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[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1039 Introduced in House (IH)]

111th CONGRESS
  1st Session
                                H. R. 1039

     To encourage and enhance the adoption of interoperable health 
 information technology to improve health care quality, reduce medical 
              errors, and increase the efficiency of care.

_______________________________________________________________________

                    IN THE HOUSE OF REPRESENTATIVES

                           February 12, 2009

 Mr. Sam Johnson of Texas (for himself, Mr. Brady of Texas, Ms. Ginny 
  Brown-Waite of Florida, Mr. Reichert, Mr. Roskam, and Mr. Boustany) 
 introduced the following bill; which was referred to the Committee on 
   Energy and Commerce, and in addition to the Committee on Ways and 
 Means, for a period to be subsequently determined by the Speaker, in 
   each case for consideration of such provisions as fall within the 
                jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL

 
     To encourage and enhance the adoption of interoperable health 
 information technology to improve health care quality, reduce medical 
              errors, and increase the efficiency of care.

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

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Promoting Health 
Information Technology Act of 2009''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
      TITLE I--STRATEGIC PLAN TOWARDS NATIONWIDE INTEROPERABILITY

Sec. 101. Office of the National Coordinator for Health Information 
                            Technology.
Sec. 102. Successor to the American Health Information Community.
Sec. 103. Health Information Technology Resource Center.
Sec. 104. Strategic plan for coordinating implementation of health 
                            information technology.
         TITLE II--MODERNIZING THE HEALTH CARE DELIVERY SYSTEM

Sec. 201. Procedures to ensure timely updating of standards that enable 
                            electronic exchanges.
Sec. 202. Federal purchasing and data collection.
Sec. 203. Study to improve preservation and protection of security and 
                            confidentiality of health information.
             TITLE III--INCENTIVIZING ADOPTION OF HEALTH IT

Sec. 301. Incentives for medical care providers to adopt health care 
                            information technology.
Sec. 302. Elimination of sunset applicable to Stark exception for 
                            electronic health records arrangements.
Sec. 303. Promotion of telehealth services.
Sec. 304. FQHCs included in electronic health records demonstration.
Sec. 305. Interest-free loan program for hospitals to adopt health 
                            information technology.

      TITLE I--STRATEGIC PLAN TOWARDS NATIONWIDE INTEROPERABILITY

SEC. 101. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION 
              TECHNOLOGY.

