II 

Calendar No. 178 

109TH CONGRESS 

1ST SESSION S. 1418 

[Report No. 109–111] 

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, Mr. NELSON of Florida, Mr. GREGG, Mr. ENSIGN, Mr. SESSIONS, 

Mr. REED, Ms. LANDRIEU, Mr. CARPER, and Mr.DURBIN) introduced the 

following bill; which was read twice and referred to the Committee on 

Health, Education, Labor, and Pensions 

JULY 27, 2005 

Reported by Mr. ENZI, with an amendment 

[Strike out all after the enacting clause and insert the part printed in italic] 

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, 
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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Wired for Health Care 

3 Quality Act’’. 

4 SEC. 2. IMPROVING HEALTH CARE, QUALITY, SAFETY, AND 

5 EFFICIENCY. 

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

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

8 ‘‘TITLE XXIX—HEALTH 

9 INFORMATION TECHNOLOGY 

10 ‘‘SEC. 2901. DEFINITIONS. 

11 ‘‘In this title: 

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

13 ‘health care provider’ means a hospital, skilled nurs14 ing facility, home health entity, health care clinic, 

15 federally qualified health center, group practice (as 

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

17 Act), a pharmacist, a pharmacy, a laboratory, a phy18 sician (as defined in section 1861(r) of the Social 

19 Security Act), a health facility operated by or pursu20 ant to a contract with the Indian Health Service, a 

21 rural health clinic, and any other category of facility 

22 or clinician determined 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) LABORATORY.—The term ‘laboratory’ has 

10 the meaning given that term in section 353. 

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

12 the meaning given that term in section 804 of the 

13 Federal Food, Drug, and Cosmetic Act. 

14 ‘‘(6) QUALIFIED HEALTH INFORMATION TECH15 NOLOGY.—The term ‘qualified health information 

16 technology’ means a computerized system (including 

17 hardware, software, and training) that— 

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

19 health information; 

20 ‘‘(B) maintains and provides permitted ac21 cess to health information in an electronic for22 mat; 

23 ‘‘(C) incorporates decision support to re24 duce medical errors and enhance health care 

25 quality; 
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1 ‘‘(D) complies with the standards adopted 

2 by the Federal Government under section 2903; 

3 and 

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

5 measures under section 2908. 

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

7 the several States, the District of Columbia, Puerto 

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

9 and the Northern Mariana Islands. 

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

11 HEALTH INFORMATION TECHNOLOGY. 

12 ‘‘(a) OFFICE OF NATIONAL HEALTH INFORMATION

13 TECHNOLOGY.—There is established within the Office of 

14 the Secretary an Office of the National Coordinator of 

15 Health Information Technology (referred to in this section 

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

17 Coordinator who shall be appointed by the President, in 

18 consultation with the Secretary, and shall report directly 

19 to the Secretary. 

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

21 to carry out programs and activities to develop a nation22 wide interoperable health information technology infra23 structure that— 

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

25 is secure and protected; 
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1 ‘‘(2) improves health care quality, reduces med2 ical errors, and advances the delivery of patient-cen3 tered medical care; 

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

5 inefficiency, medical errors, inappropriate care, and 

6 incomplete information; 

7 ‘‘(4) ensures that appropriate information to 

8 help guide medical decisions is available at the time 

9 and place of care; 

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

11 greater competition, and increased choice through 

12 the wider availability of accurate information on 

13 health care costs, quality, and outcomes; 

14 ‘‘(6) improves the coordination of care and in15 formation among hospitals, laboratories, physician 

16 offices, and other entities through an effective infra17 structure for the secure and authorized exchange of 

18 health care information; 

19 ‘‘(7) improves public health reporting and facili20 tates the early identification and rapid response to 

21 public health threats and emergencies, including bio22 terror events and infectious disease outbreaks; 

23 ‘‘(8) facilitates health research; and 

24 ‘‘(9) promotes prevention of chronic diseases. 
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1 ‘‘(c) DUTIES OF THE NATIONAL COORDINATOR.— 

2 The National Coordinator shall— 

3 ‘‘(1) serve as a member of the public-private 

4 American Health Information Collaborative estab5 lished under section 2903; 

6 ‘‘(2) serve as the principal advisor to the Sec7 retary concerning the development, application, and 

8 use of health information technology, and coordinate 

9 and oversee the health information technology pro10 grams of the Department; 

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

12 interoperable system for the electronic exchange of 

13 health information; 

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

15 standards for the electronic exchange of health infor16 mation to reduce cost and improve health care qual17 ity; 

18 ‘‘(5) ensure that health information technology 

19 policy and programs of the Department are coordi20 nated with those of relevant executive branch agen21 cies (including Federal commissions) with a goal of 

22 avoiding duplication of efforts and of helping to en23 sure that each agency undertakes health information 

24 technology activities primarily within the areas of its 

25 greatest expertise and technical capability; 
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1 ‘‘(6) to the extent permitted by law, coordinate 

2 outreach and consultation by the relevant executive 

3 branch agencies (including Federal commissions) 

4 with public and private parties of interest, including 

5 consumers, payers, employers, hospitals and other 

6 health care providers, physicians, community health 

7 centers, laboratories, vendors and other stake8 holders; 

9 ‘‘(7) advise the President regarding specific 

10 Federal health information technology programs; 

11 and 

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

13 2903(i) (excluding paragraph (4) of such section). 

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

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

16 National Coordinator, the head of any Federal agen17 cy is authorized to detail, with or without reimburse18 ment from the Office, any of the personnel of such 

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

20 duties under this section. 

21 ‘‘(2) EFFECT OF DETAIL.—Any detail of per22 sonnel under paragraph (1) shall— 

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

24 civil service status or privileges of the Federal 

25 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 
28 

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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; 
31 

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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 

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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 

•S 1418 RS 

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. 
38 

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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 

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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 RS 

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 

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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 

•S 1418 RS 

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 

•S 1418 RS 

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 

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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 RS 

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 RS 

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 RS 

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 

•S 1418 RS 

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 

•S 1418 RS 

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’’. 

6 SECTION 1. SHORT TITLE. 

7 This Act may be cited as the ‘‘Wired for Health Care 

8 Quality Act’’. 

9 SEC. 2. IMPROVING HEALTH CARE QUALITY, SAFETY, AND 

10 EFFICIENCY. 

11 The Public Health Service Act (42 U.S.C. 201 et seq.) 

12 is amended by adding at the end the following: 

13 ‘‘TITLE XXIX—HEALTH INFORMA14 TION TECHNOLOGY AND 

15 QUALITY 

16 ‘‘SEC. 2901. DEFINITIONS. 

17 ‘‘In this title: 

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

19 ‘health care provider’ means a hospital, skilled nurs20 ing facility, home health entity, health care clinic, 

21 federally qualified health center, group practice (as 

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

23 Act), a pharmacist, a pharmacy, a laboratory, a phy24 sician (as defined in section 1861(r) of the Social Se25 curity Act), a health facility operated by or pursuant 

26 to a contract with the Indian Health Service, a rural 
54 

•S 1418 RS 

1 health clinic, and any other category of facility or cli2 nician determined appropriate by the Secretary. 

