105 
quarter, whether under the State program 
funded under this part or as qualified State 
expenditures, exceeds the total such expendi-
tures of the State for non-recurrent short- 
term benefits in the corresponding quarter 
in the emergency fund base year of the 
State. 
‘‘(iii) AMOUNT OF GRANT.—Subject to 
paragraph (5), the amount of the grant to 
be made to a State under this subparagraph 
for a quarter shall be an amount equal to 
80 percent of the excess described in clause 
(ii). 
‘‘(C) GRANT RELATED TO INCREASED EX-
PENDITURES FOR SUBSIDIZED EMPLOYMENT.— 
‘‘(i) IN GENERAL.—For each calendar 
quarter in fiscal year 2009 or 2010, the 
Secretary shall make a grant from the 
Emergency Fund to each State that— 
‘‘(I) requests a grant under this 
subparagraph for the quarter; and 
‘‘(II) meets the requirement of 
clause (ii) for the quarter. 
‘‘(ii) SUBSIDIZED
EMPLOYMENT
EX-
PENDITURE REQUIREMENT.—A State meets 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00105
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
106 
the requirement of this clause for a quarter 
if the total expenditures of the State for sub-
sidized employment in the quarter, whether 
under the State program funded under this 
part or as qualified State expenditures, ex-
ceeds the total of such expenditures of the 
State in the corresponding quarter in the 
emergency fund base year of the State. 
‘‘(iii) AMOUNT OF GRANT.—Subject to 
paragraph (5), the amount of the grant to 
be made to a State under this subparagraph 
for a quarter shall be an amount equal to 
80 percent of the excess described in clause 
(ii). 
‘‘(4) AUTHORITY TO MAKE NECESSARY ADJUST-
MENTS TO DATA AND COLLECT NEEDED DATA.—In de-
termining the size of the caseload of a State and the 
expenditures of a State for basic assistance, non-re-
current short-term benefits, and subsidized employ-
ment, during any period for which the State requests 
funds under this subsection, and during the emer-
gency fund base year of the State, the Secretary may 
make appropriate adjustments to the data to ensure 
that the data reflect expenditures under the State pro-
gram funded under this part and qualified State ex-
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00106
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
107 
penditures. The Secretary may develop a mechanism 
for collecting expenditure data, including procedures 
which allow States to make reasonable estimates, and 
may set deadlines for making revisions to the data. 
‘‘(5) LIMITATION.—The total amount payable to 
a single State under subsection (b) and this subsection 
for a fiscal year shall not exceed 25 percent of the 
State family assistance grant. 
‘‘(6) LIMITATIONS ON USE OF FUNDS.—A State 
to which an amount is paid under this subsection 
may use the amount only as authorized by section 
404. 
‘‘(7) TIMING
OF
IMPLEMENTATION.—The Sec-
retary shall implement this subsection as quickly as 
reasonably possible, pursuant to appropriate guidance 
to States. 
‘‘(8) DEFINITIONS.—In this subsection: 
‘‘(A) AVERAGE MONTHLY ASSISTANCE CASE-
LOAD.—The term ‘average monthly assistance 
caseload’ means, with respect to a State and a 
quarter, the number of families receiving assist-
ance during the quarter under the State program 
funded under this part or as qualified State ex-
penditures, subject to adjustment under para-
graph (4). 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00107
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
108 
‘‘(B) EMERGENCY FUND BASE YEAR.— 
‘‘(i) IN
GENERAL.—The term ‘emer-
gency fund base year’ means, with respect 
to a State and a category described in 
clause (ii), whichever of fiscal year 2007 or 
2008 is the fiscal year in which the amount 
described by the category with respect to the 
State is the lesser. 
‘‘(ii) CATEGORIES
DESCRIBED.—The 
categories described in this clause are the 
following: 
‘‘(I) The average monthly assist-
ance caseload of the State. 
‘‘(II) The total expenditures of the 
State for non-recurrent short-term ben-
efits, whether under the State program 
funded under this part or as qualified 
State expenditures. 
‘‘(III) The total expenditures of 
the State for subsidized employment, 
whether under the State program fund-
ed under this part or as qualified State 
expenditures. 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00108
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
109 
‘‘(C) QUALIFIED STATE EXPENDITURES.— 
The term ‘qualified State expenditures’ has the 
meaning given the term in section 409(a)(7).’’. 
(b) TEMPORARY MODIFICATION OF CASELOAD REDUC-
TION CREDIT.—Section 407(b)(3)(A)(i) of such Act (42 
U.S.C. 607(b)(3)(A)(i)) is amended by inserting ‘‘(or if the 
immediately preceding fiscal year is fiscal year 2009 or 
2010, then, at State option, during the emergency fund base 
year of the State with respect to the average monthly assist-
ance caseload of the State (within the meaning of section 
403(c)(8)(B)))’’ before ‘‘under the State’’. 
(c) EFFECTIVE DATE.—The amendments made by this 
section shall take effect on the date of the enactment of this 
Act. 
SEC. 2102. ONE-TIME EMERGENCY PAYMENT TO SSI RECIPI-
ENTS. 
(a) PAYMENT AUTHORITY.— 
(1) IN
GENERAL.—At the earliest practicable 
date in calendar year 2009 but not later than 120 
days after the date of the enactment of this section, 
the Commissioner of Social Security shall make a 
one-time payment to each individual who is deter-
mined by the Commissioner in calendar year 2009 to 
be an individual who— 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00109
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
110 
(A) is entitled to a cash benefit under the 
supplemental security income program under 
title XVI of the Social Security Act (other than 
pursuant to section 1611(e)(1)(B) of such Act) 
for at least 1 day in the calendar month in 
which the first payment under this section is to 
be made; or 
(B)(i) was entitled to such a cash benefit 
(other than pursuant to section 1611(e)(1)(B) of 
such Act) for at least 1 day in the 2-month pe-
riod preceding that calendar month; and 
(ii) whose entitlement to that benefit ceased 
in that 2-month period solely because the income 
of the individual (and the income of the spouse, 
if any, of the individual) exceeded the applicable 
income limit described in paragraph (1)(A) or 
(2)(A) of section 1611(a) of such Act. 
(2) AMOUNT OF PAYMENT.—Subject to subsection 
(b)(1) of this section, the amount of the payment shall 
be— 
(A) in the case of an individual eligible for 
a payment under this section who does not have 
a spouse eligible for such a payment, an amount 
equal to the average of the cash benefits payable 
in the aggregate under section 1611 or 1619(a) 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00110
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
111 
of the Social Security Act to eligible individuals 
who do not have an eligible spouse, for the most 
recent month for which data on payment of the 
benefits are available, as determined by the Com-
missioner of Social Security; or 
(B) in the case of an individual eligible for 
a payment under this section who has a spouse 
eligible for such a payment, an amount equal to 
the average of the cash benefits payable in the 
aggregate under section 1611 or 1619(a) of the 
Social Security Act to eligible individuals who 
have an eligible spouse, for the most recent 
month for which data on payment of the benefits 
are available, as so determined. 
(b) ADMINISTRATIVE PROVISIONS.— 
(1) AUTHORITY TO WITHHOLD PAYMENT TO RE-
COVER PRIOR OVERPAYMENT OF SSI BENEFITS.—The 
Commissioner of Social Security may withhold part 
or all of a payment otherwise required to be made 
under subsection (a) of this section to an individual, 
in order to recover a prior overpayment of benefits to 
the individual under the supplemental security in-
come program under title XVI of the Social Security 
Act, subject to the limitations of section 1631(b) of 
such Act. 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00111
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
112 
(2) PAYMENT TO BE DISREGARDED IN DETER-
MINING
UNDERPAYMENTS
UNDER
THE
SSI
PRO-
GRAM.—A payment under subsection (a) shall be dis-
regarded in determining whether there has been an 
underpayment of benefits under the supplemental se-
curity income program under title XVI of the Social 
Security Act. 
(3) NONASSIGNMENT.—The provisions of section 
1631(d) of the Social Security Act shall apply with 
respect to payments under this section to the same ex-
tent as they apply in the case of title XVI of such Act. 
(c) PAYMENTS TO BE DISREGARDED FOR PURPOSES 
OF
ALL
FEDERAL
AND
FEDERALLY
ASSISTED
PRO-
GRAMS.—A payment under subsection (a) shall not be re-
garded as income to the recipient, and shall not be regarded 
as a resource of the recipient for the month of receipt and 
the following 6 months, for purposes of determining the eli-
gibility of any individual for benefits or assistance, or the 
amount or extent of benefits or assistance, under any Fed-
eral program or under any State or local program financed 
in whole or in part with Federal funds. 
