and individual customer information is not in-
cluded in the information made available 
through the clearinghouse. 
‘‘(F) OPEN INTERNET-BASED PROTOCOLS 
AND STANDARDS.—The Secretary shall require 
as a condition of receiving funding under this 
subsection that demonstration projects utilize 
open Internet-based protocols and standards if 
available.’’. 
(4) By amending paragraph (2) of section 
1304(c) to read as follows: 
‘‘(2) to carry out subsection (b), such sums as 
may be necessary.’’. 
(5) By amending subsection (a) of section 1306 
by striking ‘‘reimbursement of one-fifth (20 per-
cent)’’ and inserting ‘‘grants of up to one-half (50 
percent)’’. 
(6) By striking the last sentence of subsection 
(b)(9) of section 1306. 
(7) By striking ‘‘are eligible for’’ in subsection 
(c)(1) of section 1306 and inserting ‘‘utilize’’. 
(8) By amending subsection (e) of section 1306 
to read as follows: 
‘‘(e) PROCEDURES
AND
RULES.—The Secretary 
shall— 
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‘‘(1) establish within 60 days after the enact-
ment of the American Recovery and Reinvestment 
Act of 2009 procedures by which applicants can ob-
tain grants of not more than one-half of their docu-
mented costs; 
‘‘(2) require as a condition of receiving a grant 
under this section that grant recipients utilize open 
Internet-based protocols and standards if available; 
‘‘(3) establish procedures to ensure that there is 
no duplication or multiple payment or recovery for 
the same investment or costs, that the grant goes to 
the party making the actual expenditures for quali-
fying smart grid investments, and that the grants 
made have significant effect in encouraging and fa-
cilitating the development of a smart grid; 
‘‘(4) maintain public records of grants made, 
recipients, and qualifying smart grid investments 
which have received grants; 
‘‘(5) establish procedures to provide advance 
payment of moneys up to the full amount of the 
grant award; and 
‘‘(6) have and exercise the discretion to deny 
grants for investments that do not qualify in the 
reasonable judgment of the Secretary.’’. 
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SEC. 2003. RENEWABLE ENERGY AND ELECTRIC POWER 
TRANSMISSION LOAN GUARANTEE PROGRAM. 
(a) AMENDMENT.—Title XVII of the Energy Policy 
Act of 2005 (42 U.S.C. 16511 et seq.) is amended by add-
ing the following at the end: 
‘‘SEC. 1705. TEMPORARY PROGRAM FOR RAPID DEPLOY-
MENT OF RENEWABLE ENERGY AND ELEC-
TRIC POWER TRANSMISSION PROJECTS. 
‘‘(a) IN GENERAL.—Notwithstanding section 1703, 
the Secretary may make guarantees under this section 
only for commercial technology projects under subsection 
(b) that will commence construction not later than Sep-
tember 30, 2011. 
‘‘(b) CATEGORIES.—Projects from only the following 
categories shall be eligible for support under this section: 
‘‘(1) Renewable energy systems that generate 
electricity. 
‘‘(2) Electric power transmission systems, in-
cluding upgrading and reconductoring projects. 
‘‘(c) FACTORS RELATING
TO ELECTRIC POWER 
TRANSMISSION SYSTEMS.—In determining to make guar-
antees to projects described in subsection (b)(2), the Sec-
retary shall consider the following factors: 
‘‘(1) The viability of the project without guar-
antees. 
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‘‘(2) The availability of other Federal and State 
incentives. 
‘‘(3) The importance of the project in meeting 
reliability needs. 
‘‘(4) The effect of the project in meeting a 
State or region’s environment (including climate 
change) and energy goals. 
‘‘(d) WAGE RATE REQUIREMENTS.—The Secretary 
shall require that each recipient of support under this sec-
tion provide reasonable assurance that all laborers and 
mechanics employed in the performance of the project for 
which the assistance is provided, including those employed 
by contractors or subcontractors, will be paid wages at 
rates not less than those prevailing on similar work in the 
locality as determined by the Secretary of Labor in accord-
ance with subchapter IV of chapter 31 of part A of subtitle 
II of title 40, United States Code (commonly referred to 
as the ‘Davis-Bacon Act’). 
‘‘(e) SUNSET.—The authority to enter into guaran-
tees under this section shall expire on September 30, 
2011.’’. 
(b) TABLE OF CONTENTS AMENDMENT.—The table 
of contents for the Energy Policy Act of 2005 is amended 
by inserting after the item relating to section 1704 the 
following new item: 
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‘‘Sec. 1705. Temporary program for rapid deployment of renewable energy and 
electric power transmission projects.’’. 
SEC. 
2004. 
WEATHERIZATION 
ASSISTANCE 
PROGRAM 
AMENDMENTS. 
(a) INCOME LEVEL.—Section 412(7) of the Energy 
Conservation and Production Act (42 U.S.C. 6862(7)) is 
amended by striking ‘‘150 percent’’ both places it appears 
and inserting ‘‘200 percent’’. 
(b) ASSISTANCE LEVEL PER DWELLING UNIT.—Sec-
tion 415(c)(1) of the Energy Conservation and Production 
Act (42 U.S.C. 6865(c)(1)) is amended by striking 
‘‘$2,500’’ and inserting ‘‘$5,000’’. 
(c) EFFECTIVE USE OF FUNDS.—In providing funds 
made available by this Act for the Weatherization Assist-
ance Program, the Secretary may encourage States to give 
priority to using such funds for the most cost-effective ef-
ficiency activities, which may include insulation of attics, 
if, in the Secretary’s view, such use of funds would in-
crease the effectiveness of the program. 
SEC. 
2005. 
RENEWABLE 
ELECTRICITY 
TRANSMISSION 
STUDY. 
In completing the 2009 National Electric Trans-
mission Congestion Study, the Secretary of Energy shall 
include— 
(1) an analysis of the significant potential 
sources of renewable energy that are constrained in 
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accessing appropriate market areas by lack of ade-
quate transmission capacity; 
(2) an analysis of the reasons for failure to de-
velop the adequate transmission capacity; 
(3) recommendations for achieving adequate 
transmission capacity; and 
(4) an explanation of assumptions and projec-
tions made in the Study, including— 
(A) assumptions and projections relating 
to energy efficiency improvements in each load 
center; 
(B) assumptions and projections regarding 
the location and type of projected new genera-
tion capacity; and 
(C) assumptions and projections regarding 
projected deployment of distributed generation 
infrastructure. 
Subtitle B—Additional Energy 
Provisions 
SEC. 2101. ADDITIONAL STATE ENERGY GRANTS. 
(a) IN GENERAL.—Amounts appropriated for the 
State Energy Program under American Recovery and Re-
investment Act of 2009 shall be available to the Secretary 
of Energy for making additional grants under part D of 
title III of the Energy Policy and Conservation Act (42 
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U.S.C. 6321 et seq.). The Secretary shall make grants 
under this section in excess of the base allocation estab-
lished for a State under regulations issued pursuant to 
the authorization provided in section 365(f) of such Act 
only if the governor of the recipient State notifies the Sec-
retary of Energy that the governor will seek, to the extent 
of his or her authority, to ensure that each of the following 
will occur: 
(1) The applicable State regulatory authority 
will implement the following regulatory policies for 
each electric and gas utility with respect to which 
the State regulatory authority has ratemaking au-
thority: 
(A) Policies that ensure that a utility’s re-
covery of prudent fixed costs of service is timely 
and independent of its retail sales, without in 
the process shifting prudent costs from variable 
to fixed charges. This cost shifting constraint 
shall not apply to rate designs adopted prior to 
the date of enactment of this Act. 
(B) Cost recovery for prudent investments 
by utilities in energy efficiency. 
(C) An earnings opportunity for utilities 
associated with cost-effective energy efficiency 
savings. 
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(2) The State, or the applicable units of local 
government that have authority to adopt building 
codes, will implement the following: 
(A) A building energy code (or codes) for 
residential buildings that meets or exceeds the 
most recently published International Energy 
Conservation Code, or achieves equivalent or 
greater energy savings. 
(B) A building energy code (or codes) for 
commercial buildings throughout the State that 
meets or exceeds the ANSI/ASHRAE/IESNA 
Standard 90.1–2007, or achieves equivalent or 
greater energy savings. 
(C) A plan for the jurisdiction achieving 
compliance with the building energy code or 
codes described in subparagraphs (A) and (B) 
within 8 years of the date of enactment of this 
Act in at least 90 percent of new and renovated 
residential and commercial building space. Such 
plan shall include active training and enforce-
ment programs and measurement of the rate of 
compliance each year. 
(b) STATE MATCH.—The State cost share require-
ment under the item relating to ‘‘DEPARTMENT OF 
ENERGY; energy conservation’’ in title II of the Depart-
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ment of the Interior and Related Agencies Appropriations 
Act, 1985 (42 U.S.C. 6323a; 98 Stat. 1861) shall not 
apply to assistance provided under this section. 
(c) EQUIPMENT AND MATERIALS FOR ENERGY EFFI-
CIENCY MEASURES.—No limitation on the percentage of 
funding that may be used for the purchase and installation 
of equipment and materials for energy efficiency measures 
under grants provided under part D of title III of the En-
ergy Policy and Conservation Act (42 U.S.C. 6321 et seq.) 
shall apply to assistance provided under this section. 
SEC. 2102. INAPPLICABILITY OF LIMITATION. 
The limitations in section 399A(f)(2), (3), and (4) 
of the Energy Policy and Conservation Act (42 U.S.C. 
6371h–1(f)(2), (3), and (4)) shall not apply to grants 
funded with appropriations provided by this Act, except 
that such grant funds shall be available for not more than 
an amount equal to 80 percent of the costs of the project 
for which the grant is provided. 
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TITLE III—HEALTH INSURANCE 
ASSISTANCE FOR THE UNEM-
PLOYED 
SEC. 3001. SHORT TITLE AND TABLE OF CONTENTS OF 
TITLE. 
(a) SHORT TITLE OF TITLE.—This title may be cited 
as the ‘‘Health Insurance Assistance for the Unemployed 
Act of 2009’’. 
(b) TABLE OF CONTENTS OF TITLE.—The table of 
contents of this title is as follows: 
Sec. 3001. Short title and table of contents of title. 
Sec. 3002. Premium assistance for COBRA benefits and extension of COBRA 
benefits for older or long-term employees. 
Sec. 3003. Temporary optional Medicaid coverage for the unemployed. 
