I 

109TH CONGRESS 

2D SESSION H. R. 4726 

To enhance the adoption of a nationwide interoperable health information 

technology system and to improve the quality and reduce the costs 

of health care in the United States. 

IN THE HOUSE OF REPRESENTATIVES 

FEBRUARY 8, 2006 

Mr. ISSA introduced the following bill; which was referred to the Committee 

on Energy and Commerce 

A BILL 

To enhance the adoption of a nationwide interoperable health 

information technology system and to improve the quality 

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

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE. 

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

5 Quality Act’’. 

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

7 EFFICIENCY. 

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

9 seq.) is amended by adding at the end the following: 
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1 ‘‘TITLE XXIX—HEALTH INFORMA2 TION TECHNOLOGY AND 

3 QUALITY 

4 ‘‘SEC. 2901. DEFINITIONS. 

5 ‘‘In this title: 

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

7 ‘health care provider’ means a hospital, skilled nurs8 ing facility, home health entity, health care clinic, 

9 federally qualified health center, group practice (as 

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

11 Act), a pharmacist, a pharmacy, a laboratory, a phy12 sician (as defined in section 1861(r) of the Social 

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

14 1842(b)(18)(CC) of the Social Security Act), a 

15 health facility operated by or pursuant to a contract 

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

17 and any other category of facility or clinician deter18 mined appropriate by the Secretary. 

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

20 information’ has the meaning given such term in 

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

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

23 ‘health insurance plan’ means— 

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

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

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

3 ‘‘(C) a health maintenance organization 

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

5 ‘‘(4) INDIVIDUALLY IDENTIFIABLE HEALTH IN6 FORMATION.—The term ‘individually identifiable 

7 health information’ has the meaning given such term 

8 in section 1171 of the Social Security Act. 

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

10 the meaning given that term in section 353. 

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

12 the meaning given that term in section 804 of the 

13 Federal Food, Drug, and Cosmetic Act. 

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

16 technology’ means a computerized system (including 

17 hardware and software) that— 

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

19 health information; 

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

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

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

2 by the Federal Government under section 2903; 

3 and 

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

5 measures under section 2907. 

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

7 the several States, the District of Columbia, Puerto 

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

9 and the Northern Mariana Islands. 

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

11 HEALTH INFORMATION TECHNOLOGY. 

12 ‘‘(a) OFFICE OF NATIONAL HEALTH INFORMATION

13 TECHNOLOGY.—There is established within the Office of 

14 the Secretary an Office of the National Coordinator of 

15 Health Information Technology (referred to in this section 

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

17 Coordinator who shall be appointed by the Secretary and 

18 shall report directly to the Secretary. 

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

20 to coordinate with relevant Federal agencies and private 

21 entities and oversee programs and activities to develop a 

22 nationwide interoperable health information technology in23 frastructure that— 

24 ‘‘(1) ensures that patients’ individually identifi25 able health information is secure and protected; 
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1 ‘‘(2) improves health care quality, reduces med2 ical errors, and advances the delivery of patient-cen3 tered medical care; 

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

5 inefficiency, medical errors, inappropriate care, and 

6 incomplete information; 

7 ‘‘(4) ensures that appropriate information to 

8 help guide medical decisions is available at the time 

9 and place of care; 

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

11 greater competition, and increased choice through 

12 the wider availability of accurate information on 

13 health care costs, quality, and outcomes; 

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

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

18 health care information; 

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

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

23 ‘‘(8) facilitates health research; and 

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

2 The National Coordinator shall— 

3 ‘‘(1) serve as the principal advisor to the Sec4 retary concerning the development, application, and 

5 use of health information technology, and coordinate 

6 and oversee the health information technology pro7 grams of the Department; 

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

9 interoperable system for the electronic exchange of 

10 health information; 

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

12 standards for the electronic exchange of health infor13 mation to reduce cost and improve health care qual14 ity; 

15 ‘‘(4) ensure that health information technology 

16 policy and programs of the Department are coordi17 nated with those of relevant executive branch agen18 cies (including Federal commissions) with a goal of 

19 avoiding duplication of efforts and of helping to en20 sure that each agency undertakes health information 

21 technology activities primarily within the areas of its 

22 greatest expertise and technical capability; 

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

24 outreach and consultation by the relevant executive 

25 branch agencies (including Federal commissions) 
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1 with public and private parties of interest, including 

2 consumers, payers, employers, hospitals and other 

3 health care providers, physicians, community health 

4 centers, laboratories, vendors and other stake5 holders; 

6 ‘‘(6) advise the President regarding specific 

7 Federal health information technology programs; 

8 and 

9 ‘‘(7) prepare the reports described under sec10 tion 2903(i) (excluding paragraph (4) of such sec11 tion). 

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

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

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

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

18 duties under this section. 

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

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

22 civil service status or privileges of the Federal 

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

2 the Department employed by the National Co3 ordinator. 

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

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

8 under paragraph (1) is reimbursed. 

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

12 regardless of whether such efforts were carried out prior 

13 to or after the enactment of this title. 

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

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

16 $5,000,000 for fiscal year 2006, $5,000,000 for fiscal year 

17 2007, and such sums as may be necessary for each of fis18 cal years 2008 through 2010. 

19 ‘‘SEC. 2903. AMERICAN HEALTH INFORMATION COLLABO20 RATIVE. 

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

22 public-private American Health Information Collaborative 

23 (referred to in this section as the ‘Collaborative’) to— 
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1 ‘‘(1) advise the Secretary and recommend spe2 cific actions to achieve a nationwide interoperable 

3 health information technology infrastructure; 

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

5 a broad range of stakeholders to provide input on 

6 achieving the interoperability of health information 

7 technology; and 

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

9 communication, and security standards) for the elec10 tronic exchange of health information (including for 

11 the reporting of quality data under section 2907) for 

12 adoption by the Federal Government and voluntary 

13 adoption by private entities. 

