II 

111TH CONGRESS 

1ST SESSION S. 264 

To amend title XIX of the Social Security Act to encourage the use of 

certified health information technology by providers in the Medicaid program and the Children’s Health Insurance Program, and for other purposes. 

IN THE SENATE OF THE UNITED STATES 

JANUARY 15, 2009 

Ms. STABENOW introduced the following bill; which was read twice and 

referred to the Committee on Finance 

A BILL 

To amend title XIX of the Social Security Act to encourage 

the use of certified health information technology by 

providers in the Medicaid program and the Children’s 

Health Insurance Program, 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 ‘‘E–Centives Act of 

5 2009’’. 


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1 SEC. 2. INCREASED MATCHING PAYMENTS UNDER MED2 ICAID FOR HEALTH INFORMATION TECH3 NOLOGY. 

4 Section 1903 of the Social Security Act (42 U.S.C. 

5 1396b) is amended— 

6 (1) in subsection (a)(3)(E), by inserting ‘‘(other 

7 than costs attributable to programs described in sub8 section (bb))’’ after ‘‘costs incurred during such 

9 quarter’’; and 

10 (2) by adding at the end the following new sub11 sections: 

12 ‘‘(aa) ENHANCED PAYMENTS FOR CERTIFIED

13 HEALTH INFORMATION TECHNOLOGY INCENTIVES.— 

14 ‘‘(1) IN GENERAL.—The Secretary shall provide 

15 for payments to each State that provides incentive 

16 payments to physicians, hospitals, community health 

17 centers, rural health clinics, and community mental 

18 health centers that exhibit meaningful use of health 

19 information technology certified under this sub20 section, as determined by the measures for meaning21 ful use of health information technology under para22 graph (5). No payment may be made to a State for 

23 incentive payments made by a State for meaningful 

24 use of health information technology that occurs be25 fore January 1, 2010. 


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1 ‘‘(2) APPLICATION.—To qualify for payments 

2 under paragraph (1), a State shall submit an appli3 cation in a time and manner specified by the Sec4 retary and containing the following: 

5 ‘‘(A) A description of the incentive pay6 ments. 

7 ‘‘(B) A description of the method the State 

8 will use to allocate such incentive payments 

9 among physicians, hospitals, community health 

10 centers, rural health clinics, and community 

11 mental health centers, including how the State 

12 will prioritize payments to providers serving a 

13 high percentage of Medicaid, SCHIP, and unin14 sured patients. 

15 ‘‘(C) A time line for implementing such 

16 payment incentives. 

17 ‘‘(D) A plan for disseminating information 

18 to physicians, hospitals, community health cen19 ters, rural health clinics, and community mental 

20 health centers about the availability of such 

21 payment incentives. 

22 ‘‘(E) An assessment of the current level of 

23 use of health information technology by physi24 cians, hospitals, community health centers, 

25 rural health clinics, and community mental 


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1 health centers in the State, using a standard 

2 assessment form developed by the Secretary. 

3 ‘‘(F) Any other information required by 

4 the Secretary. 

5 ‘‘(3) AMOUNT OF PAYMENTS TO STATES.— 

6 ‘‘(A) IN GENERAL.—Subject to subpara7 graph (B), the payment made to a State under 

8 this subsection for a quarter, with respect to 

9 sums expended by such State during such quar10 ter that are attributable to providing incentive 

11 payments under paragraph (1), shall be in an 

12 amount equal to the following: 

13 ‘‘(i) For any quarter in 2010, the en14 hanced FMAP (as defined in section 

15 2105(b)) of such sums. 

16 ‘‘(ii) For any quarter in 2011 or 

17 2012, such sums multiplied by a percent18 age equal to such enhanced FMAP minus 

19 1.5 percentage points. 

20 ‘‘(iii) For any quarter in 2013 or 

21 2014, such sums multiplied by a percent22 age equal to such enhanced FMAP minus 

23 3 percentage points. 

24 ‘‘(iv) For any quarter beginning after 

25 2014, 0. 


