I 

111TH CONGRESS 

1ST SESSION H. R. 3124 

To provide for the use of improved health information technology with respect 

to certain safety net health care providers. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 8, 2009 

Ms. FUDGE (for herself, Mr. MASSA, Ms. LEE of California, Mr. LOEBSACK, 

Mr. HARE, Ms. EDDIE BERNICE JOHNSON of Texas, Mr. CARSON of Indiana, Mr. ELLISON, Mr. CLEAVER, Mr. PAYNE, Mr. JOHNSON of Georgia, Ms. WATSON, Ms. KILPATRICK of Michigan, Ms. CLARKE, Mr. 

MEEKS of New York, Mr. WATT, Ms. CORRINE BROWN of Florida, Mr. 

TOWNS, and Mr. GRAYSON) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to 

the Committees on Veterans’ Affairs and Natural Resources, 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 provide for the use of improved health information technology with respect to certain safety net health care 

providers. 

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 ‘‘Health Information 

5 Technology (IT) Public Utility Act of 2009’’. 


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1 SEC. 2. DEFINITIONS. 

2 In this Act: 

3 (1) BOARD.—The term ‘‘Board’’ means the 

4 Federal Consolidated Health Information Tech5 nology Board established under section 3. 

6 (2) RPMS.—The term ‘‘RPMS’’ means the Re7 source and Patient Management System of the In8 dian Health Service. 

9 (3) SECRETARY.—The term ‘‘Secretary’’ means 

10 the Secretary of Veterans Affairs. 

11 (4) VISTA.—The term ‘‘VistA’’ means the 

12 VistA software program utilized by the Department 

13 of Veterans Affairs. 

14 SEC. 3. FEDERAL CONSOLIDATED HEALTH INFORMATION 

15 TECHNOLOGY BOARD. 

16 (a) ESTABLISHMENT.—To facilitate the implementa17 tion of electronic health record systems among safety-net 

18 health care providers (particularly small, rural providers) 

19 there shall be established within the Office of the National 

20 Coordinator for Health Information Technology of the De21 partment of Health and Human Services, a Federal Con22 solidated Health Information Technology Board. 

23 (b) BOARD OF DIRECTORS.—The Board shall be ad24 ministered by a board of directors that shall be composed 

25 of the following individuals or their designees: 

26 (1) The Secretary. 


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1 (2) The Under Secretary for Health of the De2 partment of Veterans Affairs. 

3 (3) The Director of the Indian Health Service. 

4 (4) The Secretary of Defense. 

5 (5) The Secretary of Health and Human Serv6 ices. 

7 (6) The Director of the Agency for Healthcare 

8 Research and Quality. 

9 (7) The Administrator of the Health Resources 

10 and Services Administration. 

11 (8) The Chairman of the Federal Communica12 tions Commission. 

13 (c) DUTIES.—The Board shall— 

14 (1) provide ongoing communication with exist15 ing VistA and RPMS user groups to ensure that 

16 there is constant interoperability between such 

17 groups and to provide for the sharing of innovative 

18 ideas and technology; 

19 (2) update VistA and RPMS open source soft20 ware (including health care provider-based electronic 

21 health records, personal health records, and other 

22 software modules) on a timely basis; 

23 (3) implement and administer the 21st Century 

24 HIT Grant Program under section 4, including pro25 viding for notice in the Federal Register as well as— 


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1 (A) determining specific health information 

2 technology grant needs based on health care 

3 provider settings; 

4 (B) developing benchmarks for levels of 

5 implementation in each year that 21st Century 

6 grant funding is provided; and 

7 (C) providing ongoing VistA and RPMS 

8 technical assistance to grantees under such pro9 gram (either through the provision of direct 

10 technical support or through the awarding of 

11 competitive contracts to other qualified enti12 ties); 

13 (D) develop mechanisms to integrate VistA 

14 and RPMS with records and billing systems uti15 lized under the Medicaid and State children’s 

16 health insurance programs under titles XIX 

17 and XXI of the Social Security Act (42 U.S.C. 

18 1396 and 1397aa et seq.); 

19 (4) establish a child-specific electronic health 

20 record, consistent with the parameters to be set for 

21 child electronic health records as provided for in the 

22 American Recovery and Reinvestment Act of 2009, 

23 to be used in the Medicaid and State children’s 

24 health insurance programs under titles XIX and 

25 XXI of the Social Security Act, and under other 


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1 Federal children’s health programs determined ap2 propriate by the board of directors; 

3 (5) develop and integrate quality and perform4 ance measurement into the VistA and RPMS mod5 ules; 

6 (6) integrate the 21st Century HIT Grant Pro7 gram under section 4 with the Federal Communica8 tions Commission’s Rural Health Care Pilot Pro9 gram, with Department of Veterans Affairs hospital 

10 systems, and with other Federal health information 

11 technology health initiatives; and 

12 (7) carry out other activities determined appro13 priate by the board of directors. 

14 (d) ANNUAL AUDITS.—The Comptroller General of 

15 the United States shall annually conduct an audit of the 

16 activities of the Board during the year and submit the re17 sults of such audits to the appropriate committees of Con18 gress. 

