171 
cluding for the purposes described in sub-
paragraph (B). 
(B) PURPOSES DESCRIBED.—The purposes 
described in this subparagraph are assisting 
providers of services and suppliers in developing 
and participating in quality and patient care 
improvement activities, including developing 
new models of care. 
(C) MEDICARE
CLAIMS
DATA
MUST
BE 
PROVIDED AT NO COST.—A qualified entity may 
not charge a fee for providing the data under 
subparagraph (A)(ii). 
(3) PROTECTION OF INFORMATION.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), an analysis or data that is 
provided or sold under paragraph (1) or (2) 
shall not contain information that individually 
identifies a patient. 
(B) INFORMATION ON PATIENTS OF THE 
PROVIDER OF SERVICES OR SUPPLIER.—To the 
extent consistent with applicable information, 
privacy, security, and disclosure laws, an anal-
ysis or data that is provided or sold to a pro-
vider of services or supplier under paragraph 
(1) or (2) may contain information that individ-
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00171
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
172 
ually identifies a patient of such provider or 
supplier, including with respect to items and 
services furnished to the patient by other pro-
viders of services or suppliers. 
(C) PROHIBITION ON USING ANALYSES OR 
DATA FOR MARKETING PURPOSES.—An author-
ized user shall not use an analysis or data pro-
vided or sold under paragraph (1) or (2) for 
marketing purposes. 
(4) DATA USE AGREEMENT.—A qualified entity 
and an authorized user described in clauses (i), (ii), 
and (v) of paragraph (9)(A) shall enter into an 
agreement regarding the use of any data that the 
qualified entity is providing or selling to the author-
ized user under paragraph (2). Such agreement shall 
describe the requirements for privacy and security of 
the data and, as determined appropriate by the Sec-
retary, any prohibitions on using such data to link 
to other individually identifiable sources of informa-
tion. If the authorized user is not a covered entity 
under the rules promulgated pursuant to the Health 
Insurance Portability and Accountability Act of 
1996, the agreement shall identify the relevant regu-
lations, as determined by the Secretary, that the 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00172
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
173 
user shall comply with as if it were acting in the ca-
pacity of such a covered entity. 
(5) NO
REDISCLOSURE
OF
ANALYSES
OR 
DATA.— 
(A) IN GENERAL.—Except as provided in 
subparagraph (B), an authorized user that is 
provided or sold an analysis or data under 
paragraph (1) or (2) shall not redisclose or 
make public such analysis or data or any anal-
ysis using such data. 
(B) PERMITTED REDISCLOSURE.—A pro-
vider of services or supplier that is provided or 
sold an analysis or data under paragraph (1) or 
(2) may, as determined by the Secretary, redis-
close such analysis or data for the purposes of 
performance improvement and care coordination 
activities but shall not make public such anal-
ysis or data or any analysis using such data. 
(6) OPPORTUNITY FOR PROVIDERS OF SERV-
ICES AND SUPPLIERS TO REVIEW.—Prior to a quali-
fied entity providing or selling an analysis to an au-
thorized user under paragraph (1), to the extent 
that such analysis would individually identify a pro-
vider of services or supplier who is not being pro-
vided or sold such analysis, such qualified entity 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00173
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
174 
shall provide such provider or supplier with the op-
portunity to appeal and correct errors in the manner 
described in section 1874(e)(4)(C)(ii) of the Social 
Security Act (42 U.S.C. 1395kk(e)(4)(C)(ii)). 
(7) ASSESSMENT FOR A BREACH.— 
(A) IN GENERAL.—In the case of a breach 
of a data use agreement under this section or 
section 1874(e) of the Social Security Act (42 
U.S.C. 1395kk(e)), the Secretary shall impose 
an assessment on the qualified entity both in 
the case of— 
(i) an agreement between the Sec-
retary and a qualified entity; and 
(ii) an agreement between a qualified 
entity and an authorized user. 
(B) ASSESSMENT.—The assessment under 
subparagraph (A) shall be an amount up to 
$100 for each individual entitled to, or enrolled 
for, benefits under part A of title XVIII of the 
Social Security Act or enrolled for benefits 
under part B of such title— 
(i) in the case of an agreement de-
scribed in subparagraph (A)(i), for whom 
the Secretary provided data on to the 
qualified entity under paragraph (2); and 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00174
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
175 
(ii) in the case of an agreement de-
scribed in subparagraph (A)(ii), for whom 
the qualified entity provided data on to the 
authorized user under paragraph (2). 
