H. R. 1—91 
FEDERAL AVIATION ADMINISTRATION 
SUPPLEMENTAL FUNDING FOR FACILITIES AND EQUIPMENT 
For an additional amount for necessary investments in Federal 
Aviation Administration infrastructure, $200,000,000, to remain 
available through September 30, 2010: Provided, That funding pro-
vided under this heading shall be used to make improvements 
to power systems, air route traffic control centers, air traffic control 
towers, terminal radar approach control facilities, and navigation 
and landing equipment: Provided further, That priority be given 
to such projects or activities that will be completed within 2 years 
of enactment of this Act: Provided further, That amounts made 
available under this heading may be provided through grants in 
addition to the other instruments authorized under section 106(l)(6) 
of title 49, United States Code: Provided further, That the Federal 
share of the costs for which an expenditure is made under this 
heading shall be 100 percent: Provided further, That amounts pro-
vided under this heading may be used for expenses the agency 
incurs in administering this program: Provided further, That not 
more than 60 days after enactment of this Act, the Administrator 
shall establish a process for applying, reviewing and awarding 
grants and cooperative and other transaction agreements, including 
the form and content of an application, and requirements for the 
maintenance of records that are necessary to facilitate an effective 
audit of the use of the funding provided: Provided further, That 
section 50101 of title 49, United States Code, shall apply to funds 
provided under this heading. 
GRANTS-IN-AID FOR AIRPORTS 
For an additional amount for ‘‘Grants-In-Aid for Airports’’, to 
enable the Secretary of Transportation to make grants for discre-
tionary projects as authorized by subchapter 1 of chapter 471 and 
subchapter 1 of chapter 475 of title 49, United States Code, and 
for the procurement, installation and commissioning of runway 
incursion prevention devices and systems at airports of such title, 
$1,100,000,000, to remain available through September 30, 2010: 
Provided, That such funds shall not be subject to apportionment 
formulas, special apportionment categories, or minimum percent-
ages under chapter 471: Provided further, That the Secretary shall 
distribute funds provided under this heading as discretionary grants 
to airports, with priority given to those projects that demonstrate 
to his satisfaction their ability to be completed within 2 years 
of enactment of this Act, and serve to supplement and not supplant 
planned expenditures from airport-generated revenues or from other 
State and local sources on such activities: Provided further, That 
the Secretary shall award grants totaling not less than 50 percent 
of the funds made available under this heading within 120 days 
of enactment of this Act, and award grants for the remaining 
amounts not later than 1 year after enactment of this Act: Provided 
further, That the Federal share payable of the costs for which 
a grant is made under this heading shall be 100 percent: Provided 
further, That the amount made available under this heading shall 
not be subject to any limitation on obligations for the Grants- 
in-Aid for Airports program set forth in any Act: Provided further, 
That the Administrator of the Federal Aviation Administration 
may retain up to 0.2 percent of the funds provided under this
H. R. 1—92 
heading to fund the award and oversight by the Administrator 
of grants made under this heading. 
FEDERAL HIGHWAY ADMINISTRATION 
HIGHWAY INFRASTRUCTURE INVESTMENT 
For an additional amount for restoration, repair, construction 
and other activities eligible under paragraph (b) of section 133 
of title 23, United States Code, and for passenger and freight 
rail transportation and port infrastructure projects eligible for 
assistance under subsection 601(a)(8) of such title, $27,500,000,000, 
to remain available through September 30, 2010: Provided, That, 
after making the set-asides required under this heading, 50 percent 
of the funds made available under this heading shall be apportioned 
to States using the formula set forth in section 104(b)(3) of title 
23, United States Code, and the remaining funds shall be appor-
tioned to States in the same ratio as the obligation limitation 
for fiscal year 2008 was distributed among the States in accordance 
with the formula specified in section 120(a)(6) of division K of 
Public Law 110–161: Provided further, That funds made available 
under this heading shall be apportioned not later than 21 days 
after the date of enactment of this Act: Provided further, That 
in selecting projects to be carried out with funds apportioned under 
this heading, priority shall be given to projects that are projected 
for completion within a 3-year time frame, and are located in 
economically distressed areas as defined by section 301 of the 
Public Works and Economic Development Act of 1965, as amended 
(42 U.S.C. 3161): Provided further, That 120 days following the 
date of such apportionment, the Secretary of Transportation shall 
withdraw from each State an amount equal to 50 percent of the 
funds awarded to that State (excluding funds suballocated within 
the State) less the amount of funding obligated (excluding funds 
suballocated within the State), and the Secretary shall redistribute 
such amounts to other States that have had no funds withdrawn 
under this proviso in the manner described in section 120(c) of 
division K of Public Law 110–161: Provided further, That 1 year 
following the date of such apportionment, the Secretary shall with-
draw from each recipient of funds apportioned under this heading 
any unobligated funds, and the Secretary shall redistribute such 
amounts to States that have had no funds withdrawn under this 
proviso (excluding funds suballocated within the State) in the 
manner described in section 120(c) of division K of Public Law 
110–161: Provided further, That at the request of a State, the 
Secretary of Transportation may provide an extension of such 1- 
year period only to the extent that he feels satisfied that the 
State has encountered extreme conditions that create an unwork-
able bidding environment or other extenuating circumstances: Pro-
vided further, That before granting such an extension, the Secretary 
shall send a letter to the House and Senate Committees on Appro-
priations that provides a thorough justification for the extension: 
Provided further, That 3 percent of the funds apportioned to a 
State under this heading shall be set aside for the purposes 
described in subsection 133(d)(2) of title 23, United States Code 
(without regard to the comparison to fiscal year 2005): Provided 
further, That 30 percent of the funds apportioned to a State under 
this heading shall be suballocated within the State in the manner 
and for the purposes described in the first sentence of subsection
H. R. 1—93 
133(d)(3)(A), 
in 
subsection 
133(d)(3)(B), 
and 
in 
subsection 
133(d)(3)(D): Provided further, That such suballocation shall be 
conducted in every State: Provided further, That funds suballocated 
within a State to urbanized areas and other areas shall not be 
subject to the redistribution of amounts required 120 days following 
the date of apportionment of funds provided under this heading: 
Provided further, That of the funds provided under this heading, 
$105,000,000 shall be for the Puerto Rico highway program author-
ized under section 165 of title 23, United States Code, and 
$45,000,000 shall be for the territorial highway program authorized 
under section 215 of title 23, United States Code: Provided further, 
That of the funds provided under this heading, $60,000,000 shall 
be for capital expenditures eligible under section 147 of title 23, 
United States Code (without regard to subsection(d)): Provided fur-
ther, That the Secretary of Transportation shall distribute such 
$60,000,000 as competitive discretionary grants to States, with 
priority given to those projects that demonstrate to his satisfaction 
their ability to be completed within 2 years of enactment of this 
Act: Provided further, That of the funds provided under this 
heading, $550,000,000 shall be for investments in transportation 
at Indian reservations and Federal lands: Provided further, That 
of the funds identified in the preceding proviso, $310,000,000 shall 
be for the Indian Reservation Roads program, $170,000,000 shall 
be for the Park Roads and Parkways program, $60,000,000 shall 
be for the Forest Highway Program, and $10,000,000 shall be 
for the Refuge Roads program: Provided further, That for invest-
ments at Indian reservations and Federal lands, priority shall be 
given to capital investments, and to projects and activities that 
can be completed within 2 years of enactment of this Act: Provided 
further, That 1 year following the enactment of this Act, to ensure 
the prompt use of the $550,000,000 provided for investments at 
Indian reservations and Federal lands, the Secretary shall have 
the authority to redistribute unobligated funds within the respective 
program for which the funds were appropriated: Provided further, 
That up to 4 percent of the funding provided for Indian Reservation 
Roads may be used by the Secretary of the Interior for program 
management and oversight and project-related administrative 
expenses: Provided further, That section 134(f)(3)(C)(ii)(II) of title 
23, United States Code, shall not apply to funds provided under 
this heading: Provided further, That of the funds made available 
under this heading, $20,000,000 shall be for highway surface 
transportation and technology training under section 140(b) of title 
23, United States Code, and $20,000,000 shall be for disadvantaged 
business enterprises bonding assistance under section 332(e) of 
title 49, United States Code: Provided further, That funds made 
available under this heading shall be administered as if apportioned 
under chapter 1 of title 23, United States Code, except for funds 
made available for investments in transportation at Indian reserva-
tions and Federal lands, and for the territorial highway program, 
which shall be administered in accordance with chapter 2 of title 
23, United States Code, and except for funds made available for 
disadvantaged business enterprises bonding assistance, which shall 
be administered in accordance with chapter 3 of title 49, United 
States Code: Provided further, That the Federal share payable 
on account of any project or activity carried out with funds made 
available under this heading shall be, at the option of the recipient, 
up to 100 percent of the total cost thereof: Provided further, That
H. R. 1—94 
funds made available by this Act shall not be obligated for the 
purposes authorized under section 115(b) of title 23, United States 
Code: Provided further, That funding provided under this heading 
shall be in addition to any and all funds provided for fiscal years 
2009 and 2010 in any other Act for ‘‘Federal-aid Highways’’ and 
shall not affect the distribution of funds provided for ‘‘Federal- 
aid Highways’’ in any other Act: Provided further, That the amount 
made available under this heading shall not be subject to any 
limitation on obligations for Federal-aid highways or highway safety 
construction programs set forth in any Act: Provided further, That 
section 1101(b) of Public Law 109–59 shall apply to funds appor-
tioned under this heading: Provided further, That the Administrator 
of the Federal Highway Administration may retain up to 
$40,000,000 of the funds provided under this heading to fund the 
oversight by the Administrator of projects and activities carried 
out with funds made available to the Federal Highway Administra-
tion in this Act, and such funds shall be available through Sep-
tember 30, 2012. 
FEDERAL RAILROAD ADMINISTRATION 
CAPITAL ASSISTANCE FOR HIGH SPEED RAIL CORRIDORS AND 
INTERCITY PASSENGER RAIL SERVICE 
For an additional amount for section 501 of Public Law 110– 
432 and discretionary grants to States to pay for the cost of projects 
described in paragraphs (2)(A) and (2)(B) of section 24401 of title 
49, United States Code, subsection (b) of section 24105 of such 
title, $8,000,000,000, to remain available through September 30, 
2012: Provided, That the Secretary of Transportation shall give 
priority to projects that support the development of intercity high 
speed rail service: Provided further, That within 60 days of the 
enactment of this Act, the Secretary shall submit to the House 
and Senate Committees on Appropriations a strategic plan that 
describes how the Secretary will use the funding provided under 
this heading to improve and deploy high speed passenger rail sys-
tems: Provided further, That within 120 days of enactment of this 
Act, the Secretary shall issue interim guidance to applicants cov-
ering grant terms, conditions, and procedures until final regulations 
are issued: Provided further, That such interim guidance shall 
provide separate instructions for the high speed rail corridor pro-
gram, capital assistance for intercity passenger rail service grants, 
and congestion grants: Provided further, That the Secretary shall 
waive the requirement that a project conducted using funds pro-
vided under this heading be in a State rail plan developed under 
chapter 227 of title 49, United States Code: Provided further, That 
the Federal share payable of the costs for which a grant is made 
under this heading shall be, at the option of the recipient, up 
to 100 percent: Provided further, That projects conducted using 
funds provided under this heading must comply with the require-
ments of subchapter IV of chapter 31 of title 40, United States 
Code: Provided further, That section 24405 of title 49, United States 
Code, shall apply to funds provided under this heading: Provided 
further, That the Administrator of the Federal Railroad Administra-
tion may retain up to one-quarter of 1 percent of the funds provided 
under this heading to fund the award and oversight by the Adminis-
trator of grants made under this heading, and funds retained for 
said purposes shall remain available through September 30, 2014.
H. R. 1—95 
CAPITAL GRANTS TO THE NATIONAL RAILROAD PASSENGER 
CORPORATION 
For an additional amount for the National Railroad Passenger 
Corporation (Amtrak) to enable the Secretary of Transportation 
to make capital grants to Amtrak as authorized by section 101(c) 
of the Passenger Rail Investment and Improvement Act of 2008 
(Public Law 110–432), $1,300,000,000, to remain available through 
September 30, 2010, of which $450,000,000 shall be used for capital 
security grants: Provided, That priority for the use of non-security 
funds shall be given to projects for the repair, rehabilitation, or 
upgrade of railroad assets or infrastructure, and for capital projects 
that expand passenger rail capacity including the rehabilitation 
of rolling stock: Provided further, That none of the funds under 
this heading shall be used to subsidize the operating losses of 
Amtrak: Provided further, That funds provided under this heading 
shall be awarded not later than 30 days after the date of enactment 
of this Act: Provided further, That the Secretary shall take measures 
to ensure that projects funded under this heading shall be completed 
within 2 years of enactment of this Act, and shall serve to supple-
ment and not supplant planned expenditures for such activities 
from other Federal, State, local and corporate sources: Provided 
further, That the Secretary shall certify to the House and Senate 
Committees on Appropriations in writing compliance with the pre-
ceding proviso: Provided further, That not more than 60 percent 
of the funds provided for non-security activities under this heading 
may be used for capital projects along the Northeast Corridor: 
Provided further, That of the funding provided under this heading, 
$5,000,000 shall be made available for the Amtrak Office of 
Inspector General and made available through September 30, 2013. 
FEDERAL TRANSIT ADMINISTRATION 
TRANSIT CAPITAL ASSISTANCE 
For an additional amount for transit capital assistance grants 
authorized under section 5302(a)(1) of title 49, United States Code, 
$6,900,000,000, to remain available through September 30, 2010: 
Provided, That the Secretary of Transportation shall provide 80 
percent of the funds appropriated under this heading for grants 
under section 5307 of title 49, United States Code, and apportion 
such funds in accordance with section 5336 of such title (other 
than subsections (i)(1) and (j)): Provided further, That the Secretary 
shall apportion 10 percent of the funds appropriated under this 
heading in accordance with section 5340 of such title: Provided 
further, That the Secretary shall provide 10 percent of the funds 
appropriated under this heading for grants under section 5311 
of title 49, United States Code, and apportion such funds in accord-
ance with such section: Provided further, That funds apportioned 
under this heading shall be apportioned not later than 21 days 
after the date of enactment of this Act: Provided further, That 
180 days following the date of such apportionment, the Secretary 
shall withdraw from each urbanized area or State an amount equal 
to 50 percent of the funds apportioned to such urbanized areas 
or States less the amount of funding obligated, and the Secretary 
shall redistribute such amounts to other urbanized areas or States 
that have had no funds withdrawn under this proviso utilizing 
whatever method he deems appropriate to ensure that all funds
H. R. 1—96 
redistributed under this proviso shall be utilized promptly: Provided 
further, That 1 year following the date of such apportionment, 
the Secretary shall withdraw from each urbanized area or State 
any unobligated funds, and the Secretary shall redistribute such 
amounts to other urbanized areas or States that have had no 
funds withdrawn under this proviso utilizing whatever method he 
deems appropriate to ensure that all funds redistributed under 
this proviso shall be utilized promptly: Provided further, That at 
the request of an urbanized area or State, the Secretary of Transpor-
tation may provide an extension of such 1-year period if he feels 
satisfied that the urbanized area or State has encountered an 
unworkable 
bidding 
environment 
or 
other 
extenuating 
cir-
cumstances: Provided further, That before granting such an exten-
sion, the Secretary shall send a letter to the House and Senate 
Committees on Appropriations that provides a thorough justification 
for the extension: Provided further, That of the funds provided 
for section 5311 of title 49, United States Code, 2.5 percent shall 
be made available for section 5311(c)(1): Provided further, That 
of the funding provided under this heading, $100,000,000 shall 
be distributed as discretionary grants to public transit agencies 
for capital investments that will assist in reducing the energy 
consumption or greenhouse gas emissions of their public transpor-
tation systems: Provided further, That for such grants on energy- 
related investments, priority shall be given to projects based on 
the total energy savings that are projected to result from the invest-
ment, and projected energy savings as a percentage of the total 
energy usage of the public transit agency: Provided further, That 
applicable chapter 53 requirements shall apply to funding provided 
under this heading, except that the Federal share of the costs 
for which any grant is made under this heading shall be, at the 
option of the recipient, up to 100 percent: Provided further, That 
the amount made available under this heading shall not be subject 
to any limitation on obligations for transit programs set forth in 
any Act: Provided further, That section 1101(b) of Public Law 109– 
59 shall apply to funds appropriated under this heading: Provided 
further, That the funds appropriated under this heading shall not 
be comingled with any prior year funds: Provided further, That 
notwithstanding any other provision of law, three-quarters of 1 
percent of the funds provided for grants under section 5307 and 
section 5340, and one-half of 1 percent of the funds provided for 
grants under section 5311, shall be available for administrative 
expenses and program management oversight, and such funds shall 
be available through September 30, 2012. 
FIXED GUIDEWAY INFRASTRUCTURE INVESTMENT 
For an amount for capital expenditures authorized under sec-
tion 5309(b)(2) of title 49, United States Code, $750,000,000, to 
remain available through September 30, 2010: Provided, That the 
Secretary of Transportation shall apportion funds under this 
heading pursuant to the formula set forth in section 5337 of title 
49, United States Code: Provided further, That the funds appro-
priated under this heading shall not be commingled with any prior 
year funds: Provided further, That funds made available under 
this heading shall be apportioned not later than 21 days after 
the date of enactment of this Act: Provided further, That 180 
days following the date of such apportionment, the Secretary shall
H. R. 1—97 
withdraw from each urbanized area an amount equal to 50 percent 
of the funds apportioned to such urbanized area less the amount 
of funding obligated, and the Secretary shall redistribute such 
amounts to other urbanized areas that have had no funds with-
drawn under this proviso utilizing whatever method he or she 
deems appropriate to ensure that all funds redistributed under 
this proviso shall be utilized promptly: Provided further, That 1 
year following the date of such apportionment, the Secretary shall 
withdraw from each urbanized area any unobligated funds, and 
the Secretary shall redistribute such amounts to other urbanized 
areas that have had no funds withdrawn under this proviso utilizing 
whatever method he or she deems appropriate to ensure that all 
funds redistributed under this proviso shall be utilized promptly: 
Provided further, That at the request of an urbanized area, the 
Secretary of Transportation may provide an extension of such 1- 
year period if he or she feels satisfied that the urbanized area 
has encountered an unworkable bidding environment or other 
extenuating circumstances: Provided further, That before granting 
such an extension, the Secretary shall send a letter to the House 
and Senate Committees on Appropriations that provides a thorough 
justification for the extension: Provided further, That applicable 
chapter 53 requirements shall apply except that the Federal share 
of the costs for which a grant is made under this heading shall 
be, at the option of the recipient, up to 100 percent: Provided 
further, That the provisions of section 1101(b) of Public Law 109– 
59 shall apply to funds made available under this heading: Provided 
further, That notwithstanding any other provision of law, up to 
1 percent of the funds under this heading shall be available for 
administrative expenses and program management oversight and 
shall remain available for obligation until September 30, 2012. 
CAPITAL INVESTMENT GRANTS 
For an additional amount for ‘‘Capital Investment Grants’’, 
as authorized under section 5338(c)(4) of title 49, United States 
Code, and allocated under section 5309(m)(2)(A) of such title, to 
enable the Secretary of Transportation to make discretionary grants 
as authorized by section 5309(d) and (e) of such title, $750,000,000, 
to remain available through September 30, 2010: Provided, That 
such amount shall be allocated without regard to the limitation 
under section 5309(m)(2)(A)(i): Provided further, That in selecting 
projects to be funded, priority shall be given to projects that are 
currently in construction or are able to obligate funds within 150 
days of enactment of this Act: Provided further, That the provisions 
of section 1101(b) of Public Law 109–59 shall apply to funds made 
available under this heading: Provided further, That funds appro-
priated under this heading shall not be commingled with any prior 
year funds: Provided further, That applicable chapter 53 require-
ments shall apply, except that notwithstanding any other provision 
of law, up to 1 percent of the funds provided under this heading 
shall be available for administrative expenses and program manage-
ment oversight, and shall remain available through September 30, 
2012.
H. R. 1—98 
MARITIME ADMINISTRATION 
SUPPLEMENTAL GRANTS FOR ASSISTANCE TO SMALL SHIPYARDS 
To make grants to qualified shipyards as authorized under 
section 3508 of Public Law 110–417 or section 54101 of title 46, 
United States Code, $100,000,000, to remain available through 
September 30, 2010: Provided, That the Secretary of Transportation 
shall institute measures to ensure that funds provided under this 
heading shall be obligated within 180 days of the date of their 
distribution: Provided further, That the Maritime Administrator 
may retain and transfer to ‘‘Maritime Administration, Operations 
and Training’’ up to 2 percent of the funds provided under this 
heading to fund the award and oversight by the Administrator 
of grants made under this heading. 
