118 
‘‘(h) CONTINUOUS
IMPROVEMENT.—The Secretary 
shall annually evaluate the activities conducted under this 
section and shall, in awarding grants under this section, 
implement the lessons learned from such evaluation in a 
manner so that awards made subsequent to each such eval-
uation are made in a manner that, in the determination 
of the Secretary, will lead towards the greatest improvement 
in quality of care, decrease in costs, and the most effective 
authorized and secure electronic exchange of health informa-
tion. 
‘‘(i) REQUIRED MATCH.— 
‘‘(1) IN GENERAL.—For a fiscal year (beginning 
with fiscal year 2011), the Secretary may not make 
a grant under this section to a State unless the State 
agrees to make available non-Federal contributions 
(which may include in-kind contributions) toward the 
costs of a grant awarded under subsection (c) in an 
amount equal to— 
‘‘(A) for fiscal year 2011, not less than $1 
for each $10 of Federal funds provided under the 
grant; 
‘‘(B) for fiscal year 2012, not less than $1 
for each $7 of Federal funds provided under the 
grant; and 
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‘‘(C) for fiscal year 2013 and each subse-
quent fiscal year, not less than $1 for each $3 of 
Federal funds provided under the grant. 
‘‘(2) AUTHORITY TO REQUIRE STATE MATCH FOR 
FISCAL YEARS BEFORE FISCAL YEAR 2011.—For any 
fiscal year during the grant program under this sec-
tion before fiscal year 2011, the Secretary may deter-
mine the extent to which there shall be required a 
non-Federal contribution from a State receiving a 
grant under this section. 
‘‘SEC. 3014. COMPETITIVE GRANTS TO STATES AND INDIAN 
TRIBES FOR THE DEVELOPMENT OF LOAN 
PROGRAMS TO FACILITATE THE WIDESPREAD 
ADOPTION OF CERTIFIED EHR TECHNOLOGY. 
‘‘(a) IN GENERAL.—The National Coordinator may 
award competitive grants to eligible entities for the estab-
lishment of programs for loans to health care providers to 
conduct the activities described in subsection (e). 
‘‘(b) ELIGIBLE ENTITY DEFINED.—For purposes of 
this subsection, the term ‘eligible entity’ means a State or 
Indian tribe (as defined in the Indian Self-Determination 
and Education Assistance Act) that— 
‘‘(1) submits to the National Coordinator an ap-
plication at such time, in such manner, and con-
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taining such information as the National Coordinator 
may require; 
‘‘(2) submits to the National Coordinator a stra-
tegic plan in accordance with subsection (d) and pro-
vides to the National Coordinator assurances that the 
entity will update such plan annually in accordance 
with such subsection; 
‘‘(3) provides assurances to the National Coordi-
nator that the entity will establish a Loan Fund in 
accordance with subsection (c); 
‘‘(4) provides assurances to the National Coordi-
nator that the entity will not provide a loan from the 
Loan Fund to a health care provider unless the pro-
vider agrees to— 
‘‘(A) submit reports on quality measures 
adopted by the Federal Government (by not later 
than 90 days after the date on which such meas-
ures are adopted), to— 
‘‘(i) the Administrator of the Centers 
for Medicare & Medicaid Services (or his or 
her designee), in the case of an entity par-
ticipating in the Medicare program under 
title XVIII of the Social Security Act or the 
Medicaid program under title XIX of such 
Act; or 
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121 
‘‘(ii) the Secretary in the case of other 
entities; 
‘‘(B) demonstrate to the satisfaction of the 
Secretary (through criteria established by the 
Secretary) that any certified EHR technology 
purchased, improved, or otherwise financially 
supported under a loan under this section is 
used to exchange health information in a man-
ner that, in accordance with law and standards 
(as adopted under section 3004) applicable to the 
exchange of information, improves the quality of 
health care, such as promoting care coordination; 
‘‘(C) comply with such other requirements 
as the entity or the Secretary may require; 
‘‘(D) include a plan on how health care pro-
viders involved intend to maintain and support 
the certified EHR technology over time; and 
‘‘(E) include a plan on how the health care 
providers involved intend to maintain and sup-
port the certified EHR technology that would be 
purchased with such loan, including the type of 
resources expected to be involved and any such 
other information as the State or Indian Tribe, 
respectively, may require; and 
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122 
‘‘(5) agrees to provide matching funds in accord-
ance with subsection (h). 