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

4 information’ has the meaning given such term in sec5 tion 1171(4) of the Social Security Act. 

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

7 ‘health insurance plan’ means— 

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

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

10 ‘‘(B) a group health plan (as defined in sec11 tion 2791(a)(1)); and 

12 ‘‘(C) a health maintenance organization (as 

13 defined in section 2791(b)(3)). 

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

15 the meaning given that term in section 353. 

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

17 the meaning given that term in section 804 of the 

18 Federal Food, Drug, and Cosmetic Act. 

19 ‘‘(6) QUALIFIED HEALTH INFORMATION TECH20 NOLOGY.—The term ‘qualified health information 

21 technology’ means a computerized system (including 

22 hardware and software) that— 

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

24 health information; 
55 

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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 reduce 

5 medical errors and enhance health care quality; 

6 ‘‘(D) complies with the standards adopted 

7 by the Federal Government under section 2903; 

8 and 

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

10 measures under section 2908. 

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

12 several States, the District of Columbia, Puerto Rico, 

13 the Virgin Islands, Guam, American Samoa, and the 

14 Northern Mariana Islands. 

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

16 HEALTH INFORMATION TECHNOLOGY. 

17 ‘‘(a) OFFICE OF NATIONAL HEALTH INFORMATION

18 TECHNOLOGY.—There is established within the Office of the 

19 Secretary an Office of the National Coordinator of Health 

20 Information Technology (referred to in this section as the 

21 ‘Office’). The Office shall be headed by a National Coordi22 nator who shall be appointed by the President, in consulta23 tion with the Secretary, and shall report directly to the Sec24 retary. 
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1 ‘‘(b) PURPOSE.—It shall be the purpose of the Office 

2 to coordinate and oversee programs and activities to develop 

3 a nationwide interoperable health information technology 

4 infrastructure that— 

5 ‘‘(1) ensures that patients’ health information is 

6 secure and protected; 

7 ‘‘(2) improves health care quality, reduces med8 ical errors, and advances the delivery of patient-cen9 tered medical care; 

10 ‘‘(3) reduces health care costs resulting from inef11 ficiency, medical errors, inappropriate care, and in12 complete information; 

13 ‘‘(4) ensures that appropriate information to 

14 help guide medical decisions is available at the time 

15 and place of care; 

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

17 greater competition, and increased choice through the 

18 wider availability of accurate information on health 

19 care costs, quality, and outcomes; 

20 ‘‘(6) improves the coordination of care and infor21 mation among hospitals, laboratories, physician of22 fices, and other entities through an effective infra23 structure for the secure and authorized exchange of 

24 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.—The 

8 National Coordinator shall— 

9 ‘‘(1) serve as a member of the public-private 

10 American Health Information Collaborative estab11 lished under section 2903; 

12 ‘‘(2) serve as the principal advisor to the Sec13 retary concerning the development, application, and 

14 use of health information technology, and coordinate 

15 and oversee the health information technology pro16 grams of the Department; 

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

18 interoperable system for the electronic exchange of 

19 health information; 

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

21 standards for the electronic exchange of health infor22 mation to reduce cost and improve health care qual23 ity; 

24 ‘‘(5) ensure that health information technology 

25 policy and programs of the Department are coordi-
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1 nated with those of relevant executive branch agencies 

2 (including Federal commissions) with a goal of avoid3 ing duplication of efforts and of helping to ensure 

4 that each agency undertakes health information tech5 nology activities primarily within the areas of its 

6 greatest expertise and technical capability; 

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

8 outreach and consultation by the relevant executive 

9 branch agencies (including Federal commissions) with 

10 public and private parties of interest, including con11 sumers, payers, employers, hospitals and other health 

12 care providers, physicians, community health centers, 

13 laboratories, vendors and other stakeholders; 

14 ‘‘(7) advise the President regarding specific Fed15 eral health information technology programs; and 

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

17 2903(i) (excluding paragraph (4) of such section). 

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

19 ‘‘(1) IN GENERAL.—Upon the request of the Na20 tional Coordinator, the head of any Federal agency is 

21 authorized to detail, with or without reimbursement 

22 from the Office, any of the personnel of such agency 

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

24 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 the 

7 Department employed by the National Coordi8 nator. 

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

11 accept detailed personnel from other Federal agencies 

12 without regard to whether the agency described under 

13 paragraph (1) is reimbursed. 

14 ‘‘(e) RULE OF CONSTRUCTION.—Nothing in this sec15 tion shall be construed to require the duplication of Federal 

16 efforts with respect to the establishment of the Office, regard17 less of whether such efforts were carried out prior to or after 

18 the enactment of this title. 

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

20 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 fiscal 

23 years 2008 through 2010. 
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1 ‘‘SEC. 2903. AMERICAN HEALTH INFORMATION COLLABO2 RATIVE. 

3 ‘‘(a) PURPOSE.—The Secretary shall establish the pub4 lic-private American Health Information Collaborative (re5 ferred 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 a 

10 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 2908) 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— 

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

23 chairperson of the Collaborative; 

24 ‘‘(B) the Secretary of Defense, or his or her 

25 designee; 
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1 ‘‘(C) the Secretary of Veterans Affairs, or 

2 his or her designee; 

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

4 her designee; 

5 ‘‘(E) the National Coordinator for Health 

6 Information Technology; 

7 ‘‘(F) representatives of other relevant Fed8 eral agencies, as determined appropriate by the 

9 Secretary; and 

10 ‘‘(G) representatives from each of the fol11 lowing categories to be appointed by the Sec12 retary from nominations submitted by the pub13 lic— 

14 ‘‘(i) consumer and patient organiza15 tions; 

16 ‘‘(ii) experts in health information pri17 vacy and security; 

18 ‘‘(iii) health care providers; 

19 ‘‘(iv) health insurance plans or other 

20 third party payors; 

21 ‘‘(v) standards development organiza22 tions; 

23 ‘‘(vi) information technology vendors; 

24 ‘‘(vii) purchasers or employers; and 
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1 ‘‘(viii) State or local government agen2 cies or Indian tribe or tribal organizations. 

3 ‘‘(2) CONSIDERATIONS.—In appointing members 

4 under paragraph (1)(G), the Secretary shall select in5 dividuals with expertise in— 

6 ‘‘(A) health information privacy; 

7 ‘‘(B) health information security; 

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

9 including those individuals with expertise in uti10 lizing health information technology to improve 

11 health care quality and patient safety; 

12 ‘‘(D) data exchange; and 

13 ‘‘(E) developing health information tech14 nology standards and new health information 

15 technology. 

16 ‘‘(3) PARTICIPATION.—Membership and proce17 dures of the Collaborative shall ensure a balance 

18 among various sectors of the healthcare system so that 

19 no single sector unduly influences the recommenda20 tions of the Collaborative. 

