I 

109TH CONGRESS 

2D SESSION H. R. 4832 

To amend the Social Security Act to establish an Office of Health Information 

Technology for the purpose of creating a national interoperable health 

information infrastructure, to provide loans to health care entities seeking 

to implement such infrastructure, and to provide exceptions to certain 

health anti-kickback laws to encourage the dissemination of health information technology. 

IN THE HOUSE OF REPRESENTATIVES 

MARCH 1, 2006 

Mr. CLAY (for himself and Mr. PORTER) 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 amend the Social Security Act to establish an Office 

of Health Information Technology for the purpose of 

creating a national interoperable health information infrastructure, to provide loans to health care entities seeking to implement such infrastructure, and to provide 

exceptions to certain health anti-kickback laws to encourage the dissemination of health information technology. 

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; TABLE OF CONTENTS. 

2 (a) SHORT TITLE.—This Act may be cited as the 

3 ‘‘Electronic Health Information Technology Act of 2006’’. 

4 (b) TABLE OF CONTENTS.—The table of contents of 

5 this Act is as follows: 

Sec. 1. Short title; table of contents 

Sec. 2. Office of Health Information Technology and standards development 

Sec. 3. National Institute of Health demonstration program 

Sec. 4. Health care provider HIT loan program 

Sec. 5. Safe harbor from anti-kickback laws for health information technology 

Sec. 6. Uniform Federal and State health information standards 

6 SEC. 2. OFFICE OF HEALTH INFORMATION TECHNOLOGY 

7 AND STANDARDS DEVELOPMENT. 

8 (a) IN GENERAL.—Part A of title XI of the Social 

9 Security Act (42 U.S.C. 1301 et seq.) is amended by add10 ing at the end the following new section: 

11 ‘‘HEALTH INFORMATION TECHNOLOGY

12 ‘‘SEC. 1150A. (a) OFFICE OF HEALTH INFORMATION

13 TECHNOLOGY.— 

14 ‘‘(1) ESTABLISHMENT.—There is established 

15 within the Department of Health and Human Serv16 ices an Office of Health Information Technology (re17 ferred to in this section as the ‘Office’) that shall be 

18 headed by the Chief Health Informatics Officer of 

19 Health Information Technology (referred to in this 

20 section as the ‘Chief Health Informatics Officer’). 

21 The Chief Health Informatics Officer shall be ap22 pointed by the Secretary and shall report directly to 

23 the Secretary. The Chief Health Informatics Officer 
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1 shall be paid at a rate equal to the rate of basic pay 

2 for level IV of the Executive Schedule. 

3 ‘‘(2) OBJECTIVES OF OFFICE.—In fulfilling the 

4 duties under paragraph (3), the work of the Chief 

5 Health Informatics Officer shall be consistent with 

6 the following objectives: 

7 ‘‘(A) CONVENIENT AVAILABILITY OF

8 HEALTH INFORMATION.—Ensuring that appro9 priate information to guide medical decisions is 

10 available on the date on which and at the loca11 tion in which health care is provided to an indi12 vidual. 

13 ‘‘(B) IMPROVED HEALTH CARE.— 

14 ‘‘(i) Improving health care quality. 

15 ‘‘(ii) Advancing the delivery of appro16 priate evidence-based health care. 

17 ‘‘(iii) Reducing the occurrence of med18 ical errors, inefficiency, inappropriate 

19 health care, and incomplete information. 

20 ‘‘(iv) Reducing health costs that result 

21 from the occurrences referred to in clause 

22 (iii). 

23 ‘‘(C) PROMOTION OF EFFECTIVE HEALTH

24 CARE MARKETPLACE.—Promoting an effective 

25 marketplace for health care consumption, great-
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1 er competition, and increased choice through 

2 the wider availability of accurate information 

3 about the costs, quality, and outcomes (based 

4 on measurable public health improvements) of 

5 health care. 

6 ‘‘(D) IMPROVED COORDINATION OF

7 HEALTH CARE INFORMATION.—Improving the 

8 coordination of health information among hos9 pitals, laboratories, physician offices, and ambu10 latory care providers through an effective infra11 structure for the secure and authorized ex12 change of health information. 

13 ‘‘(E) SECURE AND PROTECTED HEALTH

14 INFORMATION.—Ensuring that the individually 

15 identifiable health information (as defined in 

16 section 1171(6)) of an individual is secure and 

17 protected. 

18 ‘‘(3) DUTIES OF CHIEF HEALTH INFORMATICS

19 OFFICER.—The Chief Health Informatics Officer 

20 shall perform the following duties: 

21 ‘‘(A) DEVELOPMENT, IMPLEMENTATION, 

22 AND MODIFICATION OF UNIFORM HIT STAND23 ARDS.—Develop, implement, and modify HIT 

24 standards, in accordance with subsections (c), 

25 (d), and (e), respectively. 
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1 ‘‘(B) DEVELOPMENT, MAINTENANCE, AND

2 IMPLEMENTATION OF INTEROPERABLE HIT

3 STRATEGIC PLAN.—Develop, maintain, and di4 rect the implementation of an interoperable 

5 HIT strategic plan (described in paragraph (4)) 

6 to guide the nationwide implementation of 

7 interoperable health information technology in 

8 the public and private health care sectors. 

9 ‘‘(C) PRINCIPAL ADVISOR TO SEC10 RETARY.—Serve as the principal advisor to the 

11 Secretary on the development and use of health 

12 information technology. 

13 ‘‘(D) DIRECTOR OF HHS HEALTH INFOR14 MATION TECHNOLOGY PROGRAMS.—Direct any 

15 programs related to health information tech16 nology that are conducted by the Secretary. 

17 ‘‘(E) COORDINATOR OF FEDERAL HEALTH

18 INFORMATION POLICY AND ACTIVITIES.—Co19 ordinate health information technology policies 

20 of the Department of Health and Human Serv21 ices and activities related to the transmission, 

22 integrity, and security of health information 

23 conducted by the Secretary with such policies 

24 and activities of Federal agencies to avoid du25 plication of effort and to ensure that each such 
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1 agency performs activities within the area of 

2 the greatest expertise and technical capability 

3 of such agency. 

4 ‘‘(F) COORDINATOR OF OUTREACH AND

5 CONSULTATION.—Coordinate programs of Fed6 eral agencies that are related to health informa7 tion technology outreach and consultation by 

8 such agencies with public and private entities, 

9 including consumers, providers, payers, and ad10 ministrators. 

11 ‘‘(G) COORDINATOR FOR PLANS FOR PRI12 VATE SECTOR HEALTH INFORMATION TECH13 NOLOGY.—Coordinate plans for Federal efforts 

14 to develop and implement interoperable HIT 

15 standards for private sector physicians and 

16 other health professionals who use electronic 

17 health records, electronic prescribing systems, 

18 evidence-based clinical support tools, patient 

19 registries, or other health information tech20 nology. 

21 ‘‘(H) ADVISOR TO OMB.—Provide to the 

22 Director of the Office of Management and 

23 Budget comments and advice with respect to 

24 specific health information technology pro25 grams. 
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1 ‘‘(I) ADMINISTRATOR OF GRANTS PRO2 GRAM.—Administer the HIT standards grants 

3 program under subsection (j). 

4 ‘‘(4) INTEROPERABLE HIT STRATEGIC PLAN.— 

5 ‘‘(A) DESCRIPTION.—For purposes of 

6 paragraph (3)(B), an interoperable HIT stra7 tegic plan is a plan that is consistent with the 

8 following: 

9 ‘‘(i) ADVANCEMENT OF HIT STAND10 ARDS.—Advances the development and na11 tional implementation of HIT standards 

12 through the collaboration of public and pri13 vate interests, and consistent with efforts 

14 in existence before the date of the enact15 ment of this section. 

16 ‘‘(ii) ACKNOWLEDGEMENT OF CER17 TAIN ISSUES INVOLVED IN ADOPTION OF

18 STANDARDS.—Ensures that the main tech19 nical, scientific, economic, and other issues 

20 affecting the adoption of HIT standards 

21 (in the public and private sectors) are ad22 dressed. 

