provides access to such comments, to 
the Secretary. 
‘‘(iii) SUBMITTAL OF FINAL PROPOSED 
ADDITION OR MODIFICATION TO NCVHS.— 
After completion of the process under clause 
(ii), the standard setting organization sub-
mits the proposed addition or modification 
to the National Committee on Vital and 
Health Statistics for review and consider-
ation under subparagraph (E). Such sub-
mission shall include information on the or-
ganization’s compliance with the notice and 
comment requirements (and responses to 
those comments) under clause (ii). 
‘‘(E) HEARING AND RECOMMENDATIONS BY 
NATIONAL COMMITTEE ON VITAL AND HEALTH 
STATISTICS.—Under the upgrade program, upon 
receipt of a proposal submitted by a standard 
setting 
organization 
under 
subparagraph 
(D)(iii) for the adoption of an addition or modi-
fication to a standard, the National Committee 
on Vital and Health Statistics shall provide no-
tice to the public and a reasonable opportunity 
for public testimony at a hearing on such addi-
tion or modification. The Secretary may partici-
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pate in such hearing in such capacity (including 
presiding ex officio) as the Secretary shall deter-
mine appropriate. Not later than 90 days after 
the date of receipt of the proposal, the Committee 
shall submit to the Secretary its recommendation 
to adopt (or not adopt) the proposed addition or 
modification. 
‘‘(F) DETERMINATION
BY
SECRETARY
TO 
ACCEPT
OR
REJECT
NATIONAL
COMMITTEE
ON 
VITAL AND HEALTH STATISTICS RECOMMENDA-
TION.— 
‘‘(i) TIMELY DETERMINATION.—Under 
the upgrade program, if the National Com-
mittee on Vital and Health Statistics sub-
mits to the Secretary a recommendation 
under subparagraph (E) to adopt a pro-
posed addition or modification, not later 
than 90 days after the date of receipt of 
such recommendation the Secretary shall 
make a determination to accept or reject the 
recommendation and shall publish notice of 
such determination in the Federal Register 
not later than 30 days after the date of the 
determination. 
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‘‘(ii) CONTENTS OF NOTICE.—If the de-
termination is to reject the recommendation, 
such notice shall include the reasons for the 
rejection. If the determination is to accept 
the recommendation, as part of such notice 
the Secretary shall promulgate the modified 
standard (including the accepted proposed 
addition or modification accepted). 
‘‘(iii) 
LIMITATION
ON
CONSIDER-
ATION.—The Secretary shall not consider a 
proposal under this subparagraph unless the 
Secretary determines that the requirements 
of subparagraph (D) (including publication 
of notice and opportunity for public com-
ment) have been met with respect to the 
proposal. 
‘‘(G) EXEMPTION
FROM
PAPERWORK
RE-
DUCTION ACT.—Chapter 35 of title 44, United 
States Code, shall not apply to a final rule pro-
mulgated under subparagraph (F).’’. 
SEC. 202. UPGRADING ASC X12 AND NCPDP STANDARDS. 
The Secretary of Health and Human Services shall 
provide by notice published in the Federal Register for the 
following replacements of standards to apply to trans-
actions occurring on or after April 1, 2009: 
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(1) ACCREDITED
STANDARDS
COMMITTEE
X12 
(ASC X12) STANDARD.—The replacement of the Accred-
ited Standards Committee X12 (ASC X12) version 
4010 adopted under section 1173(a) of such Act (42 
U.S.C. 1320d–2(a)) with the ASC X12 version 5010, 
as reviewed by the National Committee on Vital 
Health Statistics. 
(2) NATIONAL COUNCIL FOR PRESCRIPTION DRUG 
PROGRAMS
(NCPDP)
TELECOMMUNICATIONS
STAND-
ARDS.—The replacement of the National Council for 
Prescription Drug Programs (NCPDP) Telecommuni-
cations Standards version 5.1 adopted under section 
1173(a) of such Act (42 U.S.C. 1320d–2(a)) with 
whichever is the latest version of the NCPDP Tele-
communications Standards that has been approved by 
such Council and reviewed by the National Committee 
on Vital Health Statistics as of April 1, 2007. 