OFFICE OF INSPECTOR GENERAL 
SALARIES AND EXPENSES 
For an additional amount for necessary expenses of the Office 
of Inspector General to carry out the provisions of the Inspector 
General Act of 1978, as amended, $20,000,000, to remain available 
through September 30, 2013: Provided, That the funding made 
available under this heading shall be used for conducting audits 
and investigations of projects and activities carried out with funds 
made available in this Act to the Department of Transportation: 
Provided further, That the Inspector General shall have all nec-
essary authority, in carrying out the duties specified in the Inspector 
General Act, as amended (5 U.S.C. App. 3), to investigate allegations 
of fraud, including false statements to the Government (18 U.S.C. 
1001), by any person or entity that is subject to regulation by 
the Department. 
GENERAL PROVISION—DEPARTMENT OF TRANSPORTATION 
SEC. 1201. (a) MAINTENANCE OF EFFORT.—Not later than 30 
days after the date of enactment of this Act, for each amount 
that is distributed to a State or agency thereof from an appropria-
tion in this Act for a covered program, the Governor of the State 
shall certify to the Secretary of Transportation that the State will 
maintain its effort with regard to State funding for the types 
of projects that are funded by the appropriation. As part of this 
certification, the Governor shall submit to the Secretary of 
Transportation a statement identifying the amount of funds the 
State planned to expend from State sources as of the date of 
enactment of this Act during the period beginning on the date 
of enactment of this Act through September 30, 2010, for the 
types of projects that are funded by the appropriation. 
(b) FAILURE TO MAINTAIN EFFORT.— 
If a State is unable to maintain the level of effort certified 
pursuant to subsection (a), the State will be prohibited by 
the Secretary of Transportation from receiving additional 
limitation pursuant to the redistribution of the limitation on 
obligations for Federal-aid highway and highway safety 
construction programs that occurs after August 1 for fiscal 
year 2011. 
(c) PERIODIC REPORTS.—
H. R. 1—99 
(1) IN GENERAL.—Notwithstanding any other provision of 
law, each grant recipient shall submit to the covered agency 
from which they received funding periodic reports on the use 
of the funds appropriated in this Act for covered programs. 
Such reports shall be collected and compiled by the covered 
agency and transmitted to Congress. Covered agencies may 
develop such reports on behalf of grant recipients to ensure 
the accuracy and consistency of such reports. 
(2) CONTENTS OF REPORTS.—For amounts received under 
each covered program by a grant recipient under this Act, 
the grant recipient shall include in the periodic reports informa-
tion tracking- 
(A) the amount of Federal funds appropriated, allo-
cated, obligated, and outlayed under the appropriation; 
(B) the number of projects that have been put out 
to bid under the appropriation and the amount of Federal 
funds associated with such projects; 
(C) the number of projects for which contracts have 
been awarded under the appropriation and the amount 
of Federal funds associated with such contracts; 
(D) the number of projects for which work has begun 
under such contracts and the amount of Federal funds 
associated with such contracts; 
(E) the number of projects for which work has been 
completed under such contracts and the amount of Federal 
funds associated with such contracts; 
(F) the number of direct, on-project jobs created or 
sustained by the Federal funds provided for projects under 
the appropriation and, to the extent possible, the estimated 
indirect jobs created or sustained in the associated sup-
plying industries, including the number of job-years created 
and the total increase in employment since the date of 
enactment of this Act; and 
(G) for each covered program report information 
tracking the actual aggregate expenditures by each grant 
recipient from State sources for projects eligible for funding 
under the program during the period beginning on the 
date of enactment of this Act through September 30, 2010, 
as compared to the level of such expenditures that were 
planned to occur during such period as of the date of 
enactment of this Act. 
(3) TIMING OF REPORTS.—Each grant recipient shall submit 
the first of the periodic reports required under this subsection 
not later than 90 days after the date of enactment of this 
Act and shall submit updated reports not later than 180 days, 
1 year, 2 years, and 3 years after such date of enactment. 
(d) DEFINITIONS.—In this section, the following definitions 
apply: 
(1) COVERED AGENCY.—The term ‘‘covered agency’’ means 
the Office of the Secretary of Transportation, the Federal Avia-
tion Administration, the Federal Highway Administration, the 
Federal Railroad Administration, the Federal Transit Adminis-
tration and the Maritime Administration of the Department 
of Transportation. 
(2) COVERED
PROGRAM.—The term ‘‘covered program’’ 
means funds appropriated in this Act for ‘‘Supplemental Discre-
tionary Grants for a National Surface Transportation System’’
H. R. 1—100 
to the Office of the Secretary of Transportation, for ‘‘Supple-
mental Funding for Facilities and Equipment’’ and ‘‘Grants- 
in-Aid for Airports’’ to the Federal Aviation Administration; 
for ‘‘Highway Infrastructure Investment’’ to the Federal High-
way Administration; for ‘‘Capital Assistance for High Speed 
Rail Corridors and Intercity Passenger Rail Service’’ and ‘‘Cap-
ital Grants to the National Railroad Passenger Corporation’’ 
to the Federal Railroad Administration; for ‘‘Transit Capital 
Assistance’’, ‘‘Fixed Guideway Infrastructure Investment’’, and 
‘‘Capital Investment Grants’’ to the Federal Transit Administra-
tion; and ‘‘Supplemental Grants for Assistance to Small Ship-
yards’’ to the Maritime Administration. 
(3) GRANT RECIPIENT.—The term ‘‘grant recipient’’ means 
a State or other recipient of assistance provided under a covered 
program in this Act. Such term does not include a Federal 
department or agency. 
(e) Notwithstanding any other provision of law, sections 3501– 
3521 of title 44, United States Code, shall not apply to the provisions 
of this section. 
DEPARTMENT OF HOUSING AND URBAN DEVELOPMENT 
PUBLIC AND INDIAN HOUSING 
PUBLIC HOUSING CAPITAL FUND 
For an additional amount for the ‘‘Public Housing Capital Fund’’ 
to carry out capital and management activities for public housing 
agencies, as authorized under section 9 of the United States Housing 
Act of 1937 (42 U.S.C. 1437g) (the ‘‘Act’’), $4,000,000,000, to remain 
available until September 30, 2011: Provided, That the Secretary 
of Housing and Urban Development shall distribute $3,000,000,000 
of this amount by the same formula used for amounts made avail-
able in fiscal year 2008, except that the Secretary may determine 
not to allocate funding to public housing agencies currently des-
ignated as troubled or to public housing agencies that elect not 
to accept such funding: Provided further, That the Secretary shall 
obligate funds allocated by formula within 30 days of enactment 
of this Act: Provided further, That the Secretary shall make avail-
able $1,000,000,000 by competition for priority investments, 
including investments that leverage private sector funding or 
financing for renovations and energy conservation retrofit invest-
ments: Provided further, That the Secretary shall obligate competi-
tive funding by September 30, 2009: Provided further, That public 
housing authorities shall give priority to capital projects that can 
award contracts based on bids within 120 days from the date 
the funds are made available to the public housing authorities: 
Provided further, That public housing agencies shall give priority 
consideration to the rehabilitation of vacant rental units: Provided 
further, That public housing agencies shall prioritize capital projects 
that are already underway or included in the 5-year capital fund 
plans required by the Act (42 U.S.C. 1437c–1(a)): Provided further, 
That notwithstanding any other provision of law, (1) funding pro-
vided under this heading may not be used for operating or rental 
assistance activities, and (2) any restriction of funding to replace-
ment housing uses shall be inapplicable: Provided further, That 
notwithstanding any other provision of law, the Secretary shall 
institute measures to ensure that funds provided under this heading
H. R. 1—101 
shall serve to supplement and not supplant expenditures from 
other Federal, State, or local sources or funds independently gen-
erated by the grantee: Provided further, That notwithstanding sec-
tion 9(j), public housing agencies shall obligate 100 percent of 
the funds within 1 year of the date on which funds become available 
to the agency for obligation, shall expend at least 60 percent of 
funds within 2 years of the date on which funds become available 
to the agency for obligation, and shall expend 100 percent of the 
funds within 3 years of such date: Provided further, That if a 
public housing agency fails to comply with the 1-year obligation 
requirement, the Secretary shall recapture all remaining unobli-
gated funds awarded to the public housing agency and reallocate 
such funds to agencies that are in compliance with those require-
ments: Provided further, That if a public housing agency fails to 
comply with either the 2-year or the 3-year expenditure require-
ment, the Secretary shall recapture the balance of the funds 
awarded to the public housing agency and reallocate such funds 
to agencies that are in compliance with those requirements: Pro-
vided further, That in administering funds appropriated or other-
wise made available under this heading, the Secretary may waive 
or specify alternative requirements for any provision of any statute 
or regulation in connection with the obligation by the Secretary 
or the use of these funds (except for requirements related to fair 
housing, nondiscrimination, labor standards, and the environment), 
upon a finding that such a waiver is necessary to expedite or 
facilitate the use of such funds: Provided further, That, in addition 
to waivers authorized under the previous proviso, the Secretary 
may direct that requirements relating to the procurement of goods 
and services arising under state and local laws and regulations 
shall not apply to amounts made available under this heading: 
Provided further, That of the funds made available under this 
heading, up to .5 percent shall be available for staffing, training, 
technical assistance, technology, monitoring, travel, enforcement, 
research and evaluation activities: Provided further, That funds 
set aside in the previous proviso shall remain available until Sep-
tember 30, 2012: Provided further, That any funds made available 
under this heading used by the Secretary for personnel expenses 
related to administering funding under this heading shall be trans-
ferred to ‘‘Personnel Compensation and Benefits, Office of Public 
and Indian Housing’’ and shall retain the terms and conditions 
of this account, including reprogramming provisions, except that 
the period of availability set forth in the previous proviso shall 
govern such transferred funds: Provided further, That any funds 
made available under this heading used by the Secretary for 
training or other administrative expenses shall be transferred to 
‘‘Administration, Operations, and Management’’, for non-personnel 
expenses of the Department of Housing and Urban Development: 
Provided further, That any funds made available under this heading 
used by the Secretary for technology shall be transferred to 
‘‘Working Capital Fund’’. 
NATIVE AMERICAN HOUSING BLOCK GRANTS 
For an additional amount for ‘‘Native American Housing Block 
Grants’’, as authorized under title I of the Native American Housing 
Assistance and Self-Determination Act of 1996 (‘‘NAHASDA’’) (25
H. R. 1—102 
U.S.C. 4111 et seq.), $510,000,000 to remain available until Sep-
tember 30, 2011: Provided, That $255,000,000 of the amount pro-
vided under this heading shall be distributed according to the 
same funding formula used in fiscal year 2008: Provided further, 
That the Secretary shall obligate funds allocated by formula within 
30 days of enactment of this Act: Provided further, That the 
amounts distributed through the formula shall be used for new 
construction, acquisition, rehabilitation including energy efficiency 
and conservation, and infrastructure development: Provided further, 
That in selecting projects to be funded, recipients shall give priority 
to projects for which contracts can be awarded within 180 days 
from the date that funds are available to the recipients: Provided 
further, that the Secretary may obligate $255,000,000 of the amount 
provided under this heading for competitive grants to eligible enti-
ties that apply for funds authorized under NAHASDA: Provided 
further, That the Secretary shall obligate competitive funding by 
September 30, 2009: Provided further, That in awarding competitive 
funds, the Secretary shall give priority to projects that will spur 
construction and rehabilitation and will create employment 
opportunities for low-income and unemployed persons: Provided 
further, That recipients of funds under this heading shall obligate 
100 percent of such funds within 1 year of the date funds are 
made available to a recipient, expend at least 50 percent of such 
funds within 2 years of the date on which funds become available 
to such recipients for obligation and expend 100 percent of such 
funds within 3 years of such date: Provided further, That if a 
recipient fails to comply with the 2-year expenditure requirement, 
the Secretary shall recapture all remaining funds awarded to the 
recipient and reallocate such funds through the funding formula 
to recipients that are in compliance with these requirements: Pro-
vided further, That if a recipient fails to comply with the 3-year 
expenditure requirement, the Secretary shall recapture the balance 
of the funds originally awarded to the recipient: Provided further, 
That notwithstanding any other provision of law, the Secretary 
may set aside up to 2 percent of funds made available under 
this paragraph for a housing entity eligible to receive funding 
under title VIII of NAHASDA (25 U.S.C. 4221 et seq.): Provided 
further, That in administering funds appropriated or otherwise 
made available under this heading, the Secretary may waive or 
specify alternative requirements for any provision of any statute 
or regulation in connection with the obligation by the Secretary 
or the use of these funds (except for requirements related to fair 
housing, nondiscrimination, labor standards, and the environment), 
upon a finding that such a waiver is necessary to expedite or 
facilitate the use of such funds: Provided further, That of the 
funds made available under this heading, up to .5 percent shall 
be available for staffing, training, technical assistance, technology, 
monitoring, travel, enforcement, research and evaluation activities: 
Provided further, That funds set aside in the previous proviso 
shall remain available until September 30, 2012: Provided further, 
That any funds made available under this heading used by the 
Secretary for personnel expenses related to administering funding 
under this heading shall be transferred to ‘‘Personnel Compensation 
and Benefits, Office of Public and Indian Housing’’ and shall retain 
the terms and conditions of this account, including reprogramming 
provisions, except that the period of availability set forth in the
H. R. 1—103 
previous proviso shall govern such transferred funds: Provided fur-
ther, That any funds made available under this heading used by 
the Secretary for training or other administrative expenses shall 
be transferred to ‘‘Administration, Operations, and Management’’, 
for non-personnel expenses of the Department of Housing and 
Urban Development: Provided further, That any funds made avail-
able under this heading used by the Secretary for technology shall 
be transferred to ‘‘Working Capital Fund’’. 
COMMUNITY PLANNING AND DEVELOPMENT 
COMMUNITY DEVELOPMENT FUND 
For an additional amount for ‘‘Community Development Fund’’ 
$1,000,000,000, to remain available until September 30, 2010 to 
carry out the community development block grant program under 
title I of the Housing and Community Development Act of 1974 
(42 U.S.C. 5301 et seq.): Provided, That the amount appropriated 
in this paragraph shall be distributed pursuant to 42 U.S.C. 5306 
to grantees that received funding in fiscal year 2008: Provided 
further, That in administering the funds appropriated in this para-
graph, the Secretary of Housing and Urban Development shall 
establish requirements to expedite the use of the funds: Provided 
further, That in selecting projects to be funded, recipients shall 
give priority to projects that can award contracts based on bids 
within 120 days from the date the funds are made available to 
the recipients: Provided further, That in administering funds appro-
priated or otherwise made available under this heading, the Sec-
retary may waive or specify alternative requirements for any provi-
sion of any statute or regulation in connection with the obligation 
by the Secretary or the use by the recipient of these funds (except 
for requirements related to fair housing, nondiscrimination, labor 
standards, and the environment), upon a finding that such waiver 
is necessary to expedite or facilitate the timely use of such funds 
and would not be inconsistent with the overall purpose of the 
statute. 
For the provision of emergency assistance for the redevelopment 
of abandoned and foreclosed homes, as authorized under division 
B, title III of the Housing and Economic Recovery Act of 2008 
(‘‘the Act’’) (Public Law 110–289) (42 U.S.C. 5301 note), 
$2,000,000,000, to remain available until September 30, 2010: Pro-
vided, That grantees shall expend at least 50 percent of allocated 
funds within 2 years of the date funds become available to the 
grantee for obligation, and 100 percent of such funds within 3 
years of such date: Provided further, That unless otherwise noted 
herein, the provisions of the Act govern the use of the additional 
funds made available under this heading: Provided further, That 
notwithstanding the provisions of sections 2301(b) and (c)(1) and 
section 2302 of the Act, funding under this paragraph shall be 
allocated by competitions for which eligible entities shall be States, 
units of general local government, and nonprofit entities or consortia 
of nonprofit entities, which may submit proposals in partnership 
with for profit entities: Provided further, That in selecting grantees, 
the Secretary of Housing and Urban Development shall ensure 
that the grantees are in areas with the greatest number and 
percentage of foreclosures and can expend funding within the period 
allowed under this heading: Provided further, That additional award 
criteria for such competitions shall include demonstrated grantee
H. R. 1—104 
capacity to execute projects, leveraging potential, concentration of 
investment to achieve neighborhood stabilization, and any addi-
tional factors determined by the Secretary of Housing and Urban 
Development: Provided further, That the Secretary may establish 
a minimum grant size: Provided further, That the Secretary shall 
publish criteria on which to base competition for any grants 
awarded under this heading not later than 75 days after the enact-
ment of this Act and applications shall be due to HUD not later 
than 150 days after the enactment of this Act: Provided further, 
That the Secretary shall obligate all funding within 1 year of 
enactment of this Act: Provided further, That section 2301(d)(4) 
of the Act is repealed: Provided further, That section 2301(c)(3)(C) 
of the Act is amended to read ‘‘establish and operate land banks 
for homes and residential properties that have been foreclosed 
upon’’: Provided further, That funding used for section 2301(c)(3)(E) 
of the Act shall be available only for the redevelopment of demol-
ished or vacant properties as housing: Provided further, That no 
amounts made available from a grant under this heading may 
be used to demolish any public housing (as such term is defined 
in section 3 of the United States Housing Act of 1937 (42 U.S.C. 
1437a)): Provided further, That a grantee may not use more than 
10 percent of its grant under this heading for demolition activities 
under section 2301(c)(3)(C) and (D) unless the Secretary determines 
that such use represents an appropriate response to local market 
conditions: Provided further, That the recipient of any grant or 
loan from amounts made available under this heading or, after 
the date of enactment under division B, title III of the Housing 
and Economic Recovery Act of 2008, may not refuse to lease a 
dwelling unit in housing with such loan or grant to a participant 
under section 8 of the United States Housing Act of 1937 (42 
U.S.C 1437f) because of the status of the prospective tenant as 
such a participant: Provided further, That in addition to the eligible 
uses in section 2301, the Secretary may also use up to 10 percent 
of the funds provided under this heading for grantees for the 
provision of capacity building of and support for local communities 
receiving funding under section 2301 of the Act or under this 
heading: Provided further, That in administering funds appro-
priated or otherwise made available under this section, the Sec-
retary may waive or specify alternative requirements for any provi-
sion of any statute or regulation in connection with the obligation 
by the Secretary or the use of funds except for requirements related 
to fair housing, nondiscrimination, labor standards and the environ-
ment, upon a finding that such a waiver is necessary to expedite 
or facilitate the use of such funds: Provided further, That in the 
case of any acquisition of a foreclosed upon dwelling or residential 
real property acquired after the date of enactment with any amounts 
made available under this heading or under division B, title III 
of the Housing and Economic Recovery Act of 2008 (Public Law 
110–289), the initial successor in interest in such property pursuant 
to the foreclosure shall assume such interest subject to: (1) the 
provision by such successor in interest of a notice to vacate to 
any bona fide tenant at least 90 days before the effective date 
of such notice; and (2) the rights of any bona fide tenant, as 
of the date of such notice of foreclosure: (A) under any bona fide 
lease entered into before the notice of foreclosure to occupy the 
premises until the end of the remaining term of the lease, except 
that a successor in interest may terminate a lease effective on
H. R. 1—105 
the date of sale of the unit to a purchaser who will occupy the 
unit as a primary residence, subject to the receipt by the tenant 
of the 90-day notice under this paragraph; or (B) without a lease 
or with a lease terminable at will under State law, subject to 
the receipt by the tenant of the 90-day notice under this paragraph, 
except that nothing in this paragraph shall affect the requirements 
for termination of any Federal- or State-subsidized tenancy or of 
any State or local law that provides longer time periods or other 
additional protections for tenants: Provided further, That, for pur-
poses of this paragraph, a lease or tenancy shall be considered 
bona fide only if: (1) the mortgagor under the contract is not 
the tenant; (2) the lease or tenancy was the result of an arms- 
length transaction; and (3) the lease or tenancy requires the receipt 
of rent that is not substantially less than fair market rent for 
the property: Provided further, That the recipient of any grant 
or loan from amounts made available under this heading or, after 
the date of enactment, under division B, title III of the Housing 
and Economic Recovery Act of 2008 (Public Law 110–289) may 
not refuse to lease a dwelling unit in housing assisted with such 
loan or grant to a holder of a voucher or certificate of eligibility 
under section 8 of the United States Housing Act of 1937 (42 
U.S.C. 1437f) because of the status of the prospective tenant as 
such a holder: Provided further, That in the case of any qualified 
foreclosed housing for which funds made available under this 
heading or, after the date of enactment, under division B, title 
III of the Housing and Economic Recovery Act of 2008 (Public 
Law 110–289) are used and in which a recipient of assistance 
under section 8(o) of the U.S. Housing Act of 1937 resides at 
the time of foreclosure, the initial successor in interest shall be 
subject to the lease and to the housing assistance payments contract 
for the occupied unit: Provided further, That vacating the property 
prior to sale shall not constitute good cause for termination of 
the tenancy unless the property is unmarketable while occupied 
or unless the owner or subsequent purchaser desires the unit for 
personal or family use: Provided further, That if a public housing 
agency is unable to make payments under the contract to the 
immediate successor in interest after foreclosures, due to (1) an 
action or inaction by the successor in interest, including the rejec-
tion of payments or the failure of the successor to maintain the 
unit in compliance with section 8(o)(8) of the United States Housing 
Act of 1937 (42 U.S.C.1437f) or (2) an inability to identify the 
successor, the agency may use funds that would have been used 
to pay the rental amount on behalf of the family—(i) to pay for 
utilities that are the responsibility of the owner under the lease 
or applicable law, after taking reasonable steps to notify the owner 
that it intends to make payments to a utility provider in lieu 
of payments to the owner, except prior notification shall not be 
required in any case in which the unit will be or has been rendered 
uninhabitable due to the termination or threat of termination of 
service, in which case the public housing agency shall notify the 
owner within a reasonable time after making such payment; or 
(ii) for the family’s reasonable moving costs, including security 
deposit costs: Provided further, That this paragraph shall not pre-
empt any Federal, State or local law that provides more protections 
for tenants: Provided further, That of the funds made available 
under this heading, up to 1 percent shall be available for staffing, 
training, technical assistance, technology, monitoring, travel,
H. R. 1—106 
enforcement, research and evaluation activities: Provided further, 
That funds set aside in the previous proviso shall remain available 
until September 30, 2012: Provided further, That any funds made 
available under this heading used by the Secretary for personnel 
expenses related to administering funding under this heading shall 
be transferred to ‘‘Personnel Compensation and Benefits, Commu-
nity Planning and Development’’ and shall retain the terms and 
conditions of this account, including reprogramming provisions, 
except that the period of availability set forth in the previous 
proviso shall govern such transferred funds: Provided further, That 
any funds made available under this heading used by the Secretary 
for training or other administrative expenses shall be transferred 
to ‘‘Administration, Operations, and Management’’ for non-per-
sonnel expenses of the Department of Housing and Urban Develop-
ment: Provided further, That any funds made available under this 
heading used by the Secretary for technology shall be transferred 
to ‘‘Working Capital Fund’’. 