23 ‘‘(iii) EVALUATION OF BENEFITS AND

24 COSTS OF INTEROPERABLE HEALTH IN25 FORMATION TECHNOLOGY.—Evaluates the 
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1 benefits and costs of interoperable health 

2 information technology and identifies the 

3 persons affected by such benefits and 

4 costs. 

5 ‘‘(iv) ACKNOWLEDGEMENT OF PRI6 VACY AND SECURITY ISSUES.—Addresses 

7 the issues of privacy and security related 

8 to interoperable health information tech9 nology and recommends methods to ensure 

10 appropriate authorization, authentication, 

11 and encryption of data transmission over 

12 the Internet. 

13 ‘‘(v) SELF-SUFFICIENT PLAN.—Does 

14 not assume or depend upon Federal re15 sources or spending that is in addition to 

16 resources and spending authorized under 

17 the Electronic Health Information Tech18 nology Act of 2006 to accomplish the 

19 adoption of HIT standards and an inter20 operable health information technology in21 frastructure. 

22 ‘‘(vi) MEASURABLE OUTCOME

23 GOALS.—Includes measurable outcome 

24 goals, such as for determining error reduc25 tions in patient care and economic benefits 
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1 derived from the use of interoperable 

2 health information technology. 

3 ‘‘(B) REPORTS.—Not later than 180 days 

4 after the date of the appointment of the Chief 

5 Health Informatics Officer, and periodically 

6 thereafter, the Chief Health Informatics Officer 

7 shall submit to the Secretary a report on the 

8 progress of the development and implementa9 tion of the interoperable HIT strategic plan. 

10 ‘‘(b) LIMITATION ON USE OF FEDERAL FUNDS TO

11 PURCHASE HEALTH INFORMATION TECHNOLOGY PROD12 UCTS.— 

13 ‘‘(1) IN GENERAL.—Effective as provided in 

14 paragraphs (1)(B) and (2)(C) of subsection (d), no 

15 Federal funds (including grants provided under sub16 section (j)) may be used for the purchase (or up17 date) of a health information technology product un18 less the product (or update) is certified by the entity 

19 selected under paragraph (2) as complying with HIT 

20 standards in effect on the date of certification. 

21 ‘‘(2) SELECTION OF CERTIFICATION ENTITY.— 

22 For purposes of paragraph (1) and subject to para23 graph (3), the Secretary shall enter into a contract 

24 with an entity to certify that a health information 

25 technology product (or update) meets HIT stand-
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1 ards implemented under subsection (d). For pur2 poses of the preceding sentence, the Secretary may 

3 enter into a contract with a private entity, including 

4 the Certification Commission for Healthcare Infor5 mation Technology. 

6 ‘‘(3) CONTRACTING EXCEPTION.—For purposes 

7 of paragraph (2) and subsection (c)(3), the Sec8 retary may enter into a contract with the Certifi9 cation Commission for Healthcare Information Tech10 nology for purposes of such paragraph or such sub11 section, but not for both. 

12 ‘‘(c) DEVELOPMENT OF HIT STANDARDS.— 

13 ‘‘(1) REQUIREMENTS.—The Chief Health 

14 Informatics Officer shall provide for the development 

15 of HIT standards. Such standards shall comply with 

16 the following: 

17 ‘‘(A) INTEROPERABILITY.—The standards 

18 shall provide for interoperability among health 

19 information systems. 

20 ‘‘(B) APPLICATION TO ELECTRONIC

21 TRANSACTIONS AND TRANSMISSIONS.—The 

22 standards shall apply to electronic transactions 

23 and transmissions of health information, to the 

24 content of such transactions and transmissions, 

25 and to the data elements of such transactions 
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1 and transmissions, including standards for se2 curity and coding of electronic health informa3 tion created for the purpose of establishing an 

4 interoperable health information infrastructure. 

5 ‘‘(C) PROPRIETARY NEUTRALITY.—The 

6 standards shall not restrict, sponsor, promote, 

7 or prejudice in any other way the certification 

8 of health information technology products ac9 cording to brand, product line, or vendor. 

10 ‘‘(D) PATIENT SAFETY AND QUALITY OF

11 CARE.—The standards shall be consistent with 

12 the objectives of improving patient safety and 

13 the quality of care provided to patients. 

14 ‘‘(E) NO UNDUE BURDEN.—The standards 

15 shall not, to the extent practicable, impose an 

16 undue administrative or financial burden on the 

17 practice of medicine, or any other health care 

18 profession, particularly on small physician prac19 tices and practices located in rural areas. 

20 ‘‘(F) COMPATIBILITY WITH HIPAA PRIVACY

21 LAWS.—The standards shall be consistent with 

22 the standards under section 264(c) of the 

23 Health Insurance Portability and Accountability 

24 Act of 1996 (42 U.S.C. 1320d–2 note) (con-
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1 cerning the privacy of individually identifiable 

2 health information). 

3 ‘‘(2) ACCESS RESTRICTION STANDARDS.—The 

4 Chief Health Informatics Officer shall establish 

5 standards to restrict access of public and private en6 tities to health information transferred, used, or 

7 stored by health information technology. 

8 ‘‘(3) CONTRACTING AUTHORITY.—Subject to 

9 subsection (b)(3), the Chief Health Informatics Offi10 cer may enter into a contract with the Certification 

11 Commission for Healthcare Information Technology, 

12 or any other appropriate certification entity, to de13 velop HIT standards, access restriction standards 

14 described in paragraph (2), or both. 

15 ‘‘(4) HIT STANDARDS DEFINED.—For purposes 

16 of this section, the term ‘HIT standards’ means 

17 standards related to the transmission, integrity, and 

18 security of health information. 

19 ‘‘(d) IMPLEMENTATION OF HIT STANDARDS.— 

20 ‘‘(1) CONSOLIDATED HEALTH INFORMATICS

21 COUNCIL STANDARDS IN EXISTENCE BEFORE DATE

22 OF ENACTMENT.— 

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

24 year after the date of the enactment of this sec25 tion, the Chief Health Informatics Officer shall 
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1 implement all standards that were developed, 

2 implemented, or modified by the Consolidated 

3 Health Informatics Council before such date of 

4 enactment. 

5 ‘‘(B) EFFECTIVE DATES.— 

6 ‘‘(i) FEDERAL AGENCIES.—For pur7 poses of subsection (b) and not later than 

8 the date that is 30 days after the date on 

9 which HIT standards are implemented 

10 under subparagraph (A), such standards 

11 shall apply to a Federal agency. 

12 ‘‘(ii) NON-FEDERAL AGENCIES.—For 

13 purposes of subsection (b) and not later 

14 than 18 months after the date of the en15 actment of the Electronic Health Informa16 tion Technology Act of 2006, the HIT 

17 standards implemented under subpara18 graph (A) shall apply to an entity that is 

19 not a Federal agency. 

20 ‘‘(2) STANDARDS DEVELOPED AFTER DATE OF

21 ENACTMENT.— 

22 ‘‘(A) IN GENERAL.—The Chief Health 

23 Informatics Officer shall implement, in accord24 ance with subparagraph (B), each HIT stand25 ard developed under subsection (c) or modified 
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1 under subsection (e) unless the Chief Health 

2 Informatics Officer determines that the stand3 ard would not be effective in promoting an 

4 interoperable health information technology in5 frastructure. 

6 ‘‘(B) REGULATIONS.—For purposes of 

7 subparagraph (A), the Secretary shall establish 

8 guidelines for determining if a standard would 

9 not be effective in promoting an interoperable 

10 health information technology infrastructure 

11 and for specifying dates by which the Chief 

12 Health Informatics Officer is required to make 

13 a determination under such subparagraph be14 fore standards developed under subsection (c) 

15 or modified under subsection (e) shall be imple16 mented. 

17 ‘‘(C) EFFECTIVE DATES.— 

18 ‘‘(i) FEDERAL AGENCIES.—For pur19 poses of subsection (b) and not later than 

20 18 months after the date on which a HIT 

21 standard is implemented under subpara22 graph (A), such standard shall apply to a 

23 Federal agency. 

24 ‘‘(ii) NON-FEDERAL AGENCIES.—For 

25 purposes of subsection (b) and not later 
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1 than 24 months after the date on which a 

2 HIT standard is implemented under sub3 paragraph (A), such standard shall apply 

4 to an entity that is not a Federal agency. 