SEC. 3002. PREMIUM ASSISTANCE FOR COBRA BENEFITS 
AND EXTENSION OF COBRA BENEFITS FOR 
OLDER OR LONG-TERM EMPLOYEES. 
(a) PREMIUM ASSISTANCE FOR COBRA CONTINU-
ATION COVERAGE FOR INDIVIDUALS AND THEIR FAMI-
LIES.— 
(1) PROVISION OF PREMIUM ASSISTANCE.— 
(A) 
REDUCTION
OF
PREMIUMS
PAY-
ABLE.—In the case of any premium for a pe-
riod of coverage beginning on or after the date 
of the enactment of this Act for COBRA con-
tinuation coverage with respect to any assist-
ance eligible individual, such individual shall be 
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treated for purposes of any COBRA continu-
ation provision as having paid the amount of 
such premium if such individual pays 35 per-
cent of the amount of such premium (as deter-
mined without regard to this subsection). 
(B) PREMIUM REIMBURSEMENT.—For pro-
visions providing the balance of such premium, 
see section 6431 of the Internal Revenue Code 
of 1986, as added by paragraph (12). 
(2) LIMITATION OF PERIOD OF PREMIUM AS-
SISTANCE.— 
(A) IN GENERAL.—Paragraph (1)(A) shall 
not apply with respect to any assistance eligible 
individual for months of coverage beginning on 
or after the earlier of— 
(i) the first date that such individual 
is eligible for coverage under any other 
group health plan (other than coverage 
consisting of only dental, vision, coun-
seling, or referral services (or a combina-
tion thereof), coverage under a health re-
imbursement arrangement or a health 
flexible spending arrangement, or coverage 
of treatment that is furnished in an on-site 
medical facility maintained by the em-
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ployer and that consists primarily of first- 
aid services, prevention and wellness care, 
or similar care (or a combination thereof)) 
or is eligible for benefits under title XVIII 
of the Social Security Act, or 
(ii) the earliest of— 
(I) the date which is 12 months 
after the first day of first month that 
paragraph (1)(A) applies with respect 
to such individual, 
(II) the date following the expira-
tion of the maximum period of con-
tinuation coverage required under the 
applicable COBRA continuation cov-
erage provision, or 
(III) the date following the expi-
ration of the period of continuation 
coverage allowed under paragraph 
(4)(B)(ii). 
(B) TIMING
OF
ELIGIBILITY
FOR
ADDI-
TIONAL COVERAGE.—For purposes of subpara-
graph (A)(i), an individual shall not be treated 
as eligible for coverage under a group health 
plan before the first date on which such indi-
vidual could be covered under such plan. 
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(C) 
NOTIFICATION
REQUIREMENT.—An 
assistance eligible individual shall notify in writ-
ing the group health plan with respect to which 
paragraph (1)(A) applies if such paragraph 
ceases to apply by reason of subparagraph 
(A)(i). Such notice shall be provided to the 
group health plan in such time and manner as 
may be specified by the Secretary of Labor. 
(3) ASSISTANCE
ELIGIBLE
INDIVIDUAL.—For 
purposes of this section, the term ‘‘assistance eligible 
individual’’ means any qualified beneficiary if— 
(A) at any time during the period that be-
gins with September 1, 2008, and ends with 
December 31, 2009, such qualified beneficiary 
is eligible for COBRA continuation coverage, 
(B) such qualified beneficiary elects such 
coverage, and 
(C) the qualifying event with respect to the 
COBRA continuation coverage consists of the 
involuntary termination of the covered employ-
ee’s employment and occurred during such pe-
riod. 
(4) EXTENSION OF ELECTION PERIOD AND EF-
FECT ON COVERAGE.— 
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(A) IN
GENERAL.—Notwithstanding sec-
tion 605(a) of the Employee Retirement Income 
Security Act of 1974, section 4980B(f)(5)(A) of 
the Internal Revenue Code of 1986, section 
2205(a) of the Public Health Service Act, and 
section 8905a(c)(2) of title 5, United States 
Code, in the case of an individual who is a 
qualified beneficiary described in paragraph 
(3)(A) as of the date of the enactment of this 
Act and has not made the election referred to 
in paragraph (3)(B) as of such date, such indi-
vidual may elect the COBRA continuation cov-
erage under the COBRA continuation coverage 
provisions containing such sections during the 
60-day period commencing with the date on 
which the notification required under paragraph 
(7)(C) is provided to such individual. 
(B) COMMENCEMENT
OF
COVERAGE; NO 
REACH-BACK.—Any COBRA continuation cov-
erage elected by a qualified beneficiary during 
an extended election period under subparagraph 
(A)— 
(i) shall commence on the date of the 
enactment of this Act, and 
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(ii) shall not extend beyond the period 
of COBRA continuation coverage that 
would have been required under the appli-
cable COBRA continuation coverage provi-
sion if the coverage had been elected as re-
quired under such provision. 
(C) PREEXISTING CONDITIONS.—With re-
spect to a qualified beneficiary who elects 
COBRA continuation coverage pursuant to sub-
paragraph (A), the period— 
(i) beginning on the date of the quali-
fying event, and 
(ii) ending with the day before the 
date of the enactment of this Act, 
shall be disregarded for purposes of deter-
mining the 63-day periods referred to in section 
701)(2) of the Employee Retirement Income 
Security Act of 1974, section 9801(c)(2) of the 
Internal Revenue Code of 1986, and section 
2701(c)(2) of the Public Health Service Act. 
(5) EXPEDITED REVIEW OF DENIALS OF PRE-
MIUM ASSISTANCE.—In any case in which an indi-
vidual requests treatment as an assistance eligible 
individual and is denied such treatment by the group 
health plan by reason of such individual’s ineligi-
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bility for COBRA continuation coverage, the Sec-
retary of Labor (or the Secretary of Health and 
Human services in connection with COBRA continu-
ation coverage which is provided other than pursu-
ant to part 6 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974), in con-
sultation with the Secretary of the Treasury, shall 
provide for expedited review of such denial. An indi-
vidual shall be entitled to such review upon applica-
tion to such Secretary in such form and manner as 
shall be provided by such Secretary. Such Secretary 
shall make a determination regarding such individ-
ual’s eligibility within 10 business days after receipt 
of such individual’s application for review under this 
paragraph. 
(6) DISREGARD OF SUBSIDIES FOR PURPOSES 
OF
FEDERAL
AND
STATE
PROGRAMS.—Notwith-
standing any other provision of law, any premium 
reduction with respect to an assistance eligible indi-
vidual under this subsection shall not be considered 
income or resources in determining eligibility for, or 
the amount of assistance or benefits provided under, 
any other public benefit provided under Federal law 
or the law of any State or political subdivision there-
of. 
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ordination with administrators of the 
group health plans (or other entities) that 
provide or administer the COBRA continu-
ation coverage involved, provide rules re-
quiring the provision of such notice. 
(iii) FORM.—The requirement of the 
additional notification under this subpara-
graph may be met by amendment of exist-
ing notice forms or by inclusion of a sepa-
rate document with the notice otherwise 
required. 
(B) SPECIFIC REQUIREMENTS.—Each ad-
ditional notification under subparagraph (A) 
shall include— 
(i) the forms necessary for estab-
lishing eligibility for premium reduction 
under this subsection, 
(ii) the name, address, and telephone 
number necessary to contact the plan ad-
ministrator and any other person main-
taining relevant information in connection 
with such premium reduction, 
(iii) a description of the extended elec-
tion period provided for in paragraph 
(4)(A), 
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(iv) a description of the obligation of 
the qualified beneficiary under paragraph 
(2)(C) to notify the plan providing continu-
ation coverage of eligibility for subsequent 
coverage under another group health plan 
or eligibility for benefits under title XVIII 
of the Social Security Act and the penalty 
provided for failure to so notify the plan, 
and 
(v) a description, displayed in a 
prominent manner, of the qualified bene-
ficiary’s right to a reduced premium and 
any conditions on entitlement to the re-
duced premium. 
(C) NOTICE
RELATING
TO
RETROACTIVE 
COVERAGE.—In the case of an individual de-
scribed in paragraph (3)(A) who has elected 
COBRA continuation coverage as of the date of 
enactment of this Act or an individual described 
in paragraph (4)(A), the administrator of the 
group health plan (or other entity) involved 
shall provide (within 60 days after the date of 
enactment of this Act) for the additional notifi-
cation required to be provided under subpara-
graph (A). 
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(D) MODEL NOTICES.—Not later than 30 
days after the date of enactment of this Act, 
the Secretary of the Labor, in consultation with 
the Secretary of the Treasury and the Secretary 
of Health and Human Services, shall prescribe 
models for the additional notification required 
under this paragraph. 
(8) SAFEGUARDS.—The Secretary of the Treas-
ury shall provide such rules, procedures, regulations, 
and other guidance as may be necessary and appro-
priate to prevent fraud and abuse under this sub-
section. 
(9) OUTREACH.—The Secretary of Labor, in 
consultation with the Secretary of the Treasury and 
the Secretary of Health and Human Services, shall 
provide outreach consisting of public education and 
enrollment assistance relating to premium reduction 
provided under this subsection. Such outreach shall 
target employers, group health plan administrators, 
public assistance programs, States, insurers, and 
other entities as determined appropriate by such 
Secretaries. Such outreach shall include an initial 
focus on those individuals electing continuation cov-
erage who are referred to in paragraph (7)(C). In-
formation on such premium reduction, including en-
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rollment, shall also be made available on website of 
the Departments of Labor, Treasury, and Health 
and Human Services. 
(10) DEFINITIONS.—For purposes of this sub-
section— 
(A) ADMINISTRATOR.—The term ‘‘admin-
istrator’’ has the meaning given such term in 
section 3(16) of the Employee Retirement In-
come Security Act of 1974. 
(B) COBRA CONTINUATION COVERAGE.— 
The term ‘‘COBRA continuation coverage’’ 
means continuation coverage provided pursuant 
to part 6 of subtitle B of title I of the Em-
ployee Retirement Income Security Act of 1974 
(other than under section 609), title XXII of 
the Public Health Service Act, section 4980B of 
the Internal Revenue Code of 1986 (other than 
subsection (f)(1) of such section insofar as it 
relates to pediatric vaccines), or section 8905a 
of title 5, United States Code, or under a State 
program that provides continuation coverage 
comparable to such continuation coverage. Such 
term does not include coverage under a health 
flexible spending arrangement. 
