394 
determination and enrollment of individuals who are 
eligible for medical assistance only by reason of the 
application 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 matching percentage otherwise applicable. 
(c) 
CONFORMING
AMENDMENTS.—(1) 
Section 
1903(f)(4) of such Act (42 U.S.C. 1396c(f)(4)) is amend-
ed 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),’’. 
VerDate Nov 24 2008 
01:08 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00394
Fmt 6652
Sfmt 6201
E:\BILLS\H1.IH
H1
jbell on PROD1PC69 with BILLS
395 
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 Clin-
ical Health Act’’ or the ‘‘HITECH Act’’. 
(b) TABLE OF CONTENTS OF TITLE.—The table of 
contents 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. 
‘‘Subtitle A—Promotion of Health Information Technology 
‘‘Sec. 3001. Office of the National Coordinator for Health Information 
Technology. 
‘‘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 im-
plementation 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. 
VerDate Nov 24 2008 
01:08 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00395
Fmt 6652
Sfmt 6211
E:\BILLS\H1.IH
H1
jbell on PROD1PC69 with BILLS
396 
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 devel-
opment 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. 
Sec. 4314. Study on application of EHR payment incentives for providers not 
receiving other incentive payments. 
PART III—MEDICAID FUNDING 
Sec. 4321. Medicaid provider HIT adoption and operation payments; implemen-
tation funding. 
Sec. 4322. Medicaid nursing home grant program. 
Subtitle D—Privacy 
Sec. 4400. Definitions. 
PART I—IMPROVED PRIVACY PROVISIONS AND SECURITY PROVISIONS 
Sec. 4401. Application of security provisions and penalties to business associ-
ates 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; 
accounting of certain protected health information disclosures; 
access 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. 
VerDate Nov 24 2008 
01:08 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00396
Fmt 6652
Sfmt 6211
E:\BILLS\H1.IH
H1
jbell on PROD1PC69 with BILLS
397 
Sec. 4408. Business associate contracts required for certain entities. 
Sec. 4409. Clarification of application of wrongful disclosures criminal pen-
alties. 
Sec. 4410. Improved enforcement. 
Sec. 4411. Audits. 
Sec. 4412. Special rule for information to reduce medication errors and improve 
patient safety. 
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. 
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-
VerDate Nov 24 2008 
01:08 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00397
Fmt 6652
Sfmt 6201
E:\BILLS\H1.IH
H1
jbell on PROD1PC69 with BILLS
414 
disclosure of limited data sets of such in-
formation. 
‘‘(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 
electronic 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 
covered entity (as defined for purposes of 
regulations promulgated under section 
264(c) of the Health Insurance Portability 
and Accountability Act of 1996) for pur-
poses of treatment, payment, and health 
care operations (as such terms are defined 
for purposes 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, 
VerDate Nov 24 2008 
01:08 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00414
Fmt 6652
Sfmt 6201
E:\BILLS\H1.IH
H1
jbell on PROD1PC69 with BILLS
422 
‘‘(e) PUBLICATION.—The Secretary shall provide for 
publication in the Federal Register and the posting on the 
Internet website of the Office of the National Coordinator 
for Health Information Technology of all recommenda-
tions made by the HIT Standards Committee under this 
section. 
‘‘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, IM-
PLEMENTATION
SPECIFICATIONS, 
AND
CERTIFI-
CATION CRITERIA.—Not later than 90 days after the 
date of receipt of standards, implementation speci-
fications, or certification criteria endorsed under sec-
tion 3001(c), the Secretary, in consultation with rep-
resentatives of other relevant Federal agencies, shall 
jointly review such standards, implementation speci-
fications, or certification criteria and shall determine 
whether or not to propose adoption of such stand-
ards, implementation specifications, or certification 
criteria. 
VerDate Nov 24 2008 
01:08 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00422
Fmt 6652
Sfmt 6201
E:\BILLS\H1.IH
H1
jbell on PROD1PC69 with BILLS
590 
shall be further increased by the high unemployment 
percentage point adjustment specified in paragraph 
(3) for the State for the quarter. 
(2) HIGH UNEMPLOYMENT STATE.— 
(A) IN GENERAL.—In this subsection, sub-
ject to subparagraph (B), the term ‘‘high unem-
ployment State’’ means, with respect to a cal-
endar quarter in the recession adjustment pe-
riod, a State that is 1 of the 50 States or the 
District of Columbia and for which the State 
unemployment increase percentage (as com-
puted under paragraph (5)) for the quarter is 
not less than 1.5 percentage points. 