‘‘(c) ESTABLISHMENT OF FUND.—For purposes of sub-
section (b)(3), an eligible entity shall establish a certified 
EHR technology loan fund (referred to in this subsection 
as a ‘Loan Fund’) and comply with the other requirements 
contained in this section. A grant to an eligible entity under 
this section shall be deposited in the Loan Fund established 
by the eligible entity. No funds authorized by other provi-
sions of this title to be used for other purposes specified in 
this title shall be deposited in any Loan Fund. 
‘‘(d) STRATEGIC PLAN.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(b)(2), a strategic plan of an eligible entity under this 
subsection shall identify the intended uses of amounts 
available to the Loan Fund of such entity. 
‘‘(2) CONTENTS.—A strategic plan under para-
graph (1), with respect to a Loan Fund of an eligible 
entity, shall include for a year the following: 
‘‘(A) A list of the projects to be assisted 
through the Loan Fund during such year. 
‘‘(B) A description of the criteria and meth-
ods established for the distribution of funds from 
the Loan Fund during the year. 
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‘‘(C) A description of the financial status of 
the Loan Fund as of the date of submission of 
the plan. 
‘‘(D) The short-term and long-term goals of 
the Loan Fund. 
‘‘(e) USE OF FUNDS.—Amounts deposited in a Loan 
Fund, including loan repayments and interest earned on 
such amounts, shall be used only for awarding loans or loan 
guarantees, making reimbursements described in subsection 
(g)(4)(A), or as a source of reserve and security for lever-
aged loans, the proceeds of which are deposited in the Loan 
Fund established under subsection (c). Loans under this sec-
tion may be used by a health care provider to— 
‘‘(1) facilitate the purchase of certified EHR 
technology; 
‘‘(2) enhance the utilization of certified EHR 
technology; 
‘‘(3) train personnel in the use of such tech-
nology; or 
‘‘(4) improve the secure electronic exchange of 
health information. 
‘‘(f) TYPES OF ASSISTANCE.—Except as otherwise lim-
ited by applicable State law, amounts deposited into a 
Loan Fund under this section may only be used for the fol-
lowing: 
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‘‘(5) To make reimbursements described in sub-
section (g)(4)(A). 
‘‘(g) ADMINISTRATION OF LOAN FUNDS.— 
‘‘(1) COMBINED FINANCIAL ADMINISTRATION.— 
An eligible entity may (as a convenience and to avoid 
unnecessary administrative costs) combine, in accord-
ance with applicable State law, the financial admin-
istration of a Loan Fund established under this sub-
section with the financial administration of any other 
revolving fund established by the entity if otherwise 
not prohibited by the law under which the Loan Fund 
was established. 
‘‘(2) COST OF ADMINISTERING FUND.—Each eli-
gible entity may annually use not to exceed 4 percent 
of the funds provided to the entity under a grant 
under this section to pay the reasonable costs of the 
administration of the programs under this section, in-
cluding the recovery of reasonable costs expended to 
establish a Loan Fund which are incurred after the 
date of the enactment of this title. 
‘‘(3) GUIDANCE
AND
REGULATIONS.—The Na-
tional Coordinator shall publish guidance and pro-
mulgate regulations as may be necessary to carry out 
the provisions of this section, including— 
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‘‘(A) provisions to ensure that each eligible 
entity commits and expends funds allotted to the 
entity under this section as efficiently as possible 
in accordance with this title and applicable 
State laws; and 
‘‘(B) guidance to prevent waste, fraud, and 
abuse. 
