I 

108TH CONGRESS 

2D SESSION H. R. 4880

To improve the quality, efficiency, standards, and technology of health care, 

and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 21, 2004

Mr. KENNEDY of Rhode Island 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 improve the quality, efficiency, standards, and technology 

of health care, and for other purposes.

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 ‘‘Josie King Act of 

5 2004’’ or the ‘‘Quality, Efficiency, Standards, and Tech6 nology for Health Care Transformation Act of 2004’’. 

7 SEC. 2. DEFINITION. 

8 For purposes of this Act, the term ‘‘Secretary’’ 

9 means the Secretary of Health and Human Services. 
2

•HR 4880 IH 

1 SEC. 3. TABLE OF CONTENTS. 

2 The table of contents for this Act is as follows:

Sec. 1. Short title. 

Sec. 2. Definition. 

Sec. 3. Table of contents. 

TITLE I—NATIONAL HEALTH INFORMATION INFRASTRUCTURE 

Sec. 101. Purpose. 

Sec. 102. Health information technology grants. 

Sec. 103. Standards for interoperability of health information technology systems. 

Sec. 104. Loans. 

Sec. 105. Safe harbor for equipment and services provided for the development 

or implementation of a health information infrastructure. 

Sec. 106. Exception to medicare limitations on physician self-referral. 

Sec. 107. Adjustments to medicare payments to providers of service and suppliers participating in health information exchanges. 

Sec. 108. Medicaid payments for information infrastructure for health information exchange and information technology. 

Sec. 109. Definitions. 

TITLE II—HEALTH CARE OUTCOMES, BEST PRACTICES, AND 

EFFICIENCY 

Sec. 201. Research on Outcomes of Health Care Items and Services. 

Sec. 202. Consortium for Health Outcomes Research Priorities. 

Sec. 203. Center for Clinical Decision-Support Technology. 

Sec. 204. Scholarships for study in health care quality and patient safety. 

Sec. 205. Standardized measures of health care provider performance. 

Sec. 206. Definitions. 

TITLE III—INCENTIVES FOR HEALTH CARE QUALITY 

Sec. 301. Access to medicare health care claims databases. 

Sec. 302. Incorporation of measures of health care practitioner performance in 

Federal programs. 

Sec. 303. Interim claims-based practitioner performance database. 

Sec. 304. Clinical-based practitioner performance database. 

Sec. 305. Availability of performance measurements and data. 

Sec. 306. Use of health care provider performances measure for pay for performance. 

Sec. 307. Study comparing practitioner performance database. 

Sec. 308. Regulations on auditing. 

Sec. 309. AHRQ access to practitioner performance databases.
3

•HR 4880 IH 

1 TITLE I—NATIONAL HEALTH IN2 FORMATION INFRASTRUC3 TURE 

4 SEC. 101. PURPOSE. 

5 The Secretary of Health and Human Services shall 

6 implement this title with a view to developing a national 

7 health information infrastructure. 

8 SEC. 102. HEALTH INFORMATION TECHNOLOGY GRANTS. 

9 (a) PHASE I GRANTS.—

10 (1) GRANTS.—The Secretary may make not 

11 more than 20 grants to health information infra12 structure organizations to enable each grantee to de13 velop and implement over a 4-year period a commu14 nity health information technology plan that pro15 vides for a health information exchange to serve a 

16 geographic area in 1 or more States. 

17 (2) USE OF FUNDS.—The Secretary may not 

18 make a grant to a health information infrastructure 

19 organization under this section unless the organiza20 tion agrees to use the grant—

21 (A) in the first year of the grant, to de22 velop a community health information tech23 nology plan described in paragraph (3) for sub24 mission to the Secretary under paragraph (4); 

25 and 
4

•HR 4880 IH 

1 (B) in each year of the grant, but not later 

2 than the second year of the grant, to implement 

3 a health information infrastructure, including a 

4 health information exchange, in accordance with 

5 the plan. 

6 (3) COMMUNITY HEALTH INFORMATION TECH7 NOLOGY PLAN.—

8 (A) IN GENERAL.—A community health in9 formation technology plan shall provide for the 

10 establishment and implementation in a specified 

11 geographic area of a health information infra12 structure that—

13 (i) includes a health information ex14 change that allows the seamless, secure, 

15 electronic sharing of health information 

16 among health care providers and other au17 thorized users; 

18 (ii) provides consumers with secure, 

19 electronic access to their own health infor20 mation; 

21 (iii) meets data standards for inter22 operability adopted by the Secretary, in23 cluding any standards providing for inter24 operability among health information ex25 changes; 
5

•HR 4880 IH 

1 (iv) meets the privacy requirements of 

2 subsection (d); 

3 (v) provides such public health surveil4 lance and reporting capability as the Sec5 retary requires; 

6 (vi) allows for such reporting of, and 

7 access to, health information for purposes 

8 of research (other than individually identi9 fiable health information) as the Secretary 

10 requires; and 

11 (vii) allows for the reporting of health 

12 information (other than individually identi13 fiable health information) to the database 

14 established under section 304 for the pur15 pose of health care provider performance 

16 measurement in such form as required by 

17 the Secretary. 

18 (B) CONTENTS.—A community health in19 formation technology plan shall—

20 (i) be developed with the participation 

21 and widespread support of the health care 

22 community, including all stakeholders (in23 cluding small physician groups), of the ge24 ographic area to be served by the grantee’s 

25 health information exchange; 
6

•HR 4880 IH 

1 (ii) describe the technologies and sys2 tems, including interoperability data stand3 ards, that will be used to establish a health 

4 information exchange consistent with para5 graph (A)(i) and the technological require6 ments and support that will be necessary 

7 for health care providers to participate in 

8 the health information exchange; 

9 (iii) establish how health care stake10 holders will share the costs of health infor11 mation technology investments required by 

12 the community health information tech13 nology plan, including the costs of imple14 menting and maintaining new systems in 

15 physicians offices, hospitals, laboratories, 

16 community health centers, pharmacies, and 

17 other facilities of health care providers; 

18 (iv) establish how administrative and 

19 clinical savings resulting from widespread 

20 use of new health information technology 

21 will be accounted for and distributed 

22 among health care stakeholders; 

23 (v) explain how the health information 

24 infrastructure organization involved will 

25 ensure widespread participation by health 
7

•HR 4880 IH 

1 care providers (especially small physician 

2 groups) in the grantee’s health information 

3 exchange and what support and assistance 

4 will be available to physicians seeking to 

5 integrate health information technologies 

6 into their practices; 

7 (vi) describe how patients and care8 givers who are not health care providers 

9 will be able to access and utilize the health 

10 information infrastructure; 

11 (vii) establish how the health informa12 tion infrastructure will be sustained over 

13 time, including anticipated sources of rev14 enue; 

15 (viii) explain how the grantee’s health 

16 information exchange will protect patient 

17 privacy and maintain security; 

18 (ix) explain how the grantee will en19 sure the participation of health care pro20 viders serving minority communities, in21 cluding communities in which English is 

22 not the primary language spoken; and 

23 (x) require that the grantee’s health 

24 information exchange is certified by the 

25 Secretary under this section. 
8

•HR 4880 IH 

1 (4) APPROVAL OF PLAN.—

2 (A) SUBMISSION.—Not later than the end 

3 of the first year for which a health information 

4 infrastructure organization receives a grant 

5 under this subsection, the organization shall 

6 submit its community health information tech7 nology plan to the Secretary. 