(C) DEPOSIT OF AMOUNTS COLLECTED.— 
Any amounts collected pursuant to this para-
graph shall be deposited in Federal Supple-
mentary Medical Insurance Trust Fund under 
section 1841 of the Social Security Act (42 
U.S.C. 1395t). 
(8) ANNUAL
REPORTS.—Any qualified entity 
that provides or sells an analysis or data under 
paragraph (1) or (2) shall annually submit to the 
Secretary a report that includes— 
(A) a summary of the analyses provided or 
sold, including the number of such analyses, the 
number of purchasers of such analyses, and the 
total amount of fees received for such analyses; 
(B) a description of the topics and pur-
poses of such analyses; 
(C) information on the entities who re-
ceived the data under paragraph (2), the uses 
of the data, and the total amount of fees re-
ceived for providing, selling, or sharing the 
data; and 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00175
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
176 
(D) other information determined appro-
priate by the Secretary. 
(9) DEFINITIONS.—In this subsection and sub-
section (b): 
(A) AUTHORIZED USER.—The term ‘‘au-
thorized user’’ means the following: 
(i) A provider of services. 
(ii) A supplier. 
(iii) An employer (as defined in sec-
tion 3(5) of the Employee Retirement In-
surance Security Act of 1974). 
(iv) A health insurance issuer (as de-
fined in section 2791 of the Public Health 
Service Act). 
(v) A medical society or hospital asso-
ciation. 
(vi) Any entity not described in 
clauses (i) through (v) that is approved by 
the Secretary (other than an employer or 
health insurance issuer not described in 
clauses (iii) and (iv), respectively, as deter-
mined by the Secretary). 
(B) PROVIDER
OF
SERVICES.—The term 
‘‘provider of services’’ has the meaning given 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00176
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
177 
such term in section 1861(u) of the Social Se-
curity Act (42 U.S.C. 1395x(u)). 
(C) QUALIFIED ENTITY.—The term ‘‘quali-
fied entity’’ has the meaning given such term in 
section 1874(e)(2) of the Social Security Act 
(42 U.S.C. 1395kk(e)). 
(D) SECRETARY.—The term ‘‘Secretary’’ 
means the Secretary of Health and Human 
Services. 
(E) SUPPLIER.—The term ‘‘supplier’’ has 
the meaning given such term in section 1861(d) 
of 
the 
Social 
Security 
Act 
(42 
U.S.C. 
1395x(d)). 
(b) ACCESS
TO MEDICARE DATA
BY QUALIFIED 
CLINICAL DATA REGISTRIES TO FACILITATE QUALITY 
IMPROVEMENT.— 
(1) ACCESS.— 
(A) IN
GENERAL.—To the extent con-
sistent with applicable information, privacy, se-
curity, and disclosure laws, beginning July 1, 
2015, the Secretary shall, at the request of a 
qualified clinical data registry under section 
1848(m)(3)(E) of the Social Security Act (42 
U.S.C. 1395w–4(m)(3)(E)), provide the data 
described in subparagraph (B) (in a form and 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00177
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
178 
manner determined to be appropriate) to such 
qualified clinical data registry for purposes of 
linking such data with clinical outcomes data 
and performing risk-adjusted, scientifically valid 
analyses and research to support quality im-
provement or patient safety, provided that any 
public reporting of such analyses or research 
that identifies a provider of services or supplier 
shall only be conducted with the opportunity of 
such provider or supplier to appeal and correct 
errors in the manner described in subsection 
(a)(6). 
(B) DATA
DESCRIBED.—The data de-
scribed in this subparagraph is— 
(i) claims data under the Medicare 
program under title XVIII of the Social 
Security Act; and 
(ii) if the Secretary determines appro-
priate, claims data under the Medicaid 
program under title XIX of such Act and 
the State Children’s Health Insurance Pro-
gram under title XXI of such Act. 
(2) FEE.—Data described in paragraph (1)(B) 
shall be provided to a qualified clinical data registry 
under paragraph (1) at a fee equal to the cost of 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00178
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
179 
providing such data. Any fee collected pursuant to 
the preceding sentence shall be deposited in the Cen-
ters for Medicare & Medicaid Services Program 
Management Account. 