14 ‘‘(b) COMPOSITION.— 

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

16 composed of members of the public and private sec17 tors to be appointed by the Secretary, including rep18 resentatives from— 

19 ‘‘(A) consumer or patient organizations; 

20 ‘‘(B) organizations with expertise in pri21 vacy and security; 

22 ‘‘(C) health care providers; 

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

24 party payors; 

25 ‘‘(E) information technology vendors; and 
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1 ‘‘(F) purchasers or employers. 

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

3 under paragraph (1), and in developing the proce4 dures for conducting the activities of the Collabo5 rative, the Secretary shall ensure a balance among 

6 various sectors of the health care system so that no 

7 single sector unduly influences the recommendations 

8 of the Collaborative. 

9 ‘‘(3) TERMS.—Members appointed under para10 graph (1) shall serve for 2 year terms, except that 

11 any member appointed to fill a vacancy for an unex12 pired term shall be appointed for the remainder of 

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

14 180 days after the expiration of such member’s term 

15 or until a successor has been appointed. 

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

17 the functions of the Collaborative, the Secretary 

18 shall ensure an adequate opportunity for the partici19 pation of outside advisors, including individuals with 

20 expertise in— 

21 ‘‘(A) health information privacy; 

22 ‘‘(B) health information security; 

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

24 including individuals with expertise in utilizing 
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1 health information technology to improve health 

2 care quality and patient safety; 

3 ‘‘(D) data exchange; and 

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

6 technology. 

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

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

9 annually thereafter, the Collaborative shall recommend to 

10 the Secretary uniform national policies for adoption by the 

11 Federal Government and voluntary adoption by private en12 tities to support the widespread adoption of health infor13 mation technology, including— 

14 ‘‘(1) protection of individually identifiable 

15 health information through privacy and security 

16 practices; 

17 ‘‘(2) measures to prevent unauthorized access 

18 to health information, including unauthorized access 

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

20 applications; 

21 ‘‘(3) methods to notify patients if their individ22 ually identifiable health information is wrongfully 

23 disclosed; 

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

25 to health information; 
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1 ‘‘(5) fostering the public understanding of 

2 health information technology; 

3 ‘‘(6) the ongoing harmonization of industry4 wide health information technology standards; 

5 ‘‘(7) recommendations for a nationwide inter6 operable health information technology infrastruc7 ture; 

8 ‘‘(8) the identification and prioritization of spe9 cific use cases for which health information tech10 nology is valuable, beneficial, and feasible; 

11 ‘‘(9) recommendations for the establishment of 

12 an entity to ensure the continuation of the functions 

13 of the Collaborative; and 

14 ‘‘(10) other policies (including recommendations 

15 for incorporating health information technology into 

16 the provision of care and the organization of the 

17 health care workplace) determined to be necessary 

18 by the Collaborative. 

19 ‘‘(d) STANDARDS.— 

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

21 adopted by the Consolidated Health Informatics Ini22 tiative shall be deemed to have been recommended 

23 by the Collaborative under this section. 
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1 ‘‘(2) FIRST YEAR REVIEW.—Not later than 1 

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

3 Collaborative shall— 

4 ‘‘(A) review existing standards (including 

5 content, communication, and security stand6 ards) for the electronic exchange of health in7 formation; 

8 ‘‘(B) identify deficiencies and omissions in 

9 such existing standards; and 

10 ‘‘(C) identify duplication and overlap in 

11 such existing standards; 

12 and recommend new standards and modifications to 

13 such existing standards as necessary. 

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

15 after the date of enactment of this title, and annu16 ally thereafter, the Collaborative shall— 

17 ‘‘(A) review existing standards (including 

18 content, communication, and security stand19 ards) for the electronic exchange of health in20 formation; 

21 ‘‘(B) identify deficiencies and omissions in 

22 such existing standards; and 

23 ‘‘(C) identify duplication and overlap in 

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

2 such existing standards as necessary. 

3 ‘‘(4) LIMITATION.—The standards and time4 frame for adoption described in this section shall be 

5 consistent with any standards developed pursuant to 

6 the Health Insurance Portability and Accountability 

7 Act of 1996. 

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

9 after the issuance of a recommendation from the Collabo10 rative under subsection (d)(2), the Secretary of Health 

11 and Human Services, the Secretary of Veterans Affairs, 

12 and the Secretary of Defense, in collaboration with rep13 resentatives of other relevant Federal agencies, as deter14 mined appropriate by the Secretary, shall jointly review 

15 such recommendations. If appropriate, the Secretary shall 

16 provide for the adoption by the Federal Government of 

17 any standard or standards contained in such recommenda18 tion. 

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

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

21 the adoption by the Federal Government of a rec22 ommendation as provided for in subsection (e), and 

23 in compliance with chapter 113 of title 40, United 

24 States Code, no Federal agency shall expend Federal 

25 funds for the purchase of any new health informa-
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1 tion technology or health information technology sys2 tem for clinical care or for the electronic retrieval, 

3 storage, or exchange of health information that is 

4 not consistent with applicable standards adopted by 

5 the Federal Government under subsection (e). 

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

7 paragraph (1) shall be construed to restrict the pur8 chase of minor (as determined by the Secretary) 

9 hardware or software components in order to mod10 ify, correct a deficiency in, or extend the life of exist11 ing hardware or software. 

12 ‘‘(g) COORDINATION OF FEDERAL DATA COLLEC13 TION.—Not later than 3 years after the adoption by the 

14 Federal Government of a recommendation as provided for 

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

16 data for the purposes of quality reporting, surveillance, ep17 idemiology, adverse event reporting, research, or for other 

18 purposes determined appropriate by the Secretary, shall 

19 comply with standards adopted under subsection (e). 

