239 
sist of representatives of nongovernment entities, at 
least one of whom shall be a representative from an 
organization representing health care consumers. 
(2) DUTIES.—The National Committee for 
Vital and Health Statistics shall issue periodic re-
ports and review policies concerning IHRTs based 
on each of the following factors: 
(A) Privacy and security policies. 
(B) Economic progress. 
(C) Interoperability standards. 
(d) POLICIES RECOMMENDED BY FEDERAL TRADE 
COMMISSION.—The Federal Trade Commission, in con-
sultation with the National Committee for Vital and 
Health Statistics, shall recommend policies to— 
(1) provide assistance to encourage the growth 
of independent health record trusts; 
(2) track economic progress as it pertains to 
operators of independent health records trusts and 
individuals receiving nontaxable income with respect 
to accounts; 
(3) conduct public education activities regarding 
the creation and usage of the independent health 
records trusts; 
(4) establish standards for the interoperability 
of health information technology to ensure that in-
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240 
formation contained in such record may be shared 
between the trust involved, the participant, and au-
thorized EHR data users, including for the stand-
ardized collection and transmission of individual 
health records (or portions of such records) to au-
thorized EHR data users through a common inter-
face and for the portability of such records among 
independent health record trusts; and 
(5) carry out any other activities determined 
appropriate by the Federal Trade Commission. 
(e) REGULATIONS
PROMULGATED
BY
FEDERAL 
TRADE COMMISSION.—The Federal Trade Commission 
shall promulgate regulations based on, at a minimum, the 
following factors: 
(1) Requiring that an IHRT participant, who 
has an electronic health record that is maintained by 
an IHRT, be notified of a security breech with re-
spect to such record, and any corrective action taken 
on behalf of the participant. 
(2) Requiring that information sent to, or re-
ceived from, an IHRT that has been designated as 
high-risk should be authenticated through the use of 
methods such as the periodic changing of passwords, 
the use of biometrics, the use of tokens or other 
technology as determined appropriate by the council. 
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241 
(3) Requiring a delay in releasing sensitive 
health care test results and other similar informa-
tion to patients directly in order to give physicians 
time to contact the patient. 
(4) Recommendations for entities operating 
IHRTs, including requiring analysis of the potential 
risk of health transaction security breeches based on 
set criteria. 
(5) The conduct of audits of IHRTs to ensure 
that they are in compliance with the requirements 
and standards established under this subtitle. 
(6) Disclosure to IHRT participants of the 
means by which such trusts are financed, including 
revenue from the sale of patient data. 
(7) Prevention of certification of an entity seek-
ing independent heath record trust certification 
based on— 
(A) the potential for conflicts between the 
interests of such entity and the security of the 
health information involved; and 
(B) the involvement of the entity in any 
activity that is contrary to the best interests of 
a patient. 
(8) Prevention of the use of revenue sources 
that are contrary to a patient’s interests. 
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(9) Public disclosure of audits in a manner 
similar to financial audits required for publicly trad-
ed stock companies. 
(10) Requiring notification to a participating 
entity that the information contained in such record 
may not be representative of the complete or accu-
rate electronic health record of such account holder. 
(f) COMPLIANCE REPORT.—Not later than 1 year 
after the date of the enactment of this Act, and annually 
thereafter, the Commission shall submit to the Committee 
on Health, Education, Labor, and Pensions and the Com-
mittee on Finance of the Senate and the Committee on 
Energy and Commerce and the Committee on Ways and 
Means of the House of Representatives, a report on com-
pliance by and progress of independent health record 
trusts with this subtitle. Such report shall describe the fol-
lowing: 
(1) The number of complaints submitted about 
independent health record trusts, which shall be di-
vided by complaints related to security breaches, and 
complaints not related to security breaches, and may 
include other categories as the Interagency Steering 
Committee established under subsection (b) deter-
mines appropriate. 
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(2) The number of enforcement actions under-
taken by the Commission against independent health 
record trusts in response to complaints under para-
graph (1), which shall be divided by enforcement ac-
tions related to security breaches and enforcement 
actions not related to security breaches and may in-
clude other categories as the Interagency Steering 
Committee established under subsection (b) deter-
mines appropriate. 
(3) The economic progress of the individual 
owner or institution operator as achieved through 
independent health record trust usage and existing 
barriers to such usage. 
(4) The progress in security auditing as pro-
vided for by the Interagency Steering Committee 
council under subsection (b). 
(5) The other core responsibilities of the Com-
mission as described in subsection (a). 
(g) 
INTERAGENCY
MEMORANDUM
OF
UNDER-
STANDING.—The Interagency Steering Committee shall 
ensure, through the execution of an interagency memo-
randum of understanding, that— 
(1) regulations, rulings, and interpretations 
issued by Federal officials relating to the same mat-
ter over which 2 or more such officials have respon-
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244 
sibility under this subtitle are administered so as to 
have the same effect at all times; and 
(2) the memorandum provides for the coordina-
tion of policies related to enforcing the same require-
ments through such officials in order to have coordi-
nated enforcement strategy that avoids duplication 
of enforcement efforts and assigns priorities in en-
forcement. 