    (a) Establishment.--There is established within the Department of 
Health and Human Services an Office of the National Coordinator for 
Health Information Technology that shall be headed by the National 
Coordinator for Health Information Technology (referred to in this 
section as the ``National Coordinator''). The National Coordinator 
shall be appointed by the President and shall report directly to the 
Secretary of Health and Human Services. The National Coordinator shall 
be paid at a rate equal to the rate of basic pay for level IV of the 
Executive Schedule.
    (b) Goals of Nationwide Interoperable Health Information Technology 
Infrastructure.--The National Coordinator shall perform the duties 
under subsection (c) in a manner consistent with the development of a 
nationwide interoperable health information technology infrastructure 
that--
            (1) improves health care quality, reduces medical errors, 
        increases the efficiency of care, and advances the delivery of 
        appropriate, evidence-based health care services;
            (2) promotes wellness, disease prevention, and management 
        of chronic illnesses by increasing the availability and 
        transparency of information related to the health care needs of 
        an individual for such individual;
            (3) ensures that appropriate information necessary to make 
        medical decisions is available in a usable form at the time and 
        in the location that the medical service involved is provided;
            (4) produces greater value for health care expenditures by 
        reducing health care costs that result from inefficiency, 
        medical errors, inappropriate care, and incomplete information;
            (5) promotes a more effective marketplace, greater 
        competition, greater systems analysis, increased choice, 
        enhanced quality, and improved outcomes in health care 
        services;
            (6) improves the coordination of information and the 
        provision of such services through an effective infrastructure 
        for the secure and authorized exchange and use of health care 
        information; and
            (7) ensures that the confidentiality of individually 
        identifiable health information of a patient is secure and 
        protected.
    (c) Duties of National Coordinator.--
            (1) Strategic planner for interoperable health information 
        technology.--The National Coordinator shall maintain, direct, 
        and oversee the continuous improvement of a strategic plan to 
        guide the nationwide implementation of interoperable health 
        information technology in both the public and private health 
        care sectors consistent with subsection (b).
            (2) Principal advisor to hhs.--The National Coordinator 
        shall serve as the principal advisor of the Secretary of Health 
        and Human Services on the development, application, and use of 
        health information technology, and coordinate the health 
        information technology programs of the Department of Health and 
        Human Services.
            (3) Coordinator of federal government activities.--
                    (A) In general.--The National Coordinator shall 
                serve as the coordinator of Federal Government 
                activities relating to health information technology.
                    (B) Specific coordination functions.--In carrying 
                out subparagraph (A), the National Coordinator shall 
                provide for--
                            (i) the approval of standards developed and 
                        recommended by AHIC 2.0 under section 102 
                        (which may include standards relating to the 
                        interoperability, privacy, and security of 
                        health information technology) to be used in 
                        the electronic creation, maintenance, or 
                        exchange of health information; and
                            (ii) the certification and inspection of 
                        health information technology products, 
                        exchanges, and architectures to ensure that 
                        such products, exchanges, and architectures 
                        conform to the applicable standards approved 
                        under clause (i).
                Any standard approved or health information technology 
                product, exchange, or architecture certified pursuant 
                to Executive Order 13335 as of the day before the date 
                of the enactment of this Act shall be deemed to be a 
                standard approved or product, exchange, or architecture 
                certified, respectively, pursuant to this subparagraph 
                as of such date of enactment.
                    (C) Use of private entities.--The National 
                Coordinator shall, to the maximum extent possible, 
                contract with or recognize private entities in carrying 
                out subparagraph (B).
                    (D) Uniform application of standards.--A standard 
                approved under subparagraph (B)(i) for use in the 
                electronic creation, maintenance, or exchange of health 
                information shall preempt a standard adopted under 
                State law, regulation, or rule for such a use.
            (4) Intragovernmental coordinator.--The National 
        Coordinator shall ensure that health information technology 
        policies and programs of the Department of Health and Human 
        Services are coordinated with those of relevant executive 
        branch agencies and departments with a goal to avoid 
        duplication of effort and to ensure that each agency or 
        department conducts programs within the areas of its greatest 
        expertise and its mission in order to create a national 
        interoperable health information system capable of meeting 
        national public health needs effectively and efficiently.
            (5) Advisor to omb.--The National Coordinator shall provide 
        to the Director of the Office of Management and Budget comments 
        and advice with respect to specific Federal health information 
        technology programs.
    (d) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section 
for each of fiscal years 2009 through 2013.
    (e) Treatment of Executive Order 13335.--Executive Order 13335 
shall not have any force or effect after the date of the enactment of 
this Act.
    (f) Transition From ONCHIT Under Executive Order.--
            (1) In general.--All functions, personnel, assets, 
        liabilities, administrative actions, and statutory reporting 
        requirements applicable to the old National Coordinator or the 
        Office of the old National Coordinator on the date before the 
        date of the enactment of this Act shall be transferred, and 
        applied in the same manner and under the same terms and 
        conditions, to the new National Coordinator and the Office of 
        the new National Coordinator as of the date of the enactment of 
        this Act.
            (2) Acting national coordinator.--Before the appointment of 
        the new National Coordinator, the old National Coordinator 
        shall act as the National Coordinator for Health Information 
        Technology until the office is filled as provided in subsection 
        (a). The President may appoint the old National Coordinator as 
        the new National Coordinator.
            (3) Definitions.--For purposes of this subsection:
                    (A) New national coordinator.--The term ``new 
                National Coordinator'' means the National Coordinator 
                for Health Information Technology appointed under 
                subsection (a).
                    (B) Old national coordinator.--The term ``old 
                National Coordinator'' means the National Coordinator 
                for Health Information Technology appointed under 
                Executive Order 13335.

SEC. 102. SUCCESSOR TO THE AMERICAN HEALTH INFORMATION COMMUNITY.