SEC. 203. CODING AND DOCUMENTATION OF NON-MEDICAL 
INFORMATION. 
In any regulation or other action implementing the 
International Classification of Diseases, 10th revision, 
Clinical Modification (ICD–10–CM), the International 
Classification of Diseases, 10th revision, Procedure Coding 
System (ICD–10–PCS), or other version of the Inter-
national Classification of Diseases, 10th revision, the Sec-
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bajohnson on PROD1PC77 with BILLS
retary of Health and Human Services shall ensure that no 
health care provider is required to code to a level of speci-
ficity that would require documentation of non-medical in-
formation on the external cause of any given type of injury. 
TITLE III—PROMOTING THE USE 
OF 
HEALTH 
INFORMATION 
TECHNOLOGY TO BETTER CO-
ORDINATE HEALTH CARE 
SEC. 301. 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 So-
cial 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, main-
tenance, 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 
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property, equipment, or other information technology 
(including new versions, upgrades, and connectivity) 
designed primarily for the electronic creation, main-
tenance, or exchange of health information to better 
coordinate care or improve health care quality, effi-
ciency, or research.’’. 
(b) FOR CRIMINAL PENALTIES.—Section 1128B(b)(3) 
of such Act (42 U.S.C. 1320a–7b(b)(3)) is amended— 
(1) in subparagraph (G), by striking ‘‘and’’ at 
the end; 
(2) in the subparagraph (H) added by section 
237(d) of the Medicare Prescription Drug, Improve-
ment, and Modernization Act of 2003 (Public Law 
108–173; 117 Stat. 2213)— 
(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 
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(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(i)(8), or related installation, mainte-
nance, support or training services) made to a person 
by an entity that is a hospital, group practice, pre-
scription drug plan sponsor, or Medicare Advantage 
organization 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 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 entity; 
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‘‘(ii) such remuneration is arranged for in 
a written agreement that is signed by the parties 
involved (or their representatives) and that 
specifies the remuneration solicited or received 
(or offered or paid) and states that the provision 
of such remuneration is made for the primary 
purpose of better coordination of care or im-
provement of health quality, efficiency, or re-
search; and 
‘‘(iii) the entity providing the remuneration 
(or a representative of such entity) has not taken 
any action to disable any basic feature of any 
hardware or software component of such remu-
neration that would permit interoperability.’’. 
(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 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 imposes a 
criminal or civil penalty for a transaction described 
in section 1128A(b)(4) or section 1128B(b)(3)(J) of 
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such Act, as added by subsections (a)(1) and (b), re-
spectively, if the conditions described 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 Inspector General of the 
Department of Health and Human Services shall con-
duct a study to determine the impact of each of the 
safe harbors described in paragraph (3). In par-
ticular, 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 result 
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. 
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(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 described 
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. 302. EXCEPTION TO LIMITATION ON CERTAIN PHYSI-
CIAN REFERRALS (UNDER STARK) FOR PROVI-
SION 
OF 
HEALTH 
INFORMATION 
TECH-
NOLOGY 
AND 
TRAINING 
SERVICES 
TO 
HEALTH CARE PROFESSIONALS. 
(a) IN GENERAL.—Section 1877(b) of the Social Secu-
rity Act (42 U.S.C. 1395nn(b)) is amended by adding at 
the end the following new paragraph: 
‘‘(6) INFORMATION TECHNOLOGY AND TRAINING 
SERVICES.— 
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‘‘(A) IN GENERAL.—Any nonmonetary re-
muneration (in the form of health information 
technology or related installation, maintenance, 
support or training services) made by an entity 
that is a hospital, group practice, prescription 
drug plan sponsor, or a Medicare Advantage or-
ganization to a physician 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 receiving services at the en-
tity; 
‘‘(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 entity; 
‘‘(ii) such remuneration is arranged 
for in a written agreement that is signed by 
the parties involved (or their representa-
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