5 ‘‘(3) DOCUMENTATION OF COMPLIANCE.—On 

6 the date of the implementation of a HIT standard 

7 under this subsection, the Chief Health Informatics 

8 Officer shall provide documentation to the Secretary 

9 showing that the standard complies with each re10 quirement under subsection (c)(1). 

11 ‘‘(e) MODIFICATION OF STANDARDS.—The Chief 

12 Health Informatics Officer may modify, according to a 

13 procedure established by the Chief Health Informatics Of14 ficer, a HIT standard implemented under subsection (d). 

15 A standard modified under this subsection shall be imple16 mented in accordance with such subsection. 

17 ‘‘(f) AUTHORITY TO WAIVE COMPLIANCE.— 

18 ‘‘(1) IN GENERAL.—The Chief Health 

19 Informatics Officer may waive the application of 

20 HIT standards implemented under subsection (d) 

21 for not more than a one-year period, on a case-by22 case basis, in unusual or extreme circumstances. 

23 ‘‘(2) REPORTS.—Not later than 60 days after 

24 the date on which the Chief Health Informatics Offi25 cer makes such a waiver, the Chief Health 
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1 Informatics Officer shall submit to Congress a re2 port stating the purpose and circumstances justi3 fying the waiver. 

4 ‘‘(g) PENALTIES.— 

5 ‘‘(1) FEDERAL AGENCIES.—The Director of the 

6 Office of Management and Budget shall develop and 

7 implement a system to enforce compliance with HIT 

8 standards implemented under subsection (d). Such 

9 system shall include appropriate budgetary pen10 alties— 

11 ‘‘(A) for a Federal agency that is not in 

12 compliance with such standards and has not re13 ceived a waiver under subsection (f)(1); and 

14 ‘‘(B) for a Federal agency that has re15 ceived a waiver under subsection (f)(1) but, 

16 starting on a date that is after the date on 

17 which the waiver terminates, is not in compli18 ance with such standards. 

19 ‘‘(2) NON-FEDERAL ENTITIES.—An entity that 

20 is not a Federal agency shall no longer receive Fed21 eral funds for purposes of purchasing a health infor22 mation technology product if— 

23 ‘‘(A) such entity is in violation of sub24 section (b) and has not received a waiver under 

25 subsection (f)(1); or 
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1 ‘‘(B) such entity has received a waiver 

2 under subsection (f)(1) but starting on a date 

3 that is after the date on which the waiver ter4 minates the entity is not in compliance with 

5 HIT standards implemented under subsection 

6 (d). 

7 ‘‘(h) CONSULTATION AND RECOMMENDATIONS.—For 

8 purposes of developing HIT standards under subsection 

9 (c) and modifying such standards under subsection (e), 

10 the following applies: 

11 ‘‘(1) STAKEHOLDER CONSULTATION.—The 

12 Chief Health Informatics Officer, in accordance with 

13 subchapter II of chapter 5 and chapter 7 of title 5, 

14 United States Code (popularly known as the Admin15 istrative Procedure Act), shall consult with Federal 

16 agencies and private entities that are involved in the 

17 transfer or collection of health information, includ18 ing agencies of the Federal Health Architecture, 

19 members of the Consolidated Health Informatics 

20 Council, physicians, hospitals, health care delivery 

21 systems, health insurance providers, pharmaceutical 

22 and biologics manufacturers, medical device manu23 facturers, information technology vendors, patient 

24 groups, private standards-setting organizations, pub25 lic health interest groups, and other health care pro-
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1 fessionals determined by the Chief Health 

2 Informatics Officer necessary to the process of devel3 oping and modifying such standards. 

4 ‘‘(2) NATIONAL COMMITTEE ON VITAL AND

5 HEALTH STATISTICS RECOMMENDATIONS.—Not later 

6 than the date that is one year after the date of the 

7 enactment of this section, and each year thereafter, 

8 the National Committee on Vital and Health Statis9 tics shall submit to the Chief Health Informatics Of10 ficer recommendations for activities to advance the 

11 development and modification of HIT standards. 

12 ‘‘(i) TREATMENT OF STATE HIT STANDARDS.—A 

13 standard implemented under subsection (d) for application 

14 to electronic transfers or transactions described in sub15 section (c)(1)(B) shall supersede any standard prescribed 

16 by a State or local government for a similar application. 

17 ‘‘(j) HIT GRANTS PROGRAM.— 

18 ‘‘(1) ESTABLISHMENT OF PROGRAM.—In ac19 cordance with this subsection and subject to para20 graph (3) and subsection (m), the Chief Health 

21 Informatics Officer shall award one-year grants to 

22 eligible health information technology entities whose 

23 applications under paragraph (2) demonstrate a pro24 posal that will benefit an interoperable health infor-
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1 mation technology infrastructure and is consistent 

2 with the mission of such an entity. 

3 ‘‘(2) APPLICATION.—To be eligible for an 

4 award of a grant under this section, an eligible 

5 health information technology entity shall submit to 

6 the Secretary an application that contains a descrip7 tion of how the applicant proposes to use the grant 

8 funds. The application shall be submitted in such 

9 form, at such time, and containing such other infor10 mation as the Chief Health Informatics Officer may 

11 require. 

12 ‘‘(3) SET-ASIDES FOR DSH QUALIFYING FACILI13 TIES.— 

14 ‘‘(A) IN GENERAL.—The Secretary shall 

15 use at least 20 percent of the funds authorized 

16 under subsection (m) for purposes of this sec17 tion to award grants under paragraph (1) to el18 igible health information technology entities, 

19 which are DSH qualifying facilities. 

20 ‘‘(B) DSH QUALIFYING FACILITY DE21 FINED.—For purposes of subparagraph (A), the 

22 term ‘DSH qualifying facility’ means any of the 

23 following: 

24 ‘‘(i) MEDICARE DISPROPORTIONATE

25 SHARE HOSPITAL.—A hospital that quali-
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1 fies for an additional payment under sec2 tion 1886(d)(4)(F). 

3 ‘‘(ii) MEDICAID DISPROPORTIONATE

4 SHARE HOSPITAL.—A hospital that quali5 fies for an increase in the rate or amount 

6 of payment for inpatient hospital services 

7 under section 1923(a). 

8 ‘‘(iii) PROVIDER SERVING A MEDI9 CALLY UNDERSERVED POPULATION.—A 

10 health care provider that serves a medi11 cally underserved population, as defined in 

12 section 330(a)(3) of the Public Health 

13 Service Act. 

14 ‘‘(iv) CRITICAL ACCESS HOSPITAL.—A 

15 facility designated as a critical access hos16 pital in accordance with section 

17 1820(c)(2). 

18 ‘‘(4) PERMISSIBLE USE OF GRANTS.—A grant 

19 awarded under paragraph (1) may be used by an eli20 gible health information technology entity only for 

21 purposes of the proposal submitted by such entity 

22 under paragraph (2). 

23 ‘‘(5) EXTENSION OF GRANTS.—Upon the expi24 ration of a grant awarded to an eligible health infor25 mation technology entity under paragraph (1) and 
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1 the request of such entity, the Chief Health 

2 Informatics Officer, in accordance with procedures 

3 established by the Chief Health Informatics Officer, 

4 may extend the duration of the grant once by one 

5 year if the Chief Health Informatics Officer deter6 mines that the programs established and imple7 mented by such group with the grant resulted in (or 

8 are likely to result in) significant progress in bene9 fiting an interoperable health information technology 

10 infrastructure. 

11 ‘‘(6) DEFINITION OF ELIGIBLE HEALTH INFOR12 MATION TECHNOLOGY ENTITY.—For purposes of 

13 this subsection, the term ‘eligible health information 

14 technology entity’ means an entity of a State or local 

15 government or a private entity that seeks (and has 

16 the capacity) to participate in the research, develop17 ment, or implementation of HIT standards. Such 

18 term includes a health care provider, whether or not 

19 the provider participates under title XVIII or XIX, 

20 a health insurance issuer, and a group health plan. 

