130 
rimental to the program and upon notification to Congress 
as to the justification to waive the cost-share requirement. 
‘‘(e) EVALUATION.—The Secretary shall take such ac-
tion as may be necessary to evaluate the projects funded 
under this section and publish, make available, and dis-
seminate the results of such evaluations on as wide a basis 
as is practicable. 
‘‘(f) REPORTS.—Not later than 1 year after the date 
of enactment of this title, and annually thereafter, the Sec-
retary shall submit to the Committee on Health, Education, 
Labor, and Pensions and the Committee on Finance of the 
Senate, and the Committee on Energy and Commerce of 
the House of Representatives a report that— 
‘‘(1) describes the specific projects established 
under this section; and 
‘‘(2) contains recommendations for Congress 
based on the evaluation conducted under subsection 
(e). 
‘‘SEC. 3016. INFORMATION TECHNOLOGY PROFESSIONALS 
ON HEALTH CARE. 
‘‘(a) IN GENERAL.—The Secretary, in consultation 
with the Director of the National Science Foundation, shall 
provide assistance to institutions of higher education (or 
consortia thereof) to establish or expand medical health 
informatics education programs, including certification, 
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131 
undergraduate, and masters degree programs, for both 
health care and information technology students to ensure 
the rapid and effective utilization and development of 
health information technologies (in the United States health 
care infrastructure). 
‘‘(b) ACTIVITIES.—Activities for which assistance may 
be provided under subsection (a) may include the following: 
‘‘(1) Developing and revising curricula in med-
ical health informatics and related disciplines. 
‘‘(2) Recruiting and retaining students to the 
program involved. 
‘‘(3) Acquiring equipment necessary for student 
instruction in these programs, including the installa-
tion of testbed networks for student use. 
‘‘(4) Establishing or enhancing bridge programs 
in the health informatics fields between community 
colleges and universities. 
‘‘(c) PRIORITY.—In providing assistance under sub-
section (a), the Secretary shall give preference to the fol-
lowing: 
‘‘(1) Existing education and training programs. 
‘‘(2) Programs designed to be completed in less 
than six months. 
‘‘(d) FINANCIAL SUPPORT.—The Secretary may not 
provide more than 50 percent of the costs of any activity 
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132 
for which assistance is provided under subsection (a), except 
in an instance of national economic conditions which would 
render the cost-share requirement under this subsection det-
rimental to the program and upon notification to Congress 
as to the justification to waive the cost-share requirement. 
‘‘SEC. 3017. GENERAL GRANT AND LOAN PROVISIONS. 
‘‘(a) REPORTS.—The Secretary may require that an 
entity receiving assistance under this subtitle shall submit 
to the Secretary, not later than the date that is 1 year after 
the date of receipt of such assistance, a report that in-
cludes— 
‘‘(1) an analysis of the effectiveness of the activi-
ties for which the entity receives such assistance, as 
compared to the goals for such activities; and 
‘‘(2) an analysis of the impact of the project on 
health care quality and safety. 
‘‘(b) REQUIREMENT TO IMPROVE QUALITY OF CARE 
AND DECREASE IN COSTS.—The National Coordinator shall 
annually evaluate the activities conducted under this sub-
title and shall, in awarding grants, implement the lessons 
learned from such evaluation in a manner so that awards 
made subsequent to each such evaluation are made in a 
manner that, in the determination of the National Coordi-
nator, will result in the greatest improvement in the quality 
and efficiency of health care. 
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133 
‘‘SEC. 3018. AUTHORIZATION FOR APPROPRIATIONS. 
‘‘For the purposes of carrying out this subtitle, there 
is authorized to be appropriated such sums as may be nec-
essary for each of the fiscal years 2009 through 2013. 
Amounts so appropriated shall remain available until ex-
pended.’’. 
PART II—MEDICARE PROGRAM 
SEC. 4311. INCENTIVES FOR ELIGIBLE PROFESSIONALS. 
