(2) The extent to which companies perform and 
increase research and development activities in the 
United States is in part dependent on Federal tax 
policy. 
(3) The Congress should make permanent a re-
search and development credit that provides a mean-
ingful incentive to all types of taxpayers. 
SEC. 303. PERMANENT EXTENSION OF RESEARCH CREDIT. 
(a) IN GENERAL.—Section 41 of the Internal Rev-
enue Code of 1986 (relating to credit for increasing re-
search activities) is amended by striking subsection (h). 
(b) CONFORMING AMENDMENT.—Paragraph (1) of 
section 45C(b) of such Code is amended by striking sub-
paragraph (D). 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to amounts paid or incurred after 
the date of the enactment of this Act. 
SEC. 304. INCREASE IN RATES OF ALTERNATIVE INCRE-
MENTAL CREDIT. 
(a) IN GENERAL.—Subparagraph (A) of section 
41(c)(4) of the Internal Revenue Code of 1986 (relating 
to election of alternative incremental credit) is amended— 
(1) by striking ‘‘2.65 percent’’ and inserting ‘‘3 
percent’’, 
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(2) by striking ‘‘3.2 percent’’ and inserting ‘‘4 
percent’’, and 
(3) by striking ‘‘3.75 percent’’ and inserting ‘‘5 
percent’’. 
(b) EFFECTIVE DATE.—The amendment made by 
this section shall apply to taxable years ending after the 
date of the enactment of this Act. 
SEC. 305. ALTERNATIVE SIMPLIFIED CREDIT FOR QUALI-
FIED RESEARCH EXPENSES. 
(a) IN GENERAL.—Subsection (c) of section 41 of the 
Internal Revenue Code of 1986 (relating to base amount) 
is amended by redesignating paragraphs (5) and (6) as 
paragraphs (6) and (7), respectively, and by inserting 
after paragraph (4) the following new paragraph: 
‘‘(5) ELECTION OF ALTERNATIVE SIMPLIFIED 
CREDIT.— 
‘‘(A) IN GENERAL.—At the election of the 
taxpayer, the credit determined under sub-
section (a)(1) shall be equal to 12 percent of so 
much of the qualified research expenses for the 
taxable year as exceeds 50 percent of the aver-
age qualified research expenses for the 3 tax-
able years preceding the taxable year for which 
the credit is being determined. 
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‘‘(B) SPECIAL
RULE
IN
CASE
OF
NO 
QUALIFIED RESEARCH EXPENSES IN ANY OF 3 
PRECEDING TAXABLE YEARS.— 
‘‘(i) TAXPAYERS TO WHICH SUBPARA-
GRAPH
APPLIES.—The credit under this 
paragraph shall be determined under this 
subparagraph if the taxpayer has no quali-
fied research expenses in any one of the 3 
taxable years preceding the taxable year 
for which the credit is being determined. 
‘‘(ii) CREDIT RATE.—The credit de-
termined under this subparagraph shall be 
equal to 6 percent of the qualified research 
expenses for the taxable year. 
‘‘(C) ELECTION.—An election under this 
paragraph shall apply to the taxable year for 
which made and all succeeding taxable years 
unless revoked with the consent of the Sec-
retary. An election under this paragraph may 
not be made for any taxable year to which an 
election under paragraph (4) applies.’’. 
(b) COORDINATION WITH ELECTION
OF ALTER-
NATIVE INCREMENTAL CREDIT.— 
(1) IN GENERAL.—Section 41(c)(4)(B) of such 
Code (relating to election) is amended by adding at 
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the end the following: ‘‘An election under this para-
graph may not be made for any taxable year to 
which an election under paragraph (5) applies.’’. 
(2) TRANSITION RULE.—In the case of an elec-
tion under section 41(c)(4) of the Internal Revenue 
Code of 1986 which applies to the taxable year 
which includes the date of the enactment of this Act, 
such election shall be treated as revoked with the 
consent of the Secretary of the Treasury if the tax-
payer makes an election under section 41(c)(5) of 
such Code (as added by subsection (a)) for such 
year. 
(c) EFFECTIVE DATE.—The amendments made by 
this section shall apply to taxable years ending after the 
date of the enactment of this Act. 
TITLE IV—INCREASE ACCESS TO 
AND EFFICIENCY OF HEALTH 
CARE 
Subtitle A—Health Care Choice 
SEC. 401. SHORT TITLE OF SUBTITLE. 