21 ‘‘(4) TERMS.—Members appointed under para22 graph (1)(G) shall serve for 2 year terms, except that 

23 any member appointed to fill a vacancy for an unex24 pired term shall be appointed for the remainder of 

25 such term. A member may serve for not to exceed 180 
63 

•S 1418 RS 

1 days after the expiration of such member’s term or 

2 until a successor has been appointed. 

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

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

5 annually thereafter, the Collaborative shall recommend to 

6 the Secretary uniform national policies for adoption by the 

7 Federal Government and voluntary adoption by private en8 tities to support the widespread adoption of health informa9 tion technology, including— 

10 ‘‘(1) protection of health information through 

11 privacy and security practices; 

12 ‘‘(2) measures to prevent unauthorized access to 

13 health information; 

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

15 health information; 

16 ‘‘(4) fostering the public understanding of health 

17 information technology; 

18 ‘‘(5) the ongoing harmonization of industry-wide 

19 health information technology standards; 

20 ‘‘(6) recommendations for a nationwide inter21 operable health information technology infrastructure; 

22 ‘‘(7) the identification and prioritization of spe23 cific use cases for which health information technology 

24 is valuable, beneficial, and feasible; 
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1 ‘‘(8) recommendations for the establishment of an 

2 entity to ensure the continuation of the functions of 

3 the Collaborative; and 

4 ‘‘(9) other policies (including recommendations 

5 for incorporating health information technology into 

6 the provision of care and the organization of the 

7 health care workplace) determined to be necessary by 

8 the Collaborative. 

9 ‘‘(d) STANDARDS.— 

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

11 adopted by the Consolidated Health Informatics Ini12 tiative shall be deemed to have been recommended by 

13 the Collaborative under this section. 

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

15 year after the date of enactment of this title, the Col16 laborative shall— 

17 ‘‘(A) review existing standards (including 

18 content, communication, and security standards) 

19 for the electronic exchange of health information, 

20 including such standards adopted by the Sec21 retary under paragraph (2)(A); 

22 ‘‘(B) identify deficiencies and omissions in 

23 such existing standards; and 

24 ‘‘(C) identify duplication and overlap in 

25 such existing standards; 
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1 and recommend new standards and modifications to 

2 such existing standards as necessary. 

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

4 the date of enactment of this title, and annually 

5 thereafter, the Collaborative shall— 

6 ‘‘(A) review existing standards (including 

7 content, communication, and security standards) 

8 for the electronic exchange of health information, 

9 including such standards adopted by the Sec10 retary under paragraph (2)(A); 

11 ‘‘(B) identify deficiencies and omissions in 

12 such existing standards; and 

13 ‘‘(C) identify duplication and overlap in 

14 such existing standards; 

15 and recommend new standards and modifications to 

16 such existing standards as necessary. 

17 ‘‘(4) LIMITATION.—The standards and timeframe 

18 for adoption described in this section shall be con19 sistent with any standards developed pursuant to the 

20 Health Insurance Portability and Accountability Act 

21 of 1996. 

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

23 the issuance of a recommendation from the Collaborative 

24 under subsection (d)(2), the Secretary of Health and 

25 Human Services, the Secretary of Veterans Affairs, and the 
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1 Secretary of Defense, in collaboration with representatives 

2 of other relevant Federal agencies, as determined appro3 priate by the Secretary, shall jointly review such rec4 ommendations. The Secretary shall provide for the adoption 

5 by the Federal Government of any standard or standards 

6 contained in such recommendation. 

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

8 later than 1 year after the adoption by the Federal Govern9 ment of a recommendation as provided for in subsection 

10 (e), and in compliance with chapter 113 of title 40, United 

11 States Code, no Federal agency shall expend Federal funds 

12 for the purchase of any form of health information tech13 nology or health information technology system for clinical 

14 care or for the electronic retrieval, storage, or exchange of 

15 health information that is not consistent with applicable 

16 standards adopted by the Federal Government under sub17 section (e). 

18 ‘‘(g) COORDINATION OF FEDERAL DATA COLLEC19 TION.—Not later than 3 years after the adoption by the 

20 Federal Government of a recommendation as provided for 

21 in subsection (e), all Federal agencies collecting health data 

22 for the purposes of quality reporting, surveillance, epidemi23 ology, adverse event reporting, research, or for other pur24 poses determined appropriate by the Secretary, shall com25 ply with standards adopted under subsection (e). 
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1 ‘‘(h) VOLUNTARY ADOPTION.— 

2 ‘‘(1) IN GENERAL.—Any standards adopted by 

3 the Federal Government under subsection (e) shall be 

4 voluntary with respect to private entities. 

5 ‘‘(2) RULE OF CONSTRUCTION.—Nothing in this 

6 section shall be construed to require that a private en7 tity that enters into a contract with the Federal Gov8 ernment adopt the standards adopted by the Federal 

9 Government under section 2903 with respect to activi10 ties not related to the contract. 

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

12 into a contract with the Federal Government shall 

13 adopt the standards adopted by the Federal Govern14 ment under section 2903 for the purpose of activities 

15 under such Federal contract. 

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

17 Committee on Health, Education, Labor, and Pensions and 

18 the Committee on Finance of the Senate and the Committee 

19 on Energy and Commerce and the Committee on Ways and 

20 Means of the House of Representatives, on an annual basis, 

21 a report that— 

22 ‘‘(1) describes the specific actions that have been 

23 taken by the Federal Government and private entities 

24 to facilitate the adoption of an interoperable nation-
68 

•S 1418 RS 

1 wide system for the electronic exchange of health in2 formation; 

3 ‘‘(2) describes barriers to the adoption of such a 

4 nationwide system; 

5 ‘‘(3) contains recommendations to achieve full 

6 implementation of such a nationwide system; and 

7 ‘‘(4) contains a plan and progress toward the es8 tablishment of an entity to ensure the continuation of 

9 the functions of the Collaborative. 

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

11 Committee Act (5 U.S.C. App.) shall apply to the Collabo12 rative, except that the term provided for under section 

13 14(a)(2) shall be 5 years. 

14 ‘‘(k) RULE OF CONSTRUCTION.—Nothing in this sec15 tion shall be construed to require the duplication of Federal 

16 efforts with respect to the establishment of the Collaborative, 

17 regardless of whether such efforts were carried out prior to 

18 or after the enactment of this title. 

19 ‘‘(l) AUTHORIZATION OF APPROPRIATIONS.—There are 

20 authorized to be appropriated to carry out this section, 

21 $4,000,000 for fiscal year 2006, $4,000,000 for fiscal year 

22 2007, and such sums as may be necessary for each of fiscal 

23 years 2008 through 2010. 
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1 ‘‘SEC. 2904. IMPLEMENTATION AND CERTIFICATION OF 

2 HEALTH INFORMATION STANDARDS. 

3 ‘‘(a) IMPLEMENTATION.— 

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

5 the recommendations of the Collaborative, shall de6 velop criteria to ensure uniform and consistent imple7 mentation of any standards for the electronic ex8 change of health information voluntarily adopted by 

9 private entities in technical conformance with such 

10 standards adopted under this title. 