(d) APPROPRIATION.—Out of any sums in the Treas-
ury of the United States not otherwise appropriated, there 
are appropriated such sums as may be necessary to carry 
out this section. 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00112
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
113 
SEC. 2103. TEMPORARY RESUMPTION OF PRIOR CHILD SUP-
PORT LAW. 
During the period that begins with October 1, 2008, 
and ends with September 30, 2010, section 455(a)(1) of the 
Social Security Act shall be applied and administered as 
if the phrase ‘‘from amounts paid to the State under section 
458 or’’ did not appear in such section. 
TITLE III—HEALTH INSURANCE 
ASSISTANCE FOR THE UNEM-
PLOYED 
SEC. 3001. SHORT TITLE AND TABLE OF CONTENTS OF 
TITLE. 
(a) SHORT TITLE OF TITLE.—This title may be cited 
as the ‘‘Health Insurance Assistance for the Unemployed 
Act of 2009’’. 
(b) TABLE OF CONTENTS OF TITLE.—The table of con-
tents of this title is as follows: 
Sec. 3001. Short title and table of contents of title. 
Sec. 3002. Premium assistance for COBRA benefits and extension of COBRA ben-
efits for older or long-term employees. 
Sec. 3003. Temporary optional Medicaid coverage for the unemployed. 
SEC. 3002. PREMIUM ASSISTANCE FOR COBRA BENEFITS 
AND EXTENSION OF COBRA BENEFITS FOR 
OLDER OR LONG-TERM EMPLOYEES. 
(a) PREMIUM ASSISTANCE
FOR COBRA CONTINU-
ATION COVERAGE
FOR INDIVIDUALS
AND THEIR FAMI-
LIES.— 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00113
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
114 
(1) PROVISION OF PREMIUM ASSISTANCE.— 
(A) REDUCTION OF PREMIUMS PAYABLE.— 
In the case of any premium for a period of cov-
erage beginning on or after the date of the enact-
ment of this Act for COBRA continuation cov-
erage with respect to any assistance eligible indi-
vidual, such individual shall be treated for pur-
poses of any COBRA continuation provision as 
having paid the amount of such premium if such 
individual pays 35 percent of the amount of such 
premium (as determined without regard to this 
subsection). 
(B) PREMIUM REIMBURSEMENT.—For pro-
visions providing the balance of such premium, 
see section 6431 of the Internal Revenue Code of 
1986, as added by paragraph (12). 
(2) LIMITATION OF PERIOD OF PREMIUM ASSIST-
ANCE.— 
(A) IN GENERAL.—Paragraph (1)(A) shall 
not apply with respect to any assistance eligible 
individual for months of coverage beginning on 
or after the earlier of— 
(i) the first date that such individual 
is eligible for coverage under any other 
group health plan (other than coverage con-
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00114
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
115 
sisting of only dental, vision, counseling, or 
referral services (or a combination thereof), 
coverage under a health reimbursement ar-
rangement or a health flexible spending ar-
rangement, or coverage of treatment that is 
furnished in an on-site medical facility 
maintained by the employer and that con-
sists primarily of first-aid services, preven-
tion and wellness care, or similar care (or 
a combination thereof)) or is eligible for 
benefits under title XVIII of the Social Se-
curity Act, or 
(ii) the earliest of— 
(I) the date which is 12 months 
after the first day of the first month 
that paragraph (1)(A) applies with re-
spect to such individual, 
(II) the date following the expira-
tion of the maximum period of con-
tinuation coverage required under the 
applicable COBRA continuation cov-
erage provision, or 
(III) the date following the expi-
ration of the period of continuation 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00115
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
116 
coverage 
allowed 
under 
paragraph 
(4)(B)(ii). 
(B) TIMING
OF
ELIGIBILITY
FOR
ADDI-
TIONAL
COVERAGE.—For purposes of subpara-
graph (A)(i), an individual shall not be treated 
as eligible for coverage under a group health 
plan before the first date on which such indi-
vidual could be covered under such plan. 
(C) NOTIFICATION REQUIREMENT.—An as-
sistance eligible individual shall notify in writ-
ing the group health plan with respect to which 
paragraph (1)(A) applies if such paragraph 
ceases to apply by reason of subparagraph 
(A)(i). Such notice shall be provided to the group 
health plan in such time and manner as may be 
specified by the Secretary of Labor. 
(3) ASSISTANCE
ELIGIBLE
INDIVIDUAL.—For 
purposes of this section, the term ‘‘assistance eligible 
individual’’ means any qualified beneficiary if— 
(A) at any time during the period that be-
gins with September 1, 2008, and ends with De-
cember 31, 2009, such qualified beneficiary is el-
igible for COBRA continuation coverage, 
(B) such qualified beneficiary elects such 
coverage, and 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00116
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
117 
(C) the qualifying event with respect to the 
COBRA continuation coverage consists of the in-
voluntary termination of the covered employee’s 
employment and occurred during such period. 
(4) EXTENSION OF ELECTION PERIOD AND EF-
FECT ON COVERAGE.— 
(A) IN GENERAL.—Notwithstanding section 
605(a) of the Employee Retirement Income Secu-
rity Act of 1974, section 4980B(f)(5)(A) of the 
Internal Revenue Code of 1986, section 2205(a) 
of the Public Health Service Act, and section 
8905a(c)(2) of title 5, United States Code, in the 
case of an individual who is a qualified bene-
ficiary described in paragraph (3)(A) as of the 
date of the enactment of this Act and has not 
made the election referred to in paragraph 
(3)(B) as of such date, such individual may elect 
the COBRA continuation coverage under the 
COBRA continuation coverage provisions con-
taining such sections during the 60-day period 
commencing with the date on which the notifica-
tion required under paragraph (7)(C) is pro-
vided to such individual. 
(B) COMMENCEMENT
OF
COVERAGE; NO 
REACH-BACK.—Any COBRA continuation cov-
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00117
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
118 
erage elected by a qualified beneficiary during 
an extended election period under subparagraph 
(A)— 
(i) shall commence on the date of the 
enactment of this Act, and 
(ii) shall not extend beyond the period 
of COBRA continuation coverage that 
would have been required under the applica-
ble COBRA continuation coverage provision 
if the coverage had been elected as required 
under such provision. 
(C) PREEXISTING
CONDITIONS.—With re-
spect to a qualified beneficiary who elects 
COBRA continuation coverage pursuant to sub-
paragraph (A), the period— 
(i) beginning on the date of the quali-
fying event, and 
(ii) ending with the day before the date 
of the enactment of this Act, 
shall be disregarded for purposes of determining 
the 63-day periods referred to in section 701)(2) 
of the Employee Retirement Income Security Act 
of 1974, section 9801(c)(2) of the Internal Rev-
enue Code of 1986, and section 2701(c)(2) of the 
Public Health Service Act. 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00118
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
119 
(5) EXPEDITED REVIEW OF DENIALS OF PRE-
MIUM ASSISTANCE.—In any case in which an indi-
vidual requests treatment as an assistance eligible in-
dividual and is denied such treatment by the group 
health plan by reason of such individual’s ineligi-
bility for COBRA continuation coverage, the Sec-
retary of Labor (or the Secretary of Health and 
Human services in connection with COBRA continu-
ation coverage which is provided other than pursuant 
to part 6 of subtitle B of title I of the Employee Re-
tirement Income Security Act of 1974), in consulta-
tion with the Secretary of the Treasury, shall provide 
for expedited review of such denial. An individual 
shall be entitled to such review upon application to 
such Secretary in such form and manner as shall be 
provided by such Secretary. Such Secretary shall 
make a determination regarding such individual’s eli-
gibility within 10 business days after receipt of such 
individual’s application for review under this para-
graph. 
(6) DISREGARD OF SUBSIDIES FOR PURPOSES OF 
FEDERAL
AND
STATE
PROGRAMS.—Notwithstanding 
any other provision of law, any premium reduction 
with respect to an assistance eligible individual under 
this subsection shall not be considered income or re-
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00119
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
120 
sources in determining eligibility for, or the amount 
of assistance or benefits provided under, any other 
public benefit provided under Federal law or the law 
of any State or political subdivision thereof. 
(7) NOTICES TO INDIVIDUALS.— 
(A) GENERAL NOTICE.— 
(i) IN GENERAL.—In the case of notices 
provided under section 606(4) of the Em-
ployee Retirement Income Security Act of 
1974 
(29 
U.S.C. 