This subtitle may be cited as ‘‘Health Care Choice 
Act of 2006’’. 
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SEC. 402. SPECIFICATION OF CONSTITUTIONAL AUTHORITY 
FOR ENACTMENT OF LAW. 
This subtitle is enacted pursuant to the power grant-
ed Congress under article I, section 8, clause 3, of the 
United States Constitution. 
SEC. 403. FINDINGS. 
Congress finds the following: 
(1) The application of numerous and significant 
variations in State law impacts the ability of insur-
ers to offer, and individuals to obtain, affordable in-
dividual health insurance coverage, thereby impeding 
commerce in individual health insurance coverage. 
(2) Individual health insurance coverage is in-
creasingly offered through the Internet, other elec-
tronic means, and by mail, all of which are inher-
ently part of interstate commerce. 
(3) In response to these issues, it is appropriate 
to encourage increased efficiency in the offering of 
individual health insurance coverage through a col-
laborative approach by the States in regulating this 
coverage. 
(4) The establishment of risk-retention groups 
has provided a successful model for the sale of insur-
ance across State lines, as the acts establishing 
those groups allow insurance to be sold in multiple 
States but regulated by a single State. 
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SEC. 
404. 
COOPERATIVE 
GOVERNING 
OF 
INDIVIDUAL 
HEALTH INSURANCE COVERAGE. 
(a) IN GENERAL.—Title XXVII of the Public Health 
Service Act (42 U.S.C. 300gg et seq.) is amended by add-
ing at the end the following new part: 
‘‘PART D—COOPERATIVE GOVERNING OF INDIVIDUAL 
HEALTH INSURANCE COVERAGE 
‘‘DEFINITIONS 
‘‘SEC. 2795. In this part: 
‘‘(1) PRIMARY
STATE.—The term ‘primary 
State’ means, with respect to individual health insur-
ance coverage offered by a health insurance issuer, 
the State designated by the issuer as the State 
whose covered laws shall govern the health insurance 
issuer in the sale of such coverage under this part. 
An issuer, with respect to a particular policy, may 
only designate one such State as its primary State 
with respect to all such coverage it offers. Such an 
issuer may not change the designated primary State 
with respect to individual health insurance coverage 
once the policy is issued, except that such a change 
may be made upon renewal of the policy. With re-
spect to such designated State, the issuer is deemed 
to be doing business in that State. 
‘‘(2) SECONDARY STATE.—The term ‘secondary 
State’ means, with respect to individual health insur-
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ance coverage offered by a health insurance issuer, 
any State that is not the primary State. In the case 
of a health insurance issuer that is selling a policy 
in, or to a resident of, a secondary State, the issuer 
is deemed to be doing business in that secondary 
State. 
‘‘(3) HEALTH INSURANCE ISSUER.—The term 
‘health insurance issuer’ has the meaning given such 
term in section 2791(b)(2), except that such an 
issuer must be licensed in the primary State and be 
qualified to sell individual health insurance coverage 
in that State. 
‘‘(4) INDIVIDUAL
HEALTH
INSURANCE
COV-
ERAGE.—The term ‘individual health insurance cov-
erage’ means health insurance coverage offered in 
the individual market, as defined in section 
2791(e)(1). 
‘‘(5) APPLICABLE
STATE
AUTHORITY.—The 
term ‘applicable State authority’ means, with respect 
to a health insurance issuer in a State, the State in-
surance commissioner or official or officials des-
ignated by the State to enforce the requirements of 
this title for the State with respect to the issuer. 
‘‘(6) HAZARDOUS FINANCIAL CONDITION.—The 
term ‘hazardous financial condition’ means that, 
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based on its present or reasonably anticipated finan-
cial condition, a health insurance issuer is unlikely 
to be able— 
‘‘(A) to meet obligations to policyholders 
with respect to known claims and reasonably 
anticipated claims; or 
‘‘(B) to pay other obligations in the normal 
course of business. 