11 ‘‘(2) IMPLEMENTATION ASSISTANCE.—The Sec12 retary may recognize a private entity or entities to 

13 assist private entities in the implementation of the 

14 standards adopted under this title using the criteria 

15 developed by the Secretary under this section. 

16 ‘‘(b) CERTIFICATION.— 

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

18 the recommendations of the Collaborative, shall de19 velop criteria to ensure and certify that hardware and 

20 software that claim to be in compliance with any 

21 standard for the electronic exchange of health infor22 mation adopted under this title have established and 

23 maintained such compliance in technical conformance 

24 with such standards. 

25 ‘‘(2) CERTIFICATION ASSISTANCE.—The Sec26 retary may recognize a private entity or entities to 
70 

•S 1418 RS 

1 assist in the certification described under paragraph 

2 (1) using the criteria developed by the Secretary 

3 under this section. 

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

5 through consultation with the Collaborative, may accept 

6 recommendations on the development of the criteria under 

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

8 entity. 

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

10 ADOPTION OF INTEROPERABLE HEALTH IN11 FORMATION TECHNOLOGY. 

12 ‘‘(a) COMPETITIVE GRANTS TO FACILITATE THE

13 WIDESPREAD ADOPTION OF HEALTH INFORMATION TECH14 NOLOGY.— 

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

16 competitive grants to eligible entities to facilitate the 

17 purchase and enhance the utilization of qualified 

18 health information technology systems to improve the 

19 quality and efficiency of health care. 

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

21 grant under paragraph (1) an entity shall— 

22 ‘‘(A) submit to the Secretary an application 

23 at such time, in such manner, and containing 

24 such information as the Secretary may require; 
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•S 1418 RS 

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

2 plan for the implementation of data sharing and 

3 interoperability measures; 

4 ‘‘(C) be a— 

5 ‘‘(i) not for profit hospital; 

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

7 ‘‘(iii) another health care provider not 

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

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

10 Federal Government under section 2903; 

11 ‘‘(E) implement the measurement system 

12 adopted under section 2908 and report to the 

13 Secretary on such measures; 

14 ‘‘(F) demonstrate significant financial need; 

15 and 

16 ‘‘(G) provide matching funds in accordance 

17 with paragraph (4). 

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

19 grant under this subsection shall be used to facilitate 

20 the purchase and enhance the utilization of qualified 

21 health information technology systems and training 

22 personnel in the use of such technology. 

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

24 for a grant under this subsection an entity shall con25 tribute non-Federal contributions to the costs of car-
72 

•S 1418 RS 

1 rying out the activities for which the grant is award2 ed in an amount equal to $1 for each $3 of Federal 

3 funds provided under the grant. 

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

5 awarding grants under this subsection the Secretary 

6 shall give preference to— 

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

8 rural, frontier, and other underserved areas as 

9 determined by the Secretary; 

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

11 extent practicable, the qualified health informa12 tion system to local or regional health informa13 tion plan or plans; and 

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

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

16 provider. 

17 ‘‘(b) COMPETITIVE GRANTS TO STATES FOR THE DE18 VELOPMENT OF STATE LOAN PROGRAMS TO FACILITATE

19 THE WIDESPREAD ADOPTION OF HEALTH INFORMATION

20 TECHNOLOGY.— 

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

22 competitive grants to States for the establishment of 

23 State programs for loans to health care providers to 

24 facilitate the purchase and enhance the utilization of 

25 qualified health information technology. 
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1 ‘‘(2) ESTABLISHMENT OF FUND.—To be eligible 

2 to receive a competitive grant under this subsection, 

3 a State shall establish a qualified health information 

4 technology loan fund (referred to in this subsection as 

5 a ‘State loan fund’) and comply with the other re6 quirements contained in this section. A grant to a 

7 State under this subsection shall be deposited in the 

8 State loan fund established by the State. No funds au9 thorized by other provisions of this title to be used for 

10 other purposes specified in this title shall be deposited 

11 in any State loan fund. 

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

13 grant under paragraph (1) a State shall— 

14 ‘‘(A) submit to the Secretary an application 

15 at such time, in such manner, and containing 

16 such information as the Secretary may require; 

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

18 plan in accordance with paragraph (4); 

19 ‘‘(C) establish a qualified health informa20 tion technology loan fund in accordance with 

21 paragraph (2); 

22 ‘‘(D) require that health care providers re23 ceiving such loans— 

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

25 qualified health information system to a 
74 

•S 1418 RS 

1 local or regional health information net2 work; and 

3 ‘‘(ii) consult with the Health Informa4 tion Technology Resource Center established 

5 in section 914(d) to access the knowledge 

6 and experience of existing initiatives re7 garding the successful implementation and 

8 effective use of health information tech9 nology; 

10 ‘‘(E) require that health care providers re11 ceiving such loans adopt the standards adopted 

12 by the Federal Government under section 2903; 

13 ‘‘(F) require that health care providers re14 ceiving such loans implement the measurement 

15 system adopted under section 2908 and report to 

16 the Secretary on such measures; and 

17 ‘‘(G) provide matching funds in accordance 

18 with paragraph (8). 

19 ‘‘(4) STRATEGIC PLAN.— 

20 ‘‘(A) IN GENERAL.—A State that receives a 

21 grant under this subsection shall annually pre22 pare a strategic plan that identifies the intended 

23 uses of amounts available to the State loan fund 

24 of the State. 
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1 ‘‘(B) CONTENTS.—A strategic plan under 

2 subparagraph (A) shall include— 

3 ‘‘(i) a list of the projects to be assisted 

4 through the State loan fund in the first fis5 cal year that begins after the date on which 

6 the plan is submitted; 

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

8 methods established for the distribution of 

9 funds from the State loan fund; and 

10 ‘‘(iii) a description of the financial 

11 status of the State loan fund and the short12 term and long-term goals of the State loan 

13 fund. 

14 ‘‘(5) USE OF FUNDS.— 

15 ‘‘(A) IN GENERAL.—Amounts deposited in a 

16 State loan fund, including loan repayments and 

17 interest earned on such amounts, shall be used 

18 only for awarding loans or loan guarantees, or 

19 as a source of reserve and security for leveraged 

20 loans, the proceeds of which are deposited in the 

21 State loan fund established under paragraph (1). 

22 Loans under this section may be used by a 

23 health care provider to facilitate the purchase 

24 and enhance the utilization of qualified health 
76 

•S 1418 RS 

1 information technology and training of personnel 

2 in the use of such technology. 