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1 ‘‘(B) LIMITATION.— 

2 ‘‘(i) FISCAL YEAR LIMITATION.—The 

3 total amount of payments made under this 

4 subsection shall not exceed $500,000,000 

5 for any fiscal year. 

6 ‘‘(ii) ALLOCATION.—If the amounts 

7 otherwise payable under this subsection for 

8 a fiscal year exceed the amount specified in 

9 clause (i), the Secretary shall reduce the 

10 amounts payable under this subsection, in 

11 a manner specified by the Secretary, to 

12 comply with the limitation under such 

13 clause. 

14 ‘‘(iii) DUPLICATIVE PAYMENTS PRO15 HIBITED.—No payment shall be made 

16 under any other provision of this title for 

17 expenditures for which payment is made 

18 under this subsection. 

19 ‘‘(C) MANNER OF PAYMENT.—Payment to 

20 a State under this subsection shall be made in 

21 the same manner as payments under subsection 

22 (a). 

23 ‘‘(4) CERTIFICATION REQUIREMENTS FOR

24 HEALTH INFORMATION TECHNOLOGY.— 


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1 ‘‘(A) IN GENERAL.—The Secretary, in con2 sultation with the Office of the National Coor3 dinator for Health Information Technology and 

4 the Certification Commission of Health Infor5 mation Technology, shall determine the require6 ments for certification of health information 

7 technology under this subsection. 

8 ‘‘(B) INTERIM CERTIFICATION REQUIRE9 MENTS.—During any period in which the Sec10 retary has not determined such certification re11 quirements, the Secretary, for purposes of this 

12 subsection, shall use the certification require13 ments for health information technology estab14 lished by the Certification Commission for 

15 Health Information Technology. 

16 ‘‘(5) MEASURES FOR MEANINGFUL USE OF

17 HEALTH INFORMATION TECHNOLOGY.— 

18 ‘‘(A) IN GENERAL.—For purposes of this 

19 subsection, the Secretary shall publish standard 

20 measures of meaningful use of health informa21 tion technology to be used by providers to dem22 onstrate meaningful use of certified health in23 formation technology. Such measures may in24 clude— 


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1 ‘‘(i) self-certification of operational 

2 use of such technology; 

3 ‘‘(ii) the submission of (or ability to 

4 submit), in a form and manner specified 

5 by the Secretary, such information on clin6 ical measures and data (that do not in7 clude individually identifiable health infor8 mation) from such technology as indicates 

9 a meaningful utilization of such tech10 nology; and 

11 ‘‘(iii) such other means as the Sec12 retary may specify. 

13 ‘‘(B) ALTERNATIVE MEASURES.—The Sec14 retary may establish and apply different meas15 ures based on the stage of implementation or 

16 adoption of the certified health information 

17 technology involved. 

18 ‘‘(bb) PAYMENTS FOR ELECTRONIC INFORMATION

19 AND ELIGIBILITY SYSTEMS AND PATIENT REGISTRIES.— 

20 ‘‘(1) IN GENERAL.—In addition to the pay21 ments provided under subsection (a), the Secretary 

22 shall provide for payments to each State that estab23 lishes a program to— 

24 ‘‘(A) design, develop, install, maintain, and 

25 operate— 


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1 ‘‘(i) electronic information and eligi2 bility systems; and 

3 ‘‘(ii) patient registries for the purpose 

4 of disease screening; 

5 ‘‘(B) coordinate benefits and services 

6 under this title and under title XVIII for indi7 viduals under the State plan who are full-ben8 efit dual eligible individuals. 

9 ‘‘(C) train providers in the use of such sys10 tems and registries. 

11 ‘‘(2) APPLICATION.—To qualify for payments 

12 under paragraph (1), a State shall submit an appli13 cation in such time and manner as required by the 

14 Secretary and containing such information as the 

15 Secretary specifies and include, at a minimum, a de16 scription of the electronic information and eligibility 

17 systems and patient registries covered by the pro18 gram described in paragraph (1). 