    (a) In General.--The Secretary of Health and Human Services shall 
(through a grant, contract, or cooperative agreement) ensure the 
establishment and provide for the operation of an entity described in 
subsection (b) (in this Act to be referred to as ``AHIC 2.0'') for 
purposes of developing and recommending standards described in section 
101(c)(3)(B)(i) for approval under such section.
    (b) Structure and Procedures of Entity.--An entity described in 
this subsection is an entity--
            (1) in the operation of which there is broad participation 
        by a variety of public and private stakeholders, (whether 
        through membership or through other means);
            (2) that uses a consensus approach and a fair and open 
        process to support the development of standards under 
        subsection (a); and
            (3) that has a business plan and a published set of 
        governance rules that enables the entity to be self-sustaining 
        and to fulfill the purposes described in subsection (a).
    (c) Consultation.--In establishing AHIC 2.0, the entity awarded a 
grant, contract, or cooperative agreement pursuant to subsection (a), 
shall consult with a wide variety of private and public stakeholders 
that are knowledgeable with respect to standards to be developed by 
AHIC 2.0 or that would be potentially affected by the recommendations 
of AHIC 2.0.
    (d) Funding.--
            (1) Authorization of appropriations.--There are authorized 
        to be appropriated to carry out this section $13,000,000, to 
        remain available until expended.
            (2) Further federal funding other than dues prohibited.--
        Except as otherwise provided by this subsection, and except for 
        such dues as may be paid by a Federal agency for membership or 
        other participation in AHIC 2.0, no Federal agency may provide 
        funding to the entity. There are authorized to be appropriated 
        to such agencies such amounts as are necessary to pay the dues 
        described in the previous sentence.
    (e) Nonduplication of Efforts To Establish AHIC 2.0.--Nothing in 
this section shall be construed as requiring the duplication of Federal 
efforts (such as awarding a grant, contract, or cooperative agreement) 
that were carried out before the date of the enactment of this Act, 
with respect to the establishment of an entity to support the 
development and recommendation of standards under subsection (a).
    (f) Treatment of Standards Developed or Approved by AHIC.--For 
purposes of this title, a standard developed or approved (or in a stage 
of development or approval) by the American Health Information 
Community established pursuant to Executive Order 13335 (or the AHIC 
Successor, Inc. doing business as the National eHealth Collaborative) 
as of the day before the date of the enactment of this Act shall be 
deemed to be a standard developed or approved, respectively, (or in 
such stage of development or approval) by AHIC 2.0 as of such date of 
enactment.

SEC. 103. HEALTH INFORMATION TECHNOLOGY RESOURCE CENTER.

    (a) In General.--There is established within the Office of the 
National Coordinator for Health Information Technology the Health 
Information Technology Resource Center (referred to in this section as 
the ``Center'') to carry out the following functions:
            (1) Provide assistance and support for adoption and 
        implementation efforts and effective use of interoperable 
        health information technology.
            (2) Serve as a forum for the exchange of knowledge and 
        experience.
            (3) Accelerate the transmission of knowledge from existing 
        health information initiatives in both the private and public 
        sectors.
            (4) Support the establishment of regional and local health 
        information networks to facilitate the interoperability of 
        health care data across health care settings.
            (5) Develop solutions to barriers to electronic health 
        information exchange.
            (6) Provide technical assistance and tools to help health 
        information exchanges develop a path toward financial 
        sustainability.
            (7) Establish a longitudinal database to measure the 
        business sustainability of health information exchange and 
        evaluate the impact of health information exchange on community 
        health outcomes and value.
    (b) Rule of Construction.--Nothing in this section shall be 
construed to require the duplication of Federal efforts with respect to 
the establishment of the Center, regardless of whether such efforts 
were carried out prior to or after the enactment of this subsection.
    (c) Transition From National Resource Center for Health Information 
Technology Under AHRQ.--All functions, personnel, assets, and 
liabilities applicable to the National Resource Center for Health 
Information Technology under the Agency for Healthcare Research and 
Quality as of the day before the date of the enactment of this Act 
shall be transferred, and applied in the same manner and under the same 
terms and conditions, to the Health Information Technology Resource 
Center under the Office of the National Coordinator for Health 
Information Technology established under subsection (a) as of the date 
of the enactment of this Act.

SEC. 104. STRATEGIC PLAN FOR COORDINATING IMPLEMENTATION OF HEALTH 
              INFORMATION TECHNOLOGY.