8 (B) APPROVAL.—The Secretary shall ap9 prove or disapprove each community health in10 formation technology plan submitted to the Sec11 retary under this paragraph based on whether 

12 the plan complies with the requirements of this 

13 subsection. 

14 (C) EFFECT OF FAILURE TO APPROVE.—

15 The Secretary may not make any payment 

16 under this subsection to a health information 

17 infrastructure organization for the second, 

18 third, or fourth year for which the organization 

19 receives a grant unless the Secretary has ap20 proved the organization’s community health in21 formation technology plan. 

22 (5) SELECTION.—In selecting grant recipients 

23 under this section, the Secretary shall take into ac24 count the extent to which an applicant intends to de25 velop a community health information technology 
9

•HR 4880 IH 

1 plan that covers a complete medical market area (as 

2 defined by the Secretary), geographical diversity, ex3 tent of stakeholder participation, health care pro4 vider participation commitments, capacity to meas5 ure quality and efficiency improvements, and 

6 replicability. 

7 (b) PHASE II GRANTS.—

8 (1) GRANTS.—For the purpose described in 

9 paragraph (2), the Secretary shall make a grant 

10 under this subsection to each State that agrees to 

11 comply with the requirements of this subsection. 

12 (2) PURPOSE.—A funding agreement for a 

13 grant under this subsection is that the State in14 volved will use the grant only for making subgrants 

15 to health information infrastructure organizations 

16 for the purpose of—

17 (A) maintaining and upgrading existing 

18 health information exchanges; 

19 (B) replicating existing health information 

20 exchanges to develop and implement new health 

21 information exchanges in areas not previously 

22 served by an exchange in accordance with the 

23 process and requirements described in sub24 section (a); 
10

•HR 4880 IH 

1 (C) including additional stakeholders in the 

2 health information exchanges; 

3 (D) working with entities in neighboring 

4 States to expand health information exchanges 

5 on a regional basis; and 

6 (E) connecting health information ex7 changes with public health and bioterrorism 

8 surveillance programs, including those of the 

9 Centers for Disease Control and Prevention. 

10 (3) PRIVACY.—A funding agreement for a grant 

11 under this subsection is that the State involved must 

12 require that any infrastructure funded in whole or in 

13 part under this subsection must meet the privacy re14 quirements of subsection (d). 

15 (4) CERTIFICATION.—A funding agreement for 

16 a grant under this subsection is that the State in17 volved will require that each health information ex18 change funded with the grant is certified by the Sec19 retary under this section. 

20 (5) REPORTS.—A funding agreement for a 

21 grant under this subsection is that the State in22 volved will submit an annual report to the Secretary 

23 on the activities of the State under this subsection, 

24 including—
11

•HR 4880 IH 

1 (A) the status of existing health informa2 tion exchanges in the State; and 

3 (B) the development and implementation 

4 of new health information exchanges in the 

5 State in areas not previously served by an ex6 change. 

7 (6) ALLOCATION OF FUNDS.—Of the amount 

8 appropriated for each fiscal year to carry out this 

9 subsection, the Secretary shall use such appropriated 

10 amount to award a grant to each State receiving a 

11 grant under this subsection in an amount that bears 

12 the same relation to the appropriated amount as the 

13 number of physicians and hospitals in the State 

14 bears to the total number of physicians and hos15 pitals in all such States. 

16 (c) PHASE III GRANTS.—The Secretary shall con17 tinue to make grants to States in accordance with the pro18 visions of subsection (b), except that—

19 (1) grants under this subsection shall be used 

20 primarily to maintain or upgrade existing health in21 formation exchanges; and 

22 (2) the Secretary may not make a grant to a 

23 State under this subsection if less than 75 percent 

24 of the health care providers in the State are partici25 pating in a health information exchange. 
12

•HR 4880 IH 

1 (d) PRIVACY.—Any health information infrastructure 

2 funded in whole or in part under this section shall—

3 (1) comply with the regulations promulgated 

4 pursuant to section 264(c) of the Health Insurance 

5 Portability and Accountability Act of 1996 (42 

6 U.S.C. 1320d–2(d)); 

7 (2) allow patients to exclude their health infor8 mation from the health information exchange; 

9 (3) give patients the option of allowing only 

10 designated health care providers to access their per11 sonally identifiable information concerning diagnosis 

12 and treatment of sexually transmitted diseases, ad13 diction, and mental illnesses; 

14 (4) allow health care providers to access individ15 ually identifiable health information through health 

16 information exchanges only for reasonable purposes 

17 related to diagnosis and treatment; 

18 (5) allow other persons to access individually 

19 identifiable health information available through 

20 health information exchanges only with express pa21 tient consent; and 

22 (6) require health care providers, in making a 

23 transmission of individually identifiable health infor24 mation to payers through the health information in25 frastructure, to restrict the transmission to the min-
13

•HR 4880 IH 

1 imum amount of information necessary for payment 

2 of the claim involved. 

3 (e) APPLICATION.—To seek a grant under this sec4 tion, an applicant shall submit an application to the Sec5 retary in such form, in such manner, and containing such 

6 information and assurances as the Secretary may require. 

7 (f) TECHNICAL ASSISTANCE.—

8 (1) IN GENERAL.—The Secretary shall provide 

9 to health information infrastructure organizations 

10 such technical assistance as the Secretary deems ap11 propriate to carry out this section, including assist12 ance relating to questions of governance, financing, 

13 and technological approaches to the creation of 

14 health information infrastructure. 

15 (2) NATIONAL TECHNICAL ASSISTANCE CEN16 TER.—

17 (A) ESTABLISHMENT.—The Director of 

18 the Agency for Healthcare Resources and Qual19 ity shall establish and maintain a national tech20 nical assistance center to provide assistance to 

21 physicians described in subparagraph (B) to fa22 cilitate successful adoption of health informa23 tion technologies and participation in the devel24 opment and implementation of community 
14

•HR 4880 IH 

1 health information technology plans by such 

2 physicians. 