1166(4)), 
section 
4980B(f)(6)(D) of the Internal Revenue 
Code of 1986, section 2206(4) of the Public 
Health Service Act (42 U.S.C. 300bb–6(4)), 
or section 8905a(f)(2)(A) of title 5, United 
States Code, with respect to individuals 
who, during the period described in para-
graph (3)(A), become entitled to elect 
COBRA continuation coverage, such notices 
shall include an additional notification to 
the recipient of the availability of premium 
reduction with respect to such coverage 
under this subsection. 
(ii) ALTERNATIVE
NOTICE.—In the 
case of COBRA continuation coverage to 
which the notice provision under such sec-
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00120
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
121 
tions does not apply, the Secretary of 
Labor, in consultation with the Secretary of 
the Treasury and the Secretary of Health 
and Human Services, shall, in coordination 
with administrators of the group health 
plans (or other entities) that provide or ad-
minister the COBRA continuation coverage 
involved, provide rules requiring the provi-
sion of such notice. 
(iii) FORM.—The requirement of the 
additional notification under this subpara-
graph may be met by amendment of exist-
ing notice forms or by inclusion of a sepa-
rate document with the notice otherwise re-
quired. 
(B) SPECIFIC REQUIREMENTS.—Each addi-
tional notification under subparagraph (A) shall 
include— 
(i) the forms necessary for establishing 
eligibility for premium reduction under this 
subsection, 
(ii) the name, address, and telephone 
number necessary to contact the plan ad-
ministrator and any other person main-
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00121
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
122 
taining relevant information in connection 
with such premium reduction, 
(iii) a description of the extended elec-
tion period provided for in paragraph 
(4)(A), 
(iv) a description of the obligation of 
the qualified beneficiary under paragraph 
(2)(C) to notify the plan providing continu-
ation coverage of eligibility for subsequent 
coverage under another group health plan 
or eligibility for benefits under title XVIII 
of the Social Security Act and the penalty 
provided for failure to so notify the plan, 
and 
(v) a description, displayed in a 
prominent manner, of the qualified bene-
ficiary’s right to a reduced premium and 
any conditions on entitlement to the re-
duced premium. 
(C) NOTICE
RELATING
TO
RETROACTIVE 
COVERAGE.—In the case of an individual de-
scribed in paragraph (3)(A) who has elected 
COBRA continuation coverage as of the date of 
enactment of this Act or an individual described 
in paragraph (4)(A), the administrator of the 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00122
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
123 
group health plan (or other entity) involved shall 
provide (within 60 days after the date of enact-
ment of this Act) for the additional notification 
required to be provided under subparagraph (A). 
(D) MODEL NOTICES.—Not later than 30 
days after the date of enactment of this Act, the 
Secretary of the Labor, in consultation with the 
Secretary of the Treasury and the Secretary of 
Health and Human Services, shall prescribe 
models for the additional notification required 
under this paragraph. 
(8) SAFEGUARDS.—The Secretary of the Treas-
ury shall provide such rules, procedures, regulations, 
and other guidance as may be necessary and appro-
priate to prevent fraud and abuse under this sub-
section. 
(9) OUTREACH.—The Secretary of Labor, in con-
sultation with the Secretary of the Treasury and the 
Secretary of Health and Human Services, shall pro-
vide outreach consisting of public education and en-
rollment assistance relating to premium reduction 
provided under this subsection. Such outreach shall 
target employers, group health plan administrators, 
public assistance programs, States, insurers, and 
other entities as determined appropriate by such Sec-
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00123
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
124 
retaries. Such outreach shall include an initial focus 
on those individuals electing continuation coverage 
who are referred to in paragraph (7)(C). Information 
on such premium reduction, including enrollment, 
shall also be made available on website of the Depart-
ments of Labor, Treasury, and Health and Human 
Services. 
(10) DEFINITIONS.—For purposes of this sub-
section— 
(A) ADMINISTRATOR.—The term ‘‘adminis-
trator’’ has the meaning given such term in sec-
tion 3(16) of the Employee Retirement Income 
Security Act of 1974. 
(B) COBRA CONTINUATION
COVERAGE.— 
The term ‘‘COBRA continuation coverage’’ 
means continuation coverage provided pursuant 
to part 6 of subtitle B of title I of the Employee 
Retirement Income Security Act of 1974 (other 
than under section 609), title XXII of the Public 
Health Service Act, section 4980B of the Internal 
Revenue Code of 1986 (other than subsection 
(f)(1) of such section insofar as it relates to pedi-
atric vaccines), or section 8905a of title 5, 
United States Code, or under a State program 
that provides continuation coverage comparable 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00124
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
125 
to such continuation coverage. Such term does 
not include coverage under a health flexible 
spending arrangement. 
(C) COBRA CONTINUATION
PROVISION.— 
The term ‘‘COBRA continuation provision’’ 
means the provisions of law described in sub-
paragraph (B). 
(D) COVERED EMPLOYEE.—The term ‘‘cov-
ered employee’’ has the meaning given such term 
in section 607(2) of the Employee Retirement In-
come Security Act of 1974. 
(E) QUALIFIED
BENEFICIARY.—The term 
‘‘qualified beneficiary’’ has the meaning given 
such term in section 607(3) of the Employee Re-
tirement Income Security Act of 1974. 
(F) GROUP
HEALTH
PLAN.—The term 
‘‘group health plan’’ has the meaning given such 
term in section 607(1) of the Employee Retire-
ment Income Security Act of 1974. 
(G) STATE.—The term ‘‘State’’ includes the 
District of Columbia, the Commonwealth of 
Puerto Rico, the Virgin Islands, Guam, Amer-
ican Samoa, and the Commonwealth of the 
Northern Mariana Islands. 
(11) REPORTS.— 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00125
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
126 
(A) INTERIM REPORT.—The Secretary of the 
Treasury shall submit an interim report to the 
Committee on Education and Labor, the Com-
mittee on Ways and Means, and the Committee 
on Energy and Commerce of the House of Rep-
resentatives and the Committee on Health, Edu-
cation, Labor, and Pensions and the Committee 
on Finance of the Senate regarding the premium 
reduction provided under this subsection that in-
cludes— 
(i) the number of individuals provided 
such assistance as of the date of the report; 
and 
(ii) the total amount of expenditures 
incurred (with administrative expenditures 
noted separately) in connection with such 
assistance as of the date of the report. 
(B) FINAL REPORT.—As soon as practicable 
after the last period of COBRA continuation cov-
erage for which premium reduction is provided 
under this section, the Secretary of the Treasury 
shall submit a final report to each Committee re-
ferred to in subparagraph (A) that includes— 
(i) the number of individuals provided 
premium reduction under this section; 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00126
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
127 
(ii) the average dollar amount (month-
ly and annually) of premium reductions 
provided to such individuals; and 
(iii) the total amount of expenditures 
incurred (with administrative expenditures 
noted separately) in connection with pre-
mium reduction under this section. 
(12) COBRA PREMIUM ASSISTANCE.— 
(A) IN GENERAL.—Subchapter B of chapter 
65 of the Internal Revenue Code of 1986 is 
amended by adding at the end the following new 
section: 
‘‘SEC. 6431. COBRA PREMIUM ASSISTANCE. 
‘‘(a) IN GENERAL.—The entity to whom premiums are 
payable under COBRA continuation coverage shall be reim-
bursed for the amount of premiums not paid by plan bene-
ficiaries by reason of section 3002(a) of the Health Insur-
ance Assistance for the Unemployed Act of 2009. Such 
amount shall be treated as a credit against the requirement 
of such entity to make deposits of payroll taxes and the li-
ability of such entity for payroll taxes. To the extent that 
such amount exceeds the amount of such taxes, the Secretary 
shall pay to such entity the amount of such excess. No pay-
ment may be made under this subsection to an entity with 
respect to any assistance eligible individual until after such 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00127
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
128 
entity has received the reduced premium from such indi-
vidual required under section 3002(a)(1)(A) of such Act. 
‘‘(b) PAYROLL TAXES.—For purposes of this section, 
the term ‘payroll taxes’ means— 
‘‘(1) amounts required to be deducted and with-
held for the payroll period under section 3401 (relat-
ing to wage withholding), 
‘‘(2) amounts required to be deducted for the 
payroll period under section 3102 (relating to FICA 
employee taxes), and 
‘‘(3) amounts of the taxes imposed for the payroll 
period under section 3111 (relating to FICA employer 
taxes). 
‘‘(c) TREATMENT OF CREDIT.—Except as otherwise 
provided by the Secretary, the credit described in subsection 
(a) shall be applied as though the employer had paid to 
the Secretary, on the day that the qualified beneficiary’s 
premium payment is received, an amount equal to such 
credit. 
‘‘(d) TREATMENT OF PAYMENT.—For purposes of sec-
tion 1324(b)(2) of title 31, United States Code, any pay-
ment under this section shall be treated in the same manner 
as a refund of the credit under section 35. 
