I 
109TH CONGRESS 
2D SESSION 
H. R. 6289 
To establish a program to provide financial incentives for the establishment 
of interactive personal health records. 
IN THE HOUSE OF REPRESENTATIVES 
SEPTEMBER 29, 2006 
Mr. KENNEDY of Rhode Island introduced the following bill; which was re-
ferred to the Committee on Energy and Commerce, and in addition to 
the Committee on Ways and Means, for a period to be subsequently de-
termined by the Speaker, in each case for consideration of such provisions 
as fall within the jurisdiction of the committee concerned 
A BILL 
To establish a program to provide financial incentives for 
the establishment of interactive personal health records. 
Be it enacted by the Senate and House of Representa-
tives of the United States of America in Congress assembled, 
SECTION 1. SHORT TITLE. 
This Act may be cited as the ‘‘Personalized Health 
Information Act of 2006’’. 
SEC. 2. PERSONAL HEALTH RECORD (PHR) INCENTIVE 
PROGRAM. 
(a) ESTABLISHMENT.—The Secretary of Health and 
Human Services (in this section referred to as the ‘‘Sec-
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retary’’) shall establish a program (in this section referred 
to as the ‘‘program’’) to provide financial incentives for 
the establishment of interactive qualifying personal health 
records for Medicare and other patients and their health 
care providers in order to— 
(1) provide patients (or their authorized rep-
resentatives) access to and control over their per-
sonal health data and information and educational 
information so as to become healthier and more in-
formed and engaged health care consumers; 
(2) make available to authorized health care 
providers a more accurate minimum data set of pa-
tient information at all points of care; 
(3) protect patient security and privacy; 
(4) improve patients’ adherence to evidence- 
based care guidelines, preventive care, and screening 
protocols, thereby improving health outcomes and 
lowering health care costs; 
(5) improve medication adherence by patients, 
thereby improving health outcomes and lowering 
health care costs; 
(6) provide patients with more accurate, timely, 
and appropriate information related to their health 
care benefits and related administrative information; 
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(7) improve the quality and efficiency of com-
munication between health care providers and pa-
tients; 
(8) create a direct communications channel to 
patients in the event of health emergencies; and 
(9) provide access with appropriate privacy 
safeguards to de-identified health care information 
to evaluate and advance public health and health re-
search goals. 
(b) INCENTIVE PAYMENTS.— 
(1) IN
GENERAL.—Under the program, each 
qualified physician (as defined in subsection (c)) 
that has a qualifying patient (as defined in sub-
section (d)) shall receive an incentive payment from 
the PHR Incentive Fund established under sub-
section (f). In the case of such a patient of more 
than one physician, each such physician (who does 
not share in the same group practice, as defined by 
the Secretary, with another qualifying physician of 
that patient) may receive such a payment. 
(2) AMOUNT OF PAYMENT.— 
(A) IN
GENERAL.—Except as otherwise 
provided, the amount of the incentive payment 
to a qualifying physician under the program 
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shall be at least $2 per year for each qualifying 
patient of the physician. 
(B) ADJUSTMENT; LIMITATION.—The Sec-
retary shall annually retrospectively set the in-
centive payment amount based on the amount 
of the contributions into the PHR Incentive 
Fund. The Secretary shall pay PHR incentives 
payments only from such Fund. 
(C) ANNUAL LIMITATION.—The Secretary 
shall establish a maximum annual payment 
under this section to any qualifying physician. 
(3) DURATION.—Payments shall be made under 
the program during a 3-year period beginning on the 
date of implementation of the program, except that 
the Secretary may continue the program for an addi-
tional two years if the Secretary determines that 
continuation of the program for such period would 
be a cost-effective way of achieving the goals of this 
Act. 
(4) PROGRAM EDUCATION.— 
(A) PUBLICATION OF NAMES QUALIFYING 
PHYSICIANS.—In order to assist patients in 
identifying health care providers that use quali-
fying personal health records, Secretary shall 
publish on the official website for the Centers 
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for Medicare & Medicaid Services (CMS), or 
other online locations of the Secretary’s choos-
ing, a list of qualifying physicians who partici-
pate in the Medicare program and who have re-
ceived incentive payments under this section. 
(B) EDUCATION.— 
(i) PATIENT
EDUCATION.—The Sec-
retary shall, in consultation with appro-
priate organizations that represent health 
care consumers, take steps to educate 
Medicare beneficiaries and other patients 
about the health and convenience benefits 
of qualifying personal health records. 