‘‘(4) PRIVATE SECTOR CONTRIBUTIONS.— 
‘‘(A) IN
GENERAL.—A Loan Fund estab-
lished under this section may accept contribu-
tions from private sector entities, except that 
such entities may not specify the recipient or re-
cipients of any loan issued under this subsection. 
An eligible entity may agree to reimburse a pri-
vate sector entity for any contribution made 
under this subparagraph, except that the amount 
of such reimbursement may not be greater than 
the principal amount of the contribution made. 
‘‘(B) AVAILABILITY OF INFORMATION.—An 
eligible entity shall make publicly available the 
identity of, and amount contributed by, any pri-
vate sector entity under subparagraph (A) and 
may issue letters of commendation or make other 
awards (that have no financial value) to any 
such entity. 
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‘‘(h) MATCHING REQUIREMENTS.— 
‘‘(1) IN
GENERAL.—The National Coordinator 
may not make a grant under subsection (a) to an eli-
gible entity unless the entity agrees to make available 
(directly or through donations from public or private 
entities) non-Federal contributions in cash to the costs 
of carrying out the activities for which the grant is 
awarded in an amount equal to not less than $1 for 
each $5 of Federal funds provided under the grant. 
‘‘(2) DETERMINATION OF AMOUNT OF NON-FED-
ERAL CONTRIBUTION.—In determining the amount of 
non-Federal contributions that an eligible entity has 
provided pursuant to subparagraph (A), the National 
Coordinator may not include any amounts provided 
to the entity by the Federal Government. 
‘‘(i) EFFECTIVE DATE.—The Secretary may not make 
an award under this section prior to January 1, 2010. 
‘‘SEC. 3015. DEMONSTRATION PROGRAM TO INTEGRATE IN-
FORMATION TECHNOLOGY INTO CLINICAL 
EDUCATION. 
‘‘(a) IN GENERAL.—The Secretary may award grants 
under this section to carry out demonstration projects to 
develop academic curricula integrating certified EHR tech-
nology in the clinical education of health professionals. 
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Such awards shall be made on a competitive basis and pur-
suant to peer review. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
‘‘(1) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require; 
‘‘(2) submit to the Secretary a strategic plan for 
integrating certified EHR technology in the clinical 
education of health professionals to reduce medical er-
rors and enhance health care quality; 
‘‘(3) be— 
‘‘(A) a school of medicine, osteopathic medi-
cine, dentistry, or pharmacy, a graduate pro-
gram in behavioral or mental health, or any 
other graduate health professions school; 
‘‘(B) a graduate school of nursing or physi-
cian assistant studies; 
‘‘(C) a consortium of two or more schools 
described in subparagraph (A) or (B); or 
‘‘(D) an institution with a graduate med-
ical education program in medicine, osteopathic 
medicine, dentistry, pharmacy, nursing, or phy-
sician assistance studies; 
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‘‘(4) provide for the collection of data regarding 
the effectiveness of the demonstration project to be 
funded under the grant in improving the safety of pa-
tients, the efficiency of health care delivery, and in 
increasing the likelihood that graduates of the grantee 
will adopt and incorporate certified EHR technology, 
in the delivery of health care services; and 
‘‘(5) provide matching funds in accordance with 
subsection (d). 
‘‘(c) USE OF FUNDS.— 
‘‘(1) IN
GENERAL.—With respect to a grant 
under subsection (a), an eligible entity shall— 
‘‘(A) use grant funds in collaboration with 
2 or more disciplines; and 
‘‘(B) use grant funds to integrate certified 
EHR technology into community-based clinical 
education. 
‘‘(2) LIMITATION.—An eligible entity shall not 
use amounts received under a grant under subsection 
(a) to purchase hardware, software, or services. 
‘‘(d) FINANCIAL SUPPORT.—The Secretary may not 
provide more than 50 percent of the costs of any activity 
for which assistance is provided under subsection (a), except 
in an instance of national economic conditions which would 
render the cost-share requirement under this subsection det-
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