HOME INVESTMENT PARTNERSHIPS PROGRAM 
For an additional amount for capital investments in low-income 
housing tax credit projects, $2,250,000,000, to remain available 
until September 30, 2011: Provided, That such funds shall be made 
available to State housing credit agencies, as defined in section 
42(h) of the Internal Revenue Code of 1986, and shall be apportioned 
among the States based on the percentage of HOME funds appor-
tioned to each State and the participating jurisdictions therein 
for Fiscal Year 2008: Provided further, That the housing credit 
agencies in each State shall distribute these funds competitively 
under this heading and pursuant to their qualified allocation plan 
(as defined in section 42(m) of the Internal Revenue Code of 1986) 
to owners of projects who have received or receive simultaneously 
an award of low-income housing tax credits under section 42(h) 
of the Internal Revenue Code of 1986: Provided further, That 
housing credit agencies in each State shall commit not less than 
75 percent of such funds within one year of the date of enactment 
of this Act, and shall demonstrate that the project owners shall 
have expended 75 percent of the funds made available under this 
heading within two years of the date of enactment of this Act, 
and shall have expended 100 percent of the funds within 3 years 
of the date of enactment of this Act: Provided further, That failure 
by an owner to expend funds within the parameters required within 
the previous proviso shall result in a redistribution of these funds 
by a housing credit agency to a more deserving project in such 
State, except any funds not expended after 3 years from enactment 
shall be redistributed by the Secretary to other States that have 
fully utilized the funds made available to them: Provided further, 
That projects awarded low income housing tax credits under section 
42(h) of the IRC of 1986 in fiscal years 2007, 2008, or 2009 shall 
be eligible for funding under this heading: Provided further, That 
housing credit agencies shall give priority to projects that are 
expected to be completed within 3 years of enactment: Provided 
further, That any assistance provided to an eligible low income 
housing tax credit project under this heading shall be made in 
the same manner and be subject to the same limitations (including 
rent, income, and use restrictions, in lieu of corresponding limita-
tions under the HOME program) as required by the state housing
H. R. 1—107 
credit agency with respect to an award of low income housing 
credits under section 42 of the IRC of 1986: Provided further, 
That the housing credit agency shall perform asset management 
functions, or shall contract for the performance of such services, 
in either case, at the owner’s expense, to ensure compliance with 
section 42 of the IRC of 1986, and the long term viability of 
buildings funded by assistance under this heading: Provided further, 
That the term eligible basis (as such term is defined in such 
section 42) of a qualified low-income housing tax credit building 
receiving assistance under this heading shall not be reduced by 
the amount of any grant described under this heading: Provided 
further, That the Secretary shall be given access upon reasonable 
notice to a State housing credit agency to information related to 
the award of Federal funds from such housing credit agency pursu-
ant to this heading and shall establish an Internet site that shall 
identify all projects selected for an award, including the amount 
of the award and such site shall provide linkage to the housing 
credit agency allocation plan which describes the process that was 
used to make the award decision: Provided further, That in admin-
istering funds under this heading, the Secretary may waive any 
provision of any statute or regulation that the Secretary administers 
in connection with the obligation by the Secretary or the use by 
the recipient of these funds except for requirements imposed by 
this heading and requirements related to fair housing, non-discrimi-
nation, labor standards and the environment, upon a finding that 
such waiver is required to expedite the use of such funds: Provided 
further, That for purposes of environmental compliance review, 
funds under this heading that are made available to State housing 
credit agencies for distribution to projects awarded low income 
housing tax credits shall be treated as funds under the HOME 
program and shall be subject to Section 288 of the HOME Invest-
ment Partnership Act. 
HOMELESSNESS PREVENTION FUND 
For homelessness prevention and rapid re-housing activities, 
$1,500,000,000, to remain available until September 30, 2011: Pro-
vided, That funds provided under this heading shall be used for 
the provision of short-term or medium-term rental assistance; 
housing relocation and stabilization services including housing 
search, mediation or outreach to property owners, credit repair, 
security or utility deposits, utility payments, rental assistance for 
a final month at a location, moving cost assistance, and case 
management; or other appropriate activities for homelessness 
prevention and rapid re-housing of persons who have become home-
less: Provided further, That grantees receiving such assistance shall 
collect data on the use of the funds awarded and persons served 
with this assistance in the HUD Homeless Management Information 
System (‘‘HMIS’’) or other comparable database: Provided further, 
That grantees may use up to 5 percent of any grant for administra-
tive costs: Provided further, That funding made available under 
this heading shall be allocated to eligible grantees (as defined 
and designated in sections 411 and 412 of subtitle B of title IV 
of the McKinney-Vento Homeless Assistance Act, (the ‘‘Act’’)) pursu-
ant to the formula authorized by section 413 of the Act: Provided 
further, That the Secretary may establish a minimum grant size: 
Provided further, That grantees shall expend at least 60 percent
H. R. 1—108 
of funds within 2 years of the date that funds became available 
to them for obligation, and 100 percent of funds within 3 years 
of such date, and the Secretary may recapture unexpended funds 
in violation of the 2-year expenditure requirement and reallocate 
such funds to grantees in compliance with that requirement: Pro-
vided further, That the Secretary may waive statutory or regulatory 
provisions (except provisions for fair housing, nondiscrimination, 
labor standards, and the environment) necessary to facilitate the 
timely expenditure of funds: Provided further, That the Secretary 
shall publish a notice to establish such requirements as may be 
necessary to carry out the provisions of this section within 30 
days of enactment of this Act and that this notice shall take effect 
upon issuance: Provided further, That of the funds provided under 
this heading, up to .5 percent shall be available for staffing, 
training, technical assistance, technology, monitoring, research and 
evaluation activities: Provided further, That funds set aside under 
the previous proviso shall remain available until September 30, 
2012: Provided further, That any funds made available under this 
heading used by the Secretary for personnel expenses related to 
administering funding under this heading shall be transferred to 
‘‘Community Planning and Development Personnel Compensation 
and Benefits’’ and shall retain the terms and conditions of this 
account including reprogramming provisions except that the period 
of availability set forth in the previous proviso shall govern such 
transferred funds: Provided further, That any funds made available 
under this heading used by the Secretary for training or other 
administrative expenses shall be transferred to ‘‘Administration, 
Operations, and Management’’ for non-personnel expenses of the 
Department of Housing and Urban Development: Provided further, 
That any funding made available under this heading used by the 
Secretary for technology shall be transferred to ‘‘Working Capital 
Fund.’’ 
HOUSING PROGRAMS 
ASSISTED HOUSING STABILITY AND ENERGY AND GREEN RETROFIT 
INVESTMENTS 
For assistance to owners of properties receiving project-based 
assistance pursuant to section 202 of the Housing Act of 1959 
(12 U.S.C. 17012), section 811 of the Cranston-Gonzalez National 
Affordable Housing Act (42 U.S.C. 8013), or section 8 of the United 
States Housing Act of 1937 as amended (42 U.S.C. 1437f), 
$2,250,000,000, of which $2,000,000,000 shall be for an additional 
amount for paragraph (1) under the heading ‘‘Project-Based Rental 
Assistance’’ in Public Law 110–161 for payments to owners for 
12-month periods, and of which $250,000,000 shall be for grants 
or loans for energy retrofit and green investments in such assisted 
housing: Provided, That projects funded with grants or loans pro-
vided under this heading must comply with the requirements of 
subchapter IV of chapter 31 of title 40, United States Code: Provided 
further, That such grants or loans shall be provided through the 
policies, procedures, contracts, and transactional infrastructure of 
the authorized programs administered by the Office of Affordable 
Housing Preservation of the Department of Housing and Urban 
Development, on such terms and conditions as the Secretary of 
Housing and Urban Development deems appropriate to ensure the
H. R. 1—109 
maintenance and preservation of the property, the continued oper-
ation and maintenance of energy efficiency technologies, and the 
timely expenditure of funds: Provided further, That the Secretary 
may provide incentives to owners to undertake energy or green 
retrofits as a part of such grant or loan terms, including, but 
not limited to, fees to cover investment oversight and implementa-
tion by said owner, or to encourage job creation for low-income 
or very low-income individuals: Provided further, That the Secretary 
may share in a portion of future property utility savings resulting 
from improvements made by grants or loans made available under 
this heading: Provided further, That the grants or loans shall 
include a financial assessment and physical inspection of such prop-
erty: Provided further, That eligible owners must have at least 
a satisfactory management review rating, be in substantial compli-
ance with applicable performance standards and legal requirements, 
and commit to an additional period of affordability determined 
by the Secretary, but of not fewer than 15 years: Provided further, 
That the Secretary shall undertake appropriate underwriting and 
oversight with respect to grant and loan transactions and may 
set aside up to 5 percent of the funds made available under this 
heading for grants or loans for such purpose: Provided further, 
That the Secretary shall take steps necessary to ensure that owners 
receiving funding for energy and green retrofit investments under 
this heading shall expend such funding within 2 years of the date 
they received the funding: Provided further, That in administering 
funds appropriated or otherwise made available under this heading, 
the Secretary may waive or specify alternative requirements for 
any provision of any statute or regulation in connection with the 
obligation by the Secretary or the use of these funds (except for 
requirements related to fair housing, nondiscrimination, labor 
standards, and the environment), upon a finding that such a waiver 
is necessary to expedite or facilitate the use of such funds: Provided 
further, That of the funds provided under this heading for grants 
and loans, up to 1 percent shall be available for staffing, training, 
technical assistance, technology, monitoring, research and evalua-
tion activities: Provided further, That funds set aside in the previous 
proviso shall remain available until September 30, 2012: Provided 
further, That funding made available under this heading and used 
by the Secretary for personnel expenses related to administering 
funding under this heading shall be transferred to ‘‘Housing Per-
sonnel Compensation and Benefits’’ and shall retain the terms 
and conditions of this account including reprogramming provisos 
except that the period of availability set forth in the previous 
proviso shall govern such transferred funds: Provided further, That 
any funding made available under this heading used by the Sec-
retary for training and other administrative expenses shall be trans-
ferred to ‘‘Administration, Operations and Management’’ for non- 
personnel expenses of the Department of Housing and Urban 
Development: Provided further, That any funding made available 
under this heading used by the Secretary for technology shall 
be transferred to ‘‘Working Capital Fund.’’ 
OFFICE OF LEAD HAZARD CONTROL AND HEALTHY HOMES 
For an additional amount for the ‘‘Lead Hazard Reduction 
Program’’, as authorized by section 1011 of the Residential Lead- 
Based Paint Hazard Reduction Act of 1992, and by sections 501
H. R. 1—110 
and 502 of the Housing and Urban Development Act of 1974, 
$100,000,000, to remain available until September 30, 2011: Pro-
vided, That for purposes of environmental review, pursuant to 
the National Environmental Policy Act of 1969 (42 U.S.C. 4321 
et seq.) and other provisions of law that further the purposes 
of such Act, a grant under the Healthy Homes Initiative, Operation 
Lead Elimination Action Plan (LEAP), or the Lead Technical 
Studies program under this heading or under prior appropriations 
Acts for such purposes under this heading, shall be considered 
to be funds for a special project for purposes of section 305(e) 
of the Multifamily Housing Property Disposition Reform Act of 
1994: Provided further, That funds shall be awarded first to 
applicants which had applied under the Lead Hazard Reduction 
Program Notices of Funding Availability for fiscal year 2008, and 
were found in the application review to be qualified for award, 
but were not awarded because of funding limitations, and that 
any funds which remain after reservation of funds for such grants 
shall be added to the amount of funds to be awarded under the 
Lead Hazard Reduction Program Notices of Funding Availability 
for fiscal year 2009: Provided further, That each applicant for the 
Lead Hazard Program Notices of Funding Availability for fiscal 
year 2009 shall submit a detailed plan and strategy that dem-
onstrates adequate capacity that is acceptable to the Secretary 
to carry out the proposed use of funds: Provided further, That 
recipients of funds under this heading shall expend at least 50 
percent of such funds within 2 years of the date on which funds 
become available to such jurisdictions for obligation, and expend 
100 percent of such funds within 3 years of such date: Provided 
further, That if a recipient fails to comply with the 2-year expendi-
ture requirement, the Secretary shall recapture all remaining funds 
awarded to the recipient and reallocate such funds to recipients 
that are in compliance with those requirements: Provided further, 
That if a recipient fails to comply with the 3-year expenditure 
requirement, the Secretary shall recapture the balance of the funds 
awarded to the recipient: Provided further, That in administering 
funds appropriated or otherwise made available under this heading, 
the Secretary may waive or specify alternative requirements for 
any provision of any statute or regulation in connection with the 
obligation by the Secretary or the use of these funds (except for 
requirements related to fair housing, nondiscrimination, labor 
standards and the environment), upon a finding that such a waiver 
is necessary to expedite or facilitate the use of such funds: Provided 
further, That of the funds made available under this heading, 
up to .5 percent shall be available for staffing, training, technical 
assistance, technology, monitoring, travel, enforcement, research 
and evaluation activities: Provided further, That funds set aside 
in the previous proviso shall remain available until September 
30, 2012: Provided further, That any funds made available under 
this heading used by the Secretary for personnel expenses related 
to administering funding under this heading shall be transferred 
to ‘‘Personnel Compensation and Benefits, Office of Lead Hazard 
Control and Healthy Homes’’ and shall retain the terms and condi-
tions of this account, including reprogramming provisions, except 
that the period of availability set forth in the previous proviso 
shall govern such transferred funds: Provided further, That any 
funds made available under this heading used by the Secretary 
for training or other administrative expenses shall be transferred
H. R. 1—111 
to ‘‘Administration, Operations, and Management’’, for non-per-
sonnel expenses of the Department of Housing and Urban Develop-
ment: Provided further, That any funds made available under this 
heading used by the Secretary for technology shall be transferred 
to ‘‘Working Capital Fund’’. 
MANAGEMENT AND ADMINISTRATION 
OFFICE OF INSPECTOR GENERAL 
For an additional amount for the necessary salaries and 
expenses of the Office of Inspector General in carrying out the 
Inspector General Act of 1978, as amended, $15,000,000, to remain 
available until September 30, 2013: Provided, That the Inspector 
General shall have independent authority over all personnel issues 
within this office. 
GENERAL PROVISIONS—DEPARTMENT OF HOUSING AND 
URBAN DEVELOPMENT 
SEC. 1202. FHA LOAN LIMITS FOR 2009. (a) LOAN LIMIT FLOOR 
BASED ON 2008 LEVELS.—For mortgages for which the mortgagee 
issues credit approval for the borrower during calendar year 2009, 
if the dollar amount limitation on the principal obligation of a 
mortgage determined under section 203(b)(2) of the National 
Housing Act (12 U.S.C. 1709(b)(2)) for any size residence for any 
area is less than such dollar amount limitation that was in effect 
for such size residence for such area for 2008 pursuant to section 
202 of the Economic Stimulus Act of 2008 (Public Law 110–185; 
122 Stat. 620), notwithstanding any other provision of law, the 
maximum dollar amount limitation on the principal obligation of 
a mortgage for such size residence for such area for purposes 
of such section 203(b)(2) shall be considered (except for purposes 
of section 255(g) of such Act (12 U.S.C. 1715z–20(g))) to be such 
dollar amount limitation in effect for such size residence for such 
area for 2008. 
(b) DISCRETIONARY
AUTHORITY
FOR
SUB-AREAS.—Notwith-
standing any other provision of law, if the Secretary of Housing 
and Urban Development determines, for any geographic area that 
is smaller than an area for which dollar amount limitations on 
the principal obligation of a mortgage are determined under section 
203(b)(2) of the National Housing Act, that a higher such maximum 
dollar amount limitation is warranted for any particular size or 
sizes of residences in such sub-area by higher median home prices 
in such sub-area, the Secretary may, for mortgages for which the 
mortgagee issues credit approval for the borrower during calendar 
year 2009, increase the maximum dollar amount limitation for 
such size or sizes of residences for such sub-area that is otherwise 
in effect (including pursuant to subsection (a) of this section), but 
in no case to an amount that exceeds the amount specified in 
section 202(a)(2) of the Economic Stimulus Act of 2008. 
SEC. 1203. GSE CONFORMING LOAN LIMITS FOR 2009. (a) LOAN 
LIMIT FLOOR BASED ON 2008 LEVELS.—For mortgages originated 
during calendar year 2009, if the limitation on the maximum 
original principal obligation of a mortgage that may be purchased 
by the Federal National Mortgage Association or the Federal Home 
Loan Mortgage Corporation determined under section 302(b)(2) of 
the Federal National Mortgage Association Charter Act (12 U.S.C.
H. R. 1—112 
1717(b)(2)) or section 305(a)(2) of the Federal Home Loan Mortgage 
Corporation Act (12 U.S.C. 1754(a)(2)), respectively, for any size 
residence for any area is less than such maximum original principal 
obligation limitation that was in effect for such size residence 
for such area for 2008 pursuant to section 201 of the Economic 
Stimulus Act of 2008 (Public Law 110–185; 122 Stat. 619), notwith-
standing any other provision of law, the limitation on the maximum 
original principal obligation of a mortgage for such Association 
and Corporation for such size residence for such area shall be 
such maximum limitation in effect for such size residence for such 
area for 2008. 
(b) DISCRETIONARY
AUTHORITY
FOR
SUB-AREAS.—Notwith-
standing any other provision of law, if the Director of the Federal 
Housing Finance Agency determines, for any geographic area that 
is smaller than an area for which limitations on the maximum 
original principal obligation of a mortgage are determined for the 
Federal National Mortgage Association or the Federal Home Loan 
Mortgage Corporation, that a higher such maximum original prin-
cipal obligation limitation is warranted for any particular size or 
sizes of residences in such sub-area by higher median home prices 
in such sub-area, the Director may, for mortgages originated during 
2009, increase the maximum original principal obligation limitation 
for such size or sizes of residences for such sub-area that is other-
wise in effect (including pursuant to subsection (a) of this section) 
for such Association and Corporation, but in no case to an amount 
that exceeds the amount specified in the matter following the 
comma in section 201(a)(1)(B) of the Economic Stimulus Act of 
2008. 
SEC. 1204. FHA REVERSE MORTGAGE LOAN LIMITS FOR 2009. 
For mortgages for which the mortgagee issues credit approval for 
the borrower during calendar year 2009, the second sentence of 
section 255(g) of the National Housing Act (12 U.S.C. 1715z–20(g)) 
shall be considered to require that in no case may the benefits 
of insurance under such section 255 exceed 150 percent of the 
maximum dollar amount in effect under the sixth sentence of section 
305(a)(2) of the Federal Home Loan Mortgage Corporation Act 
(12 U.S.C. 1454(a)(2)). 