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(C) COBRA CONTINUATION PROVISION.— 
The term ‘‘COBRA continuation provision’’ 
means the provisions of law described in sub-
paragraph (B). 
(D) 
COVERED
EMPLOYEE.—The 
term 
‘‘covered employee’’ has the meaning given such 
term in section 607(2) of the Employee Retire-
ment Income Security Act of 1974. 
(E) QUALIFIED BENEFICIARY.—The term 
‘‘qualified beneficiary’’ has the meaning given 
such term in section 607(3) of the Employee 
Retirement Income Security Act of 1974. 
(F) GROUP
HEALTH
PLAN.—The term 
‘‘group health plan’’ has the meaning given 
such term in section 607(1) of the Employee 
Retirement Income Security Act of 1974. 
(G) STATE.—The term ‘‘State’’ includes 
the District of Columbia, the Commonwealth of 
Puerto Rico, the Virgin Islands, Guam, Amer-
ican Samoa, and the Commonwealth of the 
Northern Mariana Islands. 
(11) REPORTS.— 
(A) INTERIM REPORT.—The Secretary of 
the Treasury shall submit an interim report to 
the Committee on Education and Labor, the 
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Committee on Ways and Means, and the Com-
mittee on Energy and Commerce of the House 
of Representatives and the Committee on 
Health, Education, Labor, and Pensions and 
the Committee on Finance of the Senate re-
garding the premium reduction provided under 
this subsection that includes— 
(i) the number of individuals provided 
such assistance as of the date of the re-
port; and 
(ii) the total amount of expenditures 
incurred (with administrative expenditures 
noted separately) in connection with such 
assistance as of the date of the report. 
(B) FINAL
REPORT.—As soon as prac-
ticable after the last period of COBRA continu-
ation coverage for which premium reduction is 
provided under this section, the Secretary of the 
Treasury shall submit a final report to each 
Committee referred to in subparagraph (A) that 
includes— 
(i) the number of individuals provided 
premium reduction under this section; 
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(ii) 
the 
average 
dollar 
amount 
(monthly and annually) of premium reduc-
tions provided to such individuals; and 
(iii) the total amount of expenditures 
incurred (with administrative expenditures 
noted separately) in connection with pre-
mium reduction under this section. 
(12) COBRA PREMIUM ASSISTANCE.— 
(A) IN GENERAL.—Subchapter B of chap-
ter 65 of the Internal Revenue Code of 1986 is 
amended by adding at the end the following 
new section: 
‘‘SEC. 6431. COBRA PREMIUM ASSISTANCE. 
‘‘(a) IN GENERAL.—The entity to whom premiums 
are payable under COBRA continuation coverage shall be 
reimbursed for the amount of premiums not paid by plan 
beneficiaries by reason of section 3002(a) of the Health 
Insurance Assistance for the Unemployed Act of 2009. 
Such amount shall be treated as a credit against the re-
quirement of such entity to make deposits of payroll taxes. 
To the extent that such amount exceeds the amount of 
such taxes, the Secretary shall pay to such entity the 
amount of such excess. No payment may be made under 
this subsection to an entity with respect to any assistance 
eligible individual until after such entity has received the 
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‘‘(1) IN GENERAL.—Each entity entitled to re-
imbursement under subsection (a) for any period 
shall submit such reports as the Secretary may re-
quire, including— 
‘‘(A) an attestation of involuntary termi-
nation of employment for each covered em-
ployee on the basis of whose termination entitle-
ment to reimbursement is claimed under sub-
section (a), and 
‘‘(B) a report of the amount of payroll 
taxes offset under subsection (a) for the report-
ing period and the estimated offsets of such 
taxes for the subsequent reporting period in 
connection with reimbursements under sub-
section (a). 
‘‘(2) TIMING
OF
REPORTS
RELATING
TO 
AMOUNT
OF
PAYROLL
TAXES.—Reports required 
under paragraph (1)(B) shall be submitted at the 
same time as deposits of taxes imposed by chapters 
21, 22, and 24 or at such time as is specified by the 
Secretary. 
‘‘(f) REGULATIONS.—The Secretary may issue such 
regulations or other guidance as may be necessary or ap-
propriate to carry out this section, including the require-
ment to report information or the establishment of other 
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methods for verifying the correct amounts of payments 
and credits under this section.’’. 
(B) SOCIAL SECURITY TRUST FUNDS HELD 
HARMLESS.—In determining any amount trans-
ferred or appropriated to any fund under the 
Social Security Act, section 6431 of the Inter-
nal Revenue Code of 1986 shall not be taken 
into account. 
(C) CLERICAL AMENDMENT.—The table of 
sections for subchapter B of chapter 65 of the 
Internal Revenue Code of 1986 is amended by 
adding at the end the following new item: 
‘‘Sec. 6431. COBRA premium assistance.’’. 
(D) EFFECTIVE DATE.—The amendments 
made by this paragraph shall apply to pre-
miums to which subsection (a)(1)(A) applies. 
(13) PENALTY
FOR
FAILURE
TO
NOTIFY 
HEALTH PLAN OF CESSATION OF ELIGIBILITY FOR 
PREMIUM ASSISTANCE.— 
(A) IN GENERAL.—Part I of subchapter B 
of chapter 68 of the Internal Revenue Code of 
1986 is amended by adding at the end the fol-
lowing new section: 
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‘‘SEC. 6720C. PENALTY FOR FAILURE TO NOTIFY HEALTH 
PLAN OF CESSATION OF ELIGIBILITY FOR 
COBRA PREMIUM ASSISTANCE. 
‘‘(a) IN GENERAL.—Any person required to notify a 
group health plan under section 3002(a)(2)(C) of the 
Health Insurance Assistance for the Unemployed Act of 
2009 who fails to make such a notification at such time 
and in such manner as the Secretary of Labor may require 
shall pay a penalty of 110 percent of the premium reduc-
tion provided under such section after termination of eligi-
bility under such subsection. 
‘‘(b) REASONABLE CAUSE EXCEPTION.—No penalty 
shall be imposed under subsection (a) with respect to any 
failure if it is shown that such failure is due to reasonable 
cause and not to willful neglect.’’. 
(B) CLERICAL AMENDMENT.—The table of 
sections of part I of subchapter B of chapter 68 
of such Code is amended by adding at the end 
the following new item: 
‘‘Sec. 6720C. Penalty for failure to notify health plan of cessation of eligibility 
for COBRA premium assistance.’’. 
(C) EFFECTIVE DATE.—The amendments 
made by this paragraph shall apply to failures 
occurring after the date of the enactment of 
this Act. 
(14) COORDINATION WITH HCTC.— 
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(A) IN GENERAL.—Subsection (g) of sec-
tion 35 of the Internal Revenue Code of 1986 
is amended by redesignating paragraph (9) as 
paragraph (10) and inserting after paragraph 
(8) the following new paragraph: 
‘‘(9) COBRA PREMIUM
ASSISTANCE.—In the 
case of an assistance eligible individual who receives 
premium reduction for COBRA continuation cov-
erage under section 3002(a) of the Health Insurance 
Assistance for the Unemployed Act of 2009 for any 
month during the taxable year, such individual shall 
not be treated as an eligible individual, a certified 
individual, or a qualifying family member for pur-
poses of this section or section 7527 with respect to 
such month.’’. 
(B) EFFECTIVE
DATE.—The amendment 
made by subparagraph (A) shall apply to tax-
able years ending after the date of the enact-
ment of this Act. 
(15) EXCLUSION OF COBRA PREMIUM ASSIST-
ANCE FROM GROSS INCOME.— 
(A) IN GENERAL.—Part III of subchapter 
B of chapter 1 of the Internal Revenue Code of 
1986 is amended by inserting after section 
139B the following new section: 
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‘‘SEC. 139C. COBRA PREMIUM ASSISTANCE. 
‘‘In the case of an assistance eligible individual (as 
defined in section 3002 of the Health Insurance Assist-
ance for the Unemployed Act of 2009), gross income does 
not include any premium reduction provided under sub-
section (a) of such section.’’. 
(B) CLERICAL AMENDMENT.—The table of 
sections for part III of subchapter B of chapter 
1 of such Code is amended by inserting after 
the item relating to section 139B the following 
new item: 
‘‘Sec. 139C. COBRA premium assistance.’’. 
(C) EFFECTIVE DATE.—The amendments 
made by this paragraph shall apply to taxable 
years ending after the date of the enactment of 
this Act. 
(b) EXTENSION OF COBRA BENEFITS FOR OLDER 
OR LONG-TERM EMPLOYEES.— 
(1) ERISA AMENDMENT.—Section 602(2)(A) 
of the Employee Retirement Income Security Act of 
1974 is amended by adding at the end the following 
new clauses: 
‘‘(x) SPECIAL RULE FOR OLDER OR 
LONG-TERM EMPLOYEES GENERALLY.—In 
the case of a qualifying event described in 
section 603(2) with respect to a covered 
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employee who (as of such qualifying event) 
has attained age 55 or has completed 10 
or more years of service with the entity 
that is the employer at the time of the 
qualifying event, clauses (i) and (ii) shall 
not apply. 
‘‘(xi) YEAR
OF
SERVICE.—For pur-
poses of this subparagraph, the term ‘year 
of service’ shall have the meaning provided 
in section 202(a)(3).’’. 
(2) IRC AMENDMENT.—Clause (i) of section 
4980B(f)(2)(B) of the Internal Revenue Code of 
1986 is amended by adding at the end the following 
new subclauses: 
‘‘(X) SPECIAL RULE FOR OLDER 
OR
LONG-TERM
EMPLOYEES
GEN-
ERALLY.—In the case of a qualifying 
event described in paragraph (3)(B) 
with respect to a covered employee 
who (as of such qualifying event) has 
attained age 55 or has completed 10 
or more years of service with the enti-
ty that is the employer at the time of 
the qualifying event, subclauses (I) 
and (II) shall not apply. 
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‘‘(XI) YEAR
OF
SERVICE.—For 
purposes of this clause, the term ‘year 
of service’ shall have the meaning pro-
vided in section 202(a)(3) of the Em-
ployee Retirement Income Security 
Act of 1974.’’. 