‘‘(e) REPORTING.— 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00128
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
129 
‘‘(1) IN GENERAL.—Each entity entitled to reim-
bursement under subsection (a) for any period shall 
submit such reports as the Secretary may require, in-
cluding— 
‘‘(A) an attestation of involuntary termi-
nation of employment for each covered employee 
on the basis of whose termination entitlement to 
reimbursement is claimed under subsection (a), 
and 
‘‘(B) a report of the amount of payroll taxes 
offset under subsection (a) for the reporting pe-
riod and the estimated offsets of such taxes for 
the subsequent reporting period in connection 
with reimbursements under subsection (a). 
‘‘(2) TIMING OF REPORTS RELATING TO AMOUNT 
OF PAYROLL TAXES.—Reports required under para-
graph (1)(B) shall be submitted at the same time as 
deposits of taxes imposed by chapters 21, 22, and 24 
or at such time as is specified by the Secretary. 
‘‘(f) REGULATIONS.—The Secretary may issue such 
regulations or other guidance as may be necessary or appro-
priate to carry out this section, including the requirement 
to report information or the establishment of other methods 
for verifying the correct amounts of payments and credits 
under this section. The Secretary shall issue such regula-
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00129
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
130 
tions or guidance with respect to the application of this sec-
tion to group health plans that are multiemployer plans.’’. 
(B) SOCIAL SECURITY TRUST FUNDS HELD 
HARMLESS.—In determining any amount trans-
ferred or appropriated to any fund under the So-
cial Security Act, section 6431 of the Internal 
Revenue Code of 1986 shall not be taken into ac-
count. 
(C) CLERICAL AMENDMENT.—The table of 
sections for subchapter B of chapter 65 of the In-
ternal Revenue Code of 1986 is amended by add-
ing at the end the following new item: 
‘‘Sec. 6431. COBRA premium assistance.’’. 
(D) EFFECTIVE
DATE.—The amendments 
made by this paragraph shall apply to pre-
miums to which subsection (a)(1)(A) applies. 
(13) PENALTY FOR FAILURE TO NOTIFY HEALTH 
PLAN OF CESSATION OF ELIGIBILITY FOR PREMIUM 
ASSISTANCE.— 
(A) IN GENERAL.—Part I of subchapter B 
of chapter 68 of the Internal Revenue Code of 
1986 is amended by adding at the end the fol-
lowing new section: 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00130
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
131 
‘‘SEC. 6720C. PENALTY FOR FAILURE TO NOTIFY HEALTH 
PLAN OF CESSATION OF ELIGIBILITY FOR 
COBRA PREMIUM ASSISTANCE. 
‘‘(a) IN GENERAL.—Any person required to notify a 
group health plan under section 3002(a)(2)(C)) of the 
Health Insurance Assistance for the Unemployed Act of 
2009 who fails to make such a notification at such time 
and in such manner as the Secretary of Labor may require 
shall pay a penalty of 110 percent of the premium reduction 
provided under such section after termination of eligibility 
under such subsection. 
‘‘(b) REASONABLE CAUSE EXCEPTION.—No penalty 
shall be imposed under subsection (a) with respect to any 
failure if it is shown that such failure is due to reasonable 
cause and not to willful neglect.’’. 
(B) CLERICAL AMENDMENT.—The table of 
sections of part I of subchapter B of chapter 68 
of such Code is amended by adding at the end 
the following new item: 
‘‘Sec. 6720C. Penalty for failure to notify health plan of cessation of eligibility 
for COBRA premium assistance.’’. 
(C) EFFECTIVE
DATE.—The amendments 
made by this paragraph shall apply to failures 
occurring after the date of the enactment of this 
Act. 
(14) COORDINATION WITH HCTC.— 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00131
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
132 
(A) IN GENERAL.—Subsection (g) of section 
35 of the Internal Revenue Code of 1986 is 
amended by redesignating paragraph (9) as 
paragraph (10) and inserting after paragraph 
(8) the following new paragraph: 
‘‘(9) COBRA PREMIUM
ASSISTANCE.—In the 
case of an assistance eligible individual who receives 
premium reduction for COBRA continuation coverage 
under section 3002(a) of the Health Insurance Assist-
ance for the Unemployed Act of 2009 for any month 
during the taxable year, such individual shall not be 
treated as an eligible individual, a certified indi-
vidual, or a qualifying family member for purposes 
of this section or section 7527 with respect to such 
month.’’. 
(B) EFFECTIVE
DATE.—The amendment 
made by subparagraph (A) shall apply to tax-
able years ending after the date of the enactment 
of this Act. 
(15) EXCLUSION
OF
COBRA
PREMIUM
ASSIST-
ANCE FROM GROSS INCOME.— 
(A) IN GENERAL.—Part III of subchapter B 
of chapter 1 of the Internal Revenue Code of 
1986 is amended by inserting after section 139B 
the following new section: 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00132
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
133 
‘‘SEC. 139C. COBRA PREMIUM ASSISTANCE. 
‘‘In the case of an assistance eligible individual (as 
defined in section 3002 of the Health Insurance Assistance 
for the Unemployed Act of 2009), gross income does not in-
clude any premium reduction provided under subsection (a) 
of such section.’’. 
(B) CLERICAL AMENDMENT.—The table of 
sections for part III of subchapter B of chapter 
1 of such Code is amended by inserting after the 
item relating to section 139B the following new 
item: 
‘‘Sec. 139C. COBRA premium assistance.’’. 
(C) EFFECTIVE
DATE.—The amendments 
made by this paragraph shall apply to taxable 
years ending after the date of the enactment of 
this Act. 
(b) EXTENSION OF COBRA BENEFITS FOR OLDER OR 
LONG-TERM EMPLOYEES.— 
(1) ERISA AMENDMENT.—Section 602(2)(A) of 
the Employee Retirement Income Security Act of 
1974 is amended by adding at the end the following 
new clauses: 
‘‘(x) SPECIAL
RULE
FOR
OLDER
OR 
LONG-TERM
EMPLOYEES
GENERALLY.—In 
the case of a qualifying event described in 
section 603(2) with respect to a covered em-
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00133
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
134 
ployee who (as of such qualifying event) has 
attained age 55 or has completed 10 or 
more years of service with the entity that is 
the employer at the time of the qualifying 
event, clauses (i) and (ii) shall not apply. 
‘‘(xi) YEAR OF SERVICE.— For pur-
poses of this subparagraph, the term ‘year 
of service’ shall have the meaning provided 
in section 202(a)(3).’’. 
(2) IRC AMENDMENT.—Clause (i) of section 
4980B(f)(2)(B) of the Internal Revenue Code of 1986 
is amended by adding at the end the following new 
subclauses: 
‘‘(X) SPECIAL RULE FOR OLDER 
OR
LONG-TERM
EMPLOYEES
GEN-
ERALLY.—In the case of a qualifying 
event described in paragraph (3)(B) 
with respect to a covered employee who 
(as of such qualifying event) has at-
tained age 55 or has completed 10 or 
more years of service with the entity 
that is the employer at the time of the 
qualifying event, subclauses (I) and 
(II) shall not apply. 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00134
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
135 
‘‘(XI) YEAR
OF
SERVICE.— For 
purposes of this clause, the term ‘year 
of service’ shall have the meaning pro-
vided in section 202(a)(3) of the Em-
ployee Retirement Income Security Act 
of 1974.’’. 
(3) PHSA AMENDMENT.—Section 2202(2)(A) of 
the Public Health Service Act is amended by adding 
at the end the following new clauses: 
‘‘(viii) SPECIAL RULE FOR OLDER OR 
LONG-TERM
EMPLOYEES
GENERALLY.—In 
the case of a qualifying event described in 
section 2203(2) with respect to a covered 
employee who (as of such qualifying event) 
has attained age 55 or has completed 10 or 
more years of service with the entity that is 
the employer at the time of the qualifying 
event, clauses (i) and (ii) shall not apply. 
‘‘(ix) YEAR
OF
SERVICE.—For pur-
poses of this subparagraph, the term ‘year 
of service’ shall have the meaning provided 
in section 202(a)(3) of the Employee Retire-
ment Income Security Act of 1974.’’. 
(4) EFFECTIVE
DATE
OF
AMENDMENTS.—The 
amendments made by this subsection shall apply to 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00135
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
136 
periods of coverage which would (without regard to 
the amendments made by this section) end on or after 
the date of the enactment of this Act. 
SEC. 3003. TEMPORARY OPTIONAL MEDICAID COVERAGE 
FOR THE UNEMPLOYED. 
