(A) by moving such subparagraph 2 ems to 
the left; and 
(B) by striking the period at the end and 
inserting a semicolon; 
(3) in the subparagraph (H) added by section 
431(a) of such Act (117 Stat. 2287)— 
(A) by redesignating such subparagraph as 
subparagraph (I); 
(B) by moving such subparagraph 2 ems 
to the left; and 
(C) by striking the period at the end and 
inserting ‘‘; and’’; and 
(4) by adding at the end the following new sub-
paragraph: 
‘‘(J) any nonmonetary remuneration (in the 
form of health information technology, as defined in 
section 1128A(b)(4)(B), and related training serv-
ices) made to a person if— 
‘‘(i) such remuneration is solicited or re-
ceived (or offered or paid) without a condition 
that— 
‘‘(I) limits or restricts the use of the 
health information technology to services 
provided by the person to individuals re-
ceiving services at the location of the entity 
providing such technology; 
‘‘(II) limits or restricts the use of the 
health information technology in conjunc-
tion with other health information tech-
nology; or 
‘‘(III) takes into account the volume 
or value of referrals (or other business 
generated) by the person to the entity pro-
viding such technology; 
‘‘(ii) in the case of such remuneration 
made on a date that is on or after the date de-
scribed in section 3(d)(2) of the Health Infor-
mation Technology Promotion Act of 2005, to 
the extent the National Coordinator of Health 
Information Technology has approved a stand-
ard under section 271(c)(3)(B)(i) of the Public 
Health Service Act, the health information tech-
nology provided conforms to such standard; 
‘‘(iii) in the case of such remuneration 
made on or after the date that is three years 
after the date described in section 3(d)(2) of 
the Health Information Technology Promotion 
Act of 2005, if the Secretary establishes criteria 
under section 3(e)(3) of such Act, such remu-
neration is made in accordance with such cri-
teria; and 
‘‘(iv) such remuneration is arranged for in 
a written agreement that is signed by the par-
ties involved and that specifies the remunera-
tion solicited or received (or offered or paid).’’. 
(c) FOR LIMITATION ON CERTAIN PHYSICIAN RE-
FERRALS.—Section 1877(e) of such Act (42 U.S.C. 
1395nn(e)) is amended by adding at the end the following 
new paragraph: 
‘‘(9) INFORMATION TECHNOLOGY AND TRAIN-
ING SERVICES.—Any nonmonetary remuneration (in 
the form of health information technology, as de-
fined in section 1128A(b)(4)(B), and related train-
ing services) made by an entity to a physician if— 
‘‘(A) such remuneration is made without a 
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 location of the entity 
providing such technology; 
‘‘(ii) limits or restricts the use of the 
health information technology in conjunc-
tion with other health information tech-
nology; or 
‘‘(iii) takes into account the volume or 
value of referrals (or other business gen-
erated) by the physician to the entity pro-
viding such technology; 
‘‘(B) in the case of such remuneration 
made on a date that is on or after the date de-
scribed in section 3(d)(2) of the Health Infor-
mation Technology Promotion Act of 2005, to 
the extent the National Coordinator of Health 
Information Technology has approved a stand-
ard under section 271(c)(3)(B)(i) of the Public 
Health Service Act, the health information tech-
nology provided conforms to such standard; 
‘‘(C) in the case of such remuneration 
made on or after the date that is three years 
after the date described in section 3(d)(2) of 
the Health Information Technology Promotion 
Act of 2005, if the Secretary establishes criteria 
under section 3(e)(3) of such Act, such remu-
neration is made in accordance with such cri-
teria; and 
‘‘(D) such remuneration is arranged for in 
a written agreement that is signed by a rep-
resentative of the entity and by the physician 
and that specifies the remuneration made.’’. 
(d) REGULATION, EFFECTIVE DATE, AND EFFECT 
ON STATE LAWS.— 
(1) REGULATIONS.—Not later than 180 days 
after the date of the enactment of this Act, the Sec-
retary of Health and Human Services shall promul-
gate such regulations as may be necessary to carry 
out the provisions of this section. 
(2) EFFECTIVE DATE.—The amendments made 
by this section shall take effect on the date that is 
180 days after the date of the enactment of this Act. 
(3) PREEMPTION OF STATE LAWS.—No State 
(as defined in section 4(a)(3)) shall have in effect a 
State law that imposes a criminal or civil penalty for 
a transaction described in section 1128A(b)(4); 
1128B(b)(3)(J); or 1877(e)(9) of the Social Security 
Act, as added by this section, if the conditions de-
scribed in the respective section, with respect to such 
transaction, are met. 
(e) 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