ‘‘(iii) another health care provider not

11 described in clause (i) or (ii);

12 ‘‘(D) adopt the standards adopted by the

13 Federal Government under section 2903;

14 ‘‘(E) implement the measures adopted

15 under section 2907 and report to the Secretary

16 on such measures;

17 ‘‘(F) agree to notify patients if their indi18 vidually identifiable health information is

19 wrongfully disclosed;

20 ‘‘(G) demonstrate significant financial

21 need; and

22 ‘‘(H) provide matching funds in accord23 ance with paragraph (4).

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

25 a grant under this subsection shall be used to facili-
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1 tate the purchase and enhance the utilization of

2 qualified health information technology systems and

3 training personnel in the use of such technology.

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

5 for a grant under this subsection an entity shall con6 tribute non-Federal contributions to the costs of car7 rying out the activities for which the grant is award8 ed in an amount equal to $1 for each $3 of Federal

9 funds provided under the grant.

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

11 awarding grants under this subsection the Secretary

12 shall give preference to—

13 ‘‘(A) eligible entities that are located in

14 rural, frontier, and other underserved areas as

15 determined by the Secretary;

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

17 extent practicable, the qualified health informa18 tion system to local or regional health informa19 tion plan or plans; and

20 ‘‘(C) with respect to an entity described in

21 subsection (a)(2)(C)(iii), a nonprofit health care

22 provider.

23 ‘‘(b) COMPETITIVE GRANTS TO STATES FOR THE DE24 VELOPMENT OF STATE LOAN PROGRAMS TO FACILITATE
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1 THE WIDESPREAD ADOPTION OF HEALTH INFORMATION

2 TECHNOLOGY.—

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

4 competitive grants to States for the establishment of

5 State programs for loans to health care providers to

6 facilitate the purchase and enhance the utilization of

7 qualified health information technology.

8 ‘‘(2) ESTABLISHMENT OF FUND.—To be eligi9 ble to receive a competitive grant under this sub10 section, a State shall establish a qualified health in11 formation technology loan fund (referred to in this

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

13 the other requirements contained in this section. A

14 grant to a State under this subsection shall be de15 posited in the State loan fund established by the

16 State. No funds authorized by other provisions of

17 this title to be used for other purposes specified in

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

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

20 grant under paragraph (1) a State shall—

21 ‘‘(A) submit to the Secretary an applica22 tion at such time, in such manner, and con23 taining such information as the Secretary may

24 require;
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1 ‘‘(B) submit to the Secretary a strategic

2 plan in accordance with paragraph (4);

3 ‘‘(C) establish a qualified health informa4 tion technology loan fund in accordance with

5 paragraph (2);

6 ‘‘(D) require that health care providers re7 ceiving such loans—

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

9 qualified health information system to a

10 local or regional health information net11 work;

12 ‘‘(ii) consult with the Health Informa13 tion Technology Resource Center estab14 lished in section 914(d) to access the

15 knowledge and experience of existing initia16 tives regarding the successful implementa17 tion and effective use of health information

18 technology; and

19 ‘‘(iii) agree to notify patients if their

20 individually identifiable health information

21 is wrongfully disclosed;

22 ‘‘(E) require that health care providers re23 ceiving such loans adopt the standards adopted

24 by the Federal Government under section 2903;
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1 ‘‘(F) require that health care providers re2 ceiving such loans implement the measures

3 adopted under section 2907 and report to the

4 Secretary on such measures; and

5 ‘‘(G) provide matching funds in accordance

6 with paragraph (8).

7 ‘‘(4) STRATEGIC PLAN.—

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

9 a grant under this subsection shall annually

10 prepare a strategic plan that identifies the in11 tended uses of amounts available to the State

12 loan fund of the State.