(c) EXPANSION OF DATA AVAILABLE TO QUALIFIED 
ENTITIES.—Section 1874(e) of the Social Security Act 
(42 U.S.C. 1395kk(e)) is amended— 
(1) in the subsection heading, by striking 
‘‘MEDICARE’’; and 
(2) in paragraph (3)— 
(A) by inserting after the first sentence the 
following new sentence: ‘‘Beginning July 1, 
2015, if the Secretary determines appropriate, 
the data described in this paragraph may also 
include standardized extracts (as determined by 
the Secretary) of claims data under titles XIX 
and XXI for assistance provided under such ti-
tles for one or more specified geographic areas 
and time periods requested by a qualified enti-
ty.’’; and 
(B) in the last sentence, by inserting ‘‘or 
under titles XIX or XXI’’ before the period at 
the end. 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00179
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
180 
(d) REVISION OF PLACEMENT OF FEES.—Section 
1874(e)(4)(A) of the Social Security Act (42 U.S.C. 
1395kk(e)(4)(A)) is amended, in the second sentence— 
(1) by inserting ‘‘, for periods prior to July 1, 
2015,’’ after ‘‘deposited’’; and 
(2) by inserting the following before the period 
at the end: ‘‘, and, beginning July 1, 2015, into the 
Centers for Medicare & Medicaid Services Program 
Management Account’’. 
SEC. 9. REDUCING ADMINISTRATIVE BURDEN AND OTHER 
PROVISIONS. 
(a) MEDICARE PHYSICIAN AND PRACTITIONER OPT- 
OUT TO PRIVATE CONTRACT.— 
(1) INDEFINITE, CONTINUING AUTOMATIC EX-
TENSION OF OPT OUT ELECTION.— 
(A) IN GENERAL.—Section 1802(b)(3) of 
the Social Security Act (42 U.S.C. 1395a(b)(3)) 
is amended— 
(i) in subparagraph (B)(ii), by strik-
ing ‘‘during the 2-year period beginning on 
the date the affidavit is signed’’ and insert-
ing ‘‘during the applicable 2-year period 
(as defined in subparagraph (D))’’; 
(ii) in subparagraph (C), by striking 
‘‘during the 2-year period described in sub-
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00180
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
181 
paragraph (B)(ii)’’ and inserting ‘‘during 
the applicable 2-year period’’; and 
(iii) by adding at the end the fol-
lowing new subparagraph: 
‘‘(D) APPLICABLE
2-YEAR
PERIODS
FOR 
EFFECTIVENESS OF AFFIDAVITS.—In this sub-
section, the term ‘applicable 2-year period’ 
means, with respect to an affidavit of a physi-
cian or practitioner under subparagraph (B), 
the 2-year period beginning on the date the af-
fidavit is signed and includes each subsequent 
2-year period unless the physician or practi-
tioner involved provides notice to the Secretary 
(in a form and manner specified by the Sec-
retary), not later than 30 days before the end 
of the previous 2-year period, that the physician 
or practitioner does not want to extend the ap-
plication of the affidavit for such subsequent 2- 
year period.’’. 
(B) EFFECTIVE DATE.—The amendments 
made by subparagraph (A) shall apply to affi-
davits entered into on or after the date that is 
60 days after the date of the enactment of this 
Act. 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00181
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
182 
(2) PUBLIC AVAILABILITY OF INFORMATION ON 
OPT-OUT PHYSICIANS AND PRACTITIONERS.—Section 
1802(b) of the Social Security Act (42 U.S.C. 
1395a(b)) is amended— 
(A) in paragraph (5), by adding at the end 
the following new subparagraph: 
‘‘(D) OPT-OUT PHYSICIAN OR PRACTITIONER.— 
The term ‘opt-out physician or practitioner’ means 
a physician or practitioner who has in effect an affi-
davit under paragraph (3)(B).’’; 
(B) by redesignating paragraph (5) as 
paragraph (6); and 
(C) by inserting after paragraph (4) the 
following new paragraph: 
‘‘(5) POSTING OF INFORMATION ON OPT-OUT 
PHYSICIANS AND PRACTITIONERS.— 
‘‘(A) IN
GENERAL.—Beginning not later 
than February 1, 2015, the Secretary shall 
make publicly available through an appropriate 
publicly accessible website of the Department of 
Health and Human Services information on the 
number and characteristics of opt-out physi-
cians and practitioners and shall update such 
information on such website not less often than 
annually. 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00182
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
183 
‘‘(B) INFORMATION
TO
BE
INCLUDED.— 
The information to be made available under 
subparagraph (A) shall include at least the fol-
lowing with respect to opt-out physicians and 
practitioners: 
‘‘(i) Their number. 