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

4 State under this subsection may not be used— 

5 ‘‘(i) for the purchase or other acquisi6 tion of any health information technology 

7 system that is not a qualified health infor8 mation technology system; 

9 ‘‘(ii) to conduct activities for which 

10 Federal funds are expended under this title, 

11 or the amendments made by the Wired for 

12 Health Care Quality Act; or 

13 ‘‘(iii) for any purpose other than mak14 ing loans to eligible entities under this sec15 tion. 

16 ‘‘(6) TYPES OF ASSISTANCE.—Except as other17 wise limited by applicable State law, amounts depos18 ited into a State loan fund under this subsection may 

19 only be used for the following: 

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

21 following: 

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

23 shall be less than or equal to the market in24 terest rate. 
77 

•S 1418 RS 

1 ‘‘(ii) The principal and interest pay2 ments on each loan shall commence not 

3 later than 1 year after the loan was award4 ed, and each loan shall be fully amortized 

5 not later than 10 years after the date of the 

6 loan. 

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

8 credited with all payments of principal and 

9 interest on each loan awarded from the 

10 fund. 

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

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

13 which finance a project eligible for assistance 

14 under this subsection) if the guarantee or pur15 chase would improve credit market access or re16 duce the interest rate applicable to the obligation 

17 involved. 

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

19 the payment of principal and interest on revenue 

20 or general obligation bonds issued by the State 

21 if the proceeds of the sale of the bonds will be de22 posited into the State loan fund. 

23 ‘‘(D) To earn interest on the amounts de24 posited into the State loan fund. 

25 ‘‘(7) ADMINISTRATION OF STATE LOAN FUNDS.— 
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1 ‘‘(A) COMBINED FINANCIAL ADMINISTRA2 TION.—A State may (as a convenience and to 

3 avoid unnecessary administrative costs) combine, 

4 in accordance with State law, the financial ad5 ministration of a State loan fund established 

6 under this subsection with the financial adminis7 tration of any other revolving fund established 

8 by the State if otherwise not prohibited by the 

9 law under which the State loan fund was estab10 lished. 

11 ‘‘(B) COST OF ADMINISTERING FUND.— 

12 Each State may annually use not to exceed 4 

13 percent of the funds provided to the State under 

14 a grant under this subsection to pay the reason15 able costs of the administration of the programs 

16 under this section, including the recovery of rea17 sonable costs expended to establish a State loan 

18 fund which are incurred after the date of enact19 ment of this title. 

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

21 Secretary shall publish guidance and promulgate 

22 regulations as may be necessary to carry out the 

23 provisions of this subsection, including— 

24 ‘‘(i) provisions to ensure that each 

25 State commits and expends funds allotted to 
79 

•S 1418 RS 

1 the State under this subsection as efficiently 

2 as possible in accordance with this title and 

3 applicable State laws; and 

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

5 and abuse. 

6 ‘‘(D) PRIVATE SECTOR CONTRIBUTIONS.— 

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

8 established under this subsection may accept 

9 contributions from private sector entities, 

10 except that such entities may not specify the 

11 recipient or recipients of any loan issued 

12 under this subsection. 

13 ‘‘(ii) AVAILABILITY OF INFORMA14 TION.—A State shall make publicly avail15 able the identity of, and amount contributed 

16 by, any private sector entity under clause 

17 (i) and may issue letters of commendation 

18 or make other awards (that have no finan19 cial value) to any such entity. 

20 ‘‘(8) MATCHING REQUIREMENTS.— 

21 ‘‘(A) IN GENERAL.—The Secretary may not 

22 make a grant under paragraph (1) to a State 

23 unless the State agrees to make available (di24 rectly or through donations from public or pri25 vate entities) non-Federal contributions in cash 
80 

•S 1418 RS 

1 toward the costs of the State program to be im2 plemented under the grant in an amount equal 

3 to not less than $1 for each $1 of Federal funds 

4 provided under the grant. 

5 ‘‘(B) DETERMINATION OF AMOUNT OF NON6 FEDERAL CONTRIBUTION.—In determining the 

7 amount of non-Federal contributions that a 

8 State has provided pursuant to subparagraph 

9 (A), the Secretary may not include any amounts 

10 provided to the State by the Federal Government. 

11 ‘‘(9) PREFERENCE IN AWARDING GRANTS.—The 

12 Secretary may give a preference in awarding grants 

13 under this subsection to States that adopt value-based 

14 purchasing programs to improve health care quality. 

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

16 submit to the Committee on Health, Education, 

17 Labor, and Pensions and the Committee on Finance 

18 of the Senate, and the Committee on Energy and 

19 Commerce and the Committee on Ways and Means of 

20 the House of Representatives, a report summarizing 

21 the reports received by the Secretary from each State 

22 that receives a grant under this subsection. 

23 ‘‘(c) COMPETITIVE GRANTS FOR THE IMPLEMENTA24 TION OF REGIONAL OR LOCAL HEALTH INFORMATION

25 TECHNOLOGY PLANS.— 
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1 ‘‘(1) IN GENERAL.—The Secretary may award 

2 competitive grants to eligible entities to implement re3 gional or local health information plans to improve 

4 health care quality and efficiency through the elec5 tronic exchange of health information pursuant to the 

6 standards, protocols, and other requirements adopted 

7 by the Secretary under sections 2903 and 2908. 

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

9 grant under paragraph (1) an entity shall— 

10 ‘‘(A) demonstrate financial need to the Sec11 retary; 

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

13 missions or purposes is to use information tech14 nology to improve health care quality and effi15 ciency; 

16 ‘‘(C) adopt bylaws, memoranda of under17 standing, or other charter documents that dem18 onstrate that the governance structure and deci19 sionmaking processes of such entity allow for 

20 participation on an ongoing basis by multiple 

21 stakeholders within a community, including— 

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

23 1861(r) of the Social Security Act), includ24 ing physicians that provide services to low 

25 income and underserved populations; 
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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) of 

9 the Social Security Act); 

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

11 section 1861(aa) of the Social Security Act); 

12 ‘‘(vii) patient or consumer organiza13 tions; 

14 ‘‘(viii) employers; and 

15 ‘‘(ix) any other health care providers 

16 or other entities, as determined appropriate 

17 by the Secretary; 

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

19 extent practicable, of stakeholders in the elec20 tronic exchange of health information within the 

21 local or regional plan pursuant to paragraph 

22 (2)(C); 

23 ‘‘(E) adopt nondiscrimination and conflict 

24 of interest policies that demonstrate a commit25 ment to open, fair, and nondiscriminatory par-
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1 ticipation in the health information plan by all 

2 stakeholders; 

3 ‘‘(F) adopt the standards adopted by the 

4 Secretary under section 2903; 

5 ‘‘(G) require that health care providers re6 ceiving such grants implement the measurement 

7 system adopted under section 2908 and report to 

8 the Secretary on such measures; 

9 ‘‘(H) facilitate the electronic exchange of 

10 health information within the local or regional 

11 area and among local and regional areas; 

12 ‘‘(I) prepare and submit to the Secretary an 

13 application in accordance with paragraph (3); 

14 and 

15 ‘‘(J) agree to provide matching funds in ac16 cordance with paragraph (5). 