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

14 subparagraph (A) shall include—

15 ‘‘(i) a list of the projects to be as16 sisted through the State loan fund in the

17 first fiscal year that begins after the date

18 on which the plan is submitted;

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

20 methods established for the distribution of

21 funds from the State loan fund; and

22 ‘‘(iii) a description of the financial

23 status of the State loan fund and the

24 short-term and long-term goals of the

25 State loan fund.
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1 ‘‘(5) USE OF FUNDS.—

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

3 a State loan fund, including loan repayments

4 and interest earned on such amounts, shall be

5 used only for awarding loans or loan guaran6 tees, or as a source of reserve and security for

7 leveraged loans, the proceeds of which are de8 posited in the State loan fund established under

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

10 used by a health care provider to facilitate the

11 purchase and enhance the utilization of quali12 fied health information technology and training

13 of personnel in the use of such technology.

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

15 State under this subsection may not be used—

16 ‘‘(i) for the purchase or other acquisi17 tion of any health information technology

18 system that is not a qualified health infor19 mation technology system;

20 ‘‘(ii) to conduct activities for which

21 Federal funds are expended under this

22 title, or the amendments made by the

23 Wired for Health Care Quality Act; or
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1 ‘‘(iii) for any purpose other than mak2 ing loans to eligible entities under this sec3 tion.

4 ‘‘(6) TYPES OF ASSISTANCE.—Except as other5 wise limited by applicable State law, amounts depos6 ited into a State loan fund under this subsection

7 may only be used for the following:

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

9 following:

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

11 shall be less than or equal to the market

12 interest rate.

13 ‘‘(ii) The principal and interest pay14 ments on each loan shall commence not

15 later than 1 year after the loan was award16 ed, and each loan shall be fully amortized

17 not later than 10 years after the date of

18 the loan.

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

20 credited with all payments of principal and

21 interest on each loan awarded from the

22 fund.

23 ‘‘(B) To guarantee, or purchase insurance

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

25 which finance a project eligible for assistance
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1 under this subsection) if the guarantee or pur2 chase would improve credit market access or re3 duce the interest rate applicable to the obliga4 tion involved.

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

6 the payment of principal and interest on rev7 enue or general obligation bonds issued by the

8 State if the proceeds of the sale of the bonds

9 will be deposited into the State loan fund.

10 ‘‘(D) To earn interest on the amounts de11 posited into the State loan fund.

12 ‘‘(7) ADMINISTRATION OF STATE LOAN

13 FUNDS.—

14 ‘‘(A) COMBINED FINANCIAL ADMINISTRA15 TION.—A State may (as a convenience and to

16 avoid unnecessary administrative costs) com17 bine, in accordance with State law, the financial

18 administration of a State loan fund established

19 under this subsection with the financial admin20 istration of any other revolving fund established

21 by the State if otherwise not prohibited by the

22 law under which the State loan fund was estab23 lished.

24 ‘‘(B) COST OF ADMINISTERING FUND.—

25 Each State may annually use not to exceed 4
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1 percent of the funds provided to the State

2 under a grant under this subsection to pay the

3 reasonable costs of the administration of the

4 programs under this section, including the re5 covery of reasonable costs expended to establish

6 a State loan fund which are incurred after the

7 date of enactment of this title.

8 ‘‘(C) GUIDANCE AND REGULATIONS.—The

9 Secretary shall publish guidance and promul10 gate regulations as may be necessary to carry

11 out the provisions of this subsection,

12 including—

13 ‘‘(i) provisions to ensure that each

14 State commits and expends funds allotted

15 to the State under this subsection as effi16 ciently as possible in accordance with this

17 title and applicable State laws; and

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

19 and abuse.

20 ‘‘(D) PRIVATE SECTOR CONTRIBUTIONS.—

21 ‘‘(i) IN GENERAL.—A State loan fund

22 established under this subsection may ac23 cept contributions from private sector enti24 ties, except that such entities may not
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1 specify the recipient or recipients of any

2 loan issued under this subsection.

3 ‘‘(ii) AVAILABILITY OF INFORMA4 TION.—A State shall make publicly avail5 able the identity of, and amount contrib6 uted by, any private sector entity under

7 clause (i) and may issue letters of com8 mendation or make other awards (that

9 have no financial value) to any such entity.

10 ‘‘(8) MATCHING REQUIREMENTS.—

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

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

13 State unless the State agrees to make available

14 (directly or through donations from public or

15 private entities) non-Federal contributions in

16 cash toward the costs of the State program to

17 be implemented under the grant in an amount

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

19 funds provided under the grant.

