a national health care information infrastruc-
ture shall comply with the standards adopted or 
modified under this section. 
‘‘(B) RELATION
TO
STATE
LAWS.—Con-
sistent with subsection (a)(3)(B), the standards 
adopted or modified under this section shall su-
persede any State law or regulations pertaining 
to the electronic transmission of patient history, 
eligibility, benefit and any other information. 
‘‘(2) TIMETABLE FOR COMPLIANCE.—
‘‘(A) INITIAL COMPLIANCE.—
‘‘(i) IN GENERAL.—Not later than 24 
months after the date on which a modified 
standard is adopted under this section, 
each individual or entity to whom the 
standard applies shall comply with the 
standard. 
‘‘(ii) SPECIAL
RULES
FOR
SMALL 
HEALTH PLANS.—In the case of a ‘small 
health plan’, as defined by the Secretary 
for purposes of section 1175(b)(1)(B), 
clause (i) shall be applied by substituting, 
‘36 months’ for ‘24 months’. 
‘‘(iii) SPECIAL RULE FOR SMALL PRO-
VIDER
OF
SERVICES.—In the case of a
small provider of services, clause (i) shall 
be applied by substituting ‘36 months’ for 
‘24 months’. 
‘‘(iv) EXCEPTION.—In consultation 
with national organizations representing 
affected parties, as defined in subsection 
(a)(1)(C), the Secretary may delay initial 
compliance until such time as the Sec-
retary deems appropriate to assure max-
imum compliance. 
‘‘(d) NO REQUIREMENT TO OBTAIN SPECIFIC TECH-
NOLOGIES OR PRODUCTS.—Nothing in this part shall be 
construed to require an individual or entity to obtain spe-
cific technologies or products to utilize a national health 
care information infrastructure. 
‘‘(e) PRESERVATION OF HEALTH CARE PROVIDER OR 
OTHER ENTITY TO MAKE UNBIASED PATIENT CARE DE-
CISIONS.—Interoperable health care technology shall be 
designed to facilitate access to unbiased and evidence-
based decision support tools. All patient care decisions 
shall be based solely on the provider’s clinical expertise 
and experience, without outside influence. 
‘‘(f) SMALL HEALTH CARE PROVIDERS.—For pur-
poses of this part, a health care provider or practice is
considered ‘small’ if it is small under the provisions of sec-
tion 1862(h). 
‘‘SEC. 1182. FINANCIAL INCENTIVE TO SMALL HEALTH 
CARE PROVIDERS AND ENTITIES TO IMPLE-
MENT A NATIONAL HEALTH INFORMATION 
INFRASTRUCTURE. 
‘‘(a) IN GENERAL.—The Secretary shall include addi-
tional Medicare payment incentives to assure small health 
care providers have the capability to move toward a na-
tional health care information infrastructure by acquiring 
electronic health record systems and other health informa-
tion technologies that meet the standards adopted or 
modified under section 1181. 
‘‘(b) CONDITIONS FOR QUALIFICATION.—As a condi-
tion of qualifying for financial incentives described in this 
section, the Secretary, in consultation with national orga-
nizations representing affected parties, as defined in sec-
tion 1181(a)(1)(C), and appropriate standards setting or-
ganizations, as defined in section 1181(a)(1)(B), shall 
grant the use of financial incentives to assure that such 
technologies are consistent with the goals of creation of 
a national health information infrastructure, such as—
‘‘(1) voluntary participation in studies or dem-
onstration projects to evaluate the use of such sys-
tems to measure and report quality data based on 
accepted clinical performance measures; and 
‘‘(2) voluntary participation in studies to dem-
onstrate the impact of such technologies on improv-
ing patient care, reducing costs and increasing effi-
ciencies. 
‘‘(c) ADDITIONAL MEDICARE PAYMENT TO SMALL 
HEALTH CARE PROVIDERS AND ENTITIES FOR EXPENDI-
TURES RELATING TO THE IMPLEMENTATION OF A NA-
TIONAL HEALTH INFORMATION INFRASTRUCTURE.—
‘‘(1) IN GENERAL.—The Secretary shall provide 
for additional payment to small health care pro-
viders, including physicians and others in clinical 
practice, for the purpose of assisting such entities to 
implement, design, test, acquire, and adopt elec-
tronic health records and other health information 
technologies defined by the Secretary as a key com-
ponent of a national health care information infra-
structure that comply with the standards adopted or 
modified under section 1181. 