(a) INCENTIVE PAYMENTS.—Section 1848 of the Social 
Security Act (42 U.S.C. 1395w–4) is amended by adding 
at the end the following new subsection: 
‘‘(o) INCENTIVES FOR ADOPTION AND MEANINGFUL 
USE OF CERTIFIED EHR TECHNOLOGY.— 
‘‘(1) INCENTIVE PAYMENTS.— 
‘‘(A) IN
GENERAL.—Subject to the suc-
ceeding subparagraphs of this paragraph, with 
respect to covered professional services furnished 
by an eligible professional during a payment 
year (as defined in subparagraph (E)), if the eli-
gible professional is a meaningful EHR user (as 
determined under paragraph (2)) for the report-
ing period with respect to such year, in addition 
to the amount otherwise paid under this part, 
there also shall be paid to the eligible profes-
sional (or to an employer or facility in the cases 
described in clause (A) of section 1842(b)(6)), 
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134 
from the Federal Supplementary Medical Insur-
ance Trust Fund established under section 1841 
an amount equal to 75 percent of the Secretary’s 
estimate (based on claims submitted not later 
than 2 months after the end of the payment 
year) of the allowed charges under this part for 
all such covered professional services furnished 
by the eligible professional during such year. 
‘‘(B) LIMITATIONS ON AMOUNTS OF INCEN-
TIVE PAYMENTS.— 
‘‘(i) IN GENERAL.—In no case shall the 
amount of the incentive payment provided 
under this paragraph for an eligible profes-
sional for a payment year exceed the appli-
cable amount specified under this subpara-
graph with respect to such eligible profes-
sional and such year. 
‘‘(ii) AMOUNT.—Subject to clause (iii), 
the applicable amount specified in this sub-
paragraph for an eligible professional is as 
follows: 
‘‘(I) For the first payment year 
for such professional, $15,000. 
‘‘(II) For the second payment 
year for such professional, $12,000. 
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‘‘(III) For the third payment year 
for such professional, $8,000. 
‘‘(IV) For the fourth payment 
year for such professional, $4,000. 
‘‘(V) For the fifth payment year 
for such professional, $2,000. 
‘‘(VI) For any succeeding pay-
ment year for such professional, $0. 
‘‘(iii) PHASE
DOWN
FOR
ELIGIBLE 
PROFESSIONALS
FIRST
ADOPTING
EHR 
AFTER 2013.—If the first payment year for 
an eligible professional is after 2013, then 
the amount specified in this subparagraph 
for a payment year for such professional is 
the same as the amount specified in clause 
(ii) for such payment year for an eligible 
professional whose first payment year is 
2013. If the first payment year for an eligi-
ble professional is after 2015 then the appli-
cable amount specified in this subparagraph 
for such professional for such year and any 
subsequent year shall be $0. 
‘‘(C) NON-APPLICATION TO HOSPITAL-BASED 
ELIGIBLE PROFESSIONALS.— 
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136 
‘‘(i) IN GENERAL.—No incentive pay-
ment may be made under this paragraph in 
the case of a hospital-based eligible profes-
sional. 
‘‘(ii) HOSPITAL-BASED ELIGIBLE PRO-
FESSIONAL.—For purposes of clause (i), the 
term ‘hospital-based eligible professional’ 
means, with respect to covered professional 
services furnished by an eligible professional 
during the reporting period for a payment 
year, an eligible professional, such as a pa-
thologist, anesthesiologist, or emergency 
physician, who furnishes substantially all of 
such services in a hospital setting (whether 
inpatient or outpatient) and through the 
use of the facilities and equipment, includ-
ing computer equipment, of the hospital. 
‘‘(D) PAYMENT.— 
‘‘(i) FORM
OF
PAYMENT.—The pay-
ment under this paragraph may be in the 
form of a single consolidated payment or in 
the form of such periodic installments as the 
Secretary may specify. 
‘‘(ii) COORDINATION
OF
APPLICATION 
OF LIMITATION FOR PROFESSIONALS IN DIF-
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137 
FERENT PRACTICES.—In the case of an eli-
gible professional furnishing covered profes-
sional services in more than one practice 
(as specified by the Secretary), the Sec-
retary shall establish rules to coordinate the 
incentive payments, including the applica-
tion of the limitation on amounts of such 
incentive payments under this paragraph, 
among such practices. 
‘‘(iii) 
COORDINATION
WITH
MED-
ICAID.—The Secretary shall seek, to the 
maximum extent practicable, to avoid du-
plicative requirements from Federal and 
State Governments to demonstrate meaning-
ful use of certified EHR technology under 
this title and title XIX. In doing so, the 
Secretary may deem satisfaction of State 
requirements for such meaningful use for a 
payment year under title XIX to be suffi-
cient to qualify as meaningful use under 
this subsection and subsection (a)(7) and 
vice versa. The Secretary may also adjust 
the reporting periods under such title and 
such subsections in order to carry out this 
clause. 