(ii) PROVIDER EDUCATION.—The Sec-
retary shall take steps to educate Medicare 
providers about the patient, provider and 
overall health care benefits of using quali-
fying personal health records. 
(c) QUALIFIED PHYSICIAN DEFINED.—For purposes 
of this section, the term ‘‘qualified physician’’ means a li-
censed physician (or other licensed health care provider, 
such as a clinic, designated by the Secretary) that meets 
the following requirements, with respect to a qualifying 
patient of that physician and the qualifying personal 
health record of that patient: 
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(1) The physician (or provider) uses the QPHR 
for electronic patient registration for encounters, in-
cluding taking demographic information, insurance 
information, medication list, problems list, family 
history, and other information included within the 
QPHR. 
(2) The physician (or provider) implements 
policies to authenticate the patient’s identities pur-
suant to standards established by the Secretary in 
order to enable the QPHR to receive electronic data 
feeds from appropriate third party sources, such as 
pharmacies, pharmacy benefit managers, labora-
tories, and health plans, including the Medicare pro-
gram. 
(3) The physician (or provider), or authorized 
representative, updates the diagnosis and medication 
list (including all current medications and new medi-
cations prescribed or provided as samples) in the 
QPHR after each patient encounter, if appropriate 
and authorized by the patient, either by direct entry 
or through a data sharing arrangement using an ap-
propriate electronic means, such as an electronic 
medical record or e-prescribing. 
(4) The physician (or provider) uses the QPHR 
as appropriate and authorized by the patient to com-
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municate appropriate patient education and care 
management messages. 
(5) There is submitted to the Secretary by the 
physician (or by the administrator of the QPHR on 
the physician’s behalf) on a regular basis, but no 
less frequently than annually, a report documenting 
the number of such qualifying patients of the physi-
cian (or provider) and the use of QPHRs of such pa-
tients. 
(6) The physician (or provider) meets other re-
quirements as the Secretary may establish. 
(d) QUALIFYING PATIENT DEFINED.—For purposes 
of this section, the term ‘‘qualifying patient’’ means an 
individual for whom a qualifying personal health record 
has been established and is in operation under the pro-
gram and who is a Medicare beneficiary or is covered 
under a health benefits or other plan the sponsor of which 
is participating as a Fund partner under this section. 
(e) QUALIFYING
PERSONAL
HEALTH
RECORD 
(QPHR).— 
(1) DEFINITION.—For purposes of this section, 
the terms ‘‘qualifying personal health record’’ and 
‘‘QPHR’’ mean a record of health care related infor-
mation that meets the following requirements: 
(A) CONTROL.— 
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(i) IN GENERAL.—The record is con-
trolled solely by the patient (or the pa-
tient’s authorized representative), with the 
patient (or the patient’s authorized rep-
resentative) able to access online, print, 
copy to electronic media, or provide online 
access to authorized third parties, includ-
ing health care providers, to all individ-
ually identifiable health information held in 
the record at any time. 
(ii) ACCESS
RIGHTS.—The record 
guarantees the control of the patient (or 
the patient’s authorized representative) 
over who accesses the patient’s individually 
identifiable information contained in the 
record. 
(iii) 
TERMINATION
RIGHTS.—The 
record allows a patient to terminate the 
further use of the record service at any 
time, including elimination of the patient’s 
personal health information in the control 
of the administrator of the record. Nothing 
in this clause shall require a health care 
provider to eliminate a patient’s personal 
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health information that is in a medical 
record maintained by the provider. 
(iv) 
TRANSPORTABILITY.—The 
pa-
tient’s rights to control of the record under 
this subparagraph are not affected by 
changes in relationships with particular 
providers or health plans. 
(B) SECURITY.—The record meets min-
imum security standards, including the rules 
promulgated under section 264(c) of the Health 
Insurance Portability and Accountability Act of 
1996 (HIPAA) and other such minimum stand-
ards as identified by the Secretary under para-
graph (2), and the administrator of the record 
complies with any security and privacy stand-
ards, policies, and practices adopted under such 
paragraph. 
(C) INTEROPERABILITY.—The record com-
plies with interoperability data standards speci-
fied by the Secretary, to ensure the capability 
to integrate with other QPHRs and other 
sources of individual data, such as electronic 
health records, pharmacies, pharmacy benefit 
managers, and health plans. 
