162 
‘‘(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. 
‘‘(iv) Technologies that facilitate home 
health care and the monitoring of patients 
recuperating at home. 
‘‘(v) Technologies that help reduce med-
ical errors. 
‘‘(vi) Technologies that facilitate the 
continuity of care among health settings. 
‘‘(vii) Technologies that meet the needs 
of diverse populations. 
‘‘(viii) 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 spe-
cific expertise in policies relating to the matters de-
scribed in paragraphs (1) and (2). 
‘‘(c) MEMBERSHIP AND OPERATIONS.— 
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‘‘(1) IN
GENERAL.—The National Coordinator 
shall provide leadership in the establishment and op-
erations of the HIT Policy Committee. 
‘‘(2) MEMBERSHIP.—The membership of the HIT 
Policy Committee shall at least reflect providers, an-
cillary healthcare workers, consumers, purchasers, 
health plans, technology vendors, researchers, relevant 
Federal agencies, and individuals with technical ex-
pertise on health care quality, privacy and security, 
and on the electronic exchange and use of health in-
formation. 
‘‘(3) CONSIDERATION.—The National Coordi-
nator shall ensure that the relevant recommendations 
and comments from the National Committee on Vital 
and Health Statistics are considered in the develop-
ment 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. 
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‘‘SEC. 3003. HIT STANDARDS COMMITTEE. 
‘‘(a) ESTABLISHMENT.—There is established a com-
mittee to be known as the HIT Standards Committee to 
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 Co-
ordinator standards, implementation specifica-
tions, and certification criteria described in sub-
section (a) that have been developed, harmonized, 
or recognized by the HIT Standards Committee. 
The HIT Standards Committee shall update 
such recommendations and make new rec-
ommendations as appropriate, including in re-
sponse to a notification sent under section 
3004(b)(2). Such recommendations shall be con-
sistent with the latest recommendations made by 
the HIT Policy Committee. 
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‘‘(B) PILOT TESTING OF STANDARDS AND 
IMPLEMENTATION
SPECIFICATIONS.—In the de-
velopment, harmonization, or recognition of 
standards and implementation specifications, the 
HIT Standards Committee shall, as appropriate, 
provide for the testing of such standards and 
specifications by the National Institute for 
Standards and Technology under section 4201 of 
the HITECH Act. 
‘‘(C) CONSISTENCY.—The standards, imple-
mentation specifications, and certification cri-
teria recommended under this subsection shall be 
consistent with the standards for information 
transactions and data elements adopted pursu-
ant 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 develop-
ment, harmonization, and recognition of standards, 
implementation specifications, and certification cri-
teria necessary for the development and adoption of 
a nationwide health information technology infra-
structure that allows for the electronic use and ex-
change of health information. 
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‘‘(3) SCHEDULE.—Not later than 90 days after 
the date of the enactment of this title, the HIT Stand-
ards Committee shall develop a schedule for the assess-
ment of policy recommendations developed by the 
HIT Policy Committee under section 3002. The HIT 
Standards Committee shall update such schedule an-
nually. The Secretary shall publish such schedule in 
the Federal Register. 
‘‘(4) PUBLIC INPUT.—The HIT Standards Com-
mittee shall conduct open public meetings and develop 
a process to allow for public comment on the schedule 
described in paragraph (3) and recommendations de-
scribed in this subsection. Under such process com-
ments shall be submitted in a timely manner after the 
date of publication of a recommendation 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 providers, 
ancillary healthcare workers, consumers, purchasers, 
health plans, technology vendors, researchers, relevant 
Federal agencies, and individuals with technical ex-
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pertise on health care quality, privacy and security, 
and on the electronic exchange and use of health in-
formation. 
‘‘(3) CONSIDERATION.—The National Coordi-
nator shall ensure that the relevant recommendations 
and comments from the National Committee on Vital 
and Health Statistics are considered in the develop-
ment of standards. 
‘‘(4) ASSISTANCE.—For the purposes of carrying 
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 Com-
mittee to those consumer advocacy groups and not for 
profit entities that work in the public interest 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 recommendations 
made by the HIT Standards Committee under this section. 
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‘‘(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 provide 
for publication in the Federal Register of all deter-
minations made by the Secretary under paragraph 
(1). 
‘‘(b) ADOPTION OF INITIAL SET OF STANDARDS, IM-
PLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRI-
TERIA.— 
‘‘(1) IN GENERAL.—Not later than December 31, 
2009, the Secretary shall, through the rulemaking 
process described in section 3003, adopt an initial set 
of standards, implementation specifications, and cer-
tification criteria for the areas required for consider-
ation under section 3002(b)(2)(B). 
