S.Amdt. 254

SA 254. Mr. ENZI submitted an amendment intended to be proposed to
amendment SA 98 proposed by Mr. Inouye (for himself and Mr. Baucus) to
the bill H.R. 1, making supplemental appropriations for job
preservation and creation, infrastructure investment, energy efficiency
and science, assistance to the unemployed, and State and local fiscal
stabilization, for fiscal year ending September 30, 2009, and for other
purposes; which was ordered to lie on the table; as follows:

Beginning on page 263, strike line 11 and all that follows
through line 21 on page 390, and insert the following:

TITLE XIII--HEALTH INFORMATION TECHNOLOGY

SEC. 13001. SHORT TITLE.

This title may be cited as the ``Wired for Health Care
Quality Act''.

Subtitle A--Improving the Interoperability of Health Information
Technology

SEC. 13101. IMPROVING HEALTH CARE QUALITY, SAFETY, AND
EFFICIENCY.

(a) In General.--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. 3001. DEFINITIONS; REFERENCE.

``(a) In General.--In this title:
``(1) Entity.--The term `Entity' means the Health IT
Standards Entity established under section 3003.
``(2) Health care provider.--The term `health care
provider' means a hospital, skilled nursing facility, home
health entity, nursing facility, licensed assisted-living
facility, health care clinic, federally qualified health
center, group practice (as defined in section 1877(h)(4) of
the Social Security Act), a pharmacist, a pharmacy, a
laboratory, a physician (as defined in section 1861(r) of the
Social Security Act), a practitioner (as defined in section
1842(b)(18)(CC) of the Social Security Act), a health
facility operated by or pursuant to a contract with the
Indian Health Service, a rural health clinic, and any other
category of facility or clinician determined appropriate by
the Secretary.
``(3) Health information.--The term `health information'
has the meaning given such term in section 1171(4) of the
Social Security Act.
``(4) Health insurance plan.--
``(A) In general.--The term `health insurance plan' means--
``(i) a health insurance issuer (as defined in section
2791(b)(2));
``(ii) a group health plan (as defined in section
2791(a)(1)); and
``(iii) a health maintenance organization (as defined in
section 2791(b)(3)); or
``(iv) a safety net health plan.
``(B) Safety net health plan.--The term `safety net health
plan' means a managed care organization, as defined in
section 1932(a)(1)(B)(i) of the Social Security Act--
``(i) that is exempt from or not subject to Federal income
tax, or that is owned by an entity or entities exempt from or
not subject to Federal income tax; and
``(ii) for which not less than 75 percent of the enrolled
population receives benefits under a Federal health care
program (as defined in section 1128B(f)(1) of the Social
Security Act) or a health care plan or program which is
funded, in whole or in part, by a State (other than a program
for government employees).
``(C) References.--All references in this title to `health
plan' shall be deemed to be references to `health insurance
plan'.
``(5) Individually identifiable health information.--The
term `individually identifiable health information' has the
meaning given such term in section 1171 of the Social
Security Act.
``(6) Laboratory.--The term `laboratory' has the meaning
given such term in section 353.
``(7) National coordinator.--The term `National
Coordinator' means the National Coordinator of Health
Information Technology appointed pursuant to section 3002.
``(8) Policy committee.--The term `Policy Committee' means
the Health Information Technology Policy Committee
established under section 3004.
``(9) Qualified health information technology.--The term
`qualified health information technology' means a
computerized system (including hardware and software) that--
``(A) protects the privacy and security of health
information;
``(B) maintains and provides permitted access to health
information in an electronic format;
``(C) with respect to individually identifiable health
information maintained in a designated record set, preserves
an audit trail of each individual that has gained access to
such record set;
``(D) incorporates decision support to reduce medical
errors and enhance health care quality;
``(E) complies with the standards and implementation
specifications and certification criteria adopted by the
Federal Government under section 3003;
``(F) has the ability to transmit and exchange information
to other health information technology systems and, to the
extent feasible, public health information technology
systems; and
``(G) allows for the reporting of quality measures adopted
under section 3010.
``(10) 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.
``(b) References to Social Security Act.--Any reference in
this section to the Social Security Act shall be deemed to be
a reference to such Act as in effect on the date of enactment
of this title.

``SEC. 3002. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH
INFORMATION TECHNOLOGY.