20 ‘‘(B) DETERMINATION OF AMOUNT OF

21 NON-FEDERAL CONTRIBUTION.—In determining

22 the amount of non-Federal contributions that a

23 State has provided pursuant to subparagraph

24 (A), the Secretary may not include any
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1 amounts provided to the State by the Federal

2 Government.

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

4 The Secretary may give a preference in awarding

5 grants under this subsection to States that adopt

6 value-based purchasing programs to improve health

7 care quality.

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

9 submit to the Committee on Health, Education,

10 Labor, and Pensions and the Committee on Finance

11 of the Senate, and the Committee on Energy and

12 Commerce and the Committee on Ways and Means

13 of the House of Representatives, a report summa14 rizing the reports received by the Secretary from

15 each State that receives a grant under this sub16 section.

17 ‘‘(c) COMPETITIVE GRANTS FOR THE IMPLEMENTA18 TION OF REGIONAL OR LOCAL HEALTH INFORMATION

19 TECHNOLOGY PLANS.—

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

21 competitive grants to eligible entities to implement

22 regional or local health information plans to improve

23 health care quality and efficiency through the elec24 tronic exchange of health information pursuant to

25 the standards, protocols, and other requirements
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1 adopted by the Secretary under sections 2903 and

2 2907.

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

4 grant under paragraph (1) an entity shall—

5 ‘‘(A) demonstrate financial need to the

6 Secretary;

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

8 missions or purposes is to use information tech9 nology to improve health care quality and effi10 ciency;

11 ‘‘(C) adopt bylaws, memoranda of under12 standing, or other charter documents that dem13 onstrate that the governance structure and de14 cisionmaking processes of such entity allow for

15 participation on an ongoing basis by multiple

16 stakeholders within a community, including—

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

18 1861(r) of the Social Security Act), includ19 ing physicians that provide services to low

20 income and underserved populations;

21 ‘‘(ii) hospitals (including hospitals

22 that provide services to low income and un23 derserved populations);

24 ‘‘(iii) pharmacists or pharmacies;

25 ‘‘(iv) health insurance plans;
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1 ‘‘(v) health centers (as defined in sec2 tion 330(b)) and Federally qualified health

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

4 of the Social Security Act);

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

6 section 1861(aa) of the Social Security

7 Act);

8 ‘‘(vii) patient or consumer organiza9 tions;

10 ‘‘(viii) employers; and

11 ‘‘(ix) any other health care providers

12 or other entities, as determined appro13 priate by the Secretary;

14 ‘‘(D) demonstrate the participation, to the

15 extent practicable, of stakeholders in the elec16 tronic exchange of health information within

17 the local or regional plan pursuant to para18 graph (2)(C);

19 ‘‘(E) 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 ‘‘(F) adopt the standards adopted by the

25 Secretary under section 2903;
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1 ‘‘(G) require that health care providers re2 ceiving such grants implement the measures

3 adopted under section 2907 and report to the

4 Secretary on such measures;

5 ‘‘(H) agree to notify patients if their indi6 vidually identifiable health information is

7 wrongfully disclosed;

8 ‘‘(I) facilitate the electronic exchange of

9 health information within the local or regional

10 area and among local and regional areas;

11 ‘‘(J) prepare and submit to the Secretary

12 an application in accordance with paragraph

13 (3); and

14 ‘‘(K) agree to provide matching funds in

15 accordance with paragraph (5).

16 ‘‘(3) APPLICATION.—

17 ‘‘(A) IN GENERAL.—To be eligible to re18 ceive a grant under paragraph (1), an entity

19 shall submit to the Secretary an application at

20 such time, in such manner, and containing such

21 information as the Secretary may require.