‘‘(ii) Their physician or professional 
specialty or other designation. 
‘‘(iii) Their geographic distribution. 
‘‘(iv) The timing of their becoming 
opt-out physicians and practitioners, rel-
ative to when they first entered practice 
and with respect to applicable 2-year peri-
ods. 
‘‘(v) The proportion of such physi-
cians and practitioners who billed for 
emergency or urgent care services.’’. 
(b) GAINSHARING STUDY AND REPORT.—Not later 
than 6 months after the date of the enactment of this Act, 
the Secretary of Health and Human Services, in consulta-
tion with the Inspector General of the Department of 
Health and Human Services, shall submit to Congress a 
report with legislative recommendations to amend existing 
fraud and abuse laws, through exceptions, safe harbors, 
or other narrowly targeted provisions, to permit 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00183
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
184 
gainsharing or similar arrangements between physicians 
and hospitals that improve care while reducing waste and 
increasing efficiency. The report shall— 
(1) consider whether such provisions should 
apply to ownership interests, compensation arrange-
ments, or other relationships; 
(2) describe how the recommendations address 
accountability, transparency, and quality, including 
how best to limit inducements to stint on care, dis-
charge patients prematurely, or otherwise reduce or 
limit medically necessary care; and 
(3) consider whether a portion of any savings 
generated by such arrangements should accrue to 
the Medicare program under title XVIII of the So-
cial Security Act. 
(c) PROMOTING INTEROPERABILITY OF ELECTRONIC 
HEALTH RECORD SYSTEMS.— 
(1) RECOMMENDATIONS FOR ACHIEVING WIDE-
SPREAD EHR INTEROPERABILITY.— 
(A) OBJECTIVE.—As a consequence of a 
significant Federal investment in the implemen-
tation of health information technology through 
the Medicare and Medicaid EHR incentive pro-
grams, Congress declares it a national objective 
to achieve widespread exchange of health infor-
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00184
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
185 
mation through interoperable certified EHR 
technology nationwide by December 31, 2017. 
(B) DEFINITIONS.—In this paragraph: 
(i) 
WIDESPREAD
INTEROPER-
ABILITY.—The term ‘‘widespread inter-
operability’’ means interoperability between 
certified EHR technology systems em-
ployed by meaningful EHR users under 
the Medicare and Medicaid EHR incentive 
programs and other clinicians and health 
care providers on a nationwide basis. 
(ii) INTEROPERABILITY.—The term 
‘‘interoperability’’ means the ability of two 
or more health information systems or 
components to exchange clinical and other 
information and to use the information 
that has been exchanged using common 
standards as to provide access to longitu-
dinal information for health care providers 
in order to facilitate coordinated care and 
improved patient outcomes. 
(C) ESTABLISHMENT
OF
METRICS.—Not 
later than July 1, 2015, and in consultation 
with stakeholders, the Secretary shall establish 
metrics to be used to determine if and to the 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00185
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
186 
extent that the objective described in subpara-
graph (A) has been achieved. 
(D) RECOMMENDATIONS
IF
OBJECTIVE 
NOT
ACHIEVED.—If the Secretary of Health 
and Human Services determines that the objec-
tive described in subparagraph (A) has not been 
achieved by December 31, 2017, then the Sec-
retary shall submit to Congress a report, by not 
later than December 31, 2018, that identifies 
barriers to such objective and recommends ac-
tions that the Federal Government can take to 
achieve such objective. Such recommended ac-
tions may include recommendations— 
(i) to adjust payments for not being 
meaningful EHR users under the Medicare 
EHR incentive programs; and 
(ii) for criteria for decertifying cer-
tified EHR technology products. 