``(a) Establishment.--There is established within the
office of the Secretary, the Office of the National
Coordinator for Health Information Technology. The National
Coordinator shall be appointed by the Secretary in
consultation with the President, and shall report directly to
the Secretary.
``(b) Purpose.--The Office of the National Coordinator
shall be responsible for--
``(1) ensuring that key health information technology
initiatives are coordinated across programs of the Department
of Health and Human Services;
``(2) ensuring that health information technology policies
and programs of the Department of Health and Human Services
are coordinated with such policies and programs of other
relevant Federal agencies (including Federal commissions and
advisory committees) with a goal of avoiding duplication of
efforts and of helping to ensure that each agency undertakes
activities primarily within the areas of its greatest
expertise and technical capability;
``(3) reviewing Federal health information technology
investments to ensure that Federal health information
technology programs are meeting the objectives of the
strategic plan published by the Office of the National
Coordinator for Health Information Technology to establish a
nationwide interoperable health information technology
infrastructure;
``(4) providing comments and advice regarding specific
Federal health information technology programs, at the
request of Office of Management and Budget; and
``(5) enhancing the use of health information technology to
improve the quality of health care in the prevention and
management of chronic disease and to address population
health.
``(c) Role With Policy Committee and Entity.--The Office of
the National Coordinator shall--
``(1) serve as an ex officio member of the Policy
Committee, and act as a liaison between the Federal
Government and the Policy Committee;
``(2) serve as an ex officio member of the Entity and act
as a liaison between the Federal Government and the Entity;
and
``(3) serve as a liaison between the Entity and the Policy
Committee.
``(d) Reports and Website.--The Office of the National
Coordinator shall--
``(1) develop, publish, and update as necessary a strategic
plan for implementing a nationwide interoperable health
information technology infrastructure;
``(2) maintain and frequently update an Internet website
that--
``(A) publishes the schedule for the assessment of
standards and implementation specifications;
``(B) publishes the recommendations of the Policy
Committee;
``(C) publishes the recommendations of the Entity;
``(D) publishes quality measures adopted pursuant to this
title and the Wired for Health Care Quality Act;

[[Page S1566]]

``(E) identifies sources of funds that will be made
available to facilitate the purchase of, or enhance the
utilization of, qualified health information technology
systems, either through grants or technical assistance; and
``(F) publishes a plan for a transition of any functions of
the Office of the National Coordinator that should be
continued after September 30, 2014;
``(3) prepare a report on the lessons learned from major
public and private health care systems that have implemented
health information technology systems, including an
explanation of whether the systems and practices developed by
such systems may be applicable to and usable in whole or in
part by other health care providers; and
``(4) assess the impact of health information technology in
communities with health disparities and identify practices to
increase the adoption of such technology by health care
providers in such communities.
``(e) Rule of Construction.--Nothing in this section shall
be construed as requiring the duplication of Federal efforts
with respect to the establishment of the Office of the
National Coordinator for Health Information Technology,
regardless of whether such efforts are carried out before or
after the date of the enactment of this title.
``(f) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section, $5,000,000 for
each of fiscal years 2009 and 2010.
``(g) Sunset.--The provisions of this section shall not
apply after September 30, 2014.

``SEC. 3003. HEALTH INFORMATION TECHNOLOGY STANDARDS ENTITY.