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(D) WEB-BASED.—The record is web- 
based and capable of sharing information be-
tween patients and their providers, and ena-
bling patient-provider communication. 
(E) MESSAGING CAPABILITIES.— 
(i) EDUCATION REMINDERS.—Subject 
to clause (v), the record is capable of send-
ing patient-specific patient education, re-
minders, and clinical messages to patients 
based upon data in the record, but such 
messages shall not be sent unless such 
messages comply with standards adopted 
under paragraph (3). The Secretary shall 
work with the Secretary of Homeland Se-
curity and the Director of the Centers for 
Disease Control and Prevention to opti-
mize the public health and emergency re-
sponse capabilities of the networks created 
by QPHRs. 
(ii) FEDERAL
REMINDERS.—Subject 
to clause (v), the record provides for the 
sending on behalf of Federal agencies of 
objective, accurate, patient-specific mes-
sages to patients concerning their health 
care or benefits, but such messages shall 
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not be sent unless the messages comply 
with standards adopted under paragraph 
(3). 
(iii) FUND
PARTNER
MESSAGES.— 
Subject to clause (v), the record provides 
for the sending, on behalf of Fund part-
ners who contribute to the Fund, appro-
priate patient-specific messages to con-
sumers (with whom such partners have 
pre-existing relationships) concerning the 
patients’ health care, medications, treat-
ments, medical devices or benefits, but 
such messages shall not be sent unless 
such messages comply with standards 
adopted under paragraph (3). 
(iv) HEALTH PLAN NOTIFICATION.— 
The QPHR service notifies, no less fre-
quently than quarterly, each Fund partner 
that administers a health benefit plan of 
the individuals who are enrolled in the plan 
and who have a QPHR established. 
(v) LIMITATION ON COMMERCIAL SO-
LICITATION.—The record does not allow 
any commercial solicitations, marketing, or 
messages to patients unless the patient is 
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a patient or beneficiary of the sender, uses 
the sender’s product with a prescription or 
recommendation of a provider, or has some 
other pre-existing relationship (as defined 
by the Secretary), or other messages that 
do not comply with standards adopted 
under paragraph (3), and the record en-
sures that every message clearly identifies 
the source of the content. 
(vi) PATIENT
OPT-OUT.—The record 
allow a patient (or patient’s authorized 
representative) to opt out of receiving mes-
sages entirely or from particular sources. 
(F) PUBLIC HEALTH ANALYSIS AND RE-
SEARCH.—The record is capable of providing 
de-identified data for public health analysis and 
for research purposes. The Secretary shall con-
sult with the Commissioner of the Food and 
Drug Administration, the Director of the Na-
tional Institutes of Health, the Director of the 
Centers for Disease Control and Prevention, 
and the Administrator of the Agency for 
Healthcare Research and Quality to optimize 
the public health and post-market surveillance 
capabilities of the networks created by QPHRs. 
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(2) PRIVACY
AND
CONSUMER
PROTECTION 
STANDARDS.— 
(A) IN GENERAL.—The Secretary shall set 
minimum security, privacy and data use stand-
ards for QPHRs, in addition to such standards 
as required under regulations promulgated 
under section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996 
(HIPAA), in order to optimally protect and 
safeguard patient health care information. 
(B) CONSUMER PROTECTION BOARD.—The 
Secretary shall establish a consumer protection 
board, a majority of whose members represent 
health care consumers, including individuals 
with chronic diseases and with mental and ad-
dictive disorders. Such board shall— 
(i) recommend to the Secretary min-
imum standards to protect patient-identifi-
able information stored in or transmitted 
from a QPHR; 
(ii) recommend procedures to ensure 
the objectivity, relevance, and accuracy of 
messages 
sent 
to 
patients 
via 
their 
QPHRs; and 
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(iii) have the right to request and re-
view the security and privacy capabilities, 
policies and practices of those entities ad-
ministering QPHRs. 
(3) 
MESSAGE
STANDARDS.—The 
Secretary 
shall establish minimum standards to ensure the ob-
jectivity, accuracy and relevance of messages sent to 
individual patients under paragraph (1)(E) from a 
QPHR and to protect against the use of such 
records by Fund partners for commercial solicita-
tions or marketing. Such standards shall incorporate 
existing standards established by the Food and Drug 
Administration or other Federal agencies. 