22 ‘‘(B) REQUIRED INFORMATION.—At a

23 minimum, an application submitted under this

24 paragraph shall include—
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1 ‘‘(i) clearly identified short-term and

2 long-term objectives of the regional or local

3 health information plan;

4 ‘‘(ii) a technology plan that complies

5 with the standards adopted under section

6 2903 and that includes a descriptive and

7 reasoned estimate of costs of the hardware,

8 software, training, and consulting services

9 necessary to implement the regional or

10 local health information plan;

11 ‘‘(iii) a strategy that includes initia12 tives to improve health care quality and ef13 ficiency, including the use and reporting of

14 health care quality measures adopted

15 under section 2907;

16 ‘‘(iv) a plan that describes provisions

17 to encourage the implementation of the

18 electronic exchange of health information

19 by all physicians, including single physician

20 practices and small physician groups par21 ticipating in the health information plan;

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

23 security of personal health information

24 that is consistent with Federal and State

25 law;
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1 ‘‘(vi) a governance plan that defines

2 the manner in which the stakeholders shall

3 jointly make policy and operational deci4 sions on an ongoing basis;

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

6 describes—

7 ‘‘(I) the sustainability of the

8 plan;

9 ‘‘(II) the financial costs and ben10 efits of the plan; and

11 ‘‘(III) the entities to which such

12 costs and benefits will accrue; and

13 ‘‘(viii) in the case of an applicant enti14 ty that is unable to demonstrate the par15 ticipation of all stakeholders pursuant to

16 paragraph (2)(C), the justification from

17 the entity for any such nonparticipation.

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

19 a grant under paragraph (1) shall be used to estab20 lish and implement a regional or local health infor21 mation plan in accordance with this subsection.

22 ‘‘(5) MATCHING REQUIREMENT.—

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

24 not make a grant under this subsection to an

25 entity unless the entity agrees that, with re-
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1 spect to the costs to be incurred by the entity

2 in carrying out the infrastructure program for

3 which the grant was awarded, the entity will

4 make available (directly or through donations

5 from public or private entities) non-Federal

6 contributions toward such costs in an amount

7 equal to not less than 50 percent of such costs

8 ($1 for each $2 of Federal funds provided

9 under the grant).

10 ‘‘(B) DETERMINATION OF AMOUNT CON11 TRIBUTED.—Non-Federal contributions re12 quired under subparagraph (A) may be in cash

13 or in kind, fairly evaluated, including equip14 ment, technology, or services. Amounts provided

15 by the Federal Government, or services assisted

16 or subsidized to any significant extent by the

17 Federal Government, may not be included in

18 determining the amount of such non-Federal

19 contributions.

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

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

22 and annually thereafter during the grant period, an entity

23 that receives a grant under this section shall submit to

24 the Secretary a report on the activities carried out under

25 the grant involved. Each such report shall include—
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1 ‘‘(1) a description of the financial costs and

2 benefits of the project involved and of the entities to

3 which such costs and benefits accrue;

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

5 health care quality and safety;

6 ‘‘(3) a description of any reduction in duplica7 tive or unnecessary care as a result of the project in8 volved;

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

10 under this section to facilitate secure patient access

11 to health information; and

12 ‘‘(5) other information as required by the Sec13 retary.

14 ‘‘(e) REQUIREMENT TO ACHIEVE QUALITY IMPROVE15 MENT.—The Secretary shall annually evaluate the activi16 ties conducted under this section and shall, in awarding

17 grants, implement the lessons learned from such evalua18 tion in a manner so that awards made subsequent to each

19 such evaluation are made in a manner that, in the deter20 mination of the Secretary, will result in the greatest im21 provement in quality measures under section 2907.

22 ‘‘(f) LIMITATION.—An eligible entity may only receive

23 one non-renewable grant under subsection (a), one non24 renewable grant under subsection (b), and one non-renew25 able grant under subsection (c).
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1 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—

2 ‘‘(1) IN GENERAL.—For the purpose of car3 rying out this section, there is authorized to be ap4 propriated $116,000,000 for fiscal year 2006,

5 $141,000,000 for fiscal year 2007, and such sums

6 as may be necessary for each of fiscal years 2008

7 through 2010.

8 ‘‘(2) AVAILABILITY.—Amounts appropriated

9 under paragraph (1) shall remain available through

10 fiscal year 2010.