17 ‘‘(3) APPLICATION.— 

18 ‘‘(A) IN GENERAL.—To be eligible to receive 

19 a grant under paragraph (1), an entity shall 

20 submit to the Secretary an application at such 

21 time, in such manner, and containing such in22 formation as the Secretary may require. 

23 ‘‘(B) REQUIRED INFORMATION.—At a min24 imum, an application submitted under this 

25 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 local 

10 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 under 

15 section 2908; 

16 ‘‘(iv) a plan that describes provisions 

17 to encourage the implementation of the elec18 tronic exchange of health information by all 

19 physicians, including single physician prac20 tices and small physician groups partici21 pating in the health information plan; 

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

23 security of personal health information that 

24 is consistent with Federal and State 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 plan; 

8 ‘‘(II) the financial costs and bene9 fits of the plan; and 

10 ‘‘(III) the entities to which such 

11 costs and benefits will accrue; and 

12 ‘‘(viii) if the case of an applicant enti13 ty that is unable to demonstrate the partici14 pation of all stakeholders pursuant to para15 graph (2)(C), the justification from the enti16 ty for any such nonparticipation. 

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

18 grant under paragraph (1) shall be used to establish 

19 and implement a regional or local health information 

20 plan in accordance with this subsection. 

21 ‘‘(5) MATCHING REQUIREMENT.— 

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

23 make a grant under this subsection to an entity 

24 unless the entity agrees that, with respect to the 

25 costs to be incurred by the entity in carrying out 
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1 the infrastructure program for which the grant 

2 was awarded, the entity will make available (di3 rectly or through donations from public or pri4 vate entities) non-Federal contributions toward 

5 such costs in an amount equal to not less than 

6 50 percent of such costs ($1 for each $2 of Fed7 eral funds provided under the grant). 

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

10 under subparagraph (A) may be in cash or in 

11 kind, fairly evaluated, including equipment, 

12 technology, or services. Amounts provided by the 

13 Federal Government, or services assisted or sub14 sidized to any significant extent by the Federal 

15 Government, may not be included in deter16 mining the amount of such non-Federal con17 tributions. 

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

19 on which the first grant is awarded under this section, and 

20 annually thereafter during the grant period, an entity that 

21 receives a grant under this section shall submit to the Sec22 retary a report on the activities carried out under the grant 

23 involved. Each such report shall include— 
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1 ‘‘(1) a description of the financial costs and ben2 efits 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 to 

11 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 activities 

16 conducted under this section and shall, in awarding grants, 

17 implement the lessons learned from such evaluation in a 

18 manner so that awards made subsequent to each such eval19 uation are made in a manner that, in the determination 

20 of the Secretary, will result in the greatest improvement in 

21 quality measurement systems under section 2908. 

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

23 one non-renewable grant under subsection (a), one non-re24 newable grant under subsection (b), and one non-renewable 

25 grant under subsection (c). 
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1 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.— 

2 ‘‘(1) IN GENERAL.—For the purpose of carrying 

3 out this section, there is authorized to be appropriated 

4 $116,000,000 for fiscal year 2006, $141,000,000 for 

5 fiscal year 2007, and such sums as may be necessary 

6 for each of fiscal years 2008 through 2010. 

7 ‘‘(2) AVAILABILITY.—Amounts appropriated 

8 under paragraph (1) shall remain available through 

9 fiscal year 2010. 

10 ‘‘SEC. 2906. DEMONSTRATION PROGRAM TO INTEGRATE IN11 FORMATION TECHNOLOGY INTO CLINICAL 

12 EDUCATION. 

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

14 under this section to carry out demonstration projects to 

15 develop academic curricula integrating qualified health in16 formation technology systems in the clinical education of 

17 health professionals. Such awards shall be made on a com18 petitive basis and pursuant to peer review. 

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

20 under subsection (a), an entity shall— 

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

22 such time, in such manner, and containing such in23 formation as the Secretary may require; 

24 ‘‘(2) submit to the Secretary a strategic plan for 

25 integrating qualified health information technology in 
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1 the clinical education of health professionals and for 

2 ensuring the consistent utilization of decision support 

3 software to reduce medical errors and enhance health 

4 care quality; 

5 ‘‘(3) be— 

6 ‘‘(A) a health professions school; 

7 ‘‘(B) a school of nursing; or 

8 ‘‘(C) an institution with a graduate med9 ical education program; 

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

11 the effectiveness of the demonstration project to be 

12 funded under the grant in improving the safety of pa13 tients, the efficiency of health care delivery, and in 

14 increasing the likelihood that graduates of the grantee 

15 will adopt and incorporate health information tech16 nology, and implement the quality measurement sys17 tem adopted under section 2908, in the delivery of 

18 health care services; and 

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

20 subsection (c). 

21 ‘‘(c) USE OF FUNDS.— 

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

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

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

25 2 or more disciplines; and 
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1 ‘‘(B) use grant funds to integrate qualified 

2 health information technology into community3 based clinical education. 

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

5 use amounts received under a grant under subsection 

6 (a) to purchase hardware, software, or services. 

7 ‘‘(d) MATCHING FUNDS.— 

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

9 grant to an entity under this section only if the entity 

10 agrees to make available non-Federal contributions to11 ward the costs of the program to be funded under the 

12 grant in an amount that is not less than $1 for each 

13 $2 of Federal funds provided under the grant. 

14 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB15 UTED.—Non-Federal contributions under paragraph 

16 (1) may be in cash or in kind, fairly evaluated, in17 cluding equipment or services. Amounts provided by 

18 the Federal Government, or services assisted or sub19 sidized to any significant extent by the Federal Gov20 ernment, may not be included in determining the 

21 amount of such contributions. 

22 ‘‘(e) EVALUATION.—The Secretary shall take such ac23 tion as may be necessary to evaluate the projects funded 

24 under this section and publish, make available, and dis-
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1 seminate the results of such evaluations on as wide a basis 

2 as is practicable. 

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

4 of enactment of this title, and annually thereafter, the Sec5 retary shall submit to the Committee on Health, Education, 

6 Labor, and Pensions and the Committee on Finance of the 

7 Senate, and the Committee on Energy and Commerce and 

8 the Committee on Ways and Means of the House of Rep9 resentatives a report that— 

10 ‘‘(1) describes the specific projects established 

11 under this section; and 

12 ‘‘(2) contains recommendations for Congress 

13 based on the evaluation conducted under subsection 

14 (e). 

15 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.—There is 

16 authorized to be appropriated to carry out this section, 

17 $5,000,000 for fiscal year 2007, and such sums as may be 

18 necessary for each of fiscal years 2008 through 2010. 

19 ‘‘(h) SUNSET.—This section shall not apply after Sep20 tember 30, 2010. 

