I 
111TH CONGRESS 
1ST SESSION H. R. 3987 
To amend titles XI and XVIII of the Social Security Act to promote the 
use of health information technology to better coordinate health care. 
IN THE HOUSE OF REPRESENTATIVES 
NOVEMBER 3, 2009 
Mr. BLUNT (for himself, Mr. BARTON of Texas, Mr. BURGESS, Mrs. 
BLACKBURN, and Mr. GINGREY of Georgia) introduced the following bill; 
which was referred to the Committee on Energy and Commerce, and in 
addition to the Committee on Ways and Means, for a period to be subse-
quently determined by the Speaker, in each case for consideration of such 
provisions as fall within the jurisdiction of the committee concerned 
A BILL 
To amend titles XI and XVIII of the Social Security Act 
to promote the use of health information technology to 
better coordinate health care. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SAFE HARBORS TO ANTIKICKBACK CIVIL PEN-
ALTIES AND CRIMINAL PENALTIES FOR PRO-
VISION OF HEALTH INFORMATION TECH-
NOLOGY AND TRAINING SERVICES. 
(a) FOR CIVIL PENALTIES.—Section 1128A of the 
Social Security Act (42 U.S.C. 1320a–7a) is amended— 
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(1) in subsection (b), by adding at the end the 
following new paragraph: 
‘‘(4) For purposes of this subsection, induce-
ments to reduce or limit services described in para-
graph (1) shall not include the practical or other ad-
vantages resulting from health information tech-
nology or related installation, maintenance, support, 
or training services.’’; and 
(2) in subsection (i), by adding at the end the 
following new paragraph: 
‘‘(8) The term ‘health information technology’ 
means hardware, software, license, right, intellectual 
property, equipment, or other information tech-
nology (including new versions, upgrades, and 
connectivity) designed or provided primarily for the 
electronic creation, maintenance, or exchange of 
health information to better coordinate care or im-
prove health care quality, efficiency, or research.’’. 
(b) FOR CRIMINAL PENALTIES.—Section 1128B of 
such Act (42 U.S.C. 1320a–7b) is amended— 
(1) in subsection (b)(3)— 
(A) in subparagraph (G), by striking 
‘‘and’’ at the end; 
(B) in the subparagraph (H) added by sec-
tion 237(d) of the Medicare Prescription Drug, 
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Improvement, and Modernization Act of 2003 
(Public Law 108–173; 117 Stat. 2213)— 
(i) by moving such subparagraph 2 
ems to the left; and 
(ii) by striking the period at the end 
and inserting a semicolon; 
(C) in the subparagraph (H) added by sec-
tion 431(a) of such Act (117 Stat. 2287)— 
(i) by redesignating such subpara-
graph as subparagraph (I); 
(ii) by moving such subparagraph 2 
ems to the left; and 
(iii) by striking the period at the end 
and inserting ‘‘; and’’; and 
(D) by adding at the end the following new 
subparagraph: 
‘‘(J) any nonmonetary remuneration (in 
the form of health information technology, as 
defined in section 1128A(i)(8), or related instal-
lation, maintenance, support, or training serv-
ices) made to a person by a specified entity (as 
defined in subsection (g)) if— 
‘‘(i) the provision of such remunera-
tion is without an agreement between the 
parties or legal condition that— 
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‘‘(I) limits or restricts the use of 
the health information technology to 
services provided by the physician to 
individuals receiving services at the 
specified entity; 
‘‘(II) limits or restricts the use of 
the health information technology in 
conjunction with other health informa-
tion technology; or 
‘‘(III) conditions the provision of 
such remuneration on the referral of 
patients or business to the specified 
entity; 
‘‘(ii) such remuneration is arranged 
for in a written agreement that is signed 
by the parties involved (or their represent-
atives) and that specifies the remuneration 
solicited or received (or offered or paid) 
and states that the provision of such remu-
neration is made for the primary purpose 
of better coordination of care or improve-
ment of health quality, efficiency, or re-
search; and 
‘‘(iii) the specified entity providing the 
remuneration (or a representative of such 
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entity) has not taken any action to disable 
any basic feature of any hardware or soft-
ware component of such remuneration that 
would permit interoperability.’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(g) SPECIFIED ENTITY DEFINED.—For purposes of 
subsection (b)(3)(J), the term ‘specified entity’ means an 
entity that is a hospital, group practice, prescription drug 
plan sponsor, a Medicare Advantage organization, or any 
other such entity specified by the Secretary, considering 
the goals and objectives of this section, as well as the goals 
to better coordinate the delivery of health care and to pro-
mote the adoption and use of health information tech-
nology.’’. 