(B) MAINTENANCE
OF
STATUS.—If a 
State is a high unemployment State for a cal-
endar quarter, it shall remain a high unemploy-
ment State for each subsequent calendar quar-
ter ending before July 1, 2010. 
(3) HIGH UNEMPLOYMENT PERCENTAGE POINT 
ADJUSTMENT.— 
(A) IN
GENERAL.—The high unemploy-
ment percentage point adjustment specified in 
this paragraph for a high unemployment State 
for a quarter is equal to the product of— 
VerDate Nov 24 2008 
01:08 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00590
Fmt 6652
Sfmt 6201
E:\BILLS\H1.IH
H1
jbell on PROD1PC69 with BILLS
591 
(i) the SMAP for such State and 
quarter (determined after the application 
of subsection (a) and before the application 
of subsection (b)); and 
(ii) subject to subparagraph (B), the 
State unemployment reduction factor spec-
ified in paragraph (4) for the State and 
quarter. 
(B) 
MAINTENANCE
OF
ADJUSTMENT 
LEVEL FOR CERTAIN QUARTERS.—In no case 
shall the State unemployment reduction factor 
applied under subparagraph (A)(ii) for a State 
for a quarter (beginning on or after January 1, 
2009, and ending before July 1, 2010) be less 
than the State unemployment reduction factor 
applied to the State for the previous quarter 
(taking into account the application of this sub-
paragraph). 
(4) STATE UNEMPLOYMENT REDUCTION FAC-
TOR.—In the case of a high unemployment State for 
which the State unemployment increase percentage 
(as computed under paragraph (5)) with respect to 
a calendar quarter is— 
(A) not less than 1.5, but is less than 2.5, 
percentage points, the State unemployment re-
VerDate Nov 24 2008 
01:08 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00591
Fmt 6652
Sfmt 6201
E:\BILLS\H1.IH
H1
jbell on PROD1PC69 with BILLS
592 
duction factor for the State and quarter is 6 
percent; 
(B) not less than 2.5, but is less than 3.5, 
percentage points, the State unemployment re-
duction factor for the State and quarter is 12 
percent; or 
(C) not less than 3.5 percentage points, 
the State unemployment reduction factor for 
the State and quarter is 14 percent. 
(5) COMPUTATION OF STATE UNEMPLOYMENT 
INCREASE PERCENTAGE.— 
(A) IN GENERAL.—In this subsection, the 
‘‘State unemployment increase percentage’’ for 
a State for a calendar quarter is equal to the 
number of percentage points (if any) by 
which— 
(i) the average monthly unemployment 
rate for the State for months in the most 
recent previous 3-consecutive-month period 
for which data are available, subject to 
subparagraph (C); exceeds 
(ii) the lowest average monthly unem-
ployment rate for the State for any 3-con-
secutive-month period preceding the period 
VerDate Nov 24 2008 
01:08 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00592
Fmt 6652
Sfmt 6201
E:\BILLS\H1.IH
H1
jbell on PROD1PC69 with BILLS
593 
described in clause (i) and beginning on or 
after January 1, 2006. 
(B) AVERAGE MONTHLY UNEMPLOYMENT 
RATE DEFINED.—In this paragraph, the term 
‘‘average monthly unemployment rate’’ means 
the average of the monthly number unemployed, 
divided by the average of the monthly civilian 
labor force, seasonally adjusted, as determined 
based on the most recent monthly publications 
of the Bureau of Labor Statistics of the De-
partment of Labor. 
(C) SPECIAL RULE.—With respect to— 
(i) the first 2 calendar quarters of the 
recession adjustment period, the most re-
cent previous 3-consecutive-month period 
described in subparagraph (A)(i) shall be 
the 3-consecutive-month period beginning 
with October 2008; and 
(ii) the last 2 calendar quarters of the 
recession adjustment period, the most re-
cent previous 3-consecutive-month period 
described in such subparagraph shall be 
the 3-consecutive-month period beginning 
with December 2009. 
VerDate Nov 24 2008 
01:08 Jan 27, 2009
Jkt 079200
PO 00000
Frm 00593
Fmt 6652
Sfmt 6201
E:\BILLS\H1.IH
H1
jbell on PROD1PC69 with BILLS