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138 
‘‘(E) PAYMENT YEAR DEFINED.— 
‘‘(i) IN
GENERAL.—For purposes of 
this subsection, the term ‘payment year’ 
means a year beginning with 2011. 
‘‘(ii) FIRST, SECOND, ETC. PAYMENT 
YEAR.—The term ‘first payment year’ 
means, with respect to covered professional 
services furnished by an eligible profes-
sional, the first year for which an incentive 
payment is made for such services under 
this subsection. The terms ‘second payment 
year’, ‘third payment year’, ‘fourth pay-
ment year’, and ‘fifth payment year’ mean, 
with respect to covered professional services 
furnished by such eligible professional, each 
successive year immediately following the 
first payment year for such professional. 
‘‘(2) MEANINGFUL EHR USER.— 
‘‘(A) IN GENERAL.—For purposes of para-
graph (1), an eligible professional shall be treat-
ed as a meaningful EHR user for a reporting 
period for a payment year (or, for purposes of 
subsection (a)(7), for a reporting period under 
such subsection for a year) if each of the fol-
lowing requirements is met: 
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‘‘(i) MEANINGFUL USE OF CERTIFIED 
EHR
TECHNOLOGY.—The eligible profes-
sional demonstrates to the satisfaction of the 
Secretary, in accordance with subparagraph 
(C)(i), that during such period the profes-
sional is using certified EHR technology in 
a meaningful manner, which shall include 
the use of electronic prescribing as deter-
mined to be appropriate by the Secretary. 
‘‘(ii) INFORMATION
EXCHANGE.—The 
eligible professional demonstrates to the sat-
isfaction of the Secretary, in accordance 
with subparagraph (C)(i), that during such 
period such certified EHR technology is 
connected in a manner that provides, in ac-
cordance with law and standards applicable 
to the exchange of information, for the elec-
tronic exchange of health information to im-
prove the quality of health care, such as 
promoting care coordination. 
‘‘(iii) REPORTING ON MEASURES USING 
EHR.—Subject to subparagraph (B)(ii) and 
using such certified EHR technology, the el-
igible professional submits information for 
such period, in a form and manner speci-
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fied by the Secretary, on such clinical qual-
ity measures and such other measures as se-
lected by the Secretary under subparagraph 
(B)(i). 
The Secretary may provide for the use of alter-
native means for meeting the requirements of 
clauses (i), (ii), and (iii) in the case of an eligi-
ble professional furnishing covered professional 
services in a group practice (as defined by the 
Secretary). The Secretary shall seek to improve 
the use of electronic health records and health 
care quality over time by requiring more strin-
gent measures of meaningful use selected under 
this paragraph. 
‘‘(B) REPORTING ON MEASURES.— 
‘‘(i) SELECTION.—The Secretary shall 
select measures for purposes of subpara-
graph (A)(iii) but only consistent with the 
following: 
‘‘(I) The Secretary shall provide 
preference to clinical quality measures 
that have been endorsed by the entity 
with a contract with the Secretary 
under section 1890(a). 
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141 
‘‘(II) Prior to any measure being 
selected under this subparagraph, the 
Secretary shall publish in the Federal 
Register such measure and provide for 
a period of public comment on such 
measure. 
‘‘(ii) LIMITATION.—The Secretary may 
not require the electronic reporting of infor-
mation on clinical quality measures under 
subparagraph (A)(iii) unless the Secretary 
has the capacity to accept the information 
electronically, which may be on a pilot 
basis. 
‘‘(iii) COORDINATION
OF
REPORTING 
OF INFORMATION.—In selecting such meas-
ures, and in establishing the form and man-
ner for reporting measures under subpara-
graph (A)(iii), the Secretary shall seek to 
avoid redundant or duplicative reporting 
otherwise 
required, 
including 
reporting 
under subsection (k)(2)(C). 
‘‘(C) DEMONSTRATION OF MEANINGFUL USE 
OF CERTIFIED EHR TECHNOLOGY AND INFORMA-
TION EXCHANGE.— 
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