(f) PHR INCENTIVE FUND.— 
(1) IN GENERAL.—The Secretary shall establish 
a PHR Incentive Fund (in this section referred to 
as the ‘‘PHR Incentive Fund’’ or ‘‘Fund’’). The 
Fund may receive contributions from Fund partners 
for the sole purpose of paying PHR incentives under 
subsection (a), conducting annual studies under sub-
section (g), and otherwise carrying out the program. 
(2) FUNDING PARTNERS.— 
(A) IN
GENERAL.—The Secretary may 
enter into contracts with public or private pay-
ers, drug manufacturers, device manufacturers, 
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or other public or private entities (in this sec-
tion referred to as ‘‘Fund partners’’) to allow 
the Fund to receive contributions in accordance 
with this subsection and other terms deter-
mined by the Secretary. 
(B) FEDERAL PARTNERS.—The Secretary 
shall seek the involvement and contributions of 
the Food and Drug Administration, the Centers 
for Disease Control and Prevention, the Agency 
for Healthcare Research and Quality, and the 
Department of Homeland Security to maximize 
the effectiveness of the QPHRs in meeting the 
health, national security, emergency response, 
biosurveillance, and research goals of the Fed-
eral government in a manner consistent with 
this Act. 
(C) PARTNER ACCOUNTS.—The Fund shall 
include an account for each Fund partner, in-
cluding Medicare, separately accounting for 
each Fund partner’s contributions to the Fund. 
Incentive payments shall be debited from each 
account in accordance with this subsection. 
Amounts in the account of a Fund partner that 
are not paid in fiscal year remain available for 
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payment from such account in the subsequent 
fiscal year. 
(D) CONTRIBUTION
LEVELS.—Contribu-
tion levels to the Fund by Fund partners shall 
be set annually by the Secretary, except that 
the contribution level for the first year shall be 
as follows: 
(i) MEDICARE
CONTRIBUTION.—The 
Secretary shall contribute $2 for each 
Medicare beneficiary for whom any PHR 
incentive payment is made during such 
year 
by 
transferring 
the 
appropriate 
amount from the Medicare trust funds 
under parts A and B of the Medicare pro-
gram, in such proportion as the Secretary 
may specify. 
(ii) 
FDA-MESSAGING
CONTRIBU-
TIONS.—Each manufacturer shall con-
tribute $2 for each qualifying patient for 
each medication adherence program for 
which one or more messages are sent 
under subsection (e)(1)(E)(iii) in the year. 
(iii) OTHER
CONTRIBUTIONS.—Any 
other fund partner shall contribute $2 for 
each qualifying patient for whom a PHR 
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incentive payment is made, except that the 
Secretary may establish other contribution 
levels for device manufacturers or other 
Fund partners that employ messages sent 
under subsection (e)(1)(D)(iii). 
(E) CHARGING
FUND
PARTNERS.—Each 
Fund partner’s account shall be debited accord-
ing to the same formula with which contribu-
tions were determined. In the event that a 
Fund partner’s account does not have a suffi-
cient balance to cover the Fund partner’s liabil-
ity, the Fund partner shall make a supple-
mental contribution to the Fund to cover the 
shortfall plus such penalty as the Secretary may 
assess. 
(F) LIMITATION ON BENEFITS.—Contribu-
tions by a Fund partner to the Fund shall con-
fer no preferential access to data or information 
or any other benefit to the partner other than 
public acknowledgment under paragraph (5) 
and the ability to have messages sent to quali-
fying patients under subsection (e)(1)(D)(iii). 
(3) PUBLICATION OF FUND CONTRIBUTORS.— 
The Secretary shall publish on the official website of 
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the Centers for Medicare & Medicaid Services a list 
of Fund partners that have contributed to the Fund. 
(g) ANNUAL STUDY.— 
(1) IN GENERAL.—The Secretary shall provide 
for an annual study to assess changes patient en-
gagement in their QPHR, behavior changes, changes 
in health outcomes, and cost savings resulting from 
implementation of the program. The study shall in-
clude collection of aggregate data documenting the 
number of qualifying patient, number and kind of 
messages sent to patients, the percentage of mes-
sages opened by patients, and other measures of the 
program’s effectiveness. 
(2) FUNDING.—There are available from the 
PHR Incentive Fund not to exceed $2,000,000 each 
year to pay for the annual study under paragraph 
(1). Amounts so used shall be debited from each 
Fund partner’s account on a pro-rata basis. 
Æ 
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