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

22 OF HEALTH INFORMATION. 

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

24 contract with a private entity to carry out, a study that 

25 examines— 
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1 ‘‘(1) the variation among State laws that relate 

2 to the licensure, registration, and certification of med3 ical professionals; and 

4 ‘‘(2) how such variation among State laws im5 pacts the secure electronic exchange of health informa6 tion— 

7 ‘‘(A) among the States; and 

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

9 Government. 

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

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

12 Secretary shall publish a report that— 

13 ‘‘(1) describes the results of the study carried out 

14 under subsection (a); and 

15 ‘‘(2) makes recommendations to States regarding 

16 the harmonization of State laws based on the results 

17 of such study. 

18 ‘‘SEC. 2908. QUALITY MEASUREMENT SYSTEM. 

19 ‘‘(a) IN GENERAL.—The Secretary, in consultation 

20 with the Secretary of Veterans Affairs, the Secretary of De21 fense, and representatives of other relevant Federal agencies, 

22 as determined appropriate by the Secretary, shall develop 

23 or adopt a quality measurement system, including measures 

24 to assess that effectiveness, timeliness, patient self-manage-
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1 ment, patient centeredness, efficiency, and safety, for the 

2 purpose of measuring the quality of care patients receive. 

3 ‘‘(b) REQUIREMENTS.—The Secretary shall ensure that 

4 the quality measurement system developed under subsection 

5 (a) comply with the following: 

6 ‘‘(1) MEASURES.— 

7 ‘‘(A) IN GENERAL.—Subject to subpara8 graph (B), the Secretary shall select measures of 

9 quality to be used by the Secretary under the 

10 systems. 

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

12 measures to be used under each system pursuant 

13 to subparagraph (A), the Secretary shall, to the 

14 extent feasible, ensure that— 

15 ‘‘(i) such measures are evidence based, 

16 reliable and valid; 

17 ‘‘(ii) such measures include measures 

18 of clinical processes and outcomes, patient 

19 experience, efficiency, and equity; and 

20 ‘‘(iii) such measures include measures 

21 of overuse and underuse of health care items 

22 and services. 

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

24 under subsection (a), the Secretary shall ensure that 

25 priority is given to— 
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1 ‘‘(A) measures with the greatest potential 

2 impact for improving the quality and efficiency 

3 of care provided under Federal programs; 

4 ‘‘(B) measures that may be rapidly imple5 mented by group health plans, health insurance 

6 issuers, physicians, hospitals, nursing homes, 

7 long-term care providers, and other providers; 

8 and 

9 ‘‘(C) measures which may inform health 

10 care decisions made by consumers and patients. 

11 ‘‘(3) WEIGHTS OF MEASURES.—The Secretary 

12 shall assign weights to the measures used by the Sec13 retary under each system established under subsection 

14 (a). 

15 ‘‘(4) RISK ADJUSTMENT.—The Secretary shall es16 tablish procedures to account for differences in pa17 tient health status, patient characteristics, and geo18 graphic location. To the extent practicable, such pro19 cedures shall recognize existing procedures. 

20 ‘‘(5) MAINTENANCE.—The Secretary shall, as de21 termined appropriate, but in no case more often than 

22 once during each 12-month period, update the quality 

23 measurement systems developed under subsection (a), 

24 including through— 
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1 ‘‘(A) the addition of more accurate and pre2 cise measures under the systems and the retire3 ment of existing outdated measures under the 

4 systems; and 

5 ‘‘(B) the refinement of the weights assigned 

6 to measures under the systems. 

7 ‘‘(c) REQUIRED CONSIDERATIONS IN DEVELOPING AND

8 UPDATING THE SYSTEMS.—In developing and updating the 

9 quality measurement systems under this section, the Sec10 retary shall— 

11 ‘‘(1) consult with, and take into account the rec12 ommendations of, the entity that the Secretary has an 

13 arrangement with under subsection (e); 

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

15 providers (including physicians, pharmacists, nurses, 

16 and other health care professionals), consumers, em17 ployers, and other individuals and groups that are 

18 interested in the quality of health care; and 

19 ‘‘(3) take into account— 

20 ‘‘(A) any demonstration or pilot program 

21 conducted by the Secretary relating to measuring 

22 and rewarding quality and efficiency of care; 

23 ‘‘(B) any existing activities conducted by 

24 the Secretary relating to measuring and reward25 ing quality and efficiency; 
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1 ‘‘(C) any existing activities conducted by 

2 private entities including health insurance plans 

3 and payors; and 

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

5 of the National Academy of Sciences under sec6 tion 238(b) of the Medicare Prescription Drug, 

7 Improvement, and Modernization Act of 2003. 

8 ‘‘(d) REQUIRED CONSIDERATIONS IN IMPLEMENTING

9 THE SYSTEMS.—In implementing the quality measurement 

10 systems under this section, the Secretary shall take into ac11 count the recommendations of public-private entities— 

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

13 data collection and reporting, including the feasibility 

14 of collecting and reporting data on measures; and 

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

16 providers (including physicians, pharmacists, nurses, 

17 and other health care professionals), consumers, em18 ployers, and other individuals and groups that are 

19 interested in quality of care. 

20 ‘‘(e) ARRANGEMENT WITH AN ENTITY TO PROVIDE AD21 VICE AND RECOMMENDATIONS.— 

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

23 2006, the Secretary shall have in place an arrange24 ment with an entity that meets the requirements de25 scribed in paragraph (2) under which such entity 
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1 provides the Secretary with advice on, and rec2 ommendations with respect to, the development and 

3 updating of the quality measurement systems under 

4 this section, including the assigning of weights to the 

5 measures under subsection (b)(2). 

6 ‘‘(2) REQUIREMENTS DESCRIBED.—The require7 ments described in this paragraph are the following: 

8 ‘‘(A) The entity is a private nonprofit enti9 ty governed by an executive director and a 

10 board. 

11 ‘‘(B) The members of the entity include rep12 resentatives of— 

13 ‘‘(i) health insurance plans and health 

14 care providers with experience in the care of 

15 individuals with multiple complex chronic 

16 conditions or groups representing such 

17 health insurance plans and providers; 

18 ‘‘(ii) groups representing patients and 

19 consumers; 

20 ‘‘(iii) purchasers and employers or 

21 groups representing purchasers or employ22 ers; 

23 ‘‘(iv) organizations that focus on qual24 ity improvement as well as the measure25 ment and reporting of quality measures; 
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1 ‘‘(v) State government health pro2 grams; 

3 ‘‘(vi) individuals or entities skilled in 

4 the conduct and interpretation of bio5 medical, health services, and health econom6 ics research and with expertise in outcomes 

7 and effectiveness research and technology as8 sessment; and 

9 ‘‘(vii) individuals or entities involved 

10 in the development and establishment of 

11 standards and certification for health infor12 mation technology systems and clinical 

13 data. 

14 ‘‘(C) The membership of the entity is rep15 resentative of individuals with experience with 

16 urban health care issues and individuals with 

17 experience with rural and frontier health care 

18 issues. 