(3) PHSA AMENDMENT.—Section 2202(2)(A) 
of the Public Health Service Act is amended by add-
ing at the end the following new clauses: 
‘‘(viii) SPECIAL RULE FOR OLDER OR 
LONG-TERM EMPLOYEES GENERALLY.—In 
the case of a qualifying event described in 
section 2203(2) with respect to a covered 
employee who (as of such qualifying event) 
has attained age 55 or has completed 10 
or more years of service with the entity 
that is the employer at the time of the 
qualifying event, clauses (i) and (ii) shall 
not apply. 
‘‘(ix) YEAR
OF
SERVICE.—For pur-
poses of this subparagraph, the term ‘year 
of service’ shall have the meaning provided 
in section 202(a)(3) of the Employee Re-
tirement Income Security Act of 1974.’’. 
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(4) EFFECTIVE DATE OF AMENDMENTS.—The 
amendments made by this subsection shall apply to 
periods of coverage which would (without regard to 
the amendments made by this section) end on or 
after the date of the enactment of this Act. 
SEC. 3003. TEMPORARY OPTIONAL MEDICAID COVERAGE 
FOR THE UNEMPLOYED. 
(a) IN GENERAL.—Section 1902 of the Social Secu-
rity Act (42 U.S.C. 1396b) is amended— 
(1) in subsection (a)(10)(A)(ii)— 
(A) by striking ‘‘or’’ at the end of sub-
clause (XVIII); 
(B) by adding ‘‘or’’ at the end of subclause 
(XIX); and 
(C) by adding at the end the following new 
subclause: 
‘‘(XX) who are described in sub-
section (dd)(1) (relating to certain un-
employed individuals and their fami-
lies);’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(dd)(1) Individuals described in this paragraph 
are— 
‘‘(A) individuals who— 
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‘‘(i) are within one or more of the cat-
egories described in paragraph (2), as elected 
under the State plan; and 
‘‘(ii) meet the applicable requirements of 
paragraph (3); and 
‘‘(B) individuals who— 
‘‘(i) are the spouse, or dependent child 
under 19 years of age, of an individual de-
scribed in subparagraph (A); and 
‘‘(ii) meet the requirement of paragraph 
(3)(B). 
‘‘(2) The categories of individuals described in this 
paragraph are each of the following: 
‘‘(A)(i) Individuals who are receiving unemploy-
ment compensation benefits; and 
‘‘(ii) individuals who were receiving, but have 
exhausted, unemployment compensation benefits on 
or after July 1, 2008. 
‘‘(B) Individuals who are involuntarily unem-
ployed and were involuntarily separated from em-
ployment on or after September 1, 2008, and before 
January 1, 2011, whose family gross income does 
not exceed a percentage specified by the State (not 
to exceed 200 percent) of the income official poverty 
line (as defined by the Office of Management and 
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Budget, and revised annually in accordance with sec-
tion 673(2) of the Omnibus Budget Reconciliation 
Act of 1981) applicable to a family of the size in-
volved, 
and 
who, 
but 
for 
subsection 
(a)(10)(A)(ii)(XX), are not eligible for medical as-
sistance under this title or health assistance under 
title XXI. 
‘‘(C) Individuals who are involuntarily unem-
ployed and were involuntarily separated from em-
ployment on or after September 1, 2008, and before 
January 1, 2011, who are members of households 
participating in the supplemental nutrition assist-
ance program established under the Food and Nutri-
tion Act of 2008 (7 U.S.C. 2011 et seq), and who, 
but for subsection (a)(10)(A)(ii)(XX), are not eligi-
ble for medical assistance under this title or health 
assistance under title XXI. 
‘‘(3) The requirements of this paragraph with respect 
to an individual are the following: 
‘‘(A) In the case of individuals within a cat-
egory described in subparagraph (A) of paragraph 
(2), the individual was involuntarily separated from 
employment on or after September 1, 2008, and be-
fore January 1, 2011, or meets such comparable re-
quirement as the Secretary specifies through rule, 
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guidance, or otherwise in the case of an individual 
who was an independent contractor. 
‘‘(B) The individual is not otherwise covered 
under creditable coverage, as defined in section 
2701(c) of the Public Health Service Act (42 U.S.C. 
300gg(c)), but applied without regard to paragraph 
(1)(F) of such section and without regard to cov-
erage provided by reason of the application of sub-
section (a)(10)(A)(ii)(XX). 
‘‘(4)(A) No income or resources test shall be applied 
with respect to any category of individuals described in 
subparagraph (A) or (C) of paragraph (2) who are eligible 
for medical assistance only by reason of the application 
of subsection (a)(10)(A)(ii)(XX). 
‘‘(B) Nothing in this subsection shall be construed 
to prevent a State from imposing a resource test for the 
category of individuals described in paragraph (2)(B). 
‘‘(C) In the case of individuals described in paragraph 
(2)(A) or (2)(C), the requirements of subsections (i)(22) 
and (x) in section 1903 shall not apply.’’. 
(b) 100 PERCENT FEDERAL MATCHING RATE.— 
(1) FMAP FOR
TIME-LIMITED
PERIOD.—The 
third sentence of section 1905(b) of such Act (42 
U.S.C. 1396d(b)) is amended by inserting before the 
period at the end the following: ‘‘and for items and 
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services furnished on or after the date of enactment 
of this Act and before January 1, 2011, to individ-
uals who are eligible for medical assistance only by 
reason 
of 
the 
application 
of 
section 
1902(a)(10)(A)(ii)(XX)’’. 
(2) CERTAIN ENROLLMENT-RELATED ADMINIS-
TRATIVE COSTS.—Notwithstanding any other provi-
sion of law, for purposes of applying section 1903(a) 
of the Social Security Act (42 U.S.C. 1396b(a)), 
with respect to expenditures incurred on or after the 
date of the enactment of this Act and before Janu-
ary 1, 2011, for costs of administration (including 
outreach and the modification and operation of eligi-
bility information systems) attributable to eligibility 
determination and enrollment of individuals who are 
eligible for medical assistance only by reason of the 
application of section 1902(a)(10)(A)(ii)(XX) of 
such Act, as added by subsection (a)(1), the Federal 
matching percentage shall be 100 percent instead of 
the matching percentage otherwise applicable. 
(c) 
CONFORMING
AMENDMENTS.—(1) 
Section 
1903(f)(4) of such Act (42 U.S.C. 1396c(f)(4)) is amend-
ed by inserting ‘‘1902(a)(10)(A)(ii)(XX), or’’ after 
‘‘1902(a)(10)(A)(ii)(XIX),’’. 
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(2) Section 1905(a) of such Act (42 U.S.C. 
1396d(a)) is amended, in the matter preceding paragraph 
(1)— 
(A) by striking ‘‘or’’ at the end of clause (xii); 
(B) by adding ‘‘or’’ at the end of clause (xiii); 
and 
(C) by inserting after clause (xiii) the following 
new clause: 
‘‘(xiv) individuals described in section 
1902(dd)(1),’’. 
TITLE IV—HEALTH 
INFORMATION TECHNOLOGY 
SEC. 4001. SHORT TITLE; TABLE OF CONTENTS OF TITLE. 
(a) SHORT TITLE.—This title may be cited as the 
‘‘Health Information Technology for Economic and Clin-
ical Health Act’’ or the ‘‘HITECH Act’’. 
(b) TABLE OF CONTENTS OF TITLE.—The table of 
contents of this title is as follows: 
Sec. 4001. Short title; table of contents of title. 
Subtitle A—Promotion of Health Information Technology 
PART I—IMPROVING HEALTH CARE QUALITY, SAFETY, AND EFFICIENCY 
Sec. 4101. ONCHIT; standards development and adoption. 
‘‘TITLE XXX—HEALTH INFORMATION TECHNOLOGY AND 
QUALITY 
‘‘Sec. 3000. Definitions. 
‘‘Subtitle A—Promotion of Health Information Technology 
‘‘Sec. 3001. Office of the National Coordinator for Health Information 
Technology. 
‘‘Sec. 3002. HIT Policy Committee. 
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‘‘Sec. 3003. HIT Standards Committee. 
‘‘Sec. 3004. Process for adoption of endorsed recommendations; adoption 
of initial set of standards, implementation specifications, 
and certification criteria. 
‘‘Sec. 3005. Application and use of adopted standards and implementation 
specifications by Federal agencies. 
‘‘Sec. 3006. Voluntary application and use of adopted standards and im-
plementation specifications by private entities. 
‘‘Sec. 3007. Federal health information technology. 
‘‘Sec. 3008. Transitions. 
‘‘Sec. 3009. Relation to HIPAA privacy and security law. 
‘‘Sec. 3010. Authorization for appropriations. 
Sec. 4102. Technical amendment. 
PART II—APPLICATION AND USE OF ADOPTED HEALTH INFORMATION 
TECHNOLOGY STANDARDS; REPORTS 
Sec. 4111. Coordination of Federal activities with adopted standards and imple-
mentation specifications. 
Sec. 4112. Application to private entities. 
Sec. 4113. Study and reports. 
Subtitle B—Testing of Health Information Technology 
Sec. 4201. National Institute for Standards and Technology testing. 
Sec. 4202. Research and development programs. 
Subtitle C—Incentives for the Use of Health Information Technology 
PART I—GRANTS AND LOANS FUNDING 
Sec. 4301. Grant, loan, and demonstration programs. 
‘‘Subtitle B—Incentives for the Use of Health Information Technology 
‘‘Sec. 3011. Immediate funding to strengthen the health information tech-
nology infrastructure. 
‘‘Sec. 3012. Health information technology implementation assistance. 
‘‘Sec. 3013. State grants to promote health information technology. 
‘‘Sec. 3014. Competitive grants to States and Indian tribes for the devel-
opment of loan programs to facilitate the widespread 
adoption of certified EHR technology. 
‘‘Sec. 3015. Demonstration program to integrate information technology 
into clinical education. 
‘‘Sec. 3016. Information technology professionals on health care. 
‘‘Sec. 3017. General grant and loan provisions. 
‘‘Sec. 3018. Authorization for appropriations. 
PART II—MEDICARE PROGRAM 
Sec. 4311. Incentives for eligible professionals. 
Sec. 4312. Incentives for hospitals. 
Sec. 4313. Treatment of payments and savings; implementation funding. 
Sec. 4314. Study on application of EHR payment incentives for providers not 
receiving other incentive payments. 
PART III—MEDICAID FUNDING 
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Sec. 4321. Medicaid provider HIT adoption and operation payments; implemen-
tation funding. 
Subtitle D—Privacy 
Sec. 4400. Definitions. 