3 (B) PHYSICIANS.—The national technical 

4 assistance center shall provide assistance to 

5 physicians in geographical areas served by a 

6 health information infrastructure organization 

7 with a phase I grant under subsection (a). 

8 (C) PRIORITY.—In providing assistance to 

9 physicians under this paragraph, the national 

10 technical assistance centers shall—

11 (i) give priority to physicians in small 

12 physician groups; and 

13 (ii) as resources allow, provide assist14 ance to physicians in larger groups. 

15 (D) REQUIREMENTS.—Technical assist16 ance provided under this paragraph shall, at a 

17 minimum, include the following: 

18 (i) A clearinghouse of best practices, 

19 guidelines, and implementation strategies 

20 directed at the small medical practices that 

21 plan to adopt electronic medical records 

22 and other health information technologies. 

23 (ii) A change management tool kit to 

24 enable physicians and their office staffs to 

25 successfully prepare practice workflows for 
15

•HR 4880 IH 

1 electronic medical record adoption, to re2 ceive guidance in the selection of vendors 

3 of health information technology products 

4 and services that are appropriate within 

5 the context of the individual practice and 

6 the community setting, to implement 

7 health information technology solutions 

8 and manage the project at the practice 

9 level, and to address the ongoing need for 

10 upgrades, maintenance, and security of of11 fice-based health information technologies. 

12 (iii) The capability to provide con13 sultations and advice to small medical 

14 practices to facilitate adoption of health in15 formation technologies. 

16 (g) CERTIFICATION.—Not later than the date that is 

17 1 year after the date of the enactment of this Act, the 

18 Secretary shall establish a program of certifying health in19 formation infrastructures that are in compliance with the 

20 requirements of subsection (a)(3)(A) and any other re21 quirements of the national health information infrastruc22 ture as established by the Secretary. 

23 (h) AUTHORIZATION OF APPROPRIATIONS.—
16

•HR 4880 IH 

1 (1) IN GENERAL.—To carry out the provisions 

2 of this section other than subsection (f)(2), there are 

3 authorized to be appropriated—

4 (A) for phase I grants under subsection 

5 (a), $55,000,000 for fiscal year 2005 and 

6 $167,000,000 for each of fiscal years 2006, 

7 2007, and 2008; 

8 (B) for phase II grants under subsection 

9 (b), $400,000,000 for each of fiscal years 2009 

10 through 2013; and 

11 (C) for phase III grants under subsection 

12 (c), such sums as may be necessary for fiscal 

13 year 2014 and each subsequent fiscal year. 

14 (2) TECHNICAL ASSISTANCE.—

15 (A) IN GENERAL.—Of the amount appro16 priated to carry out this section for a fiscal 

17 year, not more than than 10 percent of such 

18 amount or $5,000,000, whichever is lesser, may 

19 be used to provide technical assistance under 

20 subsection (f)(1). 

21 (B) NATIONAL TECHNICAL ASSISTANCE

22 CENTER.—To carry out subsection (f)(2), there 

23 is authorized to be appropriated $2,500,000 for 

24 each of fiscal years 2005 through 2008. 
17

•HR 4880 IH 

1 SEC. 103. STANDARDS FOR INTEROPERABILITY OF HEALTH 

2 INFORMATION TECHNOLOGY SYSTEMS. 

3 (a) STANDARDS.—Not later than 1 year after the 

4 date of the enactment of this Act, after considering the 

5 recommendations of the Working Group, the Secretary of 

6 Health and Human Services, the Secretary of Defense, 

7 and the Secretary of Veterans Affairs, acting jointly, shall 

8 adopt data standards for the interoperability of health in9 formation technology systems. 

10 (b) PERIODIC REVIEW.—The Secretary of Health 

11 and Human Services, the Secretary of Defense, and the 

12 Secretary of Veterans Affairs, acting jointly, shall periodi13 cally review the data standards adopted under subsection 

14 (a) and, as appropriate, revise such standards. 

15 (c) APPLICATION.—The Secretary of Health and 

16 Human Services, the Secretary of Defense, and the Sec17 retary of Veterans Affairs shall require that each program 

18 using health information technology of the Department of 

19 Health and Human Services, the Department of Defense, 

20 and the Department of Veterans Affairs, respectively, 

21 complies with the data standards adopted under sub22 section (a). 

23 (d) WORKING GROUP.—

24 (1) ESTABLISHMENT.—The Secretary of Health 

25 and Human Services shall convene a Working Group 

26 to formulate recommendations on the adoption of 
18

•HR 4880 IH 

1 data standards for the interoperability of health in2 formation technology systems. 

3 (2) MEMBERSHIP.—The members of the Work4 ing Group shall include the following: 

5 (A) Health informatics experts from the 

6 Department of Defense, the Department of 

7 Health and Humans Services, the Department 

8 of Veterans Affairs, the Indian Health Service, 

9 and the private sector. 

10 (B) Practicing physicians. 

11 (C) Nurses. 

12 (D) Representatives of other health care 

13 providers. 

14 (E) Hospital administrators and hospital 

15 chief information officers. 

16 (F) Representatives of standards develop17 ment organizations. 

18 (G) Representatives of standards develop19 ment organizations. 

20 (H) Representatives of the Agency for 

21 Healthcare Research and Quality. 

22 (I) Representatives of the National Library 

23 of Medicine. 

24 (J) Other individuals, as determined ap25 propriate by the Secretary, with expertise rel-
19

•HR 4880 IH 

1 evant to recommending data standards for the 

2 interoperability of health information tech3 nology systems. 

4 (3) DUTIES.—The Working Group shall formu5 late recommendations to the Secretary of Health 

6 and Human Services, the Secretary of Defense, and 

7 the Secretary of Veterans Affairs on the adoption of 

8 data standards for the interoperability of health in9 formation technology systems, including rec10 ommendations on standards for each of the fol11 lowing: 

12 (A) Components of electronic medical 

13 records. 

14 (B) Interchange of clinical data, including, 

15 with a patient’s consent, the sharing of patient 

16 data—

17 (i) across health care provider and 

18 community boundaries; and 

19 (ii) between health care providers and 

20 patients. 

21 (C) Terminologies. 

22 (D) Medical knowledge representation. 

23 (E) Computerized physician order entry. 

24 (F) Privacy, security, and authentication 

25 of health information. 
20

•HR 4880 IH 

1 (e) AUTHORIZATION OF APPROPRIATIONS.—There 

2 are authorized to be appropriated to carry out this sec3 tion—

4 (1) $5,000,000 for each of fiscal years 2005 

5 and 2006; and 

6 (2) $2,000,000 for fiscal year 2007 and each 

7 subsequent fiscal year. 