‘‘(2) APPLICATION OF CURRENT STANDARDS, IM-
PLEMENTATION SPECIFICATIONS, AND CERTIFICATION 
CRITERIA.—The standards, implementation specifica-
tions, and certification criteria adopted before the 
date of the enactment of this title through the process 
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existing through the Office of the National Coordi-
nator for Health Information Technology may be ap-
plied towards meeting the requirement of paragraph 
(1). 
‘‘SEC. 3005. APPLICATION AND USE OF ADOPTED STAND-
ARDS 
AND 
IMPLEMENTATION 
SPECIFICA-
TIONS BY FEDERAL AGENCIES. 
‘‘For requirements relating to the application and use 
by Federal agencies of the standards and implementation 
specifications adopted under section 3004, see section 4111 
of the HITECH Act. 
‘‘SEC. 3006. VOLUNTARY APPLICATION AND USE OF ADOPT-
ED STANDARDS AND IMPLEMENTATION SPEC-
IFICATIONS BY PRIVATE ENTITIES. 
‘‘(a) IN GENERAL.—Except as provided under section 
4112 of the HITECH Act, any standard or implementation 
specification adopted under section 3004 shall be voluntary 
with respect to private entities. 
‘‘(b) RULE OF CONSTRUCTION.—Nothing in this sub-
title shall be construed to require that a private entity that 
enters into a contract with the Federal Government apply 
or use the standards and implementation specifications 
adopted under section 3004 with respect to activities not 
related to the contract. 
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‘‘SEC. 3007. FEDERAL HEALTH INFORMATION TECHNOLOGY. 
‘‘(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 Secretary 
determines that the needs and demands of providers are 
being substantially and adequately met through the market-
place. 
‘‘(b) CERTIFICATION.—In making such EHR tech-
nology publicly available, the National Coordinator shall 
ensure that the qualified EHR technology described in sub-
section (a) is certified under the program developed under 
section 3001(c)(3) to be in compliance with applicable 
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 infor-
mation technology system developed or approved under sub-
section (a) and (b). Such fee shall take into account the 
financial circumstances of smaller providers, low 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. 
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‘‘SEC. 3008. TRANSITIONS. 
‘‘(a) ONCHIT.—To the extent consistent with section 
3001, all functions, personnel, assets, liabilities, and ad-
ministrative actions applicable to the National Coordinator 
for Health Information Technology appointed under Execu-
tive Order 13335 or the Office of such National Coordinator 
on the date before the date of the enactment of this title 
shall be transferred to the National Coordinator appointed 
under section 3001(a) and the Office of such National Coor-
dinator 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 liabil-
ities 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, established under sec-
tion 3002(a) or 3003(a), as appropriate, 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 Com-
mittee, recommendations of the HIT Standards Com-
mittee shall be consistent with the most recent rec-
ommendations made by such AHIC Successor, Inc. 
‘‘(c) RULES OF CONSTRUCTION.— 
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‘‘(1) ONCHIT.—Nothing in section 3001 or sub-
section (a) shall be construed as requiring the cre-
ation 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 National 
eHealth Collaborative from modifying its charter, du-
ties, membership, and any other structure or function 
required to be consistent with section 3002 and 3003 
in a manner that would permit the Secretary to 
choose to recognize such Community as the HIT Pol-
icy 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 
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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 title IV of the HITECH Act; and 
‘‘(2) regulations under such provisions. 
‘‘SEC. 3010. AUTHORIZATION FOR APPROPRIATIONS. 
‘‘There is authorized to be appropriated to the Office 
of the National Coordinator for Health Information Tech-
nology to carry out this subtitle $250,000,000 for fiscal year 
2009.’’. 
SEC. 4102. 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’’. 
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PART II—APPLICATION AND USE OF ADOPTED 
HEALTH 
INFORMATION 
TECHNOLOGY 
STANDARDS; REPORTS 
SEC. 4111. 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 Exec-
utive 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 4101. 
(b) FEDERAL
INFORMATION
COLLECTION
ACTIVI-
TIES.—With respect to a standard or implementation speci-
fication adopted under section 3004(b) of the Public Health 
Service Act, as added by section 4101, the President shall 
take measures to ensure that Federal activities involving 
the broad collection and submission of health information 
are consistent with such standard or implementation speci-
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fication, 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 4101, shall apply for purposes of this 
part. 
SEC. 4112. 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 in-
formation technology systems, it shall utilize, where avail-
able, 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 4101. 
SEC. 4113. STUDY AND REPORTS. 
(a) REPORT ON ADOPTION OF NATIONWIDE SYSTEM.— 
Not later than 2 years after the date of the enactment of 
this Act and annually thereafter, the Secretary of Health 
and Human Services shall submit to the appropriate com-
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mittees of jurisdiction of the House of Representatives and 
the Senate a report that— 
(1) describes the specific actions that have been 
taken by the Federal Government and private entities 
to facilitate the adoption of a nationwide system for 
the electronic use and exchange of health information; 
(2) describes barriers to the adoption of such a 
nationwide system; and 
(3) contains recommendations to achieve full im-
plementation 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 clin-
ics. 