(2) PREVENTING BLOCKING THE SHARING OF 
INFORMATION.— 
(A) FOR
MEANINGFUL
EHR
PROFES-
SIONALS.—Section 1848(o)(2)(A)(ii) of the So-
cial 
Security 
Act 
(42 
U.S.C. 
1395w– 
4(o)(2)(A)(ii)) is amended by inserting before 
the period at the end the following: ‘‘, and the 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00186
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
187 
professional demonstrates (through a process 
specified by the Secretary, such as the use of an 
attestation) that the professional has not know-
ingly and willfully taken any action to limit or 
restrict the compatibility or interoperability of 
the certified EHR technology’’. 
(B) FOR MEANINGFUL EHR HOSPITALS.— 
Section 1886(n)(3)(A)(ii) of the Social Security 
Act (42 U.S.C. 1395ww(n)(3)(A)(ii)) is amend-
ed by inserting before the period at the end the 
following: ‘‘, and the hospital demonstrates 
(through a process specified by the Secretary, 
such as the use of an attestation) that the hos-
pital has not knowingly and willfully taken any 
action to limit or restrict the compatibility or 
interoperability of the certified EHR tech-
nology’’. 
(C) EFFECTIVE DATE.—The amendments 
made by this subsection shall apply to meaning-
ful EHR users as of the date that is one year 
after the date of the enactment of this Act. 
(3) STUDY AND REPORT ON THE FEASIBILITY 
OF
ESTABLISHING
A
WEBSITE
TO
COMPARE
CER-
TIFIED EHR TECHNOLOGY PRODUCTS.— 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00187
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
188 
(A) STUDY.—The Secretary shall conduct 
a study to examine the feasibility of estab-
lishing mechanisms that includes aggregated re-
sults of surveys of meaningful EHR users on 
the functionality of certified EHR technology 
products to enable such users to directly com-
pare the functionality and other features of 
such products. Such information may be made 
available through contracts with physician, hos-
pital, or other organizations that maintain such 
comparative information. 
(B) REPORT.—Not later than 1 year after 
the date of the enactment of this Act, the Sec-
retary shall submit to Congress a report on the 
website. The report shall include information on 
the benefits of, and resources needed to develop 
and maintain, such a website. 
(4) DEFINITIONS.—In this subsection: 
(A) The term ‘‘certified EHR technology’’ 
has the meaning given such term in section 
1848(o)(4) of the Social Security Act (42 
U.S.C. 1395w–4(o)(4)). 
(B) The term ‘‘meaningful EHR user’’ has 
the meaning given such term under the Medi-
care EHR incentive programs. 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00188
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
189 
(C) The term ‘‘Medicare and Medicaid 
EHR incentive programs’’ means— 
(i) in the case of the Medicare pro-
gram under title XVIII of the Social Secu-
rity Act, the incentive programs under sec-
tion 1814(l)(3), section 1848(o), sub-
sections (l) and (m) of section 1853, and 
section 1886(n) of the Social Security Act 
(42 
U.S.C. 
1395f(l)(3), 
1395w–4(o), 
1395w–23, 1395ww(n)); and 
(ii) in the case of the Medicaid pro-
gram under title XIX of such Act, the in-
centive 
program 
under 
subsections 
(a)(3)(F) and (t) of section 1903 of such 
Act (42 U.S.C. 1396b). 
(D) The term ‘‘Secretary’’ means the Sec-
retary of Health and Human Services. 
(d) GAO STUDIES AND REPORTS ON THE USE OF 
TELEHEALTH UNDER FEDERAL PROGRAMS AND ON RE-
MOTE PATIENT MONITORING SERVICES.— 
(1) STUDY ON TELEHEALTH SERVICES.—The 
Comptroller General of the United States shall con-
duct a study on the following: 
(A) How the definition of telehealth across 
various Federal programs and Federal efforts 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00189
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
190 
can inform the use of telehealth in the Medicare 
program under title XVIII of the Social Secu-
rity Act (42 U.S.C. 1395 et seq.). 
(B) Issues that can facilitate or inhibit the 
use of telehealth under the Medicare program 
under such title, including oversight and profes-
sional licensure, changing technology, privacy 
and security, infrastructure requirements, and 
varying needs across urban and rural areas. 