TITLE IX—MISCELLANEOUS 
SEC. 901. HEALTH CARE CHOICE FOR VETERANS. 
Beginning not later than 2 years after the date of 
the enactment of this Act, the Secretary of Veterans Af-
fairs may— 
(1) permit veterans, and survivors and depend-
ents of veterans, who are eligible for health care and 
services under the laws administered by the Sec-
retary to receive such care and services through such 
non-Department of Veterans Affairs providers and 
facilities as the Secretary may approve for purposes 
of this section; and 
(2) pursuant to such procedures as the Sec-
retary of Veteran Affairs shall prescribe for purposes 
of this section, make payments to such providers 
and facilities for the provision of such care and serv-
ices to veterans, and such survivors and dependents, 
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at such rates as the Secretary may specify in such 
procedures and in such manner so that the Sec-
retary ensures that the aggregate payments made by 
the Secretary to such providers and facilities do not 
exceed the aggregate amounts which the Secretary 
would have paid for such care and services if this 
section had not been enacted. 
SEC. 902. HEALTH CARE CHOICE FOR INDIANS. 
(a) IN GENERAL.—Beginning not later than 2 years 
after the date of enactment of this Act, the Secretary of 
Health and Human Services shall— 
(1) permit Indians who are eligible for health 
care and services under a health care program oper-
ated or financed by the Indian Health Service or by 
an Indian Tribe, Tribal Organization, or Urban In-
dian Organization (and any such other individuals 
who are so eligible as the Secretary may specify), to 
receive such care and services through such non- In-
dian Health Service, Indian Tribe, Tribal Organiza-
tion, or Urban Indian Organization providers and 
facilities as the Secretary shall approve for purposes 
of this section; and 
(2) pursuant to such procedures as the Sec-
retary of Health and Human Services shall prescribe 
for purposes of this section, make payments to such 
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246 
providers and facilities for the provision of such care 
and services to Indians and individuals described in 
paragraph (1), at such rates as the Secretary shall 
specify in such procedures and in such manner so 
that the Secretary ensures that the aggregate pay-
ments made by the Secretary to such providers and 
facilities do not exceed the aggregate amounts which 
the Secretary would have paid for such care and 
services if this section had not been enacted. 
(b) DEFINITIONS.—In this section, the terms ‘‘In-
dian’’, ‘‘Indian Health Program’’, ‘‘Indian Tribe’’, ‘‘Tribal 
Organization’’, and ‘‘Urban Indian Organization’’ have 
the meanings given those terms in section 4 of the Indian 
Health Care Improvement Act. 
SEC. 903. TERMINATION OF FEDERAL COORDINATING 
COUNCIL 
FOR 
COMPARATIVE 
EFFECTIVE-
NESS RESEARCH. 
The Federal Coordinating Council for Comparative 
Effectiveness Research is hereby terminated and section 
804 of the American Recovery and Reinvestment Act of 
2009 establishing and funding such Council is hereby re-
pealed. 
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SEC. 904. HHS AND GAO JOINT STUDY AND REPORT ON 
COSTS OF THE 5 MEDICAL CONDITIONS THAT 
HAVE THE GREATEST IMPACT. 
(a) STUDY.—The Secretary of Health and Human 
Services (in this section referred to as the ‘‘Secretary’’) 
and the Comptroller General of the United States (in this 
section referred to as the ‘‘Comptroller General’’) shall 
jointly conduct a study on the costs of the top 5 medical 
conditions facing the public which have the greatest im-
pact in terms of morbidity, mortality, and financial cost. 
Such study shall include— 
(1) current estimates as well as a ‘‘generational 
score’’ to capture the financial cost and health toll 
certain medical conditions will inflict on the baby 
boomer generation and on other individuals; and 
(2) a careful review of certain medical condi-
tions, including heart disease, obesity, diabetes, 
stroke, cancer, Alzheimers, and other medical condi-
tions the Secretary and Comptroller General deter-
mine appropriate. 
(b) REPORT.—Not later than 1 year after the date 
of enactment of this Act, the Secretary and the Comp-
troller General shall jointly submit to Congress a report 
containing the results of the study conducted under sub-
section (a), together with recommendations for such legis-
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lation and administrative action as the Secretary and the 
Comptroller General determine appropriate. 
(c) TARGETING OF PREVENTION AND WELLNESS EF-
FORTS.—The Secretary shall target prevention and 
wellness efforts conducted under the provisions of and 
amendments made by this Act in order to combat medical 
conditions identified in the report submitted under sub-
section (b), including such medical conditions identified as 
the top 5 medical conditions facing the public which have 
the greatest impact in terms of morbidity, mortality, and 
financial cost as of or after the date of enactment of this 
Act. 
Æ 
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