20 ‘‘(h) VOLUNTARY ADOPTION.— 

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

22 the Federal Government under subsection (e) shall 

23 be voluntary with respect to private entities. 

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

25 this section shall be construed to require that a pri-
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1 vate entity that enters into a contract with the Fed2 eral Government adopt the standards adopted by the 

3 Federal Government under this section with respect 

4 to activities not related to the contract. 

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

6 into a contract with the Federal Government shall 

7 adopt the standards adopted by the Federal Govern8 ment under this section for the purpose of activities 

9 under such Federal contract. 

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

11 Committee on Health, Education, Labor, and Pensions 

12 and the Committee on Finance of the Senate and the 

13 Committee on Energy and Commerce and the Committee 

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

15 an annual basis, a report that— 

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

17 been taken by the Federal Government and private 

18 entities to facilitate the adoption of an interoperable 

19 nationwide system for the electronic exchange of 

20 health information; 

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

22 a nationwide system; 

23 ‘‘(3) contains recommendations to achieve full 

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

2 establishment of an entity to ensure the continuation 

3 of the functions of the Collaborative. 

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

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

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

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

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

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

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

15 $4,000,000 for fiscal year 2006, $4,000,000 for fiscal year 

16 2007, and such sums as may be necessary for each of fis17 cal years 2008 through 2010. 

18 ‘‘SEC. 2904. IMPLEMENTATION AND CERTIFICATION OF 

19 HEALTH INFORMATION STANDARDS. 

20 ‘‘(a) IMPLEMENTATION.— 

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

22 the recommendations of the Collaborative, shall de23 velop criteria to ensure uniform and consistent im24 plementation of any standards for the electronic ex25 change of health information voluntarily adopted by 
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1 private entities in technical conformance with such 

2 standards adopted under this title. 

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

5 assist private entities in the implementation of the 

6 standards adopted under this title using the criteria 

7 developed by the Secretary under this section. 

8 ‘‘(b) CERTIFICATION.— 

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

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

12 and software that claim to be in compliance with ap13 plicable standards for the electronic exchange of 

14 health information adopted under this title have es15 tablished and maintained such compliance in tech16 nical conformance with such standards. 

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

19 assist in the certification described under paragraph 

20 (1) using the criteria developed by the Secretary 

21 under this section. 

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

23 through consultation with the Collaborative, may accept 

24 recommendations on the development of the criteria under 
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1 subsections (a) and (b) from a Federal agency or private 

2 entity. 

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

4 ADOPTION OF INTEROPERABLE HEALTH IN5 FORMATION TECHNOLOGY. 

6 ‘‘(a) COMPETITIVE GRANTS TO FACILITATE THE

7 WIDESPREAD ADOPTION OF HEALTH INFORMATION

8 TECHNOLOGY.— 

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

10 competitive grants to eligible entities to facilitate the 

11 purchase and enhance the utilization of qualified 

12 health information technology systems to improve 

13 the quality and efficiency of health care. 

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

15 grant under paragraph (1) an entity shall— 

16 ‘‘(A) submit to the Secretary an applica17 tion at such time, in such manner, and con18 taining such information as the Secretary may 

19 require; 

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

21 plan for the implementation of data sharing 

22 and interoperability measures; 

23 ‘‘(C) be a— 

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

25 federally qualified health center (as defined 
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1 in section 1861(aa)(4) of the Social Secu2 rity Act); 

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

4 ‘‘(iii) another health care provider not 

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

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

7 Federal Government under section 2903; 

8 ‘‘(E) implement the measures adopted 

9 under section 2907 and report to the Secretary 

10 on such measures; 

11 ‘‘(F) agree to notify patients if their indi12 vidually identifiable health information is 

13 wrongfully disclosed; 

14 ‘‘(G) demonstrate significant financial 

15 need; and 

16 ‘‘(H) provide matching funds in accord17 ance with paragraph (4). 

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

19 a grant under this subsection shall be used to facili20 tate the purchase and enhance the utilization of 

21 qualified health information technology systems and 

22 training personnel in the use of such technology. 

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

24 for a grant under this subsection an entity shall con25 tribute non-Federal contributions to the costs of car-
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1 rying out the activities for which the grant is award2 ed in an amount equal to $1 for each $3 of Federal 

3 funds provided under the grant. 

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

5 awarding grants under this subsection the Secretary 

6 shall give preference to— 

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

8 rural, frontier, and other underserved areas as 

9 determined by the Secretary; 

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

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

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

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

16 provider. 

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

19 THE WIDESPREAD ADOPTION OF HEALTH INFORMATION

20 TECHNOLOGY.— 

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

22 competitive grants to States for the establishment of 

23 State programs for loans to health care providers to 

24 facilitate the purchase and enhance the utilization of 

25 qualified health information technology. 
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1 ‘‘(2) ESTABLISHMENT OF FUND.—To be eligi2 ble to receive a competitive grant under this sub3 section, a State shall establish a qualified health in4 formation technology loan fund (referred to in this 

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

6 the other requirements contained in this section. A 

7 grant to a State under this subsection shall be de8 posited in the State loan fund established by the 

9 State. No funds authorized by other provisions of 

10 this title to be used for other purposes specified in 

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

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

13 grant under paragraph (1) a State shall— 

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

17 require; 

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

19 plan in accordance with paragraph (4); 

20 ‘‘(C) establish a qualified health informa21 tion technology loan fund in accordance with 

22 paragraph (2); 

23 ‘‘(D) require that health care providers re24 ceiving such loans— 
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1 ‘‘(i) link, to the extent practicable, the 

2 qualified health information system to a 

3 local or regional health information net4 work; 

5 ‘‘(ii) consult with the Health Informa6 tion Technology Resource Center estab7 lished in section 914(d) to access the 

8 knowledge and experience of existing initia9 tives regarding the successful implementa10 tion and effective use of health information 

11 technology; and 

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

13 individually identifiable health information 

14 is wrongfully disclosed; 

15 ‘‘(E) require that health care providers re16 ceiving such loans adopt the standards adopted 

17 by the Federal Government under section 2903; 

18 ‘‘(F) require that health care providers re19 ceiving such loans implement the measures 

20 adopted under section 2907 and report to the 

21 Secretary on such measures; and 

22 ‘‘(G) provide matching funds in accordance 

23 with paragraph (8). 