PART I—IMPROVED PRIVACY PROVISIONS AND SECURITY PROVISIONS 
Sec. 4401. Application of security provisions and penalties to business associ-
ates of covered entities; annual guidance on security provisions. 
Sec. 4402. Notification in the case of breach. 
Sec. 4403. Education on Health Information Privacy. 
Sec. 4404. Application of privacy provisions and penalties to business associates 
of covered entities. 
Sec. 4405. Restrictions on certain disclosures and sales of health information; 
accounting of certain protected health information disclosures; 
access to certain information in electronic format. 
Sec. 4406. Conditions on certain contacts as part of health care operations. 
Sec. 4407. Temporary breach notification requirement for vendors of personal 
health records and other non-HIPAA covered entities. 
Sec. 4408. Business associate contracts required for certain entities. 
Sec. 4409. Clarification of application of wrongful disclosures criminal pen-
alties. 
Sec. 4410. Improved enforcement. 
Sec. 4411. Audits. 
PART II—RELATIONSHIP TO OTHER LAWS; REGULATORY REFERENCES; 
EFFECTIVE DATE; REPORTS 
Sec. 4421. Relationship to other laws. 
Sec. 4422. Regulatory references. 
Sec. 4423. Effective date. 
Sec. 4424. Studies, reports, guidance. 
Subtitle A—Promotion of Health 
Information Technology 
PART I—IMPROVING HEALTH CARE QUALITY, 
SAFETY, AND EFFICIENCY 
SEC. 4101. ONCHIT; STANDARDS DEVELOPMENT AND ADOP-
TION. 
The Public Health Service Act (42 U.S.C. 201 et 
seq.) is amended by adding at the end the following: 
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‘‘TITLE XXX—HEALTH INFORMA-
TION 
TECHNOLOGY 
AND 
QUALITY 
‘‘SEC. 3000. DEFINITIONS. 
‘‘In this title: 
‘‘(1) CERTIFIED EHR TECHNOLOGY.—The term 
‘certified EHR technology’ means a qualified elec-
tronic health record that is certified pursuant to sec-
tion 3001(c)(5) as meeting standards adopted under 
section 3004 that are applicable to the type of 
record involved (as determined by the Secretary, 
such as an ambulatory electronic health record for 
office-based physicians or an inpatient hospital elec-
tronic health record for hospitals). 
‘‘(2) ENTERPRISE
INTEGRATION.—The term 
‘enterprise integration’ means the electronic linkage 
of health care providers, health plans, the govern-
ment, and other interested parties, to enable the 
electronic exchange and use of health information 
among all the components in the health care infra-
structure in accordance with applicable law, and 
such term includes related application protocols and 
other related standards. 
‘‘(3) HEALTH
CARE
PROVIDER.—The term 
‘health care provider’ means a hospital, skilled nurs-
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ing facility, nursing facility, home health entity or 
other long term care facility, health care clinic, Fed-
erally qualified health center, group practice (as de-
fined in section 1877(h)(4) of the Social Security 
Act), a pharmacist, a pharmacy, a laboratory, a phy-
sician (as defined in section 1861(r) of the Social 
Security Act), a practitioner (as described in section 
1842(b)(18)(C) of the Social Security Act), a pro-
vider operated by, or under contract with, the Indian 
Health Service or by an Indian tribe (as defined in 
the Indian Self-Determination and Education Assist-
ance Act), tribal organization, or urban Indian orga-
nization (as defined in section 4 of the Indian 
Health Care Improvement Act), a rural health clinic, 
a covered entity under section 340B, an ambulatory 
surgical center described in section 1833(i) of the 
Social Security Act, and any other category of facil-
ity or clinician determined appropriate by the Sec-
retary. 
‘‘(4) HEALTH INFORMATION.—The term ‘health 
information’ has the meaning given such term in 
section 1171(4) of the Social Security Act. 
‘‘(5) HEALTH
INFORMATION
TECHNOLOGY.— 
The term ‘health information technology’ means 
hardware, software, integrated technologies and re-
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lated licenses, intellectual property, upgrades, and 
packaged solutions sold as services that are specifi-
cally designed for use by health care entities for the 
electronic creation, maintenance, or exchange of 
health information. 
‘‘(6) HEALTH PLAN.—The term ‘health plan’ 
has the meaning given such term in section 1171(5) 
of the Social Security Act. 
‘‘(7) HIT POLICY COMMITTEE.—The term ‘HIT 
Policy Committee’ means such Committee estab-
lished under section 3002(a). 
‘‘(8) HIT STANDARDS COMMITTEE.—The term 
‘HIT Standards Committee’ means such Committee 
established under section 3003(a). 
‘‘(9) INDIVIDUALLY IDENTIFIABLE HEALTH IN-
FORMATION.—The term ‘individually identifiable 
health information’ has the meaning given such term 
in section 1171(6) of the Social Security Act. 
‘‘(10) LABORATORY.—The term ‘laboratory’ 
has the meaning given such term in section 353(a). 
‘‘(11) NATIONAL
COORDINATOR.—The term 
‘National Coordinator’ means the head of the Office 
of the National Coordinator for Health Information 
Technology established under section 3001(a). 
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‘‘(12) PHARMACIST.—The term ‘pharmacist’ 
has the meaning given such term in section 804(2) 
of the Federal Food, Drug, and Cosmetic Act. 
‘‘(13) 
QUALIFIED
ELECTRONIC
HEALTH 
RECORD.—The term ‘qualified electronic health 
record’ means an electronic record of health-related 
information on an individual that— 
‘‘(A) includes patient demographic and 
clinical health information, such as medical his-
tory and problem lists; and 
‘‘(B) has the capacity— 
‘‘(i) to provide clinical decision sup-
port; 
‘‘(ii) to support physician order entry; 
‘‘(iii) to capture and query informa-
tion relevant to health care quality; and 
‘‘(iv) to exchange electronic health in-
formation with, and integrate such infor-
mation from other sources. 
‘‘(14) STATE.—The term ‘State’ means each of 
the several States, the District of Columbia, Puerto 
Rico, the Virgin Islands, Guam, American Samoa, 
and the Northern Mariana Islands. 
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‘‘Subtitle A—Promotion of Health 
Information Technology 
‘‘SEC. 3001. OFFICE OF THE NATIONAL COORDINATOR FOR 
HEALTH INFORMATION TECHNOLOGY. 
‘‘(a) ESTABLISHMENT.—There is established within 
the Department of Health and Human Services an Office 
of the National Coordinator for Health Information Tech-
nology (referred to in this section as the ‘Office’). The Of-
fice shall be headed by a National Coordinator who shall 
be appointed by the Secretary and shall report directly to 
the Secretary. 
‘‘(b) PURPOSE.—The National Coordinator shall per-
form the duties under subsection (c) in a manner con-
sistent with the development of a nationwide health infor-
mation technology infrastructure that allows for the elec-
tronic use and exchange of information and that— 
‘‘(1) ensures that each patient’s health informa-
tion is secure and protected, in accordance with ap-
plicable law; 
‘‘(2) improves health care quality, reduces med-
ical errors, and advances the delivery of patient-cen-
tered medical care; 
‘‘(3) reduces health care costs resulting from 
inefficiency, medical errors, inappropriate care, du-
plicative care, and incomplete information; 
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‘‘(4) provides appropriate information to help 
guide medical decisions at the time and place of 
care; 
‘‘(5) ensures the inclusion of meaningful public 
input in such development of such infrastructure; 
‘‘(6) improves the coordination of care and in-
formation among hospitals, laboratories, physician 
offices, and other entities through an effective infra-
structure for the secure and authorized exchange of 
health care information; 
‘‘(7) improves public health activities and facili-
tates the early identification and rapid response to 
public health threats and emergencies, including bio-
terror events and infectious disease outbreaks; 
‘‘(8) facilitates health and clinical research and 
health care quality; 
‘‘(9) promotes prevention of chronic diseases; 
‘‘(10) promotes a more effective marketplace, 
greater competition, greater systems analysis, in-
creased consumer choice, and improved outcomes in 
health care services; and 
‘‘(11) improves efforts to reduce health dispari-
ties. 
‘‘(c) DUTIES OF THE NATIONAL COORDINATOR.— 
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‘‘(1) STANDARDS.—The National Coordinator 
shall review and determine whether to endorse each 
standard, implementation specification, and certifi-
cation criterion for the electronic exchange and use 
of health information that is recommended by the 
HIT Standards Committee under section 3003 for 
purposes of adoption under section 3004. The Coor-
dinator shall make such determination, and report to 
the Secretary such determination, not later than 45 
days after the date the recommendation is received 
by the Coordinator. 
‘‘(2) HIT POLICY COORDINATION.— 
‘‘(A) IN GENERAL.—The National Coordi-
nator shall coordinate health information tech-
nology policy and programs of the Department 
with those of other relevant executive branch 
agencies with a goal of avoiding duplication of 
efforts and of helping to ensure that each agen-
cy undertakes health information technology ac-
tivities primarily within the areas of its greatest 
expertise and technical capability and in a man-
ner towards a coordinated national goal. 
‘‘(B) HIT POLICY AND STANDARDS COM-
MITTEES.—The National Coordinator shall be a 
leading member in the establishment and oper-
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ations of the HIT Policy Committee and the 
HIT Standards Committee and shall serve as a 
liaison among those two Committees and the 
Federal Government. 
‘‘(3) STRATEGIC PLAN.— 
‘‘(A) IN GENERAL.—The National Coordi-
nator shall, in consultation with other appro-
priate Federal agencies (including the National 
Institute of Standards and Technology), update 
the Federal Health IT Strategic Plan (devel-
oped as of June 3, 2008) to include specific ob-
jectives, milestones, and metrics with respect to 
the following: 
‘‘(i) The electronic exchange and use 
of health information and the enterprise 
integration of such information. 
‘‘(ii) The utilization of an electronic 
health record for each person in the United 
States by 2014. 
‘‘(iii) The incorporation of privacy and 
security protections for the electronic ex-
change of an individual’s individually iden-
tifiable health information. 
‘‘(iv) Ensuring security methods to 
ensure appropriate authorization and elec-
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tronic authentication of health information 
and specifying technologies or methodolo-
gies for rendering health information unus-
able, unreadable, or indecipherable. 
‘‘(v) Specifying a framework for co-
ordination and flow of recommendations 
and policies under this subtitle among the 
Secretary, the National Coordinator, the 
HIT Policy Committee, the HIT Standards 
Committee, and other health information 
exchanges and other relevant entities. 