19 (e) AUTHORIZATION OF APPROPRIATIONS.—There is 

20 authorized to be appropriated such sums as may be nec21 essary to carry out this section. 

22 SEC. 4. 21ST CENTURY HEALTH INFORMATION TECH23 NOLOGY (HIT) GRANTS. 

24 (a) ESTABLISHMENT.—The Board shall establish a 

25 grant program, to be known as the 21st Century Health 


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1 Information Technology (HIT) Grant program, to award 

2 competitive grants to eligible safety-net health care pro3 viders to enable such providers to fully implement VistA 

4 or RPMS with respect to the patients served by such pro5 viders. 

6 (b) ELIGIBILITY.— 

7 (1) IN GENERAL.—To be eligible to receive a 

8 grant under subsection (a), an entity shall— 

9 (A) be— 

10 (i) a public or nonprofit health care 

11 provider (as defined in section 

12 254(h)(7)(B) of the Communications Act 

13 of 1934 (47 U.S.C. 254(h)(7)(B)), includ14 ing— 

15 (I) post-secondary educational in16 stitutions offering health care instruc17 tion, teaching hospitals, and medical 

18 schools; 

19 (II) a community health center 

20 receiving a grant under section 330 of 

21 the Public Health Service Act (42 

22 U.S.C. 254) or a health center that 

23 provides health care to migrants; 

24 (III) a local health department or 

25 agency, including a dedicated emerVerDate Nov 24 2008 20:59 Jul 09, 2009 Jkt 079200 PO 00000 Frm 00006 Fmt 6652 Sfmt 6201 E:\BILLS\H3124.IH H3124

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1 gency department of rural for-profit 

2 hospitals; 

3 (IV) a community mental health 

4 center; 

5 (V) a nonprofit hospital; 

6 (VI) a rural health clinic, includ7 ing a mobile clinic; 

8 (VII) a consortia of health care 

9 providers, that consists of 1 or more 

10 of the entities described in clauses (i) 

11 through (vi); and 

12 (VIII) a part-time eligible entity 

13 that is located in an otherwise ineli14 gible facility (as described in section 

15 5(b); or 

16 (ii) a free clinic (as defined in para17 graph (4); and 

18 (B) submit to the Board as application at 

19 such time, in such manner, and containing such 

20 information as the Board may require. 

21 (2) NON-ELIGIBLE ENTITIES.— 

22 (A) IN GENERAL.—An entity shall not be 

23 eligible to receive a grant under this section if 

24 such entity is a for-profit health care entity (ex25 cept as provided for in paragraph (1)(A)), or 


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1 any other type of entity that is not described in 

2 such paragraph, including— 

3 (i) an entity described in paragraph 

4 (1)(A) that is implementing an existing 

5 electronic health records system; 

6 (ii) an entity that is receiving grant 

7 funding under the Federal Communication 

8 Commission Rural Health Pilot Program; 

9 (iii) an entity receiving funding for 

10 health information technology through a 

11 Medicaid transformation grant under title 

12 XIX of the Social Security Act (42 U.S.C. 

13 1936 et seq.); 

14 (iv) a private physician office or clinic; 

15 (v) a nursing home or other long-term 

16 care facility (such as an assisted living fa17 cility); 

18 (vi) an emergency medical service fa19 cility; 

20 (vii) a residential substance abuse 

21 treatment facility; 

22 (viii) a hospice; 

23 (ix) a for-profit hospital; 

24 (x) a home health agency; 

25 (xi) a blood bank; 


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1 (xii) a social service agency; and 

2 (xiii) a community center, vocational 

3 rehabilitation center, or youth center. 

4 (B) OTHER ENTITIES.—An entity shall not 

5 be eligible to receive a grant under this section 

6 if such entity is receiving Medicare or Medicaid 

7 incentive funding under any of the amendments 

8 made by title IV of division B of the American 

9 Recovery and Reinvestment Act of 2009. 

10 (3) PREFERENCE.—In awarding grant under 

11 this section the Board shall give preference to appli12 cants that— 

13 (A) are located in geographical areas that 

14 have a greater likelihood of serving the same 

15 patients and utilizing interoperability to pro16 mote coordinated care management; or 

17 (B) demonstrate the greatest need for such 

18 award (as determined by the Secretary). 

19 (4) DEFINITION.—In this subsection, the term 

20 ‘‘free clinic’’ means a safety-net health care organi21 zation that— 

22 (A) utilizes volunteers to provide a range 

23 of medical, dental, pharmacy, or behavioral 

24 health services to economically disadvantaged 


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1 individuals the majority of whom are uninsured 

2 or underinsured; and 

3 (B) is a community-based tax-exempt orga4 nization under section 501(c)(3) of the Internal 

5 Revenue Code of 1986, or that operates as a 

6 program component or affiliate of such a 

7 501(c)(3) organization. 

8 An entity that is otherwise a free clinic under this 

9 paragraph, but that charge a nominal fee to pa10 tients, shall still be considered to be a free clinic if 

11 the entity delivers essential services regardless of the 

12 patient’s ability to pay. 