(a) IN GENERAL.—Section 1902 of the Social Security 
Act (42 U.S.C. 1396b) is amended— 
(1) in subsection (a)(10)(A)(ii)— 
(A) by striking ‘‘or’’ at the end of subclause 
(XVIII); 
(B) by adding ‘‘or’’ at the end of subclause 
(XIX); and 
(C) by adding at the end the following new 
subclause 
‘‘(XX) who are described in sub-
section (dd)(1) (relating to certain un-
employed individuals and their fami-
lies);’’; and 
(2) by adding at the end the following new sub-
section: 
‘‘(dd)(1) Individuals described in this paragraph 
are— 
‘‘(A) individuals who— 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00136
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
137 
‘‘(i) are within one or more of the categories 
described in paragraph (2), as elected under the 
State plan; and 
‘‘(ii) meet the applicable requirements of 
paragraph (3); and 
‘‘(B) individuals who— 
‘‘(i) are the spouse, or dependent child 
under 19 years of age, of an individual described 
in subparagraph (A); and 
‘‘(ii) meet the requirement of paragraph 
(3)(B). 
‘‘(2) The categories of individuals described in this 
paragraph are each of the following: 
‘‘(A) Individuals who are receiving unemploy-
ment compensation benefits. 
‘‘(B) Individuals who were receiving, but have 
exhausted, unemployment compensation benefits on or 
after July 1, 2008. 
‘‘(C) Individuals who are involuntarily unem-
ployed and were involuntarily separated from em-
ployment on or after September 1, 2008, and before 
January 1, 2011, whose family gross income does not 
exceed a percentage specified by the State (not to ex-
ceed 200 percent) of the income official poverty line 
(as defined by the Office of Management and Budget, 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00137
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
138 
and revised annually in accordance with section 
673(2) of the Omnibus Budget Reconciliation Act of 
1981) applicable to a family of the size involved, and 
who, but for subsection (a)(10)(A)(ii)(XX), are not el-
igible for medical assistance under this title or health 
assistance under title XXI. 
‘‘(D) Individuals who are involuntarily unem-
ployed and were involuntarily separated from em-
ployment on or after September 1, 2008, and before 
January 1, 2011, who are members of households par-
ticipating in the supplemental nutrition assistance 
program established under the Food and Nutrition 
Act of 2008 (7 U.S.C. 2011 et seq), and who, but for 
subsection (a)(10)(A)(ii)(XX), are not eligible for 
medical assistance under this title or health assistance 
under title XXI. 
A State plan may elect one or more of the categories de-
scribed in this paragraph but may not elect the category 
described in subparagraph (B) unless the State plan also 
elects the category described in subparagraph (A). 
‘‘(3) The requirements of this paragraph with respect 
to an individual are the following: 
‘‘(A) In the case of individuals within a category 
described in subparagraph (A) or (B) of paragraph 
(2), the individual was involuntarily separated from 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00138
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
139 
employment on or after September 1, 2008, and before 
January 1, 2011, or meets such comparable require-
ment as the Secretary specifies through rule, guid-
ance, or otherwise in the case of an individual who 
was an independent contractor. 
‘‘(B) The individual is not otherwise covered 
under creditable coverage, as defined in section 
2701(c) of the Public Health Service Act (42 U.S.C. 
300gg(c)), but applied without regard to paragraph 
(1)(F) of such section and without regard to coverage 
provided by reason of the application of subsection 
(a)(10)(A)(ii)(XX). 
‘‘(4)(A) No income or resources test shall be applied 
with respect to any category of individuals described in sub-
paragraph (A), (B), or (D) of paragraph (2) who are eligi-
ble for medical assistance only by reason of the application 
of subsection (a)(10)(A)(ii)(XX). 
‘‘(B) Nothing in this subsection shall be construed to 
prevent a State from imposing a resource test for the cat-
egory of individuals described in paragraph (2)(C)). 
‘‘(C) In the case of individuals provided medical as-
sistance by reason of the application of subsection 
(a)(10)(A)(ii)(XX), the requirements of subsections (i)(22) 
and (x) shall not apply.’’. 
(b) 100 PERCENT FEDERAL MATCHING RATE.— 
VerDate Nov 24 2008 
02:28 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00139
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
140 
(1) FMAP FOR
TIME-LIMITED
PERIOD.—The 
third sentence of section 1905(b) of such Act (42 
U.S.C. 1396d(b)) is amended by inserting before the 
period at the end the following: ‘‘and for items and 
services furnished on or after the date of enactment of 
this Act and before January 1, 2011, to individuals 
who are eligible for medical assistance only by reason 
of the application of section 1902(a)(10)(A)(ii)(XX)’’. 
(2) CERTAIN
ENROLLMENT-RELATED
ADMINIS-
TRATIVE COSTS.—Notwithstanding any other provi-
sion of law, for purposes of applying section 1903(a) 
of the Social Security Act (42 U.S.C. 1396b(a)), with 
respect to expenditures incurred on or after the date 
of the enactment of this Act and before January 1, 
2011, for costs of administration (including outreach 
and the modification and operation of eligibility in-
formation systems) attributable to eligibility deter-
mination and enrollment of individuals who are eligi-
ble for medical assistance only by reason of the appli-
cation of section 1902(a)(10)(A)(ii)(XX) of such Act, 
as added by subsection (a)(1), the Federal matching 
percentage shall be 100 percent instead of the match-
ing percentage otherwise applicable. 
(c) 
CONFORMING
AMENDMENTS.—(1) 
Section 
1903(f)(4) of such Act (42 U.S.C. 1396c(f)(4)) is amended 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00140
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
141 
by 
inserting 
‘‘1902(a)(10)(A)(ii)(XX), 
or’’ 
after 
‘‘1902(a)(10)(A)(ii)(XIX),’’. 
(2) Section 1905(a) of such Act (42 U.S.C. 1396d(a)) 
is amended, in the matter preceding paragraph (1)— 
(A) by striking ‘‘or’’ at the end of clause (xii); 
(B) by adding ‘‘or’’ at the end of clause (xiii); 
and 
(C) by inserting after clause (xiii) the following 
new clause: 
‘‘(xiv) individuals described in section 
1902(dd)(1),’’. 
TITLE IV—HEALTH 
INFORMATION TECHNOLOGY 
SEC. 4001. SHORT TITLE; TABLE OF CONTENTS OF TITLE. 
(a) SHORT TITLE.—This title may be cited as the 
‘‘Health Information Technology for Economic and Clinical 
Health Act’’ or the ‘‘HITECH Act’’. 
(b) TABLE OF CONTENTS OF TITLE.—The table of con-
tents of this title is as follows: 
Sec. 4001. Short title; table of contents of title. 
Subtitle A—Promotion of Health Information Technology 
PART I—IMPROVING HEALTH CARE QUALITY, SAFETY, AND EFFICIENCY 
Sec. 4101. ONCHIT; standards development and adoption. 
‘‘TITLE XXX—HEALTH INFORMATION TECHNOLOGY AND QUALITY 
‘‘Sec. 3000. Definitions. 
VerDate Nov 24 2008 
04:46 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00141
Fmt 6652
Sfmt 6213
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
142 
‘‘Subtitle A—Promotion of Health Information Technology 
‘‘Sec. 3001. Office of the National Coordinator for Health Information Tech-
nology. 
‘‘Sec. 3002. HIT Policy Committee. 
‘‘Sec. 3003. HIT Standards Committee. 
‘‘Sec. 3004. Process for adoption of endorsed recommendations; adoption of 
initial set of standards, implementation specifications, and 
certification criteria. 
‘‘Sec. 3005. Application and use of adopted standards and implementation 
specifications by Federal agencies. 
‘‘Sec. 3006. Voluntary application and use of adopted standards and imple-
mentation specifications by private entities. 
‘‘Sec. 3007. Federal health information technology. 
‘‘Sec. 3008. Transitions. 
‘‘Sec. 3009. Relation to HIPAA privacy and security law. 
‘‘Sec. 3010. Authorization for appropriations. 
Sec. 4102. Technical amendment. 
PART II—APPLICATION AND USE OF ADOPTED HEALTH INFORMATION 
TECHNOLOGY STANDARDS; REPORTS 
Sec. 4111. Coordination of Federal activities with adopted standards and imple-
mentation specifications. 
Sec. 4112. Application to private entities. 
Sec. 4113. Study and reports. 
Subtitle B—Testing of Health Information Technology 
Sec. 4201. National Institute for Standards and Technology testing. 
Sec. 4202. Research and development programs. 
