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AMDT. NO. 98 
‘‘Subtitle A—Promotion of Health 
Information Technology 
‘‘SEC. 3001. OFFICE OF THE NATIONAL COORDINATOR FOR 
HEALTH INFORMATION TECHNOLOGY. 
‘‘(a) ESTABLISHMENT.—There is established within 
the Department of Health and Human Services an Office 
of the National Coordinator for Health Information Tech-
nology (referred to in this section as the ‘Office’). The Of-
fice shall be headed by a National Coordinator who shall 
be appointed by the Secretary and shall report directly to 
the Secretary. 
‘‘(b) PURPOSE.—The National Coordinator shall per-
form the duties under subsection (c) in a manner con-
sistent with the development of a nationwide health infor-
mation technology infrastructure that allows for the elec-
tronic use and exchange of information and that— 
‘‘(1) ensures that each patient’s health informa-
tion is secure and protected, in accordance with ap-
plicable law; 
‘‘(2) improves health care quality, reduces med-
ical errors, and advances the delivery of patient-cen-
tered medical care; 
‘‘(3) reduces health care costs resulting from 
inefficiency, medical errors, inappropriate care, du-
plicative care, and incomplete information; 
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AMDT. NO. 98 
‘‘(4) provides appropriate information to help 
guide medical decisions at the time and place of 
care; 
‘‘(5) ensures the inclusion of meaningful public 
input in such development of such infrastructure; 
‘‘(6) improves the coordination of care and in-
formation among hospitals, laboratories, physician 
offices, and other entities through an effective infra-
structure for the secure and authorized exchange of 
health care information; 
‘‘(7) improves public health activities and facili-
tates the early identification and rapid response to 
public health threats and emergencies, including bio-
terror events and infectious disease outbreaks; 
‘‘(8) facilitates health and clinical research and 
health care quality; 
‘‘(9) promotes early detection, prevention, and 
management of chronic diseases; 
‘‘(10) promotes a more effective marketplace, 
greater competition, greater systems analysis, in-
creased consumer choice, and improved outcomes in 
health care services; and 
‘‘(11) improves efforts to reduce health dispari-
ties. 
‘‘(c) DUTIES OF THE NATIONAL COORDINATOR.— 
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‘‘(1) STANDARDS.—The National Coordinator 
shall review and determine whether to endorse each 
standard, implementation specification, and certifi-
cation criterion for the electronic exchange and use 
of health information that is recommended by the 
HIT Standards Committee under section 3003 for 
purposes of adoption under section 3004. The Coor-
dinator shall make such determination, and report to 
the Secretary such determination, not later than 45 
days after the date the recommendation is received 
by the Coordinator. 
‘‘(2) HIT POLICY COORDINATION.— 
‘‘(A) IN GENERAL.—The National Coordi-
nator shall coordinate health information tech-
nology policy and programs of the Department 
with those of other relevant executive branch 
agencies with a goal of avoiding duplication of 
efforts and of helping to ensure that each agen-
cy undertakes health information technology ac-
tivities primarily within the areas of its greatest 
expertise and technical capability and in a man-
ner towards a coordinated national goal. 
‘‘(B) HIT POLICY AND STANDARDS COM-
MITTEES.—The National Coordinator shall be a 
leading member in the establishment and oper-
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AMDT. NO. 98 
ations of the HIT Policy Committee and the 
HIT Standards Committee and shall serve as a 
liaison among those two Committees and the 
Federal Government. 
‘‘(3) STRATEGIC PLAN.— 
‘‘(A) IN GENERAL.—The National Coordi-
nator shall, in consultation with other appro-
priate Federal agencies (including the National 
Institute of Standards and Technology), update 
the Federal Health IT Strategic Plan (devel-
oped as of June 3, 2008) to include specific ob-
jectives, milestones, and metrics with respect to 
the following: 
‘‘(i) The electronic exchange and use 
of health information and the enterprise 
integration of such information. 
‘‘(ii) The utilization of an electronic 
health record for each person in the United 
States by 2014. 
‘‘(iii) The incorporation of privacy and 
security protections for the electronic ex-
change of an individual’s individually iden-
tifiable health information. 
‘‘(iv) Ensuring security methods to 
ensure appropriate authorization and elec-
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AMDT. NO. 98 
tronic authentication of health information 
and specifying technologies or methodolo-
gies for rendering health information unus-
able, unreadable, or indecipherable. 
‘‘(v) Specifying a framework for co-
ordination and flow of recommendations 
and policies under this subtitle among the 
Secretary, the National Coordinator, the 
HIT Policy Committee, the HIT Standards 
Committee, and other health information 
exchanges and other relevant entities. 
‘‘(vi) Methods to foster the public un-
derstanding of health information tech-
nology. 
‘‘(vii) Strategies to enhance the use of 
health information technology in improving 
the quality of health care, reducing medical 
errors, reducing health disparities, improv-
ing public health, increasing prevention 
and coordination with community re-
sources, and improving the continuity of 
care among health care settings. 
‘‘(viii) Specific plans for ensuring that 
populations with unique needs, such as 
children, are appropriately addressed in 
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AMDT. NO. 98 
the technology design, as appropriate, 
which 
may 
include 
technology 
that 
automates enrollment and retention for eli-
gible individuals. 
‘‘(B) 
COLLABORATION.—The 
strategic 
plan shall be updated through collaboration of 
public and private entities. 
‘‘(C) MEASURABLE
OUTCOME
GOALS.— 
The strategic plan update shall include measur-
able outcome goals. 
‘‘(D) PUBLICATION.—The National Coor-
dinator shall republish the strategic plan, in-
cluding all updates. 
‘‘(4) WEBSITE.—The National Coordinator 
shall maintain and frequently update an Internet 
website on which there is posted information on the 
work, schedules, reports, recommendations, and 
other information to ensure transparency in pro-
motion of a nationwide health information tech-
nology infrastructure. 
‘‘(5) CERTIFICATION.— 
‘‘(A) IN GENERAL.—The National Coordi-
nator, in consultation with the Director of the 
National Institute of Standards and Tech-
nology, shall develop a program (either directly 
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AMDT. NO. 98 
or by contract) for the voluntary certification of 
health information technology as being in com-
pliance with applicable certification criteria 
adopted under this subtitle. Such program shall 
include testing of the technology in accordance 
with section 14201(b) of the Health Informa-
tion Technology for Economic and Clinical 
Health Act. 
‘‘(B) 
CERTIFICATION
CRITERIA
DE-
SCRIBED.—In this title, the term ‘certification 
criteria’ means, with respect to standards and 
implementation specifications for health infor-
mation technology, criteria to establish that the 
technology meets such standards and implemen-
tation specifications. 
‘‘(6) REPORTS AND PUBLICATIONS.— 
‘‘(A) REPORT
ON
ADDITIONAL
FUNDING 
OR AUTHORITY NEEDED.—Not later than 12 
months after the date of the enactment of this 
title, the National Coordinator shall submit to 
the appropriate committees of jurisdiction of 
the House of Representatives and the Senate a 
report on any additional funding or authority 
the Coordinator or the HIT Policy Committee 
or HIT Standards Committee requires to evalu-
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AMDT. NO. 98 
ate and develop standards, implementation 
specifications, and certification criteria, or to 
achieve full participation of stakeholders in the 
adoption of a nationwide health information 
technology infrastructure that allows for the 
electronic use and exchange of health informa-
tion. 
‘‘(B) 
IMPLEMENTATION
REPORT.—The 
National Coordinator shall prepare a report 
that identifies lessons learned from major pub-
lic and private health care systems in their im-
plementation of health information technology, 
including information on whether the tech-
nologies and practices developed by such sys-
tems may be applicable to and usable in whole 
or in part by other health care providers. 
‘‘(C) ASSESSMENT OF IMPACT OF HIT ON 
COMMUNITIES WITH HEALTH DISPARITIES AND 
UNINSURED, UNDERINSURED, AND MEDICALLY 
UNDERSERVED AREAS.—The National Coordi-
nator shall assess and publish the impact of 
health information technology in communities 
with health disparities and in areas with a high 
proportion of individuals who are uninsured, 
underinsured, and medically underserved indi-
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AMDT. NO. 98 
viduals (including urban and rural areas) and 
identify practices to increase the adoption of 
such technology by health care providers in 
such communities, and the use of health infor-
mation technology to reduce and better manage 
chronic diseases. 
‘‘(D) EVALUATION
OF
BENEFITS
AND 
COSTS
OF
THE
ELECTRONIC
USE
AND
EX-
CHANGE OF HEALTH INFORMATION.—The Na-
tional Coordinator shall evaluate and publish 
evidence on the benefits and costs of the elec-
tronic use and exchange of health information 
and assess to whom these benefits and costs ac-
crue. 
‘‘(E) 
RESOURCE
REQUIREMENTS.—The 
National Coordinator shall estimate and publish 
resources required annually to reach the goal of 
utilization of an electronic health record for 
each person in the United States by 2014, in-
cluding the required level of Federal funding, 
expectations for regional, State, and private in-
vestment, and the expected contributions by vol-
unteers to activities for the utilization of such 
records. 
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AMDT. NO. 98 
‘‘(7) ASSISTANCE.—The National Coordinator 
may provide financial assistance to consumer advo-
cacy groups and not-for-profit entities that work in 
the public interest for purposes of defraying the cost 
to such groups and entities to participate under, 
whether in whole or in part, the National Tech-
nology Transfer Act of 1995 (15 U.S.C. 272 note). 
‘‘(8) GOVERNANCE FOR NATIONWIDE HEALTH 
INFORMATION
NETWORK.—The National Coordi-
nator shall establish a governance mechanism for the 
nationwide health information network. 
‘‘(d) DETAIL OF FEDERAL EMPLOYEES.— 
‘‘(1) IN GENERAL.—Upon the request of the 
National Coordinator, the head of any Federal agen-
cy is authorized to detail, with or without reimburse-
ment from the Office, any of the personnel of such 
agency to the Office to assist it in carrying out its 
duties under this section. 
‘‘(2) EFFECT OF DETAIL.—Any detail of per-
sonnel under paragraph (1) shall— 
‘‘(A) not interrupt or otherwise affect the 
civil service status or privileges of the Federal 
employee; and 
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AMDT. NO. 98 
‘‘(B) be in addition to any other staff of 
the Department employed by the National Co-
ordinator. 
‘‘(3) ACCEPTANCE
OF
DETAILEES.—Notwith-
standing any other provision of law, the Office may 
accept detailed personnel from other Federal agen-
cies without regard to whether the agency described 
under paragraph (1) is reimbursed. 
‘‘(e) CHIEF PRIVACY OFFICER OF THE OFFICE OF 
THE
NATIONAL
COORDINATOR.—Not later than 12 
months after the date of the enactment of this title, the 
Secretary shall appoint a Chief Privacy Officer of the Of-
fice of the National Coordinator, whose duty it shall be 
to advise the National Coordinator on privacy, security, 
and data stewardship of electronic health information and 
to coordinate with other Federal agencies (and similar pri-
vacy officers in such agencies), with State and regional 
efforts, and with foreign countries with regard to the pri-
vacy, security, and data stewardship of electronic individ-
ually identifiable health information. 
‘‘SEC. 3002. HIT POLICY COMMITTEE. 
‘‘(a) ESTABLISHMENT.—There is established a HIT 
Policy Committee to make policy recommendations to the 
National Coordinator relating to the implementation of a 
nationwide health information technology infrastructure, 
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AMDT. NO. 98 
including implementation of the strategic plan described 
in section 3001(c)(3). 
‘‘(b) DUTIES.— 
‘‘(1) RECOMMENDATIONS ON HEALTH INFOR-
MATION TECHNOLOGY INFRASTRUCTURE.—The HIT 
Policy Committee shall recommend a policy frame-
work for the development and adoption of a nation-
wide health information technology infrastructure 
that permits the electronic exchange and use of 
health information as is consistent with the strategic 
plan under section 3001(c)(3) and that includes the 
recommendations under paragraph (2). The Com-
mittee shall update such recommendations and make 
new recommendations as appropriate. 
‘‘(2) SPECIFIC AREAS OF STANDARD DEVELOP-
MENT.— 
‘‘(A) IN GENERAL.—The HIT Policy Com-
mittee shall recommend the areas in which 
standards, implementation specifications, and 
certification criteria are needed for the elec-
tronic exchange and use of health information 
for purposes of adoption under section 3004 
and shall recommend an order of priority for 
the development, harmonization, and recogni-
tion of such standards, specifications, and cer-
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AMDT. NO. 98 
tification criteria among the areas so rec-
ommended. Such standards and implementation 
specifications shall include named standards, 
architectures, and software schemes for the au-
thentication and security of individually identifi-
able health information and other information 
as needed to ensure the reproducible develop-
ment of common solutions across disparate en-
tities. 
‘‘(B) AREAS
REQUIRED
FOR
CONSIDER-
ATION.—For purposes of subparagraph (A), the 
HIT Policy Committee shall make recommenda-
tions for at least the following areas: 
‘‘(i) Technologies that protect the pri-
vacy of health information and promote se-
curity in a qualified electronic health 
record, including for the segmentation and 
protection from disclosure of specific and 
sensitive individually identifiable health in-
formation with the goal of minimizing the 
reluctance of patients to seek care (or dis-
close information about a condition) be-
cause of privacy concerns, in accordance 
with applicable law, and for the use and 
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AMDT. NO. 98 
disclosure of limited data sets of such in-
formation. 
‘‘(ii) A nationwide health information 
technology infrastructure that allows for 
the electronic use and accurate exchange of 
health information. 
‘‘(iii) The utilization of a certified 
electronic health record for each person in 
the United States by 2014. 
‘‘(iv) Technologies that as a part of a 
qualified electronic health record allow for 
an accounting of disclosures made by a 
covered entity (as defined for purposes of 
regulations promulgated under section 
264(c) of the Health Insurance Portability 
and Accountability Act of 1996) for pur-
poses of treatment, payment, and health 
care operations (as such terms are defined 
for purposes of such regulations). 
‘‘(v) The use of certified electronic 
health records to improve the quality of 
health care, such as by promoting the co-
ordination of health care and improving 
continuity of health care among health 
care providers, by reducing medical errors, 
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AMDT. NO. 98 
by improving population health, reducing 
chronic disease, and by advancing research 
and education. 
‘‘(C) 
OTHER
AREAS
FOR
CONSIDER-
ATION.—In making recommendations under 
subparagraph (A), the HIT Policy Committee 
may consider the following additional areas: 
‘‘(i) The appropriate uses of a nation-
wide health information infrastructure, in-
cluding for purposes of— 
‘‘(I) the collection of quality data 
and public reporting; 
‘‘(II) biosurveillance and public 
health; 
‘‘(III) medical and clinical re-
search; and 
‘‘(IV) drug safety. 
‘‘(ii) Self-service technologies that fa-
cilitate the use and exchange of patient in-
formation and reduce wait times. 
‘‘(iii) Telemedicine technologies, in 
order to reduce travel requirements for pa-
tients in remote areas. 
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AMDT. NO. 98 
‘‘(iv) Technologies that facilitate home 
health care and the monitoring of patients 
recuperating at home. 
‘‘(v) Technologies that help reduce 
medical errors. 
‘‘(vi) Technologies that facilitate the 
continuity of care among health settings. 
‘‘(vii) Technologies that meet the 
needs of diverse populations. 
‘‘(viii) Technologies and design fea-
tures that address the needs of children 
and other vulnerable populations. 
‘‘(ix) Any other technology that the 
HIT Policy Committee finds to be among 
the technologies with the greatest potential 
to improve the quality and efficiency of 
health care. 
‘‘(3) FORUM.—The HIT Policy Committee shall 
serve as a forum for broad stakeholder input with 
specific expertise in policies relating to the matters 
described in paragraphs (1) and (2). 
‘‘(c) MEMBERSHIP AND OPERATIONS.— 
‘‘(1) IN GENERAL.—The National Coordinator 
shall provide leadership in the establishment and op-
erations of the HIT Policy Committee. 
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AMDT. NO. 98 
‘‘(2) MEMBERSHIP.—The membership of the 
HIT Policy Committee shall at least reflect pro-
viders, ancillary healthcare workers, consumers, pur-
chasers, health plans, technology vendors, research-
ers, relevant Federal agencies, and individuals with 
technical expertise on health care quality, privacy 
and security, and on the electronic exchange and use 
of health information. 
‘‘(3) CONSIDERATION.—The National Coordi-
nator shall ensure that the relevant recommenda-
tions and comments from the National Committee 
on Vital and Health Statistics are considered in the 
development of policies. 
‘‘(d) APPLICATION OF FACA.—The Federal Advisory 
Committee Act (5 U.S.C. App.), other than section 14 of 
such Act, shall apply to the HIT Policy Committee. 
‘‘(e) PUBLICATION.—The Secretary shall provide for 
publication in the Federal Register and the posting on the 
Internet website of the Office of the National Coordinator 
for Health Information Technology of all policy rec-
ommendations made by the HIT Policy Committee under 
this section. 
‘‘SEC. 3003. HIT STANDARDS COMMITTEE. 
‘‘(a) ESTABLISHMENT.—There is established a com-
mittee to be known as the HIT Standards Committee to 
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AMDT. NO. 98 
recommend to the National Coordinator standards, imple-
mentation specifications, and certification criteria for the 
electronic exchange and use of health information for pur-
poses of adoption under section 3004, consistent with the 
implementation of the strategic plan described in section 
3001(c)(3) and beginning with the areas listed in section 
3002(b)(2)(B) in accordance with policies developed by 
the HIT Policy Committee. 
‘‘(b) DUTIES.— 
‘‘(1) STANDARD DEVELOPMENT.— 
‘‘(A) IN GENERAL.—The HIT Standards 
Committee shall recommend to the National 
Coordinator standards, implementation speci-
fications, and certification criteria described in 
subsection (a) that have been developed, har-
monized, or recognized by the HIT Standards 
Committee. The HIT Standards Committee 
shall update such recommendations and make 
new recommendations as appropriate, including 
in response to a notification sent under section 
3004(b)(2). Such recommendations shall be 
consistent with the latest recommendations 
made by the HIT Policy Committee. 
‘‘(B) PILOT TESTING OF STANDARDS AND 
IMPLEMENTATION SPECIFICATIONS.—In the de-
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AMDT. NO. 98 
velopment, harmonization, or recognition of 
standards and implementation specifications, 
the HIT Standards Committee shall, as appro-
priate, provide for the testing of such standards 
and specifications by the National Institute for 
Standards and Technology under section 14201 
of the Health Information Technology for Eco-
nomic and Clinical Health Act. 
‘‘(C) CONSISTENCY.—The standards, im-
plementation specifications, and certification 
criteria recommended under this subsection 
shall be consistent with the standards for infor-
mation transactions and data elements adopted 
pursuant to section 1173 of the Social Security 
Act. 
‘‘(2) FORUM.—The HIT Standards Committee 
shall serve as a forum for the participation of a 
broad range of stakeholders to provide input on the 
development, harmonization, and recognition of 
standards, implementation specifications, and certifi-
cation criteria necessary for the development and 
adoption of a nationwide health information tech-
nology infrastructure that allows for the electronic 
use and exchange of health information. 
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AMDT. NO. 98 
‘‘(3) SCHEDULE.—Not later than 90 days after 
the date of the enactment of this title, the HIT 
Standards Committee shall develop a schedule for 
the assessment of policy recommendations developed 
by the HIT Policy Committee under section 3002. 
The HIT Standards Committee shall update such 
schedule annually. The Secretary shall publish such 
schedule in the Federal Register. 
‘‘(4) PUBLIC
INPUT.—The HIT Standards 
Committee shall conduct open public meetings and 
develop a process to allow for public comment on the 
schedule described in paragraph (3) and rec-
ommendations described in this subsection. Under 
such process comments shall be submitted in a time-
ly manner after the date of publication of a rec-
ommendation under this subsection. 
‘‘(c) MEMBERSHIP AND OPERATIONS.— 
‘‘(1) IN GENERAL.—The National Coordinator 
shall provide leadership in the establishment and op-
erations of the HIT Standards Committee. 
‘‘(2) MEMBERSHIP.—The membership of the 
HIT Standards Committee shall at least reflect pro-
viders, ancillary healthcare workers, consumers, pur-
chasers, health plans, technology vendors, research-
ers, relevant Federal agencies, and individuals with 
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AMDT. NO. 98 
technical expertise on health care quality, privacy 
and security, and on the electronic exchange and use 
of health information. 
‘‘(3) CONSIDERATION.—The National Coordi-
nator shall ensure that the relevant recommenda-
tions and comments from the National Committee 
on Vital and Health Statistics are considered in the 
development of standards. 