24 ‘‘(4) STRATEGIC PLAN.— 
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1 ‘‘(A) IN GENERAL.—A State that receives 

2 a grant under this subsection shall annually 

3 prepare a strategic plan that identifies the in4 tended uses of amounts available to the State 

5 loan fund of the State. 

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

7 subparagraph (A) shall include— 

8 ‘‘(i) a list of the projects to be as9 sisted through the State loan fund in the 

10 first fiscal year that begins after the date 

11 on which the plan is submitted; 

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

13 methods established for the distribution of 

14 funds from the State loan fund; and 

15 ‘‘(iii) a description of the financial 

16 status of the State loan fund and the 

17 short-term and long-term goals of the 

18 State loan fund. 

19 ‘‘(5) USE OF FUNDS.— 

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

21 a State loan fund, including loan repayments 

22 and interest earned on such amounts, shall be 

23 used only for awarding loans or loan guaran24 tees, or as a source of reserve and security for 

25 leveraged loans, the proceeds of which are de-
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1 posited in the State loan fund established under 

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

3 used by a health care provider to facilitate the 

4 purchase and enhance the utilization of quali5 fied health information technology and training 

6 of personnel in the use of such technology. 

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

8 State under this subsection may not be used— 

9 ‘‘(i) for the purchase or other acquisi10 tion of any health information technology 

11 system that is not a qualified health infor12 mation technology system; 

13 ‘‘(ii) to conduct activities for which 

14 Federal funds are expended under this 

15 title, or the amendments made by the 

16 Wired for Health Care Quality Act; or 

17 ‘‘(iii) for any purpose other than mak18 ing loans to eligible entities under this sec19 tion. 

20 ‘‘(6) TYPES OF ASSISTANCE.—Except as other21 wise limited by applicable State law, amounts depos22 ited into a State loan fund under this subsection 

23 may only be used for the following: 

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

25 following: 
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1 ‘‘(i) The interest rate for each loan 

2 shall be less than or equal to the market 

3 interest rate. 

4 ‘‘(ii) The principal and interest pay5 ments on each loan shall commence not 

6 later than 1 year after the loan was award7 ed, and each loan shall be fully amortized 

8 not later than 10 years after the date of 

9 the loan. 

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

11 credited with all payments of principal and 

12 interest on each loan awarded from the 

13 fund. 

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

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

16 which finance a project eligible for assistance 

17 under this subsection) if the guarantee or pur18 chase would improve credit market access or re19 duce the interest rate applicable to the obliga20 tion involved. 

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

22 the payment of principal and interest on rev23 enue or general obligation bonds issued by the 

24 State if the proceeds of the sale of the bonds 

25 will be deposited into the State loan fund. 
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1 ‘‘(D) To earn interest on the amounts de2 posited into the State loan fund. 

3 ‘‘(7) ADMINISTRATION OF STATE LOAN

4 FUNDS.— 

5 ‘‘(A) COMBINED FINANCIAL ADMINISTRA6 TION.—A State may (as a convenience and to 

7 avoid unnecessary administrative costs) com8 bine, in accordance with State law, the financial 

9 administration of a State loan fund established 

10 under this subsection with the financial admin11 istration of any other revolving fund established 

12 by the State if otherwise not prohibited by the 

13 law under which the State loan fund was estab14 lished. 

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

16 Each State may annually use not to exceed 4 

17 percent of the funds provided to the State 

18 under a grant under this subsection to pay the 

19 reasonable costs of the administration of the 

20 programs under this section, including the re21 covery of reasonable costs expended to establish 

22 a State loan fund which are incurred after the 

23 date of enactment of this title. 

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

25 Secretary shall publish guidance and promul-
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•HR 4726 IH 

1 gate regulations as may be necessary to carry 

2 out the provisions of this subsection, includ3 ing— 

4 ‘‘(i) provisions to ensure that each 

5 State commits and expends funds allotted 

6 to the State under this subsection as effi7 ciently as possible in accordance with this 

8 title and applicable State laws; and 

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

10 and abuse. 

11 ‘‘(D) PRIVATE SECTOR CONTRIBUTIONS.— 

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

13 established under this subsection may ac14 cept contributions from private sector enti15 ties, except that such entities may not 

16 specify the recipient or recipients of any 

17 loan issued under this subsection. 

18 ‘‘(ii) AVAILABILITY OF INFORMA19 TION.—A State shall make publicly avail20 able the identity of, and amount contrib21 uted by, any private sector entity under 

22 clause (i) and may issue letters of com23 mendation or make other awards (that 

24 have no financial value) to any such entity. 

25 ‘‘(8) MATCHING REQUIREMENTS.— 
29 

•HR 4726 IH 

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

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

3 State unless the State agrees to make available 

4 (directly or through donations from public or 

5 private entities) non-Federal contributions in 

6 cash toward the costs of the State program to 

7 be implemented under the grant in an amount 

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

9 funds provided under the grant. 

10 ‘‘(B) DETERMINATION OF AMOUNT OF

11 NON-FEDERAL CONTRIBUTION.—In determining 

12 the amount of non-Federal contributions that a 

13 State has provided pursuant to subparagraph 

14 (A), the Secretary may not include any 

15 amounts provided to the State by the Federal 

16 Government. 

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

18 The Secretary may give a preference in awarding 

19 grants under this subsection to States that adopt 

20 value-based purchasing programs to improve health 

21 care quality. 