‘‘(7) COVERED LAWS.—The term ‘covered laws’ 
means the laws, rules, regulations, agreements, and 
orders governing the insurance business pertaining 
to— 
‘‘(A) individual health insurance coverage 
issued by a health insurance issuer; 
‘‘(B) the offer, sale, and issuance of indi-
vidual health insurance coverage to an indi-
vidual; and 
‘‘(C) the provision to an individual in rela-
tion to individual health insurance coverage 
of— 
‘‘(i) health care and insurance related 
services; 
‘‘(ii) management, operations, and in-
vestment activities of a health insurance 
issuer; and 
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‘‘(iii) loss control and claims adminis-
tration for a health insurance issuer with 
respect to liability for which the issuer pro-
vides insurance. 
‘‘(8) STATE.—The term ‘State’ means only the 
50 States and the District of Columbia. 
‘‘(9) UNFAIR
CLAIMS
SETTLEMENT
PRAC-
TICES.—The term ‘unfair claims settlement prac-
tices’ means only the following practices: 
‘‘(A) Knowingly misrepresenting to claim-
ants and insured individuals relevant facts or 
policy provisions relating to coverage at issue. 
‘‘(B) Failing to acknowledge with reason-
able promptness pertinent communications with 
respect to claims arising under policies. 
‘‘(C) Failing to adopt and implement rea-
sonable standards for the prompt investigation 
and settlement of claims arising under policies. 
‘‘(D) Failing to effectuate prompt, fair, 
and equitable settlement of claims submitted in 
which liability has become reasonably clear. 
‘‘(E) Refusing to pay claims without con-
ducting a reasonable investigation. 
‘‘(F) Failing to affirm or deny coverage of 
claims within a reasonable period of time after 
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having completed an investigation related to 
those claims. 
‘‘(10) FRAUD AND ABUSE.—The term ‘fraud 
and abuse’ means an act or omission committed by 
a person who, knowingly and with intent to defraud, 
commits, or conceals any material information con-
cerning, one or more of the following: 
‘‘(A) Presenting, causing to be presented 
or preparing with knowledge or belief that it 
will be presented to or by an insurer, a rein-
surer, broker or its agent, false information as 
part of, in support of or concerning a fact ma-
terial to one or more of the following: 
‘‘(i) An application for the issuance or 
renewal of an insurance policy or reinsur-
ance contract. 
‘‘(ii) The rating of an insurance policy 
or reinsurance contract. 
‘‘(iii) A claim for payment or benefit 
pursuant to an insurance policy or reinsur-
ance contract. 
‘‘(iv) Premiums paid on an insurance 
policy or reinsurance contract. 
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‘‘(v) Payments made in accordance 
with the terms of an insurance policy or 
reinsurance contract. 
‘‘(vi) A document filed with the com-
missioner or the chief insurance regulatory 
official of another jurisdiction. 
‘‘(vii) The financial condition of an in-
surer or reinsurer. 
‘‘(viii) The formation, acquisition, 
merger, 
reconsolidation, 
dissolution 
or 
withdrawal from one or more lines of in-
surance or reinsurance in all or part of a 
State by an insurer or reinsurer. 
‘‘(ix) The issuance of written evidence 
of insurance. 
‘‘(x) The reinstatement of an insur-
ance policy. 
‘‘(B) Solicitation or acceptance of new or 
renewal insurance risks on behalf of an insurer 
reinsurer or other person engaged in the busi-
ness of insurance by a person who knows or 
should know that the insurer or other person 
responsible for the risk is insolvent at the time 
of the transaction. 
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‘‘(C) Transaction of the business of insur-
ance in violation of laws requiring a license, cer-
tificate of authority or other legal authority for 
the transaction of the business of insurance. 
‘‘(D) Attempt to commit, aiding or abet-
ting in the commission of, or conspiracy to com-
mit the acts or omissions specified in this para-
graph. 
‘‘APPLICATION OF LAW 
‘‘SEC. 2796. (a) IN GENERAL.—The covered laws of 
the primary State shall apply to individual health insur-
ance coverage offered by a health insurance issuer in the 
primary State and in any secondary State, but only if the 
coverage and issuer comply with the conditions of this sec-
tion with respect to the offering of coverage in any sec-
ondary State. 