Subtitle C—Incentives for the Use of Health Information Technology 
PART I—GRANTS AND LOANS FUNDING 
Sec. 4301. Grant, loan, and demonstration programs. 
‘‘Subtitle B—Incentives for the Use of Health Information Technology 
‘‘Sec. 3011. Immediate funding to strengthen the health information tech-
nology infrastructure. 
‘‘Sec. 3012. Health information technology implementation assistance. 
‘‘Sec. 3013. State grants to promote health information technology. 
‘‘Sec. 3014. Competitive grants to States and Indian tribes for the develop-
ment of loan programs to facilitate the widespread adoption 
of certified EHR technology. 
‘‘Sec. 3015. Demonstration program to integrate information technology into 
clinical education. 
‘‘Sec. 3016. Information technology professionals on health care. 
‘‘Sec. 3017. General grant and loan provisions. 
‘‘Sec. 3018. Authorization for appropriations. 
PART II—MEDICARE PROGRAM 
Sec. 4311. Incentives for eligible professionals. 
Sec. 4312. Incentives for hospitals. 
Sec. 4313. Treatment of payments and savings; implementation funding. 
VerDate Nov 24 2008 
04:52 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00142
Fmt 6652
Sfmt 6213
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
143 
Sec. 4314. Study on application of EHR payment incentives for providers not re-
ceiving other incentive payments. 
PART III—MEDICAID FUNDING 
Sec. 4321. Medicaid provider HIT adoption and operation payments; implemen-
tation funding. 
Subtitle D—Privacy 
Sec. 4400. Definitions. 
PART I—IMPROVED PRIVACY PROVISIONS AND SECURITY PROVISIONS 
Sec. 4401. Application of security provisions and penalties to business associates 
of covered entities; annual guidance on security provisions. 
Sec. 4402. Notification in the case of breach. 
Sec. 4403. Education on Health Information Privacy. 
Sec. 4404. Application of privacy provisions and penalties to business associates 
of covered entities. 
Sec. 4405. Restrictions on certain disclosures and sales of health information; ac-
counting of certain protected health information disclosures; ac-
cess to certain information in electronic format. 
Sec. 4406. Conditions on certain contacts as part of health care operations. 
Sec. 4407. Temporary breach notification requirement for vendors of personal 
health records and other non-HIPAA covered entities. 
Sec. 4408. Business associate contracts required for certain entities. 
Sec. 4409. Clarification of application of wrongful disclosures criminal penalties. 
Sec. 4410. Improved enforcement. 
Sec. 4411. Audits. 
PART II—RELATIONSHIP TO OTHER LAWS; REGULATORY REFERENCES; 
EFFECTIVE DATE; REPORTS 
Sec. 4421. Relationship to other laws. 
Sec. 4422. Regulatory references. 
Sec. 4423. Effective date. 
Sec. 4424. Studies, reports, guidance. 
Subtitle E—Miscellaneous Medicare Provisions 
Sec. 4501. Moratoria on certain Medicare regulations. 
Sec. 4502. Long-term care hospital technical corrections. 
VerDate Nov 24 2008 
04:46 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00143
Fmt 6652
Sfmt 6213
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
144 
Subtitle A—Promotion of Health 
Information Technology 
PART I—IMPROVING HEALTH CARE QUALITY, 
SAFETY, AND EFFICIENCY 
SEC. 4101. ONCHIT; STANDARDS DEVELOPMENT AND ADOP-
TION. 
The Public Health Service Act (42 U.S.C. 201 et seq.) 
is amended by adding at the end the following: 
‘‘TITLE XXX—HEALTH INFORMA-
TION 
TECHNOLOGY 
AND 
QUALITY 
‘‘SEC. 3000. DEFINITIONS. 
‘‘In this title: 
‘‘(1) CERTIFIED EHR TECHNOLOGY.—The term 
‘certified EHR technology’ means a qualified elec-
tronic health record that is certified pursuant to sec-
tion 3001(c)(5) as meeting standards adopted under 
section 3004 that are applicable to the type of record 
involved (as determined by the Secretary, such as an 
ambulatory electronic health record for office-based 
physicians or an inpatient hospital electronic health 
record for hospitals). 
‘‘(2) ENTERPRISE INTEGRATION.—The term ‘en-
terprise integration’ means the electronic linkage of 
health care providers, health plans, the government, 
VerDate Nov 24 2008 
04:46 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00144
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
145 
and other interested parties, to enable the electronic 
exchange and use of health information among all the 
components in the health care infrastructure in ac-
cordance with applicable law, and such term includes 
related application protocols and other related stand-
ards. 
‘‘(3) 
HEALTH
CARE
PROVIDER.—The 
term 
‘health care provider’ means a hospital, skilled nurs-
ing facility, nursing facility, home health entity or 
other long-term care facility, health care clinic, Feder-
ally qualified health center, group practice (as defined 
in section 1877(h)(4) of the Social Security Act), a 
pharmacist, a pharmacy, a laboratory, a physician 
(as defined in section 1861(r) of the Social Security 
Act), 
a 
practitioner 
(as 
described 
in 
section 
1842(b)(18)(C) of the Social Security Act), a provider 
operated by, or under contract with, the Indian 
Health Service or by an Indian tribe (as defined in 
the Indian Self-Determination and Education Assist-
ance Act), tribal organization, or urban Indian orga-
nization (as defined in section 4 of the Indian Health 
Care Improvement Act), a rural health clinic, a cov-
ered entity under section 340B, and any other cat-
egory of facility or clinician determined appropriate 
by the Secretary. 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00145
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
146 
‘‘(4) HEALTH INFORMATION.—The term ‘health 
information’ has the meaning given such term in sec-
tion 1171(4) of the Social Security Act. 
‘‘(5) HEALTH INFORMATION TECHNOLOGY.—The 
term ‘health information technology’ means hardware, 
software, integrated technologies and related licenses, 
intellectual property, upgrades, and packaged solu-
tions sold as services that are specifically designed for 
use by health care entities for the electronic creation, 
maintenance, or exchange of health information. 
‘‘(6) HEALTH PLAN.—The term ‘health plan’ has 
the meaning given such term in section 1171(5) of the 
Social Security Act. 
‘‘(7) HIT POLICY COMMITTEE.—The term ‘HIT 
Policy Committee’ means such Committee established 
under section 3002(a). 
‘‘(8) HIT STANDARDS
COMMITTEE.—The term 
‘HIT Standards Committee’ means such Committee 
established under section 3003(a). 
‘‘(9) INDIVIDUALLY IDENTIFIABLE HEALTH IN-
FORMATION.—The term ‘individually identifiable 
health information’ has the meaning given such term 
in section 1171(6) of the Social Security Act. 
‘‘(10) LABORATORY.—The term ‘laboratory’ has 
the meaning given such term in section 353(a). 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00146
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
147 
‘‘(11) NATIONAL COORDINATOR.—The term ‘Na-
tional Coordinator’ means the head of the Office of the 
National Coordinator for Health Information Tech-
nology established under section 3001(a). 
‘‘(12) PHARMACIST.—The term ‘pharmacist’ has 
the meaning given such term in section 804(2) of the 
Federal Food, Drug, and Cosmetic Act. 
‘‘(13) 
QUALIFIED
ELECTRONIC
HEALTH 
RECORD.—The 
term 
‘qualified 
electronic 
health 
record’ means an electronic record of health-related 
information on an individual that— 
‘‘(A) includes patient demographic and 
clinical health information, such as medical his-
tory and problem lists; and 
‘‘(B) has the capacity— 
‘‘(i) to provide clinical decision sup-
port; 
‘‘(ii) to support physician order entry; 
‘‘(iii) to capture and query informa-
tion relevant to health care quality; and 
‘‘(iv) to exchange electronic health in-
formation with, and integrate such infor-
mation from other sources. 
‘‘(14) STATE.—The term ‘State’ means each of 
the several States, the District of Columbia, Puerto 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00147
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
148 
Rico, the Virgin Islands, Guam, American Samoa, 
and the Northern Mariana Islands. 
‘‘Subtitle A—Promotion of Health 
Information Technology 
‘‘SEC. 3001. OFFICE OF THE NATIONAL COORDINATOR FOR 
HEALTH INFORMATION TECHNOLOGY. 
‘‘(a) ESTABLISHMENT.—There is established within 
the Department of Health and Human Services an Office 
of the National Coordinator for Health Information Tech-
nology (referred to in this section as the ‘Office’). The Office 
shall be headed by a National Coordinator who shall be ap-
pointed by the Secretary and shall report directly to the 
Secretary. 
