quired by the repayment plan of the pro-
vider and has failed to make such repay-
ment for at least 180 consecutive days; or 
‘‘(ii) the provider otherwise violates 
the terms of the promissory note for the 
loan made to the provider and continues to 
violate such terms for 180 days. 
‘‘(B) CONSEQUENCES
OF
DEFAULT.—If, 
under subparagraph (A), an eligible health care 
provider defaults on a loan made under sub-
section (a), the Secretary may— 
‘‘(i) report such default to a major 
credit bureau; 
‘‘(ii) offset a tax refund for which the 
provider is eligible by the amount of the 
loan in default; 
‘‘(iii) garnish wages or profits of the 
provider; 
‘‘(iv) except for a provider that makes 
payment amounts for at least six consecu-
tive months for such loan in default, dis-
qualify the provider from any further loans 
under subsection (a); and
‘‘(v) pursue litigation against the pro-
vider for purposes of recovering the 
amount of the loan in default. 
‘‘(h) ADMINISTRATIVE PROVISIONS.—The Secretary 
shall issue regulations for purposes of carrying out the 
Loans Program. The regulations shall include measures 
to ensure compliance of loan originator centers, loan serv-
ice centers, and eligible health care providers with the 
Loan Program. 
‘‘(i) DEFINITIONS.—For purposes of this section: 
‘‘(1) LOAN ORIGINATOR CENTERS.—The term 
‘loan originator center’ means an entity with the ca-
pacity to perform the duties under subsection (d)(2) 
and with which the Secretary of Health and Human 
Services enters into a contract under such sub-
section. 
‘‘(2) LOAN SERVICE CENTERS.—The term ‘loan 
service center’ means an entity with the capacity to 
perform the duties under subsection (e) and with 
which the Secretary of Health and Human Services 
enters into a contract under such subsection. 
‘‘(3) HEALTH
CARE
PROVIDER.—The term 
‘health care provider’ means—
‘‘(A) a health care provider defined in sec-
tion 1171(3), including a critical access hos-
pital; and 
‘‘(B) a federally qualified health center de-
fined in section 1861(aa)(4). 
‘‘(4) ELIGIBLE HEALTH CARE PROVIDER.—The 
term ‘eligible health care provider’ means a health 
care provider that is eligible under subsection (b) to 
receive a loan under subsection (a). 
‘‘(j) EFFECTIVE DATE.—Loans under this section 
shall be available to eligible health care providers starting 
on the date that is one year after the date of the enact-
ment of this section.’’. 
(b) STUDY ON HEALTH CARE PROVIDER HIT LOAN 
PROGRAM
SAVINGS; HIT IMPLEMENTATION
INCEN-
TIVES.— 
(1) STUDY ON HEALTH CARE PROVIDER HIT 
LOAN PROGRAM SAVINGS.— 
(A) STUDY.—Each Federal entity officer 
described in subparagraph (C) shall conduct a 
study to determine any savings realized or costs 
incurred by Federal health care programs (as 
defined in section 1128B(f) of the Social Secu-
rity Act (42 U.S.C. 1320a–7b(f))) because of 
the implementation or adoption of health infor-
mation technology financed through loans made 
under the Health Care Provider HIT Loan Pro-
gram under section 1150B of the Social Secu-
rity Act, as added by subsection (a). 
(B) REPORT.—Not later than the date 
that is one year after the date of the enactment 
of this Act, each Federal entity officer described 
in subparagraph (C) shall submit a report to 
Congress on the results of the study conducted 
under subparagraph (A). 
(C) 
FEDERAL
ENTITY
OFFICER
DE-
SCRIBED.—For purposes of this paragraph, a 
Federal entity officer is each of the following: 
(i) The Comptroller General of the 
Government Accountability Office. 
(ii) The Commissioner of the Medi-
care 
Payment 
Advisory 
Commission 
(MedPAC), established by the Balanced 
Budget Act of 1997 (Public Law 105–33). 
(iii) The Administrator of the Centers 
for 
Medicare 
and 
Medicaid 
Services 
(CMS). 
(iv) The Director of the Congressional 
Budget Office. 
(2) HIT IMPLEMENTATION INCENTIVES.—
(A) STUDY.—The Secretary of Health and 
Human Services, through the Administrator of 
the Centers for Medicare and Medicaid Services 
and after consultation with the Agency for 
Healthcare Research and Quality, health care 
providers, and other interested parties, shall 
specify methods to incentivize the purchase and 
implementation of health information tech-
nology systems. Such incentives may include 
certain payment incentives made by the Federal 
Government to entities, such as prompt claims 
payments, payment differentials, cost differen-
tials, direct payments for services provided 
through health information technology, and 
bonus payments for meeting quality outcomes. 
(B) IMPLEMENTATION.—Not later than 18 
months after the date of the enactment of this 
Act, the Secretary of Health and Human Serv-
ices shall implement the methods specified in 
subparagraph (A). 
SEC. 5. SAFE HARBOR FROM ANTI-KICKBACK LAWS FOR 
HEALTH INFORMATION TECHNOLOGY. 