(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). 
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(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 seniors and 
individuals with disabilities and their care-
givers across all aging services settings, as 
specified by the Secretary; 
(ii) methods for fostering scientific in-
novation with respect to aging services tech-
nology within the business and academic 
communities; and 
(iii) developments in aging services 
technology in other countries that may be 
applied in the United States; and 
(B) identification of— 
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(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 providers 
and consumers and devising strategies to re-
moving 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 jurisdiction 
of the House of Representatives and of the Senate a 
report on the study carried out under paragraph (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 
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. 
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infrastructure may include a program to accredit inde-
pendent, non-Federal laboratories to perform testing. 
SEC. 4202. 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 lab-
oratories) 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 by 
conducting cutting-edge, multidisciplinary re-
search on the systems challenges to health care 
delivery; and 
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(B) the development and use of health infor-
mation technologies and other complementary 
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. 
(5) APPLICATIONS.—An institution of higher 
education (or a consortium thereof) seeking funding 
under this subsection shall submit an application to 
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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 under-
taken by the Center established pursuant to as-
sistance under paragraph (1) and the respective 
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 informa-
tion enterprise integration. 
(b) NATIONAL INFORMATION TECHNOLOGY RESEARCH 
AND DEVELOPMENT PROGRAM.—The National High-Per-
formance Computing Program established by section 101 of 
the High-Performance Computing Act of 1991 (15 U.S.C. 
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5511) shall coordinate Federal research and development 
programs related to the development and deployment of 
health information technology, including activities 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. 
Subtitle C—Incentives for the Use of 
Health Information Technology 
PART I—GRANTS AND LOANS FUNDING 
SEC. 4301. GRANT, LOAN, AND DEMONSTRATION PRO-
GRAMS. 
Title XXX of the Public Health Service Act, as added 
by section 4101, is amended by adding at the end the fol-
lowing new subtitle: 
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‘‘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 con-
sistent with the goals outlined in the strategic plan devel-
oped by the National Coordinator (and as available) under 
section 3001. To the greatest extent practicable, the Sec-
retary shall ensure that any funds so appropriated shall 
be used for the acquisition of health information technology 
that meets standards and certification criteria adopted be-
fore the date of the enactment of this title until such date 
as the standards are adopted under section 3004. The Sec-
retary shall invest funds through the different agencies with 
expertise in such goals, such as the Office of the National 
Coordinator for Health Information Technology, the Health 
Resources and Services Administration, the Agency for 
Healthcare Research and Quality, the Centers of Medicare 
& Medicaid Services, the Centers for Disease Control and 
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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 in-
formation exchanges, and which may include updat-
ing and implementing the infrastructure necessary 
within different agencies of the Department of Health 
and Human Services to support the electronic use 
and exchange of health information. 
‘‘(2) Development and adoption of appropriate 
certified electronic health records for categories of pro-
viders 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 
technology, including electronic health records, into a 
provider’s delivery of care, consistent with best prac-
tices learned from the Health Information Technology 
Research Center developed under section 302, includ-
ing community health centers receiving assistance 
under section 330 of the Public Health Service Act, 
covered entities under section 340B of such Act, and 
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providers participating in one or more of the pro-
grams 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 practices 
that enhance the protection of health information by 
all holders of individually identifiable health informa-
tion. 
‘‘(7) Improve and expand the use of health infor-
mation technology by public health departments. 
‘‘(8) Provide $300 million to support regional or 
sub-national efforts towards health information ex-
change. 
‘‘(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 
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out activities that are provided for under laws in effect on 
the date of the enactment of this title. 
‘‘SEC. 3012. HEALTH INFORMATION TECHNOLOGY IMPLE-
MENTATION ASSISTANCE. 
‘‘(a) HEALTH INFORMATION TECHNOLOGY EXTENSION 
PROGRAM.—To assist health care providers to adopt, imple-
ment, and effectively use certified EHR technology that al-
lows for the electronic exchange and use of health informa-
tion, the Secretary, acting through the Office of the National 
Coordinator, shall establish a health information technology 
extension program to provide health information 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 information technology services, 
such as the National Institute of Standards and Tech-
nology, in developing and implementing this program. 