8 SEC. 104. LOANS. 

9 (a) IN GENERAL.—The Secretary may make loans to 

10 health information infrastructure organizations that re11 ceive a phase I grant under section 102(a) or a phase II 

12 subgrant under section 102(b) to provide additional fund13 ing for activities under the grant, including funding for 

14 the costs of—

15 (1) developing a community health information 

16 technology plan under section 102(a)(3); and 

17 (2) implementing technology investments, train18 ing, and workflow reengineering under the plan. 

19 (b) TERMS AND CONDITIONS.—Each loan under this 

20 section shall be subject to such terms and conditions as 

21 the Secretary deems appropriate, except that—

22 (1) the repayment period of each such loan may 

23 not exceed 10 years; 

24 (2) any technology investments paid for in 

25 whole or in part with funds from the loan must com-
21

•HR 4880 IH 

1 ply with the data standards for the interoperability 

2 of health information technology systems adopted by 

3 the Secretary under section 103; 

4 (3) any technology investments paid for in 

5 whole or in part with funds from the loan must com6 ply with the privacy requirements of section 102(d); 

7 and 

8 (4) the Secretary shall require the health infor9 mation infrastructure organization involved to pro10 vide to the Secretary an annual accounting of loan 

11 funds. 

12 SEC. 105. SAFE HARBOR FOR EQUIPMENT AND SERVICES 

13 PROVIDED FOR THE DEVELOPMENT OR IM14 PLEMENTATION OF A HEALTH INFORMATION 

15 INFRASTRUCTURE. 

16 Paragraph (3) of section 1128B(b) of the Social Se17 curity Act (42 U.S.C. 1320a–7b(b)) is amended—

18 (1) by striking the period at the end of the first 

19 subparagraph (H) and inserting a semicolon; 

20 (2) by redesignating the second subparagraph 

21 (H) as subparagraph (I); 

22 (3) by striking the period at the end of sub23 paragraph (I) (as so redesignated) and inserting ‘‘; 

24 and’’; and 

25 (4) by adding at the end the following: 
22

•HR 4880 IH 

1 ‘‘(J) the provision of any equipment or 

2 services that are appropriate for the develop3 ment or implementation of a health information 

4 infrastructure under section 102 of the Quality, 

5 Efficiency, Standards, and Technology for 

6 Health Care Transformation Act of 2004, in7 cluding the provision of hardware, software, and 

8 services necessary to participate in a health in9 formation exchange so long as such equipment 

10 or services are not provided in any manner that 

11 takes into account the volume, or value, of re12 ferrals or other business generated between the 

13 parties.’’. 

14 SEC. 106. EXCEPTION TO MEDICARE LIMITATIONS ON PHY15 SICIAN SELF-REFERRAL. 

16 Section 1877(e) of the Social Security Act (42 U.S.C. 

17 1395nn(e)) is amended by adding at the end the following 

18 new paragraph: 

19 ‘‘(9) DEVELOPMENT OR IMPLEMENTATION OF A

20 HEALTH INFORMATION INFRASTRUCTURE.—The 

21 provision of any equipment or services as appro22 priate for the development or implementation of a 

23 health information infrastructure under section 102 

24 of the Quality, Efficiency, Standards, and Tech25 nology for Health Care Transformation Act of 2004, 
23

•HR 4880 IH 

1 including the provision of hardware, software, and 

2 services necessary to participate in a health informa3 tion exchange so long as such equipment or services 

4 are not provided in any manner that takes into ac5 count the volume or value of referrals or other busi6 ness generated between the parties.’’. 

7 SEC. 107. ADJUSTMENTS TO MEDICARE PAYMENTS TO PRO8 VIDERS OF SERVICE AND SUPPLIERS PAR9 TICIPATING IN HEALTH INFORMATION EX10 CHANGES. 

11 (a) IN GENERAL.—The Secretary shall establish a 

12 methodology for making adjustments in payment amounts 

13 under title XVIII of the Social Security Act (42 U.S.C. 

14 1395 et seq.) made to providers of services and suppliers 

15 who furnish items or services for which payment is made 

16 under that title who—

17 (1) participate in a health information exchange 

18 certified by the Secretary under section 103(b); or 

19 (2) in the course of furnishing items and serv20 ices for which payment may be made under such 

21 title, use information technology with patient-specific 

22 applications that the Secretary determines improve 

23 the quality and accuracy of clinical decision-making 

24 (such as electronic medical records and computerized 

25 physician order entry). 
24

•HR 4880 IH 

1 (b) ESTABLISHMENT AND MODIFICATION OF

2 CODES.—The methodology under subsection (a) shall—

3 (1) include the establishment of new codes, 

4 modification of existing codes, and adjustment of 

5 evaluation and management modifiers to such codes 

6 that take into account the costs of acquiring, using, 

7 and maintaining information technology with pa8 tient-specific applications; and 

9 (2) take into account estimated aggregate an10 nual savings in overall payments under such title 

11 XVIII attributable to the use of information tech12 nology with patient-specific applications. 

13 (c) DURATION.—The Secretary may reduce or elimi14 nate adjustments established made to subsection (a) as 

15 payment methodologies under title XVIII of the Social Se16 curity Act are adjusted to reflect provider quality and effi17 ciency. 

18 (d) RULE OF CONSTRUCTION.—In making national 

19 coverage determinations under section 1862(a) of the So20 cial Security Act (42 U.S.C. 1395y(a)) with respect to 

21 maintaining information technology with patient-specific 

22 applications, in determining whether the information tech23 nology is reasonable and necessary for the diagnosis or 

24 treatment of illness or injury or to improve the functioning 

25 of a malformed body member, the Secretary shall consider 
25

•HR 4880 IH 

1 whether the information technology improves clinical out2 comes or cost-effectiveness of treatment. 

3 (e) DEFINITIONS.—In this section: 

4 (1) PROVIDER OF SERVICES.—The term ‘‘pro5 vider of services’’ has the meaning given such term 

6 under section 1861(u) of the Social Security Act (42 

7 U.S.C. 1395x(u)). 

8 (2) SUPPLIER.—The term ‘‘supplier’’ has the 

9 meaning given such term under section 1861(d) of 

10 such Act (42 U.S.C. 1395x(d)). 

11 SEC. 108. MEDICAID PAYMENTS FOR INFORMATION INFRA12 STRUCTURE FOR HEALTH INFORMATION EX13 CHANGE AND INFORMATION TECHNOLOGY. 