TITLE XIII—HEALTH INFORMATION 
TECHNOLOGY 
SEC. 13001. SHORT TITLE; TABLE OF CONTENTS OF TITLE. 
(a) SHORT TITLE.—This title (and title IV of division B) 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 contents of 
this title is as follows: 
Sec. 13001. Short title; table of contents of title. 
Subtitle A—Promotion of Health Information Technology 
PART 1—IMPROVING HEALTH CARE QUALITY, SAFETY, AND EFFICIENCY 
Sec. 13101. ONCHIT; standards development and adoption. 
‘‘TITLE XXX—HEALTH INFORMATION TECHNOLOGY AND QUALITY 
‘‘Sec. 3000. Definitions.
H. R. 1—113 
‘‘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 ini-
tial set of standards, implementation specifications, and certification 
criteria. 
‘‘Sec. 3005. Application and use of adopted standards and implementation spec-
ifications by Federal agencies. 
‘‘Sec. 3006. Voluntary application and use of adopted standards and implemen-
tation specifications by private entities. 
‘‘Sec. 3007. Federal health information technology. 
‘‘Sec. 3008. Transitions. 
‘‘Sec. 3009. Miscellaneous provisions. 
Sec. 13102. Technical amendment. 
PART 2—APPLICATION AND USE OF ADOPTED HEALTH INFORMATION TECHNOLOGY 
STANDARDS; REPORTS 
Sec. 13111. Coordination of Federal activities with adopted standards and imple-
mentation specifications. 
Sec. 13112. Application to private entities. 
Sec. 13113. Study and reports. 
Subtitle B—Testing of Health Information Technology 
Sec. 13201. National Institute for Standards and Technology testing. 
Sec. 13202. Research and development programs. 
Subtitle C—Grants and Loans Funding 
Sec. 13301. Grant, loan, and demonstration programs. 
‘‘Subtitle B—Incentives for the Use of Health Information Technology 
‘‘Sec. 3011. Immediate funding to strengthen the health information technology 
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 development 
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 in health care. 
‘‘Sec. 3017. General grant and loan provisions. 
‘‘Sec. 3018. Authorization for appropriations. 
Subtitle D—Privacy 
Sec. 13400. Definitions. 
PART 1—IMPROVED PRIVACY PROVISIONS AND SECURITY PROVISIONS 
Sec. 13401. Application of security provisions and penalties to business associates 
of covered entities; annual guidance on security provisions. 
Sec. 13402. Notification in the case of breach. 
Sec. 13403. Education on health information privacy. 
Sec. 13404. Application of privacy provisions and penalties to business associates of 
covered entities. 
Sec. 13405. Restrictions on certain disclosures and sales of health information; ac-
counting of certain protected health information disclosures; access to 
certain information in electronic format. 
Sec. 13406. Conditions on certain contacts as part of health care operations. 
Sec. 13407. Temporary breach notification requirement for vendors of personal 
health records and other non-HIPAA covered entities. 
Sec. 13408. Business associate contracts required for certain entities. 
Sec. 13409. Clarification of application of wrongful disclosures criminal penalties. 
Sec. 13410. Improved enforcement. 
Sec. 13411. Audits. 
PART 2—RELATIONSHIP TO OTHER LAWS; REGULATORY REFERENCES; EFFECTIVE 
DATE; REPORTS 
Sec. 13421. Relationship to other laws.
H. R. 1—114 
Sec. 13422. Regulatory references. 
Sec. 13423. Effective date. 
Sec. 13424. Studies, reports, guidance. 
Subtitle A—Promotion of Health 
Information Technology 
PART 1—IMPROVING HEALTH CARE QUALITY, 
SAFETY, AND EFFICIENCY 
SEC. 13101. ONCHIT; STANDARDS DEVELOPMENT AND ADOPTION. 
The Public Health Service Act (42 U.S.C. 201 et seq.) is 
amended by adding at the end the following: 
‘‘TITLE XXX—HEALTH INFORMATION 
TECHNOLOGY AND QUALITY 
‘‘SEC. 3000. DEFINITIONS. 
‘‘In this title: 
‘‘(1) CERTIFIED EHR TECHNOLOGY.—The term ‘certified EHR 
technology’ means a qualified electronic health record that is 
certified pursuant to section 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 physi-
cians or an inpatient hospital electronic health record for hos-
pitals). 
‘‘(2) 
ENTERPRISE
INTEGRATION.—The 
term 
‘enterprise 
integration’ means the electronic linkage of health care pro-
viders, health plans, the government, and other interested par-
ties, to enable the electronic exchange and use of health 
information among all the components in the health care infra-
structure in accordance with applicable law, and such term 
includes related application protocols and other related stand-
ards. 
‘‘(3) HEALTH CARE PROVIDER.—The term ‘health care pro-
vider’ includes a hospital, skilled nursing facility, nursing 
facility, home health entity or other long term care facility, 
health care clinic, community mental health center (as defined 
in section 1913(b)(1)), renal dialysis facility, blood center, 
ambulatory surgical center described in section 1833(i) of the 
Social Security Act, emergency medical services provider, Feder-
ally qualified health center, group practice, 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-Determina-
tion and Education Assistance Act), tribal organization, or 
urban Indian organization (as defined in section 4 of the Indian 
Health Care Improvement Act), a rural health clinic, a covered 
entity under section 340B, an ambulatory surgical center 
described in section 1833(i) of the Social Security Act, a thera-
pist (as defined in section 1848(k)(3)(B)(iii) of the Social Security 
Act), and any other category of health care facility, entity,
H. R. 1—115 
practitioner, or clinician determined appropriate by the Sec-
retary. 
‘‘(4) HEALTH INFORMATION.—The term ‘health information’ 
has the meaning given such term in section 1171(4) of the 
Social Security Act. 
‘‘(5) HEALTH INFORMATION TECHNOLOGY.—The term ‘health 
information technology’ means hardware, software, integrated 
technologies or related licenses, intellectual property, upgrades, 
or packaged solutions sold as services that are designed for 
or support the use by health care entities or patients for the 
electronic creation, maintenance, access, 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 Com-
mittee’ 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
INFORMATION.— 
The term ‘individually identifiable health information’ has the 
meaning given such term in section 1171(6) of the Social Secu-
rity Act. 
‘‘(10) LABORATORY.—The term ‘laboratory’ has the meaning 
given such term in section 353(a). 
‘‘(11) NATIONAL COORDINATOR.—The term ‘National Coordi-
nator’ means the head of the Office of the National Coordinator 
for Health Information Technology 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 history and problem lists; 
and 
‘‘(B) has the capacity— 
‘‘(i) to provide clinical decision support; 
‘‘(ii) to support physician order entry; 
‘‘(iii) to capture and query information relevant 
to health care quality; and 
‘‘(iv) to exchange electronic health information 
with, and integrate such information from other 
sources. 
‘‘(14) STATE.—The term ‘State’ means each of the several 
States, the District of Columbia, Puerto Rico, the Virgin Islands, 
Guam, American Samoa, and the Northern Mariana Islands.
H. R. 1—116 
‘‘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 Depart-
ment of Health and Human Services an Office of the National 
Coordinator for Health Information Technology (referred to in this 
section as the ‘Office’). The Office shall be headed by a National 
Coordinator who shall be appointed by the Secretary and shall 
report directly to the Secretary. 
‘‘(b) PURPOSE.—The National Coordinator shall perform the 
duties under subsection (c) in a manner consistent with the develop-
ment 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 information is secure 
and protected, in accordance with applicable law; 
‘‘(2) improves health care quality, reduces medical errors, 
reduces health disparities, and advances the delivery of patient- 
centered medical care; 
‘‘(3) reduces health care costs resulting from inefficiency, 
medical errors, inappropriate care, duplicative care, and incom-
plete 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 information 
among hospitals, laboratories, physician offices, and other enti-
ties through an effective infrastructure for the secure and 
authorized exchange of health care information; 
‘‘(7) improves public health activities and facilitates the 
early identification and rapid response to public health threats 
and emergencies, including bioterror events and infectious dis-
ease outbreaks; 
‘‘(8) facilitates health and clinical research and health care 
quality; 
‘‘(9) promotes early detection, prevention, and management 
of chronic diseases; 
‘‘(10) promotes a more effective marketplace, greater com-
petition, greater systems analysis, increased consumer choice, 
and improved outcomes in health care services; and 
‘‘(11) improves efforts to reduce health disparities. 
‘‘(c) DUTIES OF THE NATIONAL COORDINATOR.— 
‘‘(1) STANDARDS.—The National Coordinator shall— 
‘‘(A) review and determine whether to endorse each 
standard, implementation specification, and certification 
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; 
‘‘(B) make such determinations under subparagraph 
(A), and report to the Secretary such determinations, not 
later than 45 days after the date the recommendation 
is received by the Coordinator; and
H. R. 1—117 
‘‘(C) review Federal health information technology 
investments to ensure that Federal health information 
technology programs are meeting the objectives of the stra-
tegic plan published under paragraph (3). 
‘‘(2) HIT POLICY COORDINATION.— 
‘‘(A) IN
GENERAL.—The National Coordinator shall 
coordinate health information technology policy and pro-
grams of the Department with those of other relevant 
executive branch agencies with a goal of avoiding duplica-
tion of efforts and of helping to ensure that each agency 
undertakes health information technology activities pri-
marily within the areas of its greatest expertise and tech-
nical capability and in a manner towards a coordinated 
national goal. 
‘‘(B) HIT POLICY AND STANDARDS COMMITTEES.—The 
National Coordinator shall be a leading member in the 
establishment and operations 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 Coordinator shall, in 
consultation with other appropriate Federal agencies 
(including the National Institute of Standards and Tech-
nology), update the Federal Health IT Strategic Plan (devel-
oped as of June 3, 2008) to include specific objectives, 
milestones, and metrics with respect to the following: 
‘‘(i) The electronic exchange and use of health 
information and the enterprise integration 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 individ-
ual’s individually identifiable health information. 
‘‘(iv) Ensuring security methods to ensure appro-
priate authorization and electronic authentication of 
health information and specifying technologies or 
methodologies for rendering health information unus-
able, unreadable, or indecipherable. 
‘‘(v) Specifying a framework for coordination and 
flow of recommendations and policies under this sub-
title among the Secretary, the National Coordinator, 
the HIT Policy Committee, the HIT Standards Com-
mittee, and other health information exchanges and 
other relevant entities. 
‘‘(vi) Methods to foster the public understanding 
of health information technology. 
‘‘(vii) Strategies to enhance the use of health 
information technology in improving the quality of 
health care, reducing medical errors, reducing health 
disparities, improving public health, increasing preven-
tion and coordination with community resources, and 
improving the continuity of care among health care 
settings. 
‘‘(viii) Specific plans for ensuring that populations 
with unique needs, such as children, are appropriately
H. R. 1—118 
addressed in the technology design, as appropriate, 
which may include technology that automates enroll-
ment and retention for eligible individuals. 
‘‘(B) COLLABORATION.—The strategic plan shall be 
updated through collaboration of public and private enti-
ties. 
‘‘(C) MEASURABLE OUTCOME GOALS.—The strategic plan 
update shall include measurable outcome goals. 
‘‘(D) PUBLICATION.—The National Coordinator shall 
republish the strategic plan, including 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, rec-
ommendations, and other information to ensure transparency 
in promotion of a nationwide health information technology 
infrastructure. 
‘‘(5) CERTIFICATION.— 
‘‘(A) IN GENERAL.—The National Coordinator, in con-
sultation with the Director of the National Institute of 
Standards and Technology, shall keep or recognize a pro-
gram or programs for the voluntary certification of health 
information technology as being in compliance with 
applicable certification criteria adopted under this subtitle. 
Such program shall include, as appropriate, testing of the 
technology in accordance with section 13201(b) of the 
Health Information Technology for Economic and Clinical 
Health Act. 
‘‘(B) CERTIFICATION CRITERIA DESCRIBED.—In this title, 
the term ‘certification criteria’ means, with respect to stand-
ards and implementation specifications for health informa-
tion technology, criteria to establish that the technology 
meets such standards and implementation 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 appropriate 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, implementa-
tion specifications, and certification criteria, or to achieve 
full participation of stakeholders in the adoption of a 
nationwide health information technology infrastructure 
that allows for the electronic use and exchange of health 
information. 
‘‘(B) IMPLEMENTATION REPORT.—The National Coordi-
nator shall prepare a report that identifies lessons learned 
from major public and private health care systems in their 
implementation of health information technology, including 
information on whether the technologies and practices 
developed by such systems may be applicable 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 
Coordinator shall assess and publish the impact of health
H. R. 1—119 
information technology in communities with health dispari-
ties and in areas with a high proportion of individuals 
who are uninsured, underinsured, and medically under-
served individuals (including urban and rural areas) and 
identify practices to increase the adoption of such tech-
nology by health care providers in such communities, and 
the use of health information technology to reduce and 
better manage chronic diseases. 
‘‘(D) EVALUATION OF BENEFITS AND COSTS OF THE ELEC-
TRONIC
USE
AND
EXCHANGE
OF
HEALTH
INFORMATION.— 
The National Coordinator shall evaluate and publish evi-
dence on the benefits and costs of the electronic use and 
exchange of health information and assess to whom these 
benefits and costs accrue. 
‘‘(E) RESOURCE REQUIREMENTS.—The National Coordi-
nator shall estimate and publish resources required 
annually to reach the goal of utilization of an electronic 
health record for each person in the United States by 
2014, including— 
‘‘(i) the required level of Federal funding; 
‘‘(ii) expectations for regional, State, and private 
investment; 
‘‘(iii) the expected contributions by volunteers to 
activities for the utilization of such records; and 
‘‘(iv) the resources needed to establish a health 
information technology workforce sufficient to support 
this effort (including education programs in medical 
informatics and health information management). 
‘‘(7) ASSISTANCE.—The National Coordinator may provide 
financial assistance to consumer advocacy 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 INFORMATION 
NETWORK.—The National Coordinator shall establish a govern-
ance mechanism for the nationwide health information network. 
‘‘(d) DETAIL OF FEDERAL EMPLOYEES.— 
‘‘(1) IN GENERAL.—Upon the request of the National Coordi-
nator, the head of any Federal agency is 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 personnel 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 Coordinator. 
‘‘(3) ACCEPTANCE
OF
DETAILEES.—Notwithstanding 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
H. R. 1—120 
shall be to advise the National Coordinator on privacy, security, 
and data stewardship of electronic health information and to coordi-
nate with other Federal agencies (and similar privacy officers in 
such agencies), 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 Com-
mittee 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
INFORMATION
TECH-
NOLOGY
INFRASTRUCTURE.—The HIT Policy Committee shall 
recommend a policy framework for the development and adop-
tion of a nationwide health information technology infrastruc-
ture that permits the electronic exchange and use of health 
information as is consistent with the strategic plan under sec-
tion 3001(c)(3) and that includes the recommendations under 
paragraph (2). The Committee shall update such recommenda-
tions and make new recommendations as appropriate. 
‘‘(2) SPECIFIC AREAS OF STANDARD DEVELOPMENT.— 
‘‘(A) IN GENERAL.—The HIT Policy Committee 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 development, harmonization, 
and recognition of such standards, specifications, and cer-
tification criteria 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 information and other information as needed to 
ensure the reproducible development of common solutions 
across disparate entities. 
‘‘(B) AREAS REQUIRED FOR CONSIDERATION.—For pur-
poses of subparagraph (A), the HIT Policy Committee shall 
make recommendations for at least the following areas: 
‘‘(i) Technologies that protect the privacy of health 
information and promote security in a qualified elec-
tronic health record, including for the segmentation 
and protection from disclosure of specific and sensitive 
individually identifiable health information with the 
goal of minimizing the reluctance of patients to seek 
care (or disclose information about a condition) because 
of privacy concerns, in accordance with applicable law, 
and for the use and disclosure of limited data sets 
of such information. 
‘‘(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.
H. R. 1—121 
‘‘(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 Account-
ability Act of 1996) for purposes 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 pro-
moting the coordination of health care and improving 
continuity of health care among health care providers, 
by reducing medical errors, by improving population 
health, by reducing health disparities, by reducing 
chronic disease, and by advancing research and edu-
cation. 
‘‘(vi) Technologies that allow individually identifi-
able health information to be rendered unusable, 
unreadable, or indecipherable to unauthorized individ-
uals when such information is transmitted in the 
nationwide health information network or physically 
transported outside of the secured, physical perimeter 
of a health care provider, health plan, or health care 
clearinghouse. 
‘‘(vii) The use of electronic systems to ensure the 
comprehensive collection of patient demographic data, 
including, at a minimum, race, ethnicity, primary lan-
guage, and gender information. 
‘‘(viii) Technologies that address the needs of chil-
dren and other vulnerable populations. 
‘‘(C) OTHER
AREAS
FOR
CONSIDERATION.—In making 
recommendations under subparagraph (A), the HIT Policy 
Committee may consider the following additional areas: 
‘‘(i) The appropriate uses of a nationwide health 
information infrastructure, including for purposes of— 
‘‘(I) the collection of quality data and public 
reporting; 
‘‘(II) biosurveillance and public health; 
‘‘(III) medical and clinical research; and 
‘‘(IV) drug safety. 
‘‘(ii) Self-service technologies that facilitate the use 
and exchange of patient information and reduce wait 
times. 
‘‘(iii) Telemedicine technologies, in order to reduce 
travel requirements for patients in remote areas. 
‘‘(iv) Technologies that facilitate home health care 
and the monitoring of patients recuperating at home. 
‘‘(v) Technologies that help reduce medical errors. 
‘‘(vi) Technologies that facilitate the continuity of 
care among health settings. 
‘‘(vii) Technologies that meet the needs of diverse 
populations. 
‘‘(viii) Methods to facilitate secure access by an 
individual to such individual’s protected health 
information. 
‘‘(ix) Methods, guidelines, and safeguards to facili-
tate secure access to patient information by a family
H. R. 1—122 
member, caregiver, or guardian acting on behalf of 
a patient due to age-related and other disability, cog-
nitive impairment, or dementia. 
‘‘(x) Any other technology that the HIT Policy Com-
mittee finds to be among the technologies with the 
greatest potential to improve the quality and efficiency 
of health care. 
‘‘(3) FORUM.—The HIT Policy Committee shall serve as 
a forum for broad stakeholder input with specific expertise 
in policies relating to the matters described in paragraphs 
(1) and (2). 
‘‘(4) CONSISTENCY
WITH
EVALUATION
CONDUCTED
UNDER 
MIPPA.— 
‘‘(A) REQUIREMENT FOR CONSISTENCY.—The HIT Policy 
Committee shall ensure that recommendations made under 
paragraph (2)(B)(vi) are consistent with the evaluation con-
ducted under section 1809(a) of the Social Security Act. 
‘‘(B) SCOPE.—Nothing in subparagraph (A) shall be 
construed to limit the recommendations under paragraph 
(2)(B)(vi) to the elements described in section 1809(a)(3) 
of the Social Security Act. 
‘‘(C) TIMING.—The requirement under subparagraph 
(A) shall be applicable to the extent that evaluations have 
been conducted under section 1809(a) of the Social Security 
Act, regardless of whether the report described in sub-
section (b) of such section has been submitted. 
‘‘(c) MEMBERSHIP AND OPERATIONS.— 
‘‘(1) IN GENERAL.—The National Coordinator shall take a 
leading position in the establishment and operations of the 
HIT Policy Committee. 
‘‘(2) MEMBERSHIP.—The HIT Policy Committee shall be 
composed of members to be appointed as follows: 
‘‘(A) 3 members shall be appointed by the Secretary, 
1 of whom shall be appointed to represent the Department 
of Health and Human Services and 1 of whom shall be 
a public health official. 
‘‘(B) 1 member shall be appointed by the majority 
leader of the Senate. 
‘‘(C) 1 member shall be appointed by the minority 
leader of the Senate. 
‘‘(D) 1 member shall be appointed by the Speaker of 
the House of Representatives. 
‘‘(E) 1 member shall be appointed by the minority 
leader of the House of Representatives. 
‘‘(F) Such other members as shall be appointed by 
the President as representatives of other relevant Federal 
agencies. 