‘‘(4) ASSISTANCE.—For the purposes of car-
rying out this section, the Secretary may provide or 
ensure that financial assistance is provided by the 
HIT Standards Committee to defray in whole or in 
part any membership fees or dues charged by such 
Committee to those consumer advocacy groups and 
not for profit entities that work in the public inter-
est as a part of their mission. 
‘‘(d) APPLICATION OF FACA.—The Federal Advisory 
Committee Act (5 U.S.C. App.), other than section 14, 
shall apply to the HIT Standards Committee. 
‘‘(e) PUBLICATION.—The Secretary shall provide for 
publication in the Federal Register and the posting on the 
Internet website of the Office of the National Coordinator 
for Health Information Technology of all recommenda-
tions made by the HIT Standards Committee under this 
section. 
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AMDT. NO. 98 
‘‘SEC. 3004. PROCESS FOR ADOPTION OF ENDORSED REC-
OMMENDATIONS; ADOPTION OF INITIAL SET 
OF STANDARDS, IMPLEMENTATION SPECI-
FICATIONS, AND CERTIFICATION CRITERIA. 
‘‘(a) PROCESS FOR ADOPTION OF ENDORSED REC-
OMMENDATIONS.— 
‘‘(1) REVIEW OF ENDORSED STANDARDS, IM-
PLEMENTATION
SPECIFICATIONS, 
AND
CERTIFI-
CATION CRITERIA.—Not later than 90 days after the 
date of receipt of standards, implementation speci-
fications, or certification criteria endorsed under sec-
tion 3001(c), the Secretary, in consultation with rep-
resentatives of other relevant Federal agencies, shall 
jointly review such standards, implementation speci-
fications, or certification criteria and shall determine 
whether or not to propose adoption of such stand-
ards, implementation specifications, or certification 
criteria. 
‘‘(2) DETERMINATION TO ADOPT STANDARDS, 
IMPLEMENTATION
SPECIFICATIONS, AND
CERTIFI-
CATION CRITERIA.—If the Secretary determines— 
‘‘(A) to propose adoption of any grouping 
of such standards, implementation specifica-
tions, or certification criteria, the Secretary 
shall, by regulation, determine whether or not 
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AMDT. NO. 98 
to adopt such grouping of standards, implemen-
tation specifications, or certification criteria; or 
‘‘(B) not to propose adoption of any group-
ing of standards, implementation specifications, 
or certification criteria, the Secretary shall no-
tify the National Coordinator and the HIT 
Standards Committee in writing of such deter-
mination and the reasons for not proposing the 
adoption of such recommendation. 
‘‘(3) PUBLICATION.—The Secretary shall pro-
vide for publication in the Federal Register of all de-
terminations made by the Secretary under para-
graph (1). 
‘‘(b) ADOPTION OF INITIAL SET OF STANDARDS, IM-
PLEMENTATION SPECIFICATIONS, AND CERTIFICATION 
CRITERIA.— 
‘‘(1) IN GENERAL.—Not later than December 
31, 2009, the Secretary shall, through the rule-
making process described in section 3003, adopt an 
initial set of standards, implementation specifica-
tions, and certification criteria for the areas required 
for consideration under section 3002(b)(2)(B). 
‘‘(2) APPLICATION
OF
CURRENT
STANDARDS, 
IMPLEMENTATION
SPECIFICATIONS, AND
CERTIFI-
CATION CRITERIA.—The standards, implementation 
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AMDT. NO. 98 
or use the standards and implementation specifications 
adopted under section 3004 with respect to activities not 
related to the contract. 
‘‘SEC. 
3007. 
FEDERAL 
HEALTH 
INFORMATION 
TECH-
NOLOGY. 
‘‘(a) IN GENERAL.—The National Coordinator shall 
support the development, routine updating and provision 
of qualified EHR technology (as defined in section 3000) 
consistent with subsections (b) and (c) unless the Sec-
retary determines that the needs and demands of pro-
viders are being substantially and adequately met through 
the marketplace. 
‘‘(b) CERTIFICATION.—In making such EHR tech-
nology publicly available, the National Coordinator shall 
ensure that the qualified EHR technology described in 
subsection (a) is certified under the program developed 
under section 3001(c)(3) to be in compliance with applica-
ble standards adopted under section 3003(a). 
‘‘(c) AUTHORIZATION
TO
CHARGE
A
NOMINAL 
FEE.—The National Coordinator may impose a nominal 
fee for the adoption by a health care provider of the health 
information technology system developed or approved 
under subsection (a) and (b). Such fee shall take into ac-
count the financial circumstances of smaller providers, low 
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AMDT. NO. 98 
income providers, and providers located in rural or other 
medically underserved areas. 
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion shall be construed to require that a private or govern-
ment entity adopt or use the technology provided under 
this section. 
‘‘SEC. 3008. TRANSITIONS. 
‘‘(a) ONCHIT.—To the extent consistent with sec-
tion 3001, all functions, personnel, assets, liabilities, and 
administrative actions applicable to the National Coordi-
nator for Health Information Technology appointed under 
Executive Order 13335 or the Office of such National Co-
ordinator on the date before the date of the enactment 
of this title shall be transferred to the National Coordi-
nator appointed under section 3001(a) and the Office of 
such National Coordinator as of the date of the enactment 
of this title. 
‘‘(b) AHIC.— 
‘‘(1) To the extent consistent with sections 
3002 and 3003, all functions, personnel, assets, and 
liabilities applicable to the AHIC Successor, Inc. 
doing business as the National eHealth Collaborative 
as of the day before the date of the enactment of 
this title shall be transferred to the HIT Policy 
Committee or the HIT Standards Committee, estab-
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AMDT. NO. 98 
lished under section 3002(a) or 3003(a), as appro-
priate, as of the date of the enactment of this title. 
‘‘(2) In carrying out section 3003(b)(1)(A), 
until recommendations are made by the HIT Policy 
Committee, recommendations of the HIT Standards 
Committee shall be consistent with the most recent 
recommendations made by such AHIC Successor, 
Inc. 
‘‘(c) RULES OF CONSTRUCTION.— 
‘‘(1) ONCHIT.—Nothing in section 3001 or 
subsection (a) shall be construed as requiring the 
creation of a new entity to the extent that the Office 
of the National Coordinator for Health Information 
Technology established pursuant to Executive Order 
13335 is consistent with the provisions of section 
3001. 
‘‘(2) AHIC.—Nothing in sections 3002 or 3003 
or subsection (b) shall be construed as prohibiting 
the AHIC Successor, Inc. doing business as the Na-
tional eHealth Collaborative from modifying its char-
ter, duties, membership, and any other structure or 
function required to be consistent with section 3002 
and 3003 in a manner that would permit the Sec-
retary to choose to recognize such AHIC Successor, 
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AMDT. NO. 98 
Inc. as the HIT Policy Committee or the HIT 
Standards Committee. 
‘‘SEC. 3009. RELATION TO HIPAA PRIVACY AND SECURITY 
LAW. 
‘‘(a) IN GENERAL.—With respect to the relation of 
this title to HIPAA privacy and security law: 
‘‘(1) This title may not be construed as having 
any effect on the authorities of the Secretary under 
HIPAA privacy and security law. 
‘‘(2) The purposes of this title include ensuring 
that the health information technology standards 
and implementation specifications adopted under 
section 3004 take into account the requirements of 
HIPAA privacy and security law. 
‘‘(b) DEFINITION.—For purposes of this section, the 
term ‘HIPAA privacy and security law’ means— 
‘‘(1) the provisions of part C of title XI of the 
Social Security Act, section 264 of the Health Insur-
ance Portability and Accountability Act of 1996, and 
subtitle D of the Health Information Technology for 
Economic and Clinical Health Act; and 
‘‘(2) regulations under such provisions.’’. 
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AMDT. NO. 98 
SEC. 13102. TECHNICAL AMENDMENT. 
Section 1171(5) of the Social Security Act (42 U.S.C. 
1320d) is amended by striking ‘‘or C’’ and inserting ‘‘C, 
or D’’. 
PART II—APPLICATION AND USE OF ADOPTED 
HEALTH 
INFORMATION 
TECHNOLOGY 
STANDARDS; REPORTS 
SEC. 13111. COORDINATION OF FEDERAL ACTIVITIES WITH 
ADOPTED STANDARDS AND IMPLEMENTA-
TION SPECIFICATIONS. 
(a) SPENDING
ON HEALTH INFORMATION TECH-
NOLOGY SYSTEMS.—As each agency (as defined in the Ex-
ecutive Order issued on August 22, 2006, relating to pro-
moting quality and efficient health care in Federal govern-
ment administered or sponsored health care programs) im-
plements, acquires, or upgrades health information tech-
nology systems used for the direct exchange of individually 
identifiable health information between agencies and with 
non-Federal entities, it shall utilize, where available, 
health information technology systems and products that 
meet standards and implementation specifications adopted 
under section 3004(b) of the Public Health Service Act, 
as added by section 13101. 
(b) FEDERAL INFORMATION COLLECTION ACTIVI-
TIES.—With respect to a standard or implementation 
specification adopted under section 3004(b) of the Public 
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AMDT. NO. 98 
Health Service Act, as added by section 13101, the Presi-
dent shall take measures to ensure that Federal activities 
involving the broad collection and submission of health in-
formation are consistent with such standard or implemen-
tation specification, respectively, within three years after 
the date of such adoption. 
(c) APPLICATION OF DEFINITIONS.—The definitions 
contained in section 3000 of the Public Health Service 
Act, as added by section 13101, shall apply for purposes 
of this part. 
SEC. 13112. APPLICATION TO PRIVATE ENTITIES. 
Each agency (as defined in such Executive Order 
issued on August 22, 2006, relating to promoting quality 
and efficient health care in Federal government adminis-
tered or sponsored health care programs) shall require in 
contracts or agreements with health care providers, health 
plans, or health insurance issuers that as each provider, 
plan, or issuer implements, acquires, or upgrades health 
information technology systems, it shall utilize, where 
available, health information technology systems and prod-
ucts that meet standards and implementation specifica-
tions adopted under section 3004(b) of the Public Health 
Service Act, as added by section 13101. 
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AMDT. NO. 98 
SEC. 13113. STUDY AND REPORTS. 
(a) REPORT ON ADOPTION OF NATIONWIDE SYS-
TEM.—Not later than 2 years after the date of the enact-
ment of this Act and annually thereafter, the Secretary 
of Health and Human Services shall submit to the appro-
priate committees of jurisdiction of the House of Rep-
resentatives and the Senate a report that— 
(1) describes the specific actions that have been 
taken by the Federal Government and private enti-
ties to facilitate the adoption of a nationwide system 
for the electronic use and exchange of health infor-
mation; 
(2) describes barriers to the adoption of such a 
nationwide system; and 
(3) contains recommendations to achieve full 
implementation of such a nationwide system. 
(b) REIMBURSEMENT INCENTIVE STUDY AND RE-
PORT.— 
(1) STUDY.—The Secretary of Health and 
Human Services shall carry out, or contract with a 
private entity to carry out, a study that examines 
methods to create efficient reimbursement incentives 
for improving health care quality in Federally quali-
fied health centers, rural health clinics, and free 
clinics. 
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AMDT. NO. 98 
(2) REPORT.—Not later than 2 years after the 
date of the enactment of this Act, the Secretary of 
Health and Human Services shall submit to the ap-
propriate committees of jurisdiction of the House of 
Representatives and the Senate a report on the 
study carried out under paragraph (1). 
(c) AGING SERVICES TECHNOLOGY STUDY AND RE-
PORT.— 
(1) IN GENERAL.—The Secretary of Health and 
Human Services shall carry out, or contract with a 
private entity to carry out, a study of matters relat-
ing to the potential use of new aging services tech-
nology to assist seniors, individuals with disabilities, 
and their caregivers throughout the aging process. 
(2) MATTERS
TO
BE
STUDIED.—The study 
under paragraph (1) shall include— 
(A) an evaluation of— 
(i) methods for identifying current, 
emerging, and future health technology 
that can be used to meet the needs of sen-
iors and individuals with disabilities and 
their caregivers across all aging services 
settings, as specified by the Secretary; 
(ii) methods for fostering scientific in-
novation with respect to aging services 
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AMDT. NO. 98 
technology within the business and aca-
demic communities; and 
(iii) developments in aging services 
technology in other countries that may be 
applied in the United States; and 
(B) identification of— 
(i) barriers to innovation in aging 
services technology and devising strategies 
for removing such barriers; and 
(ii) barriers to the adoption of aging 
services technology by health care pro-
viders and consumers and devising strate-
gies to removing such barriers. 
(3) REPORT.—Not later than 24 months after 
the date of the enactment of this Act, the Secretary 
shall submit to the appropriate committees of juris-
diction of the House of Representatives and of the 
Senate a report on the study carried out under para-
graph (1). 
(4) DEFINITIONS.—For purposes of this sub-
section: 
(A) AGING SERVICES TECHNOLOGY.—The 
term ‘‘aging services technology’’ means health 
technology that meets the health care needs of 
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AMDT. NO. 98 
seniors, individuals with disabilities, and the 
caregivers of such seniors and individuals. 
(B) SENIOR.—The term ‘‘senior’’ has such 
meaning as specified by the Secretary. 
Subtitle B—Testing of Health 
Information Technology 
SEC. 13201. NATIONAL INSTITUTE FOR STANDARDS AND 
TECHNOLOGY TESTING. 
(a) PILOT TESTING OF STANDARDS AND IMPLEMEN-
TATION SPECIFICATIONS.—In coordination with the HIT 
Standards Committee established under section 3003 of 
the Public Health Service Act, as added by section 13101, 
with respect to the development of standards and imple-
mentation specifications under such section, the Director 
of the National Institute for Standards and Technology 
shall test such standards and implementation specifica-
tions, as appropriate, in order to assure the efficient im-
plementation and use of such standards and implementa-
tion specifications. 
(b) VOLUNTARY TESTING PROGRAM.—In coordina-
tion with the HIT Standards Committee established under 
section 3003 of the Public Health Service Act, as added 
by section 13101, with respect to the development of 
standards and implementation specifications under such 
section, the Director of the National Institute of Stand-
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AMDT. NO. 98 
ards and Technology shall support the establishment of 
a conformance testing infrastructure, including the devel-
opment of technical test beds. The development of this 
conformance testing infrastructure may include a program 
to accredit independent, non-Federal laboratories to per-
form testing. 
SEC. 13202. RESEARCH AND DEVELOPMENT PROGRAMS. 
(a) HEALTH CARE INFORMATION ENTERPRISE INTE-
GRATION RESEARCH CENTERS.— 
(1) IN GENERAL.—The Director of the National 
Institute of Standards and Technology, in consulta-
tion with the Director of the National Science Foun-
dation and other appropriate Federal agencies, shall 
establish a program of assistance to institutions of 
higher education (or consortia thereof which may in-
clude nonprofit entities and Federal Government 
laboratories) to establish multidisciplinary Centers 
for Health Care Information Enterprise Integration. 
(2) REVIEW; COMPETITION.—Grants shall be 
awarded under this subsection on a merit-reviewed, 
competitive basis. 
(3) PURPOSE.—The purposes of the Centers de-
scribed in paragraph (1) shall be— 
(A) to generate innovative approaches to 
health care information enterprise integration 
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AMDT. NO. 98 
by conducting cutting-edge, multidisciplinary 
research on the systems challenges to health 
care delivery; and 
(B) the development and use of health in-
formation technologies and other complemen-
tary fields. 
(4) RESEARCH AREAS.—Research areas may in-
clude— 
(A) interfaces between human information 
and communications technology systems; 
(B) voice-recognition systems; 
(C) software that improves interoperability 
and connectivity among health information sys-
tems; 
(D) software dependability in systems crit-
ical to health care delivery; 
(E) measurement of the impact of informa-
tion technologies on the quality and productivity 
of health care; 
(F) health information enterprise manage-
ment; 
(G) health information technology security 
and integrity; and 
(H) relevant health information technology 
to reduce medical errors. 
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AMDT. NO. 98 
(5) APPLICATIONS.—An institution of higher 
education (or a consortium thereof) seeking funding 
under this subsection shall submit an application to 
the Director of the National Institute of Standards 
and Technology at such time, in such manner, and 
containing such information as the Director may re-
quire. The application shall include, at a minimum, 
a description of— 
(A) the research projects that will be un-
dertaken by the Center established pursuant to 
assistance under paragraph (1) and the respec-
tive contributions of the participating entities; 
(B) how the Center will promote active col-
laboration among scientists and engineers from 
different disciplines, such as information tech-
nology, biologic sciences, management, social 
sciences, and other appropriate disciplines; 
(C) technology transfer activities to dem-
onstrate and diffuse the research results, tech-
nologies, and knowledge; and 
(D) how the Center will contribute to the 
education and training of researchers and other 
professionals in fields relevant to health infor-
mation enterprise integration. 
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AMDT. NO. 98 
(b) NATIONAL
INFORMATION
TECHNOLOGY
RE-
SEARCH AND DEVELOPMENT PROGRAM.—The National 
High-Performance Computing Program established by 
section 101 of the High-Performance Computing Act of 
1991 (15 U.S.C. 5511) shall coordinate Federal research 
and development programs related to the development and 
deployment of health information technology, including ac-
tivities related to— 
(1) computer infrastructure; 
(2) data security; 
(3) development of large-scale, distributed, reli-
able computing systems; 
(4) wired, wireless, and hybrid high-speed net-
working; 
(5) development of software and software-inten-
sive systems; 
(6) human-computer interaction and informa-
tion management technologies; and 
(7) the social and economic implications of in-
formation technology. 
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AMDT. NO. 98 
Subtitle C—Incentives for the Use 
of Health Information Technology 
PART I—GRANTS AND LOANS FUNDING 
SEC. 13301. GRANT, LOAN, AND DEMONSTRATION PRO-
GRAMS. 
Title XXX of the Public Health Service Act, as added 
by section 13101, is amended by adding at the end the 
following new subtitle: 
‘‘Subtitle B—Incentives for the Use 
of Health Information Technology 
‘‘SEC. 3011. IMMEDIATE FUNDING TO STRENGTHEN THE 
HEALTH INFORMATION TECHNOLOGY INFRA-
STRUCTURE. 
‘‘(a) IN GENERAL.—The Secretary of Health and 
Human Services shall, using amounts appropriated under 
section 3018, invest in the infrastructure necessary to 
allow for and promote the electronic exchange and use of 
health information for each individual in the United States 
consistent with the goals outlined in the strategic plan de-
veloped by the National Coordinator (and, as available) 
under section 3001. To the greatest extent practicable, the 
Secretary shall ensure that any funds so appropriated 
shall be used for the acquisition of health information 
technology that meets standards and certification criteria 
adopted before the date of the enactment of this title until 
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AMDT. NO. 98 
such date as the standards are adopted under section 
3004. The Secretary shall invest funds through the dif-
ferent agencies with expertise in such goals, such as the 
Office of the National Coordinator for Health Information 
Technology, the Health Resources and Services Adminis-
tration, the Agency for Healthcare Research and Quality, 
the Centers of Medicare & Medicaid Services, the Centers 
for Disease Control and Prevention, and the Indian 
Health Service to support the following: 
‘‘(1) Health information technology architecture 
that will support the nationwide electronic exchange 
and use of health information in a secure, private, 
and accurate manner, including connecting health 
information exchanges, and which may include up-
dating and implementing the infrastructure nec-
essary within different agencies of the Department 
of Health and Human Services to support the elec-
tronic use and exchange of health information. 
‘‘(2) Development and adoption of appropriate 
certified electronic health records for categories of 
providers not eligible for support under title XVIII 
or XIX of the Social Security Act for the adoption 
of such records. 
‘‘(3) Training on and dissemination of informa-
tion on best practices to integrate health information 
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AMDT. NO. 98 
technology, including electronic health records, into 
a provider’s delivery of care, consistent with best 
practices learned from the Health Information Tech-
nology Research Center developed under section 
3012, including community health centers receiving 
assistance under section 330 of the Public Health 
Service Act, covered entities under section 340B of 
such Act, and providers participating in one or more 
of the programs under titles XVIII, XIX, and XXI 
of the Social Security Act (relating to Medicare, 
Medicaid, and the State Children’s Health Insurance 
Program). 
‘‘(4) Infrastructure and tools for the promotion 
of telemedicine, including coordination among Fed-
eral agencies in the promotion of telemedicine. 
‘‘(5) Promotion of the interoperability of clinical 
data repositories or registries. 
‘‘(6) Promotion of technologies and best prac-
tices that enhance the protection of health informa-
tion by all holders of individually identifiable health 
information. 