14 (a) PAYMENT.—In the case of a State that provides 

15 funding under a State plan under title XIX of the Social 

16 Security Act (42 U.S.C. 1396 et seq.) for the design, de17 velopment, and installation of information infrastructure 

18 consisting of a health information exchange and informa19 tion technology operated by health care providers pursuant 

20 to a community health information technology plan ap21 proved by the Secretary under section 102, the Secretary 

22 shall make matching payments to States under section 

23 1903(a) of such Act (42 U.S.C. 1396b(a)) for such fund24 ing. 
26

•HR 4880 IH 

1 (b) 90 PERCENT FMAP FOR PHASE I GRANTS.—In 

2 addition to payment amounts provided for in subsection 

3 (a), for calendar quarters occurring during the first three 

4 years during which a State provides funding referred to 

5 in subsection (a), the Secretary shall provide for payment 

6 to such State at the rate provided for under section 

7 1903(a)(3)(A)(i) of such Act (42 U.S.C. 

8 1396b(a)(3)(A)(i)). 

9 SEC. 109. DEFINITIONS. 

10 In this title: 

11 (1) The term ‘‘health care provider’’ means an 

12 entity involved in consultation, prevention, diagnosis, 

13 and treatment, including but not limited to a physi14 cian group, physician in individual practice, hospital, 

15 community health center, skilled nursing facility, 

16 laboratory, imaging center, or pharmacy. 

17 (2) The term ‘‘health information infrastructure 

18 organization’’ means an organization that—

19 (A) facilitates the drafting and implemen20 tation of a community health information infra21 structure plan for a given geographic area in 1 

22 or more States; 

23 (B) with respect to each area to be served 

24 by the organization with a grant under this sec25 tion, is designated by the Governors of the 
27

•HR 4880 IH 

1 States involved as the exclusive health informa2 tion infrastructure organization for that area; 

3 and 

4 (C) is governed by a board that—

5 (i) includes representatives of health 

6 care insurers and other third party payors, 

7 government health care programs, employ8 ers, physicians and other health care pro9 viders, hospitals, and consumers; and 

10 (ii) may include representatives of or11 ganized labor. 

12 (3) The term ‘‘physician’’ has the meaning 

13 given to that term in section 1861(r) of the Social 

14 Security Act (42 U.S.C. 1395x(r)). 

15 (4) The term ‘‘small physician group’’ means a 

16 physician practice group of 10 or fewer physicians. 

17 (5) The term ‘‘State’’ includes the 50 States 

18 and the District of Columbia. 

19 (6) The term ‘‘Working Group’’ means the 

20 working group convened under section 103. 
28

•HR 4880 IH 

1 TITLE II—HEALTH CARE OUT2 COMES, BEST PRACTICES, 

3 AND EFFICIENCY 

4 SEC. 201. RESEARCH ON OUTCOMES OF HEALTH CARE 

5 ITEMS AND SERVICES. 

6 Section 1013 of the Medicare Prescription Drug, Im7 provement, and Modernization Act of 2003 (42 U.S.C. 

8 299b–7) is amended—

9 (1) in subsection (a)—

10 (A) in clause (i) of paragraph (1)(A), by 

11 inserting ‘‘cost-effectiveness,’’ before ‘‘compara12 tive clinical effectiveness,’’; 

13 (B) by striking paragraph (2) and insert14 ing the following: 

15 ‘‘(2) PRIORITIES.—In carrying out this section, 

16 the Secretary shall adopt and implement the prior17 ities established by the Consortium for Health Out18 comes Research Priorities under section 202 of the 

19 Quality, Efficiency, Standards, and Technology for 

20 Health Care Transformation Act of 2004.’’; and 

21 (C) in clause (i) of paragraph (3)(A), by 

22 inserting ‘‘cost-effectiveness,’’ before ‘‘compara23 tive clinical effectiveness,’’; 

24 (2) by striking subsection (d); 
29

•HR 4880 IH 

1 (3) in subsection (e), by inserting 

2 ‘‘$150,000,000 for fiscal year 2005, $250,000,000 

3 for fiscal year 2006, $400,000,000 for fiscal year 

4 2007, $750,000,000 for fiscal year 2008, 

5 $1,000,000,000 for fiscal year 2009,’’ before ‘‘and 

6 such sums as may be necessary for each fiscal year 

7 thereafter’’; and 

8 (4) by redesignating subsection (e) as sub9 section (d). 

10 SEC. 202. CONSORTIUM FOR HEALTH OUTCOMES RE11 SEARCH PRIORITIES. 

12 (a) ESTABLISHMENT.—The Director of the Agency 

13 for Healthcare Research and Quality shall enter into an 

14 agreement with the Institute of Medicine to establish the 

15 Consortium for Health Outcomes Research Priorities. 

16 (b) MEMBERS.—

17 (1) IN GENERAL.—The Consortium shall be 

18 composed of the ex officio members listed in para19 graph (2) and the members appointed by the Insti20 tute of Medicine under paragraph (3). 

21 (2) EX OFFICIO MEMBERS.—The ex officio 

22 members of the Consortium shall include the fol23 lowing: 

24 (A) The Administrator of the Centers for 

25 Medicare and Medicaid Services. 
30

•HR 4880 IH 

1 (B) The Commissioner of Food and Drugs. 

2 (C) The Director of the Agency for 

3 Healthcare Research and Quality. 

4 (D) The Director of the Centers for Dis5 ease Control and Prevention. 

6 (E) The Director of the Indian Health 

7 Service. 

8 (F) The Director of the National Institutes 

9 of Health. 

10 (G) The Assistant Secretary of Defense for 

11 Health Affairs. 

12 (H) The Under Secretary for Health, De13 partment of Veterans Affairs. 

14 (3) APPOINTED MEMBERS.—The members of 

15 the Consortium appointed by the Institute of Medi16 cine shall include the following: 

17 (A) Academics. 

18 (B) Practicing physicians. 

19 (C) Representatives of the following: 

20 (i) Hospitals. 

21 (ii) Drug companies. 

22 (iii) Device companies. 

23 (iv) Health care insurers, including 

24 State medicaid programs under title XIX 
31

•HR 4880 IH 

1 of the Social Security Act (42 U.S.C. 1396 

2 et seq.). 

3 (v) Employers or employer groups 

4 with a history of supporting health care 

5 quality initiatives. 

6 (vi) Patient advocacy groups. 

7 (vii) Professional societies. 

8 (viii) Health foundations. 

9 (4) MAJORITY OF MEMBERS.—A majority of 

10 the members of the Consortium shall be appointed 

11 by the Institute of Medicine under paragraph (3). 

12 (c) DUTIES.—The Consortium shall—

13 (1) establish research priorities under sub14 section (d); and 

15 (2) carry out section 205 (relating to standard16 ized measures of health care provider performance). 