21 ‘‘(k) PROGRESS AND COMPLIANCE REPORTS.— 

22 ‘‘(1) BIENNIAL PROGRESS REPORTS.—The 

23 Chief Health Informatics Officer shall submit to 

24 Congress biennial reports on the progress of the de25 velopment and implementation of HIT standards. 
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1 ‘‘(2) ANNUAL COMPLIANCE REPORTS.—The 

2 Chief Health Informatics Officer shall submit to 

3 Congress an annual report that assesses the compli4 ance of all Federal Health Architecture agencies 

5 with HIT standards. 

6 ‘‘(3) ADMINISTRATIVE PROVISIONS.—For pur7 poses of paragraphs (1) and (2), the Chief Health 

8 Informatics Officer shall specify dates on which such 

9 reports shall be submitted under such paragraphs, 

10 the periods during which progress or compliance 

11 shall be assessed under such paragraphs, and a 

12 method for assessing such progress or compliance, 

13 respectively. 

14 ‘‘(4) BI-ANNUAL GAP ASSESSMENT.— 

15 ‘‘(A) IN GENERAL.—Starting on the date 

16 that is one year after the date of the enactment 

17 of this section, the Chief Health Informatics 

18 Officer shall request the Institute of Medicine 

19 to enter into an agreement with the Officer 

20 under which such Institute conducts a bi-annual 

21 assessment that identifies problems that present 

22 barriers to adaptation of HIT standards imple23 mented during the period of such assessment. 

24 Such assessment shall— 
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1 ‘‘(i) analyze the impact and effective2 ness of such standards; 

3 ‘‘(ii) identify the costs and long-term 

4 savings to Federal agencies of complying 

5 with such standards during the period of 

6 the assessment; 

7 ‘‘(iii) identify the impact of such 

8 standards on patient safety, on the quality 

9 of medical care provided to patients, and 

10 on mortality rates; 

11 ‘‘(iv) identify significant administra12 tive or business practice efficiencies and in13 efficiencies that result from the implemen14 tation of such standards; 

15 ‘‘(v) identify ways to improve methods 

16 of developing and implementing such 

17 standards in public and private sectors; 

18 and 

19 ‘‘(vi) recommend requirements and 

20 guidelines for future research and develop21 ment of such standards. 

22 ‘‘(B) REPORT.—Not later than 60 days 

23 after the last day of each period of semi-annual 

24 assessment conducted under subparagraph (A), 
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1 the Secretary shall submit to Congress a report 

2 on the findings of such assessment. 

3 ‘‘(l) DEFINITIONS.—For purposes of this section: 

4 ‘‘(1) HEALTH INFORMATION.—The term ‘health 

5 information’ has the meaning given such term in 

6 section 1171(4). 

7 ‘‘(2) HEALTH INFORMATION TECHNOLOGY.— 

8 The term ‘health information technology’ means 

9 products, devices, or systems that allow for the elec10 tronic collection, storage, exchange, or management 

11 of health information. 

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

13 ‘health care provider’ means— 

14 ‘‘(A) a health care provider defined in sec15 tion 1171(3), including a critical access hos16 pital; and 

17 ‘‘(B) a federally qualified health center de18 fined in section 1861(aa)(4). 

19 ‘‘(4) INTEROPERABILITY.—The term ‘interoper20 ability’ means the ability of different information 

21 systems and software applications to communicate 

22 and to exchange information accurately, effectively, 

23 and consistently. 

24 ‘‘(5) FEDERAL AGENCY.—The term ‘Federal 

25 agency’ means a department or agency of the Fed-
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1 eral Government that possesses, uses, or transfers 

2 health information. 

3 ‘‘(6) FEDERAL HEALTH ARCHITECTURE.—The 

4 term ‘Federal Health Architecture’ means the entity 

5 overseen by the Secretary and the Director of the 

6 Office of Management and Budget and administered 

7 by the National Coordinator for Health Information 

8 Technology pursuant to Executive Order 13335 to 

9 provide the structure for collaboration and interoper10 ability among Federal health efforts. 

11 ‘‘(7) CONSOLIDATED HEALTH INFORMATICS

12 COUNCIL.—The term ‘Consolidated Health 

13 Informatics Council’ means the initiative overseen by 

14 the Secretary and the Director of the Office of Man15 agement and Budget and administered by the Na16 tional Coordinator for Health Information Tech17 nology pursuant to Executive Order 13335 to adopt 

18 existing health information interoperability stand19 ards. 

20 ‘‘(m) AUTHORIZATION OF APPROPRIATIONS.—There 

21 is authorized to be appropriated such funds as are nec22 essary, but not more than $750,000,000, for each of fiscal 

23 years 2007 through 2011 to carry out this section. Of such 

24 amounts made available for a fiscal year, the Secretary 

25 shall allocate— 
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1 ‘‘(1) not less than 60 percent for the HIT 

2 grants program under subsection (j); and 

3 ‘‘(2) not less than 10 percent for research and 

4 development activities and demonstration programs 

5 carried out by the Office.’’. 

6 (b) APPOINTMENT OF CHIEF HEALTH INFORMATICS

7 OFFICER OF THE OFFICE OF HEALTH INFORMATION

8 TECHNOLOGY.—Not later than 60 days after the date of 

9 the enactment of this Act, the Secretary of Health and 

10 Human Services shall appoint a Chief Health Informatics 

11 Officer of the Office of Health Information Technology 

12 under section 1150A(a) of the Social Security Act, as 

13 added by subsection (a). 

14 (c) TRANSITION FROM OFFICE OF THE NATIONAL

15 COORDINATOR FOR HEALTH INFORMATION TECH16 NOLOGY.— 

17 (1) FUNCTIONS, PERSONNEL, ASSETS, AND LI18 ABILITIES.— 

19 (A) IN GENERAL.—There shall be trans20 ferred to the Chief Health Informatics Officer 

21 the functions, personnel, assets, and liabilities 

22 of the National Coordinator. For purposes of 

23 the previous sentence, the term ‘‘assets’’ in24 cludes contracts, facilities, property, records, 

25 unobligated or unexpended balances of appro-
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1 priations, and other funds or resources (other 

2 than personnel). 

3 (B) EMPLOYMENT PROVISIONS.—The 

4 transfer pursuant to subparagraph (A) of per5 sonnel shall not alter the terms and conditions 

6 of employment, including compensation, of any 

7 employee so transferred. 

8 (C) CHIEF HEALTH INFORMATICS OFFICER

9 AND NATIONAL COORDINATOR DEFINED.—For 

10 purposes of this subsection: 

11 (i) CHIEF HEALTH INFORMATICS OF12 FICER.—The term ‘‘Chief Health 

13 Informatics Officer’’ means the Chief 

14 Health Informatics Officer of Health In15 formation Technology appointed under sec16 tion 1150A of the Social Security Act, as 

17 added by subsection (a). 

18 (ii) NATIONAL COORDINATOR.—The 

19 term ‘‘National Coordinator’’ means the 

20 National Coordinator for Health Informa21 tion Technology appointed under Executive 

22 Order 13335. 

23 (2) ACTING CHIEF HEALTH INFORMATICS OFFI24 CER.—Before the appointment of the Chief Health 

25 Informatics Officer, the National Coordinator shall 
28 

•HR 4832 IH 

1 act as the Chief Health Informatics Officer until the 

2 office is filled as provided in section 1150A(a) of the 

3 Social Security Act. The Secretary may appoint the 

4 National Coordinator as the Chief Health 

5 Informatics Officer. 

6 (3) COMPLETED ADMINISTRATIVE ACTIONS.— 

7 (A) IN GENERAL.—Completed administra8 tive actions of the Office of the National Coor9 dinator shall continue in effect according to 

10 their terms until amended, modified, super11 seded, terminated, set aside, or revoked by the 

12 Office of the Chief Health Informatics Officer. 

13 (B) COMPLETED ADMINISTRATIVE ACTION

14 DESCRIBED.—For purposes of subparagraph 

15 (A), the term ‘‘completed administrative action’’ 

16 includes orders, determinations, rules, regula17 tions, personnel actions, permits, agreements, 

18 grants, contracts, certificates, licenses, registra19 tions, and privileges. 