13 (c) USE OF FUNDS.—An entity shall use amounts re14 ceived under a grant under this section to fully implement 

15 the VistA or RPMS with respect to the patients served 

16 by such entity. Such implementation shall include at least 

17 the meaningful use (as defined by the Secretary of Health 

18 and Human Services) of such systems, including any on19 going updates and changes to such definition. 

20 (d) TERM AND RENEWAL.—A grant under this sec21 tion shall be for a period of not to exceed 5 years and 

22 may be renewed, as determined appropriate by the Board, 

23 based on the achievement of benchmarks required by the 

24 Board. 

25 (e) ANNUAL REPORTING.— 


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1 (1) BY GRANTEES.—Not later than 1 year after 

2 the date on which an entity receives a grant under 

3 this section, and annually during each year in which 

4 such entity has received funds under such grant, 

5 such entity shall submit to the Board a report con6 cerning the activities carried out under the grant. 

7 (2) BY BOARD.—Not later than 2 years after 

8 the date of enactment of this Act, and annually 

9 thereafter, the Board shall submit to the appropriate 

10 committees of Congress a report concerning the ac11 tivities carried out under this section, including— 

12 (A) a description of the grants that have 

13 been awarded under this section and the pur14 poses of such grants; 

15 (B) specific implementation information 

16 with respect to activities carried out by grant17 ees; 

18 (C) the costs and savings achieved under 

19 the program under this section; 

20 (D) a description of any innovations devel21 oped by health care providers as a result of the 

22 implementation of activities under this grant; 

23 (E) a description of the results of grant 

24 activities on patient care quality measurement 


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1 (including reductions in medication errors and 

2 the provision of care management); 

3 (F) a description of the extent of electronic 

4 health record use across health care provider 

5 settings; 

6 (G) a description of the extent to which in7 tegration of VistA and RPMS with Medicaid 

8 and State children’s health insurance program 

9 billing has been achieved; and 

10 (H) any other information determined nec11 essary by the Board. 

12 (f) ANNUAL AUDITS.—The Comptroller General of 

13 the United States shall annually conduct an audit of the 

14 grant program carried out under this section and submit 

15 the results of such audits to the Board and the appro16 priate committees of Congress. 

17 (g) AUTHORIZATION OF APPROPRIATIONS.—There is 

18 authorized to be appropriated to carry out this section— 

19 (1) $2,000,000,000 for each of fiscal years 

20 2010 and 2011; and 

21 (2) $1,000,000,000 for each of fiscal years 

22 2012 through 2014. 


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1 SEC. 5. 21ST CENTURY HEALTH INFORMATION TECH2 NOLOGY DEMONSTRATION PROGRAM FOR IN3 ELIGIBLE ENTITIES. 

4 (a) IN GENERAL.—The Board may use not to exceed 

5 10 percent of the amount appropriate for each fiscal year 

6 under section 4(g) to award competitive grants to eligible 

7 long-term care providers for the conduct of demonstration 

8 projects to implement VistA or RPMS with respect to the 

9 individuals served by such providers. 

10 (b) ELIGIBILITY.— 

11 (1) IN GENERAL.—To be eligible to receive a 

12 grant under subsection (a), an entity shall— 

13 (A) be a— 

14 (i) nursing home or other long-term 

15 care facility (such as an assisted living fa16 cility); 

17 (ii) a hospice; or 

18 (iii) a home health agency; and 

19 (B) submit to the Board as application at 

20 such time, in such manner, and containing such 

21 information as the Board may require, includ22 ing a description of the manner in which the 

23 applicant will use grant funds to implement 

24 VistA or RPMS with respect to the individuals 

25 served by such applicant to achieve one or more 

26 of the following: 


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1 (i) Improve care coordination and 

2 chronic disease management. 

3 (ii) Reduce hospitalizations. 

4 (iii) Reduce patient churning between 

5 the hospital, nursing home, hospice, and 

6 home health entity. 

7 (iv) Increase the ability of long-term 

8 care patients to remain in their homes and 

9 communities. 

10 (v) Improve patient completion, and 

11 provider execution, of advance directives. 

12 (2) NONELIGIBILITY.—An entity shall not be 

13 eligible to receive a grant under this section if such 

14 entity is receiving Medicare or Medicaid incentive 

15 funding under any of the amendments made by title 

16 IV of division B of the American Recovery and Rein17 vestment Act of 2009. 

18 (c) USE OF FUNDS.—An entity shall use amounts re19 ceived under a grant under this section to implement the 

20 VistA or RPMS with respect to the individuals served by 

21 such entity. Such implementation shall include at least the 

22 meaningful use (as defined by the Secretary of Health and 

23 Human Services) of such systems, including any ongoing 

24 updates and changes to such definition. 


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1 (d) DURATION.—A grant under this section shall be 

2 for a period of not to exceed 3 years, as determined appro3 priate by the Board. 

4 (e) REPORTING.—The Board, as part of the report 

5 submitted under section 4(e)(2), shall provide comprehen6 sive information on the activities conducted under grants 

7 awarded under this section. 

Æ 


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