    (a) In General.--Not later than 180 days after the date of the 
enactment of this Act, the Secretary of Health and Human Services, in 
consultation with entities involved in the area of health information 
technology, shall develop a strategic plan related to the need for 
coordination in such area.
    (b) Coordination of Specific Implementation Processes.--The 
strategic plan under subsection (a) shall address the need for 
coordination in the implementation of the following:
            (1) Health information technology standards.--Health 
        information technology standards approved under section 
        101(c)(3)(B)(i).
            (2) HIPAA transaction standards.--Transaction standards 
        under section 1173(a) of the Social Security Act (42 U.S.C. 
        1320d-2(d)).
    (c) Coordination Among Specific Federal Entities.--The strategic 
plan under subsection (a) shall address any methods to coordinate, with 
respect to the electronic exchange of health information, actions taken 
by the following entities:
            (1) The Office of the National Coordinator for Health 
        Information Technology.
            (2) AHIC 2.0 established under section 102.
            (3) The Office of Electronic Standards and Security of the 
        Centers for Medicare and Medicaid Services.
            (4) The National Committee on Vital Health Statistics.
            (5) Any other entity involved in the electronic exchange of 
        health information that the Secretary determines appropriate.

         TITLE II--MODERNIZING THE HEALTH CARE DELIVERY SYSTEM

SEC. 201. PROCEDURES TO ENSURE TIMELY UPDATING OF STANDARDS THAT ENABLE 
              ELECTRONIC EXCHANGES.