``(a) Establishment.--The Secretary, through a grant,
contract, or cooperative agreement, shall provide for the
establishment of a public-private entity to be known as the
`Health IT Standards Entity' (referred to in this title as
the `Entity') to--
``(1) set priorities and support the development,
harmonization, and recognition of standards, implementation
specifications, and certification criteria for the electronic
exchange of health information (including for the reporting
of quality data under section 3010); and
``(2) serve as a forum for the participation of a broad
range of stakeholders with specific technical expertise in
the development of standards, implementation specifications,
and certification criteria to provide input on the effective
implementation of health information technology systems.
``(b) Structure.--In providing for the establishment of the
Entity pursuant to subsection (a), the Secretary shall ensure
the following:
``(1) Diverse composition.--The Entity is initially
composed of members representing the Federal Government,
consumers and patient organizations, organizations with
expertise in privacy, organizations with expertise in
security, health care providers, health plans and other third
party payers, information technology vendors, purchasers and
employers, health informatics and entities engaged in
research and academia, health information exchanges,
organizations with expertise in infrastructure and technical
standards, organizations with expertise in quality
improvement, and other appropriate health entities.
``(2) Broad participation.--There is broad participation in
the Entity by a variety of public and private stakeholders,
either through membership in the Entity or through another
means.
``(3) Published business plan; governance rules.--The
Entity has a business plan and a published set of governance
rules that will enable it to be self-sustaining and to
fulfill the purposes stated in this section, and the Entity
publishes such plan and such rules on an Internet website
that it develops and maintains.
``(4) Chairperson; vice chairperson.--The Entity may
designate one member to serve as the chairperson and one
member to serve as the vice chairperson of the Entity.
``(5) Department membership.--The Secretary shall be a
member of the Entity, and the National Coordinator shall act
as a liaison among the Entity, the Community, and the Federal
Government.
``(6) Balance among sectors.--In developing the procedures
for conducting the activities of the Entity, the Entity 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 Entity.
``(c) Standards and Implementation Specifications.--
``(1) Activities of the entity.--In providing for the
establishment of the Entity pursuant to subsection (a), the
Secretary shall ensure the following:
``(A) Publication of schedule.--Not later than 90 days
after the date on which the Entity is established, the Entity
shall develop and publish a schedule for the assessment of
standards and implementation specifications under this
section, and update such schedule annually.
``(B) First year standards activity.--Consistent with the
initial schedule published under subparagraph (A) and not
later than 1 year after date on which the Entity is
established, the Entity shall develop, harmonize, or
recognize such standards and implementation specifications.
``(C) Subsequent standards activity.--The Entity shall
review at least annually, and modify as appropriate,
standards and implementation specifications that the Entity
has previously developed, harmonized, or recognized, and
continue to develop, harmonize, or recognize additional
standards and implementation specifications, consistent with
the updated schedule published pursuant to subparagraph (A).
``(D) Recognition of entity to make recommendations.--The
Entity, in consultation with the Secretary, may recognize a
private entity or entities for the purpose of developing,
harmonizing, or updating standards and implementation
specifications, consistent with this section, and making
recommendations on such subjects to the Entity, in order to
achieve uniform and consistent implementation of the
standards and implementation specifications.
``(E) Standard testing pilot project.--The Entity may
conduct, or, in consultation with the Secretary, may
recognize a private entity or entities to conduct, a pilot
project to test the standards and implementation
specifications developed, harmonized, or recognized under
this section in order to provide for the efficient
implementation of such standards and implementation
specifications.
``(2) Review.--The Secretary shall review the standards and
implementation specifications described in paragraphs (1)(A)
and (1)(B).
``(3) Publication.--
``(A) Schedule.--The Secretary shall publish the schedules
developed under paragraph (1)(A) in the Federal Register and
on the Internet website of the Department of Health and Human
Services.
``(B) Standards and implementation specifications.--All
standards and implementation specifications developed,
harmonized, or recognized by the Entity pursuant to this
section shall be published in the Federal Register and on the
Internet website of the Office of the National Coordinator.
``(4) Federal action.--Not later than 6 months after the
issuance of a standard or implementation specification by the
Entity under this subsection, the Secretary, the Secretary of
Veterans Affairs, and the Secretary of Defense, in
collaboration with representatives of other relevant Federal
agencies as determined appropriate by the President, shall
jointly review such standard or implementation specification.
If appropriate, the President shall provide for the adoption
by the Federal Government of any such standard or
implementation specification. Such determination shall be
published in the Federal Register and on the Internet website
of the Office of the National Coordinator within 30 days
after the date on which such determination is made.
``(d) Open and Public Process.--In providing for the
establishment of the Entity pursuant to subsection (a), the
Secretary shall ensure the following:
``(1) Consensus approach; open process.--The Entity shall
use a consensus approach and a fair and open process to
support the development, harmonization, and recognition of
standards described in subsection (a)(1).
``(2) Participation of outside advisers.--The Entity shall
ensure an adequate opportunity for the participation of
outside advisors, including individuals with expertise in--
``(A) health information privacy;
``(B) health information security;
``(C) health care quality and patient safety, including
individuals with expertise in utilizing health information
technology to improve healthcare quality and patient safety;
``(D) long-term care and aging services; and
``(E) data exchange and developing health information
technology standards and new health information technology.
``(3) Open meetings.--Plenary and other regularly scheduled
formal meetings of the Entity (or established subgroups
thereof) shall be open to the public.
``(4) Publication of meeting notices and materials prior to
meetings.--The Entity shall develop and maintains an Internet
website on which it publishes, prior to each meeting, a
meeting notice, a meeting agenda, and meeting materials.
``(5) Opportunity for public comment.--The Entity shall
develop a process that allows for public comment during the
process by which the Entity develops, harmonizes, or
recognizes standards and implementation specifications.
``(6) Report.--Not later than 12 months after the date of
enactment of this title, the Entity publishes a report on
progress made in developing, harmonizing, and recognizing
standards, implementation specifications, and certification
criteria, and in achieving broad participation of
stakeholders in its processes.
``(e) Certification.--In providing for the establishment of
the Entity pursuant to subsection (a), the Secretary shall
ensure that--
``(1) the Entity, in consultation with the Secretary, may
recognize a private entity or entities for the purpose of
developing, updating, and recommending to the Entity criteria
to certify that appropriate categories of health information
technology products that claim to be in compliance with
applicable standards and implementation specifications
developed, harmonized, or recognized under this title have
established such compliance;
``(2) the Entity, in consultation with the Secretary,
reviews, and if appropriate, adopts such criteria; and
``(3) the Entity, in consultation with the Secretary, may
recognize a private entity or