11 ‘‘SEC. 2906. DEMONSTRATION PROGRAM TO INTEGRATE IN12 FORMATION TECHNOLOGY INTO CLINICAL

13 EDUCATION.

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

15 under this section to carry out demonstration projects to

16 develop academic curricula integrating qualified health in17 formation technology systems in the clinical education of

18 health professionals. Such awards shall be made on a com19 petitive basis and pursuant to peer review.

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

21 under subsection (a), an entity shall—

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

23 such time, in such manner, and containing such in24 formation as the Secretary may require;
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1 ‘‘(2) submit to the Secretary a strategic plan

2 for integrating qualified health information tech3 nology in the clinical education of health profes4 sionals and for ensuring the consistent utilization of

5 decision support software to reduce medical errors

6 and enhance health care quality;

7 ‘‘(3) be—

8 ‘‘(A) a health professions school;

9 ‘‘(B) a school of nursing; or

10 ‘‘(C) an institution with a graduate med11 ical education program;

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

13 the effectiveness of the demonstration project to be

14 funded under the grant in improving the safety of

15 patients, the efficiency of health care delivery, and

16 in increasing the likelihood that graduates of the

17 grantee will adopt and incorporate health informa18 tion technology, and implement the quality measures

19 adopted under section 2907, in the delivery of health

20 care services; and

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

22 subsection (c).

23 ‘‘(c) USE OF FUNDS.—

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

25 under subsection (a), an eligible entity shall—
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1 ‘‘(A) use grant funds in collaboration with

2 2 or more disciplines; and

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

4 health information technology into community5 based clinical education.

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

7 use amounts received under a grant under sub8 section (a) to purchase hardware, software, or serv9 ices.

10 ‘‘(d) MATCHING FUNDS.—

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

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

13 entity agrees to make available non-Federal con14 tributions toward the costs of the program to be

15 funded under the grant in an amount that is not

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

17 under the grant.

18 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB19 UTED.—Non-Federal contributions under paragraph

20 (1) may be in cash or in kind, fairly evaluated, in21 cluding equipment or services. Amounts provided by

22 the Federal Government, or services assisted or sub23 sidized to any significant extent by the Federal Gov24 ernment, may not be included in determining the

25 amount of such contributions.
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1 ‘‘(e) EVALUATION.—The Secretary shall take such

2 action as may be necessary to evaluate the projects funded

3 under this section and publish, make available, and dis4 seminate the results of such evaluations on as wide a basis

5 as is practicable.

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

7 of enactment of this title, and annually thereafter, the Sec8 retary shall submit to the Committee on Health, Edu9 cation, Labor, and Pensions and the Committee on Fi10 nance of the Senate, and the Committee on Energy and

11 Commerce and the Committee on Ways and Means of the

12 House of Representatives a report that—

13 ‘‘(1) describes the specific projects established

14 under this section; and

15 ‘‘(2) contains recommendations for Congress

16 based on the evaluation conducted under subsection

17 (e).

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

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

20 $5,000,000 for fiscal year 2007, and such sums as may

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

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

23 September 30, 2010.
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1 ‘‘SEC. 2907. QUALITY MEASURES.

2 ‘‘(a) IN GENERAL.—The Secretary shall develop

3 quality measures, including measures to assess the effec4 tiveness, timeliness, patient self-management, patient

5 centeredness, efficiency, and safety, for the purpose of

6 measuring the quality of care patients receive.

7 ‘‘(b) REQUIREMENTS.—The Secretary shall ensure

8 that the quality measures developed under this section

9 comply with the following:

10 ‘‘(1) MEASURES.—

11 ‘‘(A) REQUIREMENTS.—In developing the

12 quality measures under this section, the Sec13 retary shall, to the extent feasible, ensure

14 that—

15 ‘‘(i) such measures are evidence

16 based, reliable, and valid;

17 ‘‘(ii) such measures are consistent

18 with the purposes described in section

19 2902(b);

20 ‘‘(iii) such measures include measures

21 of clinical processes and outcomes, patient

22 experience, efficiency, and equity; and

23 ‘‘(iv) such measures include measures

24 of overuse and underuse of health care

25 items and services.
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1 ‘‘(2) PRIORITIES.—In developing the quality

2 measures under this section, the Secretary shall en3 sure that priority is given to—

4 ‘‘(A) measures with the greatest potential

5 impact for improving the quality and efficiency

6 of care provided under this Act;

7 ‘‘(B) measures that may be rapidly imple8 mented by group health plans, health insurance

9 issuers, physicians, hospitals, nursing homes,

10 long-term care providers, and other providers;

11 and

12 ‘‘(C) measures which may inform health

13 care decisions made by consumers and patients.