    Section 1174(b) of the Social Security Act (42 U.S.C. 1320d-3(b)) 
is amended--
            (1) in paragraph (1)--
                    (A) in the first sentence, by inserting ``and in 
                accordance with paragraph (3)'' before the period; and
                    (B) by adding at the end the following new 
                sentence: ``For purposes of this subsection and section 
                1173(c)(2), the term `modification' includes a new 
                version or a version upgrade.''; and
            (2) by adding at the end the following new paragraph:
            ``(3) Expedited procedures for adoption of additions and 
        modifications to standards.--
                    ``(A) In general.--For purposes of paragraph (1), 
                the Secretary shall provide for an expedited upgrade 
                program (in this paragraph referred to as the `upgrade 
                program'), in accordance with this paragraph, to 
                develop and approve additions and modifications to the 
                standards adopted under section 1173(a) to improve the 
                quality of such standards or to extend the 
                functionality of such standards to meet evolving 
                requirements in health care.
                    ``(B) Publication of notices.--Under the upgrade 
                program:
                            ``(i) Voluntary notice of initiation of 
                        process.--Not later than 30 days after the date 
                        the Secretary receives a notice from a standard 
                        setting organization that the organization is 
                        initiating a process to develop an addition or 
                        modification to a standard adopted under 
                        section 1173(a), the Secretary shall publish a 
                        notice in the Federal Register that--
                                    ``(I) identifies the subject matter 
                                of the addition or modification;
                                    ``(II) provides a description of 
                                how persons may participate in the 
                                development process; and
                                    ``(III) invites public 
                                participation in such process.
                            ``(ii) Voluntary notice of preliminary 
                        draft of additions or modifications to 
                        standards.--Not later than 30 days after the 
                        date the Secretary receives a notice from a 
                        standard setting organization that the 
                        organization has prepared a preliminary draft 
                        of an addition or modification to a standard 
                        adopted by section 1173(a), the Secretary shall 
                        publish a notice in the Federal Register that--
                                    ``(I) identifies the subject matter 
                                of (and summarizes) the addition or 
                                modification;
                                    ``(II) specifies the procedure for 
                                obtaining the draft;
                                    ``(III) provides a description of 
                                how persons may submit comments in 
                                writing and at any public hearing or 
                                meeting held by the organization on the 
                                addition or modification; and
                                    ``(IV) invites submission of such 
                                comments and participation in such 
                                hearing or meeting without requiring 
                                the public to pay a fee to participate.
                            ``(iii) Notice of proposed addition or 
                        modification to standards.--Not later than 30 
                        days after the date the Secretary receives a 
                        notice from a standard setting organization 
                        that the organization has a proposed addition 
                        or modification to a standard adopted under 
                        section 1173(a) that the organization intends 
                        to submit under subparagraph (D)(iii), the 
                        Secretary shall publish a notice in the Federal 
                        Register that contains, with respect to the 
                        proposed addition or modification, the 
                        information required in the notice under clause 
                        (ii) with respect to the addition or 
                        modification.
                            ``(iv) Construction.--Nothing in this 
                        paragraph shall be construed as requiring a 
                        standard setting organization to request the 
                        notices described in clauses (i) and (ii) with 
                        respect to an addition or modification to a 
                        standard in order to qualify for an expedited 
                        determination under subparagraph (C) with 
                        respect to a proposal submitted to the 
                        Secretary for adoption of such addition or 
                        modification.
                    ``(C) Provision of expedited determination.--Under 
                the upgrade program and with respect to a proposal by a 
                standard setting organization for an addition or 
                modification to a standard adopted under section 
                1173(a), if the Secretary determines that the standard 
                setting organization developed such addition or 
                modification in accordance with the requirements of 
                subparagraph (D) and the National Committee on Vital 
                and Health Statistics recommends approval of such 
                addition or modification under subparagraph (E), the 
                Secretary shall provide for expedited treatment of such 
                proposal in accordance with subparagraph (F).
                    ``(D) Requirements.--The requirements under this 
                subparagraph with respect to a proposed addition or 
                modification to a standard by a standard setting 
                organization are the following:
                            ``(i) Request for publication of notice.--
                        The standard setting organization submits to 
                        the Secretary a request for publication in the 
                        Federal Register of a notice described in 
                        subparagraph (B)(iii) for the proposed addition 
                        or modification.
                            ``(ii) Process for receipt and 
                        consideration of public comment.--The standard 
                        setting organization provides for a process 
                        through which, after the publication of the 
                        notice referred to under clause (i), the 
                        organization--
                                    ``(I) receives and responds to 
                                public comments submitted on a timely 
                                basis on the proposed addition or 
                                modification before submitting such 
                                proposed addition or modification to 
                                the National Committee on Vital and 
                                Health Statistics under clause (iii);
                                    ``(II) makes publicly available a 
                                written explanation for its response in 
                                the proposed addition or modification 
                                to comments submitted on a timely 
                                basis; and
                                    ``(III) makes public comments 
                                received under clause (I) available, or 
                                provides access to such comments, to 
                                the Secretary.
                            ``(iii) Submittal of final proposed 
                        addition or modification to ncvhs.--After 
                        completion of the process under clause (ii), 
                        the standard setting organization submits the 
                        proposed addition or modification to the 
                        National Committee on Vital and Health 
                        Statistics for review and consideration under 
                        subparagraph (E). Such submission shall include 
                        information on the organization's compliance 
                        with the notice and comment requirements (and 
                        responses to those comments) under clause (ii).
                    ``(E) Hearing and recommendations by national 
                committee on vital and health statistics.--Under the 
                upgrade program, upon receipt of a proposal submitted 
                by a standard setting organization under subparagraph 
                (D)(iii) for the adoption of an addition or 
                modification to a standard, the National Committee on 
                Vital and Health Statistics shall provide notice to the 
                public and a reasonable opportunity for public 
                testimony at a hearing on such addition or 
                modification. The Secretary may participate in such 
                hearing in such capacity (including presiding ex 
                officio) as the Secretary shall determine appropriate. 
                Not later than 90 days after the date of receipt of the 
                proposal, the Committee shall submit to the Secretary 
                its recommendation to adopt (or not adopt) the proposed 
                addition or modification.
                    ``(F) Determination by secretary to accept or 
                reject national committee on vital and health 
                statistics recommendation.--
                            ``(i) Timely determination.--Under the 
                        upgrade program, if the National Committee on 
                        Vital and Health Statistics submits to the 
                        Secretary a recommendation under subparagraph 
                        (E) to adopt a proposed addition or 
                        modification, not later than 90 days after the 
                        date of receipt of such recommendation the 
                        Secretary shall make a determination to accept 
                        or reject the recommendation and shall publish 
                        notice of such determination in the Federal 
                        Register not later than 30 days after the date 
                        of the determination.
                            ``(ii) Contents of notice.--If the 
                        determination is to reject the recommendation, 
                        such notice shall include the reasons for the 
                        rejection. If the determination is to accept 
                        the recommendation, as part of such notice the 
                        Secretary shall promulgate the modified 
                        standard (including the accepted proposed 
                        addition or modification accepted).
                            ``(iii) Limitation on consideration.--The 
                        Secretary shall not consider a proposal under 
                        this subparagraph unless the Secretary 
                        determines that the requirements of 
                        subparagraph (D) (including publication of 
                        notice and opportunity for public comment) have 
                        been met with respect to the proposal.
                    ``(G) Exemption from paperwork reduction act.--
                Chapter 35 of title 44, United States Code, shall not 
                apply to a final rule promulgated under subparagraph 
                (F).''.

