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 
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; 
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(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 
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-
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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. 
(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; 
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(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: 
‘‘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 shall, using 
amounts appropriated under section 3018, invest in the 
infrastructure necessary to allow for and promote the elec-
tronic exchange and use of health information for each 
individual in the United States consistent with the goals 
outlined in the strategic plan developed by the National 
Coordinator (and as available) under section 3001. To the 
greatest extent practicable, the Secretary shall ensure that 
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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 enact-
ment of this title until such date as the standards are 
adopted under section 3004. The Secretary 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 Re-
search 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, as defined in section 3000, not eligible for 
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support under title XVIII or XIX of the Social Secu-
rity 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 
practices learned from the Health Information Tech-
nology Research Center developed under section 
3012(b), including community health centers receiv-
ing assistance under section 330, covered entities 
under section 340B, 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. 
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‘‘(7) Improvement and expansion of the use of 
health information technology by public health de-
partments. 
‘‘(8) Provision of $300 million to support re-
gional or sub-national efforts towards health infor-
mation 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 the 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. 
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100 
The National Coordinator shall consult with other Federal 
agencies with demonstrated experience and expertise in in-
formation technology services, such as the National Insti-
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. 
‘‘(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 
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101 
clerical staff and others involved in the care and 
care coordination of patients, from the health 
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 
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102 
health care settings and improve the quality of 
health care; 
‘‘(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. 
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103 
‘‘(2) AFFILIATION.—Regional centers shall be 
affiliated with any United States-based nonprofit in-
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; 
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104 
‘‘(D) participation, to the extent prac-
ticable, in health information exchanges; 
‘‘(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, 
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105 
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 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 title, 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. 
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106 
‘‘(B) Procedures to be followed by the ap-
plicants. 
‘‘(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. 
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107 
‘‘(8) BIENNIAL
EVALUATION.—Each regional 
center which receives financial assistance under this 
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 
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108 
organizations according to nationally recognized stand-
ards. 
‘‘(b) PLANNING GRANTS.—The Secretary may award 
a grant to a State or qualified State-designated entity (as 
described in subsection (f)) 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 
(d). 
‘‘(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 (e) (regardless 
of whether such plan was prepared using amounts 
awarded under subsection (b)); 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 (c) shall be used to conduct activi-
ties to facilitate and expand the electronic movement and 
use of health information among organizations according 
to nationally recognized standards through activities that 
include— 
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109 
‘‘(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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110 
‘‘(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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111 
‘‘(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 (b) and (c), a State or 
qualified State-designated entity shall consult with and 
consider the recommendations of— 
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112 
‘‘(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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113 
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 this section 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 (c) 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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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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‘‘(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 Administrator of the Centers 
for Medicare & Medicaid Services (or his 
or her designee), in the case of an entity 
participating 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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used to exchange health information in a man-
ner that, in accordance with law and standards 
(as adopted under section 3004) 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 health care 
providers involved intend to maintain and sup-
port the certified EHR technology over time; 
and 
‘‘(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 
‘‘(5) agrees to provide matching funds in ac-
cordance with subsection (h). 
‘‘(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-
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quirements 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 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. 
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‘‘(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 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 (c). 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 
limited by applicable State law, amounts deposited into a 
Loan Fund under this section may only be used for the 
following: 
‘‘(1) To award loans that comply with the fol-
lowing: 
‘‘(A) The interest rate for each loan shall 
not exceed the market interest rate. 
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‘‘(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). 
‘‘(g) ADMINISTRATION OF LOAN FUNDS.— 
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‘‘(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 section 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 in-
curred 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 section as efficiently as 
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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 section may accept contribu-
tions 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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‘‘(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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