‘‘(2) 
TYPES
OF
REIMBURSEMENT
INCEN-
TIVES.—In developing the reimbursement incentives 
described in paragraph (1), the Secretary shall con-
sider inclusion of one or more of the following types 
of incentives:
‘‘(A) Adds-ons to payments for evaluation 
and management services. 
‘‘(B) Care management fees for physicians 
who use information technology to manage care 
of patients with chronic illnesses. 
‘‘(C) Payments for structured e-mail 
consults resulting in a separately identifiable 
medical service from other evaluation and man-
agement services. 
‘‘(D) Any other method deemed appro-
priate by the Secretary to encourage participa-
tion. 
‘‘(3) 
AMOUNT
OF
REIMBURSEMENT.—The 
amount of reimbursement made to small health care 
providers and entities to implement a national health 
care information infrastructure shall be in a manner 
determined by the Secretary, in accordance with sec-
tion 1181(b)(2)(ii), that takes into account the costs 
of implementation, training, and complying with 
standards. 
‘‘(4) EXEMPTION FROM BUDGET NEUTRALITY 
UNDER THE PHYSICIAN FEE SCHEDULE.—Any in-
creased expenditures pursuant to this section shall 
be treated as additional allowed expenditures for
purposes of computing any update under section 
1848(d). 
‘‘SEC. 1183. OPTIONAL FINANCIAL INCENTIVES TO SMALL 
HEALTH CARE PROVIDERS AND ENTITIES TO 
IMPLEMENT A NATIONAL HEALTH INFORMA-
TION INFRASTRUCTURE. 
‘‘(a) IN GENERAL.—The Secretary may utilize any, 
all, or a combination of financial incentives thereof, to as-
sure small health care providers have the capability to 
move toward a national health care information infra-
structure by acquiring electronic health record systems 
and other health information technologies that meet the 
standards adopted or modified under section 1181. 
‘‘(b) CONDITIONS FOR QUALIFICATION.—As a condi-
tion of qualifying for financial incentives described in this 
section, the Secretary, in consultation with national orga-
nizations representing affected parties, as defined in sec-
tion 1181(a)(1)(C), and appropriate standards setting or-
ganizations, as defined in section 1181(a)(1)(B), shall 
grant the use of financial incentives to assure that such 
technologies are consistent with the goals of creation of 
a national health information infrastructure, such as—
‘‘(1) voluntary participation in studies or dem-
onstration projects to evaluate the use of such sys-
tems to measure and report quality data based on 
accepted clinical performance measures; and 
‘‘(2) voluntary participation in studies to dem-
onstrate the impact of such technologies on improv-
ing patient care, reducing costs and increasing effi-
ciencies. 
‘‘(c) GRANTS TO SMALL HEALTH CARE PROVIDERS 
AND ENTITIES FOR EXPENDITURES RELATING TO THE 
IMPLEMENTATION OF A NATIONAL HEALTH INFORMA-
TION INFRASTRUCTURE.—
‘‘(1) IN GENERAL.—The Secretary is authorized 
to make grants to small health care providers, in-
cluding physicians and others in clinical practice, for 
the purpose of assisting such entities to implement, 
design, test, acquire, and adopt electronic health 
records and other health information technologies 
identified by the Secretary as a key component of a 
national health care information infrastructure that 
comply with the standards adopted or modified 
under section 1181. 
‘‘(2) AMOUNT OF GRANT.—The grant amount 
made to small health care providers and entities to 
implement a national health care information infra-
structure shall be in a manner determined by the 
Secretary, in accordance with section 1181(b)(2)(ii),
that takes into account the costs of implementation, 
training, and complying with standards. 
‘‘(3) APPLICATION.—No grant may be made 
under this subsection except pursuant to a grant ap-
plication that is submitted in a time, manner, and 
form approved by the Secretary. 
‘‘(4) AUTHORIZATION
OF
APPROPRIATIONS.—
There are authorized to be appropriated to carry out 
this subsection such sums as may be necessary for 
each fiscal year. 