‘‘(G) 13 members shall be appointed by the Comptroller 
General of the United States of whom— 
‘‘(i) 3 members shall advocates for patients or con-
sumers; 
‘‘(ii) 2 members shall represent health care pro-
viders, one of which shall be a physician; 
‘‘(iii) 1 member shall be from a labor organization 
representing health care workers; 
‘‘(iv) 1 member shall have expertise in health 
information privacy and security;
H. R. 1—123 
‘‘(v) 1 member shall have expertise in improving 
the health of vulnerable populations; 
‘‘(vi) 1 member shall be from the research commu-
nity; 
‘‘(vii) 1 member shall represent health plans or 
other third-party payers; 
‘‘(viii) 1 member shall represent information tech-
nology vendors; 
‘‘(ix) 1 member shall represent purchasers or 
employers; and 
‘‘(x) 1 member shall have expertise in health care 
quality measurement and reporting. 
‘‘(3) PARTICIPATION.—The members of the HIT Policy Com-
mittee appointed under paragraph (2) shall represent a balance 
among various sectors of the health care system so that no 
single sector unduly influences the recommendations of the 
Policy Committee. 
‘‘(4) TERMS.— 
‘‘(A) IN GENERAL.—The terms of the members of the 
HIT Policy Committee shall be for 3 years, except that 
the Comptroller General shall designate staggered terms 
for the members first appointed. 
‘‘(B) VACANCIES.—Any member appointed to fill a 
vacancy in the membership of the HIT Policy Committee 
that occurs prior to the expiration of the term for which 
the member’s predecessor was appointed shall be appointed 
only for the remainder of that term. A member may serve 
after the expiration of that member’s term until a successor 
has been appointed. A vacancy in the HIT Policy Committee 
shall be filled in the manner in which the original appoint-
ment was made. 
‘‘(5) OUTSIDE INVOLVEMENT.—The HIT Policy Committee 
shall ensure an opportunity for the participation in activities 
of the Committee of outside advisors, including individuals 
with expertise in the development of policies for the electronic 
exchange and use of health information, including in the areas 
of health information privacy and security. 
‘‘(6) QUORUM.—A majority of the member of the HIT Policy 
Committee shall constitute a quorum for purposes of voting, 
but a lesser number of members may meet and hold hearings. 
‘‘(7) FAILURE
OF
INITIAL
APPOINTMENT.—If, on the date 
that is 45 days after the date of enactment of this title, an 
official authorized under paragraph (2) to appoint one or more 
members of the HIT Policy Committee has not appointed the 
full number of members that such paragraph authorizes such 
official to appoint, the Secretary is authorized to appoint such 
members. 
‘‘(8) CONSIDERATION.—The National Coordinator shall 
ensure that the relevant and available recommendations and 
comments from the National Committee on Vital and Health 
Statistics are considered in the development of policies. 
‘‘(d) APPLICATION OF FACA.—The Federal Advisory Committee 
Act (5 U.S.C. App.), other than section 14 of such Act, shall apply 
to the HIT Policy Committee. 
‘‘(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
H. R. 1—124 
Technology of all policy recommendations made by the HIT Policy 
Committee under this section. 
‘‘SEC. 3003. HIT STANDARDS COMMITTEE. 
‘‘(a) ESTABLISHMENT.—There is established a committee to be 
known as the HIT Standards Committee to recommend to the 
National Coordinator standards, implementation specifications, and 
certification criteria for the electronic exchange and use of health 
information for purposes of adoption under section 3004, consistent 
with the implementation of the strategic plan described in section 
3001(c)(3) and beginning with the areas listed in section 
3002(b)(2)(B) in accordance with policies developed by the HIT 
Policy Committee. 
‘‘(b) DUTIES.— 
‘‘(1) STANDARDS DEVELOPMENT.— 
‘‘(A) IN GENERAL.—The HIT Standards Committee shall 
recommend 
to 
the 
National 
Coordinator 
standards, 
implementation specifications, and certification criteria 
described in subsection (a) that have been developed, har-
monized, or recognized by the HIT Standards Committee. 
The HIT Standards Committee shall update such rec-
ommendations and make new recommendations as appro-
priate, including in response to a notification sent under 
section 3004(a)(2)(B). Such recommendations shall be con-
sistent with the latest recommendations made by the HIT 
Policy Committee. 
‘‘(B) HARMONIZATION.—The HIT Standards Committee 
recognize harmonized or updated standards from an entity 
or entities for the purpose of harmonizing or updating 
standards and implementation specifications in order to 
achieve uniform and consistent implementation of the 
standards and implementation specifications. 
‘‘(C) PILOT TESTING OF STANDARDS AND IMPLEMENTA-
TION SPECIFICATIONS.—In the development, harmonization, 
or recognition of standards and implementation specifica-
tions, the HIT Standards Committee shall, as appropriate, 
provide for the testing of such standards and specifications 
by the National Institute for Standards and Technology 
under section 13201(a) of the Health Information Tech-
nology for Economic and Clinical Health Act. 
‘‘(D) CONSISTENCY.—The standards, implementation 
specifications, and certification criteria recommended under 
this subsection shall be consistent with the standards for 
information transactions and data elements adopted pursu-
ant to section 1173 of the Social Security Act. 
‘‘(2) FORUM.—The HIT Standards Committee shall serve 
as a forum for the participation of a broad range of stakeholders 
to provide input on the development, harmonization, and rec-
ognition of standards, implementation specifications, and cer-
tification criteria necessary for the development and adoption 
of a nationwide health information technology infrastructure 
that allows for the electronic use and exchange of health 
information. 
‘‘(3) SCHEDULE.—Not later than 90 days after the date 
of the enactment of this title, the HIT Standards Committee 
shall develop a schedule for the assessment of policy rec-
ommendations developed by the HIT Policy Committee under
H. R. 1—125 
section 3002. The HIT Standards Committee shall update such 
schedule annually. The Secretary shall publish such schedule 
in the Federal Register. 
‘‘(4) PUBLIC INPUT.—The HIT Standards Committee shall 
conduct open public meetings and develop a process to allow 
for public comment on the schedule described in paragraph 
(3) and recommendations described in this subsection. Under 
such process comments shall be submitted in a timely manner 
after the date of publication of a recommendation under this 
subsection. 
‘‘(5) CONSIDERATION.—The National Coordinator shall 
ensure that the relevant and available recommendations and 
comments from the National Committee on Vital and Health 
Statistics are considered in the development of standards. 
‘‘(c) MEMBERSHIP AND OPERATIONS.— 
‘‘(1) IN GENERAL.—The National Coordinator shall take a 
leading position in the establishment and operations of the 
HIT Standards Committee. 
‘‘(2) MEMBERSHIP.—The membership of the HIT Standards 
Committee shall at least reflect providers, ancillary healthcare 
workers, consumers, purchasers, health plans, technology ven-
dors, researchers, relevant Federal agencies, and individuals 
with technical expertise on health care quality, privacy and 
security, and on the electronic exchange and use of health 
information. 
‘‘(3) PARTICIPATION.—The members of the HIT Standards 
Committee appointed under this subsection shall represent a 
balance among various sectors of the health care system so 
that no single sector unduly influences the recommendations 
of such Committee. 
‘‘(4) OUTSIDE INVOLVEMENT.—The HIT Policy Committee 
shall ensure an opportunity for the participation in activities 
of the Committee of outside advisors, including individuals 
with expertise in the development of standards for the electronic 
exchange and use of health information, including in the areas 
of health information privacy and security. 
‘‘(5) BALANCE AMONG SECTORS.—In developing the proce-
dures for conducting the activities of the HIT Standards Com-
mittee, the HIT Standards Committee shall act to ensure a 
balance among various sectors of the health care system so 
that no single sector unduly influences the actions of the HIT 
Standards Committee. 
‘‘(6) ASSISTANCE.—For the purposes of carrying out this 
section, the Secretary may provide or ensure that financial 
assistance is provided by the HIT Standards Committee to 
defray in whole or in part any membership fees or dues charged 
by such Committee to those consumer advocacy groups and 
not for profit entities that work in the public interest as a 
part of their mission. 
‘‘(d) APPLICATION OF FACA.—The Federal Advisory Committee 
Act (5 U.S.C. App.), other than section 14, shall apply to the 
HIT Standards Committee. 
‘‘(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 recommendations made by the HIT Standards 
Committee under this section.
H. R. 1—126 
‘‘SEC. 3004. PROCESS FOR ADOPTION OF ENDORSED RECOMMENDA-
TIONS; ADOPTION OF INITIAL SET OF STANDARDS, 
IMPLEMENTATION 
SPECIFICATIONS, 
AND 
CERTIFI-
CATION CRITERIA. 
‘‘(a) PROCESS
FOR
ADOPTION
OF
ENDORSED
RECOMMENDA-
TIONS.— 
‘‘(1) REVIEW
OF
ENDORSED
STANDARDS, IMPLEMENTATION 
SPECIFICATIONS, AND CERTIFICATION CRITERIA.—Not later than 
90 days after the date of receipt 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 stand-
ards, implementation specifications, or certification criteria and 
shall determine whether or not to propose adoption of such 
standards, implementation specifications, or certification cri-
teria. 
‘‘(2) DETERMINATION TO ADOPT STANDARDS, IMPLEMENTA-
TION SPECIFICATIONS, AND CERTIFICATION CRITERIA.—If the Sec-
retary determines— 
‘‘(A) to propose adoption of any grouping of such stand-
ards, implementation specifications, or certification criteria, 
the Secretary shall, by regulation under section 553 of 
title 5, United States Code, determine whether or not to 
adopt such grouping of standards, implementation speci-
fications, or certification criteria; or 
‘‘(B) not to propose adoption of any grouping of stand-
ards, implementation specifications, or certification criteria, 
the Secretary shall notify the National Coordinator and 
the HIT Standards Committee in writing of such deter-
mination and the reasons for not proposing the adoption 
of such recommendation. 
‘‘(3) PUBLICATION.—The Secretary shall provide for publica-
tion in the Federal Register of all determinations made by 
the Secretary under paragraph (1). 
‘‘(b) ADOPTION
OF STANDARDS, IMPLEMENTATION SPECIFICA-
TIONS, AND CERTIFICATION CRITERIA.— 
‘‘(1) IN GENERAL.—Not later than December 31, 2009, the 
Secretary shall, through the rulemaking process consistent with 
subsection (a)(2)(A), adopt an initial set of standards, 
implementation specifications, and certification criteria for the 
areas required for consideration under section 3002(b)(2)(B). 
The rulemaking for the initial set of standards, implementation 
specifications, and certification criteria may be issued on an 
interim, final basis. 
‘‘(2) APPLICATION OF CURRENT STANDARDS, IMPLEMENTATION 
SPECIFICATIONS, AND CERTIFICATION CRITERIA.—The standards, 
implementation specifications, and certification criteria adopted 
before the date of the enactment of this title through the 
process existing through the Office of the National Coordinator 
for Health Information Technology may be applied towards 
meeting the requirement of paragraph (1). 
‘‘(3) SUBSEQUENT
STANDARDS
ACTIVITY.—The Secretary 
shall adopt additional standards, implementation specifications, 
and certification criteria as necessary and consistent with the 
schedule published under section 3003(b)(2).
H. R. 1—127 
‘‘SEC. 3005. APPLICATION AND USE OF ADOPTED STANDARDS AND 
IMPLEMENTATION SPECIFICATIONS BY FEDERAL AGEN-
CIES. 
‘‘For requirements relating to the application and use by Fed-
eral agencies of the standards and implementation specifications 
adopted under section 3004, see section 13111 of the Health 
Information Technology for Economic and Clinical Health Act. 
‘‘SEC. 3006. VOLUNTARY APPLICATION AND USE OF ADOPTED STAND-
ARDS AND IMPLEMENTATION SPECIFICATIONS BY PRI-
VATE ENTITIES. 
‘‘(a) IN GENERAL.—Except as provided under section 13112 
of the HITECH Act, nothing in such Act or in the amendments 
made by such Act shall be construed— 
‘‘(1) to require a private entity to adopt or comply with 
a standard or implementation specification adopted under sec-
tion 3004; or 
‘‘(2) to provide a Federal agency authority, other than the 
authority such agency may have under other provisions of 
law, to require a private entity to comply with such a standard 
or implementation specification. 
‘‘(b) RULE OF CONSTRUCTION.—Nothing in this subtitle shall 
be construed to require that a private entity that enters into a 
contract with the Federal Government apply or use the standards 
and implementation specifications adopted under section 3004 with 
respect to activities not related to the contract. 
‘‘SEC. 3007. FEDERAL HEALTH INFORMATION TECHNOLOGY. 
‘‘(a) IN GENERAL.—The National Coordinator shall support the 
development and routine updating of qualified electronic health 
record technology (as defined in section 3000) consistent with sub-
sections (b) and (c) and make available such qualified electronic 
health record technology unless the Secretary determines through 
an assessment that the needs and demands of providers are being 
substantially and adequately met through the marketplace. 
‘‘(b) CERTIFICATION.—In making such electronic health record 
technology publicly available, the National Coordinator shall ensure 
that the qualified electronic health record technology described 
in subsection (a) is certified under the program developed under 
section 3001(c)(3) to be in compliance with applicable standards 
adopted under section 3003(a). 
‘‘(c) AUTHORIZATION TO CHARGE A NOMINAL FEE.—The National 
Coordinator may impose a nominal fee for the adoption by a health 
care provider of the health information technology system developed 
or approved under subsection (a) and (b). Such fee shall take into 
account the financial circumstances of smaller providers, low income 
providers, and providers located in rural or other medically under-
served areas. 
‘‘(d) RULE OF CONSTRUCTION.—Nothing in this section shall 
be construed to require that a private or government entity adopt 
or use the technology provided under this section. 
‘‘SEC. 3008. TRANSITIONS. 
‘‘(a) ONCHIT.—To the extent consistent with section 3001, 
all functions, personnel, assets, liabilities, and administrative 
actions applicable to the National Coordinator for Health Informa-
tion Technology appointed under Executive Order No. 13335 or 
the Office of such National Coordinator on the date before the
H. R. 1—128 
date of the enactment of this title shall be transferred to the 
National Coordinator appointed under section 3001(a) and the Office 
of such National Coordinator as of the date of the enactment of 
this title. 
‘‘(b) NATIONAL EHEALTH COLLABORATIVE.—Nothing in sections 
3002 or 3003 or this subsection shall be construed as prohibiting 
the AHIC Successor, Inc. doing business as the National eHealth 
Collaborative from modifying its charter, duties, membership, and 
any other structure or function required to be consistent with 
section 3002 and 3003 so as to allow the Secretary to recognize 
such AHIC Successor, Inc. as the HIT Policy Committee or the 
HIT Standards Committee. 
‘‘(c) CONSISTENCY OF RECOMMENDATIONS.—In carrying out sec-
tion 3003(b)(1)(A), until recommendations are made by the HIT 
Policy Committee, recommendations of the HIT Standards Com-
mittee shall be consistent with the most recent recommendations 
made by such AHIC Successor, Inc. 
‘‘SEC. 3009. MISCELLANEOUS PROVISIONS. 
‘‘(a) RELATION TO HIPAA PRIVACY AND SECURITY LAW.— 
‘‘(1) IN GENERAL.—With respect to the relation of this title 
to HIPAA privacy and security law: 
‘‘(A) This title may not be construed as having any 
effect on the authorities of the Secretary under HIPAA 
privacy and security law. 
‘‘(B) The purposes of this title include ensuring that 
the 
health 
information 
technology 
standards 
and 
implementation specifications adopted under section 3004 
take into account the requirements of HIPAA privacy and 
security law. 
‘‘(2) DEFINITION.—For purposes of this section, the term 
‘HIPAA privacy and security law’ means— 
‘‘(A) the provisions of part C of title XI of the Social 
Security Act, section 264 of the Health Insurance Port-
ability and Accountability Act of 1996, and subtitle D of 
title IV of the Health Information Technology for Economic 
and Clinical Health Act; and 
‘‘(B) regulations under such provisions. 
‘‘(b) FLEXIBILITY.—In administering the provisions of this title, 
the Secretary shall have flexibility in applying the definition of 
health care provider under section 3000(3), including the authority 
to omit certain entities listed in such definition when applying 
such definition under this title, where appropriate.’’. 
SEC. 13102. TECHNICAL AMENDMENT. 
Section 1171(5) of the Social Security Act (42 U.S.C. 1320d) 
is amended by striking ‘‘or C’’ and inserting ‘‘C, or D’’. 
PART 2—APPLICATION AND USE OF ADOPTED 
HEALTH 
INFORMATION 
TECHNOLOGY 
STANDARDS; REPORTS 
SEC. 13111. COORDINATION OF FEDERAL ACTIVITIES WITH ADOPTED 
STANDARDS AND IMPLEMENTATION SPECIFICATIONS. 
(a) SPENDING
ON HEALTH INFORMATION TECHNOLOGY SYS-
TEMS.—As each agency (as defined by the Director of the Office 
of Management and Budget, in consultation with the Secretary
H. R. 1—129 
of Health and Human Services) implements, acquires, or upgrades 
health information technology systems used for the direct exchange 
of individually identifiable health information between agencies 
and with non-Federal entities, it shall utilize, where available, 
health information technology systems and products that meet 
standards and implementation specifications adopted under section 
3004 of the Public Health Service Act, as added by section 13101. 
(b) FEDERAL
INFORMATION
COLLECTION
ACTIVITIES.—With 
respect to a standard or implementation specification adopted under 
section 3004 of the Public Health Service Act, as added by section 
13101, the President shall take measures to ensure that Federal 
activities involving the broad collection and submission of health 
information are consistent with such standard or implementation 
specification, respectively, within three years after the date of such 
adoption. 
(c) APPLICATION
OF DEFINITIONS.—The definitions contained 
in section 3000 of the Public Health Service Act, as added by 
section 13101, shall apply for purposes of this part. 
SEC. 13112. APPLICATION TO PRIVATE ENTITIES. 
Each agency (as defined in such Executive Order issued on 
August 22, 2006, relating to promoting quality and efficient health 
care in Federal government administered or sponsored health care 
programs) shall require in contracts or agreements with health 
care providers, health plans, or health insurance issuers that as 
each provider, plan, or issuer implements, acquires, or upgrades 
health information technology systems, it shall utilize, where avail-
able, health information technology systems and products that meet 
standards and implementation specifications adopted under section 
3004 of the Public Health Service Act, as added by section 13101. 
SEC. 13113. STUDY AND REPORTS. 
(a) REPORT ON ADOPTION OF NATIONWIDE SYSTEM.—Not later 
than 2 years after the date of the enactment of this Act and 
annually thereafter, the Secretary of Health and Human Services 
shall submit to the appropriate committees of jurisdiction of the 
House of Representatives and the Senate a report that— 
(1) describes the specific actions that have been taken 
by the Federal Government and private entities to facilitate 
the adoption of a nationwide system for the electronic use 
and exchange of health information; 
(2) describes barriers to the adoption of such a nationwide 
system; and 
(3) contains recommendations to achieve full implementa-
tion of such a nationwide system. 
(b) REIMBURSEMENT INCENTIVE STUDY AND REPORT.— 
(1) STUDY.—The Secretary of Health and Human Services 
shall carry out, or contract with a private entity to carry out, 
a study that examines methods to create efficient reimburse-
ment incentives for improving health care quality in Federally 
qualified health centers, rural health clinics, and free clinics. 
(2) REPORT.—Not later than 2 years after the date of the 
enactment of this Act, the Secretary of Health and Human 
Services shall submit to the appropriate committees of jurisdic-
tion of the House of Representatives and the Senate a report 
on the study carried out under paragraph (1). 
(c) AGING SERVICES TECHNOLOGY STUDY AND REPORT.—
H. R. 1—130 
(1) IN
GENERAL.—The Secretary of Health and Human 
Services shall carry out, or contract with a private entity to 
carry out, a study of matters relating to the potential use 
of new aging services technology to assist seniors, individuals 
with disabilities, and their caregivers throughout the aging 
process. 
(2) MATTERS TO BE STUDIED.—The study under paragraph 
(1) shall include— 
(A) an evaluation of— 
(i) methods for identifying current, emerging, and 
future health technology that can be used to meet 
the needs of seniors and individuals with disabilities 
and their caregivers across all aging services settings, 
as specified by the Secretary; 
(ii) methods for fostering scientific innovation with 
respect to aging services technology within the business 
and academic communities; and 
(iii) developments in aging services technology in 
other countries that may be applied in the United 
States; and 
(B) identification of— 
(i) barriers to innovation in aging services tech-
nology and devising strategies for removing such bar-
riers; and 
(ii) barriers to the adoption of aging services tech-
nology by health care providers and consumers and 
devising strategies to removing such barriers. 
(3) REPORT.—Not later than 24 months after the date of 
the enactment of this Act, the Secretary shall submit to the 
appropriate committees of jurisdiction of the House of Rep-
resentatives and of the Senate a report on the study carried 
out under paragraph (1). 
(4) DEFINITIONS.—For purposes of this subsection: 
(A) AGING SERVICES TECHNOLOGY.—The term ‘‘aging 
services technology’’ means health technology that meets 
the health care needs of seniors, individuals with disabil-
ities, and the caregivers of such seniors and individuals. 