14 ‘‘(3) RISK ADJUSTMENT.—The Secretary shall

15 establish procedures to account for differences in pa16 tient health status, patient characteristics, and geo17 graphic location. To the extent practicable, such pro18 cedures shall recognize existing procedures.

19 ‘‘(4) MAINTENANCE.—The Secretary shall, as

20 determined appropriate, but in no case more often

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

22 quality measures, including through the addition of

23 more accurate and precise measures and the retire24 ment of existing outdated measures.
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1 ‘‘(5) RELATIONSHIP WITH PROGRAMS UNDER

2 THE SOCIAL SECURITY ACT.—The Secretary shall

3 ensure that the quality measures developed under

4 this section—

5 ‘‘(A) complement quality measures devel6 oped by the Secretary under programs adminis7 tered by the Secretary under the Social Security

8 Act, including programs under titles XVIII,

9 XIX, and XXI of such Act; and

10 ‘‘(B) do not conflict with the needs and

11 priorities of the programs under titles XVIII,

12 XIX, and XXI of such Act, as set forth by the

13 Administrator of the Centers for Medicare &

14 Medicaid Services.

15 ‘‘(c) REQUIRED CONSIDERATIONS IN DEVELOPING

16 AND UPDATING THE MEASURES.—In developing and up17 dating the quality measures under this section, the Sec18 retary may take into account—

19 ‘‘(1) any demonstration or pilot program con20 ducted by the Secretary relating to measuring and

21 rewarding quality and efficiency of care;

22 ‘‘(2) any existing activities conducted by the

23 Secretary relating to measuring and rewarding qual24 ity and efficiency;
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1 ‘‘(3) any existing activities conducted by private

2 entities, including health insurance plans and

3 payors;

4 ‘‘(4) the report by the Institute of Medicine of

5 the National Academy of Sciences under section

6 238(b) of the Medicare Prescription Drug, Improve7 ment, and Modernization Act of 2003; and

8 ‘‘(5) issues of data collection and reporting, in9 cluding the feasibility of collecting and reporting

10 data on measures.

11 ‘‘(d) SOLICITATION OF ADVICE AND RECOMMENDA12 TIONS.—On and after July 1, 2006, the Secretary shall

13 consult with the following regarding the development, up14 dating, and use of quality measures developed under this

15 section:

16 ‘‘(1) Health insurance plans and health care

17 providers, including such plans and providers with

18 experience in the care of the frail elderly and indi19 viduals with multiple complex chronic conditions, or

20 groups representing such health insurance plans and

21 providers.

22 ‘‘(2) Groups representing patients and con23 sumers.

24 ‘‘(3) Purchasers and employers or groups rep25 resenting purchasers or employers.
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1 ‘‘(4) Organizations that focus on quality im2 provement as well as the measurement and reporting

3 of quality measures.

4 ‘‘(5) Organizations that certify and license

5 health care providers.

6 ‘‘(6) State government public health programs.

7 ‘‘(7) Individuals or entities skilled in the con8 duct and interpretation of biomedical, health serv9 ices, and health economics research and with exper10 tise in outcomes and effectiveness research and tech11 nology assessment.

12 ‘‘(8) Individuals or entities involved in the de13 velopment and establishment of standards and cer14 tification for health information technology systems

15 and clinical data.

16 ‘‘(9) Individuals or entities with experience

17 with—

18 ‘‘(A) urban health care issues;

19 ‘‘(B) safety net health care issues; and

20 ‘‘(C) rural and frontier health care issues.

21 ‘‘(e) USE OF QUALITY MEASURES.—

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

23 conducted or supported by the Secretary under this

24 Act, the Secretary shall, to the extent practicable,
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1 adopt and utilize the quality measures developed

2 under this section.