SEC. 202. FEDERAL PURCHASING AND DATA COLLECTION.

    (a) Coordination of Federal Spending.--
            (1) In general.--Subject to section 203(c), not later than 
        1 year after the date of the approval of an applicable standard 
        under section 101(c)(3)(B)(i), no Federal funds may be used for 
        the purchase of any health information technology or health 
        information technology system for clinical care or for the 
        electronic retrieval, storage, or exchange of health 
        information unless such technology or system has been certified 
        under section 101(c)(3)(B)(ii) with respect to compliance with 
        such standard.
            (2) Rule of construction.--Nothing in paragraph (1) shall 
        be construed to restrict the purchase of minor (as determined 
        by the Secretary) hardware or software components in order to 
        modify, correct a deficiency in, or extend the life of existing 
        hardware or software.
    (b) Coordination of Federal Data Collection.--Subject to section 
203(c), not later than 3 years after the date of the approval of an 
applicable standard under section 101(c)(3)(B)(i), all Federal agencies 
collecting health data in an electronic format for the purposes of 
quality reporting, surveillance, epidemiology, adverse event reporting, 
research, or for other purposes determined appropriate by the Secretary 
of Health and Human Services, shall comply with such standard.

SEC. 203. STUDY TO IMPROVE PRESERVATION AND PROTECTION OF SECURITY AND 
              CONFIDENTIALITY OF HEALTH INFORMATION.

    (a) In General.--The Secretary of Health and Human Services shall 
conduct a study of current Federal security and confidentiality 
standards to determine the strengths and weaknesses of such standards 
for purposes of protecting the security and confidentiality of 
individually identifiable health information while taking into account 
the need for timely and efficient exchanges of health information to 
improve quality of care and ensure the availability of health 
information necessary to make medical decisions at the location in 
which the medical care involved is provided.
    (b) Report.--Not later than 24 months after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
submit to Congress a report on the study under subsection (a) and shall 
include in such report recommendations for improving the current 
Federal security and confidentiality standards, including 
recommendations for a mechanism to track breaches to the security or 
confidentiality of individually identifiable health information and for 
appropriate penalties to apply in the case of such a breach.
    (c) Preservation of Current Security and Confidentiality Standards 
Before Submittal of Report.--None of the provisions of this Act or 
amendments made by this Act may limit, or require issuance of a 
regulation that would limit, the effect of a current Federal security 
and confidentiality standard before the date of the submittal of the 
report under subsection (b).
    (d) Current Federal Security and Confidentiality Standards 
Defined.--For purposes of this section, the term ``current Federal 
security and confidentiality standards'' means the Federal privacy 
standards established pursuant to section 264(c) of the Health 
Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2 
note) and security standards established under section 1173(d) of the 
Social Security Act.

             TITLE III--INCENTIVIZING ADOPTION OF HEALTH IT

SEC. 301. INCENTIVES FOR MEDICAL CARE PROVIDERS TO ADOPT HEALTH CARE 
              INFORMATION TECHNOLOGY.

