I 
111TH CONGRESS 
1ST SESSION H. R. 1031 
To promote a better health information system. 
IN THE HOUSE OF REPRESENTATIVES 
FEBRUARY 12, 2009 
Mr. BURGESS introduced the following bill; which was referred to the Com-
mittee on Energy and Commerce, and in addition to the Committee on 
Ways and Means, for a period to be subsequently determined by the 
Speaker, in each case for consideration of such provisions as fall within 
the jurisdiction of the committee concerned 
A BILL 
To promote a better health information system. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE AND TABLE OF CONTENTS. 
(a) SHORT TITLE.—This Act may be cited as the 
‘‘Health Information Technology Promotion Act of 2009’’. 
(b) TABLE OF CONTENTS.—The table of contents of 
this Act is as follows: 
Sec. 1. Short title and table of contents. 
Sec. 2. Preserving privacy and security laws. 
TITLE I—PROMOTING THE USE OF HEALTH INFORMATION 
TECHNOLOGY TO BETTER COORDINATE HEALTH CARE 
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Sec. 101. Safe harbors to antikickback civil penalties and criminal penalties for 
provision of Health Information Technology and training serv-
ices. 
Sec. 102. Exception to limitation on certain physician referrals (under Stark) 
for provision of Health Information Technology and training 
services to health care professionals. 
Sec. 103. Rules of construction regarding use of consortia. 
TITLE II—ADDITIONAL PROVISIONS 
Sec. 201. Promotion of telehealth services. 
Sec. 202. Study and report on expansion of home health-related telehealth serv-
ices. 
Sec. 203. Study and report on store and forward technology for telehealth. 
Sec. 204. Ensuring health care providers participating in PHSA programs, 
Medicaid, SCHIP, or the MCH program may maintain health 
information in electronic form. 
Sec. 205. Ensuring health care providers participating in the Medicare program 
may maintain health information in electronic form. 
Sec. 206. Study and report on State, regional, and community health informa-
tion exchanges. 
Sec. 207. Promoting Health Information Technology as a tool for chronic dis-
ease management. 
SEC. 2. PRESERVING PRIVACY AND SECURITY LAWS. 
Nothing in this Act (or the amendments made by this 
Act) shall be construed to affect the scope, substance, or 
applicability of section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996 and any regu-
lation issued pursuant to such section. 
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TITLE I—PROMOTING THE USE 
OF 
HEALTH 
INFORMATION 
TECHNOLOGY TO BETTER CO-
ORDINATE HEALTH CARE 
SEC. 101. 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— 
(1) in subsection (b), by adding at the end the 
following new paragraph: 
‘‘(4) For purposes of this subsection, inducements to 
reduce or limit services described in paragraph (1) shall 
not include the practical or other advantages resulting 
from health information technology 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 
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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, 
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: 
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‘‘(J) any nonmonetary remuneration (in the 
form of health information technology, as defined in 
section 1128A(i)(8), or related installation, mainte-
nance, support, or training services) made to a per-
son by a specified entity (as defined in subsection 
(g)) if— 
‘‘(i) the provision of such remuneration is 
without an agreement between the parties or 
legal condition that— 
‘‘(I) limits or restricts the use of the 
health information technology to services 
provided by the physician to individuals re-
ceiving services at the specified entity; 
‘‘(II) limits or restricts the use of the 
health information technology in conjunc-
tion with other health information tech-
nology; 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 par-
ties involved (or their representatives) and that 
specifies the remuneration solicited or received 
(or offered or paid) and states that the provi-
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sion of such remuneration is made for the pri-
mary purpose of better coordination of care or 
improvement of health quality, efficiency, or re-
search; and 
‘‘(iii) the specified entity providing the re-
muneration (or a representative 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 inter-
operability.’’; 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 
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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-
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. 
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(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. 
(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). 
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SEC. 102. 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: 
‘‘(6) INFORMATION TECHNOLOGY AND TRAIN-
ING SERVICES.— 
‘‘(A) IN GENERAL.—Any nonmonetary re-
muneration (in the form of health information 
technology or related installation, maintenance, 
support, or training services) made by a speci-
fied entity to a physician if— 
‘‘(i) the provision of such remunera-
tion is without an agreement between the 
parties or legal condition that— 
‘‘(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 
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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 
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 
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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. 