3 ‘‘(2) COLLABORATIVE AGREEMENTS.—With re4 spect to activities conducted or supported by the

5 Secretary under this Act, the Secretary may estab6 lish collaborative agreements with private entities,

7 including group health plans and health insurance

8 issuers, providers, purchasers, consumer organiza9 tions, and entities receiving a grant under section

10 2905, to—

11 ‘‘(A) encourage the use of the quality

12 measures adopted by the Secretary under this

13 section; and

14 ‘‘(B) foster uniformity between the health

15 care quality measures utilized by private enti16 ties.

17 ‘‘(3) REPORTING.—The Secretary shall imple18 ment procedures to enable the Department of

19 Health and Human Services to accept the electronic

20 submission of data for purposes of—

21 ‘‘(A) quality measurement using the qual22 ity measures developed under this section and

23 using the standards adopted by the Federal

24 Government under section 2903; and
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1 ‘‘(B) for reporting measures used to make

2 value-based payments under programs under

3 the Social Security Act.

4 ‘‘(f) DISSEMINATION OF INFORMATION.—Beginning

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

6 information available to health care consumers, health

7 professionals, public health officials, researchers, and

8 other appropriate individuals and entities, the Secretary

9 shall provide for the dissemination, aggregation, and anal10 ysis of quality measures collected under section 2905 and

11 the dissemination of recommendations and best practices

12 derived in part from such analysis.

13 ‘‘(g) TECHNICAL ASSISTANCE.—The Secretary shall

14 provide technical assistance to public and private entities

15 to enable such entities to—

16 ‘‘(1) implement and use evidence-based guide17 lines with the greatest potential to improve health

18 care quality, efficiency, and patient safety; and

19 ‘‘(2) establish mechanisms for the rapid dis20 semination of information regarding evidence-based

21 guidelines with the greatest potential to improve

22 health care quality, efficiency, and patient safety.

23 ‘‘(h) RULE OF CONSTRUCTION.—Nothing in this title

24 shall be construed as prohibiting the Secretary, acting

25 through the Administrator of the Centers for Medicare &
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1 Medicaid Services, from developing quality measures (and

2 timing requirements for reporting such measures) for use

3 under programs administered by the Secretary under the

4 Social Security Act, including programs under titles

5 XVIII, XIX, and XXI of such Act.’’.

6 SEC. 3. LICENSURE AND THE ELECTRONIC EXCHANGE OF

7 HEALTH INFORMATION.

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

9 Human Services shall carry out, or contract with a private

10 entity to carry out, a study that examines—

11 (1) the variation among State laws that relate

12 to the licensure, registration, and certification of

13 medical professionals; and

14 (2) how such variation among State laws im15 pacts the secure electronic exchange of health

16 information—

17 (A) among the States; and

18 (B) between the States and the Federal

19 Government.

20 (b) REPORT AND RECOMMENDATIONS.—Not later

21 than 1 year after the date of enactment of this Act, the

22 Secretary of Health and Human Services shall publish a

23 report that—

24 (1) describes the results of the study carried

25 out under subsection (a); and
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1 (2) makes recommendations to States regarding

2 the harmonization of State laws based on the results

3 of such study.

4 SEC. 4. ENSURING PRIVACY AND SECURITY.

5 Nothing in this Act (or the amendments made by this

6 Act) shall be construed to affect the scope, substance, or

7 applicability of—

8 (1) section 264 of the Health Insurance Port9 ability and Accountability Act of 1996;

10 (2) sections 1171 through 1179 of the Social

11 Security Act; and

12 (3) any regulation issued pursuant to any such

13 section.

14 SEC. 5. GAO STUDY.

15 Not later than 6 months after the date of enactment

16 of this Act, the Comptroller General of the United States

17 shall submit to Congress a report on the necessity and

18 workability of requiring health plans (as defined in section

19 1171 of the Social Security Act (42 U.S.C. 1320d)),

20 health care clearinghouses (as defined in such section

21 1171), and health care providers (as defined in such sec22 tion 1171) who transmit health information in electronic

23 form, to notify patients if their individually identifiable

24 health information (as defined in such section 1171) is

25 wrongfully disclosed.
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1 SEC. 6. STUDY OF REIMBURSEMENT INCENTIVES.