‘‘(b) PURPOSE.—The National Coordinator shall per-
form the duties under subsection (c) in a manner consistent 
with the development of a nationwide health information 
technology infrastructure that allows for the electronic use 
and exchange of information and that— 
‘‘(1) ensures that each patient’s health informa-
tion is secure and protected, in accordance with ap-
plicable law; 
‘‘(2) improves health care quality, reduces med-
ical errors, and advances the delivery of patient-cen-
tered medical care; 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00148
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
149 
‘‘(3) reduces health care costs resulting from inef-
ficiency, medical errors, inappropriate care, duplica-
tive care, and incomplete information; 
‘‘(4) provides appropriate information to help 
guide medical decisions at the time and place of care; 
‘‘(5) ensures the inclusion of meaningful public 
input in such development of such infrastructure; 
‘‘(6) improves the coordination of care and infor-
mation among hospitals, laboratories, physician of-
fices, and other entities through an effective infra-
structure for the secure and authorized exchange of 
health care information; 
‘‘(7) improves public health activities and facili-
tates the early identification and rapid response to 
public health threats and emergencies, including bio-
terror events and infectious disease outbreaks; 
‘‘(8) facilitates health and clinical research and 
health care quality; 
‘‘(9) promotes prevention of chronic diseases; 
‘‘(10) promotes a more effective marketplace, 
greater competition, greater systems analysis, in-
creased consumer choice, and improved outcomes in 
health care services; and 
‘‘(11) improves efforts to reduce health dispari-
ties. 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00149
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
150 
‘‘(c) DUTIES OF THE NATIONAL COORDINATOR.— 
‘‘(1) STANDARDS.—The National Coordinator 
shall review and determine whether to endorse each 
standard, implementation specification, and certifi-
cation criterion for the electronic exchange and use of 
health information that is recommended by the HIT 
Standards Committee under section 3003 for purposes 
of adoption under section 3004. The Coordinator shall 
make such determination, and report to the Secretary 
such determination, not later than 45 days after the 
date the recommendation is received by the Coordi-
nator. 
‘‘(2) HIT POLICY COORDINATION.— 
‘‘(A) IN GENERAL.—The National Coordi-
nator shall coordinate health information tech-
nology policy and programs of the Department 
with those of other relevant executive branch 
agencies with a goal of avoiding duplication of 
efforts and of helping to ensure that each agency 
undertakes health information technology activi-
ties primarily within the areas of its greatest ex-
pertise and technical capability and in a man-
ner towards a coordinated national goal. 
‘‘(B) HIT POLICY AND STANDARDS COMMIT-
TEES.—The National Coordinator shall be a 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00150
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
151 
leading member in the establishment and oper-
ations of the HIT Policy Committee and the 
HIT Standards Committee and shall serve as a 
liaison among those two Committees and the 
Federal Government. 
‘‘(3) STRATEGIC PLAN.— 
‘‘(A) IN GENERAL.—The National Coordi-
nator shall, in consultation with other appro-
priate Federal agencies (including the National 
Institute of Standards and Technology), update 
the Federal Health IT Strategic Plan (developed 
as of June 3, 2008) to include specific objectives, 
milestones, and metrics with respect to the fol-
lowing: 
‘‘(i) The electronic exchange and use of 
health information and the enterprise inte-
gration of such information. 
‘‘(ii) The utilization of an electronic 
health record for each person in the United 
States by 2014. 
‘‘(iii) The incorporation of privacy 
and security protections for the electronic 
exchange of an individual’s individually 
identifiable health information. 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00151
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
152 
‘‘(iv) Ensuring security methods to en-
sure appropriate authorization and elec-
tronic authentication of health information 
and specifying technologies or methodologies 
for rendering health information unusable, 
unreadable, or indecipherable. 
‘‘(v) Specifying a framework for co-
ordination and flow of recommendations 
and policies under this subtitle among the 
Secretary, the National Coordinator, the 
HIT Policy Committee, the HIT Standards 
Committee, and other health information 
exchanges and other relevant entities. 
‘‘(vi) Methods to foster the public un-
derstanding of health information tech-
nology. 
‘‘(vii) Strategies to enhance the use of 
health information technology in improving 
the quality of health care, reducing medical 
errors, reducing health disparities, improv-
ing public health, and improving the con-
tinuity of care among health care settings. 
‘‘(B) COLLABORATION.—The strategic plan 
shall be updated through collaboration of public 
and private entities. 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00152
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
153 
‘‘(C) MEASURABLE OUTCOME GOALS.—The 
strategic plan update shall include measurable 
outcome goals. 
‘‘(D) PUBLICATION.—The National Coordi-
nator shall republish the strategic plan, includ-
ing all updates. 
‘‘(4) WEBSITE.—The National Coordinator shall 
maintain and frequently update an Internet website 
on which there is posted information on the work, 
schedules, reports, recommendations, and other infor-
mation to ensure transparency in promotion of a na-
tionwide health information technology infrastruc-
ture. 
‘‘(5) CERTIFICATION.— 
‘‘(A) IN GENERAL.—The National Coordi-
nator, in consultation with the Director of the 
National Institute of Standards and Technology, 
shall develop a program (either directly or by 
contract) for the voluntary certification of health 
information technology as being in compliance 
with applicable certification criteria adopted 
under this subtitle. Such program shall include 
testing of the technology in accordance with sec-
tion 4201(b) of the HITECH Act. 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00153
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
154 
‘‘(B) 
CERTIFICATION
CRITERIA
DE-
SCRIBED.—In this title, the term ‘certification 
criteria’ means, with respect to standards and 
implementation specifications for health infor-
mation technology, criteria to establish that the 
technology meets such standards and implemen-
tation specifications. 
‘‘(6) REPORTS AND PUBLICATIONS.— 
‘‘(A) REPORT ON ADDITIONAL FUNDING OR 
AUTHORITY NEEDED.—Not later than 12 months 
after the date of the enactment of this title, the 
National Coordinator shall submit to the appro-
priate committees of jurisdiction of the House of 
Representatives and the Senate a report on any 
additional funding or authority the Coordinator 
or the HIT Policy Committee or HIT Standards 
Committee requires to evaluate and develop 
standards, implementation specifications, and 
certification criteria, or to achieve full participa-
tion of stakeholders in the adoption of a nation-
wide health information technology infrastruc-
ture that allows for the electronic use and ex-
change of health information. 
‘‘(B) IMPLEMENTATION REPORT.—The Na-
tional Coordinator shall prepare a report that 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00154
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
155 
identifies lessons learned from major public and 
private health care systems in their implementa-
tion of health information technology, including 
information on whether the technologies and 
practices developed by such systems may be ap-
plicable to and usable in whole or in part by 
other health care providers. 
‘‘(C) ASSESSMENT OF IMPACT OF HIT ON 
COMMUNITIES WITH HEALTH DISPARITIES AND 
UNINSURED, UNDERINSURED, AND
MEDICALLY 
UNDERSERVED
AREAS.—The National Coordi-
nator shall assess and publish the impact of 
health information technology in communities 
with health disparities and in areas with a high 
proportion of individuals who are uninsured, 
underinsured, and medically underserved indi-
viduals (including urban and rural areas) and 
identify practices to increase the adoption of 
such technology by health care providers in such 
communities. 
‘‘(D) EVALUATION OF BENEFITS AND COSTS 
OF THE ELECTRONIC USE AND EXCHANGE OF 
HEALTH
INFORMATION.—The National Coordi-
nator shall evaluate and publish evidence on the 
benefits and costs of the electronic use and ex-
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00155
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
156 
change of health information and assess to whom 
these benefits and costs accrue. 
‘‘(E) RESOURCE REQUIREMENTS.—The Na-
tional Coordinator shall estimate and publish re-
sources required annually to reach the goal of 
utilization of an electronic health record for each 
person in the United States by 2014, including 
the required level of Federal funding, expecta-
tions for regional, State, and private investment, 
and the expected contributions by volunteers to 
activities for the utilization of such records. 
‘‘(7) ASSISTANCE.—The National Coordinator 
may provide financial assistance to consumer advo-
cacy groups and not-for-profit entities that work in 
the public interest for purposes of defraying the cost 
to such groups and entities to participate under, 
whether in whole or in part, the National Technology 
Transfer Act of 1995 (15 U.S.C. 272 note). 
‘‘(8) GOVERNANCE FOR NATIONWIDE HEALTH IN-
FORMATION
NETWORK.—The National Coordinator 
shall establish a governance mechanism for the na-
tionwide health information network. 
‘‘(d) DETAIL OF FEDERAL EMPLOYEES.— 
‘‘(1) IN GENERAL.—Upon the request of the Na-
tional Coordinator, the head of any Federal agency is 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00156
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
157 
authorized to detail, with or without reimbursement 
from the Office, any of the personnel of such agency 
to the Office to assist it in carrying out its duties 
under this section. 