19 ‘‘(3) AMOUNT OF PAYMENTS TO STATES.— 

20 ‘‘(A) IN GENERAL.—The payments made a 

21 State under this subsection shall be an amount 

22 equal to— 

23 ‘‘(i) 90 percent of so much of the 

24 sums expended by such State during any 


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1 quarter commencing on or after January 

2 1, 2010, as are attributable to— 

3 ‘‘(I) the design, development, or 

4 installation of electronic information 

5 and eligibility systems and patient 

6 registries under paragraph (1); and 

7 ‘‘(II) training staff employed by 

8 providers on the use of such system or 

9 registry during the three-year period 

10 beginning on the date such system or 

11 registry is installed; and 

12 ‘‘(ii) 75 percent of so much of the 

13 sums expended by such State during any 

14 quarter commencing on or after January 

15 1, 2010, as are attributable to— 

16 ‘‘(I) the maintenance of such sys17 tems and registries; and 

18 ‘‘(II) training for staff employed 

19 by providers on the use of a system or 

20 registry that occurs after the last day 

21 of the end of the period described in 

22 clause (i)(II). 

23 ‘‘(B) MANNER OF PAYMENT.—Payment to 

24 a State under this subsection shall be made in 


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1 the same manner as payments under subsection 

2 (a). 

3 ‘‘(4) ELECTRONIC INFORMATION AND ELIGI4 BILITY SYSTEM DEFINED.—For purposes of this 

5 subsection, the term ‘electronic information and eli6 gibility system’ means a system for determining eli7 gibility and exchanging information that meets such 

8 requirements as the Secretary shall specify. Such re9 quirements for a system shall include a requirement 

10 that the system— 

11 ‘‘(A) be interconnected and interoperable 

12 with other electronic systems and registries, in13 cluding— 

14 ‘‘(i) systems administered by the Cen15 ters for Disease Control for disease report16 ing purposes; 

17 ‘‘(ii) systems that exist for the pur18 pose of determining eligibility for the Medi19 care program under title XVIII; and 

20 ‘‘(iii) systems that exist for the pur21 pose of determining eligibility for the Tem22 porary Assistance for Needy Families pro23 gram under title IV, free and reduced price 

24 lunches under the Richard B. Russell Na25 tional School Lunch Act (42 U.S.C. 1751 


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1 et seq.), or other federally funded pro2 grams targeted to low-income populations; 

3 and 

4 ‘‘(B) can be used to automatically send, re5 ceive, and integrate data (including laboratory 

6 results and medical histories) from systems and 

7 registries administered by other providers or or8 ganizations or through a health information ex9 change.’’. 

10 SEC. 3. MEDICAID TRANSFORMATION PAYMENTS REPORT. 

11 (a) IN GENERAL.—Not later than June 30, 2009, the 

12 Secretary of Health and Human Services shall submit to 

13 Congress a report on Medicaid transformation payments 

14 under section 1903(z) of the Social Security Act (42 

15 U.S.C. 1396b(z)). 

16 (b) CONTENTS.—The report under subsection (a) 

17 shall include— 

18 (1) a description— 

19 (A) of the financial costs and benefits of 

20 the Medicaid transformation payments; 

21 (B) of the entities to which such costs and 

22 benefits accrue; and 

23 (C) of any reduction in duplicative or un24 necessary care resulting from methods adopted 

25 by States and funded by such payments; and 


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1 (2) an analysis of the information contained in 

2 the reports submitted to the Secretary by States 

3 under section 1903(z)(3)(C) of the Social Security 

4 Act during the two-year period ending on December 

5 31, 2008, including— 

6 (A) the impact of the methods funded by 

7 the payments on— 

8 (i) health care quality and safety; and 

9 (ii) the privacy and security of identi10 fiable health information; 

11 (B) the effect of such methods on fur12 thering interconnectedness between— 

13 (i) providers and State Medicaid pro14 grams; and 

15 (ii) State Medicaid programs and 

16 other programs for low-income populations 

17 administered by State and Federal entities; 

18 (C) the extent to which such methods re19 duce the administrative burden on such pro20 grams; and 

21 (D) the contribution of the payments to 

22 the goals of public health and public health re23 porting. 

Æ 


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