‘‘(b) HEALTH INFORMATION TECHNOLOGY RESEARCH 
CENTER.— 
‘‘(1) IN GENERAL.—The Secretary shall create a 
Health Information Technology Research Center (in 
this section referred to as the ‘Center’) to provide tech-
nical assistance and develop or recognize best prac-
tices to support and accelerate efforts to adopt, imple-
ment, and effectively utilize health information tech-
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nology that allows for the electronic exchange and use 
of information in compliance with standards, imple-
mentation specifications, and certification 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 In-
stitute of Standards and Technology; 
‘‘(B) users of health information technology, 
such as providers and their support and clerical 
staff and others involved in the care and care co-
ordination of patients, from the health care and 
health information technology industry; 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; 
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‘‘(C) assemble, analyze, and widely dissemi-
nate evidence and experience related to the adop-
tion, implementation, and effective use of health 
information technology that allows for the elec-
tronic exchange and use of information includ-
ing through the regional centers described in sub-
section (c); 
‘‘(D) provide technical assistance for the es-
tablishment and evaluation of regional and local 
health information networks to facilitate the elec-
tronic exchange of information across health care 
settings and improve the quality of health care; 
‘‘(E) provide technical assistance for the de-
velopment and dissemination of solutions to bar-
riers to the exchange of electronic health informa-
tion; and 
‘‘(F) learn about effective strategies to adopt 
and utilize health information technology in 
medically underserved communities. 
‘‘(c) HEALTH INFORMATION TECHNOLOGY REGIONAL 
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 cen-
ters’) to provide technical assistance and disseminate 
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best practices and other information learned from the 
Center to support and accelerate efforts to adopt, im-
plement, and effectively utilize health information 
technology that allows for the electronic exchange and 
use of information in compliance with standards, im-
plementation specifications, and certification criteria 
adopted under section 3004. Activities conducted 
under this subsection shall be consistent with the stra-
tegic plan developed by the National Coordinator, 
(and, as available) under section 3001. 
‘‘(2) AFFILIATION.—Regional centers shall be af-
filiated with any U.S.-based nonprofit institution or 
organization, or group thereof, that applies and is 
awarded financial assistance under this section. Indi-
vidual 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, ef-
fective use, upgrading, and ongoing maintenance 
of health information technology, including elec-
tronic health records, to healthcare providers na-
tionwide; 
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‘‘(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 infor-
mation; 
‘‘(D) participation, to the extent prac-
ticable, in health information exchanges; and 
‘‘(E) utilization, when appropriate, of the 
expertise and capability that exists in Federal 
agencies other than the Department; and 
‘‘(F) integration of health information tech-
nology, including electronic health records, into 
the initial and ongoing training of health profes-
sionals and others in the healthcare industry 
that would be instrumental to improving the 
quality of healthcare through the smooth and ac-
curate electronic use and exchange of health in-
formation. 
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‘‘(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). 
‘‘(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 maintain 
such a center, except in an instance of national eco-
nomic conditions which would render this cost-share 
requirement detrimental to the program and upon no-
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tification 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 de-
scription of the program for establishing regional cen-
ters under this subsection. Such description shall in-
clude the following: 
‘‘(A) A detailed explanation of the program 
and the programs goals. 
‘‘(B) Procedures to be followed by the appli-
cants. 
‘‘(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 merits 
of the application, including those portions of the ap-
plication regarding— 
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‘‘(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 cen-
ter which receives financial assistance under this sub-
section shall be evaluated biennially by an evaluation 
panel appointed by the Secretary. Each evaluation 
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 meas-
ure the involved center’s performance against the ob-
jective specified in paragraph (3). The Secretary shall 
not continue to provide funding to a regional 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 sub-
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section if it has received positive evaluations and a 
finding by the Secretary that continuation of Federal 
funding to the center was in the best interest of provi-
sion of health information technology extension serv-
ices. 
‘‘SEC. 3013. STATE GRANTS TO PROMOTE HEALTH INFORMA-
TION TECHNOLOGY. 
‘‘(a) IN GENERAL.—The Secretary, acting through the 
National Coordinator, shall establish a program in accord-
ance with this section to facilitate and expand the electronic 
movement and use of health information among organiza-
tions according to nationally recognized standards. 
‘‘(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 containing 
such information as the Secretary may specify, for the pur-
pose of planning activities described in subsection (b). 
‘‘(c) IMPLEMENTATION GRANTS.—The Secretary may 
award a grant to a State or qualified State-designated enti-
ty 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 
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‘‘(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 accord-
ing to nationally recognized standards through activities 
that include— 
‘‘(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 available 
towards a nationwide effort to promote health infor-
mation technology; 
‘‘(3) complementing other Federal grants, pro-
grams, and efforts towards the promotion of health 
information technology; 
‘‘(4) providing technical assistance for the devel-
opment 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 un-
derserved communities; 
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‘‘(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 information; 
‘‘(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 sub-
section is a plan that describes the activities to be 
carried out by a State or by the qualified State-des-
ignated entity within such State to facilitate and ex-
pand the electronic movement and use of health infor-
mation among organizations according to nationally 
recognized standards and implementation specifica-
tions. 