‘‘(7) Improve and expand the use of health in-
formation technology by public health departments. 
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‘‘(8) Provide $300,000,000 to support regional 
or sub-national efforts towards health information 
exchange. 
‘‘(b) COORDINATION.—The Secretary shall ensure 
funds under this section are used in a coordinated manner 
with other health information promotion activities. 
‘‘(c) ADDITIONAL USE OF FUNDS.—In addition to 
using funds as provided in subsection (a), the Secretary 
may use amounts appropriated under section 3018 to 
carry out activities that are provided for under laws in 
effect on the date of enactment of this title. 
‘‘SEC. 3012. HEALTH INFORMATION TECHNOLOGY IMPLE-
MENTATION ASSISTANCE. 
‘‘(a) HEALTH INFORMATION TECHNOLOGY EXTEN-
SION PROGRAM.—To assist health care providers to adopt, 
implement, and effectively use certified EHR technology 
that allows for the electronic exchange and use of health 
information, the Secretary, acting through the Office of 
the National Coordinator, shall establish a health informa-
tion technology extension program to provide health infor-
mation technology assistance services to be carried out 
through the Department of Health and Human Services. 
The National Coordinator shall consult with other Federal 
agencies with demonstrated experience and expertise in in-
formation technology services, such as the National Insti-
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AMDT. NO. 98 
tute of Standards and Technology, in developing and im-
plementing this program. 
‘‘(b) HEALTH
INFORMATION
TECHNOLOGY
RE-
SEARCH CENTER.— 
‘‘(1) IN GENERAL.—The Secretary shall create 
a Health Information Technology Research Center 
(in this section referred to as the ‘Center’) to pro-
vide technical assistance and develop or recognize 
best practices to support and accelerate efforts to 
adopt, implement, and effectively utilize health infor-
mation technology that allows for the electronic ex-
change and use of information in compliance with 
standards, implementation specifications, and certifi-
cation criteria adopted under section 3004(b). 
‘‘(2) INPUT.—The Center shall incorporate 
input from— 
‘‘(A) other Federal agencies with dem-
onstrated experience and expertise in informa-
tion technology services such as the National 
Institute of Standards and Technology; 
‘‘(B) users of health information tech-
nology, such as providers and their support and 
clerical staff and others involved in the care and 
care coordination of patients, from the health 
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AMDT. NO. 98 
care and health information technology indus-
try; and 
‘‘(C) others as appropriate. 
‘‘(3) PURPOSES.—The purposes of the Center 
are to— 
‘‘(A) provide a forum for the exchange of 
knowledge and experience; 
‘‘(B) accelerate the transfer of lessons 
learned from existing public and private sector 
initiatives, including those currently receiving 
Federal financial support; 
‘‘(C) assemble, analyze, and widely dis-
seminate evidence and experience related to the 
adoption, implementation, and effective use of 
health information technology that allows for 
the electronic exchange and use of information 
including through the regional centers described 
in subsection (c); 
‘‘(D) provide technical assistance for the 
establishment and evaluation of regional and 
local health information networks to facilitate 
the electronic exchange of information across 
health care settings and improve the quality of 
health care; 
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‘‘(E) provide technical assistance for the 
development and dissemination of solutions to 
barriers to the exchange of electronic health in-
formation; and 
‘‘(F) learn about effective strategies to 
adopt and utilize health information technology 
in medically underserved communities. 
‘‘(c) HEALTH
INFORMATION
TECHNOLOGY
RE-
GIONAL EXTENSION CENTERS.— 
‘‘(1) IN GENERAL.—The Secretary shall provide 
assistance for the creation and support of regional 
centers (in this subsection referred to as ‘regional 
centers’) to provide technical assistance and dissemi-
nate best practices and other information learned 
from the Center to support and accelerate efforts to 
adopt, implement, and effectively utilize health infor-
mation technology that allows for the electronic ex-
change and use of information in compliance with 
standards, implementation specifications, and certifi-
cation criteria adopted under section 3004. Activities 
conducted under this subsection shall be consistent 
with the strategic plan developed by the National 
Coordinator (and, as available) under section 3001. 
‘‘(2) AFFILIATION.—Regional centers shall be 
affiliated with any United States-based nonprofit in-
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AMDT. NO. 98 
stitution or organization, or group thereof, that ap-
plies and is awarded financial assistance under this 
section. Individual awards shall be decided on the 
basis of merit. 
‘‘(3) OBJECTIVE.—The objective of the regional 
centers is to enhance and promote the adoption of 
health information technology through— 
‘‘(A) assistance with the implementation, 
effective use, upgrading, and ongoing mainte-
nance of health information technology, includ-
ing electronic health records, to healthcare pro-
viders nationwide; 
‘‘(B) broad participation of individuals 
from industry, universities, and State govern-
ments; 
‘‘(C) active dissemination of best practices 
and research on the implementation, effective 
use, upgrading, and ongoing maintenance of 
health information technology, including elec-
tronic health records, to health care providers 
in order to improve the quality of healthcare 
and protect the privacy and security of health 
information; 
‘‘(D) participation, to the extent prac-
ticable, in health information exchanges; 
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AMDT. NO. 98 
‘‘(E) utilization, when appropriate, of the 
expertise and capability that exists in federal 
agencies other than the Department; and 
‘‘(F) integration of health information 
technology, including electronic health records, 
into the initial and ongoing training of health 
professionals and others in the healthcare in-
dustry that would be instrumental to improving 
the quality of healthcare through the smooth 
and accurate electronic use and exchange of 
health information. 
‘‘(4) REGIONAL
ASSISTANCE.—Each regional 
center shall aim to provide assistance and education 
to all providers in a region, but shall prioritize any 
direct assistance first to the following: 
‘‘(A) Public or not-for-profit hospitals or 
critical access hospitals. 
‘‘(B) Federally qualified health centers (as 
defined in section 1861(aa)(4) of the Social Se-
curity Act). 
‘‘(C) Entities that are located in rural and 
other areas that serve uninsured, underinsured, 
and medically underserved individuals (regard-
less of whether such area is urban or rural). 
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AMDT. NO. 98 
‘‘(D) Individual or small group practices 
(or a consortium thereof) that are primarily fo-
cused on primary care. 
‘‘(5) FINANCIAL SUPPORT.—The Secretary may 
provide financial support to any regional center cre-
ated under this subsection for a period not to exceed 
four years. The Secretary may not provide more 
than 50 percent of the capital and annual operating 
and maintenance funds required to create and main-
tain such a center, except in an instance of national 
economic conditions which would render this cost- 
share requirement detrimental to the program and 
upon notification to Congress as to the justification 
to waive the cost-share requirement. 
‘‘(6) NOTICE OF PROGRAM DESCRIPTION AND 
AVAILABILITY OF FUNDS.—The Secretary shall pub-
lish in the Federal Register, not later than 90 days 
after the date of the enactment of this Act, a draft 
description of the program for establishing regional 
centers under this subsection. Such description shall 
include the following: 
‘‘(A) A detailed explanation of the program 
and the programs goals. 
‘‘(B) Procedures to be followed by the ap-
plicants. 
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AMDT. NO. 98 
‘‘(C) Criteria for determining qualified ap-
plicants. 
‘‘(D) Maximum support levels expected to 
be available to centers under the program. 
‘‘(7) APPLICATION
REVIEW.—The Secretary 
shall subject each application under this subsection 
to merit review. In making a decision whether to ap-
prove such application and provide financial support, 
the Secretary shall consider at a minimum the mer-
its of the application, including those portions of the 
application regarding— 
‘‘(A) the ability of the applicant to provide 
assistance under this subsection and utilization 
of health information technology appropriate to 
the needs of particular categories of health care 
providers; 
‘‘(B) the types of service to be provided to 
health care providers; 
‘‘(C) geographical diversity and extent of 
service area; and 
‘‘(D) the percentage of funding and 
amount of in-kind commitment from other 
sources. 
‘‘(8) BIENNIAL
EVALUATION.—Each regional 
center which receives financial assistance under this 
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AMDT. NO. 98 
subsection shall be evaluated biennially by an evalua-
tion panel appointed by the Secretary. Each evalua-
tion panel shall be composed of private experts, none 
of whom shall be connected with the center involved, 
and of Federal officials. Each evaluation panel shall 
measure the involved center’s performance against 
the objective specified in paragraph (3). The Sec-
retary shall not continue to provide funding to a re-
gional center unless its evaluation is overall positive. 
‘‘(9) CONTINUING SUPPORT.—After the second 
year of assistance under this subsection a regional 
center may receive additional support under this 
subsection if it has received positive evaluations and 
a finding by the Secretary that continuation of Fed-
eral funding to the center was in the best interest 
of provision of health information technology exten-
sion services. 
‘‘SEC. 3013. STATE GRANTS TO PROMOTE HEALTH INFOR-
MATION TECHNOLOGY. 
‘‘(a) IN GENERAL.—The Secretary, acting through 
the National Coordinator, shall establish a program in ac-
cordance with this section to facilitate and expand the 
electronic movement and use of health information among 
organizations according to nationally recognized stand-
ards. 
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AMDT. NO. 98 
‘‘(b) PLANNING GRANTS.—The Secretary may award 
a grant to a State or qualified State-designated entity (as 
described in subsection (d)) that submits an application 
to the Secretary at such time, in such manner, and con-
taining such information as the Secretary may specify, for 
the purpose of planning activities described in subsection 
(b). 
‘‘(c) IMPLEMENTATION
GRANTS.—The Secretary 
may award a grant to a State or qualified State designated 
entity that— 
‘‘(1) has submitted, and the Secretary has ap-
proved, a plan described in subsection (c) (regardless 
of whether such plan was prepared using amounts 
awarded under paragraph (1)); and 
‘‘(2) submits an application at such time, in 
such manner, and containing such information as 
the Secretary may specify. 
‘‘(d) USE OF FUNDS.—Amounts received under a 
grant under subsection (a)(3) shall be used to conduct ac-
tivities to facilitate and expand the electronic movement 
and use of health information among organizations ac-
cording to nationally recognized standards through activi-
ties that include— 
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AMDT. NO. 98 
‘‘(1) enhancing broad and varied participation 
in the authorized and secure nationwide electronic 
use and exchange of health information; 
‘‘(2) identifying State or local resources avail-
able towards a nationwide effort to promote health 
information technology; 
‘‘(3) complementing other Federal grants, pro-
grams, and efforts towards the promotion of health 
information technology; 
‘‘(4) providing technical assistance for the de-
velopment and dissemination of solutions to barriers 
to the exchange of electronic health information; 
‘‘(5) promoting effective strategies to adopt and 
utilize health information technology in medically 
underserved communities; 
‘‘(6) assisting patients in utilizing health infor-
mation technology; 
‘‘(7) encouraging clinicians to work with Health 
Information Technology Regional Extension Centers 
as described in section 3012, to the extent they are 
available and valuable; 
‘‘(8) supporting public health agencies’ author-
ized use of and access to electronic health informa-
tion; 
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AMDT. NO. 98 
‘‘(9) promoting the use of electronic health 
records for quality improvement including through 
quality measures reporting; and 
‘‘(10) such other activities as the Secretary may 
specify. 
‘‘(e) PLAN.— 
‘‘(1) IN GENERAL.—A plan described in this 
subsection is a plan that describes the activities to 
be carried out by a State or by the qualified State- 
designated entity within such State to facilitate and 
expand the electronic movement and use of health 
information among organizations according to na-
tionally recognized standards and implementation 
specifications. 
‘‘(2) REQUIRED ELEMENTS.—A plan described 
in paragraph (1) shall— 
‘‘(A) be pursued in the public interest; 
‘‘(B) be consistent with the strategic plan 
developed by the National Coordinator (and, as 
available) under section 3001; 
‘‘(C) include a description of the ways the 
State or qualified State-designated entity will 
carry out the activities described in subsection 
(b); and 
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AMDT. NO. 98 
‘‘(D) contain such elements as the Sec-
retary may require. 
‘‘(f) QUALIFIED STATE-DESIGNATED ENTITY.—For 
purposes of this section, to be a qualified State-designated 
entity, with respect to a State, an entity shall— 
‘‘(1) be designated by the State as eligible to 
receive awards under this section; 
‘‘(2) be a not-for-profit entity with broad stake-
holder representation on its governing board; 
‘‘(3) demonstrate that one of its principal goals 
is to use information technology to improve health 
care quality and efficiency through the authorized 
and secure electronic exchange and use of health in-
formation; 
‘‘(4) adopt nondiscrimination and conflict of in-
terest policies that demonstrate a commitment to 
open, fair, and nondiscriminatory participation by 
stakeholders; and 
‘‘(5) conform to such other requirements as the 
Secretary may establish. 
‘‘(g) REQUIRED CONSULTATION.—In carrying out 
activities described in subsections (a)(2) and (a)(3), a 
State or qualified State-designated entity shall consult 
with and consider the recommendations of— 
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AMDT. NO. 98 
‘‘(1) health care providers (including providers 
that provide services to low income and underserved 
populations); 
‘‘(2) health plans; 
‘‘(3) patient or consumer organizations that 
represent the population to be served; 
‘‘(4) health information technology vendors; 
‘‘(5) health care purchasers and employers; 
‘‘(6) public health agencies; 
‘‘(7) health professions schools, universities and 
colleges; 
‘‘(8) clinical researchers; 
‘‘(9) other users of health information tech-
nology such as the support and clerical staff of pro-
viders and others involved in the care and care co-
ordination of patients; and 
‘‘(10) such other entities, as may be determined 
appropriate by the Secretary. 
‘‘(h) CONTINUOUS IMPROVEMENT.—The Secretary 
shall annually evaluate the activities conducted under this 
section and shall, in awarding grants under this section, 
implement the lessons learned from such evaluation in a 
manner so that awards made subsequent to each such 
evaluation are made in a manner that, in the determina-
tion of the Secretary, will lead towards the greatest im-
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AMDT. NO. 98 
provement in quality of care, decrease in costs, and the 
most effective authorized and secure electronic exchange 
of health information. 
‘‘(i) REQUIRED MATCH.— 
‘‘(1) IN GENERAL.—For a fiscal year (begin-
ning with fiscal year 2011), the Secretary may not 
make a grant under subsection (a) to a State unless 
the State agrees to make available non-Federal con-
tributions (which may include in-kind contributions) 
toward the costs of a grant awarded under sub-
section (a)(3) in an amount equal to— 
‘‘(A) for fiscal year 2011, not less than $1 
for each $10 of Federal funds provided under 
the grant; 
‘‘(B) for fiscal year 2012, not less than $1 
for each $7 of Federal funds provided under 
the grant; and 
‘‘(C) for fiscal year 2013 and each subse-
quent fiscal year, not less than $1 for each $3 
of Federal funds provided under the grant. 
‘‘(2) AUTHORITY
TO
REQUIRE
STATE
MATCH 
FOR FISCAL YEARS BEFORE FISCAL YEAR 2011.—For 
any fiscal year during the grant program under this 
section before fiscal year 2011, the Secretary may 
determine the extent to which there shall be required 
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AMDT. NO. 98 
a non-Federal contribution from a State receiving a 
grant under this section. 
‘‘SEC. 3014. COMPETITIVE GRANTS TO STATES AND INDIAN 
TRIBES FOR THE DEVELOPMENT OF LOAN 
PROGRAMS 
TO 
FACILITATE 
THE 
WIDE-
SPREAD ADOPTION OF CERTIFIED EHR TECH-
NOLOGY. 
‘‘(a) IN GENERAL.—The National Coordinator may 
award competitive grants to eligible entities for the estab-
lishment of programs for loans to health care providers 
to conduct the activities described in subsection (e). 
‘‘(b) ELIGIBLE ENTITY DEFINED.—For purposes of 
this subsection, the term ‘eligible entity’ means a State 
or Indian tribe (as defined in the Indian Self-Determina-
tion and Education Assistance Act) that— 
‘‘(1) submits to the National Coordinator an 
application at such time, in such manner, and con-
taining such information as the National Coordi-
nator may require; 
‘‘(2) submits to the National Coordinator a 
strategic plan in accordance with subsection (d) and 
provides to the National Coordinator assurances that 
the entity will update such plan annually in accord-
ance with such subsection; 
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AMDT. NO. 98 
‘‘(3) provides assurances to the National Coor-
dinator that the entity will establish a Loan Fund 
in accordance with subsection (c); 
‘‘(4) provides assurances to the National Coor-
dinator that the entity will not provide a loan from 
the Loan Fund to a health care provider unless the 
provider agrees to— 
‘‘(A) submit reports on quality measures 
adopted by the Federal Government (by not 
later than 90 days after the date on which such 
measures are adopted), to— 
‘‘(i) the Director of the Centers for 
Medicare & Medicaid Services (or his or 
her designee), in the case of an entity par-
ticipating in the Medicare program under 
title XVIII of the Social Security Act or 
the Medicaid program under title XIX of 
such Act; or 
‘‘(ii) the Secretary in the case of other 
entities; 
‘‘(B) demonstrate to the satisfaction of the 
Secretary (through criteria established by the 
Secretary) that any certified EHR technology 
purchased, improved, or otherwise financially 
supported under a loan under this section is 
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AMDT. NO. 98 
used to exchange health information in a man-
ner that, in accordance with law and standards 
(as adopted under section 3005) applicable to 
the exchange of information, improves the qual-
ity of health care, such as promoting care co-
ordination; 
‘‘(C) comply with such other requirements 
as the entity or the Secretary may require; 
‘‘(D) include a plan on how healthcare pro-
viders involved intend to maintain and support 
the certified EHR technology over time; and 
‘‘(E) include a plan on how the healthcare 
providers involved intend to maintain and sup-
port the certified EHR technology that would 
be purchased with such loan, including the type 
of resources expected to be involved and any 
such other information as the State or Indian 
tribe, respectively, may require; and 
‘‘(5) agrees to provide matching funds in ac-
cordance with subsection (i). 
‘‘(c) ESTABLISHMENT OF FUND.—For purposes of 
subsection (b)(3), an eligible entity shall establish a cer-
tified EHR technology loan fund (referred to in this sub-
section as a ‘Loan Fund’) and comply with the other re-
quirements contained in this section. A grant to an eligible 
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AMDT. NO. 98 
entity under this section shall be deposited in the Loan 
Fund established by the eligible entity. No funds author-
ized by other provisions of this title to be used for other 
purposes specified in this title shall be deposited in any 
Loan Fund. 
‘‘(d) STRATEGIC PLAN.— 
‘‘(1) IN GENERAL.—For purposes of subsection 
(b)(2), a strategic plan of an eligible entity under 
this subsection shall identify the intended uses of 
amounts available to the Loan Fund of such entity. 
‘‘(2) CONTENTS.—A strategic plan under para-
graph (1), with respect to a Loan Fund of an eligi-
ble entity, shall include for a year the following: 
‘‘(A) A list of the projects to be assisted 
through the Loan Fund during such year. 
‘‘(B) A description of the criteria and 
methods established for the distribution of 
funds from the Loan Fund during the year. 
‘‘(C) A description of the financial status 
of the Loan Fund as of the date of submission 
of the plan. 
‘‘(D) The short-term and long-term goals 
of the Loan Fund. 
‘‘(e) USE OF FUNDS.—Amounts deposited in a Loan 
Fund, including loan repayments and interest earned on 
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AMDT. NO. 98 
such amounts, shall be used only for awarding loans or 
loan guarantees, making reimbursements described in sub-
section (g)(4)(A), or as a source of reserve and security 
for leveraged loans, the proceeds of which are deposited 
in the Loan Fund established under subsection (a). Loans 
under this section may be used by a health care provider 
to— 
‘‘(1) facilitate the purchase of certified EHR 
technology; 
‘‘(2) enhance the utilization of certified EHR 
technology (which may include costs associated with 
upgrading health information technology so that it 
meets criteria necessary to be a certified EHR tech-
nology); 
‘‘(3) train personnel in the use of such tech-
nology; or 
‘‘(4) improve the secure electronic exchange of 
health information. 
‘‘(f) TYPES OF ASSISTANCE.—Except as otherwise 
limited by applicable State law, amounts deposited into a 
Loan Fund under this subsection may only be used for 
the following: 
‘‘(1) To award loans that comply with the fol-
lowing: 
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AMDT. NO. 98 
‘‘(A) The interest rate for each loan shall 
not exceed the market interest rate. 
‘‘(B) The principal and interest payments 
on each loan shall commence not later than 1 
year after the date the loan was awarded, and 
each loan shall be fully amortized not later than 
10 years after the date of the loan. 
‘‘(C) The Loan Fund shall be credited with 
all payments of principal and interest on each 
loan awarded from the Loan Fund. 