20 (4) REFERENCES.—References relating to the 

21 Office of the National Coordinator that precede the 

22 effective date of this Act shall be deemed to refer, 

23 as appropriate, to the Office of the Chief Health 

24 Informatics Officer. 
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•HR 4832 IH 

1 (5) STATUTORY REPORTING REQUIREMENTS.— 

2 Any statutory reporting requirement that applied to 

3 the Office of the National Coordinator immediately 

4 before the effective date of this Act shall apply to 

5 the Office of the Chief Health Informatics Officer 

6 following such date. 

7 (6) TREATMENT OF EXECUTIVE ORDER 13335.— 

8 Executive Order 13335 shall not have any force or 

9 effect after the date of the appointment of the first 

10 Chief Health Informatics Officer. 

11 SEC. 3. NATIONAL INSTITUTE OF HEALTH DEMONSTRA12 TION PROGRAM. 

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

14 Human Services, acting through the Director of the Na15 tional Institute of Health, shall carry out a demonstration 

16 program to determine methods by which contextual access 

17 criteria and analysis technologies for specific diseases and 

18 health criteria may be used to search patient electronic 

19 health records and aggregated health information without 

20 using personal identifying information of patients. Partici21 pants in the program shall include representatives of Fed22 eral health agencies, State health agencies, research facili23 ties approved for clinical trials of the National Institute 

24 of Health, health insurance organizations, self-insured 

25 corporations, and private sector health care providers. 
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•HR 4832 IH 

1 (b) REPORT.—Not later than two years after the date 

2 of the enactment of this Act, the Secretary of Health and 

3 Human Services shall submit to Congress a report on the 

4 findings of the demonstration program under subsection 

5 (a). 

6 SEC. 4. HEALTH CARE PROVIDER HIT LOAN PROGRAM. 

7 (a) PROGRAM ESTABLISHED.—Part A of title XI of 

8 the Social Security Act (42 U.S.C. 1301 et seq.), as 

9 amended by section 2, is further amended by adding at 

10 the end the following new section: 

11 ‘‘SEC. 1150B HEALTH CARE PROVIDER HIT LOAN PROGRAM. 

12 ‘‘(a) PROGRAM ESTABLISHED.— 

13 ‘‘(1) IN GENERAL.—There is established a pro14 gram to be known as the ‘Health Care Provider HIT 

15 Loan Program’ (referred to in this section as the 

16 ‘Loan Program’. 

17 ‘‘(2) ENTITLEMENT.—There are hereby made 

18 available, in accordance with the provisions of this 

19 section, such sums as may be necessary to make 

20 loans under the Loan Program to all eligible health 

21 care providers, including critical access hospitals and 

22 federally qualified health centers, to enable the im23 plementation and adoption by such providers of 

24 health information technology systems that promote 

25 interoperability among health care settings. 
31 

•HR 4832 IH 

1 ‘‘(b) ELIGIBILITY.— 

2 ‘‘(1) APPLICATION.—To be eligible to partici3 pate in the Loan Program, a health care provider 

4 shall submit to a loan originator center an applica5 tion that demonstrates the following: 

6 ‘‘(A) STATE LICENSED.—The provider is 

7 licensed by an appropriate State agency to per8 form the duties of the provider. 

9 ‘‘(B) PARTICIPANT IN THE MEDICARE PRO10 GRAM.—The provider participates under title 

11 XVIII. 

12 ‘‘(C) USE OF LOAN FUNDS FOR INTER13 OPERABLE HIT PROJECT.—The loan will be 

14 used to purchase, implement, or improve health 

15 information technology and such health infor16 mation technology is interoperable with a 

17 shared health facility, hospital, or health system 

18 in the community of the provider. 

19 ‘‘(D) NO DEFAULT ON EXISTING LOANS.— 

20 The provider is not in default on an existing 

21 Federal loan. 

22 ‘‘(2) ADMINISTRATION OF APPLICATION.—The 

23 application shall be submitted in such form, at such 

24 time, and containing such additional information as 

25 the Secretary may require. 
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•HR 4832 IH 

1 ‘‘(c) DUTIES OF THE SECRETARY.—The Secretary, 

2 through the Chief Health Informatics Officer of Health 

3 Information Technology, shall carry out the Loan Pro4 gram. In carrying out the Loan Program, the Secretary 

5 shall, with respect to loans made under subsection (a)— 

6 ‘‘(1) enter into contracts under subsections (d) 

7 and (e) for purposes of originating and servicing, re8 spectively, such loans; 

9 ‘‘(2) review requests submitted by a loan origi10 nator center for such loans; 

11 ‘‘(3) transfer loans funds to loan originator cen12 ters; 

13 ‘‘(4) monitor activities performed by loan origi14 nator centers under subsection (d) and loan service 

15 centers under subsection (e); and 

16 ‘‘(5) monitor the rate at which eligible health 

17 care providers default on such loans made to such 

18 providers. 

19 ‘‘(d) ORIGINATION OF LOANS.— 

20 ‘‘(1) FUNDS FOR ORIGINATION OF LOANS.—The 

21 Secretary shall provide funds, out of funds available 

22 pursuant to subsection (a), for loans under this sec23 tion through a loan originator center to an eligible 

24 health care provider. 
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•HR 4832 IH 

1 ‘‘(2) CONTRACTS WITH LOAN ORIGINATOR CEN2 TERS.—The Secretary of Health and Human Serv3 ices shall enter into contracts with loan originator 

4 centers under which the loan originator centers 

5 shall, with respect to loans under subsection (a)— 

6 ‘‘(A) assess applications submitted under 

7 subsection (b); 

8 ‘‘(B) originate such loans to eligible pro9 viders in accordance with this section, including 

10 request loan funds from the Secretary for an el11 igible provider, disburse loan funds to an eligi12 ble provider, and notify the Secretary that such 

13 funds have been disbursed; 

14 ‘‘(C) obtain from an eligible provider a 

15 note or evidence of obligation on such a loan 

16 and provide that such note or evidence shall be 

17 the property of the Secretary; 

18 ‘‘(D) set forth a schedule for disbursement 

19 of the proceeds of the loan in installments; and 

20 ‘‘(E) perform administrative functions, as 

21 determined by the Secretary necessary to the 

22 origination of loan funds, including monthly ac23 count reconciliation. 

24 ‘‘(e) CONTRACTS WITH LOAN SERVICE CENTERS

25 FOR SERVICING LOANS.—The Secretary of Health and 
34 

•HR 4832 IH 

1 Human Services shall enter into contracts with loan serv2 ice centers under which the loans service centers shall, 

3 with respect to loan funds disbursed to an eligible health 

4 care provider— 

5 ‘‘(1) monitor the eligibility status of such pro6 viders to receive such loan funds; 

7 ‘‘(2) submit to such providers bills and collect 

8 from such providers payments for such loan funds in 

9 accordance with the applicable repayment plan of 

10 the provider under subsection (g)(1); 

11 ‘‘(3) conduct initial collection services on delin12 quent payments by such providers for loans under 

13 this section; and 

14 ‘‘(4) transfer loans in default to a debt collec15 tion system. 

16 ‘‘(f) TERMS AND CONDITIONS OF LOANS.— 

17 ‘‘(1) AMOUNTS OF LOANS.— 

18 ‘‘(A) DETERMINATION OF AMOUNTS.—The 

19 determination of the amount of a loan made 

20 under subsection (a) to an eligible health care 

21 provider shall be calculated, in accordance with 

22 a methodology specified by the Secretary, based 

23 on the projected health IT cost and the size of 

24 the provider (as determined by a method speci25 fied by the Secretary. 
35 

•HR 4832 IH 

1 ‘‘(B) DEFINITION OF PROJECTED HEALTH

2 IT COST.—For purposes of this paragraph and 

3 paragraph (2), the term ‘projected health IT 

4 cost’ means the cost to the eligible health care 

5 provider to purchase, implement, or improve the 

6 health information technology involved in the 

7 application under subsection (b)(1). 

8 ‘‘(2) LOAN LIMITS.— 

9 ‘‘(A) ESTABLISHMENT OF LIMITS.—The 

10 Secretary shall establish limits on loans under 

11 the Loan Program, based on categories under 

12 subparagraph (B). 