    (a) In General.--Subsection (b) of section 179 of the Internal 
Revenue Code of 1986 is amended by adding at the end the following new 
paragraph:
            ``(8) Increased limitation for health care information 
        technology.--
                    ``(A) In general.--In the case of a medical care 
                provider for any taxable year beginning after December 
                31, 2008, and before January 1, 2014--
                            ``(i) the dollar amount in effect under 
                        paragraph (1) shall be increased by the lesser 
                        of--
                                    ``(I) $250,000, or
                                    ``(II) the cost of qualified health 
                                care information technology placed in 
                                service by such provider during the 
                                taxable year, and
                            ``(ii) the dollar amount in effect under 
                        paragraph (2) shall be increased by the lesser 
                        of--
                                    ``(I) $800,000, or
                                    ``(II) the cost of qualified health 
                                care information technology placed in 
                                service by such provider during the 
                                taxable year.
                    ``(B) Definitions.--For purposes of this 
                subsection--
                            ``(i) Qualified health care information 
                        technology.--The term `qualified health care 
                        information technology' means section 179 
                        property which--
                                    ``(I) has been certified pursuant 
                                to section 101(c)(3)(B)(ii) of the 
                                Promoting Health Information Technology 
                                Act of 2009, and
                                    ``(II) is used primarily for the 
                                electronic creation, maintenance, and 
                                exchange of medical care information to 
                                improve the quality or efficiency of 
                                medical care.
                            ``(ii) Medical care provider.--The term 
                        `medical care provider' means any person 
                        engaged in the trade or business of providing 
                        medical care.
                            ``(iii) Medical care.--The term `medical 
                        care' has the meaning given such term by 
                        section 213(d).''.
    (b) Effective Date.--The amendment made by this section shall apply 
to property placed in service after December 31, 2008.

SEC. 302. ELIMINATION OF SUNSET APPLICABLE TO STARK EXCEPTION FOR 
              ELECTRONIC HEALTH RECORDS ARRANGEMENTS.

    In applying section 1877(e) of the Social Security Act (42 U.S.C. 
1395(e)), with respect to a regulation implementing such section by 
providing an exception to the prohibition against making certain 
physician referrals in the case of the offering or payment of 
nonmonetary remuneration (consisting of items and services in the form 
of software or information technology and training services) necessary 
and used predominantly to create, maintain, transmit, or receive 
electronic health records, the Secretary of Health and Human Services 
shall not limit the period in which such an exception under such a 
regulation applies.

SEC. 303. PROMOTION OF TELEHEALTH SERVICES.

    (a) Facilitating the Provision of Telehealth Services Across State 
Lines.--
            (1) In general.--The Secretary of Health and Human Services 
        shall, in coordination with physicians, health care 
        practitioners, patient advocates, and representatives of 
        States, encourage and facilitate the adoption of State 
        reciprocity agreements for practitioner licensure in order to 
        expedite the provision across State lines of telehealth 
        services.
            (2) Report.--Not later than 18 months after the date of the 
        enactment of this Act, the Secretary of Health and Human 
        Services shall submit to Congress a report on the actions taken 
        to carry out paragraph (1).
            (3) State defined.--For purposes of this subsection, the 
        term ``State'' has the meaning given that term for purposes of 
        title XVIII of the Social Security Act.
    (b) Study and Report on Expansion of Home Health-Related Telehealth 
Services.--
            (1) Study.--The Secretary of Health and Human Services 
        shall conduct a study to determine the feasibility, 
        advisability, and the costs of--
                    (A) including coverage and payment for home health-
                related telehealth services as part of home health 
                services under title XVIII of the Social Security Act; 
                and
                    (B) expanding the list of sites described in 
                paragraph (4)(C)(ii) of section 1834(m) of the Social 
                Security Act (42 U.S.C. 1395m(m)) to include county 
                mental health clinics or other publicly funded mental 
                health facilities for the purpose of payment under such 
                section for the provision of telehealth services at 
                such clinics or facilities.
            (2) Specifics of study.--Such study shall demonstrate 
        whether the changes described in subparagraphs (A) and (B) of 
        paragraph (1) are likely to result in the following:
                    (A) Enhanced health outcomes for individuals with 
                one or more chronic conditions.
                    (B) Health outcomes for individuals furnished 
                telehealth services or home health-related telehealth 
                services that are at least comparable to the health 
                outcomes for individuals furnished similar items and 
                services by a health care provider at the same location 
                of the individual or at the home of the individual, 
                respectively.
                    (C) Facilitation of communication of more accurate 
                clinical information between health care providers.
                    (D) Closer monitoring of individuals by health care 
                providers.
                    (E) Overall reduction in expenditures for health 
                care items and services.
                    (F) Improved access to health care.
            (3) Home health-related telehealth services defined.--For 
        purposes of this subsection, the term ``home health-related 
        telehealth services'' means technology-based professional 
        consultations, patient monitoring, patient training services, 
        clinical observation, patient assessment, and any other health 
        services that utilize telecommunications technologies. Such 
        term does not include a telecommunication that consists solely 
        of a telephone audio conversation, facsimile, electronic text 
        mail, or consultation between two health care providers.
            (4) Report.--Not later than 18 months after the date of the 
        enactment of this Act, the Secretary of Health and Human 
        Services shall submit to Congress a report on the study 
        conducted under paragraph (1) and shall include in such report 
        such recommendations for legislation or administration action 
        as the Secretary determines appropriate.
    (c) Study and Report on Store and Forward Technology for 
Telehealth.--
            (1) Study.--The Secretary of Health and Human Services, 
        acting through the Director of the Office for the Advancement 
        of Telehealth, shall conduct a study on the use of store and 
        forward technologies (that provide for the asynchronous 
        transmission of health care information in single or multimedia 
        formats) in the provision of telehealth services. Such study 
        shall include an assessment of the feasibility, advisability, 
        and the costs of expanding the use of such technologies for use 
        in the diagnosis and treatment of certain health conditions, as 
        specified by the Secretary.
            (2) Report.--Not later than 18 months after the date of the 
        enactment of this Act, the Secretary of Health and Human 
        Services shall submit to Congress a report on the study 
        conducted under paragraph (1) and shall include in such report 
        such recommendations for legislation or administration action 
        as the Secretary determines appropriate.