‘‘(2) REQUIRED ELEMENTS.—A plan described 
in paragraph (1) shall— 
‘‘(A) be pursued in the public interest; 
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‘‘(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 
‘‘(D) contain such elements as the Secretary 
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 re-
ceive 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 
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‘‘(5) conform to such other requirements as the 
Secretary may establish. 
‘‘(g) REQUIRED CONSULTATION.—In carrying out ac-
tivities described in subsections (a)(2) and (a)(3), a State 
or qualified State-designated entity shall consult with and 
consider the recommendations of— 
‘‘(1) health care providers (including providers 
that provide services to low income and underserved 
populations); 
‘‘(2) health plans; 
‘‘(3) patient or consumer organizations that rep-
resent 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 technology 
such as the support and clerical staff of providers and 
others involved in the care and care coordination of 
patients; and 
‘‘(10) such other entities, as may be determined 
appropriate by the Secretary. 
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‘‘(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 eval-
uation are made in a manner that, in the determination 
of the Secretary, will lead towards the greatest improvement 
in quality of care, decrease in costs, and the most effective 
authorized and secure electronic exchange of health informa-
tion. 
‘‘(i) REQUIRED MATCH.— 
‘‘(1) IN GENERAL.—For a fiscal year (beginning 
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 contribu-
tions (which may include in-kind contributions) to-
ward the costs of a grant awarded under subsection 
(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 
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‘‘(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 sec-
tion before fiscal year 2011, the Secretary may deter-
mine the extent to which there shall be required 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 WIDESPREAD 
ADOPTION OF CERTIFIED EHR TECHNOLOGY. 
‘‘(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-Determination 
and Education Assistance Act) that— 
‘‘(1) submits to the National Coordinator an ap-
plication at such time, in such manner, and con-
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taining such information as the National Coordinator 
may require; 
‘‘(2) submits to the National Coordinator a stra-
tegic plan in accordance with subsection (d) and pro-
vides to the National Coordinator assurances that the 
entity will update such plan annually in accordance 
with such subsection; 
‘‘(3) provides assurances to the National Coordi-
nator that the entity will establish a Loan Fund in 
accordance with subsection (c); 
‘‘(4) provides assurances to the National Coordi-
nator that the entity will not provide a loan from the 
Loan Fund to a health care provider unless the pro-
vider 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 meas-
ures are adopted), to— 
‘‘(i) the Director of the Centers for 
Medicare & Medicaid Services (or his or her 
designee), in the case of an entity partici-
pating in the Medicare program under title 
XVIII of the Social Security Act or the 
Medicaid program under title XIX of such 
Act; or 
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‘‘(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 
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 quality of 
health care, such as promoting care coordination; 
and 
‘‘(C) comply with such other requirements 
as the entity or the Secretary may require; 
‘‘(D) include a plan on how health care pro-
viders involved intend to maintain and support 
the certified EHR technology over time; 
‘‘(E) include a plan on how the health care 
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 
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‘‘(5) agrees to provide matching funds in accord-
ance with subsection (i). 
‘‘(c) ESTABLISHMENT OF FUND.—For purposes of sub-
section (b)(3), an eligible entity shall establish a certified 
EHR technology loan fund (referred to in this subsection 
as a ‘Loan Fund’) and comply with the other requirements 
contained in this section. A grant to an eligible entity under 
this section shall be deposited in the Loan Fund established 
by the eligible entity. No funds authorized by other provi-
sions 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 eligible 
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 meth-
ods established for the distribution of funds from 
the Loan Fund during the year. 
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‘‘(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 
such amounts, shall be used only for awarding loans or loan 
guarantees, making reimbursements described in subsection 
(g)(4)(A), or as a source of reserve and security for lever-
aged 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; 
‘‘(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 lim-
ited by applicable State law, amounts deposited into a 
Loan Fund under this subsection may only be used for the 
following: 
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‘‘(1) To award loans that comply with the fol-
lowing: 
‘‘(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 finance 
a project eligible for assistance under this subsection) 
if the guarantee or purchase would improve 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 deposited 
into the Loan Fund. 
‘‘(4) To earn interest on the amounts deposited 
into the Loan Fund. 
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‘‘(5) To make reimbursements described in sub-
section (g)(4)(A). 
‘‘(g) ADMINISTRATION OF LOAN FUNDS.— 
‘‘(1) COMBINED FINANCIAL ADMINISTRATION.— 
An eligible entity may (as a convenience and to avoid 
unnecessary administrative costs) combine, in accord-
ance with applicable State law, the financial admin-
istration of a Loan Fund established under this sub-
section 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 eli-
gible entity may annually use not to exceed 4 percent 
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— 
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‘‘(A) provisions to ensure that each eligible 
entity commits and expends funds allotted to the 
entity under this subsection as efficiently as pos-
sible in accordance with this title and applicable 
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 contribu-
tions from private sector entities, except that 
such entities may not specify the recipient or re-
cipients of any loan issued under this subsection. 