(B) SENIOR.—The term ‘‘senior’’ has such meaning as 
specified by the Secretary. 
Subtitle B—Testing of Health Information 
Technology 
SEC. 13201. NATIONAL INSTITUTE FOR STANDARDS AND TECHNOLOGY 
TESTING. 
(a) PILOT TESTING OF STANDARDS AND IMPLEMENTATION SPECI-
FICATIONS.—In coordination with the HIT Standards Committee 
established under section 3003 of the Public Health Service Act, 
as added by section 13101, with respect to the development of 
standards and implementation specifications under such section, 
the Director of the National Institute for Standards and Technology 
shall test such standards and implementation specifications, as 
appropriate, in order to assure the efficient implementation and 
use of such standards and implementation specifications. 
(b) VOLUNTARY TESTING PROGRAM.—In coordination with the 
HIT Standards Committee established under section 3003 of the
H. R. 1—131 
Public Health Service Act, as added by section 13101, with respect 
to the development of standards and implementation specifications 
under such section, the Director of the National Institute of Stand-
ards and Technology shall support the establishment of a conform-
ance testing infrastructure, including the development of technical 
test beds. The development of this conformance testing infrastruc-
ture may include a program to accredit independent, non-Federal 
laboratories to perform testing. 
SEC. 13202. RESEARCH AND DEVELOPMENT PROGRAMS. 
(a) HEALTH
CARE
INFORMATION
ENTERPRISE
INTEGRATION 
RESEARCH CENTERS.— 
(1) IN GENERAL.—The Director of the National Institute 
of Standards and Technology, in consultation with the Director 
of the National Science Foundation and other appropriate Fed-
eral agencies, shall establish a program of assistance to institu-
tions of higher education (or consortia thereof which may 
include nonprofit entities and Federal Government laboratories) 
to establish multidisciplinary Centers for Health Care Informa-
tion Enterprise Integration. 
(2) REVIEW; COMPETITION.—Grants shall be awarded under 
this subsection on a merit-reviewed, competitive basis. 
(3) PURPOSE.—The purposes of the Centers described in 
paragraph (1) shall be— 
(A) to generate innovative approaches to health care 
information enterprise integration by conducting cutting- 
edge, multidisciplinary research on the systems challenges 
to health care delivery; and 
(B) the development and use of health information 
technologies and other complementary fields. 
(4) RESEARCH AREAS.—Research areas may include— 
(A) interfaces between human information and commu-
nications technology systems; 
(B) voice-recognition systems; 
(C) software that improves interoperability and 
connectivity among health information systems; 
(D) software dependability in systems critical to health 
care delivery; 
(E) measurement of the impact of information tech-
nologies on the quality and productivity of health care; 
(F) health information enterprise management; 
(G) health information technology security and integ-
rity; and 
(H) relevant health information technology to reduce 
medical errors. 
(5) APPLICATIONS.—An institution of higher education (or 
a consortium thereof) seeking funding under this subsection 
shall submit an application to the Director of the National 
Institute of Standards and Technology at such time, in such 
manner, and containing such information as the Director may 
require. The application shall include, at a minimum, a descrip-
tion of— 
(A) the research projects that will be undertaken by 
the Center established pursuant to assistance under para-
graph (1) and the respective contributions of the partici-
pating entities;
H. R. 1—132 
(B) how the Center will promote active collaboration 
among scientists and engineers from different disciplines, 
such as information technology, biologic sciences, manage-
ment, social sciences, and other appropriate disciplines; 
(C) technology transfer activities to demonstrate and 
diffuse the research results, technologies, and knowledge; 
and 
(D) how the Center will contribute to the education 
and training of researchers and other professionals in fields 
relevant to health information enterprise integration. 
(b) NATIONAL
INFORMATION
TECHNOLOGY
RESEARCH
AND 
DEVELOPMENT PROGRAM.—The National High-Performance Com-
puting Program established by section 101 of the High-Performance 
Computing Act of 1991 (15 U.S.C. 5511) shall include Federal 
research and development programs related to health information 
technology. 
Subtitle C—Grants and Loans Funding 
SEC. 13301. GRANT, LOAN, AND DEMONSTRATION PROGRAMS. 
Title XXX of the Public Health Service Act, as added by section 
13101, is amended by adding at the end the following new subtitle: 
‘‘Subtitle B—Incentives for the Use of 
Health Information Technology 
‘‘SEC. 3011. IMMEDIATE FUNDING TO STRENGTHEN THE HEALTH 
INFORMATION TECHNOLOGY INFRASTRUCTURE. 
‘‘(a) IN GENERAL.—The Secretary shall, using amounts appro-
priated under section 3018, invest in the infrastructure necessary 
to allow for and promote the electronic exchange and use of health 
information for each individual in the United States consistent 
with the goals outlined in the strategic plan developed by the 
National Coordinator (and as available) under section 3001. The 
Secretary shall invest funds through the different agencies with 
expertise in such goals, such as the Office of the National Coordi-
nator for Health Information Technology, the Health Resources 
and Services Administration, the Agency for Healthcare Research 
and Quality, the Centers of Medicare & Medicaid Services, the 
Centers for Disease Control and Prevention, and the Indian Health 
Service to support the following: 
‘‘(1) Health information technology architecture that will 
support the nationwide electronic exchange and use of health 
information in a secure, private, and accurate manner, 
including connecting health information exchanges, and which 
may include updating and implementing the infrastructure nec-
essary within different agencies of the Department of Health 
and Human Services to support the electronic use and exchange 
of health information. 
‘‘(2) Development and adoption of appropriate certified elec-
tronic health records for categories of health care providers 
not eligible for support under title XVIII or XIX of the Social 
Security Act for the adoption of such records. 
‘‘(3) Training on and dissemination of information on best 
practices to integrate health information technology, including
H. R. 1—133 
electronic health records, into a provider’s delivery of care, 
consistent with best practices learned from the Health Informa-
tion Technology Research Center developed under section 
3012(b), including community health centers receiving assist-
ance under section 330, covered entities under section 340B, 
and providers participating in one or more of the programs 
under titles XVIII, XIX, and XXI of the Social Security Act 
(relating to Medicare, Medicaid, and the State Children’s Health 
Insurance Program). 
‘‘(4) Infrastructure and tools for the promotion of telemedi-
cine, including coordination among Federal agencies in the 
promotion of telemedicine. 
‘‘(5) Promotion of the interoperability of clinical data reposi-
tories or registries. 
‘‘(6) Promotion of technologies and best practices that 
enhance the protection of health information by all holders 
of individually identifiable health information. 
‘‘(7) Improvement and expansion of the use of health 
information technology by public health departments. 
‘‘(b) COORDINATION.—The Secretary shall ensure funds under 
this section are used in a coordinated manner with other health 
information promotion activities. 
‘‘(c) ADDITIONAL USE OF FUNDS.—In addition to using funds 
as provided in subsection (a), the Secretary may use amounts appro-
priated under section 3018 to carry out health information tech-
nology activities that are provided for under laws in effect on 
the date of the enactment of this title. 
‘‘(d) STANDARDS
FOR ACQUISITION
OF HEALTH INFORMATION 
TECHNOLOGY.—To the greatest extent practicable, the Secretary 
shall ensure that where funds are expended under this section 
for the acquisition of health information technology, such funds 
shall be used to acquire health information technology that meets 
applicable standards adopted under section 3004. Where it is not 
practicable to expend funds on health information technology that 
meets such applicable standards, the Secretary shall ensure that 
such health information technology meets applicable standards 
otherwise adopted by the Secretary. 
‘‘SEC. 3012. HEALTH INFORMATION TECHNOLOGY IMPLEMENTATION 
ASSISTANCE. 
‘‘(a) HEALTH
INFORMATION
TECHNOLOGY
EXTENSION
PRO-
GRAM.—To assist health care providers to adopt, implement, and 
effectively use certified EHR technology that allows for the elec-
tronic exchange and use of health information, the Secretary, acting 
through the Office of the National Coordinator, shall establish 
a health information technology extension program to provide 
health information technology assistance services to be carried out 
through the Department of Health and Human Services. The 
National Coordinator shall consult with other Federal agencies 
with demonstrated experience and expertise in information tech-
nology services, such as the National Institute of Standards and 
Technology, in developing and implementing this program. 
‘‘(b) HEALTH INFORMATION TECHNOLOGY RESEARCH CENTER.— 
‘‘(1) IN
GENERAL.—The Secretary shall create a Health 
Information Technology Research Center (in this section 
referred to as the ‘Center’) to provide technical assistance and 
develop or recognize best practices to support and accelerate
H. R. 1—134 
efforts to adopt, implement, and effectively utilize health 
information technology that allows for the electronic exchange 
and use of information in compliance with standards, 
implementation specifications, and certification criteria adopted 
under section 3004. 
‘‘(2) INPUT.—The Center shall incorporate input from— 
‘‘(A) other Federal agencies with demonstrated experi-
ence and expertise in information technology services such 
as the National Institute of Standards and Technology; 
‘‘(B) users of health information technology, such as 
providers and their support and clerical staff and others 
involved in the care and care coordination of patients, 
from the health care and health information technology 
industry; and 
‘‘(C) others as appropriate. 
‘‘(3) PURPOSES.—The purposes of the Center are to— 
‘‘(A) provide a forum for the exchange of knowledge 
and experience; 
‘‘(B) accelerate the transfer of lessons learned from 
existing public and private sector initiatives, including 
those currently receiving Federal financial support; 
‘‘(C) assemble, analyze, and widely disseminate evi-
dence and experience related to the adoption, implementa-
tion, and effective use of health information technology 
that allows for the electronic exchange and use of informa-
tion including through the regional centers described in 
subsection (c); 
‘‘(D) provide technical assistance for the establishment 
and evaluation of regional and local health information 
networks to facilitate the electronic exchange of information 
across health care settings and improve the quality of 
health care; 
‘‘(E) provide technical assistance for the development 
and dissemination of solutions to barriers to the exchange 
of electronic health information; and 
‘‘(F) learn about effective strategies to adopt and utilize 
health information technology in medically underserved 
communities. 
‘‘(c) HEALTH INFORMATION TECHNOLOGY REGIONAL EXTENSION 
CENTERS.— 
‘‘(1) IN GENERAL.—The Secretary shall provide assistance 
for the creation and support of regional centers (in this sub-
section referred to as ‘regional centers’) to provide technical 
assistance and disseminate best practices and other information 
learned from the Center to support and accelerate efforts to 
adopt, implement, and effectively utilize health information 
technology that allows for the electronic exchange and use 
of information in compliance with standards, implementation 
specifications, and certification criteria adopted under section 
3004. Activities conducted under this subsection shall be con-
sistent with the strategic plan developed by the National 
Coordinator, (and, as available) under section 3001. 
‘‘(2) AFFILIATION.—Regional centers shall be affiliated with 
any United States-based nonprofit institution or organization, 
or group thereof, that applies and is awarded financial assist-
ance under this section. Individual awards shall be decided 
on the basis of merit.
H. R. 1—135 
‘‘(3) OBJECTIVE.—The objective of the regional centers is 
to enhance and promote the adoption of health information 
technology through— 
‘‘(A) assistance with the implementation, effective use, 
upgrading, and ongoing maintenance of health information 
technology, 
including 
electronic 
health 
records, 
to 
healthcare providers nationwide; 
‘‘(B) broad participation of individuals from industry, 
universities, and State governments; 
‘‘(C) active dissemination of best practices and research 
on the implementation, effective use, upgrading, and 
ongoing maintenance of health information technology, 
including electronic health records, to health care providers 
in order to improve the quality of healthcare and protect 
the privacy and security of health information; 
‘‘(D) participation, to the extent practicable, in health 
information exchanges; 
‘‘(E) utilization, when appropriate, of the expertise and 
capability that exists in Federal agencies other than the 
Department; and 
‘‘(F) integration of health information technology, 
including electronic health records, into the initial and 
ongoing training of health professionals and others in the 
healthcare industry that would be instrumental to 
improving the quality of healthcare through the smooth 
and accurate electronic use and exchange of health informa-
tion. 
‘‘(4) REGIONAL ASSISTANCE.—Each regional center shall aim 
to provide assistance and education to all providers in a region, 
but shall prioritize any direct assistance first to the following: 
‘‘(A) Public or not-for-profit hospitals or critical access 
hospitals. 
‘‘(B) Federally qualified health centers (as defined in 
section 1861(aa)(4) of the Social Security Act). 
‘‘(C) Entities that are located in rural and other areas 
that serve uninsured, underinsured, and medically under-
served individuals (regardless of whether such area is 
urban or rural). 
‘‘(D) Individual or small group practices (or a consor-
tium thereof) that are primarily focused on primary care. 
‘‘(5) FINANCIAL
SUPPORT.—The Secretary may provide 
financial support to any regional center created under this 
subsection for a period not to exceed four years. The Secretary 
may not provide more than 50 percent of the capital and 
annual operating and maintenance funds required to create 
and maintain such a center, except in an instance of national 
economic conditions which would render this cost-share require-
ment detrimental to the program and upon notification to Con-
gress as to the justification to waive the cost-share requirement. 
‘‘(6) NOTICE OF PROGRAM DESCRIPTION AND AVAILABILITY 
OF FUNDS.—The Secretary shall publish in the Federal Register, 
not later than 90 days after the date of the enactment of 
this title, a draft description of the program for establishing 
regional centers under this subsection. Such description shall 
include the following: 
‘‘(A) A detailed explanation of the program and the 
programs goals.
H. R. 1—136 
‘‘(B) Procedures to be followed by the applicants. 
‘‘(C) Criteria for determining qualified applicants. 
‘‘(D) Maximum support levels expected to be available 
to centers under the program. 
‘‘(7) APPLICATION REVIEW.—The Secretary shall subject each 
application under this subsection to merit review. In making 
a decision whether to approve such application and provide 
financial support, the Secretary shall consider at a minimum 
the merits of the application, including those portions of the 
application regarding— 
‘‘(A) the ability of the applicant to provide assistance 
under this subsection and utilization of health information 
technology appropriate to the needs of particular categories 
of health care providers; 
‘‘(B) the types of service to be provided to health care 
providers; 
‘‘(C) geographical diversity and extent of service area; 
and 
‘‘(D) the percentage of funding and amount of in-kind 
commitment from other sources. 
‘‘(8) BIENNIAL
EVALUATION.—Each regional center which 
receives financial assistance under this subsection shall be 
evaluated biennially by an evaluation panel appointed by the 
Secretary. Each evaluation panel shall be composed of private 
experts, none of whom shall be connected with the center 
involved, and of Federal officials. Each evaluation panel shall 
measure the involved center’s performance against the objective 
specified in paragraph (3). The Secretary shall not continue 
to provide funding to a regional center unless its evaluation 
is overall positive. 
‘‘(9) CONTINUING SUPPORT.—After the second year of assist-
ance under this subsection, a regional center may receive addi-
tional support under this subsection if it has received positive 
evaluations and a finding by the Secretary that continuation 
of Federal funding to the center was in the best interest of 
provision of health information technology extension services. 
‘‘SEC. 3013. STATE GRANTS TO PROMOTE HEALTH INFORMATION TECH-
NOLOGY. 
‘‘(a) IN GENERAL.—The Secretary, acting through the National 
Coordinator, shall establish a program in accordance with this 
section to facilitate and expand the electronic movement and use 
of health information among organizations according to nationally 
recognized standards. 
‘‘(b) PLANNING GRANTS.—The Secretary may award a grant 
to a State or qualified State-designated entity (as described in 
subsection (f)) that submits an application to the Secretary at 
such time, in such manner, and containing such information as 
the Secretary may specify, for the purpose of planning activities 
described in subsection (d). 
‘‘(c) IMPLEMENTATION GRANTS.—The Secretary may award a 
grant to a State or qualified State designated entity that— 
‘‘(1) has submitted, and the Secretary has approved, a 
plan described in subsection (e) (regardless of whether such 
plan was prepared using amounts awarded under subsection 
(b); and
H. R. 1—137 
‘‘(2) submits an application at such time, in such manner, 
and containing such information as the Secretary may specify. 
‘‘(d) USE OF FUNDS.—Amounts received under a grant under 
subsection (c) shall be used to conduct activities to facilitate and 
expand the electronic movement and use of health information 
among organizations according to nationally recognized standards 
through activities that include— 
‘‘(1) enhancing broad and varied participation in the author-
ized and secure nationwide electronic use and exchange of 
health information; 
‘‘(2) identifying State or local resources available towards 
a nationwide effort to promote health information technology; 
‘‘(3) complementing other Federal grants, programs, and 
efforts towards the promotion of health information technology; 
‘‘(4) providing technical assistance for the development and 
dissemination of solutions to barriers to the exchange of elec-
tronic health information; 
‘‘(5) promoting effective strategies to adopt and utilize 
health information technology in medically underserved 
communities; 
‘‘(6) assisting patients in utilizing health information tech-
nology; 
‘‘(7) encouraging clinicians to work with Health Information 
Technology Regional Extension Centers as described in section 
3012, to the extent they are available and valuable; 
‘‘(8) supporting public health agencies’ authorized use of 
and access to electronic health information; 
‘‘(9) promoting the use of electronic health records for 
quality improvement including through quality measures 
reporting; and 
‘‘(10) such other activities as the Secretary may specify. 
‘‘(e) PLAN.— 
‘‘(1) IN GENERAL.—A plan described in this subsection is 
a plan that describes the activities to be carried out by a 
State or by the qualified State-designated entity within such 
State to facilitate and expand the electronic movement and 
use of health information among organizations according to 
nationally recognized standards and implementation specifica-
tions. 
‘‘(2) REQUIRED ELEMENTS.—A plan described in paragraph 
(1) shall— 
‘‘(A) be pursued in the public interest; 
‘‘(B) be consistent with the strategic plan developed 
by the National Coordinator, (and, as available) under sec-
tion 3001; 
‘‘(C) include a description of the ways the State or 
qualified State-designated entity will carry out the activi-
ties described in subsection (b); and 
‘‘(D) contain such elements as the Secretary may 
require. 
‘‘(f) QUALIFIED STATE-DESIGNATED ENTITY.—For purposes of 
this section, to be a qualified State-designated entity, with respect 
to a State, an entity shall— 
‘‘(1) be designated by the State as eligible to receive awards 
under this section; 
‘‘(2) be a not-for-profit entity with broad stakeholder rep-
resentation on its governing board;
H. R. 1—138 
‘‘(3) demonstrate that one of its principal goals is to use 
information technology to improve health care quality and effi-
ciency through the authorized and secure electronic exchange 
and use of health information; 
‘‘(4) adopt nondiscrimination and conflict of interest policies 
that demonstrate a commitment to open, fair, and nondiscrim-
inatory participation by stakeholders; and 
‘‘(5) conform to such other requirements as the Secretary 
may establish. 
‘‘(g) REQUIRED
CONSULTATION.—In carrying out activities 
described in subsections (b) and (c), a State or qualified State- 
designated entity shall consult with and consider the recommenda-
tions of— 
‘‘(1) health care providers (including providers that provide 
services to low income and underserved populations); 
‘‘(2) health plans; 
‘‘(3) patient or consumer organizations that represent the 
population to be served; 
‘‘(4) health information technology vendors; 
‘‘(5) health care purchasers and employers; 
‘‘(6) public health agencies; 
‘‘(7) health professions schools, universities and colleges; 
‘‘(8) clinical researchers; 
‘‘(9) other users of health information technology such as 
the support and clerical staff of providers and others involved 
in the care and care coordination of patients; and 
‘‘(10) such other entities, as may be determined appropriate 
by the Secretary. 
‘‘(h) CONTINUOUS IMPROVEMENT.—The Secretary shall annually 
evaluate the activities conducted under this section and shall, in 
awarding grants under this section, 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 deter-
mination of the Secretary, will lead towards the greatest improve-
ment in quality of care, decrease in costs, and the most effective 
authorized and secure electronic exchange of health information. 
‘‘(i) REQUIRED MATCH.— 
‘‘(1) IN GENERAL.—For a fiscal year (beginning with fiscal 
year 2011), the Secretary may not make a grant under this 
section to a State unless the State agrees to make available 
non-Federal contributions (which may include in-kind contribu-
tions) toward the costs of a grant awarded under subsection 
(c) in an amount equal to— 
‘‘(A) for fiscal year 2011, not less than $1 for each 
$10 of Federal funds provided under the grant; 
‘‘(B) for fiscal year 2012, not less than $1 for each 
$7 of Federal funds provided under the grant; and 
‘‘(C) for fiscal year 2013 and each subsequent fiscal 
year, not less than $1 for each $3 of Federal funds provided 
under the grant. 