‘‘(b) EXEMPTIONS FROM COVERED LAWS IN A SEC-
ONDARY STATE.—Except as provided in this section, a 
health insurance issuer with respect to its offer, sale, re-
newal, and issuance of individual health insurance cov-
erage in any secondary State is exempt from any covered 
laws of the secondary State (and any rules, regulations, 
agreements, or orders sought or issued by such State 
under or related to such covered laws) to the extent that 
such laws would— 
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‘‘(1) make unlawful, or regulate, directly or in-
directly, the operation of the health insurance issuer 
operating in the secondary State, except that any 
secondary State may require such an issuer— 
‘‘(A) to pay, on a nondiscriminatory basis, 
applicable premium and other taxes (including 
high risk pool assessments) which are levied on 
insurers and surplus lines insurers, brokers, or 
policyholders under the laws of the State; 
‘‘(B) to register with and designate the 
State insurance commissioner as its agent solely 
for the purpose of receiving service of legal doc-
uments or process; 
‘‘(C) to submit to an examination of its fi-
nancial condition by the State insurance com-
missioner in any State in which the issuer is 
doing business to determine the issuer’s finan-
cial condition, if— 
‘‘(i) the State insurance commissioner 
of the primary State has not done an ex-
amination within the period recommended 
by the National Association of Insurance 
Commissioners; and 
‘‘(ii) any such examination is con-
ducted in accordance with the examiners’ 
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handbook of the National Association of 
Insurance Commissioners and is coordi-
nated to avoid unjustified duplication and 
unjustified repetition; 
‘‘(D) to comply with a lawful order 
issued— 
‘‘(i) in a delinquency proceeding com-
menced by the State insurance commis-
sioner if there has been a finding of finan-
cial impairment under subparagraph (C); 
or 
‘‘(ii) in a voluntary dissolution pro-
ceeding; 
‘‘(E) to comply with an injunction issued 
by a court of competent jurisdiction, upon a pe-
tition by the State insurance commissioner al-
leging that the issuer is in hazardous financial 
condition; 
‘‘(F) to participate, on a nondiscriminatory 
basis, in any insurance insolvency guaranty as-
sociation or similar association to which a 
health insurance issuer in the State is required 
to belong; 
‘‘(G) to comply with any State law regard-
ing fraud and abuse (as defined in section 
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2795(10)), except that if the State seeks an in-
junction regarding the conduct described in this 
subparagraph, such injunction must be obtained 
from a court of competent jurisdiction; or 
‘‘(H) to comply with any State law regard-
ing unfair claims settlement practices (as de-
fined in section 2795(9)); 
‘‘(2) require any individual health insurance 
coverage issued by the issuer to be countersigned by 
an insurance agent or broker residing in that Sec-
ondary State; or 
‘‘(3) otherwise discriminate against the issuer 
issuing insurance in both the primary State and in 
any secondary State. 
‘‘(c) CLEAR
AND CONSPICUOUS DISCLOSURE.—A 
health insurance issuer shall provide the following, in 12- 
point bold type, in any insurance coverage offered in a 
secondary State under this part by such a health insur-
ance issuer and at renewal of the policy, with the 5 blank 
spaces therein being appropriately filled with the name of 
the health insurance issuer, the name of primary State, 
the name of the secondary State, the name of the sec-
ondary State, and the name of the secondary State, re-
spectively, for the coverage concerned: 
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‘Notice 
‘This policy is issued by lllll and is 
governed by the laws and regulations of the 
State of lllll, and it has met all the laws 
of that State as determined by that State’s De-
partment of Insurance. This policy may be 
less expensive than others because it is not 
subject to all of the insurance laws and regu-
lations of the State of lllll, including 
coverage of some services or benefits man-
dated by the law of the State of lllll. Ad-
ditionally, this policy is not subject to all of 
the consumer protection laws or restrictions 
on rate changes of the State of lllll. As 
with all insurance products, before pur-
chasing this policy, you should carefully re-
view the policy and determine what health 
care services the policy covers and what bene-
fits it provides, including any exclusions, limi-
tations, or conditions for such services or ben-
efits.’. 
‘‘(d) PROHIBITION ON CERTAIN RECLASSIFICATIONS 
AND PREMIUM INCREASES.— 
‘‘(1) IN GENERAL.—For purposes of this sec-
tion, a health insurance issuer that provides indi-
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vidual health insurance coverage to an individual 
under this part in a primary or secondary State may 
not upon renewal— 
‘‘(A) move or reclassify the individual in-
sured under the health insurance coverage from 
the class such individual is in at the time of 
issue of the contract based on the health-status 
related factors of the individual; or 
‘‘(B) increase the premiums assessed the 
individual for such coverage based on a health 
status-related factor or change of a health sta-
tus-related factor or the past or prospective 
claim experience of the insured individual. 