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

23 submit to the Committee on Health, Education, 

24 Labor, and Pensions and the Committee on Finance 

25 of the Senate, and the Committee on Energy and 
30 

•HR 4726 IH 

1 Commerce and the Committee on Ways and Means 

2 of the House of Representatives, a report summa3 rizing the reports received by the Secretary from 

4 each State that receives a grant under this sub5 section. 

6 ‘‘(c) COMPETITIVE GRANTS FOR THE IMPLEMENTA7 TION OF REGIONAL OR LOCAL HEALTH INFORMATION

8 TECHNOLOGY PLANS.— 

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

10 competitive grants to eligible entities to implement 

11 regional or local health information plans to improve 

12 health care quality and efficiency through the elec13 tronic exchange of health information pursuant to 

14 the standards, protocols, and other requirements 

15 adopted by the Secretary under sections 2903 and 

16 2907. 

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

18 grant under paragraph (1) an entity shall— 

19 ‘‘(A) demonstrate financial need to the 

20 Secretary; 

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

22 missions or purposes is to use information tech23 nology to improve health care quality and effi24 ciency; 
31 

•HR 4726 IH 

1 ‘‘(C) adopt bylaws, memoranda of under2 standing, or other charter documents that dem3 onstrate that the governance structure and de4 cisionmaking processes of such entity allow for 

5 participation on an ongoing basis by multiple 

6 stakeholders within a community, including— 

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

8 1861(r) of the Social Security Act), includ9 ing physicians that provide services to low 

10 income and underserved populations; 

11 ‘‘(ii) hospitals (including hospitals 

12 that provide services to low income and un13 derserved populations); 

14 ‘‘(iii) pharmacists or pharmacies; 

15 ‘‘(iv) health insurance plans; 

16 ‘‘(v) health centers (as defined in sec17 tion 330(b)) and Federally qualified health 

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

19 of the Social Security Act); 

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

21 section 1861(aa) of the Social Security 

22 Act); 

23 ‘‘(vii) patient or consumer organiza24 tions; 

25 ‘‘(viii) employers; and 
32 

•HR 4726 IH 

1 ‘‘(ix) any other health care providers 

2 or other entities, as determined appro3 priate by the Secretary; 

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

5 extent practicable, of stakeholders in the elec6 tronic exchange of health information within 

7 the local or regional plan pursuant to para8 graph (2)(C); 

9 ‘‘(E) adopt nondiscrimination and conflict 

10 of interest policies that demonstrate a commit11 ment to open, fair, and nondiscriminatory par12 ticipation in the health information plan by all 

13 stakeholders; 

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

15 Secretary under section 2903; 

16 ‘‘(G) require that health care providers re17 ceiving such grants implement the measures 

18 adopted under section 2907 and report to the 

19 Secretary on such measures; 

20 ‘‘(H) agree to notify patients if their indi21 vidually identifiable health information is 

22 wrongfully disclosed; 

23 ‘‘(I) facilitate the electronic exchange of 

24 health information within the local or regional 

25 area and among local and regional areas; 
33 

•HR 4726 IH 

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

2 an application in accordance with paragraph 

3 (3); and 

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

5 accordance with paragraph (5). 

6 ‘‘(3) APPLICATION.— 

7 ‘‘(A) IN GENERAL.—To be eligible to re8 ceive a grant under paragraph (1), an entity 

9 shall submit to the Secretary an application at 

10 such time, in such manner, and containing such 

11 information as the Secretary may require. 

12 ‘‘(B) REQUIRED INFORMATION.—At a 

13 minimum, an application submitted under this 

14 paragraph shall include— 

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

16 long-term objectives of the regional or local 

17 health information plan; 

18 ‘‘(ii) a technology plan that complies 

19 with the standards adopted under section 

20 2903 and that includes a descriptive and 

21 reasoned estimate of costs of the hardware, 

22 software, training, and consulting services 

23 necessary to implement the regional or 

24 local health information plan; 
34 

•HR 4726 IH 

1 ‘‘(iii) a strategy that includes initia2 tives to improve health care quality and ef3 ficiency, including the use and reporting of 

4 health care quality measures adopted 

5 under section 2907; 

6 ‘‘(iv) a plan that describes provisions 

7 to encourage the implementation of the 

8 electronic exchange of health information 

9 by all physicians, including single physician 

10 practices and small physician groups par11 ticipating in the health information plan; 

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

13 security of personal health information 

14 that is consistent with Federal and State 

15 law; 

16 ‘‘(vi) a governance plan that defines 

17 the manner in which the stakeholders shall 

18 jointly make policy and operational deci19 sions on an ongoing basis; 

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

21 describes— 

22 ‘‘(I) the sustainability of the 

23 plan; 

24 ‘‘(II) the financial costs and ben25 efits of the plan; and 
35 

•HR 4726 IH 

1 ‘‘(III) the entities to which such 

2 costs and benefits will accrue; and 

3 ‘‘(viii) in the case of an applicant enti4 ty that is unable to demonstrate the par5 ticipation of all stakeholders pursuant to 

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

7 the entity for any such nonparticipation. 

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

9 a grant under paragraph (1) shall be used to estab10 lish and implement a regional or local health infor11 mation plan in accordance with this subsection. 