‘‘(d) REVOLVING LOANS TO SMALL HEALTH CARE 
PROVIDERS AND ENTITIES FOR EXPENDITURES RELAT-
ING TO THE IMPLEMENTATION OF A NATIONAL HEALTH 
INFORMATION INFRASTRUCTURE.—
‘‘(1) IN GENERAL.—The Secretary is authorized 
to make and guarantee loans to small health care 
providers, including physicians and others in clinical 
practice, for the purpose of assisting such entities to 
implement, design, test, acquire, and adopt elec-
tronic health records and other health information 
technologies identified by the Secretary as a key 
component of a national health care information in-
frastructure that comply with the standards adopted 
or modified under section 1181.
‘‘(2) AMOUNT
OF
LOAN.—The loan amount 
made to small health care providers and entities to 
implement a national health care information infra-
structure shall be in a manner determined by the 
Secretary, in accordance with section 1181(b)(2)(ii), 
that takes into account the costs of implementation, 
training, and complying with standards. 
‘‘(3) APPLICATION.—No loan may be made 
under this subsection except pursuant to a loan ap-
plication that is submitted in a time, manner, and 
form approved by the Secretary. 
‘‘(4) AUTHORIZATION
OF
APPROPRIATIONS.—
There are authorized to be appropriated to carry out 
this subsection such sums as may be necessary for 
each fiscal year.’’. 
SEC. 5. REFUNDABLE CREDIT FOR HEALTH CARE INFOR-
MATION INFRASTRUCTURE. 
(a) IN GENERAL.—Subpart C of part IV of sub-
chapter A of chapter 1 of the Internal Revenue Code of 
1986 (relating to refundable credits) is amended by redes-
ignating section 36 as section 37 and by inserting after 
section 35 the following new section: 
‘‘SEC. 36. HEALTH CARE INFORMATION INFRASTRUCTURE. 
‘‘(a) IN GENERAL.—In the case of a qualified health 
care provider, there shall be allowed as a credit against
the tax imposed by this chapter for the taxable year an 
amount equal to 10 percent of the amounts paid or in-
curred during the taxable year by the taxpayer for estab-
lishing a qualified health information technology system. 
‘‘(b) QUALIFIED
HEALTH
INFORMATION
TECH-
NOLOGY SYSTEM.—For purposes of this section, the term 
‘qualified health information technology system’ means a 
system which has been individually approved by the Sec-
retary of Health and Human Services for purposes of this 
section and which consists of electronic health record sys-
tems and other health information technologies that meet 
the standards and conditions of qualification adopted or 
modified under sections 1181 and 1183 of the Social Secu-
rity Act. 
‘‘(c) QUALIFIED HEALTH CARE PROVIDER.—For 
purposes of this section, the term ‘qualified health care 
provider’ means any person in the trade or business of 
providing health care. 
‘‘(d) TERMINATION.—This section shall not apply to 
amounts paid or incurred during taxable years beginning 
after December 31, 2014.’’. 
(b) DENIAL OF DOUBLE BENEFIT.—Section 280C of 
such Code is amended by adding at the end the following 
new subsection:
‘‘(e) CREDIT FOR HEALTH CARE INFORMATION IN-
FRASTRUCTURE.—No deduction shall be allowed for that 
portion of the expenses (otherwise allowable as a deduc-
tion) taken into account in determining the credit under 
section 36 for the taxable year which is equal to the 
amount of the credit determined for such taxable year 
under section 36(a).’’. 
(c) CONFORMING AMENDMENTS.—
(1) Paragraph (2) of section 1324(b) of title 
31, United States Code, is amended by inserting ‘‘or 
36’’ after ‘‘section 35’’. 
(2) The table of sections for subpart C of part 
IV of subchapter A of chapter 1 of the Internal Rev-
enue Code of 1986 is amended by striking the item 
relating to section 36 and inserting the following 
new items:
‘‘Sec. 36. Health care information infrastructure. 
‘‘Sec. 37. Overpayment of taxes.’’.
(d) EFFECTIVE DATE.—The amendments made by 
this section shall apply to amounts paid or incurred during 
taxable years beginning after December 31, 2005.
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