‘‘(2) CONSTRUCTION.—Nothing in paragraph 
(1) shall be construed to prohibit a health insurance 
issuer— 
‘‘(A) from terminating or discontinuing 
coverage or a class of coverage in accordance 
with subsections (b) and (c) of section 2742; 
‘‘(B) from raising premium rates for all 
policy holders within a class based on claims ex-
perience; 
‘‘(C) from changing premiums or offering 
discounted premiums to individuals who engage 
in wellness activities at intervals prescribed by 
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the issuer, if such premium changes or incen-
tives— 
‘‘(i) are disclosed to the consumer in 
the insurance contract; 
‘‘(ii) are based on specific wellness ac-
tivities that are not applicable to all indi-
viduals; and 
‘‘(iii) are not obtainable by all individ-
uals to whom coverage is offered; 
‘‘(D) from reinstating lapsed coverage; or 
‘‘(E) from retroactively adjusting the rates 
charged an individual insured individual if the 
initial rates were set based on material mis-
representation by the individual at the time of 
issue. 
‘‘(e) PRIOR OFFERING
OF POLICY
IN PRIMARY 
STATE.—A health insurance issuer may not offer for sale 
individual health insurance coverage in a secondary State 
unless that coverage is currently offered for sale in the 
primary State. 
‘‘(f) LICENSING
OF AGENTS
OR BROKERS
FOR 
HEALTH INSURANCE ISSUERS.—Any State may require 
that a person acting, or offering to act, as an agent or 
broker for a health insurance issuer with respect to the 
offering of individual health insurance coverage obtain a 
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license from that State, except that a State many not im-
pose any qualification or requirement which discriminates 
against a nonresident agent or broker. 
‘‘(g) DOCUMENTS FOR SUBMISSION TO STATE IN-
SURANCE COMMISSIONER.—Each health insurance issuer 
issuing individual health insurance coverage in both pri-
mary and secondary States shall submit— 
‘‘(1) to the insurance commissioner of each 
State in which it intends to offer such coverage, be-
fore it may offer individual health insurance cov-
erage in such State— 
‘‘(A) a copy of the plan of operation or fea-
sibility study or any similar statement of the 
policy being offered and its coverage (which 
shall include the name of its primary State and 
its principal place of business); 
‘‘(B) written notice of any change in its 
designation of its primary State; and 
‘‘(C) written notice from the issuer of the 
issuer’s compliance with all the laws of the pri-
mary State; and 
‘‘(2) to the insurance commissioner of each sec-
ondary State in which it offers individual health in-
surance coverage, a copy of the issuer’s quarterly fi-
nancial statement submitted to the primary State, 
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which statement shall be certified by an independent 
public accountant and contain a statement of opin-
ion on loss and loss adjustment expense reserves 
made by— 
‘‘(A) a member of the American Academy 
of Actuaries; or 
‘‘(B) a qualified loss reserve specialist. 
‘‘(h) POWER OF COURTS TO ENJOIN CONDUCT.— 
Nothing in this section shall be construed to affect the 
authority of any Federal or State court to enjoin— 
‘‘(1) the solicitation or sale of individual health 
insurance coverage by a health insurance issuer to 
any person or group who is not eligible for such in-
surance; or 
‘‘(2) the solicitation or sale of individual health 
insurance coverage by, or operation of, a health in-
surance issuer that is in hazardous financial condi-
tion. 
‘‘(i) STATE POWERS TO ENFORCE STATE LAWS.— 
‘‘(1) IN GENERAL.—Subject to the provisions of 
subsection (b)(1)(G) (relating to injunctions) and 
paragraph (2), nothing in this section shall be con-
strued to affect the authority of any State to make 
use of any of its powers to enforce the laws of such 
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State with respect to which a health insurance issuer 
is not exempt under subsection (b). 
‘‘(2) COURTS OF COMPETENT JURISDICTION.— 
If a State seeks an injunction regarding the conduct 
described in paragraphs (1) and (2) of subsection 
(h), such injunction must be obtained from a Fed-
eral or State court of competent jurisdiction. 
‘‘(j) STATES’ AUTHORITY TO SUE.—Nothing in this 
section shall affect the authority of any State to bring ac-
tion in any Federal or State court. 