12 ‘‘(5) MATCHING REQUIREMENT.— 

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

14 not make a grant under this subsection to an 

15 entity unless the entity agrees that, with re16 spect to the costs to be incurred by the entity 

17 in carrying out the infrastructure program for 

18 which the grant was awarded, the entity will 

19 make available (directly or through donations 

20 from public or private entities) non-Federal 

21 contributions toward such costs in an amount 

22 equal to not less than 50 percent of such costs 

23 ($1 for each $2 of Federal funds provided 

24 under the grant). 
36 

•HR 4726 IH 

1 ‘‘(B) DETERMINATION OF AMOUNT CON2 TRIBUTED.—Non-Federal contributions re3 quired under subparagraph (A) may be in cash 

4 or in kind, fairly evaluated, including equip5 ment, technology, or services. Amounts provided 

6 by the Federal Government, or services assisted 

7 or subsidized to any significant extent by the 

8 Federal Government, may not be included in 

9 determining the amount of such non-Federal 

10 contributions. 

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

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

13 and annually thereafter during the grant period, an entity 

14 that receives a grant under this section shall submit to 

15 the Secretary a report on the activities carried out under 

16 the grant involved. Each such report shall include— 

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

18 benefits of the project involved and of the entities to 

19 which such costs and benefits accrue; 

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

21 health care quality and safety; 

22 ‘‘(3) a description of any reduction in duplica23 tive or unnecessary care as a result of the project in24 volved; 
37 

•HR 4726 IH 

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

2 under this section to facilitate secure patient access 

3 to health information; and 

4 ‘‘(5) other information as required by the Sec5 retary. 

6 ‘‘(e) REQUIREMENT TO ACHIEVE QUALITY IMPROVE7 MENT.—The Secretary shall annually evaluate the activi8 ties conducted under this section and shall, in awarding 

9 grants, implement the lessons learned from such evalua10 tion in a manner so that awards made subsequent to each 

11 such evaluation are made in a manner that, in the deter12 mination of the Secretary, will result in the greatest im13 provement in quality measures under section 2907. 

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

15 one non-renewable grant under subsection (a), one non16 renewable grant under subsection (b), and one non-renew17 able grant under subsection (c). 

18 ‘‘(g) AUTHORIZATION OF APPROPRIATIONS.— 

19 ‘‘(1) IN GENERAL.—For the purpose of car20 rying out this section, there is authorized to be ap21 propriated $116,000,000 for fiscal year 2006, 

22 $141,000,000 for fiscal year 2007, and such sums 

23 as may be necessary for each of fiscal years 2008 

24 through 2010. 
38 

•HR 4726 IH 

1 ‘‘(2) AVAILABILITY.—Amounts appropriated 

2 under paragraph (1) shall remain available through 

3 fiscal year 2010. 

4 ‘‘SEC. 2906. DEMONSTRATION PROGRAM TO INTEGRATE IN5 FORMATION TECHNOLOGY INTO CLINICAL 

6 EDUCATION. 

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

8 under this section to carry out demonstration projects to 

9 develop academic curricula integrating qualified health in10 formation technology systems in the clinical education of 

11 health professionals. Such awards shall be made on a com12 petitive basis and pursuant to peer review. 

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

14 under subsection (a), an entity shall— 

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

16 such time, in such manner, and containing such in17 formation as the Secretary may require; 

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

19 for integrating qualified health information tech20 nology in the clinical education of health profes21 sionals and for ensuring the consistent utilization of 

22 decision support software to reduce medical errors 

23 and enhance health care quality; 

24 ‘‘(3) be— 

25 ‘‘(A) a health professions school; 
39 

•HR 4726 IH 

1 ‘‘(B) a school of nursing; or 

2 ‘‘(C) an institution with a graduate med3 ical education program; 

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

5 the effectiveness of the demonstration project to be 

6 funded under the grant in improving the safety of 

7 patients, the efficiency of health care delivery, and 

8 in increasing the likelihood that graduates of the 

9 grantee will adopt and incorporate health informa10 tion technology, and implement the quality measures 

11 adopted under section 2907, in the delivery of health 

12 care services; and 

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

14 subsection (c). 

15 ‘‘(c) USE OF FUNDS.— 

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

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

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

19 2 or more disciplines; and 

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

21 health information technology into community22 based clinical education. 

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

24 use amounts received under a grant under sub-
40 

•HR 4726 IH 

1 section (a) to purchase hardware, software, or serv2 ices. 

3 ‘‘(d) MATCHING FUNDS.— 

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

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

6 entity agrees to make available non-Federal con7 tributions toward the costs of the program to be 

8 funded under the grant in an amount that is not 

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

10 under the grant. 

11 ‘‘(2) DETERMINATION OF AMOUNT CONTRIB12 UTED.—Non-Federal contributions under paragraph 

13 (1) may be in cash or in kind, fairly evaluated, in14 cluding equipment or services. Amounts provided by 

15 the Federal Government, or services assisted or sub16 sidized to any significant extent by the Federal Gov17 ernment, may not be included in determining the 

18 amount of such contributions. 

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

20 action as may be necessary to evaluate the projects funded 

21 under this section and publish, make available, and dis22 seminate the results of such evaluations on as wide a basis 

23 as is practicable. 

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

25 of enactment of this title, and annually thereafter, the Sec-
41 

•HR 4726 IH 

1 retary shall submit to the Committee on Health, Edu2 cation, Labor, and Pensions and the Committee on Fi3 nance of the Senate, and the Committee on Energy and 

4 Commerce and the Committee on Ways and Means of the 

5 House of Representatives a report that— 

6 ‘‘(1) describes the specific projects established 

7 under this section; and 

8 ‘‘(2) contains recommendations for Congress 

9 based on the evaluation conducted under subsection 

10 (e). 

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

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

13 $5,000,000 for fiscal year 2007, and such sums as may 

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

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

16 September 30, 2010. 

17 ‘‘SEC. 2907. QUALITY MEASURES. 

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

19 quality measures, including measures to assess the effec20 tiveness, timeliness, patient self-management, patient 

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

22 measuring the quality of care patients receive. 