‘‘(2) To guarantee, or purchase insurance for, 
a local obligation (all of the proceeds of which fi-
nance a project eligible for assistance under this 
subsection) if the guarantee or purchase would im-
prove credit market access or reduce the interest 
rate applicable to the obligation involved. 
‘‘(3) As a source of revenue or security for the 
payment of principal and interest on revenue or gen-
eral obligation bonds issued by the eligible entity if 
the proceeds of the sale of the bonds will be depos-
ited into the Loan Fund. 
‘‘(4) To earn interest on the amounts deposited 
into the Loan Fund. 
‘‘(5) To make reimbursements described in sub-
section (g)(4)(A). 
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AMDT. NO. 98 
‘‘(g) ADMINISTRATION OF LOAN FUNDS.— 
‘‘(1) COMBINED FINANCIAL ADMINISTRATION.— 
An eligible entity may (as a convenience and to 
avoid unnecessary administrative costs) combine, in 
accordance with applicable State law, the financial 
administration of a Loan Fund established under 
this subsection with the financial administration of 
any other revolving fund established by the entity if 
otherwise not prohibited by the law under which the 
Loan Fund was established. 
‘‘(2) COST OF ADMINISTERING FUND.—Each el-
igible entity may annually use not to exceed 4 per-
cent of the funds provided to the entity under a 
grant under this subsection to pay the reasonable 
costs of the administration of the programs under 
this section, including the recovery of reasonable 
costs expended to establish a Loan Fund which are 
incurred after the date of the enactment of this title. 
‘‘(3) GUIDANCE AND REGULATIONS.—The Na-
tional Coordinator shall publish guidance and pro-
mulgate regulations as may be necessary to carry 
out the provisions of this section, including— 
‘‘(A) provisions to ensure that each eligible 
entity commits and expends funds allotted to 
the entity under this subsection as efficiently as 
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AMDT. NO. 98 
possible in accordance with this title and appli-
cable State laws; and 
‘‘(B) guidance to prevent waste, fraud, and 
abuse. 
‘‘(4) PRIVATE SECTOR CONTRIBUTIONS.— 
‘‘(A) IN GENERAL.—A Loan Fund estab-
lished under this subsection may accept con-
tributions from private sector entities, except 
that such entities may not specify the recipient 
or recipients of any loan issued under this sub-
section. An eligible entity may agree to reim-
burse a private sector entity for any contribu-
tion made under this subparagraph, except that 
the amount of such reimbursement may not be 
greater than the principal amount of the con-
tribution made. 
‘‘(B) AVAILABILITY
OF
INFORMATION.— 
An eligible entity shall make publicly available 
the identity of, and amount contributed by, any 
private sector entity under subparagraph (A) 
and may issue letters of commendation or make 
other awards (that have no financial value) to 
any such entity. 
‘‘(h) MATCHING REQUIREMENTS.— 
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AMDT. NO. 98 
‘‘(1) IN GENERAL.—The National Coordinator 
may not make a grant under subsection (a) to an el-
igible entity unless the entity agrees to make avail-
able (directly or through donations from public or 
private entities) non-Federal contributions in cash to 
the costs of carrying out the activities for which the 
grant is awarded in an amount equal to not less 
than $1 for each $5 of Federal funds provided under 
the grant. 
‘‘(2) DETERMINATION
OF
AMOUNT
OF
NON- 
FEDERAL
CONTRIBUTION.—In 
determining 
the 
amount of non-Federal contributions that an eligible 
entity has provided pursuant to subparagraph (A), 
the National Coordinator may not include any 
amounts provided to the entity by the Federal Gov-
ernment. 
‘‘(i) EFFECTIVE DATE.—The Secretary may not 
make an award under this section prior to January 1, 
2010. 
‘‘SEC. 3015. DEMONSTRATION PROGRAM TO INTEGRATE IN-
FORMATION TECHNOLOGY INTO CLINICAL 
EDUCATION. 
‘‘(a) IN GENERAL.—The Secretary may award grants 
under this section to carry out demonstration projects to 
develop academic curricula integrating certified EHR 
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AMDT. NO. 98 
technology in the clinical education of health professionals. 
Such awards shall be made on a competitive basis and 
pursuant to peer review. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant 
under subsection (a), an entity shall— 
‘‘(1) submit to the Secretary an application at 
such time, in such manner, and containing such in-
formation as the Secretary may require; 
‘‘(2) submit to the Secretary a strategic plan 
for integrating certified EHR technology in the clin-
ical education of health professionals to reduce med-
ical errors, increase access to prevention, reduce 
chronic diseases, and enhance health care quality; 
‘‘(3) be— 
‘‘(A) a school of medicine, osteopathic 
medicine, dentistry, or pharmacy, a graduate 
program in behavioral or mental health, or any 
other graduate health professions school; 
‘‘(B) a graduate school of nursing or phy-
sician assistant studies; 
‘‘(C) a consortium of two or more schools 
described in subparagraph (A) or (B); or 
‘‘(D) an institution with a graduate med-
ical education program in medicine, osteopathic 
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AMDT. NO. 98 
medicine, dentistry, pharmacy, nursing, or phy-
sician assistance studies. 
‘‘(4) provide for the collection of data regarding 
the effectiveness of the demonstration project to be 
funded under the grant in improving the safety of 
patients, the efficiency of health care delivery, and 
in increasing the likelihood that graduates of the 
grantee will adopt and incorporate certified EHR 
technology, in the delivery of health care services; 
and 
‘‘(5) provide matching funds in accordance with 
subsection (d). 
‘‘(c) USE OF FUNDS.— 
‘‘(1) IN GENERAL.—With respect to a grant 
under subsection (a), an eligible entity shall— 
‘‘(A) use grant funds in collaboration with 
2 or more disciplines; and 
‘‘(B) use grant funds to integrate certified 
EHR technology into community-based clinical 
education. 
‘‘(2) LIMITATION.—An eligible entity shall not 
use amounts received under a grant under sub-
section (a) to purchase hardware, software, or serv-
ices. 
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AMDT. NO. 98 
‘‘(d) FINANCIAL SUPPORT.—The Secretary may not 
provide more than 50 percent of the costs of any activity 
for which assistance is provided under subsection (a), ex-
cept in an instance of national economic conditions which 
would render the cost-share requirement under this sub-
section detrimental to the program and upon notification 
to Congress as to the justification to waive the cost-share 
requirement. 
‘‘(e) EVALUATION.—The Secretary shall take such 
action as may be necessary to evaluate the projects funded 
under this section and publish, make available, and dis-
seminate the results of such evaluations on as wide a basis 
as is practicable. 
‘‘(f) REPORTS.—Not later than 1 year after the date 
of enactment of this title, and annually thereafter, the Sec-
retary shall submit to the Committee on Health, Edu-
cation, Labor, and Pensions and the Committee on Fi-
nance of the Senate, and the Committee on Energy and 
Commerce of the House of Representatives a report 
that— 
‘‘(1) describes the specific projects established 
under this section; and 
‘‘(2) contains recommendations for Congress 
based on the evaluation conducted under subsection 
(e). 
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AMDT. NO. 98 
‘‘SEC. 3016. INFORMATION TECHNOLOGY PROFESSIONALS 
ON HEALTH CARE. 
‘‘(a) IN GENERAL.—The Secretary, in consultation 
with the Director of the National Science Foundation, 
shall provide assistance to institutions of higher education 
(or consortia thereof) to establish or expand medical 
health informatics education programs, including certifi-
cation, undergraduate, and masters degree programs, for 
both health care and information technology students to 
ensure the rapid and effective utilization and development 
of health information technologies (in the United States 
health care infrastructure). 
‘‘(b) ACTIVITIES.—Activities for which assistance 
may be provided under subsection (a) may include the fol-
lowing: 
‘‘(1) Developing and revising curricula in med-
ical health informatics and related disciplines. 
‘‘(2) Recruiting and retaining students to the 
program involved. 
‘‘(3) Acquiring equipment necessary for student 
instruction in these programs, including the installa-
tion of testbed networks for student use. 
‘‘(4) Establishing or enhancing bridge programs 
in the health informatics fields between community 
colleges and universities. 
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AMDT. NO. 98 
‘‘(c) PRIORITY.—In providing assistance under sub-
section (a), the Secretary shall give preference to the fol-
lowing: 
‘‘(1) Existing education and training programs. 
‘‘(2) Programs designed to be completed in less 
than six months. 
‘‘(d) FINANCIAL SUPPORT.—The Secretary may not 
provide more than 50 percent of the costs of any activity 
for which assistance is provided under subsection (a), ex-
cept in an instance of national economic conditions which 
would render the cost-share requirement under this sub-
section detrimental to the program and upon notification 
to Congress as to the justification to waive the cost-share 
requirement. 
‘‘SEC. 3017. GENERAL GRANT AND LOAN PROVISIONS. 
‘‘(a) REPORTS.—The Secretary may require that an 
entity receiving assistance under this title shall submit to 
the Secretary, not later than the date that is 1 year after 
the date of receipt of such assistance, a report that in-
cludes— 
‘‘(1) an analysis of the effectiveness of such ac-
tivities for which the entity receives such assistance, 
as compared to the goals for such activities; and 
‘‘(2) an analysis of the impact of the project on 
healthcare quality and safety. 
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AMDT. NO. 98 
‘‘(b) REQUIREMENT TO IMPROVE QUALITY OF CARE 
AND DECREASE IN COSTS.—The National Coordinator 
shall annually evaluate the activities conducted under this 
title and shall, in awarding grants, implement the lessons 
learned from such evaluation in a manner so that awards 
made subsequent to each such evaluation are made in a 
manner that, in the determination of the National Coordi-
nator, will result in the greatest improvement in the qual-
ity and efficiency of health care. 
‘‘SEC. 3018. AUTHORIZATION FOR APPROPRIATIONS. 
‘‘For the purposes of carrying out this subtitle, there 
is authorized to be appropriated such sums as may be nec-
essary for each of the fiscal years 2009 through 2013. 
Amounts so appropriated shall remain available until ex-
pended.’’. 
Subtitle D—Privacy 
SEC. 13400. DEFINITIONS. 
In this subtitle, except as specified otherwise: 
(1) BREACH.—The term ‘‘breach’’ means the 
unauthorized acquisition, access, use, or disclosure 
of protected health information which compromises 
the security, privacy, or integrity of protected health 
information maintained by or on behalf of a person. 
Such term does not include any unintentional acqui-
sition, access, use, or disclosure of such information 
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AMDT. NO. 98 
by an employee or agent of the covered entity or 
business associate involved if such acquisition, ac-
cess, use, or disclosure, respectively, was made in 
good faith and within the course and scope of the 
employment or other contractual relationship of such 
employee or agent, respectively, with the covered en-
tity or business associate and if such information is 
not further acquired, accessed, used, or disclosed by 
such employee or agent. 
(2) BUSINESS ASSOCIATE.—The term ‘‘business 
associate’’ has the meaning given such term in sec-
tion 160.103 of title 45, Code of Federal Regula-
tions. 
(3) COVERED ENTITY.—The term ‘‘covered en-
tity’’ has the meaning given such term in section 
160.103 of title 45, Code of Federal Regulations. 
(4) DISCLOSE.—The terms ‘‘disclose’’ and ‘‘dis-
closure’’ have the meaning given the term ‘‘disclo-
sure’’ in section 160.103 of title 45, Code of Federal 
Regulations. 
(5) ELECTRONIC HEALTH RECORD.—The term 
‘‘electronic health record’’ means an electronic 
record of health-related information on an individual 
that is created, gathered, managed, and consulted by 
authorized health care clinicians and staff. 
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AMDT. NO. 98 
ty (as defined in paragraph (3)), that offers or 
maintains a personal health record. 
PART I—IMPROVED PRIVACY PROVISIONS AND 
SECURITY PROVISIONS 
SEC. 13401. APPLICATION OF SECURITY PROVISIONS AND 
PENALTIES TO BUSINESS ASSOCIATES OF 
COVERED ENTITIES; ANNUAL GUIDANCE ON 
SECURITY PROVISIONS. 
(a) APPLICATION OF SECURITY PROVISIONS.—Sec-
tions 164.308, 164.310, 164.312, and 164.316 of title 45, 
Code of Federal Regulations, shall apply to a business as-
sociate of a covered entity in the same manner that such 
sections apply to the covered entity. The additional re-
quirements of this title that relate to security and that 
are made applicable with respect to covered entities shall 
also be applicable to such a business associate and shall 
be incorporated into the business associate agreement be-
tween the business associate and the covered entity. 
(b) APPLICATION
OF CIVIL
AND CRIMINAL PEN-
ALTIES.—In the case of a business associate that violates 
any security provision specified in subsection (a), sections 
1176 and 1177 of the Social Security Act (42 U.S.C. 
1320d-5, 1320d-6) shall apply to the business associate 
with respect to such violation in the same manner such 
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AMDT. NO. 98 
sections apply to a covered entity that violates such secu-
rity provision. 
(c) ANNUAL GUIDANCE.—For the first year begin-
ning after the date of the enactment of this Act and annu-
ally thereafter, the Secretary of Health and Human Serv-
ices shall, in consultation with industry stakeholders, an-
nually issue guidance on the most effective and appro-
priate technical safeguards for use in carrying out the sec-
tions referred to in subsection (a) and the security stand-
ards in subpart C of part 164 of title 45, Code of Federal 
Regulations, as such provisions are in effect as of the date 
before the enactment of this Act. 
SEC. 13402. NOTIFICATION IN THE CASE OF BREACH. 
(a) IN GENERAL.—A covered entity that accesses, 
maintains, retains, modifies, records, stores, destroys, or 
otherwise holds, uses, or discloses unsecured protected 
health information (as defined in subsection (h)(1)) shall, 
in the case of a breach of such information that is discov-
ered by the covered entity, notify each individual whose 
unsecured protected health information has been, or is 
reasonably believed by the covered entity to have been, 
accessed, acquired, or disclosed as a result of such breach. 
(b) NOTIFICATION OF COVERED ENTITY BY BUSI-
NESS ASSOCIATE.—A business associate of a covered enti-
ty that accesses, maintains, retains, modifies, records, 
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AMDT. NO. 98 
stores, destroys, or otherwise holds, uses, or discloses un-
secured protected health information shall, following the 
discovery of a breach of such information, notify the cov-
ered entity of such breach. Such notice shall include the 
identification of each individual whose unsecured protected 
health information has been, or is reasonably believed by 
the business associate to have been, accessed, acquired, 
or disclosed during such breach. 
(c) BREACHES TREATED AS DISCOVERED.—For pur-
poses of this section, a breach shall be treated as discov-
ered by a covered entity or by a business associate as of 
the first day on which such breach is known to such entity 
or associate, respectively, (including any person, other 
than the individual committing the breach, that is an em-
ployee, officer, or other agent of such entity or associate, 
respectively) or should reasonably have been known to 
such entity or associate (or person) to have occurred. 
(d) TIMELINESS OF NOTIFICATION.— 
(1) IN GENERAL.—Subject to subsection (g), all 
notifications required under this section shall be 
made without unreasonable delay and in no case 
later than 60 calendar days after the discovery of a 
breach by the covered entity involved (or business 
associate involved in the case of a notification re-
quired under subsection (b)). 
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AMDT. NO. 98 
(2) BURDEN OF PROOF.—The covered entity in-
volved (or business associate involved in the case of 
a notification required under subsection (b)), shall 
have the burden of demonstrating that all notifica-
tions were made as required under this part, includ-
ing evidence demonstrating the necessity of any 
delay. 
(e) METHODS OF NOTICE.— 
(1) 
INDIVIDUAL
NOTICE.—Notice 
required 
under this section to be provided to an individual, 
with respect to a breach, shall be provided promptly 
and in the following form: 
(A) Written notification by first-class mail 
to the individual (or the next of kin of the indi-
vidual if the individual is deceased) at the last 
known address of the individual or the next of 
kin, respectively, or, if specified as a preference 
by the individual, by electronic mail. The notifi-
cation may be provided in one or more mailings 
as information is available. 
(B) In the case in which there is insuffi-
cient, or out-of-date contact information (in-
cluding a phone number, email address, or any 
other form of appropriate communication) that 
precludes direct written (or, if specified by the 
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AMDT. NO. 98 
individual under subparagraph (A), electronic) 
notification to the individual, a substitute form 
of notice shall be provided, including, in the 
case that there are 10 or more individuals for 
which there is insufficient or out-of-date contact 
information, a conspicuous posting for a period 
determined by the Secretary on the home page 
of the Web site of the covered entity involved or 
notice in major print or broadcast media, in-
cluding major media in geographic areas where 
the individuals affected by the breach likely re-
side. Such a notice in media or web posting will 
include a toll-free phone number where an indi-
vidual can learn whether or not the individual’s 
unsecured protected health information is pos-
sibly included in the breach. 
(C) In any case deemed by the covered en-
tity involved to require urgency because of pos-
sible imminent misuse of unsecured protected 
health information, the covered entity, in addi-
tion to notice provided under subparagraph (A), 
may provide information to individuals by tele-
phone or other means, as appropriate. 
(2) MEDIA NOTICE.—Notice shall be provided 
to prominent media outlets serving a State or juris-
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AMDT. NO. 98 
diction, following the discovery of a breach described 
in subsection (a), if the unsecured protected health 
information of more than 500 residents of such 
State or jurisdiction is, or is reasonably believed to 
have been, accessed, acquired, or disclosed during 
such breach. 
(3) NOTICE TO SECRETARY.—Notice shall be 
provided to the Secretary by covered entities of un-
secured protected health information that has been 
acquired or disclosed in a breach. If the breach was 
with respect to 500 or more individuals than such 
notice must be provided immediately. If the breach 
was with respect to less than 500 individuals, the 
covered entity may maintain a log of any such 
breach occurring and annually submit such a log to 
the Secretary documenting such breaches occurring 
during the year involved. 
(4) POSTING ON HHS PUBLIC WEBSITE.—The 
Secretary shall make available to the public on the 
Internet website of the Department of Health and 
Human Services a list that identifies each covered 
entity involved in a breach described in subsection 
(a) in which the unsecured protected health informa-
tion of more than 500 individuals is acquired or dis-
closed. 
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AMDT. NO. 98 
(f) CONTENT OF NOTIFICATION.—Regardless of the 
method by which notice is provided to individuals under 
this section, notice of a breach shall include, to the extent 
possible, the following: 
(1) A brief description of what happened, in-
cluding the date of the breach and the date of the 
discovery of the breach, if known. 
(2) A description of the types of unsecured pro-
tected health information that were involved in the 
breach (such as full name, Social Security number, 
date of birth, home address, account number, or dis-
ability code). 
(3) The steps individuals should take to protect 
themselves from potential harm resulting from the 
breach. 
(4) A brief description of what the covered enti-
ty involved is doing to investigate the breach, to 
mitigate losses, and to protect against any further 
breaches. 
(5) Contact procedures for individuals to ask 
questions or learn additional information, which 
shall include a toll-free telephone number, an e-mail 
address, Web site, or postal address. 
(g) DELAY OF NOTIFICATION AUTHORIZED FOR LAW 
ENFORCEMENT PURPOSES.—If a law enforcement official 
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AMDT. NO. 98 
determines that a notification, notice, or posting required 
under this section would impede a criminal investigation 
or cause damage to national security, such notification, 
notice, or posting shall be delayed in the same manner 
as provided under section 164.528(a)(2) of title 45, Code 
of Federal Regulations, in the case of a disclosure covered 
under such section. 
(h) UNSECURED PROTECTED HEALTH INFORMA-
TION.— 
(1) DEFINITION.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), for purposes of this section, the 
term ‘‘unsecured protected health information’’ 
means protected health information that is not 
secured through the use of a technology or 
methodology specified by the Secretary in the 
guidance issued under paragraph (2). 
(B) EXCEPTION
IN
CASE
TIMELY
GUID-
ANCE NOT ISSUED.—In the case that the Sec-
retary does not issue guidance under paragraph 
(2) by the date specified in such paragraph, for 
purposes of this section, the term ‘‘unsecured 
protected health information’’ shall mean pro-
tected health information that is not secured by 
a technology standard that renders protected 
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AMDT. NO. 98 
health information unusable, unreadable, or in-
decipherable to unauthorized individuals and is 
developed or endorsed by a standards devel-
oping organization that is accredited by the 
American National Standards Institute. 
(2) GUIDANCE.—For purposes of paragraph (1) 
and section 13407(f)(3), not later than the date that 
is 60 days after the date of the enactment of this 
Act, the Secretary shall, after consultation with 
stakeholders, issue (and annually update) guidance 
specifying the technologies and methodologies that 
render 
protected 
health 
information 
unusable, 
unreadable, or indecipherable to unauthorized indi-
viduals. 