‘‘(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 
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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.— 
(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. 
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(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). 
SEC. 103. 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 
101(b)(1), the following: ‘‘For purposes of subparagraph 
(J), nothing in such subparagraph shall be construed as 
preventing a specified entity, consistent with the specific 
requirements of such subparagraph, from forming a con-
sortium composed of health care providers, payers, em-
ployers, and other interested entities to collectively pur-
chase and donate health information technology, or from 
offering health care providers a choice of health informa-
tion technology products in order to take into account the 
varying needs of such providers receiving such products.’’. 
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(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 102(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— 
‘‘(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.’’. 
TITLE II—ADDITIONAL 
PROVISIONS 
SEC. 201. PROMOTION OF TELEHEALTH SERVICES. 
(a) FACILITATING THE PROVISION OF TELEHEALTH 
SERVICES ACROSS STATE LINES.—The Secretary of 
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Health and Human Services shall, in coordination with 
physicians, health care practitioners, patient advocates, 
and representatives of States, encourage and facilitate the 
adoption of State reciprocity agreements for practitioner 
licensure in order to expedite the provision across State 
lines of telehealth services. 
(b) REPORT.—Not later than 18 months after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services shall submit to Congress a report 
on the actions taken to carry out subsection (a). 
(c) STATE DEFINED.—For purposes of this sub-
section, the term ‘‘State’’ has the meaning given that term 
for purposes of title XVIII of the Social Security Act. 
SEC. 202. STUDY AND REPORT ON EXPANSION OF HOME 
HEALTH-RELATED TELEHEALTH SERVICES. 
(a) STUDY.—The Secretary of Health and Human 
Services shall conduct a study to determine the feasibility, 
advisability, and the costs of— 
(1) including coverage and payment for home 
health-related telehealth services as part of home 
health services under title XVIII of the Social Secu-
rity Act; and 
(2) expanding the list of sites described in para-
graph (4)(C)(ii) of section 1834(m) of the Social Se-
curity Act (42 U.S.C. 1395m(m)) to include county 
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mental health clinics or other publicly funded mental 
health facilities for the purpose of payment under 
such section for the provision of telehealth services 
at such clinics or facilities. 
(b) SPECIFICS OF STUDY.—Such study shall dem-
onstrate whether the changes described in paragraphs (1) 
and (2) of subsection (a) will result in the following: 
(1) Enhanced health outcomes for individuals 
with one or more chronic conditions. 
(2) Health outcomes for individuals furnished 
telehealth services or home health-related telehealth 
services that are at least comparable to the health 
outcomes for individuals furnished similar items and 
services by a health care provider at the same loca-
tion of the individual or at the home of the indi-
vidual, respectively. 
(3) Facilitation of communication of more accu-
rate clinical information between health care pro-
viders. 
(4) Closer monitoring of individuals by health 
care providers. 
(5) Overall reduction in expenditures for health 
care items and services. 
(6) Improved access to health care. 
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(c) HOME HEALTH-RELATED TELEHEALTH SERV-
ICES DEFINED.—For purposes of this section, the term 
‘‘home health-related telehealth services’’ means tech-
nology-based professional consultations, patient moni-
toring, patient training services, clinical observation, pa-
tient assessment, and any other health services that utilize 
telecommunications technologies. Such term does not in-
clude a telecommunication that consists solely of a tele-
phone audio conversation, facsimile, electronic text mail, 
or consultation between two health care providers. 
(d) REPORT.—Not later than 18 months after the 
date of the enactment of this Act, the Secretary of Health 
and Human Services shall submit to Congress a report 
on the study conducted under subsection (a) and shall in-
clude in such report such recommendations for legislation 
or administration action as the Secretary determines ap-
propriate. 
SEC. 203. STUDY AND REPORT ON STORE AND FORWARD 
TECHNOLOGY FOR TELEHEALTH. 
(a) STUDY.—The Secretary of Health and Human 
Services, acting through the Director of the Office for the 
Advancement of Telehealth, shall conduct a study on the 
use of store and forward technologies (that provide for the 
asynchronous transmission of health care information in 
single or multimedia formats) in the provision of tele-
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