13 ‘‘(B) CREATION OF LOAN LIMIT CAT14 EGORIES.—For purposes of subparagraph (A), 

15 the Secretary shall create categories of eligible 

16 health care providers that represent various 

17 ranges of health IT costs to such providers and 

18 sizes of such providers. The Secretary shall as19 sign to each category a value that shall be the 

20 maximum amount for a loan made under the 

21 Loan Program to an eligible health care pro22 vider whose projected health IT cost and whose 

23 size correspond with the range of costs and 

24 sizes represented by such category. 

25 ‘‘(3) INTEREST RATES.— 
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•HR 4832 IH 

1 ‘‘(A) DETERMINATION OF INTEREST

2 RATE.—Subject to subparagraph (B), the appli3 cable rate of interest for a loan under this sec4 tion, during any 12-month period beginning on 

5 July 1 and ending on June 30 shall be deter6 mined on the preceeding June 1 and be equal 

7 to— 

8 ‘‘(i) the bond equivalent rate of 91- 

9 day Treasury bills auctioned at the first 

10 auction held prior to such June 1; plus 

11 ‘‘(ii) 3.1 percent. 

12 ‘‘(B) MAXIMUM INTEREST RATE.—A rate 

13 of interest determined under subparagraph (A) 

14 shall not exceed 8.25 percent. 

15 ‘‘(C) INTEREST RATE DISCOUNTS.—The 

16 Secretary may prescribe by regulation such re17 ductions in the interest rate paid by an eligible 

18 health care provider for a loan under subsection 

19 (a) as the Secretary determines appropriate to 

20 encourage on-time repayment of the loan. Such 

21 reductions may be offered only if the Secretary 

22 determines the reductions are cost neutral and 

23 in the best financial interest of the Federal 

24 Government. 
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•HR 4832 IH 

1 ‘‘(4) ORIGINATION FEES.—The Secretary shall 

2 charge an eligible health care provider who receives 

3 a loan under subsection (a) an origination fee of 4 

4 percent of the principal amount of loan and, if appli5 cable, a fee for loan insurance. 

6 ‘‘(g) REPAYMENT OF LOANS.— 

7 ‘‘(1) REPAYMENT PLANS.— 

8 ‘‘(A) DESIGN AND SELECTION.— 

9 ‘‘(i) IN GENERAL.—Consistent with 

10 criteria established by the Secretary, the 

11 Secretary shall offer an eligible health care 

12 provider who receives a loan under the 

13 Loan Program (and the provider may 

14 choose one of) the plans for repayment of 

15 such loan, including repayment of principal 

16 and interest on such loan, described in 

17 clause (ii). Such criteria shall be different 

18 for eligible health care providers that are 

19 physicians or medical groups, or that are 

20 DSH qualifying facilities described in 

21 clause (iii) or (iv) of section 

22 1150A(j)(3)(B), in order to take into ac23 count the different financial ability of such 

24 providers to repay loans made. The Sec25 retary shall allow the provider to accel-
38 

•HR 4832 IH 

1 erate, without penalty, repayment on the 

2 loans involved. 

3 ‘‘(ii) REPAYMENT PLANS.—The plans 

4 described in this clause are the following: 

5 ‘‘(I) STANDARD REPAYMENT

6 PLAN.—A standard repayment plan, 

7 with annual payment amount paid 

8 over a fixed period of time. 

9 ‘‘(II) INCOME CONTINGENT RE10 PAYMENT PLAN.—An income contin11 gent repayment plan, with varying 

12 monthly payment amounts based on 

13 the income of the eligible health care 

14 provider involved, paid over an ex15 tended period of time prescribed by 

16 the Secretary, not to exceed 25 years. 

17 ‘‘(B) SELECTION BY SECRETARY.—If an 

18 eligible health care provider that receives a loan 

19 under the Loan Program does not select a re20 payment plan for such loan described in sub21 paragraph (A)(ii), the Secretary shall select the 

22 repayment plan described in subclause (I) of 

23 such subsection. 

24 ‘‘(C) CHANGES IN SELECTION.—An eligible 

25 health care provider that receives a loan under 
39 

•HR 4832 IH 

1 the Loan Program may change the selection of 

2 such provider of a repayment plan under sub3 paragraph (A)(ii), or the Secretary’s selection 

4 of a plan for the provider under subparagraph 

5 (B), as the case may be, under such terms and 

6 conditions as may be established by the Sec7 retary. 

8 ‘‘(D) ALTERNATIVE REPAYMENT PLANS.— 

9 The Secretary may provide, on a case by case 

10 basis, an alternative repayment plan to an eligi11 ble health care provider that receives a loan 

12 under the Loan Program who demonstrates to 

13 the satisfaction of the Secretary that the terms 

14 and conditions of the repayment plans available 

15 under subparagraph (A)(ii) are not adequate to 

16 accommodate an exceptional circumstance of 

17 the provider. In designing such an alternative 

18 repayment plan, the Secretary shall ensure that 

19 such plan does not exceed the cost to the Fed20 eral Government, as determined on the basis of 

21 the present value of future payments by such 

22 providers, of loans made using the plans avail23 able under subparagraph (A)(ii). 

24 ‘‘(2) REPAYMENT RELIEF.— 
40 

•HR 4832 IH 

1 ‘‘(A) REQUIRED PROGRAM FOR LOAN FOR2 GIVENESS.—The Secretary shall, in accordance 

3 with guidelines specified by the Secretary, es4 tablish a program for the forgiveness of a loan 

5 provided under the Loan Program to an eligible 

6 health care provider that is— 

7 ‘‘(i) a physician or medical group that 

8 serves a medically underserved population, 

9 as defined in section 330(a)(3) of the Pub10 lic Health Service Act; or 

11 ‘‘(ii) a participant in the National 

12 Health Service Corps Loan Repayment 

13 Program under section 338B of such Act. 

14 ‘‘(B) AUTHORITY FOR ADDITIONAL RE15 LIEF.—The Secretary may, in accordance with 

16 guidelines specified by the Secretary, provide 

17 for the deferment, forbearance, consolidation, 

18 discharge, or forgiveness of another loan pro19 vided under the Loan Program. 

20 ‘‘(3) LOAN DEFAULT.— 

21 ‘‘(A) TERMS OF DEFAULT.—An eligible 

22 health care provider that receives a loan under 

23 subsection (a) has defaulted on such loan if— 

24 ‘‘(i) the provider fails to make a pay25 ment amount for the loan by the date re-
41 

•HR 4832 IH 

1 quired by the repayment plan of the pro2 vider and has failed to make such repay3 ment for at least 180 consecutive days; or 

4 ‘‘(ii) the provider otherwise violates 

5 the terms of the promissory note for the 

6 loan made to the provider and continues to 

7 violate such terms for 180 days. 

8 ‘‘(B) CONSEQUENCES OF DEFAULT.—If, 

9 under subparagraph (A), an eligible health care 

10 provider defaults on a loan made under sub11 section (a), the Secretary may— 

12 ‘‘(i) report such default to a major 

13 credit bureau; 

14 ‘‘(ii) offset a tax refund for which the 

15 provider is eligible by the amount of the 

16 loan in default; 

17 ‘‘(iii) garnish wages or profits of the 

18 provider; 

19 ‘‘(iv) except for a provider that makes 

20 payment amounts for at least six consecu21 tive months for such loan in default, dis22 qualify the provider from any further loans 

23 under subsection (a); and 
42 

•HR 4832 IH 

1 ‘‘(v) pursue litigation against the pro2 vider for purposes of recovering the 

3 amount of the loan in default. 

4 ‘‘(h) ADMINISTRATIVE PROVISIONS.—The Secretary 

5 shall issue regulations for purposes of carrying out the 

6 Loans Program. The regulations shall include measures 

7 to ensure compliance of loan originator centers, loan serv8 ice centers, and eligible health care providers with the 

9 Loan Program. 

10 ‘‘(i) DEFINITIONS.—For purposes of this section: 

11 ‘‘(1) LOAN ORIGINATOR CENTERS.—The term 

12 ‘loan originator center’ means an entity with the ca13 pacity to perform the duties under subsection (d)(2) 

14 and with which the Secretary of Health and Human 

15 Services enters into a contract under such sub16 section. 

17 ‘‘(2) LOAN SERVICE CENTERS.—The term ‘loan 

18 service center’ means an entity with the capacity to 

19 perform the duties under subsection (e) and with 

20 which the Secretary of Health and Human Services 

21 enters into a contract under such subsection. 