2 The Secretary of Health and Human Services shall

3 carry out, or contract with a private entity to carry out,

4 a study that examines methods to create efficient reim5 bursement incentives for improving health care quality in

6 Federally qualified health centers, rural health clinics, and

7 free clinics.

8 SEC. 7. HEALTH INFORMATION TECHNOLOGY RESOURCE

9 CENTER.

10 Section 914 of the Public Health Service Act (42

11 U.S.C. 299b–3) is amended by adding at the end the fol12 lowing:

13 ‘‘(d) HEALTH INFORMATION TECHNOLOGY RE14 SOURCE CENTER.—

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

16 through the Director, shall develop a Health Infor17 mation Technology Resource Center to provide tech18 nical assistance and develop best practices to sup19 port and accelerate efforts to adopt, implement, and

20 effectively use interoperable health information tech21 nology in compliance with section 2903 and 2907.

22 ‘‘(2) PURPOSES.—The purpose of the Center is

23 to—

24 ‘‘(A) provide a forum for the exchange of

25 knowledge and experience;
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1 ‘‘(B) accelerate the transfer of lessons

2 learned from existing public and private sector

3 initiatives, including those currently receiving

4 Federal financial support;

5 ‘‘(C) assemble, analyze, and widely dis6 seminate evidence and experience related to the

7 adoption, implementation, and effective use of

8 interoperable health information technology.

9 ‘‘(D) provide for the establishment of re10 gional and local health information networks to

11 facilitate the development of interoperability

12 across health care settings and improve the

13 quality of health care;

14 ‘‘(E) provide for the development of solu15 tions to barriers to the exchange of electronic

16 health information; and

17 ‘‘(F) conduct other activities identified by

18 the States, local or regional health information

19 networks, or health care stakeholders as a focus

20 for developing and sharing best practices.

21 ‘‘(3) SUPPORT FOR ACTIVITIES.—To provide

22 support for the activities of the Center, the Director

23 shall modify the requirements, if necessary, that

24 apply to the National Resource Center for Health

25 Information Technology to provide the necessary in-
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1 frastructure to support the duties and activities of

2 the Center and facilitate information exchange

3 across the public and private sectors.

4 ‘‘(4) RULE OF CONSTRUCTION.—Nothing in

5 this subsection shall be construed to require the du6 plication of Federal efforts with respect to the estab7 lishment of the Center, regardless of whether such

8 efforts were carried out prior to or after the enact9 ment of this subsection.

10 ‘‘(e) TECHNICAL ASSISTANCE TELEPHONE NUMBER

11 OR WEBSITE.—The Secretary shall establish a toll-free

12 telephone number or Internet website to provide health

13 care providers and patients with a single point of contact

14 to—

15 ‘‘(1) learn about Federal grants and technical

16 assistance services related to interoperable health in17 formation technology;

18 ‘‘(2) learn about qualified health information

19 technology and the quality measures adopted by the

20 Federal Government under sections 2903 and 2907;

21 ‘‘(3) learn about regional and local health infor22 mation networks for assistance with health informa23 tion technology; and

24 ‘‘(4) disseminate additional information deter25 mined by the Secretary.
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1 ‘‘(f) AUTHORIZATION OF APPROPRIATIONS.—There

2 is authorized to be appropriated, such sums as may be

3 necessary for each of fiscal years 2006 and 2007 to carry

4 out this subsection.’’.

5 SEC. 8. REAUTHORIZATION OF INCENTIVE GRANTS RE6 GARDING TELEMEDICINE.

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

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

9 2006’’ and inserting ‘‘2006 through 2010’’.

Passed the Senate November 18 (legislative day, November 17), 2005.

Attest:

Secretary.
109TH CONGRESS

1ST SESSION S. 1418

AN ACT

To enhance the adoption of a nationwide interoperhealth care in the United States. improve the quality and reduce the costs of able health information technology system and to