An eligible entity may agree to reimburse a pri-
vate sector entity for any contribution made 
under this subparagraph, except that the amount 
of such reimbursement may not be greater than 
the principal amount of the contribution made. 
‘‘(B) AVAILABILITY OF INFORMATION.—An 
eligible entity shall make publicly available the 
identity of, and amount contributed by, any pri-
vate sector entity under subparagraph (A) and 
may issue letters of commendation or make other 
awards (that have no financial value) to any 
such entity. 
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‘‘(h) MATCHING REQUIREMENTS.— 
‘‘(1) IN
GENERAL.—The National Coordinator 
may not make a grant under subsection (a) to an eli-
gible entity unless the entity agrees to make available 
(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-FED-
ERAL 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 Government. 
‘‘(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 tech-
nology in the clinical education of health professionals. 
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Such awards shall be made on a competitive basis and pur-
suant 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 clinical 
education of health professionals to reduce medical er-
rors and enhance health care quality; 
‘‘(3) be— 
‘‘(A) a school of medicine, osteopathic medi-
cine, dentistry, or pharmacy, a graduate pro-
gram in behavioral or mental health, or any 
other graduate health professions school; 
‘‘(B) a graduate school of nursing or physi-
cian 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 
medicine, dentistry, pharmacy, nursing, or phy-
sician assistance studies. 
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‘‘(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 pa-
tients, 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 subsection 
(a) to purchase hardware, software, or services. 
‘‘(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), except 
in an instance of national economic conditions which would 
render the cost-share requirement under this subsection det-
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rimental 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 ac-
tion 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, Education, 
Labor, and Pensions and the Committee on Finance 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). 
‘‘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 certification, 
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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 following: 
‘‘(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. 
‘‘(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 
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for which assistance is provided under subsection (a), except 
in an instance of national economic conditions which would 
render the cost-share requirement under this subsection det-
rimental 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 the activi-
ties 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 
health care quality and safety. 
‘‘(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 quality 
and efficiency of health care. 
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‘‘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.’’. 
PART II—MEDICARE PROGRAM 
SEC. 4311. INCENTIVES FOR ELIGIBLE PROFESSIONALS. 
(a) INCENTIVE PAYMENTS.—Section 1848 of the Social 
Security Act (42 U.S.C. 1395w–4) is amended by adding 
at the end the following new subsection: 
‘‘(o) INCENTIVES FOR ADOPTION AND MEANINGFUL 
USE OF CERTIFIED EHR TECHNOLOGY.— 
‘‘(1) INCENTIVE PAYMENTS.— 
‘‘(A) IN
GENERAL.—Subject to the suc-
ceeding subparagraphs of this paragraph, with 
respect to covered professional services furnished 
by an eligible professional during a payment 
year (as defined in subparagraph (E)), if the eli-
gible professional is a meaningful EHR user (as 
determined under paragraph (2)) for the report-
ing period with respect to such year, in addition 
to the amount otherwise paid under this part, 
there also shall be paid to the eligible profes-
sional (or to an employer or facility in the cases 
described in clause (A) of section 1842(b)(6)), 
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from the Federal Supplementary Medical Insur-
ance Trust Fund established under section 1841 
an amount equal to 75 percent of the Secretary’s 
estimate (based on claims submitted not later 
than 2 months after the end of the payment 
year) of the allowed charges under this part for 
all such covered professional services furnished 
by the eligible professional during such year. 
‘‘(B) LIMITATIONS ON AMOUNTS OF INCEN-
TIVE PAYMENTS.— 
‘‘(i) IN GENERAL.—In no case shall the 
amount of the incentive payment provided 
under this paragraph for an eligible profes-
sional for a payment year exceed the appli-
cable amount specified under this subpara-
graph with respect to such eligible profes-
sional and such year. 
‘‘(ii) AMOUNT.—Subject to clause (iii), 
the applicable amount specified in this sub-
paragraph for an eligible professional is as 
follows: 
‘‘(I) For the first payment year 
for such professional, $15,000. 
‘‘(II) For the second payment 
year for such professional, $12,000. 
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‘‘(III) For the third payment year 
for such professional, $8,000. 
‘‘(IV) For the fourth payment 
year for such professional, $4,000. 
‘‘(V) For the fifth payment year 
for such professional, $2,000. 
‘‘(VI) For any succeeding pay-
ment year for such professional, $0. 