(c) EFFECTIVE DATE
AND EFFECT
ON STATE 
LAWS.— 
(1) EFFECTIVE DATE.—The amendments made 
by subsections (a) and (b) shall take effect on the 
date that is 120 days after the date of the enact-
ment of this Act. 
(2) PREEMPTION OF STATE LAWS.—No State 
(as defined in section 1101(a) of the Social Security 
Act (42 U.S.C. 1301(a)) for purposes of title XI of 
such Act) shall have in effect a State law that im-
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poses a criminal or civil penalty for a transaction de-
scribed 
in 
section 
1128A(b)(4) 
or 
section 
1128B(b)(3)(J) of such Act, as added by subsections 
(a)(1) and (b), respectively, if the conditions de-
scribed in the respective provision, with respect to 
such transaction, are met. 
(d) STUDY AND REPORT TO ASSESS EFFECT OF 
SAFE HARBORS ON HEALTH SYSTEM.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall conduct a study to determine 
the impact of each of the safe harbors described in 
paragraph (3). In particular, the study shall examine 
the following: 
(A) The effectiveness of each safe harbor 
in increasing the adoption of health information 
technology. 
(B) The types of health information tech-
nology provided under each safe harbor. 
(C) The extent to which the financial or 
other business relationships between providers 
under each safe harbor have changed as a re-
sult of the safe harbor in a way that adversely 
affects or benefits the health care system or 
choices available to consumers. 
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(D) The impact of the adoption of health 
information technology on health care quality, 
cost, and access under each safe harbor. 
(2) REPORT.—Not later than three years after 
the effective date described in subsection (c)(1), the 
Secretary of Health and Human Services shall sub-
mit to Congress a report on the study under para-
graph (1). 
(3) SAFE HARBORS DESCRIBED.—For purposes 
of paragraphs (1) and (2), the safe harbors de-
scribed in this paragraph are— 
(A) 
the 
safe 
harbor 
under 
section 
1128A(b)(4) of such Act (42 U.S.C. 1320a– 
7a(b)(4)), as added by subsection (a)(1); and 
(B) 
the 
safe 
harbor 
under 
section 
1128B(b)(3)(J) of such Act (42 U.S.C. 1320a– 
7b(b)(3)(J)), as added by subsection (b). 
SEC. 2. EXCEPTION TO LIMITATION ON CERTAIN PHYSI-
CIAN REFERRALS (UNDER STARK) FOR PRO-
VISION OF HEALTH INFORMATION TECH-
NOLOGY 
AND 
TRAINING 
SERVICES 
TO 
HEALTH CARE PROFESSIONALS. 
(a) IN GENERAL.—Section 1877(b) of the Social Se-
curity Act (42 U.S.C. 1395nn(b)) is amended by adding 
at the end the following new paragraph: 
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by the parties involved (or their represent-
atives) and that specifies the remuneration 
made and states that the provision of such 
remuneration is made for the primary pur-
pose of better coordination of care or im-
provement of health quality, efficiency, or 
research; and 
‘‘(iii) the specified entity (or a rep-
resentative of such entity) has not taken 
any action to disable any basic feature of 
any hardware or software component of 
such remuneration that would permit 
interoperability. 