SEC. 304. FQHCS INCLUDED IN ELECTRONIC HEALTH RECORDS DEMONSTRATION.

    Effective as of the date of the enactment of this Act, in 
developing and implementing a demonstration initiative to foster the 
implementation and adoption of electronic health records and health 
information technology, the Centers of Medicare & Medicaid Services 
shall provide for the eligibility of Federally qualified health centers 
(as defined in section 1861(aa)(4) of the Social Security Act (42 
U.S.C. 1395x(aa)(4)) to participate in such demonstration.

SEC. 305. INTEREST-FREE LOAN PROGRAM FOR HOSPITALS TO ADOPT HEALTH 
              INFORMATION TECHNOLOGY.

    (a) In General.--The Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall establish a loan 
program that provides loans to hospitals to purchase and implement 
health information technology products certified pursuant to section 
101(c)(3)(B)(ii).
    (b) Application.--No loan may be provided under this section to a 
hospital except pursuant to an application that is submitted and 
approved in a time, manner, and form specified by the Secretary. A loan 
under this section shall be on such terms and conditions and meet such 
requirements as the Secretary determines appropriate, in accordance 
with the provisions of this section.
    (c) Permissible Use of Loan Funds.--A loan provided under this 
section shall be used only for the purchase and implementation of 
health information technology products certified pursuant to section 
1019c)(3)(B)(ii).
    (d) Preference.--In making loans under this section, the Secretary 
shall give preference to any applicant for such a loan that is a 
hospital receiving a high amount of disproportionate share hospital 
payments under section 1886(d)(5)(F) of the Social Security Act (42 
U.S.C. 1395ww(d)(5)(F)).
    (e) Repayment of Loans.--The Secretary shall establish a schedule 
for the repayment of loans provided under this section.
    (f) No Interest Charged.--The Secretary shall not charge or collect 
interest on any loan made under this section.
    (g) Penalties.--The Secretary shall establish penalties to which a 
hospital receiving a loan under this section would be subject if such 
hospital is in violation of any of the terms, conditions, or 
requirements specified by the Secretary under subsection (b) or under 
this section.
    (h) Funding.--
            (1) Authorization of appropriations.--For purposes of 
        carrying out this section, there are authorized to be 
        appropriated such sums as may be necessary for fiscal year 2009 
        and each succeeding fiscal year.
            (2) Availability.--Amounts appropriated under paragraph (1) 
        shall remain available until expended.
            (3) Repaid loan amounts.--Any amount repaid by, or 
        recovered from, a hospital under this section shall be credited 
        to the appropriation account from which the loan amount 
        involved was originally paid. Any amount so credited shall be 
        available only for the purpose of carrying out the loan program 
        under this section.
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