‘‘(iii) PHASE
DOWN
FOR
ELIGIBLE 
PROFESSIONALS
FIRST
ADOPTING
EHR 
AFTER 2013.—If the first payment year for 
an eligible professional is after 2013, then 
the amount specified in this subparagraph 
for a payment year for such professional is 
the same as the amount specified in clause 
(ii) for such payment year for an eligible 
professional whose first payment year is 
2013. If the first payment year for an eligi-
ble professional is after 2015 then the appli-
cable amount specified in this subparagraph 
for such professional for such year and any 
subsequent year shall be $0. 
‘‘(C) NON-APPLICATION TO HOSPITAL-BASED 
ELIGIBLE PROFESSIONALS.— 
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‘‘(i) IN GENERAL.—No incentive pay-
ment may be made under this paragraph in 
the case of a hospital-based eligible profes-
sional. 
‘‘(ii) HOSPITAL-BASED ELIGIBLE PRO-
FESSIONAL.—For purposes of clause (i), the 
term ‘hospital-based eligible professional’ 
means, with respect to covered professional 
services furnished by an eligible professional 
during the reporting period for a payment 
year, an eligible professional, such as a pa-
thologist, anesthesiologist, or emergency 
physician, who furnishes substantially all of 
such services in a hospital setting (whether 
inpatient or outpatient) and through the 
use of the facilities and equipment, includ-
ing computer equipment, of the hospital. 
‘‘(D) PAYMENT.— 
‘‘(i) FORM
OF
PAYMENT.—The pay-
ment under this paragraph may be in the 
form of a single consolidated payment or in 
the form of such periodic installments as the 
Secretary may specify. 
‘‘(ii) COORDINATION
OF
APPLICATION 
OF LIMITATION FOR PROFESSIONALS IN DIF-
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FERENT PRACTICES.—In the case of an eli-
gible professional furnishing covered profes-
sional services in more than one practice 
(as specified by the Secretary), the Sec-
retary shall establish rules to coordinate the 
incentive payments, including the applica-
tion of the limitation on amounts of such 
incentive payments under this paragraph, 
among such practices. 
‘‘(iii) 
COORDINATION
WITH
MED-
ICAID.—The Secretary shall seek, to the 
maximum extent practicable, to avoid du-
plicative requirements from Federal and 
State Governments to demonstrate meaning-
ful use of certified EHR technology under 
this title and title XIX. In doing so, the 
Secretary may deem satisfaction of State 
requirements for such meaningful use for a 
payment year under title XIX to be suffi-
cient to qualify as meaningful use under 
this subsection and subsection (a)(7) and 
vice versa. The Secretary may also adjust 
the reporting periods under such title and 
such subsections in order to carry out this 
clause. 
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‘‘(E) PAYMENT YEAR DEFINED.— 
‘‘(i) IN
GENERAL.—For purposes of 
this subsection, the term ‘payment year’ 
means a year beginning with 2011. 
‘‘(ii) FIRST, SECOND, ETC. PAYMENT 
YEAR.—The term ‘first payment year’ 
means, with respect to covered professional 
services furnished by an eligible profes-
sional, the first year for which an incentive 
payment is made for such services under 
this subsection. The terms ‘second payment 
year’, ‘third payment year’, ‘fourth pay-
ment year’, and ‘fifth payment year’ mean, 
with respect to covered professional services 
furnished by such eligible professional, each 
successive year immediately following the 
first payment year for such professional. 
‘‘(2) MEANINGFUL EHR USER.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1), an eligible professional shall be treat-
ed as a meaningful EHR user for a reporting 
period for a payment year (or, for purposes of 
subsection (a)(7), for a reporting period under 
such subsection for a year) if each of the fol-
lowing requirements is met: 
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‘‘(i) MEANINGFUL USE OF CERTIFIED 
EHR
TECHNOLOGY.—The eligible profes-
sional demonstrates to the satisfaction of the 
Secretary, in accordance with subparagraph 
(C)(i), that during such period the profes-
sional is using certified EHR technology in 
a meaningful manner, which shall include 
the use of electronic prescribing as deter-
mined to be appropriate by the Secretary. 
‘‘(ii) INFORMATION
EXCHANGE.—The 
eligible professional demonstrates to the sat-
isfaction of the Secretary, in accordance 
with subparagraph (C)(i), that during such 
period such certified EHR technology is 
connected in a manner that provides, in ac-
cordance with law and standards applicable 
to the exchange of information, for the elec-
tronic exchange of health information to im-
prove the quality of health care, such as 
promoting care coordination. 
‘‘(iii) REPORTING ON MEASURES USING 
EHR.—Subject to subparagraph (B)(ii) and 
using such certified EHR technology, the el-
igible professional submits information for 
such period, in a form and manner speci-
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fied by the Secretary, on such clinical qual-
ity measures and such other measures as se-
lected by the Secretary under subparagraph 
(B)(i). 