‘‘(vi) Methods to foster the public un-
derstanding of health information tech-
nology. 
‘‘(vii) Strategies to enhance the use of 
health information technology in improving 
the quality of health care, reducing medical 
errors, reducing health disparities, improv-
ing public health, and improving the con-
tinuity of care among health care settings. 
‘‘(B) 
COLLABORATION.—The 
strategic 
plan shall be updated through collaboration of 
public and private entities. 
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‘‘(C) MEASURABLE
OUTCOME
GOALS.— 
The strategic plan update shall include measur-
able outcome goals. 
‘‘(D) PUBLICATION.—The National Coor-
dinator shall republish the strategic plan, in-
cluding all updates. 
‘‘(4) WEBSITE.—The National Coordinator 
shall maintain and frequently update an Internet 
website on which there is posted information on the 
work, schedules, reports, recommendations, and 
other information to ensure transparency in pro-
motion of a nationwide health information tech-
nology infrastructure. 
‘‘(5) CERTIFICATION.— 
‘‘(A) IN GENERAL.—The National Coordi-
nator, in consultation with the Director of the 
National Institute of Standards and Tech-
nology, shall develop a program (either directly 
or by contract) for the voluntary certification of 
health information technology as being in com-
pliance with applicable certification criteria 
adopted under this subtitle. Such program shall 
include testing of the technology in accordance 
with section 4201(b) of the HITECH Act. 
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‘‘(B) 
CERTIFICATION
CRITERIA
DE-
SCRIBED.—In this title, the term ‘certification 
criteria’ means, with respect to standards and 
implementation specifications for health infor-
mation technology, criteria to establish that the 
technology meets such standards and implemen-
tation specifications. 
‘‘(6) REPORTS AND PUBLICATIONS.— 
‘‘(A) REPORT
ON
ADDITIONAL
FUNDING 
OR AUTHORITY NEEDED.—Not later than 12 
months after the date of the enactment of this 
title, the National Coordinator shall submit to 
the appropriate committees of jurisdiction of 
the House of Representatives and the Senate a 
report on any additional funding or authority 
the Coordinator or the HIT Policy Committee 
or HIT Standards Committee requires to evalu-
ate and develop standards, implementation 
specifications, and certification criteria, or to 
achieve full participation of stakeholders in the 
adoption of a nationwide health information 
technology infrastructure that allows for the 
electronic use and exchange of health informa-
tion. 
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‘‘(B) 
IMPLEMENTATION
REPORT.—The 
National Coordinator shall prepare a report 
that identifies lessons learned from major pub-
lic and private health care systems in their im-
plementation of health information technology, 
including information on whether the tech-
nologies and practices developed by such sys-
tems may be applicable to and usable in whole 
or in part by other health care providers. 
‘‘(C) ASSESSMENT OF IMPACT OF HIT ON 
COMMUNITIES WITH HEALTH DISPARITIES AND 
UNINSURED, UNDERINSURED, AND MEDICALLY 
UNDERSERVED AREAS.—The National Coordi-
nator shall assess and publish the impact of 
health information technology in communities 
with health disparities and in areas with a high 
proportion of individuals who are uninsured, 
underinsured, and medically underserved indi-
viduals (including urban and rural areas) and 
identify practices to increase the adoption of 
such technology by health care providers in 
such communities. 
‘‘(D) EVALUATION
OF
BENEFITS
AND 
COSTS
OF
THE
ELECTRONIC
USE
AND
EX-
CHANGE OF HEALTH INFORMATION.—The Na-
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tional Coordinator shall evaluate and publish 
evidence on the benefits and costs of the elec-
tronic use and exchange of health information 
and assess to whom these benefits and costs ac-
crue. 
‘‘(E) 
RESOURCE
REQUIREMENTS.—The 
National Coordinator shall estimate and publish 
resources required annually to reach the goal of 
utilization of an electronic health record for 
each person in the United States by 2014, in-
cluding the required level of Federal funding, 
expectations for regional, State, and private in-
vestment, and the expected contributions by vol-
unteers to activities for the utilization of such 
records. 
‘‘(7) ASSISTANCE.—The National Coordinator 
may provide financial assistance to consumer advo-
cacy groups and not-for-profit entities that work in 
the public interest for purposes of defraying the cost 
to such groups and entities to participate under, 
whether in whole or in part, the National Tech-
nology Transfer Act of 1995 (15 U.S.C. 272 note). 
‘‘(8) GOVERNANCE FOR NATIONWIDE HEALTH 
INFORMATION
NETWORK.—The National Coordi-
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nator shall establish a governance mechanism for the 
nationwide health information network. 
‘‘(d) DETAIL OF FEDERAL EMPLOYEES.— 
‘‘(1) IN GENERAL.—Upon the request of the 
National Coordinator, the head of any Federal agen-
cy is authorized to detail, with or without reimburse-
ment from the Office, any of the personnel of such 
agency to the Office to assist it in carrying out its 
duties under this section. 
‘‘(2) EFFECT OF DETAIL.—Any detail of per-
sonnel under paragraph (1) shall— 
‘‘(A) not interrupt or otherwise affect the 
civil service status or privileges of the Federal 
employee; and 
‘‘(B) be in addition to any other staff of 
the Department employed by the National Co-
ordinator. 
‘‘(3) ACCEPTANCE
OF
DETAILEES.—Notwith-
standing any other provision of law, the Office may 
accept detailed personnel from other Federal agen-
cies without regard to whether the agency described 
under paragraph (1) is reimbursed. 
‘‘(e) CHIEF PRIVACY OFFICER OF THE OFFICE OF 
THE
NATIONAL
COORDINATOR.—Not later than 12 
months after the date of the enactment of this title, the 
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Secretary shall appoint a Chief Privacy Officer of the Of-
fice of the National Coordinator, whose duty it shall be 
to advise the National Coordinator on privacy, security, 
and data stewardship of electronic health information and 
to coordinate with other Federal agencies (and similar pri-
vacy officers in such agencies), with State and regional 
efforts, and with foreign countries with regard to the pri-
vacy, security, and data stewardship of electronic individ-
ually identifiable health information. 
‘‘SEC. 3002. HIT POLICY COMMITTEE. 
‘‘(a) ESTABLISHMENT.—There is established a HIT 
Policy Committee to make policy recommendations to the 
National Coordinator relating to the implementation of a 
nationwide health information technology infrastructure, 
including implementation of the strategic plan described 
in section 3001(c)(3). 
‘‘(b) DUTIES.— 
‘‘(1) RECOMMENDATIONS ON HEALTH INFOR-
MATION TECHNOLOGY INFRASTRUCTURE.—The HIT 
Policy Committee shall recommend a policy frame-
work for the development and adoption of a nation-
wide health information technology infrastructure 
that permits the electronic exchange and use of 
health information as is consistent with the strategic 
plan under section 3001(c)(3) and that includes the 
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recommendations under paragraph (2). The Com-
mittee shall update such recommendations and make 
new recommendations as appropriate. 
‘‘(2) SPECIFIC AREAS OF STANDARD DEVELOP-
MENT.— 
‘‘(A) IN GENERAL.—The HIT Policy Com-
mittee shall recommend the areas in which 
standards, implementation specifications, and 
certification criteria are needed for the elec-
tronic exchange and use of health information 
for purposes of adoption under section 3004 
and shall recommend an order of priority for 
the development, harmonization, and recogni-
tion of such standards, specifications, and cer-
tification criteria among the areas so rec-
ommended. Such standards and implementation 
specifications shall include named standards, 
architectures, and software schemes for the au-
thentication and security of individually identifi-
able health information and other information 
as needed to ensure the reproducible develop-
ment of common solutions across disparate en-
tities. 
‘‘(B) AREAS
REQUIRED
FOR
CONSIDER-
ATION.—For purposes of subparagraph (A), the 
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HIT Policy Committee shall make recommenda-
tions for at least the following areas: 
‘‘(i) Technologies that protect the pri-
vacy of health information and promote se-
curity in a qualified electronic health 
record, including for the segmentation and 
protection from disclosure of specific and 
sensitive individually identifiable health in-
formation with the goal of minimizing the 
reluctance of patients to seek care (or dis-
close information about a condition) be-
cause of privacy concerns, in accordance 
with applicable law, and for the use and 
disclosure of limited data sets of such in-
formation. 
‘‘(ii) A nationwide health information 
technology infrastructure that allows for 
the electronic use and accurate exchange of 
health information. 
‘‘(iii) The utilization of a certified 
electronic health record for each person in 
the United States by 2014. 
‘‘(iv) Technologies that as a part of a 
qualified electronic health record allow for 
an accounting of disclosures made by a 
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covered entity (as defined for purposes of 
regulations promulgated under section 
264(c) of the Health Insurance Portability 
and Accountability Act of 1996) for pur-
poses of treatment, payment, and health 
care operations (as such terms are defined 
for purposes of such regulations). 
‘‘(v) The use of certified electronic 
health records to improve the quality of 
health care, such as by promoting the co-
ordination of health care and improving 
continuity of health care among health 
care providers, by reducing medical errors, 
by improving population health, and by ad-
vancing research and education. 
‘‘(C) 
OTHER
AREAS
FOR
CONSIDER-
ATION.—In making recommendations under 
subparagraph (A), the HIT Policy Committee 
may consider the following additional areas: 
‘‘(i) The appropriate uses of a nation-
wide health information infrastructure, in-
cluding for purposes of— 
‘‘(I) the collection of quality data 
and public reporting; 
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‘‘(II) biosurveillance and public 
health; 
‘‘(III) medical and clinical re-
search; and 
‘‘(IV) drug safety. 
‘‘(ii) Self-service technologies that fa-
cilitate the use and exchange of patient in-
formation and reduce wait times. 
‘‘(iii) Telemedicine technologies, in 
order to reduce travel requirements for pa-
tients in remote areas. 
‘‘(iv) Technologies that facilitate home 
health care and the monitoring of patients 
recuperating at home. 
‘‘(v) Technologies that help reduce 
medical errors. 
‘‘(vi) Technologies that facilitate the 
continuity of care among health settings. 
‘‘(vii) Technologies that meet the 
needs of diverse populations. 
‘‘(viii) Any other technology that the 
HIT Policy Committee finds to be among 
the technologies with the greatest potential 
to improve the quality and efficiency of 
health care. 
