‘‘(III) takes into account the vol-
ume or value of referrals (or other 
business generated) by the physician 
to the hospital or critical access hos-
pital. 
‘‘(ii) Such remuneration is arranged 
for in a written agreement that is signed 
by a representative of the hospital or 
critical access hospital and by the physi-
cian and that specifies the remuneration 
made and states that the provision of 
such remuneration is made for the pri-
mary purpose of better coordination of 
care or improvement of health care qual-
ity or efficiency. 
‘‘(B) For purposes of subparagraph (A) 
and sections 1128B(b)(3)(J) and 1877(e)(9)— 
‘‘(i) the term ‘health information tech-
nology’ means hardware, software, li-
cense, intellectual property, equipment, 
or other information technology (includ-
ing 
new 
versions, 
upgrades, 
and 
connectivity) or related services used for 
the electronic creation, maintenance, and 
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exchange of clinical health information; 
and 
‘‘(ii) the term ‘HIT effective date’ 
means the date that is 180 days after the 
date of the enactment of this paragraph.’’. 
(b) 
FOR
CRIMINAL
PENALTIES.—Section 
1128B(b)(3) of such Act (42 U.S.C. 1320a– 
7b(b)(3)) is amended— 
(1) in subparagraph (G), by striking 
‘‘and’’ at the end; 
(2) in the subparagraph (H) as added 
by section 237(d) of the Medicare Pre-
scription Drug, Improvement, and Mod-
ernization Act of 2003 (Public Law 108– 
173; 117 Stat. 2213)— 
(A) by moving such subparagraph 
2 ems to the left; and 
(B) by striking the period at the 
end and inserting a semicolon; 
(3) in the subparagraph (H) added by 
section 431(a) of such Act (117 Stat. 
2287)— 
(A) by redesignating such sub-
paragraph as subparagraph (I); 
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(B) by moving such subparagraph 
2 ems to the left; and 
(C) by striking the period at the 
end and inserting ‘‘; and’’; and 
(4) by adding at the end the following 
new subparagraph: 
‘‘(J) any nonmonetary remuneration 
(in the form of health information tech-
nology, 
as 
defined 
in 
section 
1128A(b)(4)(B)(i), and related services) so-
licited or received by a person on or after 
the HIT effective date (as defined in sec-
tion 1128A(b)(4)(B)(ii)) (or offered or paid 
to a person on or after such date) if— 
‘‘(i) such remuneration is solicited 
or received (or offered or paid) with-
out a condition that— 
‘‘(I) limits or restricts the use 
of the health information tech-
nology to services provided by the 
person to individuals receiving 
services at the location of the en-
tity providing such technology; 
‘‘(II) limits or restricts the use 
of the health information tech-
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bajohnson on PROD1PC77 with BILLS
nology in conjunction with other 
health information technology; or 
‘‘(III) takes into account the 
volume or value of referrals (or 
other business generated) by the 
person to the entity providing 
such technology; and 
‘‘(ii) such remuneration is ar-
ranged for in a written agreement 
that is signed by a representative of 
the entity and by the physician and 
that specifies the remuneration made 
and states that the provision of such 
remuneration is made for the pri-
mary purpose of better coordination 
of care or improvement of health care 
quality or efficiency.’’. 
(c) FOR LIMITATION ON CERTAIN PHYSICIAN 
REFERRALS.—Section 1877(e) of such Act (42 
U.S.C. 1395nn(e)) is amended by adding at the 
end the following new paragraph: 
‘‘(9) INFORMATION
TECHNOLOGY
AND 
SERVICES.—Any nonmonetary remunera-
tion (in the form of health information 
technology, 
as 
defined 
in 
section 
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bajohnson on PROD1PC77 with BILLS
1128A(b)(4)(B)(i), and related services) 
made on or after the HIT effective date 
(as defined in section 1128A(b)(4)(B)(ii)) 
by an entity to a physician if the fol-
lowing requirements are met: 
‘‘(A) The provision of such remu-
neration is made without a condition 
that— 
‘‘(i) limits or restricts the use 
of the health information tech-
nology to services provided by the 
physician to individuals receiving 
services at the location of the en-
tity providing such technology; 
‘‘(ii) limits or restricts the use 
of the health information tech-
nology in conjunction with other 
health information technology; or 
‘‘(iii) takes into account the 
volume or value of referrals (or 
other business generated) by the 
physician to the entity providing 
such technology. 
‘‘(B) Such remuneration is ar-
ranged for in a written agreement 
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that is signed by a representative of 
the entity and by the physician and 
that specifies the remuneration made 
and states that the provision of such 
remuneration is made for the pri-
mary purpose of better coordination 
of care or improvement of health care 
quality or efficiency.’’. 
(d) REGULATION, EFFECTIVE DATE, AND EF-
FECT ON STATE LAWS.— 
(1) REGULATIONS.—Not later than the 
HIT effective date, the Secretary of 
Health and Human Services shall promul-
gate such regulations as may be nec-
essary to carry out the provisions of this 
section. 
(2) HIT EFFECTIVE DATE DEFINED.—For 
purposes of this subsection and sub-
section (e), the term ‘‘HIT effective date’’ 
has the meaning given such term in sec-
tion 1128A(b)(4)(B)(ii) of the Social Secu-
rity Act, as added by subsection (a). 
(3) PREEMPTION
OF
STATE
LAWS.—No 
State (as defined in section 4(c)(3)) shall 
have in effect a State law that imposes a 
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