The Secretary may provide for the use of alter-
native means for meeting the requirements of 
clauses (i), (ii), and (iii) in the case of an eligi-
ble professional furnishing covered professional 
services in a group practice (as defined by the 
Secretary). The Secretary shall seek to improve 
the use of electronic health records and health 
care quality over time by requiring more strin-
gent measures of meaningful use selected under 
this paragraph. 
‘‘(B) REPORTING ON MEASURES.— 
‘‘(i) SELECTION.—The Secretary shall 
select measures for purposes of subpara-
graph (A)(iii) but only consistent with the 
following: 
‘‘(I) The Secretary shall provide 
preference to clinical quality measures 
that have been endorsed by the entity 
with a contract with the Secretary 
under section 1890(a). 
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‘‘(II) Prior to any measure being 
selected under this subparagraph, the 
Secretary shall publish in the Federal 
Register such measure and provide for 
a period of public comment on such 
measure. 
‘‘(ii) LIMITATION.—The Secretary may 
not require the electronic reporting of infor-
mation on clinical quality measures under 
subparagraph (A)(iii) unless the Secretary 
has the capacity to accept the information 
electronically, which may be on a pilot 
basis. 
‘‘(iii) COORDINATION
OF
REPORTING 
OF INFORMATION.—In selecting such meas-
ures, and in establishing the form and man-
ner for reporting measures under subpara-
graph (A)(iii), the Secretary shall seek to 
avoid redundant or duplicative reporting 
otherwise 
required, 
including 
reporting 
under subsection (k)(2)(C). 
‘‘(C) DEMONSTRATION OF MEANINGFUL USE 
OF CERTIFIED EHR TECHNOLOGY AND INFORMA-
TION EXCHANGE.— 
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‘‘(i) IN GENERAL.—A professional may 
satisfy the demonstration requirement of 
clauses (i) and (ii) of subparagraph (A) 
through means specified by the Secretary, 
which may include— 
‘‘(I) an attestation; 
‘‘(II) the submission of claims 
with appropriate coding (such as a 
code indicating that a patient encoun-
ter was documented using certified 
EHR technology); 
‘‘(III) a survey response; 
‘‘(IV) reporting under subpara-
graph (A)(iii); and 
‘‘(V) other means specified by the 
Secretary. 
‘‘(ii) USE OF PART D DATA.—Notwith-
standing sections 1860D–15(d)(2)(B) and 
1860D–15(f)(2), the Secretary may use data 
regarding drug claims submitted for pur-
poses of section 1860D–15 that are nec-
essary for purposes of subparagraph (A). 
‘‘(3) APPLICATION.— 
‘‘(A) 
PHYSICIAN
REPORTING
SYSTEM 
RULES.—Paragraphs (5), (6), and (8) of sub-
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section (k) shall apply for purposes of this sub-
section in the same manner as they apply for 
purposes of such subsection. 
‘‘(B) COORDINATION
WITH
OTHER
PAY-
MENTS.—The provisions of this subsection shall 
not be taken into account in applying the provi-
sions of subsection (m) of this section and of sec-
tion 1833(m) and any payment under such pro-
visions shall not be taken into account in com-
puting allowable charges under this subsection. 
‘‘(C) LIMITATIONS ON REVIEW.—There shall 
be no administrative or judicial review under 
section 1869, section 1878, or otherwise of the de-
termination of any incentive payment under this 
subsection and the payment adjustment under 
subsection (a)(7), including the determination of 
a meaningful EHR user under paragraph (2), a 
limitation under paragraph (1)(B), and the ex-
ception under subsection (a)(7)(B). 
‘‘(D) POSTING ON WEBSITE.—The Secretary 
shall post on the Internet website of the Centers 
for Medicare & Medicaid Services, in an easily 
understandable format, a list of the names, busi-
ness addresses, and business phone numbers of 
the eligible professionals who are meaningful 
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for the hospital for a period selected by the 
Secretary with respect to such payment 
year. 
‘‘(iii) TRANSITION FACTOR.—The tran-
sition factor specified in subparagraph (E) 
for the hospital for the payment year. 
‘‘(B) BASE
AMOUNT.—The base amount 
specified in this subparagraph is $2,000,000. 
‘‘(C) DISCHARGE RELATED AMOUNT.—The 
discharge related amount specified in this sub-
paragraph for a 12-month period selected by the 
Secretary shall be determined as the sum of the 
amount, based upon total discharges (regardless 
of any source of payment) for the period, for 
each discharge up to the 23,000th discharge as 
follows: 
‘‘(i) For the 1,150th through the 
9,200th discharge, $200. 
‘‘(ii) For the 9,201st through the 
13,800th discharge, 50 percent of the 
amount specified in clause (i). 
‘‘(iii) For the 13,801st through the 
23,000th discharge, 30 percent of the 
amount specified in clause (i). 
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