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‘‘(3) FORUM.—The HIT Policy Committee shall 
serve as a forum for broad stakeholder input with 
specific expertise in policies relating to the matters 
described in paragraphs (1) and (2). 
‘‘(c) MEMBERSHIP AND OPERATIONS.— 
‘‘(1) IN GENERAL.—The National Coordinator 
shall provide leadership in the establishment and op-
erations of the HIT Policy Committee. 
‘‘(2) MEMBERSHIP.—The membership of the 
HIT Policy Committee shall at least reflect pro-
viders, ancillary healthcare workers, consumers, pur-
chasers, health plans, technology vendors, research-
ers, relevant Federal agencies, and individuals with 
technical expertise on health care quality, privacy 
and security, and on the electronic exchange and use 
of health information. 
‘‘(3) CONSIDERATION.—The National Coordi-
nator shall ensure that the relevant recommenda-
tions and comments from the National Committee 
on Vital and Health Statistics are considered in the 
development of policies. 
‘‘(d) APPLICATION OF FACA.—The Federal Advisory 
Committee Act (5 U.S.C. App.), other than section 14 of 
such Act, shall apply to the HIT Policy Committee. 
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‘‘(e) PUBLICATION.—The Secretary shall provide for 
publication in the Federal Register and the posting on the 
Internet website of the Office of the National Coordinator 
for Health Information Technology of all policy rec-
ommendations made by the HIT Policy Committee under 
this section. 
‘‘SEC. 3003. HIT STANDARDS COMMITTEE. 
‘‘(a) ESTABLISHMENT.—There is established a com-
mittee to be known as the HIT Standards Committee to 
recommend to the National Coordinator standards, imple-
mentation specifications, and certification criteria for the 
electronic exchange and use of health information for pur-
poses of adoption under section 3004, consistent with the 
implementation of the strategic plan described in section 
3001(c)(3) and beginning with the areas listed in section 
3002(b)(2)(B) in accordance with policies developed by 
the HIT Policy Committee. 
‘‘(b) DUTIES.— 
‘‘(1) STANDARDS DEVELOPMENT.— 
‘‘(A) IN GENERAL.—The HIT Standards 
Committee shall recommend to the National 
Coordinator standards, implementation speci-
fications, and certification criteria described in 
subsection (a) that have been developed, har-
monized, or recognized by the HIT Standards 
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Committee. The HIT Standards Committee 
shall update such recommendations and make 
new recommendations as appropriate, including 
in response to a notification sent under section 
3004(b)(2). Such recommendations shall be 
consistent with the latest recommendations 
made by the HIT Policy Committee. 
‘‘(B) PILOT TESTING OF STANDARDS AND 
IMPLEMENTATION SPECIFICATIONS.—In the de-
velopment, harmonization, or recognition of 
standards and implementation specifications, 
the HIT Standards Committee shall, as appro-
priate, provide for the testing of such standards 
and specifications by the National Institute for 
Standards and Technology under section 4201 
of the HITECH Act. 
‘‘(C) CONSISTENCY.—The standards, im-
plementation specifications, and certification 
criteria recommended under this subsection 
shall be consistent with the standards for infor-
mation transactions and data elements adopted 
pursuant to section 1173 of the Social Security 
Act. 
‘‘(2) FORUM.—The HIT Standards Committee 
shall serve as a forum for the participation of a 
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broad range of stakeholders to provide input on the 
development, harmonization, and recognition of 
standards, implementation specifications, and certifi-
cation criteria necessary for the development and 
adoption of a nationwide health information tech-
nology infrastructure that allows for the electronic 
use and exchange of health information. 
‘‘(3) SCHEDULE.—Not later than 90 days after 
the date of the enactment of this title, the HIT 
Standards Committee shall develop a schedule for 
the assessment of policy recommendations developed 
by the HIT Policy Committee under section 3002. 
The HIT Standards Committee shall update such 
schedule annually. The Secretary shall publish such 
schedule in the Federal Register. 
‘‘(4) PUBLIC
INPUT.—The HIT Standards 
Committee shall conduct open public meetings and 
develop a process to allow for public comment on the 
schedule described in paragraph (3) and rec-
ommendations described in this subsection. Under 
such process comments shall be submitted in a time-
ly manner after the date of publication of a rec-
ommendation under this subsection. 
‘‘(c) MEMBERSHIP AND OPERATIONS.— 
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‘‘(1) IN GENERAL.—The National Coordinator 
shall provide leadership in the establishment and op-
erations of the HIT Standards Committee. 
‘‘(2) MEMBERSHIP.—The membership of the 
HIT Standards Committee shall at least reflect pro-
viders, ancillary healthcare workers, consumers, pur-
chasers, health plans, technology vendors, research-
ers, relevant Federal agencies, and individuals with 
technical expertise on health care quality, privacy 
and security, and on the electronic exchange and use 
of health information. 
‘‘(3) CONSIDERATION.—The National Coordi-
nator shall ensure that the relevant recommenda-
tions and comments from the National Committee 
on Vital and Health Statistics are considered in the 
development of standards. 
‘‘(4) ASSISTANCE.—For the purposes of car-
rying out this section, the Secretary may provide or 
ensure that financial assistance is provided by the 
HIT Standards Committee to defray in whole or in 
part any membership fees or dues charged by such 
Committee to those consumer advocacy groups and 
not for profit entities that work in the public inter-
est as a part of their mission. 
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‘‘(d) APPLICATION OF FACA.—The Federal Advisory 
Committee Act (5 U.S.C. App.), other than section 14, 
shall apply to the HIT Standards Committee. 
‘‘(e) PUBLICATION.—The Secretary shall provide for 
publication in the Federal Register and the posting on the 
Internet website of the Office of the National Coordinator 
for Health Information Technology of all recommenda-
tions made by the HIT Standards Committee under this 
section. 
‘‘SEC. 3004. PROCESS FOR ADOPTION OF ENDORSED REC-
OMMENDATIONS; ADOPTION OF INITIAL SET 
OF STANDARDS, IMPLEMENTATION SPECI-
FICATIONS, AND CERTIFICATION CRITERIA. 
‘‘(a) PROCESS FOR ADOPTION OF ENDORSED REC-
OMMENDATIONS.— 
‘‘(1) REVIEW OF ENDORSED STANDARDS, IM-
PLEMENTATION
SPECIFICATIONS, 
AND
CERTIFI-
CATION CRITERIA.—Not later than 90 days after the 
date of receipt of standards, implementation speci-
fications, or certification criteria endorsed under sec-
tion 3001(c), the Secretary, in consultation with rep-
resentatives of other relevant Federal agencies, shall 
jointly review such standards, implementation speci-
fications, or certification criteria and shall determine 
whether or not to propose adoption of such stand-
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ards, implementation specifications, or certification 
criteria. 
‘‘(2) DETERMINATION TO ADOPT STANDARDS, 
IMPLEMENTATION
SPECIFICATIONS, AND
CERTIFI-
CATION CRITERIA.—If the Secretary determines— 
‘‘(A) to propose adoption of any grouping 
of such standards, implementation specifica-
tions, or certification criteria, the Secretary 
shall, by regulation, determine whether or not 
to adopt such grouping of standards, implemen-
tation specifications, or certification criteria; or 
‘‘(B) not to propose adoption of any group-
ing of standards, implementation specifications, 
or certification criteria, the Secretary shall no-
tify the National Coordinator and the HIT 
Standards Committee in writing of such deter-
mination and the reasons for not proposing the 
adoption of such recommendation. 
‘‘(3) PUBLICATION.—The Secretary shall pro-
vide for publication in the Federal Register of all de-
terminations made by the Secretary under para-
graph (1). 
‘‘(b) ADOPTION OF INITIAL SET OF STANDARDS, IM-
PLEMENTATION SPECIFICATIONS, AND CERTIFICATION 
CRITERIA.— 
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‘‘(1) IN GENERAL.—Not later than December 
31, 2009, the Secretary shall, through the rule-
making process described in section 3003, adopt an 
initial set of standards, implementation specifica-
tions, and certification criteria for the areas required 
for consideration under section 3002(b)(2)(B). 
‘‘(2) APPLICATION
OF
CURRENT
STANDARDS, 
IMPLEMENTATION
SPECIFICATIONS, AND
CERTIFI-
CATION CRITERIA.—The standards, implementation 
specifications, and certification criteria adopted be-
fore the date of the enactment of this title through 
the process existing through the Office of the Na-
tional Coordinator for Health Information Tech-
nology may be applied towards meeting the require-
ment of paragraph (1). 
‘‘SEC. 3005. APPLICATION AND USE OF ADOPTED STAND-
ARDS 
AND 
IMPLEMENTATION 
SPECIFICA-
TIONS BY FEDERAL AGENCIES. 
‘‘For requirements relating to the application and use 
by Federal agencies of the standards and implementation 
specifications adopted under section 3004, see section 
4111 of the HITECH Act. 
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‘‘SEC. 3006. VOLUNTARY APPLICATION AND USE OF ADOPT-
ED 
STANDARDS 
AND 
IMPLEMENTATION 
SPECIFICATIONS BY PRIVATE ENTITIES. 
‘‘(a) IN GENERAL.—Except as provided under section 
4112 of the HITECH Act, any standard or implementa-
tion specification adopted under section 3004 shall be vol-
untary with respect to private entities. 
‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sub-
title shall be construed to require that a private entity that 
enters into a contract with the Federal Government apply 
or use the standards and implementation specifications 
adopted under section 3004 with respect to activities not 
related to the contract. 
‘‘SEC. 
3007. 
FEDERAL 
HEALTH 
INFORMATION 
TECH-
NOLOGY. 
‘‘(a) IN GENERAL.—The National Coordinator shall 
support the development, routine updating, and provision 
of qualified EHR technology (as defined in section 3000) 
consistent with subsections (b) and (c) unless the Sec-
retary determines that the needs and demands of pro-
viders are being substantially and adequately met through 
the marketplace. 
‘‘(b) CERTIFICATION.—In making such EHR tech-
nology publicly available, the National Coordinator shall 
ensure that the qualified EHR technology described in 
subsection (a) is certified under the program developed 
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under section 3001(c)(3) to be in compliance with applica-
ble standards adopted under section 3003(a). 
‘‘(c) AUTHORIZATION
TO
CHARGE
A
NOMINAL 
FEE.—The National Coordinator may impose a nominal 
fee for the adoption by a health care provider of the health 
information technology system developed or approved 
under subsection (a) and (b). Such fee shall take into ac-
count the financial circumstances of smaller providers, low 
income providers, and providers located in rural or other 
medically underserved areas. 