‘‘(2) AUTHORITY TO REQUIRE STATE MATCH FOR FISCAL YEARS 
BEFORE FISCAL YEAR 2011.—For any fiscal year during the grant 
program under this section before fiscal year 2011, the Sec-
retary may determine the extent to which there shall be 
required a non-Federal contribution from a State receiving 
a grant under this section.
H. R. 1—139 
‘‘SEC. 3014. COMPETITIVE GRANTS TO STATES AND INDIAN TRIBES 
FOR THE DEVELOPMENT OF LOAN PROGRAMS TO FACILI-
TATE THE WIDESPREAD ADOPTION OF CERTIFIED EHR 
TECHNOLOGY. 
‘‘(a) IN
GENERAL.—The National Coordinator may award 
competitive grants to eligible entities for the establishment of pro-
grams for loans to health care providers to conduct the activities 
described in subsection (e). 
‘‘(b) ELIGIBLE ENTITY DEFINED.—For purposes of this sub-
section, the term ‘eligible entity’ means a State or Indian tribe 
(as defined in the Indian Self-Determination and Education Assist-
ance Act) that— 
‘‘(1) submits to the National Coordinator an application 
at such time, in such manner, and containing such information 
as the National Coordinator may require; 
‘‘(2) submits to the National Coordinator a strategic plan 
in accordance with subsection (d) and provides to the National 
Coordinator assurances that the entity will update such plan 
annually in accordance with such subsection; 
‘‘(3) provides assurances to the National Coordinator that 
the entity will establish a Loan Fund in accordance with sub-
section (c); 
‘‘(4) provides assurances to the National Coordinator that 
the entity will not provide a loan from the Loan Fund to 
a health care provider unless the provider agrees to— 
‘‘(A) submit reports on quality measures adopted by 
the Federal Government (by not later than 90 days after 
the date on which such measures are adopted), to— 
‘‘(i) the Administrator of the Centers for Medicare 
& Medicaid Services (or his or her designee), in the 
case of an entity participating in the Medicare program 
under title XVIII of the Social Security Act or the 
Medicaid program under title XIX of such Act; or 
‘‘(ii) the Secretary in the case of other entities; 
‘‘(B) demonstrate to the satisfaction of the Secretary 
(through criteria established by the Secretary) that any 
certified EHR technology purchased, improved, or otherwise 
financially supported under a loan under this section is 
used to exchange health information in a manner that, 
in accordance with law and standards (as adopted under 
section 3004) applicable to the exchange of information, 
improves the quality of health care, such as promoting 
care coordination; and 
‘‘(C) comply with such other requirements as the entity 
or the Secretary may require; 
‘‘(D) include a plan on how health care providers 
involved intend to maintain and support the certified EHR 
technology over time; 
‘‘(E) include a plan on how the health care providers 
involved intend to maintain and support the certified EHR 
technology that would be purchased with such loan, 
including the type of resources expected to be involved 
and any such other information as the State or Indian 
Tribe, respectively, may require; and 
‘‘(5) agrees to provide matching funds in accordance with 
subsection (h).
H. R. 1—140 
‘‘(c) ESTABLISHMENT
OF FUND.—For purposes of subsection 
(b)(3), an eligible entity shall establish a certified EHR technology 
loan fund (referred to in this subsection as a ‘Loan Fund’) and 
comply with the other requirements contained in this section. A 
grant to an eligible entity under this section shall be deposited 
in the Loan Fund established by the eligible entity. No funds 
authorized by other provisions of this title to be used for other 
purposes specified in this title shall be deposited in any Loan 
Fund. 
‘‘(d) STRATEGIC PLAN.— 
‘‘(1) IN GENERAL.—For purposes of subsection (b)(2), a stra-
tegic plan of an eligible entity under this subsection shall 
identify the intended uses of amounts available to the Loan 
Fund of such entity. 
‘‘(2) CONTENTS.—A strategic plan under paragraph (1), with 
respect to a Loan Fund of an eligible entity, shall include 
for a year the following: 
‘‘(A) A list of the projects to be assisted through the 
Loan Fund during such year. 
‘‘(B) A description of the criteria and methods estab-
lished for the distribution of funds from the Loan Fund 
during the year. 
‘‘(C) A description of the financial status of the Loan 
Fund as of the date of submission of the plan. 
‘‘(D) The short-term and long-term goals of the Loan 
Fund. 
‘‘(e) USE
OF FUNDS.—Amounts deposited in a Loan Fund, 
including loan repayments and interest earned on such amounts, 
shall be used only for awarding loans or loan guarantees, making 
reimbursements described in subsection (g)(4)(A), or as a source 
of reserve and security for leveraged loans, the proceeds of which 
are deposited in the Loan Fund established under subsection (c). 
Loans under this section may be used by a health care provider 
to— 
‘‘(1) facilitate the purchase of certified EHR technology; 
‘‘(2) enhance the utilization of certified EHR technology 
(which may include costs associated with upgrading health 
information technology so that it meets criteria necessary to 
be a certified EHR technology); 
‘‘(3) train personnel in the use of such technology; or 
‘‘(4) improve the secure electronic exchange of health 
information. 
‘‘(f) TYPES
OF ASSISTANCE.—Except as otherwise limited by 
applicable State law, amounts deposited into a Loan Fund under 
this section may only be used for the following: 
‘‘(1) To award loans that comply with the following: 
‘‘(A) The interest rate for each loan shall not exceed 
the market interest rate. 
‘‘(B) The principal and interest payments on each loan 
shall commence not later than 1 year after the date the 
loan was awarded, and each loan shall be fully amortized 
not later than 10 years after the date of the loan. 
‘‘(C) The Loan Fund shall be credited with all payments 
of principal and interest on each loan awarded from the 
Loan Fund. 
‘‘(2) To guarantee, or purchase insurance for, a local obliga-
tion (all of the proceeds of which finance a project eligible
H. R. 1—141 
for assistance under this subsection) if the guarantee or pur-
chase would improve credit market access or reduce the interest 
rate applicable to the obligation involved. 
‘‘(3) As a source of revenue or security for the payment 
of principal and interest on revenue or general obligation bonds 
issued by the eligible entity if the proceeds of the sale of 
the bonds will be deposited into the Loan Fund. 
‘‘(4) To earn interest on the amounts deposited into the 
Loan Fund. 
‘‘(5) To make reimbursements described in subsection 
(g)(4)(A). 
‘‘(g) ADMINISTRATION OF LOAN FUNDS.— 
‘‘(1) COMBINED
FINANCIAL
ADMINISTRATION.—An eligible 
entity may (as a convenience and to avoid unnecessary adminis-
trative costs) combine, in accordance with applicable State law, 
the financial administration of a Loan Fund established under 
this subsection with the financial administration of any other 
revolving fund established by the entity if otherwise not prohib-
ited by the law under which the Loan Fund was established. 
‘‘(2) COST OF ADMINISTERING FUND.—Each eligible entity 
may annually use not to exceed 4 percent of the funds provided 
to the entity under a grant under this section to pay the 
reasonable costs of the administration of the programs under 
this section, including the recovery of reasonable costs expended 
to establish a Loan Fund which are incurred after the date 
of the enactment of this title. 
‘‘(3) GUIDANCE AND REGULATIONS.—The National Coordi-
nator shall publish guidance and promulgate regulations as 
may be necessary to carry out the provisions of this section, 
including— 
‘‘(A) provisions to ensure that each eligible entity com-
mits and expends funds allotted to the entity under this 
section as efficiently as possible in accordance with this 
title and applicable State laws; and 
‘‘(B) guidance to prevent waste, fraud, and abuse. 
‘‘(4) PRIVATE SECTOR CONTRIBUTIONS.— 
‘‘(A) IN GENERAL.—A Loan Fund established under this 
section may accept contributions from private sector enti-
ties, except that such entities may not specify the recipient 
or recipients of any loan issued under this subsection. 
An eligible entity may agree to reimburse a private sector 
entity for any contribution made under this subparagraph, 
except that the amount of such reimbursement may not 
be greater than the principal amount of the contribution 
made. 
‘‘(B) AVAILABILITY OF INFORMATION.—An eligible entity 
shall make publicly available the identity of, and amount 
contributed by, any private sector entity under subpara-
graph (A) and may issue letters of commendation or make 
other awards (that have no financial value) to any such 
entity. 
‘‘(h) MATCHING REQUIREMENTS.— 
‘‘(1) IN GENERAL.—The National Coordinator may not make 
a grant under subsection (a) to an eligible entity unless the 
entity agrees to make available (directly or through donations 
from public or private entities) non-Federal contributions in 
cash to the costs of carrying out the activities for which the
H. R. 1—142 
grant is awarded in an amount equal to not less than $1 
for each $5 of Federal funds provided under the grant. 
‘‘(2) DETERMINATION
OF
AMOUNT
OF
NON-FEDERAL
CON-
TRIBUTION.—In determining the amount of non-Federal con-
tributions that an eligible entity has provided pursuant to 
subparagraph (A), the National Coordinator may not include 
any amounts provided to the entity by the Federal Government. 
‘‘(i) EFFECTIVE DATE.—The Secretary may not make an award 
under this section prior to January 1, 2010. 
‘‘SEC. 3015. DEMONSTRATION PROGRAM TO INTEGRATE INFORMATION 
TECHNOLOGY INTO CLINICAL EDUCATION. 
‘‘(a) IN GENERAL.—The Secretary may award grants under this 
section to carry out demonstration projects to develop academic 
curricula integrating certified EHR technology in the clinical edu-
cation of health professionals. Such awards shall be made on a 
competitive basis and pursuant to peer review. 
‘‘(b) ELIGIBILITY.—To be eligible to receive a grant under sub-
section (a), an entity shall— 
‘‘(1) submit to the Secretary an application at such time, 
in such manner, and containing such information as the Sec-
retary may require; 
‘‘(2) submit to the Secretary a strategic plan for integrating 
certified EHR technology in the clinical education of health 
professionals to reduce medical errors, increase access to 
prevention, reduce chronic diseases, and enhance health care 
quality; 
‘‘(3) be— 
‘‘(A) a school of medicine, osteopathic medicine, den-
tistry, or pharmacy, a graduate program in behavioral or 
mental health, or any other graduate health professions 
school; 
‘‘(B) a graduate school of nursing or physician assistant 
studies; 
‘‘(C) a consortium of two or more schools described 
in subparagraph (A) or (B); or 
‘‘(D) an institution with a graduate medical education 
program in medicine, osteopathic medicine, dentistry, phar-
macy, nursing, or physician assistance studies; 
‘‘(4) provide for the collection of data regarding the effective-
ness of the demonstration project to be funded under the grant 
in improving the safety of patients, the efficiency of health 
care delivery, and in increasing the likelihood that graduates 
of the grantee will adopt and incorporate certified EHR tech-
nology, in the delivery of health care services; and 
‘‘(5) provide matching funds in accordance with subsection 
(d). 
‘‘(c) USE OF FUNDS.— 
‘‘(1) IN GENERAL.—With respect to a grant under subsection 
(a), an eligible entity shall— 
‘‘(A) use grant funds in collaboration with 2 or more 
disciplines; and 
‘‘(B) use grant funds to integrate certified EHR tech-
nology into community-based clinical education. 
‘‘(2) LIMITATION.—An eligible entity shall not use amounts 
received under a grant under subsection (a) to purchase hard-
ware, software, or services.
H. R. 1—143 
‘‘(d) FINANCIAL SUPPORT.—The Secretary may not provide more 
than 50 percent of the costs of any activity 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 detrimental to the program and upon notifica-
tion to Congress as to the justification to waive the cost-share 
requirement. 
‘‘(e) EVALUATION.—The Secretary shall take such action as may 
be necessary to evaluate the projects funded under this section 
and publish, make available, and disseminate 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 Secretary 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 IN HEALTH 
CARE. 
‘‘(a) IN GENERAL.—The Secretary, in consultation with the 
Director of the National Science Foundation, shall provide assist-
ance to institutions of higher education (or consortia thereof) to 
establish or expand medical health informatics education programs, 
including certification, undergraduate, and masters degree pro-
grams, 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 pro-
vided under subsection (a) may include the following: 
‘‘(1) Developing and revising curricula in medical 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 installation of testbed net-
works 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 subsection (a), 
the Secretary shall give preference to the following: 
‘‘(1) Existing education and training programs. 
‘‘(2) Programs designed to be completed in less than six 
months. 
‘‘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 Sec-
retary, not later than the date that is 1 year after the date of 
receipt of such assistance, a report that includes—
H. R. 1—144 
‘‘(1) an analysis of the effectiveness of the activities 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 subtitle 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 
Coordinator, will result in the greatest improvement in the quality 
and efficiency of health care. 
‘‘SEC. 3018. AUTHORIZATION FOR APPROPRIATIONS. 
‘‘For the purposes of carrying out this subtitle, there is author-
ized to be appropriated such sums as may be necessary for each 
of the fiscal years 2009 through 2013.’’. 
Subtitle D—Privacy 
SEC. 13400. DEFINITIONS. 
In this subtitle, except as specified otherwise: 
(1) BREACH.— 
(A) IN
GENERAL.—The term ‘‘breach’’ means the 
unauthorized acquisition, access, use, or disclosure of pro-
tected health information which compromises the security 
or privacy of such information, except where an unauthor-
ized person to whom such information is disclosed would 
not reasonably have been able to retain such information. 
(B) EXCEPTIONS.—The term ‘‘breach’’ does not include— 
(i) any unintentional acquisition, access, or use 
of protected health information by an employee or indi-
vidual acting under the authority of a covered entity 
or business associate if— 
(I) such acquisition, access, or use was made 
in good faith and within the course and scope 
of the employment or other professional relation-
ship of such employee or individual, respectively, 
with the covered entity or business associate; and 
(II) such information is not further acquired, 
accessed, used, or disclosed by any person; or 
(ii) any inadvertent disclosure from an individual 
who is otherwise authorized to access protected health 
information at a facility operated by a covered entity 
or business associate to another similarly situated indi-
vidual at same facility; and 
(iii) any such information received as a result of 
such disclosure is not further acquired, accessed, used, 
or disclosed without authorization by any person. 
(2) BUSINESS ASSOCIATE.—The term ‘‘business associate’’ 
has the meaning given such term in section 160.103 of title 
45, Code of Federal Regulations. 
(3) COVERED ENTITY.—The term ‘‘covered entity’’ has the 
meaning given such term in section 160.103 of title 45, Code 
of Federal Regulations.
H. R. 1—145 
(4) DISCLOSE.—The terms ‘‘disclose’’ and ‘‘disclosure’’ have 
the meaning given the term ‘‘disclosure’’ in section 160.103 
of title 45, Code of Federal Regulations. 
(5) ELECTRONIC
HEALTH
RECORD.—The term ‘‘electronic 
health record’’ means an electronic record of health-related 
information on an individual that is created, gathered, man-
aged, and consulted by authorized health care clinicians and 
staff. 
(6) HEALTH CARE OPERATIONS.—The term ‘‘health care oper-
ation’’ has the meaning given such term in section 164.501 
of title 45, Code of Federal Regulations. 
(7) HEALTH CARE PROVIDER.—The term ‘‘health care pro-
vider’’ has the meaning given such term in section 160.103 
of title 45, Code of Federal Regulations. 
(8) HEALTH PLAN.—The term ‘‘health plan’’ has the meaning 
given such term in section 160.103 of title 45, Code of Federal 
Regulations. 
(9) NATIONAL COORDINATOR.—The term ‘‘National Coordi-
nator’’ means the head of the Office of the National Coordinator 
for Health Information Technology established under section 
3001(a) of the Public Health Service Act, as added by section 
13101. 
(10) PAYMENT.—The term ‘‘payment’’ has the meaning 
given such term in section 164.501 of title 45, Code of Federal 
Regulations. 
(11) PERSONAL
HEALTH
RECORD.—The term ‘‘personal 
health record’’ means an electronic record of PHR identifiable 
health information (as defined in section 13407(f)(2)) on an 
individual that can be drawn from multiple sources and that 
is managed, shared, and controlled by or primarily for the 
individual. 
(12) PROTECTED
HEALTH
INFORMATION.—The term ‘‘pro-
tected health information’’ has the meaning given such term 
in section 160.103 of title 45, Code of Federal Regulations. 
(13) SECRETARY.—The term ‘‘Secretary’’ means the Sec-
retary of Health and Human Services. 
(14) SECURITY.—The term ‘‘security’’ has the meaning given 
such term in section 164.304 of title 45, Code of Federal Regula-
tions. 
(15) STATE.—The term ‘‘State’’ means each of the several 
States, the District of Columbia, Puerto Rico, the Virgin Islands, 
Guam, American Samoa, and the Northern Mariana Islands. 
(16) TREATMENT.—The term ‘‘treatment’’ has the meaning 
given such term in section 164.501 of title 45, Code of Federal 
Regulations. 
(17) USE.—The term ‘‘use’’ has the meaning given such 
term in section 160.103 of title 45, Code of Federal Regulations. 
(18) VENDOR OF PERSONAL HEALTH RECORDS.—The term 
‘‘vendor of personal health records’’ means an entity, other 
than a covered entity (as defined in paragraph (3)), that offers 
or maintains a personal health record.
H. R. 1—146 
PART 1—IMPROVED PRIVACY PROVISIONS 
AND SECURITY PROVISIONS 
SEC. 13401. APPLICATION OF SECURITY PROVISIONS AND PENALTIES 
TO BUSINESS ASSOCIATES OF COVERED ENTITIES; 
ANNUAL GUIDANCE ON SECURITY PROVISIONS. 
(a) APPLICATION OF SECURITY PROVISIONS.—Sections 164.308, 
164.310, 164.312, and 164.316 of title 45, Code of Federal Regula-
tions, shall apply to a business associate of a covered entity in 
the same manner that such sections apply to the covered entity. 
The additional requirements of this title that relate to security 
and that are made applicable with respect to covered entities shall 
also be applicable to such a business associate and shall be incor-
porated into the business associate agreement between the business 
associate and the covered entity. 
(b) APPLICATION OF CIVIL AND CRIMINAL PENALTIES.—In the 
case of a business associate that violates any security provision 
specified in subsection (a), sections 1176 and 1177 of the Social 
Security Act (42 U.S.C. 1320d–5, 1320d–6) shall apply to the busi-
ness associate with respect to such violation in the same manner 
such sections apply to a covered entity that violates such security 
provision. 
(c) ANNUAL GUIDANCE.—For the first year beginning after the 
date of the enactment of this Act and annually thereafter, the 
Secretary of Health and Human Services shall, after consultation 
with stakeholders, annually issue guidance on the most effective 
and appropriate technical safeguards for use in carrying out the 
sections referred to in subsection (a) and the security standards 
in subpart C of part 164 of title 45, Code of Federal Regulations, 
including 
the 
use 
of 
standards 
developed 
under 
section 
3002(b)(2)(B)(vi) of the Public Health Service Act, as added by 
section 13101 of this Act, as such provisions are in effect as of 
the date before the enactment of this Act. 
SEC. 13402. NOTIFICATION IN THE CASE OF BREACH. 
(a) IN GENERAL.—A covered entity that accesses, maintains, 
retains, modifies, records, stores, destroys, or otherwise holds, uses, 
or discloses unsecured protected health information (as defined 
in subsection (h)(1)) shall, in the case of a breach of such information 
that is discovered by the covered entity, notify each individual 
whose unsecured protected health information has been, or is 
reasonably believed by the covered entity to have been, accessed, 
acquired, or disclosed as a result of such breach. 
(b) NOTIFICATION
OF COVERED ENTITY
BY BUSINESS ASSO-
CIATE.—A business associate of a covered entity that accesses, main-
tains, retains, modifies, records, stores, destroys, or otherwise holds, 
uses, or discloses unsecured protected health information shall, 
following the discovery of a breach of such information, notify 
the covered entity of such breach. Such notice shall include the 
identification of each individual whose unsecured protected health 
information has been, or is reasonably believed by the business 
associate to have been, accessed, acquired, or disclosed during such 
breach. 
(c) BREACHES TREATED AS DISCOVERED.—For purposes of this 
section, a breach shall be treated as discovered by a covered entity 
or by a business associate as of the first day on which such breach 
is known to such entity or associate, respectively, (including any
H. R. 1—147 
person, other than the individual committing the breach, that is 
an employee, officer, or other agent of such entity or associate, 
respectively) or should reasonably have been known to such entity 
or associate (or person) to have occurred. 
(d) TIMELINESS OF NOTIFICATION.— 
(1) IN GENERAL.—Subject to subsection (g), all notifications 
required under this section shall be made without unreasonable 
delay and in no case later than 60 calendar days after the 
discovery of a breach by the covered entity involved (or business 
associate involved in the case of a notification required under 
subsection (b)). 
(2) BURDEN OF PROOF.—The covered entity involved (or 
business associate involved in the case of a notification required 
under subsection (b)), shall have the burden of demonstrating 
that all notifications were made as required under this part, 
including evidence demonstrating the necessity of any delay. 