‘‘(B) HEALTH INFORMATION TECHNOLOGY 
DEFINED.—For purposes of this paragraph, the 
term ‘health information technology’ means 
hardware, software, license, right, intellectual 
property, equipment, or other information tech-
nology (including new versions, upgrades, and 
connectivity) designed or provided primarily for 
the electronic creation, maintenance, or ex-
change of health information to better coordi-
nate care or improve health care quality, effi-
ciency, or research. 
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‘‘(C) SPECIFIED
ENTITY
DEFINED.—For 
purposes of this paragraph, the term ‘specified 
entity’ means an entity that is a hospital, group 
practice, prescription drug plan sponsor, a 
Medicare Advantage organization, or any other 
such entity specified by the Secretary, consid-
ering the goals and objectives of this section, as 
well as the goals to better coordinate the deliv-
ery of health care and to promote the adoption 
and use of health information technology.’’. 
(b) EFFECTIVE DATE; EFFECT ON STATE LAWS.— 
(1) EFFECTIVE DATE.—The amendment made 
by subsection (a) shall take effect on the date that 
is 120 days after the date of the enactment of this 
Act. 
(2) PREEMPTION OF STATE LAWS.—No State 
(as defined in section 1101(a) of the Social Security 
Act (42 U.S.C. 1301(a)) for purposes of title XI of 
such Act) shall have in effect a State law that im-
poses a criminal or civil penalty for a transaction de-
scribed in section 1877(b)(6) of such Act, as added 
by subsection (a), if the conditions described in such 
section, with respect to such transaction, are met. 
(c) STUDY AND REPORT TO ASSESS EFFECT OF EX-
CEPTION ON HEALTH SYSTEM.— 
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(1) IN GENERAL.—The Secretary of Health and 
Human Services shall conduct a study to determine 
the impact of the exception under section 1877(b)(6) 
of such Act (42 U.S.C. 1395nn(b)(6)), as added by 
subsection (a). In particular, the study shall examine 
the following: 
(A) The effectiveness of the exception in 
increasing the adoption of health information 
technology. 
(B) The types of health information tech-
nology provided under the exception. 
(C) The extent to which the financial or 
other business relationships between providers 
under the exception have changed as a result of 
the exception in a way that adversely affects or 
benefits the health care system or choices avail-
able to consumers. 
(D) The impact of the adoption of health 
information technology on health care quality, 
cost, and access under the exception. 
(2) REPORT.—Not later than three years after 
the effective date described in subsection (b)(1), the 
Secretary of Health and Human Services shall sub-
mit to Congress a report on the study under para-
graph (1). 
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SEC. 3. RULES OF CONSTRUCTION REGARDING USE OF 
CONSORTIA. 
(a) APPLICATION TO SAFE HARBOR FROM CRIMINAL 
PENALTIES.—Section 1128B(b)(3) of the Social Security 
Act (42 U.S.C. 1320a–7b(b)(3)) is amended by adding 
after and below subparagraph (J), as added by section 
1(b)(1), the following: ‘‘For purposes of subparagraph (J), 
nothing in such subparagraph shall be construed as pre-
venting a specified entity, consistent with the specific re-
quirements of such subparagraph, from forming a consor-
tium composed of health care providers, payers, employ-
ers, and other interested entities to collectively purchase 
and donate health information technology, or from offer-
ing health care providers a choice of health information 
technology products in order to take into account the vary-
ing needs of such providers receiving such products.’’. 
(b) APPLICATION
TO STARK EXCEPTION.—Para-
graph (6) of section 1877(b) of the Social Security Act 
(42 U.S.C. 1395nn(b)), as added by section 2(a), is 
amended by adding at the end the following new subpara-
graph: 
‘‘(D) RULE OF CONSTRUCTION.—For pur-
poses of subparagraph (A), nothing in such 
subparagraph shall be construed as preventing 
a specified entity, consistent with the specific 
requirements of such subparagraph, from— 
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‘‘(i) forming a consortium composed 
of health care providers, payers, employers, 
and other interested entities to collectively 
purchase and donate health information 
technology; or 
‘‘(ii) offering health care providers a 
choice of health information technology 
products in order to take into account the 
varying needs of such providers receiving 
such products.’’. 
Æ 
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