(a) FOR CIVIL PENALTIES.—Section 1128A(b) of the 
Social Security Act (42 U.S.C. 1320a–7a(b)) is amended 
by adding at the end the following new paragraph:
‘‘(4)(A) For purposes of this subsection, a payment 
described in paragraph (1) does not include any nonmone-
tary remuneration (in the form of permitted support) 
made by a hospital or critical access hospital to a physi-
cian if— 
‘‘(i) such remuneration is made (or is believed 
in good faith to be made) without regard to the 
amount or quality of referrals made or business gen-
erated by the physician to the critical access hospital 
or hospital; and 
‘‘(ii) in the case of such remuneration made on 
or after the date that is four years after the date de-
scribed in section 5(d)(2) of the Electronic Health 
Information Technology Act of 2006, such remu-
neration is made (or is believed in good faith to be 
made) in accordance with the criteria (relating to 
compliance with interoperability standards) estab-
lished by the Secretary under section 5(e) of such 
Act. 
‘‘(B) For purposes of subparagraph (A) and sections 
1128B(b)(3)(J) and 1877(e)(9), the term ‘permitted sup-
port’ means any equipment, item, information, right, li-
cense, intellectual property, software, or service (or fund-
ing used exclusively to provide or pay for such equipment, 
item, information, right, license, intellectual property,
software, or service) that is used for at least the purpose 
of exchanging health information.’’. 
(b) 
FOR
CRIMINAL
PENALTIES.—Section 
1128B(b)(3) of such Act (42 U.S.C. 1320a–7b(b)(3)) is 
amended— 
(1) in subparagraph (G), by striking ‘‘and’’ at 
the end; 
(2) in the subparagraph (H) added by section 
237(d) of the Medicare Prescription Drug, Improve-
ment, and Modernization Act of 2003 (Public Law 
108–173; 117 Stat. 2213)— 
(A) by moving such subparagraph 2 ems to 
the left; and 
(B) by striking the period at the end and 
inserting a semicolon; 
(3) in the subparagraph (H) added by section 
431(a) of such Act (117 Stat. 2287)— 
(A) by redesignating such subparagraph as 
subparagraph (I); 
(B) by moving such subparagraph 2 ems 
to the left; and 
(C) by striking the period at the end and 
inserting ‘‘; and’’; and 
(4) by adding at the end the following new sub-
paragraph:
‘‘(J) any nonmonetary remuneration (in the 
form of permitted support, as defined in section 
1128A(b)(4)(B)) made to a person if— 
‘‘(i) such remuneration is solicited or re-
ceived (or offered or paid) (or believed in good 
faith to be solicited, received, offered, or paid) 
without regard to the amount or quality of re-
ferrals made or business generated by the per-
son; and 
‘‘(ii) in the case of such remuneration 
made on or after the date that is four years 
after the date described in section 5(d)(2) of 
the Electronic Health Information Technology 
Act of 2006, such remuneration is solicited or 
received (or offered or paid) (or believed in 
good faith to be solicited, received, offered, or 
paid) in accordance with the criteria (relating 
to compliance with interoperability standards) 
established by the Secretary under section 5(e) 
of such Act.’’. 
(c) FOR LIMITATION ON CERTAIN PHYSICIAN RE-
FERRALS.—Section 1877(e) of such Act (42 U.S.C. 
1395nn(e)) is amended by adding at the end the following 
new paragraph:
‘‘(9) INFORMATION TECHNOLOGY AND TRAIN-
ING SERVICES.—Any nonmonetary remuneration (in 
the form of permitted support, as defined in section 
1128A(b)(4)(B)) made by an entity to a physician 
if— 
‘‘(A) such remuneration is made (or be-
lieved in good faith to be made) without regard 
to the amount or quality of referrals made or 
business generated by the physician to the enti-
ty; and 
‘‘(B) in the case of such remuneration 
made on or after the date that is four years 
after the date described in section 5(d)(2) of 
the Electronic Health Information Technology 
Act of 2006, such remuneration is made (or be-
lieved in good faith to be made) in accordance 
with the criteria (relating to compliance with 
interoperability standards) established by the 
Secretary under section 5(e) of such Act.’’. 
(d) REGULATIONS, EFFECTIVE DATE, AND EFFECT 
ON STATE LAWS.— 
(1) REGULATIONS.— 
(A) IN
GENERAL.—Subject to subpara-
graph (B) and not later than the date that is 
180 days after the date of the enactment of this
Act, the Secretary of Health and Human Serv-
ices shall issue such regulations as may be nec-
essary to carry out the provisions of this sec-
tion. 
(B) NOTICE
AND
COMMENT.—Not later 
than the date that is 60 days after the date of 
the enactment of this Act, the Secretary of 
Health and Human Services shall issue a notice 
of proposed rulemaking, with respect to the reg-
ulations issued under subparagraph (A). 
(C) 
SUBSEQUENT
REGULATIONS.—Any 
regulation issued by the Secretary on a date 
after the date described in subparagraph (A), 
with respect to the safe harbors described in 
paragraph (4), shall be issued after notice and 
comment. 
(2) EFFECTIVE DATE.—The amendments made 
by this section shall take effect on the date that is 
180 days after the date of the enactment of this Act. 
(3) EFFECT OF STATE LAWS.—No State (as de-
fined in section 1101(a)) shall have in effect a State 
law that imposes a criminal or civil penalty for a 
transaction 
described 
in 
section 
1128A(b)(4); 
1128B(b)(3)(J); or 1877(e)(9) of the Social Security 
Act, as added by this section, if—