19 ‘‘(D) If the entity requires a fee for member20 ship, the entity shall provide assurances to the 

21 Secretary that such fees are not a substantial 

22 barrier to participation in the entity’s activities 

23 related to the arrangement with the Secretary. 

24 ‘‘(E) The entity— 
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1 ‘‘(i) permits any member described in 

2 subparagraph (B) to vote on matters of the 

3 entity related to the arrangement with the 

4 Secretary under paragraph (1); and 

5 ‘‘(ii) ensures that member voting pro6 vides a balance among disparate stake7 holders, so that no member organization de8 scribed in subparagraph (B) unduly influ9 ences the outcome. 

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

11 arrangement with the Secretary under para12 graph (1), the entity conducts its business in an 

13 open and transparent manner and provides the 

14 opportunity for public comment. 

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

16 consensus standards setting organization as de17 fined for purposes of section 12(d) of the Na18 tional Technology Transfer and Advancement 

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

20 Management and Budget Revised Circular A– 

21 119 (published in the Federal Register on Feb22 ruary 10, 1998). 

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

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

25 conducted or supported by the Secretary under this 
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1 Act, the Secretary shall, to the extent practicable, 

2 adopt and utilize the measurement system developed 

3 under this section. 

4 ‘‘(2) COLLABORATIVE AGREEMENTS.—With re5 spect to activities conducted or supported by the Sec6 retary under this Act, the Secretary may establish 

7 collaborative agreements with private entities, includ8 ing group health plans and health insurance issuers, 

9 providers, purchasers, consumer organizations, and 

10 entities receiving a grant under section 2905, to— 

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

12 quality measures adopted by the Secretary under 

13 this 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 Health 

19 and Human Services to accept the electronic submis20 sion of data for purposes of quality measurement 

21 using the quality measurement system adopted under 

22 this section and using the standards adopted by the 

23 Federal Government under section 2903. 

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

25 on January 1, 2008, in order to make comparative quality 
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1 information available to health care consumers, health pro2 fessionals, public health officials, researchers, and other ap3 propriate individuals and entities, the Secretary shall pro4 vide for the dissemination, aggregation, and analysis of 

5 quality measures collected under section 2905 and the dis6 semination of recommendations and best practices derived 

7 in part from such analysis. 

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

9 provide technical assistance to public and private entities 

10 to enable such entities to— 

11 ‘‘(1) implement and use evidence-based guide12 lines with the greatest potential to improve health 

13 care quality, efficiency, and patient safety; and 

14 ‘‘(2) establish mechanisms for the rapid dissemi15 nation of information regarding evidence-based guide16 lines with the greatest potential to improve health 

17 care quality, efficiency, and patient safety. 

18 ‘‘SEC. 2909. ENSURING PRIVACY AND SECURITY. 

19 ‘‘Nothing in this title shall be construed to affect the 

20 scope or substance of— 

21 ‘‘(1) section 264 of the Health Insurance Port22 ability and Accountability Act of 1996; 

23 ‘‘(2) sections 1171 through 1179 of the Social Se24 curity Act; and 
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1 ‘‘(3) any regulation issued pursuant to any such 

2 section; 

3 and such sections shall remain in effect. 

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

5 ‘‘The Secretary shall carry out, or contract with a pri6 vate entity to carry out, a study that examines methods 

7 to create efficient reimbursement incentives for improving 

8 health care quality in Federally qualified health centers, 

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

10 SEC. 3. HEALTH INFORMATION TECHNOLOGY RESOURCE 

11 CENTER. 

12 Section 914 of the Public Health Service Act (42 

13 U.S.C. 299b–3) is amended by adding at the end the fol14 lowing: 

15 ‘‘(d) HEALTH INFORMATION TECHNOLOGY RESOURCE

16 CENTER.— 

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

18 through the Director, shall develop a Health Informa19 tion Technology Resource Center to provide technical 

20 assistance and develop best practices to support and 

21 accelerate efforts to adopt, implement, and effectively 

22 use interoperable health information technology in 

23 compliance with section 2903 and 2908. 

24 ‘‘(2) HEALTH INFORMATION TECHNOLOGY RE25 SOURCE CENTER.— 
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1 ‘‘(A) IN GENERAL.—The Center shall sup2 port activities to meet goals, including— 

3 ‘‘(i) providing for the widespread 

4 adoption of interoperable health informa5 tion technology; 

6 ‘‘(ii) providing for the establishment of 

7 regional and local health information net8 works to facilitate the development of inter9 operability across health care settings and 

10 improve the quality of health care; 

11 ‘‘(iii) the development of solutions to 

12 barriers to the exchange of electronic health 

13 information; or 

14 ‘‘(iv) other activities identified by the 

15 States, local or regional health information 

16 networks, or health care stakeholders as a 

17 focus for developing and sharing best prac18 tices. 

19 ‘‘(B) PURPOSES.—The purpose of the Cen20 ter is to— 

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

22 of knowledge and experience; 

23 ‘‘(ii) accelerate the transfer of lessons 

24 learned from existing public and private 
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1 sector initiatives, including those currently 

2 receiving Federal financial support; and 

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

4 disseminate evidence and experience related 

5 to the adoption, implementation, and effec6 tive use of interoperable health information 

7 technology. 

8 ‘‘(C) SUPPORT FOR ACTIVITIES.—To pro9 vide support for the activities of the Center, the 

10 Director shall modify the requirements, if nec11 essary, that apply to the National Resource Cen12 ter for Health Information Technology to provide 

13 the necessary infrastructure to support the duties 

14 and activities of the Center and facilitate infor15 mation exchange across the public and private 

16 sectors. 

17 ‘‘(3) TECHNICAL ASSISTANCE TELEPHONE NUM18 BER OR WEBSITE.—The Secretary shall establish a 

19 toll-free telephone number or Internet website to pro20 vide health care providers and patients with a single 

21 point of contact to— 

22 ‘‘(A) learn about Federal grants and tech23 nical assistance services related to interoperable 

24 health information technology; 
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1 ‘‘(B) learn about qualified health informa2 tion technology and the quality measurement 

3 system adopted by the Federal Government 

4 under sections 2903 and 2908; 

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

6 information networks for assistance with health 

7 information technology; and 

8 ‘‘(D) disseminate additional information 

9 determined by the Secretary. 

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

11 subsection shall be construed to require the duplica12 tion of Federal efforts with respect to the establish13 ment of the Center, regardless of whether such efforts 

14 were carried out prior to or after the enactment of 

15 this subsection.’’. 

16 SEC. 4. REAUTHORIZATION OF INCENTIVE GRANTS RE17 GARDING TELEMEDICINE. 

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

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

20 2006’’ and inserting ‘‘2006 through 2010’’. 
Calendar No. 178 

109TH CONGRESS 

1ST SESSION S. 1418 

[Report No. 109–111] 

A BILL 

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 

JULY 27, 2005 

Reported with an amendment