‘‘(2) EFFECT OF DETAIL.—Any detail of per-
sonnel under paragraph (1) shall— 
‘‘(A) not interrupt or otherwise affect the 
civil service status or privileges of the Federal 
employee; and 
‘‘(B) be in addition to any other staff of the 
Department employed by the National Coordi-
nator. 
‘‘(3) ACCEPTANCE
OF
DETAILEES.—Notwith-
standing any other provision of law, the Office may 
accept detailed personnel from other Federal agencies 
without regard to whether the agency described under 
paragraph (1) is reimbursed. 
‘‘(e) CHIEF PRIVACY OFFICER OF THE OFFICE OF THE 
NATIONAL COORDINATOR.—Not later than 12 months after 
the date of the enactment of this title, the Secretary shall 
appoint a Chief Privacy Officer of the Office of the National 
Coordinator, whose duty it shall be to advise the National 
Coordinator on privacy, security, and data stewardship of 
electronic health information and to coordinate with other 
Federal agencies (and similar privacy officers in such agen-
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00157
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
158 
cies), with State and regional efforts, and with foreign 
countries with regard to the privacy, security, and data 
stewardship of electronic individually identifiable health 
information. 
‘‘SEC. 3002. HIT POLICY COMMITTEE. 
‘‘(a) ESTABLISHMENT.—There is established a HIT 
Policy Committee to make policy recommendations to the 
National Coordinator relating to the implementation of a 
nationwide health information technology infrastructure, 
including implementation of the strategic plan described in 
section 3001(c)(3). 
‘‘(b) DUTIES.— 
‘‘(1) RECOMMENDATIONS ON HEALTH INFORMA-
TION TECHNOLOGY INFRASTRUCTURE.—The HIT Pol-
icy Committee shall recommend a policy framework 
for the development and adoption of a nationwide 
health information technology infrastructure that per-
mits the electronic exchange and use of health infor-
mation as is consistent with the strategic plan under 
section 3001(c)(3) and that includes the recommenda-
tions under paragraph (2). The Committee shall up-
date such recommendations and make new rec-
ommendations as appropriate. 
‘‘(2) SPECIFIC AREAS OF STANDARD DEVELOP-
MENT.— 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00158
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
159 
‘‘(A) IN GENERAL.—The HIT Policy Com-
mittee shall recommend the areas in which 
standards, implementation specifications, and 
certification criteria are needed for the electronic 
exchange and use of health information for pur-
poses of adoption under section 3004 and shall 
recommend an order of priority for the develop-
ment, harmonization, and recognition of such 
standards, specifications, and certification cri-
teria among the areas so recommended. Such 
standards and implementation specifications 
shall include named standards, architectures, 
and software schemes for the authentication and 
security of individually identifiable health infor-
mation and other information as needed to en-
sure the reproducible development of common so-
lutions across disparate entities. 
‘‘(B) AREAS
REQUIRED
FOR
CONSIDER-
ATION.—For purposes of subparagraph (A), the 
HIT Policy Committee shall make recommenda-
tions for at least the following areas: 
‘‘(i) Technologies that protect the pri-
vacy of health information and promote se-
curity in a qualified electronic health 
record, including for the segmentation and 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00159
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
160 
protection from disclosure of specific and 
sensitive individually identifiable health in-
formation with the goal of minimizing the 
reluctance of patients to seek care (or dis-
close information about a condition) be-
cause of privacy concerns, in accordance 
with applicable law, and for the use and 
disclosure of limited data sets of such infor-
mation. 
‘‘(ii) A nationwide health information 
technology infrastructure that allows for the 
electronic use and accurate exchange of 
health information. 
‘‘(iii) The utilization of a certified elec-
tronic health record for each person in the 
United States by 2014. 
‘‘(iv) Technologies that as a part of a 
qualified electronic health record allow for 
an accounting of disclosures made by a cov-
ered entity (as defined for purposes of regu-
lations promulgated under section 264(c) of 
the Health Insurance Portability and Ac-
countability Act of 1996) for purposes of 
treatment, payment, and health care oper-
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00160
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
161 
ations (as such terms are defined for pur-
poses of such regulations). 
‘‘(v) The use of certified electronic 
health records to improve the quality of 
health care, such as by promoting the co-
ordination of health care and improving 
continuity of health care among health care 
providers, by reducing medical errors, by 
improving population health, and by ad-
vancing research and education. 
‘‘(C) OTHER AREAS FOR CONSIDERATION.— 
In making recommendations under subpara-
graph (A), the HIT Policy Committee may con-
sider the following additional areas: 
‘‘(i) The appropriate uses of a nation-
wide health information infrastructure, in-
cluding for purposes of— 
‘‘(I) the collection of quality data 
and public reporting; 
‘‘(II) biosurveillance and public 
health; 
‘‘(III) medical and clinical re-
search; and 
‘‘(IV) drug safety. 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00161
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
168 
‘‘SEC. 3004. PROCESS FOR ADOPTION OF ENDORSED REC-
OMMENDATIONS; ADOPTION OF INITIAL SET 
OF STANDARDS, IMPLEMENTATION SPECI-
FICATIONS, AND CERTIFICATION CRITERIA. 
‘‘(a) PROCESS FOR ADOPTION OF ENDORSED REC-
OMMENDATIONS.— 
‘‘(1) REVIEW OF ENDORSED STANDARDS, IMPLE-
MENTATION SPECIFICATIONS, AND CERTIFICATION CRI-
TERIA.—Not later than 90 days after the date of re-
ceipt of standards, implementation specifications, or 
certification criteria endorsed under section 3001(c), 
the Secretary, in consultation with representatives of 
other relevant Federal agencies, shall jointly review 
such standards, implementation specifications, or cer-
tification criteria and shall determine whether or not 
to propose adoption of such standards, implementa-
tion specifications, or certification criteria. 
‘‘(2) DETERMINATION TO ADOPT STANDARDS, IM-
PLEMENTATION SPECIFICATIONS, AND CERTIFICATION 
CRITERIA.—If the Secretary determines— 
‘‘(A) to propose adoption of any grouping of 
such standards, implementation specifications, 
or certification criteria, the Secretary shall, by 
regulation, determine whether or not to adopt 
such grouping of standards, implementation 
specifications, or certification criteria; or 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00168
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
180 
Subtitle B—Testing of Health 
Information Technology 
SEC. 4201. NATIONAL INSTITUTE FOR STANDARDS AND 
TECHNOLOGY TESTING. 
(a) PILOT TESTING OF STANDARDS AND IMPLEMENTA-
TION SPECIFICATIONS.—In coordination with the HIT 
Standards Committee established under section 3003 of the 
Public Health Service Act, as added by section 4101, with 
respect to the development of standards and implementation 
specifications under such section, the Director of the Na-
tional Institute for Standards and Technology shall test 
such standards and implementation specifications, as ap-
propriate, in order to assure the efficient implementation 
and use of such standards and implementation specifica-
tions. 
(b) VOLUNTARY TESTING PROGRAM.—In coordination 
with the HIT Standards Committee established under sec-
tion 3003 of the Public Health Service Act, as added by 
section 4101, with respect to the development of standards 
and implementation specifications under such section, the 
Director of the National Institute of Standards and Tech-
nology shall support the establishment of a conformance 
testing infrastructure, including the development of tech-
nical test beds. The development of this conformance testing 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00180
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS
233 
in the aggregate that would be payable if pay-
ment for services furnished by such professionals 
was payable under part B instead of this part. 
‘‘(B) AVOIDING
DUPLICATION
OF
PAY-
MENTS.— 
‘‘(i) IN GENERAL.—If an eligible pro-
fessional described in paragraph (2) is eligi-
ble for the maximum incentive payment 
under section 1848(o)(1)(A) for the same 
payment period, the payment incentive 
shall be made only under such section and 
not under this subsection. 
‘‘(ii) METHODS.—In the case of an eli-
gible professional described in paragraph 
(2) who is eligible for an incentive payment 
under section 1848(o)(1)(A) but is not de-
scribed in clause (i) for the same payment 
period, the Secretary shall develop a proc-
ess— 
‘‘(I) to ensure that duplicate pay-
ments are not made with respect to an 
eligible professional both under this 
subsection 
and 
under 
section 
1848(o)(1)(A); and 
VerDate Nov 24 2008 
03:18 Jan 28, 2009
Jkt 079200
PO 00000
Frm 00233
Fmt 6652
Sfmt 6203
E:\BILLS\H598.RH
H598
SMARTINEZ on PROD1PC64 with BILLS