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

24 that the quality measures developed under this section 

25 comply with the following: 
42 

•HR 4726 IH 

1 ‘‘(1) MEASURES.— 

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

3 quality measures under this section, the Sec4 retary shall, to the extent feasible, ensure 

5 that— 

6 ‘‘(i) such measures are evidence 

7 based, reliable, and valid; 

8 ‘‘(ii) such measures are consistent 

9 with the purposes described in section 

10 2902(b); 

11 ‘‘(iii) such measures include measures 

12 of clinical processes and outcomes, patient 

13 experience, efficiency, and equity; and 

14 ‘‘(iv) such measures include measures 

15 of overuse and underuse of health care 

16 items and services. 

17 ‘‘(2) PRIORITIES.—In developing the quality 

18 measures under this section, the Secretary shall en19 sure that priority is given to— 

20 ‘‘(A) measures with the greatest potential 

21 impact for improving the quality and efficiency 

22 of care provided under this Act; 

23 ‘‘(B) measures that may be rapidly imple24 mented by group health plans, health insurance 

25 issuers, physicians, hospitals, nursing homes, 
43 

•HR 4726 IH 

1 long-term care providers, and other providers; 

2 and 

3 ‘‘(C) measures which may inform health 

4 care decisions made by consumers and patients. 

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

6 establish procedures to account for differences in pa7 tient health status, patient characteristics, and geo8 graphic location. To the extent practicable, such pro9 cedures shall recognize existing procedures. 

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

11 determined appropriate, but in no case more often 

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

13 quality measures, including through the addition of 

14 more accurate and precise measures and the retire15 ment of existing outdated measures. 

16 ‘‘(5) RELATIONSHIP WITH PROGRAMS UNDER

17 THE SOCIAL SECURITY ACT.—The Secretary shall 

18 ensure that the quality measures developed under 

19 this section— 

20 ‘‘(A) complement quality measures devel21 oped by the Secretary under programs adminis22 tered by the Secretary under the Social Security 

23 Act, including programs under titles XVIII, 

24 XIX, and XXI of such Act; and 
44 

•HR 4726 IH 

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

2 priorities of the programs under titles XVIII, 

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

4 Administrator of the Centers for Medicare & 

5 Medicaid Services. 

6 ‘‘(c) REQUIRED CONSIDERATIONS IN DEVELOPING

7 AND UPDATING THE MEASURES.—In developing and up8 dating the quality measures under this section, the Sec9 retary may take into account— 

10 ‘‘(1) any demonstration or pilot program con11 ducted by the Secretary relating to measuring and 

12 rewarding quality and efficiency of care; 

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

14 Secretary relating to measuring and rewarding qual15 ity and efficiency; 

16 ‘‘(3) any existing activities conducted by private 

17 entities, including health insurance plans and 

18 payors; 

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

20 the National Academy of Sciences under section 

21 238(b) of the Medicare Prescription Drug, Improve22 ment, and Modernization Act of 2003; and 

23 ‘‘(5) issues of data collection and reporting, in24 cluding the feasibility of collecting and reporting 

25 data on measures. 
45 

•HR 4726 IH 

1 ‘‘(d) SOLICITATION OF ADVICE AND RECOMMENDA2 TIONS.—On and after July 1, 2006, the Secretary shall 

3 consult with the following regarding the development, up4 dating, and use of quality measures developed under this 

5 section: 

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

7 providers, including such plans and providers with 

8 experience in the care of the frail elderly and indi9 viduals with multiple complex chronic conditions, or 

10 groups representing such health insurance plans and 

11 providers. 

12 ‘‘(2) Groups representing patients and con13 sumers. 

14 ‘‘(3) Purchasers and employers or groups rep15 resenting purchasers or employers. 

16 ‘‘(4) Organizations that focus on quality im17 provement as well as the measurement and reporting 

18 of quality measures. 

19 ‘‘(5) Organizations that certify and license 

20 health care providers. 

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

22 ‘‘(7) Individuals or entities skilled in the con23 duct and interpretation of biomedical, health serv24 ices, and health economics research and with exper-
46 

•HR 4726 IH 

1 tise in outcomes and effectiveness research and tech2 nology assessment. 

3 ‘‘(8) Individuals or entities involved in the de4 velopment and establishment of standards and cer5 tification for health information technology systems 

6 and clinical data. 

7 ‘‘(9) Individuals or entities with experience 

8 with— 

9 ‘‘(A) urban health care issues; 

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

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

12 ‘‘(e) USE OF QUALITY MEASURES.— 

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

14 conducted or supported by the Secretary under this 

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

16 adopt and utilize the quality measures developed 

17 under this section. 

18 ‘‘(2) COLLABORATIVE AGREEMENTS.—With re19 spect to activities conducted or supported by the 

20 Secretary under this Act, the Secretary may estab21 lish collaborative agreements with private entities, 

22 including group health plans and health insurance 

23 issuers, providers, purchasers, consumer organiza24 tions, and entities receiving a grant under section 

25 2905, to— 
47 

•HR 4726 IH 

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

2 measures adopted by the Secretary under this 

3 section; and 

4 ‘‘(B) foster uniformity between the health 

5 care quality measures utilized by private enti6 ties. 

7 ‘‘(3) REPORTING.—The Secretary shall imple8 ment procedures to enable the Department of 

9 Health and Human Services to accept the electronic 

10 submission of data for purposes of— 

11 ‘‘(A) quality measurement using the qual12 ity measures developed under this section and 

13 using the standards adopted by the Federal 

14 Government under section 2903; and 

15 ‘‘(B) for reporting measures used to make 

16 value-based payments under programs under 

17 the Social Security Act. 

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

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

20 information available to health care consumers, health 

21 professionals, public health officials, researchers, and 

22 other appropriate individuals and entities, the Secretary 

23 shall provide for the dissemination, aggregation, and anal24 ysis of quality measures collected under section 2905 and 
48 

•HR 4726 IH 

1 the dissemination of recommendations and best practices 

2 derived in part from such analysis. 