(i) REPORT TO CONGRESS ON BREACHES.— 
(1) IN GENERAL.—Not later than 12 months 
after the date of the enactment of this Act and an-
nually thereafter, the Secretary shall prepare and 
submit to the Committee on Finance and the Com-
mittee on Health, Education, Labor, and Pensions 
of the Senate and the Committee on Ways and 
Means and the Committee on Energy and Commerce 
of the House of Representatives a report containing 
the information described in paragraph (2) regard-
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AMDT. NO. 98 
ing breaches for which notice was provided to the 
Secretary under subsection (e)(3). 
(2) INFORMATION.—The information described 
in this paragraph regarding breaches specified in 
paragraph (1) shall include— 
(A) the number and nature of such 
breaches; and 
(B) actions taken in response to such 
breaches. 
(j) REGULATIONS; EFFECTIVE DATE.—To carry out 
this section, the Secretary of Health and Human Services 
shall promulgate interim final regulations by not later 
than the date that is 180 days after the date of the enact-
ment of this title. The provisions of this section shall apply 
to breaches that are discovered on or after the date that 
is 30 days after the date of publication of such interim 
final regulations. 
SEC. 13403. EDUCATION ON HEALTH INFORMATION PRI-
VACY. 
(a) REGIONAL OFFICE PRIVACY ADVISORS.—Not 
later than 6 months after the date of the enactment of 
this Act, the Secretary shall designate an individual in 
each regional office of the Department of Health and 
Human Services to offer guidance and education to cov-
ered entities, business associates, and individuals on their 
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AMDT. NO. 98 
rights and responsibilities related to Federal privacy and 
security requirements for protected health information. 
(b) EDUCATION INITIATIVE ON USES OF HEALTH IN-
FORMATION.—Not later than 12 months after the date of 
the enactment of this Act, the Office for Civil Rights with-
in the Department of Health and Human Services shall 
develop and maintain a multi-faceted national education 
initiative to enhance public transparency regarding the 
uses of protected health information, including programs 
to educate individuals about the potential uses of their 
protected health information, the effects of such uses, and 
the rights of individuals with respect to such uses. Such 
programs shall be conducted in a variety of languages and 
present information in a clear and understandable man-
ner. 
SEC. 13404. APPLICATION OF PRIVACY PROVISIONS AND 
PENALTIES TO BUSINESS ASSOCIATES OF 
COVERED ENTITIES. 
(a) APPLICATION OF CONTRACT REQUIREMENTS.— 
In the case of a business associate of a covered entity that 
obtains or creates protected health information pursuant 
to a written contract (or other written arrangement) de-
scribed in section 164.502(e)(2) of title 45, Code of Fed-
eral Regulations, with such covered entity, the business 
associate may use and disclose such protected health infor-
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AMDT. NO. 98 
mation only if such use or disclosure, respectively, is in 
compliance with each applicable requirement of section 
164.504(e) of such title. The additional requirements of 
this subtitle that relate to privacy and that are made ap-
plicable with respect to covered entities shall also be appli-
cable to such a business associate and shall be incor-
porated into the business associate agreement between the 
business associate and the covered entity. 
(b) APPLICATION OF KNOWLEDGE ELEMENTS ASSO-
CIATED WITH CONTRACTS.—Section 164.504(e)(1)(ii) of 
title 45, Code of Federal Regulations, shall apply to a 
business associate described in subsection (a), with respect 
to compliance with such subsection, in the same manner 
that such section applies to a covered entity, with respect 
to compliance with the standards in sections 164.502(e) 
and 164.504(e) of such title, except that in applying such 
section 164.504(e)(1)(ii) each reference to the business as-
sociate, with respect to a contract, shall be treated as a 
reference to the covered entity involved in such contract. 
(c) APPLICATION
OF CIVIL
AND CRIMINAL PEN-
ALTIES.—In the case of a business associate that violates 
any provision of subsection (a) or (b), the provisions of 
sections 1176 and 1177 of the Social Security Act (42 
U.S.C. 1320d-5, 1320d-6) shall apply to the business as-
sociate with respect to such violation in the same manner 
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AMDT. NO. 98 
as such provisions apply to a person who violates a provi-
sion of part C of title XI of such Act. 
SEC. 13405. RESTRICTIONS ON CERTAIN DISCLOSURES AND 
SALES OF HEALTH INFORMATION; ACCOUNT-
ING OF CERTAIN PROTECTED HEALTH IN-
FORMATION DISCLOSURES; ACCESS TO CER-
TAIN INFORMATION IN ELECTRONIC FOR-
MAT. 
(a) REQUESTED RESTRICTIONS ON CERTAIN DIS-
CLOSURES OF HEALTH INFORMATION.—In the case that 
an individual requests under paragraph (a)(1)(i)(A) of 
section 164.522 of title 45, Code of Federal Regulations, 
that a covered entity restrict the disclosure of the pro-
tected health information of the individual, notwith-
standing paragraph (a)(1)(ii) of such section, the covered 
entity must comply with the requested restriction if— 
(1) except as otherwise required by law, the dis-
closure is to a health plan for purposes of carrying 
out payment or health care operations (and is not 
for purposes of carrying out treatment); and 
(2) the protected health information pertains 
solely to a health care item or service for which the 
health care provider involved has been paid out of 
pocket in full. 
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AMDT. NO. 98 
(b) DISCLOSURES REQUIRED TO BE LIMITED TO 
THE
LIMITED
DATA
SET
OR
THE
MINIMUM
NEC-
ESSARY.— 
(1) IN GENERAL.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), a covered entity shall be treated as 
being in compliance with section 164.502(b)(1) 
of title 45, Code of Federal Regulations, with 
respect to the use, disclosure, or request of pro-
tected health information described in such sec-
tion, only if the covered entity limits such pro-
tected health information, to the extent prac-
ticable, to the limited data set (as defined in 
section 164.514(e)(2) of such title) or, if needed 
by such entity, to the minimum necessary to ac-
complish the intended purpose of such use, dis-
closure, or request, respectively. 
(B) 
GUIDANCE.—Not 
later 
than 
months after the date of the enactment of this 
section, the Secretary shall issue guidance on 
what constitutes ‘‘minimum necessary’’ for pur-
poses of subpart E of part 164 of title 45, Code 
of Federal Regulation. In issuing such guidance 
the Secretary shall take into consideration the 
guidance under section 13424(c). 
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AMDT. NO. 98 
(C) SUNSET.—Subparagraph (A) shall not 
apply on and after the effective date on which 
the Secretary issues the guidance under sub-
paragraph (B). 
(2) 
DETERMINATION
OF
MINIMUM
NEC-
ESSARY.—For purposes of paragraph (1), in the 
case of the disclosure of protected health informa-
tion, the covered entity or business associate dis-
closing such information shall determine what con-
stitutes the minimum necessary to accomplish the 
intended purpose of such disclosure. 
(3) APPLICATION OF EXCEPTIONS.—The excep-
tions described in section 164.502(b)(2) of title 45, 
Code of Federal Regulations, shall apply to the re-
quirement under paragraph (1) as of the effective 
date described in section 13423 in the same manner 
that such exceptions apply to section 164.502(b)(1) 
of such title before such date. 
(4) RULE OF CONSTRUCTION.—Nothing in this 
subsection shall be construed as affecting the use, 
disclosure, or request of protected health information 
that has been de-identified. 
(c) ACCOUNTING OF CERTAIN PROTECTED HEALTH 
INFORMATION DISCLOSURES REQUIRED IF COVERED EN-
TITY USES ELECTRONIC HEALTH RECORD.— 
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AMDT. NO. 98 
(1) IN GENERAL.—In applying section 164.528 
of title 45, Code of Federal Regulations, in the case 
that a covered entity uses or maintains an electronic 
health record with respect to protected health infor-
mation— 
(A) 
the 
exception 
under 
paragraph 
(a)(1)(i) of such section shall not apply to dis-
closures through an electronic health record 
made by such entity of such information; and 
(B) an individual shall have a right to re-
ceive an accounting of disclosures described in 
such paragraph of such information made by 
such covered entity during only the three years 
prior to the date on which the accounting is re-
quested. 
(2) REGULATIONS.—The Secretary shall pro-
mulgate regulations on what information shall be 
collected about each disclosure referred to in para-
graph (1)(A) not later than 18 months after the 
date on which the Secretary adopts standards on ac-
counting for disclosure described in the section 
3002(b)(2)(B)(iv) of the Public Health Service Act, 
as added by section 13101. Such regulations shall 
only require such information to be collected through 
an electronic health record in a manner that takes 
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AMDT. NO. 98 
into account the interests of individuals in learning 
the circumstances under which their protected health 
information is being disclosed and takes into account 
the administrative burden of accounting for such 
disclosures. 
(3) CONSTRUCTION.—Nothing in this sub-
section shall be construed as— 
(A) requiring a covered entity to account 
for disclosures of protected health information 
that are not made by such covered entity; or 
(B) requiring a business associate of a cov-
ered entity to account for disclosures of pro-
tected health information that are not made by 
such business associate. 
(4) REASONABLE FEE.—A covered entity may 
impose a reasonable fee on an individual for an ac-
counting performed under paragraph (1)(B). Any 
such fee shall not be greater than the entity’s labor 
costs in responding to the request. 
(5) EFFECTIVE DATE.— 
(A) CURRENT
USERS
OF
ELECTRONIC 
RECORDS.—In the case of a covered entity inso-
far as it acquired an electronic health record as 
of January 1, 2009, paragraph (1) shall apply 
to disclosures, with respect to protected health 
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AMDT. NO. 98 
information, made by the covered entity from 
such a record on and after January 1, 2014. 
(B) OTHERS.—In the case of a covered en-
tity insofar as it acquires an electronic health 
record after January 1, 2010, paragraph (1) 
shall apply to disclosures, with respect to pro-
tected health information, made by the covered 
entity from such record on and after the later 
of the following: 
(i) January 1, 2011; or 
(ii) the date that it acquires an elec-
tronic health record. 
(d) REVIEW OF HEALTH CARE OPERATIONS.—Not 
later than 18 months after the date of the enactment of 
this title, the Secretary shall promulgate regulations to 
eliminate from the definition of health care operations 
under section 164.501 of title 45, Code of Federal Regula-
tions, those activities that can reasonably and efficiently 
be conducted through the use of information that is de- 
identified (in accordance with the requirements of section 
164.514(b) of such title) or that should require a valid 
authorization for use or disclosure. In promulgating such 
regulations, the Secretary may choose to narrow or clarify 
activities that the Secretary chooses to retain in the defini-
tion of health care operations and the Secretary shall take 
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AMDT. NO. 98 
into account the report under section 13424(d). In such 
regulations the Secretary shall specify the date on which 
such regulations shall apply to disclosures made by a cov-
ered entity, but in no case would such date be sooner than 
the date that is 24 months after the date of the enactment 
of this section. 
(e) PROHIBITION ON SALE OF ELECTRONIC HEALTH 
RECORDS OR PROTECTED HEALTH INFORMATION OB-
TAINED FROM ELECTRONIC HEALTH RECORDS.— 
(1) IN GENERAL.—Except as provided in para-
graph (2), a covered entity or business associate 
shall not directly or indirectly receive remuneration 
in exchange for any protected health information of 
an individual unless the covered entity obtained from 
the individual, in accordance with section 164.508 of 
title 45, Code of Federal Regulations, a valid au-
thorization that includes, in accordance with such 
section, a specification of whether the protected 
health information can be further exchanged for re-
muneration by the entity receiving protected health 
information of that individual. 
(2) EXCEPTIONS.—Paragraph (1) shall not 
apply in the following cases: 
(A) The purpose of the exchange is for re-
search or public health activities (as described 
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AMDT. NO. 98 
in sections 164.501, 164.512(i), and 164.512(b) 
of title 45, Code of Federal Regulations) and 
the price charged reflects the costs of prepara-
tion and transmittal of the data for such pur-
pose. 
(B) The purpose of the exchange is for the 
treatment of the individual and the price 
charges reflects not more than the costs of 
preparation and transmittal of the data for 
such purpose. 
(C) The purpose of the exchange is the 
health care operation specifically described in 
subparagraph (iv) of paragraph (6) of the defi-
nition of healthcare operations in section 
164.501 of title 45, Code of Federal Regula-
tions. 
(D) The purpose of the exchange is for re-
muneration that is provided by a covered entity 
to a business associate for activities involving 
the exchange of protected health information 
that the business associate undertakes on behalf 
of and at the specific request of the covered en-
tity pursuant to a business associate agreement. 
(E) The purpose of the exchange is to pro-
vide an individual with a copy of the individ-
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AMDT. NO. 98 
ual’s protected health information pursuant to 
section 164.524 of title 45, Code of Federal 
Regulations. 
(F) The purpose of the exchange is other-
wise determined by the Secretary in regulations 
to be similarly necessary and appropriate as the 
exceptions provided in subparagraphs (A) 
through (E). 
(3) REGULATIONS.—The Secretary shall pro-
mulgate regulations to carry out this subsection, in-
cluding exceptions described in paragraph (2), not 
later than 18 months after the date of the enact-
ment of this title. 
(4) EFFECTIVE
DATE.—Paragraph (1) shall 
apply to exchanges occurring on or after the date 
that is 6 months after the date of the promulgation 
of final regulations implementing this subsection. 
(f) ACCESS TO CERTAIN INFORMATION IN ELEC-
TRONIC FORMAT.—In applying section 164.524 of title 
45, Code of Federal Regulations, in the case that a cov-
ered entity uses or maintains an electronic health record 
with respect to protected health information of an indi-
vidual— 
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AMDT. NO. 98 
(1) the individual shall have a right to obtain 
from such covered entity a copy of such information 
in an electronic format; and 
(2) notwithstanding paragraph (c)(4) of such 
section, any fee that the covered entity may impose 
for providing such individual with a copy of such in-
formation (or a summary or explanation of such in-
formation) if such copy (or summary or explanation) 
is in an electronic form shall not be greater than the 
entity’s labor costs in responding to the request for 
the copy (or summary or explanation). 
SEC. 13406. CONDITIONS ON CERTAIN CONTACTS AS PART 
OF HEALTH CARE OPERATIONS. 
(a) MARKETING.— 
(1) IN GENERAL.—A communication by a cov-
ered entity or business associate that is about a 
product or service and that encourages recipients of 
the communication to purchase or use the product 
or service shall not be considered a health care oper-
ation for purposes of subpart E of part 164 of title 
45, Code of Federal Regulations, unless the commu-
nication is made as described in subparagraph (i), 
(ii), or (iii) of paragraph (1) of the definition of 
marketing in section 164.501 of such title. 
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AMDT. NO. 98 
(2) 
PAYMENT
FOR
CERTAIN
COMMUNICA-
TIONS.—A covered entity or business associate may 
not receive direct or indirect payment in exchange 
for making any communication described in sub-
paragraph (i), (ii), or (iii) of paragraph (1) of the 
definition of marketing in section 164.501 of title 
45, Code of Federal Regulations, except— 
(A) a business associate of a covered entity 
may receive payment from the covered entity 
for making any such communication on behalf 
of the covered entity that is consistent with the 
written contract (or other written arrangement) 
described in section 164.502(e)(2) of such title 
between such business associate and covered en-
tity; 
(B) a covered entity may receive payment 
in exchange for making any such communica-
tion if the entity obtains from the recipient of 
the communication, in accordance with section 
164.508 of title 45, Code of Federal Regula-
tions, a valid authorization (as described in 
paragraph (b) of such section) with respect to 
such communication; and 
(C) where such communication describes 
only a health care item or service that has pre-
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AMDT. NO. 98 
viously been prescribed for or administered to 
the recipient of the communication, or a family 
member of such recipient. 
(b) FUNDRAISING.—Fundraising for the benefit of a 
covered entity shall not be considered a health care oper-
ation for purposes of section 164.501 of title 45, Code of 
Federal Regulations. 
(c) EFFECTIVE DATE.—This section shall apply to 
contracting occurring on or after the effective date speci-
fied under section 13423. 
SEC. 13407. TEMPORARY BREACH NOTIFICATION REQUIRE-
MENT FOR VENDORS OF PERSONAL HEALTH 
RECORDS AND OTHER NON-HIPAA COVERED 
ENTITIES. 
(a) IN GENERAL.—In accordance with subsection (c), 
each vendor of personal health records, following the dis-
covery of a breach of security of unsecured PHR identifi-
able health information that is in a personal health record 
maintained or offered by such vendor, and each entity de-
scribed in clause (ii) or (iii) of section 13424(b)(1)(A), fol-
lowing the discovery of a breach of security of such infor-
mation that is obtained through a product or service pro-
vided by such entity, shall— 
(1) notify each individual who is a citizen or 
resident of the United States whose unsecured PHR 
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AMDT. NO. 98 
identifiable health information was acquired by an 
unauthorized person as a result of such a breach of 
security; and 
(2) notify the Federal Trade Commission. 
(b) NOTIFICATION BY THIRD PARTY SERVICE PRO-
VIDERS.—A third party service provider that provides 
services to a vendor of personal health records or to an 
entity described in clause (ii) or (iii) of section 
13424(b)(1)(A) in connection with the offering or mainte-
nance of a personal health record or a related product or 
service and that accesses, maintains, retains, modifies, 
records, stores, destroys, or otherwise holds, uses, or dis-
closes unsecured PHR identifiable health information in 
such a record as a result of such services shall, following 
the discovery of a breach of security of such information, 
notify such vendor or entity, respectively, of such breach. 
Such notice shall include the identification of each indi-
vidual whose unsecured PHR identifiable health informa-
tion has been, or is reasonably believed to have been, 
accessed, acquired, or disclosed during such breach. 
(c) APPLICATION OF REQUIREMENTS FOR TIMELI-
NESS, METHOD, AND CONTENT
OF NOTIFICATIONS.— 
Subsections (c), (d), (e), and (f) of section 13402 shall 
apply to a notification required under subsection (a) and 
a vendor of personal health records, an entity described 
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AMDT. NO. 98 
in subsection (a) and a third party service provider de-
scribed in subsection (b), with respect to a breach of secu-
rity under subsection (a) of unsecured PHR identifiable 
health information in such records maintained or offered 
by such vendor, in a manner specified by the Federal 
Trade Commission. 
(d) NOTIFICATION OF THE SECRETARY.—Upon re-
ceipt of a notification of a breach of security under sub-
section (a)(2), the Federal Trade Commission shall notify 
the Secretary of such breach. 
(e) ENFORCEMENT.—A violation of subsection (a) or 
(b) shall be treated as an unfair and deceptive act or prac-
tice in violation of a regulation under section 18(a)(1)(B) 
of the Federal Trade Commission Act (15 U.S.C. 
57a(a)(1)(B)) regarding unfair or deceptive acts or prac-
tices. 
(f) DEFINITIONS.—For purposes of this section: 
(1) BREACH OF SECURITY.—The term ‘‘breach 
of security’’ means, with respect to unsecured PHR 
identifiable health information of an individual in a 
personal health record, acquisition of such informa-
tion without the authorization of the individual. 
(2) PHR IDENTIFIABLE
HEALTH
INFORMA-
TION.—The term ‘‘PHR identifiable health informa-
tion’’ means individually identifiable health informa-
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AMDT. NO. 98 
tion, as defined in section 1171(6) of the Social Se-
curity Act (42 U.S.C. 1320d(6)), and includes, with 
respect to an individual, information— 
(A) that is provided by or on behalf of the 
individual; and 
(B) that identifies the individual or with 
respect to which there is a reasonable basis to 
believe that the information can be used to 
identify the individual. 
(3) UNSECURED
PHR
IDENTIFIABLE
HEALTH 
INFORMATION.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B), the term ‘‘unsecured PHR identifi-
able health information’’ means PHR identifi-
able health information that is not protected 
through the use of a technology or methodology 
specified by the Secretary in the guidance 
issued under section 13402(h)(2). 
(B) EXCEPTION
IN
CASE
TIMELY
GUID-
ANCE NOT ISSUED.—In the case that the Sec-
retary does not issue guidance under section 
13402(h)(2) by the date specified in such sec-
tion, for purposes of this section, the term ‘‘un-
secured PHR identifiable health information’’ 
shall mean PHR identifiable health information 
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AMDT. NO. 98 
that is not secured by a technology standard 
that renders protected health information unus-
able, unreadable, or indecipherable to unauthor-
ized individuals and that is developed or en-
dorsed by a standards developing organization 
that is accredited by the American National 
Standards Institute. 