‘‘(k) GENERALLY APPLICABLE LAWS.—Nothing in 
this section shall be construed to affect the applicability 
of State laws generally applicable to persons or corpora-
tions. 
‘‘PRIMARY STATE MUST MEET FEDERAL FLOOR BEFORE 
ISSUER MAY SELL INTO SECONDARY STATES 
‘‘SEC. 2797. A health insurance issuer may not offer, 
sell, or issue individual health insurance coverage in a sec-
ondary State if the primary State does not meet the fol-
lowing requirements: 
‘‘(1) The State insurance commissioner must 
use a risk-based capital formula for the determina-
tion of capital and surplus requirements for all 
health insurance issuers. 
‘‘(2) The State must have legislation or regula-
tions in place establishing an independent review 
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process for individuals who are covered by individual 
health insurance coverage unless the issuer provides 
an independent review mechanism functionally equiv-
alent (as determined by the primary State insurance 
commissioner or official) to that prescribed in the 
‘Health Carrier External Review Model Act’ of the 
National Association of Insurance Commissioners for 
all individuals who purchase insurance coverage 
under the terms of this part. 
‘‘ENFORCEMENT 
‘‘SEC. 2798. (a) IN GENERAL.—Subject to subsection 
(b), with respect to specific individual health insurance 
coverage the primary State for such coverage has sole ju-
risdiction to enforce the primary State’s covered laws in 
the primary State and any secondary State. 
‘‘(b) SECONDARY STATE’S AUTHORITY.—Nothing in 
subsection (a) shall be construed to affect the authority 
of a secondary State to enforce its laws as set forth in 
the exception specified in section 2796(b)(1). 
‘‘(c) COURT INTERPRETATION.—In reviewing action 
initiated by the applicable secondary State authority, the 
court of competent jurisdiction shall apply the covered 
laws of the primary State. 
‘‘(d) NOTICE OF COMPLIANCE FAILURE.—In the case 
of individual health insurance coverage offered in a sec-
ondary State that fails to comply with the covered laws 
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of the primary State, the applicable State authority of the 
secondary State may notify the applicable State authority 
of the primary State.’’. 
(b) EFFECTIVE DATE.—The amendment made by 
subsection (a) shall apply to individual health insurance 
coverage offered, issued, or sold after the date of the en-
actment of this Act. 
SEC. 405. SEVERABILITY. 
If any provision of this subtitle or the application of 
such provision to any person or circumstance is held to 
be unconstitutional, the remainder of this subtitle and the 
application of the provisions of such to any other person 
or circumstance shall not be affected. 
Subtitle B—Health Information 
Technology Promotion 
SEC. 411. SHORT TITLE OF SUBTITLE. 
This subtitle may be cited as the ‘‘Health Informa-
tion Technology Promotion Act of 2006’’. 
SEC. 412. OFFICE OF THE NATIONAL COORDINATOR FOR 
HEALTH INFORMATION TECHNOLOGY. 
(a) IN GENERAL.—Title II of the Public Health Serv-
ice Act is amended by adding at the end the following new 
part: 
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‘‘PART D—HEALTH INFORMATION TECHNOLOGY 
‘‘OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH 
INFORMATION TECHNOLOGY 
‘‘SEC. 271. (a) ESTABLISHMENT.—There is estab-
lished within the Department of Health and Human Serv-
ices an Office of the National Coordinator for Health In-
formation Technology that shall be headed by the National 
Coordinator for Health Information Technology (referred 
to in this section as the ‘National Coordinator’). The Na-
tional Coordinator shall be appointed by the President and 
shall report directly to the Secretary. The National Coor-
dinator shall be paid at a rate equal to the rate of basic 
pay for level IV of the Executive Schedule. 
‘‘(b) GOALS
OF
NATIONWIDE
INTEROPERABLE 
HEALTH
INFORMATION
TECHNOLOGY
INFRASTRUC-
TURE.—The National Coordinator shall perform the du-
ties under subsection (c) in a manner consistent with the 
development of a nationwide interoperable health informa-
tion technology infrastructure that— 
‘‘(1) improves health care quality, reduces med-
ical errors, increases the efficiency of care, and ad-
vances the delivery of appropriate, evidence-based 
health care services; 
‘‘(2) promotes wellness, disease prevention, and 
management of chronic illnesses by increasing the 
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