(C) Potential implications of greater use of 
telehealth with respect to payment and delivery 
system transformations under the Medicare 
program under such title XVIII and the Med-
icaid program under title XIX of such Act (42 
U.S.C. 1396 et seq.). 
(D) How the Centers for Medicare & Med-
icaid Services conducts oversight of payments 
made under the Medicare program under such 
title XVIII to providers for telehealth services. 
(2) STUDY ON REMOTE PATIENT MONITORING 
SERVICES.— 
(A) IN GENERAL.—The Comptroller Gen-
eral of the United States shall conduct a 
study— 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00190
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
191 
(i) of the dissemination of remote pa-
tient monitoring technology in the private 
health insurance market; 
(ii) of the financial incentives in the 
private health insurance market relating to 
adoption of such technology; 
(iii) of the barriers to adoption of 
such services under the Medicare program 
under title XVIII of the Social Security 
Act; 
(iv) that evaluates the patients, condi-
tions, and clinical circumstances that could 
most benefit from remote patient moni-
toring services; and 
(v) that evaluates the challenges re-
lated to establishing appropriate valuation 
for remote patient monitoring services 
under the Medicare physician fee schedule 
under section 1848 of the Social Security 
Act (42 U.S.C. 1395w–4) in order to accu-
rately reflect the resources involved in fur-
nishing such services. 
(B) DEFINITIONS.—For purposes of this 
paragraph: 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00191
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
192 
(i) REMOTE
PATIENT
MONITORING 
SERVICES.—The term ‘‘remote patient 
monitoring services’’ means services fur-
nished through remote patient monitoring 
technology. 
(ii) REMOTE
PATIENT
MONITORING 
TECHNOLOGY.—The term ‘‘remote patient 
monitoring technology’’ means a coordi-
nated system that uses one or more home- 
based or mobile monitoring devices that 
automatically transmit vital sign data or 
information on activities of daily living and 
may include responses to assessment ques-
tions collected on the devices wirelessly or 
through a telecommunications connection 
to a server that complies with the Federal 
regulations (concerning the privacy of indi-
vidually identifiable health information) 
promulgated under section 264(c) of the 
Health Insurance Portability and Account-
ability Act of 1996, as part of an estab-
lished plan of care for that patient that in-
cludes the review and interpretation of that 
data by a health care professional. 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00192
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
193 
(3) REPORTS.—Not later than 24 months after 
the date of the enactment of this Act, the Comp-
troller General shall submit to Congress— 
(A) a report containing the results of the 
study conducted under paragraph (1); and 
(B) a report containing the results of the 
study conducted under paragraph (2). 
A report required under this paragraph shall be sub-
mitted together with recommendations for such leg-
islation and administrative action as the Comptroller 
General determines appropriate. The Comptroller 
General may submit one report containing the re-
sults described in subparagraphs (A) and (B) and 
the recommendations described in the previous sen-
tence. 
(e) 
RULE
OF
CONSTRUCTION
REGARDING 
HEALTHCARE PROVIDER STANDARDS OF CARE.— 
(1) MAINTENANCE
OF
STATE
STANDARDS.— 
The development, recognition, or implementation of 
any guideline or other standard under any Federal 
health care provision shall not be construed— 
(A) to establish the standard of care or 
duty of care owed by a health care provider to 
a patient in any medical malpractice or medical 
product liability action or claim; or 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00193
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
194 
(B) to preempt any standard of care or 
duty of care, owed by a health care provider to 
a patient, duly established under State or com-
mon law. 
(2) DEFINITIONS.—For purposes of this sub-
section: 
(A) FEDERAL HEALTH CARE PROVISION.— 
The term ‘‘Federal health care provision’’ 
means any provision of the Patient Protection 
and Affordable Care Act (Public Law 111– 
148), title I or subtitle B of title II of the 
Health Care and Education Reconciliation Act 
of 2010 (Public Law 111–152), or title XVIII 
or XIX of the Social Security Act. 
(B) HEALTH CARE PROVIDER.—The term 
‘‘health care provider’’ means any individual or 
entity— 
(i) licensed, registered, or certified 
under Federal or State laws or regulations 
to provide health care services; or 
(ii) required to be so licensed, reg-
istered, or certified but that is exempted 
by other statute or regulation. 