(g) REGULATIONS; EFFECTIVE DATE; SUNSET.— 
(1) 
REGULATIONS; 
EFFECTIVE
DATE.—To 
carry out this section, the Secretary of Health and 
Human Services shall promulgate interim final regu-
lations by not later than the date that is 180 days 
after the date of the enactment of this section. The 
provisions of this section shall apply to breaches of 
security that are discovered on or after the date that 
is 30 days after the date of publication of such in-
terim final regulations. 
(2) SUNSET.—The provisions of this section 
shall not apply to breaches of security occurring on 
or after the earlier of the following the dates: 
(A) The date on which a standard relating 
to requirements for entities that are not covered 
entities that includes requirements relating to 
breach notification has been promulgated by the 
Secretary. 
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AMDT. NO. 98 
(B) The date on which a standard relating 
to requirements for entities that are not covered 
entities that includes requirements relating to 
breach notification has been promulgated by the 
Federal Trade Commission and has taken ef-
fect. 
SEC. 13408. BUSINESS ASSOCIATE CONTRACTS REQUIRED 
FOR CERTAIN ENTITIES. 
Each organization, with respect to a covered entity, 
that provides data transmission of protected health infor-
mation to such entity (or its business associate) and that 
requires access on a routine basis to such protected health 
information, such as a Health Information Exchange Or-
ganization, Regional Health Information Organization, E- 
prescribing Gateway, or each vendor that contracts with 
a covered entity to allow that covered entity to offer a per-
sonal health record to patients as part of its electronic 
health record, is required to enter into a written contract 
(or other written arrangement) described in section 
164.502(e)(2) of title 45, Code of Federal Regulations and 
a written contract (or other arrangement) described in 
section 164.308(b) of such title, with such entity and shall 
be treated as a business associate of the covered entity 
for purposes of the provisions of this subtitle and subparts 
C and E of part 164 of title 45, Code of Federal Regula-
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AMDT. NO. 98 
tions, as such provisions are in effect as of the date of 
enactment of this title. 
SEC. 13409. CLARIFICATION OF APPLICATION OF WRONG-
FUL DISCLOSURES CRIMINAL PENALTIES. 
Section 1177(a) of the Social Security Act (42 U.S.C. 
1320d–6(a)) is amended by adding at the end the fol-
lowing new sentence: ‘‘For purposes of the previous sen-
tence, a person (including an employee or other individual) 
shall be considered to have obtained or disclosed individ-
ually identifiable health information in violation of this 
part if the information is maintained by a covered entity 
(as defined in the HIPAA privacy regulation described in 
section 1180(b)(3)) and the individual obtained or dis-
closed such information without authorization.’’. 
SEC. 13410. IMPROVED ENFORCEMENT. 
(a) IN GENERAL.—Section 1176 of the Social Secu-
rity Act (42 U.S.C. 1320d-5) is amended— 
(1) in subsection (b)(1), by striking ‘‘the act 
constitutes an offense punishable under section 
1177’’ and inserting ‘‘a penalty has been imposed 
under section 1177 with respect to such act’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(c) NONCOMPLIANCE
DUE
TO
WILLFUL
NE-
GLECT.— 
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AMDT. NO. 98 
‘‘(1) IN GENERAL.—A violation of a provision 
of this part due to willful neglect is a violation for 
which the Secretary is required to impose a penalty 
under subsection (a)(1). 
‘‘(2) REQUIRED INVESTIGATION.—For purposes 
of paragraph (1), the Secretary shall formally inves-
tigate any complaint of a violation of a provision of 
this part if a preliminary investigation of the facts 
of the complaint indicate such a possible violation 
due to willful neglect.’’. 
(b) EFFECTIVE DATE; REGULATIONS.— 
(1) The amendments made by subsection (a) 
shall apply to penalties imposed on or after the date 
that is 24 months after the date of the enactment 
of this title. 
(2) Not later than 18 months after the date of 
the enactment of this title, the Secretary of Health 
and Human Services shall promulgate regulations to 
implement such amendments. 
(c) DISTRIBUTION OF CERTAIN CIVIL MONETARY 
PENALTIES COLLECTED.— 
(1) IN
GENERAL.—Subject to the regulation 
promulgated pursuant to paragraph (3), any civil 
monetary penalty or monetary settlement collected 
with respect to an offense punishable under this sub-
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AMDT. NO. 98 
title or section 1176 of the Social Security Act (42 
U.S.C. 1320d-5) insofar as such section relates to 
privacy or security shall be transferred to the Office 
of Civil Rights of the Department of Health and 
Human Services to be used for purposes of enforcing 
the provisions of this subtitle and subparts C and E 
of part 164 of title 45, Code of Federal Regulations, 
as such provisions are in effect as of the date of en-
actment of this Act. 
(2) GAO REPORT.—Not later than 18 months 
after the date of the enactment of this title, the 
Comptroller General shall submit to the Secretary a 
report including recommendations for a methodology 
under which an individual who is harmed by an act 
that constitutes an offense referred to in paragraph 
(1) may receive a percentage of any civil monetary 
penalty or monetary settlement collected with re-
spect to such offense. 
(3) ESTABLISHMENT
OF
METHODOLOGY
TO 
DISTRIBUTE PERCENTAGE OF CMPS COLLECTED TO 
HARMED
INDIVIDUALS.—Not later than 3 years 
after the date of the enactment of this title, the Sec-
retary shall establish by regulation and based on the 
recommendations submitted under paragraph (2), a 
methodology under which an individual who is 
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AMDT. NO. 98 
harmed by an act that constitutes an offense re-
ferred to in paragraph (1) may receive a percentage 
of any civil monetary penalty or monetary settlement 
collected with respect to such offense. 
(4) APPLICATION
OF
METHODOLOGY.—The 
methodology under paragraph (3) shall be applied 
with respect to civil monetary penalties or monetary 
settlements imposed on or after the effective date of 
the regulation. 
(d) TIERED INCREASE IN AMOUNT OF CIVIL MONE-
TARY PENALTIES.— 
(1) IN GENERAL.—Section 1176(a)(1) of the 
Social Security Act (42 U.S.C. 1320d-5(a)(1)) is 
amended by striking ‘‘who violates a provision of 
this part a penalty of not more than’’ and all that 
follows and inserting the following: ‘‘who violates a 
provision of this part— 
‘‘(A) in the case of a violation of such pro-
vision in which it is established that the person 
did not know (and by exercising reasonable dili-
gence would not have known) that such person 
violated such provision, a penalty for each such 
violation of an amount that is at least the 
amount described in paragraph (3)(A) but not 
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AMDT. NO. 98 
to exceed the amount described in paragraph 
(3)(D); 
‘‘(B) in the case of a violation of such pro-
vision in which it is established that the viola-
tion was due to reasonable cause and not to 
willful neglect, a penalty for each such violation 
of an amount that is at least the amount de-
scribed in paragraph (3)(B) but not to exceed 
the amount described in paragraph (3)(D); and 
‘‘(C) in the case of a violation of such pro-
vision in which it is established that the viola-
tion was due to willful neglect— 
‘‘(i) if the violation is corrected as de-
scribed in subsection (b)(3)(A), a penalty 
in an amount that is at least the amount 
described in paragraph (3)(C) but not to 
exceed the amount described in paragraph 
(3)(D); and 
‘‘(ii) if the violation is not corrected 
as described in such subsection, a penalty 
in an amount that is at least the amount 
described in paragraph (3)(D). 
‘‘In determining the amount of a penalty under 
this section for a violation, the Secretary shall 
base such determination on the nature and ex-
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AMDT. NO. 98 
(ii) in subparagraph (B), by striking 
‘‘(A)(ii)’’ and inserting ‘‘(A)’’ each place it 
appears. 
(4) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to violations occurring 
after the date of the enactment of this title. 
(e) ENFORCEMENT THROUGH STATE ATTORNEYS 
GENERAL.— 
(1) IN GENERAL.—Section 1176 of the Social 
Security Act (42 U.S.C. 1320d–5) is amended by 
adding at the end the following new subsection: 
‘‘(d) ENFORCEMENT BY STATE ATTORNEYS GEN-
ERAL.— 
‘‘(1) CIVIL
ACTION.—Except as provided in 
subsection (b), in any case in which the attorney 
general of a State has reason to believe that an in-
terest of one or more of the residents of that State 
has been or is threatened or adversely affected by 
any person who violates a provision of this part, the 
attorney general of the State, as parens patriae, may 
bring a civil action on behalf of such residents of the 
State in a district court of the United States of ap-
propriate jurisdiction— 
‘‘(A) to enjoin further such violation by the 
defendant; or 
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AMDT. NO. 98 
‘‘(B) to obtain damages on behalf of such 
residents of the State, in an amount equal to 
the amount determined under paragraph (2). 
‘‘(2) STATUTORY DAMAGES.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1)(B), the amount determined under 
this paragraph is the amount calculated by mul-
tiplying the number of violations by up to $100. 
For purposes of the preceding sentence, in the 
case of a continuing violation, the number of 
violations shall be determined consistent with 
the HIPAA privacy regulations (as defined in 
section 1180(b)(3)) for violations of subsection 
(a). 
‘‘(B) LIMITATION.—The total amount of 
damages imposed on the person for all viola-
tions of an identical requirement or prohibition 
during a calendar year may not exceed $25,000. 
‘‘(C) REDUCTION
OF
DAMAGES.—In as-
sessing damages under subparagraph (A), the 
court may consider the factors the Secretary 
may consider in determining the amount of a 
civil money penalty under subsection (a) under 
the HIPAA privacy regulations. 
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AMDT. NO. 98 
‘‘(3) ATTORNEY FEES.—In the case of any suc-
cessful action under paragraph (1), the court, in its 
discretion, may award the costs of the action and 
reasonable attorney fees to the State. 
‘‘(4) NOTICE TO SECRETARY.—The State shall 
serve prior written notice of any action under para-
graph (1) upon the Secretary and provide the Sec-
retary with a copy of its complaint, except in any 
case in which such prior notice is not feasible, in 
which case the State shall serve such notice imme-
diately upon instituting such action. The Secretary 
shall have the right— 
‘‘(A) to intervene in the action; 
‘‘(B) upon so intervening, to be heard on 
all matters arising therein; and 
‘‘(C) to file petitions for appeal. 
‘‘(5) CONSTRUCTION.—For purposes of bring-
ing any civil action under paragraph (1), nothing in 
this section shall be construed to prevent an attor-
ney general of a State from exercising the powers 
conferred on the attorney general by the laws of that 
State. 
‘‘(6) VENUE; SERVICE OF PROCESS.— 
‘‘(A) VENUE.—Any action brought under 
paragraph (1) may be brought in the district 
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AMDT. NO. 98 
court of the United States that meets applicable 
requirements relating to venue under section 
1391 of title 28, United States Code. 
‘‘(B) SERVICE OF PROCESS.—In an action 
brought under paragraph (1), process may be 
served in any district in which the defendant— 
‘‘(i) is an inhabitant; or 
‘‘(ii) maintains a physical place of 
business. 
‘‘(7) LIMITATION
ON
STATE
ACTION
WHILE 
FEDERAL ACTION IS PENDING.—If the Secretary has 
instituted an action against a person under sub-
section (a) with respect to a specific violation of this 
part, no State attorney general may bring an action 
under this subsection against the person with re-
spect to such violation during the pendency of that 
action. 
‘‘(8) APPLICATION OF CMP STATUTE OF LIMI-
TATION.—A civil action may not be instituted with 
respect to a violation of this part unless an action 
to impose a civil money penalty may be instituted 
under subsection (a) with respect to such violation 
consistent with the second sentence of section 
1128A(c)(1).’’. 
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AMDT. NO. 98 
(2) CONFORMING
AMENDMENTS.—Subsection 
(b) of such section, as amended by subsection (d)(3), 
is amended— 
(A) in paragraph (1), by striking ‘‘A pen-
alty may not be imposed under subsection (a)’’ 
and inserting ‘‘No penalty may be imposed 
under subsection (a) and no damages obtained 
under subsection (d)’’; 
(B) in paragraph (2)(A)— 
(i) after ‘‘subsection (a)(1)(C),’’, by 
striking ‘‘a penalty may not be imposed 
under subsection (a)’’ and inserting ‘‘no 
penalty may be imposed under subsection 
(a) and no damages obtained under sub-
section (d)’’; and 
(ii) in clause (ii), by inserting ‘‘or 
damages’’ after ‘‘the penalty’’; 
(C) in paragraph (2)(B)(i), by striking 
‘‘The period’’ and inserting ‘‘With respect to 
the imposition of a penalty by the Secretary 
under subsection (a), the period’’; and 
(D) in paragraph (3), by inserting ‘‘and 
any damages under subsection (d)’’ after ‘‘any 
penalty under subsection (a)’’. 
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AMDT. NO. 98 
(3) EFFECTIVE DATE.—The amendments made 
by this subsection shall apply to violations occurring 
after the date of the enactment of this Act. 
(f) ALLOWING CONTINUED USE OF CORRECTIVE AC-
TION.—Such section is further amended by adding at the 
end the following new subsection: 
‘‘(e) ALLOWING CONTINUED USE OF CORRECTIVE 
ACTION.—Nothing in this section shall be construed as 
preventing the Office of Civil Rights of the Department 
of Health and Human Services from continuing, in its dis-
cretion, to use corrective action without a penalty in cases 
where the person did not know (and by exercising reason-
able diligence would not have known) of the violation in-
volved.’’. 
SEC. 13411. AUDITS. 
The Secretary shall provide for periodic audits to en-
sure that covered entities and business associates that are 
subject to the requirements of this subtitle and subparts 
C and E of part 164 of title 45, Code of Federal Regula-
tions, as such provisions are in effect as of the date of 
enactment of this Act, comply with such requirements. 
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AMDT. NO. 98 
PART II—RELATIONSHIP TO OTHER LAWS; REGU-
LATORY REFERENCES; EFFECTIVE DATE; RE-
PORTS 
SEC. 13421. RELATIONSHIP TO OTHER LAWS. 
(a) APPLICATION OF HIPAA STATE PREEMPTION.— 
Section 1178 of the Social Security Act (42 U.S.C. 
1320d–7) shall apply to a provision or requirement under 
this subtitle in the same manner that such section applies 
to a provision or requirement under part C of title XI of 
such Act or a standard or implementation specification 
adopted or established under sections 1172 through 1174 
of such Act. 
(b) HEALTH INSURANCE PORTABILITY
AND AC-
COUNTABILITY ACT.—The standards governing the pri-
vacy and security of individually identifiable health infor-
mation promulgated by the Secretary under sections 
262(a) and 264 of the Health Insurance Portability and 
Accountability Act of 1996 shall remain in effect to the 
extent that they are consistent with this subtitle. The Sec-
retary shall by rule amend such Federal regulations as re-
quired to make such regulations consistent with this sub-
title. In carrying out the preceding sentence, the Secretary 
shall revise the definition of ‘‘psychotherapy notes’’ in sec-
tion 164.501 of title 45, Code of Federal Regulations, to 
include test data that is related to direct responses, scores, 
items, forms, protocols, manuals, or other materials that 
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AMDT. NO. 98 
are part of a mental health evaluation, as determined by 
the mental health professional providing treatment or 
evaluation. 
SEC. 13422. REGULATORY REFERENCES. 
Each reference in this subtitle to a provision of the 
Code of Federal Regulations refers to such provision as 
in effect on the date of the enactment of this title (or to 
the most recent update of such provision). 
SEC. 13423. EFFECTIVE DATE. 
Except as otherwise specifically provided, the provi-
sions of part I shall take effect on the date that is 12 
months after the date of the enactment of this title. 
SEC. 13424. STUDIES, REPORTS, GUIDANCE. 
(a) REPORT ON COMPLIANCE.— 
(1) IN GENERAL.—For the first year beginning 
after the date of the enactment of this Act and an-
nually thereafter, the Secretary shall prepare and 
submit to the Committee on Health, Education, 
Labor, and Pensions of the Senate and the Com-
mittee on Ways and Means and the Committee on 
Energy and Commerce of the House of Representa-
tives a report concerning complaints of alleged viola-
tions of law, including the provisions of this subtitle 
as well as the provisions of subparts C and E of part 
164 of title 45, Code of Federal Regulations, (as 
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AMDT. NO. 98 
such provisions are in effect as of the date of enact-
ment of this Act) relating to privacy and security of 
health information that are received by the Secretary 
during the year for which the report is being pre-
pared. Each such report shall include, with respect 
to such complaints received during the year— 
(A) the number of such complaints; 
(B) the number of such complaints re-
solved informally, a summary of the types of 
such complaints so resolved, and the number of 
covered entities that received technical assist-
ance from the Secretary during such year in 
order to achieve compliance with such provi-
sions and the types of such technical assistance 
provided; 
(C) the number of such complaints that 
have resulted in the imposition of civil monetary 
penalties or have been resolved through mone-
tary settlements, including the nature of the 
complaints involved and the amount paid in 
each penalty or settlement; 
(D) the number of compliance reviews con-
ducted and the outcome of each such review; 
(E) the number of subpoenas or inquiries 
issued; 
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AMDT. NO. 98 
(F) the Secretary’s plan for improving 
compliance with and enforcement of such provi-
sions for the following year; and 
(G) the number of audits performed and a 
summary of audit findings pursuant to section 
13411. 
(2) AVAILABILITY
TO
PUBLIC.—Each report 
under paragraph (1) shall be made available to the 
public on the Internet website of the Department of 
Health and Human Services. 
(b) STUDY AND REPORT ON APPLICATION OF PRI-
VACY AND SECURITY REQUIREMENTS TO NON-HIPAA 
COVERED ENTITIES.— 
(1) STUDY.—Not later than one year after the 
date of the enactment of this title, the Secretary, in 
consultation with the Federal Trade Commission, 
shall conduct a study, and submit a report under 
paragraph (2), on privacy and security requirements 
for entities that are not covered entities or business 
associates as of the date of the enactment of this 
title, including— 
(A) requirements relating to security, pri-
vacy, and notification in the case of a breach of 
security or privacy (including the applicability 
of an exemption to notification in the case of 
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AMDT. NO. 98 
individually identifiable health information that 
has been rendered unusable, unreadable, or in-
decipherable through technologies or methodolo-
gies recognized by appropriate professional or-
ganization or standard setting bodies to provide 
effective security for the information) that 
should be applied to— 
(i) vendors of personal health records; 
(ii) entities that offer products or 
services through the website of a vendor of 
personal health records; 
(iii) entities that are not covered enti-
ties and that offer products or services 
through the websites of covered entities 
that offer individuals personal health 
records; 
(iv) entities that are not covered enti-
ties and that access information in a per-
sonal health record or send information to 
a personal health record; and 
(v) third party service providers used 
by a vendor or entity described in clause 
(i), (ii), (iii), or (iv) to assist in providing 
personal health record products or services; 
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AMDT. NO. 98 
(B) a determination of which Federal gov-
ernment agency is best equipped to enforce 
such requirements recommended to be applied 
to such vendors, entities, and service providers 
under subparagraph (A); and 
(C) a timeframe for implementing regula-
tions based on such findings. 
(2) REPORT.—The Secretary shall submit to 
the Committee on Finance, the Committee on 
Health, Education, Labor, and Pensions, and the 
Committee on Commerce of the Senate and the 
Committee on Ways and Means and the Committee 
on Energy and Commerce of the House of Rep-
resentatives a report on the findings of the study 
under paragraph (1) and shall include in such report 
recommendations on the privacy and security re-
quirements described in such paragraph. 
(c) GUIDANCE ON IMPLEMENTATION SPECIFICATION 
TO DE-IDENTIFY PROTECTED HEALTH INFORMATION.— 
Not later than 12 months after the date of the enactment 
of this title, the Secretary shall, in consultation with stake-
holders, issue guidance on how best to implement the re-
quirements for the de-identification of protected health in-
formation under section 164.514(b) of title 45, Code of 
Federal Regulations. 
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AMDT. NO. 98 
(d) GAO REPORT ON TREATMENT DISCLOSURES.— 
Not later than one year after the date of the enactment 
of this title, the Comptroller General of the United States 
shall submit to the Committee on Health, Education, 
Labor, and Pensions of the Senate and the Committee on 
Ways and Means and the Committee on Energy and Com-
merce of the House of Representatives a report on the 
best practices related to the disclosure among health care 
providers of protected health information of an individual 
for purposes of treatment of such individual. Such report 
shall include an examination of the best practices imple-
mented by States and by other entities, such as health 
information exchanges and regional health information or-
ganizations, an examination of the extent to which such 
best practices are successful with respect to the quality 
of the resulting health care provided to the individual and 
with respect to the ability of the health care provider to 
manage such best practices, and an examination of the 
use of electronic informed consent for disclosing protected 
health information for treatment, payment, and health 
care operations. 