17 (d) RESEARCH PRIORITIES.—

18 (1) ESTABLISHMENT.—On an annual basis, the 

19 Consortium shall establish priorities for research 

20 conducted or supported by the Agency for 

21 Healthcare Research and Quality under section 1013 

22 of the Medicare Prescription Drug, Improvement, 

23 and Modernization Act of 2003 (42 U.S.C. 299b–7) 

24 (relating to the effectiveness and efficiency of health 

25 care items and services). 
32

•HR 4880 IH 

1 (2) CONSIDERATION.—In establishing research 

2 priorities under subsection (c)(1), the Consortium 

3 shall take into consideration—

4 (A) the extent to which health care items 

5 and services—

6 (i) impact large numbers of people; or 

7 (ii) impose high health care costs; and 

8 (B) the extent of the need for data with re9 spect to diseases or conditions affected by those 

10 health care items and services. 

11 (3) TRANSPARENCY.—In carrying out this sec12 tion, the Consortium shall ensure that research pri13 orities are established in a manner that is publicly 

14 transparent. 

15 SEC. 203. CENTER FOR CLINICAL DECISION-SUPPORT 

16 TECHNOLOGY. 

17 (a) ESTABLISHMENT.—The Director, in collaboration 

18 with the National Library of Medicine, shall establish and 

19 support by grant or contract a Center for Clinical Deci20 sion-Support Technology to enable health care providers 

21 across the United States to more efficiently and rapidly 

22 embed knowledge-based elements in their clinical informa23 tion systems. 

24 (b) DUTIES.—The Center for Clinical Decision-Sup25 port Technology shall—
33

•HR 4880 IH 

1 (1) design and develop new approaches to 

2 knowledge organization, modeling, and decision sup3 port; 

4 (2) develop standards and promote existing 

5 standards for guideline models, standard data sets, 

6 vocabularies, and interfaces among components of 

7 the decision-support system; 

8 (3) build tools to facilitate the encoding of med9 ical knowledge in a structured form to enable such 

10 knowledge to be used in patient-specific decision 

11 support, associated with other relevant evidence, up12 dated and maintained, and adapted to local systems 

13 and environments; 

14 (4) define and regularly update methods to de15 termine the effectiveness of such tools, including the 

16 appropriateness of the knowledge, the ease of adap17 tation to local environments, and the success of the 

18 intended application in achieving specific goals; 

19 (5) generalize or abstract the features of spe20 cific applications in the systems of the affiliated 

21 health care delivery organizations that have been 

22 found to be successful, but for which sharing and 

23 dissemination are not easily achieved, due to system24 specific designs; and 
34

•HR 4880 IH 

1 (6) explore optimal interface approaches to ac2 cess and use of knowledge resources for health care 

3 providers and consumers. 

4 (c) AUTHORIZATION OF APPROPRIATIONS.—To carry 

5 out this section, there are authorized to be appropriated 

6 $2,000,000 for fiscal year 2005 and such sums as may 

7 be necessary for each subsequent fiscal year. 

8 SEC. 204. SCHOLARSHIPS FOR STUDY IN HEALTH CARE 

9 QUALITY AND PATIENT SAFETY. 

10 (a) PURPOSES.—The purposes of this section are to 

11 improve health care quality and patient safety and to 

12 achieve a corresponding reduction in health care costs by 

13 providing scholarships to future health care leaders for 

14 study in the fields of health care quality and patient safe15 ty. 

16 (b) SCHOLARSHIPS.—For the purposes described in 

17 subsection (a), the Director may make grants to eligible 

18 institutions for the awarding of scholarships to physicians, 

19 nurses, other health care personnel, and administrators to 

20 enable such individuals to obtain a master’s degree or a 

21 doctoral degree in the field of health care quality and pa22 tient safety. 

23 (c) PRIORITY.—A condition on the receipt of a grant 

24 under this section is that the eligible institution, in award-
35

•HR 4880 IH 

1 ing scholarships, will give priority to applicants whose 

2 studies will focus on—

3 (1) measuring, monitoring, and improving the 

4 clinical and financial performance of health care 

5 service organizations; or 

6 (2) providing leadership for organizational 

7 change within the health care system. 

8 (d) USE OF SCHOLARSHIPS.—A scholarship under 

9 this section may be used to pay the costs of all reasonable 

10 educational expenses, including tuition, fees, and books, 

11 and such stipends as the Director determines to be appro12 priate. 

13 (e) FLEXIBILITY.—A condition on the receipt of a 

14 grant under this section is that the eligible institution will 

15 offer flexibility to scholarship recipients who desire to con16 tinue clinical practice while pursuing a course of study, 

17 including by allowing such recipients to pursue a course 

18 of study on a part-time basis. 

19 (f) DEFINITION.—In this section: 

20 (1) The terms ‘‘accredited’’ and ‘‘school of pub21 lic health’’ have the meanings given to those terms 

22 in section 799B of the Public Health Service Act 

23 (42 U.S.C. 295p). 

24 (2) The term ‘‘eligible institution’’ means an ac25 credited school of public health offering a master’s 
36

•HR 4880 IH 

1 degree or a doctoral degree in the field of health 

2 care quality and patient safety with a curriculum 

3 that—

4 (A) is interdisciplinary; 

5 (B) includes coursework and training in—

6 (i) health services research; 

7 (ii) health care quality; 

8 (iii) decision analysis; 

9 (iv) cost-benefit and cost-effectiveness 

10 analysis; and 

11 (v) management skills and leadership; 

12 and 

13 (C) includes fieldwork in a health care fa14 cility. 

15 (g) AUTHORIZATION OF APPROPRIATIONS.—To carry 

16 out this section, there are authorized to be appropriated 

17 $2,000,000 for fiscal year 2005 and such sums as may 

18 be necessary for each subsequent fiscal year. 

19 SEC. 205. STANDARDIZED MEASURES OF HEALTH CARE 

20 PROVIDER PERFORMANCE. 

21 (a) PRIORITIES.—Not later than 1 year after the date 

22 of the enactment of this Act, the Consortium shall identify 

23 priorities for developing, updating, and endorsing stand24 ardized measures of health care provider performance 

25 under this section. Such priorities shall—
37

•HR 4880 IH 

1 (1) first be developed for each of the 20 priority 

2 areas for improvement in health care quality speci3 fied in the report by the Institute of Medicine enti4 tled ‘‘Priority Areas for National Action: Trans5 forming Health Care Quality’’; 

6 (2) include priorities for measures of health 

7 care provider performance based on adherence to 

8 evidence-based medicine, patient outcomes, effi9 ciency, and patient satisfaction; 

10 (3) include priorities for measures specific to a 

11 range of practice settings, including individual doc12 tors and small physician groups; 

13 (4) emphasize the development of reliable, risk14 adjusted outcome measures; and 

15 (5) be updated on an annual basis. 

16 (b) DEVELOPMENT.—The Director shall enter into 

17 agreements with medical specialty societies, private ac18 crediting organizations, and other appropriate organiza19 tions to develop and update measures of health care pro20 vider performance in accordance with the priorities identi21 fied under subsection (a). 