(e) METHODS OF NOTICE.— 
(1) INDIVIDUAL NOTICE.—Notice required under this section 
to be provided to an individual, with respect to a breach, 
shall be provided promptly and in the following form: 
(A) Written notification by first-class mail to the indi-
vidual (or the next of kin of the individual if the individual 
is deceased) at the last known address of the individual 
or the next of kin, respectively, or, if specified as a pref-
erence by the individual, by electronic mail. The notification 
may be provided in one or more mailings as information 
is available. 
(B) In the case in which there is insufficient, or out- 
of-date contact information (including a phone number, 
email address, or any other form of appropriate communica-
tion) that precludes direct written (or, if specified by the 
individual under subparagraph (A), electronic) notification 
to the individual, a substitute form of notice shall be pro-
vided, including, in the case that there are 10 or more 
individuals for which there is insufficient or out-of-date 
contact information, a conspicuous posting for a period 
determined by the Secretary on the home page of the 
Web site of the covered entity involved or notice in major 
print or broadcast media, including major media in 
geographic areas where the individuals affected by the 
breach likely reside. Such a notice in media or web posting 
will include a toll-free phone number where an individual 
can learn whether or not the individual’s unsecured pro-
tected health information is possibly included in the breach. 
(C) In any case deemed by the covered entity involved 
to require urgency because of possible imminent misuse 
of unsecured protected health information, the covered 
entity, in addition to notice provided under subparagraph 
(A), may provide information to individuals by telephone 
or other means, as appropriate. 
(2) MEDIA NOTICE.—Notice shall be provided to prominent 
media outlets serving a State or jurisdiction, following the 
discovery of a breach described in subsection (a), if the 
unsecured protected health information of more than 500 resi-
dents of such State or jurisdiction is, or is reasonably believed 
to have been, accessed, acquired, or disclosed during such 
breach.
H. R. 1—148 
(3) NOTICE
TO
SECRETARY.—Notice shall be provided to 
the Secretary by covered entities of unsecured protected health 
information that has been acquired or disclosed in a breach. 
If the breach was with respect to 500 or more individuals 
than such notice must be provided immediately. If the breach 
was with respect to less than 500 individuals, the covered 
entity may maintain a log of any such breach occurring and 
annually submit such a log to the Secretary documenting such 
breaches occurring during the year involved. 
(4) POSTING ON HHS PUBLIC WEBSITE.—The Secretary shall 
make available to the public on the Internet website of the 
Department of Health and Human Services a list that identifies 
each covered entity involved in a breach described in subsection 
(a) in which the unsecured protected health information of 
more than 500 individuals is acquired or disclosed. 
(f) CONTENT OF NOTIFICATION.—Regardless of the method by 
which notice is provided to individuals under this section, notice 
of a breach shall include, to the extent possible, the following: 
(1) A brief description of what happened, including the 
date of the breach and the date of the discovery of the breach, 
if known. 
(2) A description of the types of unsecured protected health 
information that were involved in the breach (such as full 
name, Social Security number, date of birth, home address, 
account number, or disability code). 
(3) The steps individuals should take to protect themselves 
from potential harm resulting from the breach. 
(4) A brief description of what the covered entity involved 
is doing to investigate the breach, to mitigate losses, and to 
protect against any further breaches. 
(5) Contact procedures for individuals to ask questions 
or learn additional information, which shall include a toll- 
free telephone number, an e-mail address, Web site, or postal 
address. 
(g) DELAY OF NOTIFICATION AUTHORIZED FOR LAW ENFORCE-
MENT PURPOSES.—If a law enforcement official determines that 
a notification, notice, or posting required under this section would 
impede a criminal investigation or cause damage to national secu-
rity, such notification, notice, or posting shall be delayed in the 
same manner as provided under section 164.528(a)(2) of title 45, 
Code of Federal Regulations, in the case of a disclosure covered 
under such section. 
(h) UNSECURED PROTECTED HEALTH INFORMATION.— 
(1) DEFINITION.— 
(A) IN GENERAL.—Subject to subparagraph (B), for pur-
poses of this section, the term ‘‘unsecured protected health 
information’’ means protected health information that is 
not secured through the use of a technology or methodology 
specified by the Secretary in the guidance issued under 
paragraph (2). 
(B) EXCEPTION IN CASE TIMELY GUIDANCE NOT ISSUED.— 
In the case that the Secretary does not issue guidance 
under paragraph (2) by the date specified in such para-
graph, for purposes of this section, the term ‘‘unsecured 
protected health information’’ shall mean protected health 
information that is not secured by a technology standard 
that renders protected health information unusable,
H. R. 1—149 
unreadable, or indecipherable to unauthorized individuals 
and is developed or endorsed by a standards developing 
organization that is accredited by the American National 
Standards Institute. 
(2) GUIDANCE.—For purposes of paragraph (1) and section 
13407(f)(3), not later than the date that is 60 days after the 
date of the enactment of this Act, the Secretary shall, after 
consultation with stakeholders, issue (and annually update) 
guidance specifying the technologies and methodologies that 
render protected health information unusable, unreadable, or 
indecipherable to unauthorized individuals, including the use 
of standards developed under section 3002(b)(2)(B)(vi) of the 
Public Health Service Act, as added by section 13101 of this 
Act. 
(i) REPORT TO CONGRESS ON BREACHES.— 
(1) IN GENERAL.—Not later than 12 months after the date 
of the enactment of this Act and annually thereafter, the Sec-
retary shall prepare and submit to the Committee on Finance 
and the Committee on Health, Education, Labor, and Pensions 
of the Senate and the Committee on Ways and Means and 
the Committee on Energy and Commerce of the House of Rep-
resentatives a report containing the information described in 
paragraph (2) regarding breaches for which notice was provided 
to the Secretary under subsection (e)(3). 
(2) INFORMATION.—The information described in this para-
graph regarding breaches specified in paragraph (1) shall 
include— 
(A) the number and nature of such breaches; and 
(B) actions taken in response to such breaches. 
(j) REGULATIONS; EFFECTIVE DATE.—To carry out this section, 
the Secretary of Health and Human Services shall promulgate 
interim final regulations by not later than the date that is 180 
days after the date of the enactment of this title. The provisions 
of this section shall apply to breaches that are discovered on or 
after the date that is 30 days after the date of publication of 
such interim final regulations. 
SEC. 13403. EDUCATION ON HEALTH INFORMATION PRIVACY. 
(a) REGIONAL OFFICE PRIVACY ADVISORS.—Not later than 6 
months after the date of the enactment of this Act, the Secretary 
shall designate an individual in each regional office of the Depart-
ment of Health and Human Services to offer guidance and education 
to covered entities, business associates, and individuals on their 
rights and responsibilities related to Federal privacy and security 
requirements for protected health information. 
(b) EDUCATION INITIATIVE ON USES OF HEALTH INFORMATION.— 
Not later than 12 months after the date of the enactment of this 
Act, the Office for Civil Rights within the Department of Health 
and Human Services shall develop and maintain a multi-faceted 
national education initiative to enhance public transparency 
regarding the uses of protected health information, including pro-
grams to educate individuals about the potential uses of their 
protected health information, the effects of such uses, and the 
rights of individuals with respect to such uses. Such programs 
shall be conducted in a variety of languages and present information 
in a clear and understandable manner.
H. R. 1—150 
SEC. 13404. APPLICATION OF PRIVACY PROVISIONS AND PENALTIES 
TO BUSINESS ASSOCIATES OF COVERED ENTITIES. 
(a) APPLICATION
OF CONTRACT REQUIREMENTS.—In the case 
of a business associate of a covered entity that obtains or creates 
protected health information pursuant to a written contract (or 
other written arrangement) described in section 164.502(e)(2) of 
title 45, Code of Federal Regulations, with such covered entity, 
the business associate may use and disclose such protected health 
information only if such use or disclosure, respectively, is in compli-
ance with each applicable requirement of section 164.504(e) of such 
title. The additional requirements of this subtitle that relate to 
privacy and that are made applicable with respect to covered enti-
ties shall also be applicable to such a business associate and shall 
be incorporated into the business associate agreement between the 
business associate and the covered entity. 
(b) APPLICATION OF KNOWLEDGE ELEMENTS ASSOCIATED WITH 
CONTRACTS.—Section 164.504(e)(1)(ii) of title 45, Code of Federal 
Regulations, shall apply to a business associate described in sub-
section (a), with respect to compliance with such subsection, in 
the same manner that such section applies to a covered entity, 
with respect to compliance with the standards in sections 164.502(e) 
and 164.504(e) of such title, except that in applying such section 
164.504(e)(1)(ii) each reference to the business associate, with 
respect to a contract, shall be treated as a reference to the covered 
entity involved in such contract. 
(c) APPLICATION OF CIVIL AND CRIMINAL PENALTIES.—In the 
case of a business associate that violates any provision of subsection 
(a) or (b), the provisions of sections 1176 and 1177 of the Social 
Security Act (42 U.S.C. 1320d–5, 1320d–6) shall apply to the busi-
ness associate with respect to such violation in the same manner 
as such provisions apply to a person who violates a provision 
of part C of title XI of such Act. 
SEC. 13405. RESTRICTIONS ON CERTAIN DISCLOSURES AND SALES OF 
HEALTH INFORMATION; ACCOUNTING OF CERTAIN PRO-
TECTED HEALTH INFORMATION DISCLOSURES; ACCESS 
TO CERTAIN INFORMATION IN ELECTRONIC FORMAT. 
(a) REQUESTED RESTRICTIONS
ON CERTAIN DISCLOSURES
OF 
HEALTH INFORMATION.—In the case that an individual requests 
under paragraph (a)(1)(i)(A) of section 164.522 of title 45, Code 
of Federal Regulations, that a covered entity restrict the disclosure 
of the protected health information of the individual, notwith-
standing paragraph (a)(1)(ii) of such section, the covered entity 
must comply with the requested restriction if— 
(1) except as otherwise required by law, the disclosure 
is to a health plan for purposes of carrying out payment or 
health care operations (and is not for purposes of carrying 
out treatment); and 
(2) the protected health information pertains solely to a 
health care item or service for which the health care provider 
involved has been paid out of pocket in full. 
(b) DISCLOSURES REQUIRED TO BE LIMITED TO THE LIMITED 
DATA SET OR THE MINIMUM NECESSARY.— 
(1) IN GENERAL.— 
(A) IN GENERAL.—Subject to subparagraph (B), a cov-
ered entity shall be treated as being in compliance with
H. R. 1—151 
section 164.502(b)(1) of title 45, Code of Federal Regula-
tions, with respect to the use, disclosure, or request of 
protected health information described in such section, only 
if the covered entity limits such protected health informa-
tion, to the extent practicable, to the limited data set 
(as defined in section 164.514(e)(2) of such title) or, if 
needed by such entity, to the minimum necessary to accom-
plish the intended purpose of such use, disclosure, or 
request, respectively. 
(B) GUIDANCE.—Not later than 18 months after the 
date of the enactment of this section, the Secretary shall 
issue guidance on what constitutes ‘‘minimum necessary’’ 
for purposes of subpart E of part 164 of title 45, Code 
of Federal Regulation. In issuing such guidance the Sec-
retary shall take into consideration the guidance under 
section 13424(c) and the information necessary to improve 
patient outcomes and to detect, prevent, and manage 
chronic disease. 
(C) SUNSET.—Subparagraph (A) shall not apply on and 
after the effective date on which the Secretary issues the 
guidance under subparagraph (B). 
(2) DETERMINATION OF MINIMUM NECESSARY.—For purposes 
of paragraph (1), in the case of the disclosure of protected 
health information, the covered entity or business associate 
disclosing such information shall determine what constitutes 
the minimum necessary to accomplish the intended purpose 
of such disclosure. 
(3) APPLICATION OF EXCEPTIONS.—The exceptions described 
in section 164.502(b)(2) of title 45, Code of Federal Regulations, 
shall apply to the requirement under paragraph (1) as of the 
effective date described in section 13423 in the same manner 
that such exceptions apply to section 164.502(b)(1) of such 
title before such date. 
(4) RULE OF CONSTRUCTION.—Nothing in this subsection 
shall be construed as affecting the use, disclosure, or request 
of protected health information that has been de-identified. 
(c) ACCOUNTING OF CERTAIN PROTECTED HEALTH INFORMATION 
DISCLOSURES REQUIRED
IF COVERED ENTITY USES ELECTRONIC 
HEALTH RECORD.— 
‘‘(1) IN GENERAL.—In applying section 164.528 of title 45, 
Code of Federal Regulations, in the case that a covered entity 
uses or maintains an electronic health record with respect 
to protected health information— 
‘‘(A) the exception under paragraph (a)(1)(i) of such 
section shall not apply to disclosures through an electronic 
health record made by such entity of such information; 
and 
‘‘(B) an individual shall have a right to receive an 
accounting of disclosures described in such paragraph of 
such information made by such covered entity during only 
the three years prior to the date on which the accounting 
is requested. 
‘‘(2) REGULATIONS.—The Secretary shall promulgate regula-
tions on what information shall be collected about each disclo-
sure referred to in paragraph (1), not later than 6 months 
after the date on which the Secretary adopts standards on 
accounting 
for 
disclosure 
described 
in 
the 
section
H. R. 1—152 
3002(b)(2)(B)(iv) of the Public Health Service Act, as added 
by section 13101. Such regulations shall only require such 
information to be collected through an electronic health record 
in a manner that takes into account the interests of the individ-
uals in learning the circumstances under which their protected 
health information is being disclosed and takes into account 
the administrative burden of accounting for such disclosures. 
‘‘(3) PROCESS.—In response to an request from an individual 
for an accounting, a covered entity shall elect to provide either 
an— 
‘‘(A) accounting, as specified under paragraph (1), for 
disclosures of protected health information that are made 
by such covered entity and by a business associate acting 
on behalf of the covered entity; or 
‘‘(B) accounting, as specified under paragraph (1), for 
disclosures that are made by such covered entity and pro-
vide a list of all business associates acting on behalf of 
the covered entity, including contact information for such 
associates (such as mailing address, phone, and email 
address). 
A business associate included on a list under subparagraph 
(B) shall provide an accounting of disclosures (as required under 
paragraph (1) for a covered entity) made by the business asso-
ciate upon a request made by an individual directly to the 
business associate for such an accounting. 
‘‘(4) EFFECTIVE DATE.— 
‘‘(A) CURRENT USERS OF ELECTRONIC RECORDS.—In the 
case of a covered entity insofar as it acquired an electronic 
health record as of January 1, 2009, paragraph (1) shall 
apply to disclosures, with respect to protected health 
information, made by the covered entity from such a record 
on and after January 1, 2014. 
‘‘(B) OTHERS.—In the case of a covered entity insofar 
as it acquires an electronic health record after January 
1, 2009, paragraph (1) shall apply to disclosures, with 
respect to protected health information, made by the cov-
ered entity from such record on and after the later of 
the following: 
‘‘(i) January 1, 2011; or 
‘‘(ii) the date that it acquires an electronic health 
record. 
‘‘(C) LATER DATE.—The Secretary may set an effective 
date that is later that the date specified under subpara-
graph (A) or (B) if the Secretary determines that such 
later date is necessary, but in no case may the date speci-
fied under— 
‘‘(i) subparagraph (A) be later than 2016; or 
‘‘(ii) subparagraph (B) be later than 2013.’’ 
(d) PROHIBITION ON SALE OF ELECTRONIC HEALTH RECORDS 
OR PROTECTED HEALTH INFORMATION.— 
(1) IN GENERAL.—Except as provided in paragraph (2), a 
covered entity or business associate shall not directly or 
indirectly receive remuneration in exchange for any protected 
health information of an individual unless the covered entity 
obtained from the individual, in accordance with section 164.508 
of title 45, Code of Federal Regulations, a valid authorization 
that includes, in accordance with such section, a specification
H. R. 1—153 
of whether the protected health information can be further 
exchanged for remuneration by the entity receiving protected 
health information of that individual. 
(2) EXCEPTIONS.—Paragraph (1) shall not apply in the fol-
lowing cases: 
(A) The purpose of the exchange is for public health 
activities (as described in section 164.512(b) of title 45, 
Code of Federal Regulations). 
(B) The purpose of the exchange is for research (as 
described in sections 164.501 and 164.512(i) of title 45, 
Code of Federal Regulations) and the price charged reflects 
the costs of preparation and transmittal of the data for 
such purpose. 
(C) The purpose of the exchange is for the treatment 
of the individual, subject to any regulation that the Sec-
retary may promulgate to prevent protected health 
information from inappropriate access, use, or disclosure. 
(D) The purpose of the exchange is the health care 
operation specifically described in subparagraph (iv) of 
paragraph (6) of the definition of healthcare operations 
in section 164.501 of title 45, Code of Federal Regulations. 
(E) The purpose of the exchange is for remuneration 
that is provided by a covered entity to a business associate 
for activities involving the exchange of protected health 
information that the business associate undertakes on 
behalf of and at the specific request of the covered entity 
pursuant to a business associate agreement. 
(F) The purpose of the exchange is to provide an indi-
vidual with a copy of the individual’s protected health 
information pursuant to section 164.524 of title 45, Code 
of Federal Regulations. 
(G) The purpose of the exchange is otherwise deter-
mined by the Secretary in regulations to be similarly nec-
essary and appropriate as the exceptions provided in sub-
paragraphs (A) through (F). 
(3) REGULATIONS.—Not later than 18 months after the 
date of enactment of this title, the Secretary shall promulgate 
regulations to carry out this subsection. In promulgating such 
regulations, the Secretary— 
(A) shall evaluate the impact of restricting the excep-
tion described in paragraph (2)(A) to require that the price 
charged for the purposes described in such paragraph 
reflects the costs of the preparation and transmittal of 
the data for such purpose, on research or public health 
activities, including those conducted by or for the use of 
the Food and Drug Administration; and 
(B) may further restrict the exception described in 
paragraph (2)(A) to require that the price charged for the 
purposes described in such paragraph reflects the costs 
of the preparation and transmittal of the data for such 
purpose, if the Secretary finds that such further restriction 
will not impede such research or public health activities. 
(4) EFFECTIVE
DATE.—Paragraph (1) shall apply to 
exchanges occurring on or after the date that is 6 months 
after the date of the promulgation of final regulations imple-
menting this subsection.
H. R. 1—154 
(e) ACCESS TO CERTAIN INFORMATION IN ELECTRONIC FORMAT.— 
In applying section 164.524 of title 45, Code of Federal Regulations, 
in the case that a covered entity uses or maintains an electronic 
health record with respect to protected health information of an 
individual— 
(1) the individual shall have a right to obtain from such 
covered entity a copy of such information in an electronic format 
and, if the individual chooses, to direct the covered entity 
to transmit such copy directly to an entity or person designated 
by the individual, provided that any such choice is clear, con-
spicuous, and specific; and 
(2) notwithstanding paragraph (c)(4) of such section, any 
fee that the covered entity may impose for providing such 
individual with a copy of such information (or a summary 
or explanation of such information) if such copy (or summary 
or explanation) is in an electronic form shall not be greater 
than the entity’s labor costs in responding to the request for 
the copy (or summary or explanation). 
SEC. 13406. CONDITIONS ON CERTAIN CONTACTS AS PART OF HEALTH 
CARE OPERATIONS. 
(a) MARKETING.— 
(1) IN
GENERAL.—A communication by a covered entity 
or business associate that is about a product or service and 
that encourages recipients of the communication to purchase 
or use the product or service shall not be considered a health 
care operation for purposes of subpart E of part 164 of title 
45, Code of Federal Regulations, unless the communication 
is made as described in subparagraph (i), (ii), or (iii) of para-
graph (1) of the definition of marketing in section 164.501 
of such title. 
(2) PAYMENT FOR CERTAIN COMMUNICATIONS.—A commu-
nication by a covered entity or business associate that is 
described in subparagraph (i), (ii), or (iii) of paragraph (1) 
of the definition of marketing in section 164.501 of title 45, 
Code of Federal Regulations, shall not be considered a health 
care operation for purposes of subpart E of part 164 of title 
45, Code of Federal Regulations if the covered entity receives 
or has received direct or indirect payment in exchange for 
making such communication, except where— 
(A)(i) such communication describes only a drug or 
biologic that is currently being prescribed for the recipient 
of the communication; and 
(ii) any payment received by such covered entity in 
exchange for making a communication described in clause 
(i) is reasonable in amount; 
(B) each of the following conditions apply— 
(i) the communication is made by the covered 
entity; and 
(ii) the covered entity making such communication 
obtains from the recipient of the communication, in 
accordance with section 164.508 of title 45, Code of 
Federal 
Regulations, 
a 
valid 
authorization 
(as 
described in paragraph (b) of such section) with respect 
to such communication; or 
(C) each of the following conditions apply—