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AMDT. NO. 98 
TITLE XIV—STATE FISCAL STABILIZATION 
DEPARTMENT OF EDUCATION 
STATE FISCAL STABILIZATION FUND 
For necessary expenses for a State Fiscal Stabiliza-
tion Fund, $79,000,000,000, which shall be administered 
by the Department of Education, and shall be available 
through September 30, 2010. 
GENERAL PROVISIONS—THIS TITLE 
SEC. 1401. ALLOCATIONS. 
(a) OUTLYING AREAS.—The Secretary of Education 
shall first allocate one-half of 1 percent to the outlying 
areas on the basis of their respective needs, as determined 
by the Secretary, for activities consistent with this title 
under such terms and conditions as the Secretary may de-
termine. 
(b) ADMINISTRATION AND OVERSIGHT.—The Sec-
retary may reserve up to $25,000,000 for administration 
and oversight of this title, including for program evalua-
tion. 
(c) RESERVATION FOR ADDITIONAL PROGRAMS.— 
After reserving funds under subsections (a) and (b), the 
Secretary shall reserve $15,000,000,000 for grants under 
sections 1406 and 1407. 
(d) STATE ALLOCATIONS.—After carrying out sub-
sections (a), (b), and (c), the Secretary shall allocate the 
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AMDT. NO. 98 
remaining funds made available to carry out this title to 
the States as follows: 
(1) 61 percent on the basis of their relative 
population of individuals aged 5 through 24. 
(2) 39 percent on the basis of their relative 
total population. 
(e) STATE GRANTS.—From funds allocated under 
subsection (d), the Secretary shall make grants to the 
Governor of each State. 
(f) REALLOCATION.—The Governor shall return to 
the Secretary any funds received under subsection (e) that 
the Governor does not obligate within 1 year of receiving 
a grant, and the Secretary shall reallocate such funds to 
the remaining States in accordance with subsection (d). 
SEC. 1402. STATE USES OF FUNDS. 
(a) EDUCATION FUND.— 
(1) IN GENERAL.—The Governor shall use at 
least 61 percent of the State’s allocation under sec-
tion 1401 for the support of elementary, secondary, 
and postsecondary education and, as applicable, 
early childhood education programs and services. 
(2) RESTORING 2008 STATE SUPPORT FOR EDU-
CATION.— 
(A) IN
GENERAL.—The Governor shall 
first use the funds described in paragraph (1)— 
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AMDT. NO. 98 
(i) to provide the amount of funds, 
through the State’s principal elementary 
and secondary funding formula, that is 
needed to restore State support for elemen-
tary and secondary education to the fiscal 
year 2008 level; and where applicable, to 
allow existing State formula increases for 
fiscal years 2009, 2010, and 2011 to be 
implemented and allow funding for phasing 
in State equity and adequacy adjustments 
that were enacted prior to July 1, 2008; 
and 
(ii) to provide the amount of funds to 
public institutions of higher education in 
the State that is needed to restore State 
support for postsecondary education to the 
fiscal year 2008 level. 
(B) SHORTFALL.—If the Governor deter-
mines that the amount of funds available under 
paragraph (1) is insufficient to restore State 
support for education to the levels described in 
clauses (i) and (ii) of subparagraph (A), the 
Governor shall allocate those funds between 
those clauses in proportion to the relative short-
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AMDT. NO. 98 
fall in State support for the education sectors 
described in those clauses. 
(3) SUBGRANTS TO IMPROVE BASIC PROGRAMS 
OPERATED
BY
LOCAL
EDUCATIONAL
AGENCIES.— 
After carrying out paragraph (2), the Governor shall 
use any funds remaining under paragraph (1) to 
provide local educational agencies in the State with 
subgrants based on their relative shares of funding 
under part A of title I of the Elementary and Sec-
ondary Education Act of 1965 (20 U.S.C. 6311 et 
seq.) for the most recent year for which data are 
available. 
(b) OTHER GOVERNMENT SERVICES.—The Governor 
may use up to 39 percent of the State’s allocation under 
section 1401 for public safety and other government serv-
ices, which may include assistance for elementary and sec-
ondary education and public institutions of higher edu-
cation. 
SEC. 1403. USES OF FUNDS BY LOCAL EDUCATIONAL AGEN-
CIES. 
(a) IN GENERAL.—A local educational agency that 
receives funds under this title may use the funds for any 
activity authorized by the Elementary and Secondary Edu-
cation Act of 1965 (20 U.S.C. 6301 et seq.) (‘‘ESEA’’), 
the Individuals with Disabilities Education Act (20 U.S.C. 
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AMDT. NO. 98 
1400 et seq.) (‘‘IDEA’’), or the Carl D. Perkins Career 
and Technical Education Act of 2006 (20 U.S.C. 2301 
et seq.) (‘‘the Perkins Act’’). 
(b) PROHIBITION.—A local educational agency may 
not use funds received under this title for capital projects 
unless authorized by ESEA, IDEA, or the Perkins Act. 
SEC. 1404. USES OF FUNDS BY INSTITUTIONS OF HIGHER 
EDUCATION. 
(a) IN GENERAL.—A public institution of higher edu-
cation that receives funds under this title shall use the 
funds for education and general expenditures, and in such 
a way as to mitigate the need to raise tuition and fees 
for in-State students. 
(b) PROHIBITION.—An institution of higher edu-
cation may not use funds received under this title to in-
crease its endowment. 
(c) ADDITIONAL PROHIBITION.—An institution of 
higher education may not use funds received under this 
title for construction, renovation, or facility repair. 
SEC. 1405. STATE APPLICATIONS. 
(a) IN GENERAL.—The Governor of a State desiring 
to receive an allocation under section 1401 shall submit 
an application at such time, in such manner, and con-
taining such information as the Secretary may reasonably 
require. 
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AMDT. NO. 98 
(b) APPLICATION.—The Governor shall— 
(1) include the assurances described in sub-
section (d); 
(2) provide baseline data that demonstrates the 
State’s current status in each of the areas described 
in such assurances; and 
(3) describe how the State intends to use its al-
location. 
(c) INCENTIVE GRANT APPLICATION.—The Governor 
of a State seeking a grant under section 1406 shall— 
(1) submit an application for consideration; 
(2) describe the status of the State’s progress 
in each of the areas described in subsection (d); 
(3) describe the achievement and graduation 
rates of public elementary and secondary school stu-
dents in the State, and the strategies the State is 
employing to help ensure that all subgroups of stu-
dents identified in 1111(b)(2) of ESEA in the State 
continue making progress toward meeting the 
State’s student academic achievement standards; 
(4) describe how the State would use its grant 
funding to improve student academic achievement in 
the State, including how it will allocate the funds to 
give priority to high-need schools and local edu-
cational agencies; and 
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AMDT. NO. 98 
(5) include a plan for evaluating its progress in 
closing achievement gaps. 
(d) ASSURANCES.—An application under subsection 
(b) shall include the following assurances: 
(1) MAINTENANCE OF EFFORT.— 
(A) ELEMENTARY AND SECONDARY EDU-
CATION.—The State will, in each of fiscal years 
2009 and 2010, maintain State support for ele-
mentary and secondary education at least at 
the level of such support in fiscal year 2006. 
(B) HIGHER EDUCATION.—The State will, 
in each of fiscal years 2009 and 2010, maintain 
State support for public institutions of higher 
education (not including support for capital 
projects or for research and development) at 
least at the level of such support in fiscal year 
2006. 
(2) ACHIEVING EQUITY IN TEACHER DISTRIBU-
TION.—The State will take action, including activi-
ties outlined in section 2113(c) of ESEA, to increase 
the number, and improve the distribution, of effec-
tive teachers and principals in high-poverty schools 
and local educational agencies throughout the State. 
(3) IMPROVING
COLLECTION
AND
USE
OF 
DATA.—The State will establish a longitudinal data 
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AMDT. NO. 98 
system that includes the elements described in sec-
tion 6401(e)(2)(D) of the America COMPETES Act 
(20 U.S.C. 9871). 
(4) 
STANDARDS
AND
ASSESSMENTS.—The 
State— 
(A) will enhance the quality of academic 
assessments described in section 1111(b)(3) of 
ESEA (20 U.S.C. 6311(b)(3)) through activi-
ties such as those described in section 6112(a) 
of such Act (20 U.S.C. 7301a(a)); 
(B) will comply with the requirements of 
paragraphs (3)(C)(ix) and (6) of section 
1111(b) of ESEA (20 U.S.C. 6311(b)) and sec-
tion 
612(a)(16) 
of 
IDEA 
(20 
U.S.C. 
1412(a)(16)) related to the inclusion of children 
with disabilities and limited English proficient 
students in State assessments, the development 
of valid and reliable assessments for those stu-
dents, and the provision of accommodations 
that enable their participation in State assess-
ments; and 
(C) will take steps to improve State aca-
demic content standards and student academic 
achievement 
standards 
consistent 
with 
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AMDT. NO. 98 
6401(e)(1)(A)(ii) of the America COMPETES 
Act. 
(5) will ensure compliance with the require-
ments of section 1116(a)(7)(C)(iv) and section 
1116(a)(8)(B) with respect to schools identified 
under such sections. 
SEC. 1406. STATE INCENTIVE GRANTS. 
(a) IN GENERAL.—From the total amount reserved 
under section 1401(c) that is not used for section 1407, 
the Secretary shall, in fiscal year 2010, make grants to 
States that have made significant progress in meeting the 
objectives of paragraphs (2), (3), (4), and (5) of section 
1405(d). 
(b) BASIS FOR GRANTS.—The Secretary shall deter-
mine which States receive grants under this section, and 
the amount of those grants, on the basis of information 
provided in State applications under section 1405 and 
such other criteria as the Secretary determines appro-
priate. 
(c) SUBGRANTS
TO LOCAL EDUCATIONAL AGEN-
CIES.—Each State receiving a grant under this section 
shall use at least 50 percent of the grant to provide local 
educational agencies in the State with subgrants based on 
their relative shares of funding under part A of title I of 
ESEA (20 U.S.C. 6311 et seq.) for the most recent year. 
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AMDT. NO. 98 
SEC. 1407. INNOVATION FUND. 
(a) IN GENERAL.— 
(1) ELIGIBLE
ENTITY.—For the purposes of 
this section, the term ‘‘eligible entity’’ means— 
(A) A local educational agency; or 
(B) a partnership between a nonprofit or-
ganization and— 
(i) one or more local educational agen-
cies; 
(ii) or a consortium of schools. 
(2) PROGRAM ESTABLISHED.—From the total 
amount reserved under section 1401(c), the Sec-
retary may reserve up to $650,000,000 to establish 
an Innovation Fund, which shall consist of academic 
achievement awards that recognize eligible entities 
that meet the requirements described in subsection 
(b). 
(3) BASIS FOR AWARDS.—The Secretary shall 
make awards to eligible entities that have made sig-
nificant gains in closing the achievement gap as de-
scribed in subsection (b)(1)— 
(A) to allow such eligible entities to expand 
their work and serve as models for best prac-
tices; 
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(B) to allow such eligible entities to work 
in partnership with the private sector and the 
philanthropic community; and 
(C) to identify and document best practices 
that can be shared, and taken to scale based on 
demonstrated success. 
(b) ELIGIBILITY.—To be eligible for such an award, 
an eligible entity shall— 
(1) have significantly closed the achievement 
gaps between groups of students described in section 
1111(b)(2) of ESEA (20 U.S.C. 6311(b)(2)); 
(2) have exceeded the State’s annual measur-
able 
objectives 
consistent 
with 
such 
section 
1111(b)(2) for 2 or more consecutive years or have 
demonstrated success in significantly increasing stu-
dent academic achievement for all groups of stu-
dents described in such section through another 
measure, such as measures described in section 
1111(c)(2) of ESEA; 
(3) have made significant improvement in other 
areas, such as graduation rates or increased recruit-
ment and placement of high-quality teachers and 
school leaders, as demonstrated with meaningful 
data; and 
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(4) demonstrate that they have established 
partnerships with the private sector, which may in-
clude philanthropic organizations, and that the pri-
vate sector will provide matching funds in order to 
help bring results to scale. 
SEC. 1408. STATE REPORTS. 
A State receiving funds under this title shall submit 
a report to the Secretary, at such time and in such manner 
as the Secretary may require, that describes— 
(1) the uses of funds provided under this title 
within the State; 
(2) how the State distributed the funds it re-
ceived under this title; 
(3) the number of jobs that the Governor esti-
mates were saved or created with funds the State re-
ceived under this title; 
(4) tax increases that the Governor estimates 
were averted because of the availability of funds 
from this title; 
(5) the State’s progress in reducing inequities 
in the distribution of teachers, in implementing a 
State student longitudinal data system, and in devel-
oping and implementing valid and reliable assess-
ments for limited English proficient students and 
children with disabilities; 
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(6) the tuition and fee increases for in-State 
students imposed by public institutions of higher 
education in the State during the period of avail-
ability of funds under this title, and a description of 
any actions taken by the State to limit those in-
creases; and 
(7) the extent to which public institutions of 
higher education maintained, increased, or decreased 
enrollment of in-State students, including students 
eligible for Pell Grants or other need-based financial 
assistance. 
SEC. 1409. EVALUATION. 
The Comptroller General of the United States shall 
conduct evaluations of the programs under sections 1406 
and 1407 which shall include, but not be limited to, the 
criteria used for the awards made, the States selected for 
awards, award amounts, how each State used the award 
received, and the impact of this funding on the progress 
made toward closing achievement gaps. 
SEC. 1410. SECRETARY’S REPORT TO CONGRESS. 
The Secretary shall submit a report to the Committee 
on Education and Labor of the House of Representatives, 
the Committee on Health, Education, Labor, and Pen-
sions of the Senate, and the Committees on Appropria-
tions of the House of Representatives and of the Senate, 
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not less than 6 months following the submission of the 
State reports, that evaluates the information provided in 
the State reports under section 1408. 
SEC. 1411. PROHIBITION ON PROVISION OF CERTAIN AS-
SISTANCE. 
No recipient of funds under this title shall use such 
funds to provide financial assistance to students to attend 
private elementary or secondary schools, unless such funds 
are used to provide special education and related services 
to children with disabilities, as authorized by the Individ-
uals with Disabilities Education Act (20 U.S.C. 1400 et 
seq.). 
SEC. 1412. DEFINITIONS. 
Except as otherwise provided in this title, as used in 
this title— 
(1) the term ‘‘institution of higher education’’ 
has the meaning given such term in section 101 of 
the Higher Education Act of 1965 (20 U.S.C. 
1001); 
(2) the term ‘‘Secretary’’ means the Secretary 
of Education; 
(3) the term ‘‘State’’ means each of the 50 
States, the District of Columbia, and the Common-
wealth of Puerto Rico; and 
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(4) any other term that is defined in section 
9101 of ESEA (20 U.S.C. 7801) shall have the 
meaning given the term in such section. 
SEC. 1413. REGULATORY RELIEF. 
(a) WAIVER AUTHORITY.—Subject to subsections (b) 
and (c), the Secretary of Education may, as applicable, 
waive or modify, in order to ease fiscal burdens, any re-
quirement relating to the following: 
(1) Maintenance of effort. 
(2) The use of Federal funds to supplement, 
not supplant, non-Federal funds. 
(b) DURATION.—A waiver under this section shall be 
for fiscal years 2009 and 2010. 
(c) LIMITATIONS.— 
(1) RELATION TO IDEA.—Nothing in this sec-
tion shall be construed to permit the Secretary to 
waive or modify any provision of the Individuals 
with Disabilities Education Act (20 U.S.C. 1400 et 
seq.), except as described in a(1) and a(2). 
(2) MAINTENANCE
OF
EFFORT.—If the Sec-
retary grants a waiver or modification under this 
section waiving or modifying a requirement relating 
to maintenance of effort for fiscal years 2009 and 
2010, the level of effort required for fiscal year 2011 
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shall not be reduced because of the waiver or modi-
fication. 
TITLE XV—RECOVERY ACCOUNT-
ABILITY AND TRANSPARENCY 
BOARD AND RECOVERY INDE-
PENDENT ADVISORY PANEL 
SEC. 1501. DEFINITIONS. 
In this title: 
(1) AGENCY.—The term ‘‘agency’’ has the 
meaning given under section 551 of title 5, United 
States Code. 
(2) BOARD.—The term ‘‘Board’’ means the Re-
covery Accountability and Transparency Board es-
tablished in section 1511. 
(3) CHAIRPERSON.—The term ‘‘Chairperson’’ 
means the Chairperson of the Board. 
(4) COVERED
FUNDS.—The term ‘‘covered 
funds’’ means any funds that are expended or obli-
gated— 
(A) from appropriations made under this 
Act; and 
(B) under any other authorities provided 
under this Act. 
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(5) PANEL.—The term ‘‘Panel’’ means the Re-
covery Independent Advisory Panel established in 
section 1531. 
Subtitle 
A—Recovery 
Account-
ability and Transparency Board 
SEC. 1511. ESTABLISHMENT OF THE RECOVERY ACCOUNT-
ABILITY AND TRANSPARENCY BOARD. 
There is established the Recovery Accountability and 
Transparency Board to coordinate and conduct oversight 
of covered funds to prevent fraud, waste, and abuse. 
SEC. 1512. COMPOSITION OF BOARD. 
(a) CHAIRPERSON.— 
(1) DESIGNATION
OR
APPOINTMENT.—The 
President shall— 
(A) designate the Deputy Director for 
Management of the Office of Management and 
Budget to serve as Chairperson of the Board; 
(B) designate another Federal officer who 
was appointed by the President to a position 
that required the advice and consent of the 
Senate, to serve as Chairperson of the Board; 
or 
(C) appoint an individual as the Chair-
person of the Board, by and with the advice 
and consent of the Senate. 
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(2) COMPENSATION.— 
(A) DESIGNATION
OF
FEDERAL
OFFI-
CER.—If the President designates a Federal of-
ficer under paragraph (1)(A) or (B) to serve as 
Chairperson, that Federal officer may not re-
ceive additional compensation for services per-
formed as Chairperson. 
(B) APPOINTMENT OF NON-FEDERAL OF-
FICER.—If the President appoints an individual 
as Chairperson under paragraph (1)(C), that 
individual shall be compensated at the rate of 
basic pay prescribed for level IV of the Execu-
tive Schedule under section 5315 of title 5, 
United States Code. 
(b) MEMBERS.—The members of the Board shall in-
clude— 
(1) the Inspectors General of the Departments 
of Agriculture, Commerce, Education, Energy, 
Health and Human Services, Homeland Security, 
Justice, Transportation, Treasury, and the Treasury 
Inspector General for Tax Administration; and 
(2) any other Inspector General as designated 
by the President from any agency that expends or 
obligates covered funds. 
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SEC. 1513. FUNCTIONS OF THE BOARD. 
(a) FUNCTIONS.— 
(1) IN GENERAL.—The Board shall coordinate 
and conduct oversight of covered funds in order to 
prevent fraud, waste, and abuse. 
(2) SPECIFIC
FUNCTIONS.—The functions of 
the Board shall include— 
(A) reviewing whether the reporting of con-
tracts and grants using covered funds meets ap-
plicable standards and specifies the purpose of 
the contract or grant and measures of perform-
ance; 
(B) reviewing whether competition require-
ments applicable to contracts and grants using 
covered funds have been satisfied; 
(C) auditing and investigating covered 
funds to determine whether wasteful spending, 
poor contract or grant management, or other 
abuses are occurring; 
(D) reviewing whether there are sufficient 
qualified acquisition and grant personnel over-
seeing covered funds; 
(E) reviewing whether personnel whose du-
ties involve acquisitions or grants made with 
covered funds receive adequate training; and 
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(F) reviewing whether there are appro-
priate mechanisms for interagency collaboration 
relating to covered funds. 
(b) REPORTS.— 
(1) QUARTERLY
REPORTS.—The Board shall 
submit quarterly reports to the President and Con-
gress, including the Committees on Appropriations 
of the Senate and House of Representatives, summa-
rizing the findings of the Board and the findings of 
inspectors general of agencies. The Board may sub-
mit additional reports as appropriate. 
(2) ANNUAL REPORTS.—The Board shall sub-
mit annual reports to the President and the Com-
mittees on Appropriations of the Senate and House 
of Representatives, consolidating applicable quarterly 
reports on the use of covered funds. 
(3) PUBLIC AVAILABILITY.— 
(A) IN GENERAL.—All reports submitted 
under this subsection shall be made publicly 
available and posted on a website established by 
the Board. 