22 (c) ENDORSEMENT.—

23 (1) IN GENERAL.—The Director shall enter into 

24 an agreement with the National Quality Forum for 
38

•HR 4880 IH 

1 the endorsement by such entity of standardized 

2 measures of health care provider performance. 

3 (2) REQUIREMENTS.—The agreement entered 

4 into under this subsection shall require the National 

5 Quality Forum—

6 (A) to endorse standardized measures of 

7 health care provider performance for each of 

8 the 20 priority areas described in subsection 

9 (a)(1); 

10 (B) to endorse other such measures over 

11 time consistent with the priorities identified 

12 under subsection (a); and 

13 (C) to recommend aggregate measures of 

14 health care provider performance to create sim15 plified comparisons of health care provider per16 formance. 

17 SEC. 206. DEFINITIONS. 

18 In this title: 

19 (1) The term ‘‘Consortium’’ means the Consor20 tium for Health Outcomes Research Priorities estab21 lished under section 202. 

22 (2) The term ‘‘Director’’ means the Director of 

23 the Agency for Healthcare Research and Quality. 
39

•HR 4880 IH 

1 TITLE III—INCENTIVES FOR 

2 HEALTH CARE QUALITY 

3 SEC. 301. ACCESS TO MEDICARE HEALTH CARE CLAIMS 

4 DATABASES. 

5 (a) ACCESS BY HEALTH PLANS.—

6 (1) IN GENERAL.—The Center for Medicare 

7 and Medicaid Services shall make available to a 

8 group health plan, that meets the condition under 

9 paragraph (2), all data in the possession of the Sec10 retary with respect to the most recent claims sub11 mitted to the Secretary for items and services fur12 nished to medicare beneficiaries for which payment 

13 is made under title XVIII of the Social Security Act. 

14 (2) CONDITION OF ACCESS.—The condition re15 ferred to in paragraph (1) for a group health plan 

16 to have access to data under that paragraph is that 

17 the group health plan contribute claims-based health 

18 care provider performance data to the health care 

19 provider performance database established under 

20 section 303. 

21 (b) PRIVACY PROTECTIONS.—

22 (1) IN GENERAL.—A request under subsection 

23 (a) is subject to the provisions of the Health Insur24 ance Portability and Accountability Act and the Pri25 vacy Act. 
40

•HR 4880 IH 

1 (2) SPECIFIC PROTECTIONS.—

2 (A) ENCRYPTION.—The Secretary shall en3 sure that any identification number of a bene4 ficiary to which a claim relates is encrypted in 

5 a consistent fashion in order to access data with 

6 respect to that beneficiary for claims for items 

7 and services under each applicable part of title 

8 XVIII. 

9 (B) DELETION OF PERSONAL IDENTIFYING

10 INFORMATION.—The Secretary shall ensure 

11 that the data omits the name, date of birth, 

12 street address and the last two applicable postal 

13 codes of each of the beneficiaries. 

14 (3) EXCLUSION OF CERTAIN DATA.—In the 

15 case of a provider of services or a supplier that sub16 mits a low volume of claims to the Secretary for 

17 items or services furnished to medicare beneficiaries, 

18 or in the case of certain rare medical conditions or 

19 treatments, the Secretary may exclude data with re20 spect to such claims, conditions, or treatment from 

21 a request under subsection (a) in order to protect 

22 patient privacy. 

23 (c) FORM OF REQUEST.—Requests under subsection 

24 (a) shall require such information, and be in such form, 

25 as the Secretary determines appropriate. Such a request 
41

•HR 4880 IH 

1 shall include the applicable period and areas for which 

2 such claims data is requested. 

3 (d) FEE.—The Secretary may require the payment 

4 of a fee by each group health plan that submits a request 

5 under subsection (a) to offset administrative costs in6 curred by the Secretary in carrying out this section. 

7 (e) AUTHORITY TO CONTRACT.—If the Secretary de8 termines that data could be made available more promptly, 

9 the Secretary may enter into arrangements with private 

10 entities to merge data for claims under each part of title 

11 XVIII of the Social Security Act. The Secretary shall en12 sure that a unique encryption applies to each beneficiary 

13 encryption. 

14 SEC. 302. INCORPORATION OF MEASURES OF HEALTH 

15 CARE PRACTITIONER PERFORMANCE IN FED16 ERAL PROGRAMS. 

17 (a) IN GENERAL.—Not later than 1 year after the 

18 date of the enactment of this Act, the Secretary of De19 fense, the Secretary of Health and Human Services, the 

20 Secretary of Veterans Affairs, and the Director of the In21 dian Health Service shall incorporate, to the extent prac22 ticable, measures of health care practitioner performance 

23 endorsed by the National Quality Forum into the health 

24 care programs of the Department of Defense, the Depart25 ment of Health and Human Services, the Department of 
42

•HR 4880 IH 

1 Veterans Affairs, and the Indian Health Service, respec2 tively for the purpose of improving program quality and 

3 efficiency. 

4 (b) REPORT TO CONGRESS.—Not later than 18 

5 months after the date of the enactment of this Act, each 

6 Federal official specified in subsection (a) shall submit a 

7 report to the Congress on the results of the official’s ac8 tivities under this section. 

9 SEC. 303. INTERIM CLAIMS-BASED PRACTITIONER PER10 FORMANCE DATABASE. 

11 (a) IN GENERAL.—Not later than the date that is 

12 18 months after the date of the enactment of this Act, 

13 the Secretary shall establish a claims-based practitioner 

14 performance database that comprises de-indentified claims 

15 data under the medicare program under title XVIII of the 

16 Social Security Act and claims data from any group health 

17 plan that voluntarily submits de-identified health care 

18 claims data to the Secretary for such purpose. 

19 (b) REQUIREMENT FOR PARTICIPATION BY FEHB 

20 PLANS.—The Director of the Office of Personnel Manage21 ment shall require, as a condition under chapter 89 of title 

22 5, United States Code, that each plan under contract with 

23 the Director under such chapter submit de-identified 

24 claims data to practitioner performance database. 
43

•HR 4880 IH 

1 (c) PERFORMANCE MEASUREMENTS.—Not later than 

2 1 year after the date specified in subsection (a), and not 

3 less frequently than annually thereafter, the Secretary, 

4 from data in the database established under this section, 

5 shall prepare practitioner performance measurements. 

6 Such measurements shall—

7 (1) be based on performance measures endorsed 

8 by the National Quality Forum; 

9 (2) measure—

10 (A) the performance of individual physi11 cians, physician groups (if any), and hospitals; 

12 or 

13 (B) if records are not available for meas14 uring such performance, the performance of the 

15 smallest practitioner unit for which records are 

16 available; and 

17 (3) be presented in such manner as the Sec18 retary determines will accurately and clearly rep19 resent the comparative performance quality and effi20 ciency of physicians, physician groups, and hospitals. 