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

4 provide technical assistance to public and private entities 

5 to enable such entities to— 

6 ‘‘(1) implement and use evidence-based guide7 lines with the greatest potential to improve health 

8 care quality, efficiency, and patient safety; and 

9 ‘‘(2) establish mechanisms for the rapid dis10 semination of information regarding evidence-based 

11 guidelines with the greatest potential to improve 

12 health care quality, efficiency, and patient safety. 

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

14 shall be construed as prohibiting the Secretary, acting 

15 through the Administrator of the Centers for Medicare & 

16 Medicaid Services, from developing quality measures (and 

17 timing requirements for reporting such measures) for use 

18 under programs administered by the Secretary under the 

19 Social Security Act, including programs under titles 

20 XVIII, XIX, and XXI of such Act.’’. 

21 SEC. 3. LICENSURE AND THE ELECTRONIC EXCHANGE OF 

22 HEALTH INFORMATION. 

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

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

25 entity to carry out, a study that examines— 
49 

•HR 4726 IH 

1 (1) the variation among State laws that relate 

2 to the licensure, registration, and certification of 

3 medical professionals; and 

4 (2) how such variation among State laws im5 pacts the secure electronic exchange of health infor6 mation— 

7 (A) among the States; and 

8 (B) between the States and the Federal 

9 Government. 

10 (b) REPORT AND RECOMMENDATIONS.—Not later 

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

12 Secretary of Health and Human Services shall publish a 

13 report that— 

14 (1) describes the results of the study carried 

15 out under subsection (a); and 

16 (2) makes recommendations to States regarding 

17 the harmonization of State laws based on the results 

18 of such study. 

19 SEC. 4. ENSURING PRIVACY AND SECURITY. 

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

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

22 applicability of— 

23 (1) section 264 of the Health Insurance Port24 ability and Accountability Act of 1996; 
50 

•HR 4726 IH 

1 (2) sections 1171 through 1179 of the Social 

2 Security Act; and 

3 (3) any regulation issued pursuant to any such 

4 section. 

5 SEC. 5. GAO STUDY. 

6 Not later than 6 months after the date of enactment 

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

8 shall submit to Congress a report on the necessity and 

9 workability of requiring health plans (as defined in section 

10 1171 of the Social Security Act (42 U.S.C. 1320d)), 

11 health care clearinghouses (as defined in such section 

12 1171), and health care providers (as defined in such sec13 tion 1171) who transmit health information in electronic 

14 form, to notify patients if their individually identifiable 

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

16 wrongfully disclosed. 

17 SEC. 6. STUDY OF REIMBURSEMENT INCENTIVES. 

18 The Secretary of Health and Human Services shall 

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

20 a study that examines methods to create efficient reim21 bursement incentives for improving health care quality in 

22 Federally qualified health centers, rural health clinics, and 

23 free clinics. 
51 

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1 SEC. 7. HEALTH INFORMATION TECHNOLOGY RESOURCE 

2 CENTER. 

3 Section 914 of the Public Health Service Act (42 

4 U.S.C. 299b–3) is amended by adding at the end the fol5 lowing: 

6 ‘‘(d) HEALTH INFORMATION TECHNOLOGY RE7 SOURCE CENTER.— 

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

9 through the Director, shall develop a Health Infor10 mation Technology Resource Center to provide tech11 nical assistance and develop best practices to sup12 port and accelerate efforts to adopt, implement, and 

13 effectively use interoperable health information tech14 nology in compliance with section 2903 and 2907. 

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

16 to— 

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

18 knowledge and experience; 

19 ‘‘(B) accelerate the transfer of lessons 

20 learned from existing public and private sector 

21 initiatives, including those currently receiving 

22 Federal financial support; 

23 ‘‘(C) assemble, analyze, and widely dis24 seminate evidence and experience related to the 

25 adoption, implementation, and effective use of 

26 interoperable health information technology; 
52 

•HR 4726 IH 

1 ‘‘(D) provide for the establishment of re2 gional and local health information networks to 

3 facilitate the development of interoperability 

4 across health care settings and improve the 

5 quality of health care; 

6 ‘‘(E) provide for the development of solu7 tions to barriers to the exchange of electronic 

8 health information; and 

9 ‘‘(F) conduct other activities identified by 

10 the States, local or regional health information 

11 networks, or health care stakeholders as a focus 

12 for developing and sharing best practices. 

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

14 support for the activities of the Center, the Director 

15 shall modify the requirements, if necessary, that 

16 apply to the National Resource Center for Health 

17 Information Technology to provide the necessary in18 frastructure to support the duties and activities of 

19 the Center and facilitate information exchange 

20 across the public and private sectors. 

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

22 this subsection shall be construed to require the du23 plication of Federal efforts with respect to the estab24 lishment of the Center, regardless of whether such 
53 

•HR 4726 IH 

1 efforts were carried out prior to or after the enact2 ment of this subsection. 

3 ‘‘(e) TECHNICAL ASSISTANCE TELEPHONE NUMBER

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

5 telephone number or Internet website to provide health 

6 care providers and patients with a single point of contact 

7 to— 

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

9 assistance services related to interoperable health in10 formation technology; 

11 ‘‘(2) learn about qualified health information 

12 technology and the quality measures adopted by the 

13 Federal Government under sections 2903 and 2907; 

14 ‘‘(3) learn about regional and local health infor15 mation networks for assistance with health informa16 tion technology; and 

17 ‘‘(4) disseminate additional information deter18 mined by the Secretary. 

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

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

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

22 out this subsection.’’. 
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1 SEC. 8. REAUTHORIZATION OF INCENTIVE GRANTS RE2 GARDING TELEMEDICINE. 

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

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

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

Æ