(B) REDACTIONS.—Any portion of a re-
port submitted under this subsection may be re-
dacted when made publicly available, if that 
portion would disclose information that is not 
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AMDT. NO. 98 
subject to disclosure under section 552 of title 
5, United States Code (commonly known as the 
Freedom of Information Act). 
(c) RECOMMENDATIONS.— 
(1) IN GENERAL.—The Board shall make rec-
ommendations to agencies on measures to prevent 
fraud, waste, and abuse relating to covered funds. 
(2) RESPONSIVE REPORTS.—Not later than 30 
days after receipt of a recommendation under para-
graph (1), an agency shall submit a report to the 
President, the congressional committees of jurisdic-
tion, including the Committees on Appropriations of 
the Senate and House of Representatives, and the 
Board on— 
(A) whether the agency agrees or disagrees 
with the recommendations; and 
(B) any actions the agency will take to im-
plement the recommendations. 
SEC. 1514. POWERS OF THE BOARD. 
(a) IN GENERAL.—The Board shall conduct, super-
vise, and coordinate audits and investigations by inspec-
tors general of agencies relating to covered funds. 
(b) AUDITS
AND
INVESTIGATIONS.—The Board 
may— 
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(1) conduct its own independent audits and in-
vestigations relating to covered funds; and 
(2) collaborate on audits and investigations re-
lating to covered funds with any inspector general of 
an agency. 
(c) AUTHORITIES.— 
(1) AUDITS
AND
INVESTIGATIONS.—In con-
ducting audits and investigations, the Board shall 
have the authorities provided under section 6 of the 
Inspector General Act of 1978 (5 U.S.C. App.). 
(2) STANDARDS AND GUIDELINES.—The Board 
shall carry out the powers under subsections (a) and 
(b) in accordance with section 4(b)(1) of the Inspec-
tor General Act of 1978 (5 U.S.C. App.). 
(d) PUBLIC HEARINGS.—The Board may hold public 
hearings and Board personnel may conduct investigative 
depositions. The head of each agency shall make all offi-
cers and employees of that agency available to provide tes-
timony to the Board and Board personnel. The Board may 
issue subpoenas to compel the testimony of persons who 
are not Federal officers or employees. Any such subpoenas 
may be enforced as provided under section 6 of the Inspec-
tor General Act of 1978 (5 U.S.C. App.). 
(e) CONTRACTS.—The Board may enter into con-
tracts to enable the Board to discharge its duties under 
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AMDT. NO. 98 
this subtitle, including contracts and other arrangements 
for audits, studies, analyses, and other services with public 
agencies and with private persons, and make such pay-
ments as may be necessary to carry out the duties of the 
Board. 
(f) TRANSFER OF FUNDS.—The Board may transfer 
funds appropriated to the Board for expenses to support 
administrative support services and audits or investiga-
tions of covered funds to any office of inspector general, 
the Office of Management and Budget, the General Serv-
ices Administration, and the Panel. 
SEC. 1515. EMPLOYMENT, PERSONNEL, AND RELATED AU-
THORITIES. 
(a) EMPLOYMENT AND PERSONNEL AUTHORITIES.— 
(1) IN GENERAL.— 
(A) AUTHORITIES.—Subject to paragraph 
(2), the Board may exercise the authorities of 
subsections (b) through (i) of section 3161 of 
title 5, United States Code (without regard to 
subsection (a) of that section). 
(B) APPLICATION.—For purposes of exer-
cising the authorities described under subpara-
graph (A), the term ‘‘Chairperson of the 
Board’’ shall be substituted for the term ‘‘head 
of a temporary organization’’. 
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AMDT. NO. 98 
(C) CONSULTATION.—In exercising the au-
thorities described under subparagraph (A), the 
Chairperson shall consult with members of the 
Board. 
(2) EMPLOYMENT AUTHORITIES.—In exercising 
the employment authorities under subsection (b) of 
section 3161 of title 5, United States Code, as pro-
vided under paragraph (1) of this subsection— 
(A) paragraph (2) of subsection (b) of sec-
tion 3161 of that title (relating to periods of 
appointments) shall not apply; and 
(B) no period of appointment may exceed 
the date on which the Board terminates under 
section 1521. 
(b) INFORMATION AND ASSISTANCE.— 
(1) IN GENERAL.—Upon request of the Board 
for information or assistance from any agency or 
other entity of the Federal Government, the head of 
such entity shall, insofar as is practicable and not in 
contravention of any existing law, furnish such infor-
mation or assistance to the Board, or an authorized 
designee. 
(2) REPORT
OF
REFUSALS.—Whenever infor-
mation or assistance requested by the Board is, in 
the judgment of the Board, unreasonably refused or 
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AMDT. NO. 98 
not provided, the Board shall report the cir-
cumstances to the congressional committees of juris-
diction, including the Committees on Appropriations 
of the Senate and House of Representatives, without 
delay. 
(c) ADMINISTRATIVE SUPPORT.—The General Serv-
ices Administration shall provide the Board with adminis-
trative support services, including the provision of office 
space and facilities. 
SEC. 1516. INDEPENDENCE OF INSPECTORS GENERAL. 
(a) INDEPENDENT AUTHORITY.—Nothing in this 
subtitle shall affect the independent authority of an in-
spector general to determine whether to conduct an audit 
or investigation of covered funds. 
(b) REQUESTS BY BOARD.—If the Board requests 
that an inspector general conduct or refrain from con-
ducting an audit or investigation and the inspector general 
rejects the request in whole or in part, the inspector gen-
eral shall, not later than 30 days after rejecting the re-
quest, submit a report to the Board, the head of the appli-
cable agency, and the congressional committees of juris-
diction, including the Committees on Appropriations of the 
Senate and House of Representatives. The report shall 
state the reasons that the inspector general has rejected 
the request in whole or in part. 
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AMDT. NO. 98 
SEC. 1517. COORDINATION WITH THE COMPTROLLER GEN-
ERAL AND STATE AUDITORS. 
The Board shall coordinate its oversight activities 
with the Comptroller General of the United States and 
State auditor generals. 
SEC. 1518. PROTECTING STATE AND LOCAL GOVERNMENT 
AND CONTRACTOR WHISTLEBLOWERS. 
(a) PROHIBITION OF REPRISALS.—An employee of 
any non-Federal employer receiving covered funds may not 
be discharged, demoted, or otherwise discriminated 
against as a reprisal for disclosing to the Board, an in-
spector general, the Comptroller General, a member of 
Congress, or a the head of a Federal agency, or their rep-
resentatives, information that the employee reasonably be-
lieves is evidence of— 
(1) gross mismanagement of an agency contract 
or grant relating to covered funds; 
(2) a gross waste of covered funds; 
(3) a substantial and specific danger to public 
health or safety; or 
(4) a violation of law related to an agency con-
tract (including the competition for or negotiation of 
a contract) or grant, awarded or issued relating to 
covered funds. 
(b) INVESTIGATION OF COMPLAINTS.— 
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(1) IN GENERAL.—A person who believes that 
the person has been subjected to a reprisal prohib-
ited by subsection (a) may submit a complaint to the 
appropriate inspector general. Unless the inspector 
general determines that the complaint is frivolous, 
the inspector general shall investigate the complaint 
and, upon completion of such investigation, submit 
a report of the findings of the investigation to the 
person, the person’s employer, the head of the ap-
propriate agency, and the Board. 
(2) TIME LIMITATIONS FOR ACTIONS.— 
(A) IN
GENERAL.—Except as provided 
under subparagraph (B), the inspector general 
shall make a determination that a complaint is 
frivolous or submit a report under paragraph 
(1) within 180 days after receiving the com-
plaint. 
(B) EXTENSION.—If the inspector general 
is unable to complete an investigation in time to 
submit a report within the 180-day period spec-
ified under subparagraph (A) and the person 
submitting the complaint agrees to an extension 
of time, the inspector general shall submit a re-
port under paragraph (1) within such additional 
period of time as shall be agreed upon between 
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AMDT. NO. 98 
the inspector general and the person submitting 
the complaint. 
(c) REMEDY AND ENFORCEMENT AUTHORITY.— 
(1) AGENCY ACTION.—Not later than 30 days 
after receiving an inspector general report under 
subsection (b), the head of the agency concerned 
shall determine whether there is sufficient basis to 
conclude that the non-Federal employer has sub-
jected the complainant to a reprisal prohibited by 
subsection (a) and shall either issue an order deny-
ing relief or shall take 1 or more of the following ac-
tions: 
(A) Order the employer to take affirmative 
action to abate the reprisal. 
(B) Order the employer to reinstate the 
person to the position that the person held be-
fore the reprisal, together with the compensa-
tion (including back pay), employment benefits, 
and other terms and conditions of employment 
that would apply to the person in that position 
if the reprisal had not been taken. 
(C) Order the employer to pay the com-
plainant an amount equal to the aggregate 
amount of all costs and expenses (including at-
torneys’ fees and expert witnesses’ fees) that 
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AMDT. NO. 98 
were reasonably incurred by the complainant 
for, or in connection with, bringing the com-
plaint regarding the reprisal, as determined by 
the head of the agency. 
(2) CIVIL ACTION.—If the head of an agency 
issues an order denying relief under paragraph (1) 
or has not issued an order within 210 days after the 
submission of a complaint under subsection (b), or 
in the case of an extension of time under subsection 
(b)(2)(B), not later than 30 days after the expira-
tion of the extension of time, and there is no show-
ing that such delay is due to the bad faith of the 
complainant, the complainant shall be deemed to 
have exhausted all administrative remedies with re-
spect to the complaint, and the complainant may 
bring a de novo action at law or equity against the 
employer to seek compensatory damages and other 
relief available under this section in the appropriate 
district court of the United States, which shall have 
jurisdiction over such an action without regard to 
the amount in controversy. Such an action shall, at 
the request of either party to the action, be tried by 
the court with a jury. 
(3) EVIDENCE.—An inspector general deter-
mination and an agency head order denying relief 
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under paragraph (2) shall be admissible in evidence 
in any de novo action at law or equity brought in ac-
cordance with this subsection. 
(4) JUDICIAL
ENFORCEMENT
OF
ORDER.— 
Whenever a person fails to comply with an order 
issued under paragraph (1), the head of the agency 
shall file an action for enforcement of such order in 
the United States district court for a district in 
which the reprisal was found to have occurred. In 
any action brought under this paragraph, the court 
may grant appropriate relief, including injunctive re-
lief and compensatory and exemplary damages. 
(5) JUDICIAL REVIEW.—Any person adversely 
affected or aggrieved by an order issued under para-
graph (1) may obtain review of the order’s conform-
ance with this subsection, and any regulations issued 
to carry out this section, in the United States court 
of appeals for a circuit in which the reprisal is al-
leged in the order to have occurred. No petition 
seeking such review may be filed more than 60 days 
after issuance of the order by the head of the agen-
cy. Review shall conform to chapter 7 of title 5, 
United States Code. 
(d) RULE OF CONSTRUCTION.—Nothing in this sec-
tion may be construed to authorize the discharge of, demo-
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tion of, or discrimination against an employee for a disclo-
sure other than a disclosure protected by subsection (a) 
or to modify or derogate from a right or remedy otherwise 
available to the employee. 
SEC. 1519. BOARD WEBSITE. 
(a) ESTABLISHMENT.—The Board shall establish and 
maintain a user-friendly, public-facing website to foster 
greater accountability and transparency in the use of cov-
ered funds. 
(b) PURPOSE.—The website established and main-
tained under subsection (a) shall be a portal or gateway 
to key information relating to this Act and provide connec-
tions to other Government websites with related informa-
tion. 
(c) CONTENT AND FUNCTION.—In establishing the 
website established and maintained under subsection (a), 
the Board shall ensure the following: 
(1) The website shall provide materials explain-
ing what this Act means for citizens. The materials 
shall be easy to understand and regularly updated. 
(2) The website shall provide accountability in-
formation, including a database of findings from au-
dits, inspectors general, and the Government Ac-
countability Office. 
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AMDT. NO. 98 
(3) The website shall provide data on relevant 
economic, financial, grant, and contract information 
in user-friendly visual presentations to enhance pub-
lic awareness of the use of covered funds. 
(4) The website shall provide detailed data on 
contracts awarded by the Government that expend 
covered funds, including information about the com-
petitiveness of the contracting process, notification 
of solicitations for contracts to be awarded, and in-
formation about the process that was used for the 
award of contracts. 
(5) The website shall include printable reports 
on covered funds obligated by month to each State 
and congressional district. 
(6) The website shall provide a means for the 
public to give feedback on the performance of con-
tracts that expend covered funds. 
(7) The website shall be enhanced and updated 
as necessary to carry out the purposes of this sub-
title. 
(d) WAIVER.—The Board may exclude posting con-
tractual or other information on the website on a case- 
by-case basis when necessary to protect national security. 
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AMDT. NO. 98 
SEC. 1520. AUTHORIZATION OF APPROPRIATIONS. 
There are authorized to be appropriated such sums 
as necessary to carry out this subtitle. 
SEC. 1521. TERMINATION OF THE BOARD. 
The Board shall terminate on September 30, 2012. 
Subtitle B—Recovery Independent 
Advisory Panel 
SEC. 1531. ESTABLISHMENT OF RECOVERY INDEPENDENT 
ADVISORY PANEL. 
(a) ESTABLISHMENT.—There is established the Re-
covery Independent Advisory Panel. 
(b) MEMBERSHIP.—The Panel shall be composed of 
5 members who shall be appointed by the President. 
(c) QUALIFICATIONS.—Members shall be appointed 
on the basis of expertise in economics, public finance, con-
tracting, accounting, or any other relevant field. 
(d) INITIAL MEETING.—Not later than 30 days after 
the date on which all members of the Panel have been 
appointed, the Panel shall hold its first meeting. 
(e) MEETINGS.—The Panel shall meet at the call of 
the Chairperson of the Panel. 
(f) QUORUM.—A majority of the members of the 
Panel shall constitute a quorum, but a lesser number of 
members may hold hearings. 
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(g) CHAIRPERSON AND VICE CHAIRPERSON.—The 
Panel shall select a Chairperson and Vice Chairperson 
from among its members. 
SEC. 1532. DUTIES OF THE PANEL. 
The Panel shall make recommendations to the Board 
on actions the Board could take to prevent fraud, waste, 
and abuse relating to covered funds. 
SEC. 1533. POWERS OF THE PANEL. 
(a) HEARINGS.—The Panel may hold such hearings, 
sit and act at such times and places, take such testimony, 
and receive such evidence as the Panel considers advisable 
to carry out this subtitle. 
(b) INFORMATION FROM FEDERAL AGENCIES.—The 
Panel may secure directly from any agency such informa-
tion as the Panel considers necessary to carry out this sub-
title. Upon request of the Chairperson of the Panel, the 
head of such agency shall furnish such information to the 
Panel. 
(c) POSTAL SERVICES.—The Panel may use the 
United States mails in the same manner and under the 
same conditions as agencies of the Federal Government. 
(d) GIFTS.—The Panel may accept, use, and dispose 
of gifts or donations of services or property. 
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SEC. 1534. PANEL PERSONNEL MATTERS. 
(a) COMPENSATION OF MEMBERS.—Each member of 
the Panel who is not an officer or employee of the Federal 
Government shall be compensated at a rate equal to the 
daily equivalent of the annual rate of basic pay prescribed 
for level IV of the Executive Schedule under section 5315 
of title 5, United States Code, for each day (including 
travel time) during which such member is engaged in the 
performance of the duties of the Panel. All members of 
the Panel who are officers or employees of the United 
States shall serve without compensation in addition to that 
received for their services as officers or employees of the 
United States. 
(b) TRAVEL EXPENSES.—The members of the Panel 
shall be allowed travel expenses, including per diem in lieu 
of subsistence, at rates authorized for employees of agen-
cies under subchapter I of chapter 57 of title 5, United 
States Code, while away from their homes or regular 
places of business in the performance of services for the 
Panel. 
(c) STAFF.— 
(1) IN
GENERAL.—The Chairperson of the 
Panel may, without regard to the civil service laws 
and regulations, appoint and terminate an executive 
director and such other additional personnel as may 
be necessary to enable the Panel to perform its du-
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ties. The employment of an executive director shall 
be subject to confirmation by the Panel. 
(2) COMPENSATION.—The Chairperson of the 
Panel may fix the compensation of the executive di-
rector and other personnel without regard to chapter 
51 and subchapter III of chapter 53 of title 5, 
United States Code, relating to classification of posi-
tions and General Schedule pay rates, except that 
the rate of pay for the executive director and other 
personnel may not exceed the rate payable for level 
V of the Executive Schedule under section 5316 of 
such title. 
(3) PERSONNEL AS FEDERAL EMPLOYEES.— 
(A) IN GENERAL.—The executive director 
and any personnel of the Panel who are employ-
ees shall be employees under section 2105 of 
title 5, United States Code, for purposes of 
chapters 63, 81, 83, 84, 85, 87, 89, 89A, 89B, 
and 90 of that title. 
(B) MEMBERS OF PANEL.—Subparagraph 
(A) shall not be construed to apply to members 
of the Panel. 
(d) DETAIL
OF GOVERNMENT EMPLOYEES.—Any 
Federal Government employee may be detailed to the 
Panel without reimbursement, and such detail shall be 
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without interruption or loss of civil service status or privi-
lege. 
(e) PROCUREMENT OF TEMPORARY AND INTERMIT-
TENT SERVICES.—The Chairperson of the Panel may pro-
cure temporary and intermittent services under section 
3109(b) of title 5, United States Code, at rates for individ-
uals which do not exceed the daily equivalent of the annual 
rate of basic pay prescribed for level V of the Executive 
Schedule under section 5316 of such title. 
(f) ADMINISTRATIVE SUPPORT.—The General Serv-
ices Administration shall provide the Board with adminis-
trative support services, including the provision of office 
space and facilities. 
SEC. 1535. TERMINATION OF THE PANEL. 
The Panel shall terminate on September 30, 2012. 
SEC. 1536. AUTHORIZATION OF APPROPRIATIONS. 
There are authorized to be appropriated such sums 
as necessary to carry out this subtitle. 
Subtitle C—Reports of the Council 
of Economic Advisers 
SEC. 1541. REPORTS OF THE COUNCIL OF ECONOMIC AD-
VISERS. 
(a) IN GENERAL.—In consultation with the Director 
of the Office of Management and Budget and the Sec-
retary of the Treasury, the Chairperson of the Council of 
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Economic Advisers shall submit quarterly reports to the 
Committees on Appropriations of the Senate and House 
of Representatives that detail the estimated impact of pro-
grams funded through covered funds on employment, eco-
nomic growth, and other key economic indicators. 
(b) SUBMISSION.—The first report under subsection 
(a) shall be submitted not later than 15 days after the 
end of the first full quarter following the date of enact-
ment of this Act. The last report required to be submitted 
under subsection (a) shall apply to the quarter in which 
the Board terminates under section 1521. 
TITLE XVI—GENERAL PROVISIONS—THIS ACT 
EMERGENCY DESIGNATION 
SEC. 1601. Each amount in this Act is designated 
as an emergency requirement and necessary to meet emer-
gency needs pursuant to section 204(a) of S. Con. Res. 
21 (110th Congress) and section 301(b)(2) of S. Con. Res. 
70 (110th Congress), the concurrent resolutions on the 
budget for fiscal years 2008 and 2009. 
AVAILABILITY 
SEC. 1602. No part of any appropriation contained 
in this Act shall remain available for obligation beyond 
the current fiscal year unless expressly so provided herein. 
RELATIONSHIP TO OTHER APPROPRIATIONS 
SEC. 1603. Each amount appropriated or made avail-
able in this Act is in addition to amounts otherwise appro-
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priated for the fiscal year involved. Enactment of this Act 
shall have no effect on the availability of amounts under 
the Continuing Appropriations Resolution, 2009 (division 
A of Public Law 110–329). 
BUY AMERICAN 
SEC. 1604. USE OF AMERICAN IRON, STEEL, AND 
MANUFACTURED GOODS. (a) None of the funds appro-
priated or otherwise made available by this Act may be 
used for a project for the construction, alteration, mainte-
nance, or repair of a public building or public work unless 
all of the iron, steel, and manufactured goods used in the 
project are produced in the United States. 
(b) Subsection (a) shall not apply in any case in 
which the head of the Federal department or agency in-
volved finds that— 
(1) applying subsection (a) would be incon-
sistent with the public interest; 
(2) iron, steel, and the relevant manufactured 
goods are not produced in the United States if suffi-
cient and reasonably available quantities and of a 
satisfactory quality; or 
(3) inclusion of iron, steel, and manufactured 
goods produced in the United States will increase 
the cost of the overall project by more than 25 per-
cent. 
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