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to require that a private or govern-
ment entity adopt or use the technology provided under 
this section. 
‘‘SEC. 3008. TRANSITIONS. 
‘‘(a) ONCHIT.—To the extent consistent with sec-
tion 3001, all functions, personnel, assets, liabilities, and 
administrative actions applicable to the National Coordi-
nator for Health Information Technology appointed under 
Executive Order 13335 or the Office of such National Co-
ordinator on the date before the date of the enactment 
of this title shall be transferred to the National Coordi-
nator appointed under section 3001(a) and the Office of 
such National Coordinator as of the date of the enactment 
of this title. 
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‘‘(b) AHIC.— 
‘‘(1) To the extent consistent with sections 
3002 and 3003, all functions, personnel, assets, and 
liabilities applicable to the AHIC Successor, Inc. 
doing business as the National eHealth Collaborative 
as of the day before the date of the enactment of 
this title shall be transferred to the HIT Policy 
Committee or the HIT Standards Committee, estab-
lished under section 3002(a) or 3003(a), as appro-
priate, as of the date of the enactment of this title. 
‘‘(2) In carrying out section 3003(b)(1)(A), 
until recommendations are made by the HIT Policy 
Committee, recommendations of the HIT Standards 
Committee shall be consistent with the most recent 
recommendations made by such AHIC Successor, 
Inc. 
‘‘(c) RULES OF CONSTRUCTION.— 
‘‘(1) ONCHIT.—Nothing in section 3001 or 
subsection (a) shall be construed as requiring the 
creation of a new entity to the extent that the Office 
of the National Coordinator for Health Information 
Technology established pursuant to Executive Order 
13335 is consistent with the provisions of section 
3001. 
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‘‘(2) AHIC.—Nothing in sections 3002 or 3003 
or subsection (b) shall be construed as prohibiting 
the AHIC Successor, Inc. doing business as the Na-
tional eHealth Collaborative from modifying its char-
ter, duties, membership, and any other structure or 
function required to be consistent with section 3002 
and 3003 in a manner that would permit the Sec-
retary to choose to recognize such AHIC Successor, 
Inc. as the HIT Policy Committee or the HIT 
Standards Committee. 
‘‘SEC. 3009. RELATION TO HIPAA PRIVACY AND SECURITY 
LAW. 
‘‘(a) IN GENERAL.—With respect to the relation of 
this title to HIPAA privacy and security law: 
‘‘(1) This title may not be construed as having 
any effect on the authorities of the Secretary under 
HIPAA privacy and security law. 
‘‘(2) The purposes of this title include ensuring 
that the health information technology standards 
and implementation specifications adopted under 
section 3004 take into account the requirements of 
HIPAA privacy and security law. 
‘‘(b) DEFINITION.—For purposes of this section, the 
term ‘HIPAA privacy and security law’ means— 
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‘‘(1) the provisions of part C of title XI of the 
Social Security Act, section 264 of the Health Insur-
ance Portability and Accountability Act of 1996, and 
subtitle D of title IV of the HITECH Act; and 
‘‘(2) regulations under such provisions. 
‘‘SEC. 3010. AUTHORIZATION FOR APPROPRIATIONS. 
‘‘There is authorized to be appropriated to the Office 
of the National Coordinator for Health Information Tech-
nology to carry out this subtitle $250,000,000 for fiscal 
year 2009.’’. 
SEC. 4102. TECHNICAL AMENDMENT. 
Section 1171(5) of the Social Security Act (42 U.S.C. 
1320d) is amended by striking ‘‘or C’’ and inserting ‘‘C, 
or D’’. 
PART II—APPLICATION AND USE OF ADOPTED 
HEALTH 
INFORMATION 
TECHNOLOGY 
STANDARDS; REPORTS 
SEC. 4111. COORDINATION OF FEDERAL ACTIVITIES WITH 
ADOPTED STANDARDS AND IMPLEMENTA-
TION SPECIFICATIONS. 
(a) SPENDING
ON HEALTH INFORMATION TECH-
NOLOGY SYSTEMS.—As each agency (as defined in the Ex-
ecutive Order issued on August 22, 2006, relating to pro-
moting quality and efficient health care in Federal govern-
ment administered or sponsored health care programs) im-
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plements, acquires, or upgrades health information tech-
nology systems used for the direct exchange of individually 
identifiable health information between agencies and with 
non-Federal entities, it shall utilize, where available, 
health information technology systems and products that 
meet standards and implementation specifications adopted 
under section 3004 of the Public Health Service Act, as 
added by section 4101. 
(b) FEDERAL INFORMATION COLLECTION ACTIVI-
TIES.—With respect to a standard or implementation 
specification adopted under section 3004 of the Public 
Health Service Act, as added by section 4101, the Presi-
dent shall take measures to ensure that Federal activities 
involving the broad collection and submission of health in-
formation are consistent with such standard or implemen-
tation specification, respectively, within three years after 
the date of such adoption. 
(c) APPLICATION OF DEFINITIONS.—The definitions 
contained in section 3000 of the Public Health Service 
Act, as added by section 4101, shall apply for purposes 
of this part. 
SEC. 4112. APPLICATION TO PRIVATE ENTITIES. 
Each agency (as defined in such Executive Order 
issued on August 22, 2006, relating to promoting quality 
and efficient health care in Federal government adminis-
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tered or sponsored health care programs) shall require in 
contracts or agreements with health care providers, health 
plans, or health insurance issuers that as each provider, 
plan, or issuer implements, acquires, or upgrades health 
information technology systems, it shall utilize, where 
available, health information technology systems and prod-
ucts that meet standards and implementation specifica-
tions adopted under section 3004 of the Public Health 
Service Act, as added by section 4101. 
SEC. 4113. STUDY AND REPORTS. 
(a) REPORT ON ADOPTION OF NATIONWIDE SYS-
TEM.—Not later than 2 years after the date of the enact-
ment of this Act and annually thereafter, the Secretary 
of Health and Human Services shall submit to the appro-
priate committees of jurisdiction of the House of Rep-
resentatives and the Senate a report that— 
(1) describes the specific actions that have been 
taken by the Federal Government and private enti-
ties to facilitate the adoption of a nationwide system 
for the electronic use and exchange of health infor-
mation; 
(2) describes barriers to the adoption of such a 
nationwide system; and 
(3) contains recommendations to achieve full 
implementation of such a nationwide system. 
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(b) REIMBURSEMENT INCENTIVE STUDY AND RE-
PORT.— 
(1) STUDY.—The Secretary of Health and 
Human Services shall carry out, or contract with a 
private entity to carry out, a study that examines 
methods to create efficient reimbursement incentives 
for improving health care quality in Federally quali-
fied health centers, rural health clinics, and free 
clinics. 
(2) REPORT.—Not later than 2 years after the 
date of the enactment of this Act, the Secretary of 
Health and Human Services shall submit to the ap-
propriate committees of jurisdiction of the House of 
Representatives and the Senate a report on the 
study carried out under paragraph (1). 
(c) AGING SERVICES TECHNOLOGY STUDY AND RE-
PORT.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall carry out, or contract with a 
private entity to carry out, a study of matters relat-
ing to the potential use of new aging services tech-
nology to assist seniors, individuals with disabilities, 
and their caregivers throughout the aging process. 
(2) MATTERS
TO
BE
STUDIED.—The study 
under paragraph (1) shall include— 
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(A) an evaluation of— 
(i) methods for identifying current, 
emerging, and future health technology 
that can be used to meet the needs of sen-
iors and individuals with disabilities and 
their caregivers across all aging services 
settings, as specified by the Secretary; 
(ii) methods for fostering scientific in-
novation with respect to aging services 
technology within the business and aca-
demic communities; and 
(iii) developments in aging services 
technology in other countries that may be 
applied in the United States; and 
(B) identification of— 
(i) barriers to innovation in aging 
services technology and devising strategies 
for removing such barriers; and 
(ii) barriers to the adoption of aging 
services technology by health care pro-
viders and consumers and devising strate-
gies to removing such barriers. 
(3) REPORT.—Not later than 24 months after 
the date of the enactment of this Act, the Secretary 
shall submit to the appropriate committees of juris-
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diction of the House of Representatives and of the 
Senate a report on the study carried out under para-
graph (1). 
(4) DEFINITIONS.—For purposes of this sub-
section: 
(A) AGING SERVICES TECHNOLOGY.—The 
term ‘‘aging services technology’’ means health 
technology that meets the health care needs of 
seniors, individuals with disabilities, and the 
caregivers of such seniors and individuals. 
(B) SENIOR.—The term ‘‘senior’’ has such 
meaning as specified by the Secretary. 
Subtitle B—Testing of Health 
Information Technology 
SEC. 4201. NATIONAL INSTITUTE FOR STANDARDS AND 
TECHNOLOGY TESTING. 
(a) PILOT TESTING OF STANDARDS AND IMPLEMEN-
TATION SPECIFICATIONS.—In coordination with the HIT 
Standards Committee established under section 3003 of 
the Public Health Service Act, as added by section 4101, 
with respect to the development of standards and imple-
mentation specifications under such section, the Director 
of the National Institute for Standards and Technology 
shall test such standards and implementation specifica-
tions, as appropriate, in order to assure the efficient im-
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plementation and use of such standards and implementa-
tion specifications. 
(b) VOLUNTARY TESTING PROGRAM.—In coordina-
tion with the HIT Standards Committee established under 
section 3003 of the Public Health Service Act, as added 
by section 4101, with respect to the development of stand-
ards and implementation specifications under such sec-
tion, the Director of the National Institute of Standards 
and Technology shall support the establishment of a con-
formance testing infrastructure, including the develop-
ment of technical test beds. The development of this con-
formance testing infrastructure may include a program to 
accredit independent, non-Federal laboratories to perform 
testing. 
SEC. 4202. RESEARCH AND DEVELOPMENT PROGRAMS. 
(a) HEALTH CARE INFORMATION ENTERPRISE INTE-
GRATION RESEARCH CENTERS.— 
(1) IN GENERAL.—The Director of the National 
Institute of Standards and Technology, in consulta-
tion with the Director of the National Science Foun-
dation and other appropriate Federal agencies, shall 
establish a program of assistance to institutions of 
higher education (or consortia thereof which may in-
clude nonprofit entities and Federal Government 
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