(C) MEDICAL MALPRACTICE OR MEDICAL 
PRODUCT
LIABILITY
ACTION
OR
CLAIM.—The 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00194
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
195 
term ‘‘medical malpractice or medical product 
liability action or claim’’ means a medical mal-
practice action or claim (as defined in section 
431(7) of the Health Care Quality Improve-
ment Act of 1986 (42 U.S.C. 11151(7))) and 
includes a liability action or claim relating to a 
health care provider’s prescription or provision 
of a drug, device, or biological product (as such 
terms are defined in section 201 of the Federal 
Food, Drug, and Cosmetic Act or section 351 
of the Public Health Service Act). 
(D) STATE.—The term ‘‘State’’ includes 
the District of Columbia, Puerto Rico, and any 
other commonwealth, possession, or territory of 
the United States. 
(3) PRESERVATION OF STATE LAW.—No provi-
sion of the Patient Protection and Affordable Care 
Act (Public Law 111–148), title I or subtitle B of 
title II of the Health Care and Education Reconcili-
ation Act of 2010 (Public Law 111–152), or title 
XVIII or XIX of the Social Security Act shall be 
construed to preempt any State or common law gov-
erning medical professional or medical product liabil-
ity actions or claims. 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00195
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
196 
SEC. 10. SAVINGS FROM OVERSEAS CONTINGENCY AND RE-
LATED ACTIVITIES. 
(a) IN GENERAL.—Section 251 of the Balanced 
Budget and Emergency Deficit Control Act of 1985 (2 
U.S.C. 901) is amended— 
(1) in subsection (b)(2)(A)(ii), by inserting ‘‘for 
fiscal years 2012 through 2015,’’ before ‘‘the Con-
gress’’; and 
(2) by adding at the end the following: 
‘‘(E) 
OVERSEAS
CONTINGENCY
OPER-
ATIONS/GLOBAL WAR ON TERRORISM.—If, for 
fiscal years 2016 through 2021, appropriations 
for discretionary accounts are enacted that 
Congress designates for Overseas Contingency 
Operations/Global War on Terrorism in statute 
on an account by account basis and the Presi-
dent subsequently so designates, the adjustment 
for the fiscal year shall be the total of such ap-
propriations for the fiscal year in discretionary 
accounts designated as being for Overseas Con-
tingency Operations/Global War on Terrorism, 
but not to exceed— 
‘‘(i) 
For 
fiscal 
year 
2016, 
$29,946,000,000 in budget authority. 
‘‘(ii) 
For 
fiscal 
year 
2017, 
$29,946,000,000 in budget authority. 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00196
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
197 
‘‘(iii) 
For 
fiscal 
year 
2018, 
$29,946,000,000 in budget authority. 
‘‘(iv) 
For 
fiscal 
year 
2019, 
$29,946,000,000 in budget authority. 
‘‘(v) 
For 
fiscal 
year 
2020, 
$29,946,000,000 in budget authority. 
‘‘(vi) 
For 
fiscal 
year 
2021, 
$29,946,000,000 in budget authority.’’. 
(b) BREACH.—Section 251(a)(2) of such Act (2 
U.S.C. 901(a)(2)) is amended to read as follows: 
‘‘(2) ELIMINATING A BREACH.— 
‘‘(A) IN GENERAL.—Each non-exempt ac-
count within a category shall be reduced by a 
dollar amount calculated by multiplying the en-
acted level of sequestrable budgetary resources 
in that account by the uniform percentage nec-
essary to eliminate a breach within that cat-
egory. 
‘‘(B) 
OVERSEAS
CONTINGENCIES.—Any 
amount of budget authority for Overseas Con-
tingency Operations/Global War on Terrorism 
for fiscal years 2016 through 2021 in excess of 
the levels set in subsection 251(b)(2)(E) shall 
be counted in determining whether a breach has 
occurred in the security category and the non-
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00197
Fmt 6652
Sfmt 6201
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS
198 
security category on a proportional basis to the 
total spending for overseas contingency oper-
ations in the security category and the nonsecu-
rity category.’’. 
Æ 
VerDate Mar 15 2010 
03:09 Mar 14, 2014
Jkt 039200
PO 00000
Frm 00198
Fmt 6652
Sfmt 6301
E:\BILLS\H4209.IH
H4209
jbell on DSK7SPTVN1PROD with BILLS