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

23 ‘health care provider’ means— 
43 

•HR 4832 IH 

1 ‘‘(A) a health care provider defined in sec2 tion 1171(3), including a critical access hos3 pital; and 

4 ‘‘(B) a federally qualified health center de5 fined in section 1861(aa)(4). 

6 ‘‘(4) ELIGIBLE HEALTH CARE PROVIDER.—The 

7 term ‘eligible health care provider’ means a health 

8 care provider that is eligible under subsection (b) to 

9 receive a loan under subsection (a). 

10 ‘‘(j) EFFECTIVE DATE.—Loans under this section 

11 shall be available to eligible health care providers starting 

12 on the date that is one year after the date of the enact13 ment of this section.’’. 

14 (b) STUDY ON HEALTH CARE PROVIDER HIT LOAN

15 PROGRAM SAVINGS; HIT IMPLEMENTATION INCEN16 TIVES.— 

17 (1) STUDY ON HEALTH CARE PROVIDER HIT

18 LOAN PROGRAM SAVINGS.— 

19 (A) STUDY.—Each Federal entity officer 

20 described in subparagraph (C) shall conduct a 

21 study to determine any savings realized or costs 

22 incurred by Federal health care programs (as 

23 defined in section 1128B(f) of the Social Secu24 rity Act (42 U.S.C. 1320a–7b(f))) because of 

25 the implementation or adoption of health infor-
44 

•HR 4832 IH 

1 mation technology financed through loans made 

2 under the Health Care Provider HIT Loan Pro3 gram under section 1150B of the Social Secu4 rity Act, as added by subsection (a). 

5 (B) REPORT.—Not later than the date 

6 that is one year after the date of the enactment 

7 of this Act, each Federal entity officer described 

8 in subparagraph (C) shall submit a report to 

9 Congress on the results of the study conducted 

10 under subparagraph (A). 

11 (C) FEDERAL ENTITY OFFICER DE12 SCRIBED.—For purposes of this paragraph, a 

13 Federal entity officer is each of the following: 

14 (i) The Comptroller General of the 

15 Government Accountability Office. 

16 (ii) The Commissioner of the Medi17 care Payment Advisory Commission 

18 (MedPAC), established by the Balanced 

19 Budget Act of 1997 (Public Law 105–33). 

20 (iii) The Administrator of the Centers 

21 for Medicare and Medicaid Services 

22 (CMS). 

23 (iv) The Director of the Congressional 

24 Budget Office. 

25 (2) HIT IMPLEMENTATION INCENTIVES.— 
45 

•HR 4832 IH 

1 (A) STUDY.—The Secretary of Health and 

2 Human Services, through the Administrator of 

3 the Centers for Medicare and Medicaid Services 

4 and after consultation with the Agency for 

5 Healthcare Research and Quality, health care 

6 providers, and other interested parties, shall 

7 specify methods to incentivize the purchase and 

8 implementation of health information tech9 nology systems. Such incentives may include 

10 certain payment incentives made by the Federal 

11 Government to entities, such as prompt claims 

12 payments, payment differentials, cost differen13 tials, direct payments for services provided 

14 through health information technology, and 

15 bonus payments for meeting quality outcomes. 

16 (B) IMPLEMENTATION.—Not later than 18 

17 months after the date of the enactment of this 

18 Act, the Secretary of Health and Human Serv19 ices shall implement the methods specified in 

20 subparagraph (A). 

21 SEC. 5. SAFE HARBOR FROM ANTI-KICKBACK LAWS FOR 

22 HEALTH INFORMATION TECHNOLOGY. 

23 (a) FOR CIVIL PENALTIES.—Section 1128A(b) of the 

24 Social Security Act (42 U.S.C. 1320a–7a(b)) is amended 

25 by adding at the end the following new paragraph: 
46 

•HR 4832 IH 

1 ‘‘(4)(A) For purposes of this subsection, a payment 

2 described in paragraph (1) does not include any nonmone3 tary remuneration (in the form of permitted support) 

4 made by a hospital or critical access hospital to a physi5 cian if— 

6 ‘‘(i) such remuneration is made (or is believed 

7 in good faith to be made) without regard to the 

8 amount or quality of referrals made or business gen9 erated by the physician to the critical access hospital 

10 or hospital; and 

11 ‘‘(ii) in the case of such remuneration made on 

12 or after the date that is four years after the date de13 scribed in section 5(d)(2) of the Electronic Health 

14 Information Technology Act of 2006, such remu15 neration is made (or is believed in good faith to be 

16 made) in accordance with the criteria (relating to 

17 compliance with interoperability standards) estab18 lished by the Secretary under section 5(e) of such 

19 Act. 

20 ‘‘(B) For purposes of subparagraph (A) and sections 

21 1128B(b)(3)(J) and 1877(e)(9), the term ‘permitted sup22 port’ means any equipment, item, information, right, li23 cense, intellectual property, software, or service (or fund24 ing used exclusively to provide or pay for such equipment, 

25 item, information, right, license, intellectual property, 
47 

•HR 4832 IH 

1 software, or service) that is used for at least the purpose 

2 of exchanging health information.’’. 

3 (b) FOR CRIMINAL PENALTIES.—Section 

4 1128B(b)(3) of such Act (42 U.S.C. 1320a–7b(b)(3)) is 

5 amended— 

6 (1) in subparagraph (G), by striking ‘‘and’’ at 

7 the end; 

8 (2) in the subparagraph (H) added by section 

9 237(d) of the Medicare Prescription Drug, Improve10 ment, and Modernization Act of 2003 (Public Law 

11 108–173; 117 Stat. 2213)— 

12 (A) by moving such subparagraph 2 ems to 

13 the left; and 

14 (B) by striking the period at the end and 

15 inserting a semicolon; 

16 (3) in the subparagraph (H) added by section 

17 431(a) of such Act (117 Stat. 2287)— 

18 (A) by redesignating such subparagraph as 

19 subparagraph (I); 

20 (B) by moving such subparagraph 2 ems 

21 to the left; and 

22 (C) by striking the period at the end and 

23 inserting ‘‘; and’’; and 

24 (4) by adding at the end the following new sub25 paragraph: 
48 

•HR 4832 IH 

1 ‘‘(J) any nonmonetary remuneration (in the 

2 form of permitted support, as defined in section 

3 1128A(b)(4)(B)) made to a person if— 

4 ‘‘(i) such remuneration is solicited or re5 ceived (or offered or paid) (or believed in good 

6 faith to be solicited, received, offered, or paid) 

7 without regard to the amount or quality of re8 ferrals made or business generated by the per9 son; and 

10 ‘‘(ii) in the case of such remuneration 

11 made on or after the date that is four years 

12 after the date described in section 5(d)(2) of 

13 the Electronic Health Information Technology 

14 Act of 2006, such remuneration is solicited or 

15 received (or offered or paid) (or believed in 

16 good faith to be solicited, received, offered, or 

17 paid) in accordance with the criteria (relating 

18 to compliance with interoperability standards) 

19 established by the Secretary under section 5(e) 

20 of such Act.’’. 

21 (c) FOR LIMITATION ON CERTAIN PHYSICIAN RE22 FERRALS.—Section 1877(e) of such Act (42 U.S.C. 