21 (d) PRIVACY PROTECTIONS.—The Secretary shall en22 sure that—

23 (1) any patient identifier is encrypted or omit24 ted in a consistent fashion; 
44

•HR 4880 IH 

1 (2) the data omits the name, date of birth, 

2 street address and the last two applicable postal 

3 codes of each patient; and 

4 (3) the amount of the charge for services fur5 nished is omitted. 

6 (e) REQUIREMENT FOR SUBMISSION OF DATA BY

7 ALL GROUP HEALTH PLANS.—Not later than four years 

8 after the date referred to in subsection (a), each group 

9 health plan shall contribute de-indentified claims data nec10 essary for performance measurement to the practitioner 

11 performance database established under subsection (a). As 

12 soon as practicable, the Secretary shall make available an13 nual performance measures to the public. 

14 (f) TERMINATION.—Beginning on the date that is 10 

15 years after the date referred to in subsection (a), the Sec16 retary shall discontinue the collection of data under this 

17 section. 

18 SEC. 304. CLINICAL-BASED PRACTITIONER PERFORMANCE 

19 DATABASE. 

20 (a) ESTABLISHMENT.—Not later than 18 months 

21 after the date of the enactment of this Act, the Secretary 

22 shall establish a practitioner performance database that 

23 comprises data from any health care practitioner that vol24 untarily submits de-indentified health care data to the 

25 Secretary for such purpose. 
45

•HR 4880 IH 

1 (b) PRIVACY PROTECTIONS.—The Secretary shall re2 quire health care practitioners to encrypt or omit all indi3 vidually identifiable patient information from data sub4 mitted to the Secretary under this section, including by 

5 ensuring that—

6 (1) any patient identifier is encrypted or omit7 ted in a consistent fashion; 

8 (2) the data omits the name, date of birth, 

9 street address, and the last 2 applicable postal codes 

10 of each patient; and 

11 (3) the amount of the charge for services fur12 nished is omitted. 

13 (c) PERFORMANCE MEASUREMENTS.—Not later than 

14 1 year after the date specified in subsection (a), and not 

15 less frequently than annually thereafter, the Secretary, 

16 from data in the database established under this section, 

17 shall prepare practitioner performance measurements. 

18 Such measurements shall—

19 (1) be based on performance measures endorsed 

20 by the National Quality Forum; 

21 (2) measure—

22 (A) the performance of individual physi23 cians, physician groups (if any), and hospitals; 

24 or 
46

•HR 4880 IH 

1 (B) if records are not available for meas2 uring such performance, the performance of the 

3 smallest practitioner unit for which records are 

4 available; and 

5 (3) be presented in such manner as the Sec6 retary determines will accurately and clearly rep7 resent the comparative performance quality and effi8 ciency of physicians, physician groups, and hospitals. 

9 (d) CERTAIN PRACTITIONERS.—As a condition on 

10 any grant or subgrant awarded to a health information 

11 infrastructure organization under section 102, the Sec12 retary shall require the organization to agree that the or13 ganization will not allow any health care practitioner to 

14 participate in a health information exchange established 

15 or implemented with the grant unless the practitioner sub16 mits claims data to the Secretary in accordance with this 

17 section. 

18 SEC. 305. AVAILABILITY OF PERFORMANCE MEASURE19 MENTS AND DATA. 

20 (a) PERFORMANCE MEASURES.—The Secretary shall 

21 make publicly available the practitioner performance 

22 measurements prepared under sections 303 and 304. 

23 (b) DATA.—The Secretary shall restrict access to the 

24 data in the databases under sections 303 and 304 to indi25 viduals requesting such information in connection with re-
47

•HR 4880 IH 

1 search conducted or supported by the Agency for 

2 Healthcare Research and Quality. 

3 SEC. 306. USE OF HEALTH CARE PROVIDER PERFORM4 ANCES MEASURE FOR PAY FOR PERFORM5 ANCE. 

6 (a) IN GENERAL.—The Secretary may provide for 

7 adjustments to payment systems under title XVIII of the 

8 Social Security Act based on performance measurements 

9 of physicians, physician groups, and institutional providers 

10 of services. Insofar as the Secretary exercises the author11 ity under the preceding sentence, in the case of providers 

12 with both claims-based and clinical-based measurements, 

13 the Secretary shall use the clinical-based measurements 

14 for any pay-for-performance unless the provider elects to 

15 use claims-based measurements. In no case may an elec16 tion under the preceding sentence be in effect after the 

17 date that is 6 years after the date of the enactment of 

18 this Act. 

19 (b) MEDPAC RECOMMENDATIONS.—The Medicare 

20 Payment Advisory Commission shall include in the March 

21 2007 report to Congress, and annually thereafter, specific 

22 recommendations for the amount of adjustments to pay23 ment systems and beneficiary cost-sharing under title 

24 XVIII of the Social Security Act based on performance 

25 measurements in order to share savings under such title 
48

•HR 4880 IH 

1 attributable to quality improvement with practitioners, to 

2 create incentives for better practitioner performance, and 

3 shift medicare beneficiary caseload to higher quality, more 

4 efficient practitioners. 

5 (c) SENSE OF CONGRESS.—It is the sense of the Con6 gress that the Director of the Office of Personnel Manage7 ment should encourage plans with contracts under chapter 

8 89 of title 5, United States Code, to include differential 

9 payments, differential cost-sharing, or both based on HHS 

10 practitioner performance measurements under section 

11 303. 

12 SEC. 307. STUDY COMPARING PRACTITIONER PERFORM13 ANCE DATABASE. 

14 Not later than 54 months after the date of the enact15 ment of this Act, the Director of the Agency for 

16 Healthcare Research and Quality shall—

17 (1) conduct a study to compare the interim 

18 claims-based practitioner performance database es19 tablished under section 303 with the clinical-based 

20 practitioner performance database established under 

21 section 304, including by assessing the scope, cause, 

22 and import of any differences between the 2 data23 bases in practitioner performance measurement; and 

24 (2) submit a report to the Congress on the re25 sults of the study. 
49

•HR 4880 IH 

1 SEC. 308. REGULATIONS ON AUDITING. 

2 The Secretary shall establish regulations governing 

3 the audit of group health plans that submit data under 

4 section 303 and health care practitioners that submit data 

5 under section 304 for compliance with such sections. 

6 SEC. 309. AHRQ ACCESS TO PRACTITIONER PERFORMANCE 

7 DATABASES. 

8 The Director of the Agency for Healthcare Research 

9 and Quality shall have access to the data in the databases 

10 established under sections 303 and 304 for health out11 comes research, including research conducted internally or 

12 by external researchers.

Æ