23 1395nn(e)) is amended by adding at the end the following 

24 new paragraph: 
49 

•HR 4832 IH 

1 ‘‘(9) INFORMATION TECHNOLOGY AND TRAIN2 ING SERVICES.—Any nonmonetary remuneration (in 

3 the form of permitted support, as defined in section 

4 1128A(b)(4)(B)) made by an entity to a physician 

5 if— 

6 ‘‘(A) such remuneration is made (or be7 lieved in good faith to be made) without regard 

8 to the amount or quality of referrals made or 

9 business generated by the physician to the enti10 ty; and 

11 ‘‘(B) in the case of such remuneration 

12 made on or after the date that is four years 

13 after the date described in section 5(d)(2) of 

14 the Electronic Health Information Technology 

15 Act of 2006, such remuneration is made (or be16 lieved in good faith to be made) in accordance 

17 with the criteria (relating to compliance with 

18 interoperability standards) established by the 

19 Secretary under section 5(e) of such Act.’’. 

20 (d) REGULATIONS, EFFECTIVE DATE, AND EFFECT

21 ON STATE LAWS.— 

22 (1) REGULATIONS.— 

23 (A) IN GENERAL.—Subject to subpara24 graph (B) and not later than the date that is 

25 180 days after the date of the enactment of this 
50 

•HR 4832 IH 

1 Act, the Secretary of Health and Human Serv2 ices shall issue such regulations as may be nec3 essary to carry out the provisions of this sec4 tion. 

5 (B) NOTICE AND COMMENT.—Not later 

6 than the date that is 60 days after the date of 

7 the enactment of this Act, the Secretary of 

8 Health and Human Services shall issue a notice 

9 of proposed rulemaking, with respect to the reg10 ulations issued under subparagraph (A). 

11 (C) SUBSEQUENT REGULATIONS.—Any 

12 regulation issued by the Secretary on a date 

13 after the date described in subparagraph (A), 

14 with respect to the safe harbors described in 

15 paragraph (4), shall be issued after notice and 

16 comment. 

17 (2) EFFECTIVE DATE.—The amendments made 

18 by this section shall take effect on the date that is 

19 180 days after the date of the enactment of this Act. 

20 (3) EFFECT OF STATE LAWS.—No State (as de21 fined in section 1101(a)) shall have in effect a State 

22 law that imposes a criminal or civil penalty for a 

23 transaction described in section 1128A(b)(4); 

24 1128B(b)(3)(J); or 1877(e)(9) of the Social Security 

25 Act, as added by this section, if— 
51 

•HR 4832 IH 

1 (A) the conditions described in the respec2 tive section, with respect to such transaction, 

3 are met; or 

4 (B) the person or entity involved in such 

5 transaction acted in good faith under the belief 

6 that such conditions are met. 

7 (4) SAFE HARBORS DESCRIBED.—For purposes 

8 of paragraphs (1) and subsection (e), the safe har9 bors described in this paragraph are— 

10 (A) the safe harbor under paragraph (4) of 

11 section 1128A(b) of the Social Security Act (42 

12 U.S.C. 1320a–7a(b)), as added by subsection 

13 (a); 

14 (B) the safe harbor under subparagraph 

15 (J) of section 1128B(b)(3) of such Act (42 

16 U.S.C. 1320a–7b(b)(3)), as added by subsection 

17 (b); and 

18 (C) the safe harbor under paragraph (9) of 

19 section 1877(e) of such Act (42 U.S.C. 

20 1395nn(e)), as added by subsection (c). 

21 (e) INTEROPERABILITY CRITERIA FOR PERMISSIBLE

22 HEALTH INFORMATION TECHNOLOGY REMUNERATION

23 UNDER SAFE HARBORS.—Starting on the date that is 

24 four years after the effective date described in subsection 

25 (d)(2) and every two years thereafter, the Secretary of 
52 

•HR 4832 IH 

1 Health and Human Services may issue regulations that 

2 establish criteria for nonmonetary remuneration (in the 

3 form of permitted support defined under section 

4 1128A(b)(4) of the Social Security Act, as added by sub5 section (a)) for purposes of the safe harbors described in 

6 subsection (d)(4). The Secretary shall base such criteria 

7 on the extent to which the permitted support conforms to 

8 a standard implemented under section 1150A(d) of the 

9 Social Security Act, as added by section 2, based on the 

10 following considerations: 

11 (1) WIDE ACCEPTANCE OF STANDARD.—The 

12 standard is widely accepted within the health care 

13 industry and has been used within the industry for 

14 a sufficient amount of time to ensure successful im15 plementation. 

16 (2) NECESSITY.—The standard is necessary to 

17 improve the quality of health care or patient safety, 

18 or to provide greater administrative efficiencies. 

19 (3) COST BENEFIT ANALYSIS.—The results of a 

20 cost benefit test conducted to determine the effect of 

21 applying the standard for purposes of the safe har22 bors described in subsection (d)(4). 
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1 SEC. 6. UNIFORM FEDERAL AND STATE HEALTH INFORMA2 TION STANDARDS. 

3 (a) STUDY TO DETERMINE EXTENT OF VARIATION

4 IN STATE HEALTH INFORMATION LAWS AND REGULA5 TIONS.— 

6 (1) IN GENERAL.—The Secretary of Health and 

7 Human Services shall conduct a study of State laws 

8 and regulations relating to the security and con9 fidentiality of individually identifiable health infor10 mation to determine— 

11 (A) the degree to which such laws and reg12 ulations vary among States, and between the 

13 States and the Federal privacy standards estab14 lished pursuant to section 264(c) of the Health 

15 Insurance Portability and Accountability Act of 

16 1996 (42 U.S.C. 1320d–2 note) and security 

17 standards established under section 1173(d) of 

18 the Social Security Act; and 

19 (B) how any such variation may adversely 

20 impact the electronic exchange of clinical health 

21 information among States, the Federal Govern22 ment, and private entities. 

23 (2) REPORT.—Not later than 18 months after 

24 the date of the enactment of this Act, the Secretary 

25 of Health and Human Services shall submit to Con-
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1 gress a report on the study under paragraph (1) and 

2 shall include in such report— 

3 (A) a determination by the Secretary 

4 whether the State laws and regulations de5 scribed in such paragraph should be conformed 

6 to a set of Federal standards to protect the se7 curity and confidentiality of patient health in8 formation and to improve health care quality or 

9 efficiency; and 

10 (B) recommendations for legislation to 

11 conform such State laws and regulations to 

12 such a set of Federal standards. 

13 (3) STATE DEFINED.—For purposes of this 

14 subsection, the term ‘‘State’’ has the meaning given 

15 such term when used in title XI of the Social Secu16 rity Act, as provided under section 1101(a) of such 

17 Act (42 U.S.C. 1301(a)). 

18 (b) CONFIDENTIALITY AND SECURITY REGULATIONS

19 PREEMPTION OF STATE LAWS IF CONGRESS FAILS TO

20 ESTABLISH UNIFORM STANDARDS.— 

21 (1) IN GENERAL.—Section 1178(a) of the So22 cial Security Act (42 U.S.C. 1320d–7(a)) is amend23 ed— 
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1 (A) in paragraph (1) by inserting after 

2 ‘‘Except as provided in paragraph (2)’’ the fol3 lowing: ‘‘and subject to paragraph (3)’’; and 

4 (B) by adding at the end the following new 

5 paragraph: 

6 ‘‘(3) UNIFORM STANDARDS.— 

7 ‘‘(A) IN GENERAL.—If legislation to create 

8 uniform Federal standards, and to preempt 

9 State laws, with respect to the confidentiality 

10 and security of individually identifiable health 

11 information is not enacted by Congress on the 

12 date that is 36 months after the date of the en13 actment of the Electronic Health Information 

14 Technology Act of 2006, the regulation and 

15 standards described in subparagraph (B) shall 

16 supersede any contrary provision of State law. 

17 ‘‘(B) APPLICATION OF UNIFORM STAND18 ARDS.—The regulation and standards described 

19 in this subparagraph are the regulation promul20 gated under section 264(c)(1) of the Health In21 surance Portability and Accountability Act of 

22 1996 and the standards under section 1173(d), 

23 as modified by the Secretary to the extent the 

24 Secretary determines, after consideration of the 

25 results of the study conducted under section 
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1 6(a) of the Electronic Health Information Tech2 nology Act of 2006, necessary to promote uni3 form national standards.’’. 

4 (2) HIPAA CONFORMING AMENDMENT.—Sec5 tion 264(c)(2) of the Health Insurance Portability 

6 and Accountability Act of 1996 (42 U.S.C. 1320d– 

7 2 note) is amended by striking ‘‘A regulation’’ and 

8 inserting ‘‘(A) Subject to section 1178(a)(3) of the 

9 Social Security Act, a regulation’’. 

Æ