[[Page S1567]]

entities to conduct the certifications described under
paragraph (1) using the criteria adopted under this
subsection.
``(f) Rule of Construction.--Nothing in this section shall
be construed as requiring the duplication of Federal efforts
with respect to activities described in this section that are
existing on the date of enactment of this title, including
the establishment of an entity to support the development,
harmonization, or recognition of standards, implementation
specifications, and certification criteria, regardless of
whether such efforts are carried out prior to or after such
date of the enactment.
``(g) Flexibility.--The provisions of Public Law 92-463 (as
amended) shall not apply to the Entity.
``(h) Requirement to Consider Recommendations.--In carrying
out the activities described in this section, the Entity
shall integrate the recommendations of the Policy Committee
that are adopted by the Secretary under section 3004(c).
``(i) Authorization of Appropriations.--There are
authorized to be appropriated to carry out this section,
$2,000,000 for each of the fiscal years 2009 and 2010 to be
available until expended.

``SEC. 3004. HEALTH INFORMATION TECHNOLOGY POLICY COMMITTEE.

``(a) Establishment.--There is established a committee to
be known as the Health Information Technology Policy
Committee to provide advice to the Secretary and the heads of
any relevant Federal agencies concerning the policy
considerations related to health information technology.
``(b) Purpose.--The Policy Committee shall--
``(1) not later than 1 year after the date of enactment of
this title, and semiannually thereafter, make recommendations
concerning a policy framework for the development and
adoption of a nationwide interoperable health information
technology infrastructure;
``(2) not later than 1 year after the date of enactment of
this title, and annually thereafter, make recommendations
concerning national policies for adoption by the Federal
Government, and voluntary adoption by private entities, to
support the widespread adoption of health information
technology, including--
``(A) the protection of individually identifiable health
information, including policies concerning the individual's
ability to control the acquisition, uses, and disclosures of
individually identifiable health information;
``(B) methods to protect individually identifiable health
information from improper use and disclosures and methods to
notify patients if their individually identifiable health
information is wrongfully disclosed;
``(C) methods to facilitate secure access to such
individual's individually identifiable health information;
``(D) methods, guidelines, and safeguards to facilitate
secure access to patient information by a family member,
caregiver, or guardian acting on behalf of a patient due to
age-related and other disability, cognitive impairment, or
dementia that prevents a patient from accessing the patient's
individually identifiable health information;
``(E) the appropriate uses of a nationwide health
information network including--
``(i) the collection of quality data and public reporting;
``(ii) biosurveillance and public health;
``(iii) medical and clinical research; and
``(iv) drug safety;
``(F) fostering the public understanding of health
information technology;
``(G) strategies to enhance the use of health information
technology in preventing and managing chronic disease;
``(H) policies to take into account the input of employees
and staff who are directly involved in patient care of such
health care providers in the design, implementation, and use
of health information technology systems;
``(I) other policies determined to be necessary by the
Policy Committee; and
``(J) best practices in the communication of privacy
protections and procedures to ensure comprehension by
individuals with limited English proficiency and limited
health literacy; and
``(3) serve as a forum for the participation of a broad
range of stakeholders to provide input on improving the
effective implementation of health information technology
systems.
``(c) Publication.--All recommendations made by the Policy
Committee pursuant to this section shall be published in the
Federal Register and on the Internet website of the National
Coordinator. The Secretary shall review all recommendations
and determine which recommendations shall be adopted by the
Federal Government and such determination shall be published
on the Internet website of the Office of the National
Coordinator within 30 days after the date of such adoption.
``(d) Membership.--
``(1) In general.--The Policy Committee shall be composed
of members to be appointed as follows:
``(A) 1 member shall be appointed by the Secretary.
``(B) 1 member shall be appointed by the Secretary of
Veterans Affairs who shall represent the Department of
Veterans Affairs.
``(C) 1 member shall be appointed by the Secretary of
Defense who shall represent the Department of Defense.
``(D) 1 member shall be appointed by the majority leader of
the Senate.
``(E) 1 member shall be appointed by the minority leader of
the Senate.
``(F) 1 member shall be appointed by the Speaker of the
House of Representatives.
``(G) 1 member shall be appointed by the minority leader of
the House of Representatives.
``(H) Eleven members shall be appointed by the Comptroller
General of whom--
``(i) three members shall represent patients or consumers;
``(ii) one member shall represent health care providers;
``(iii) one member shall be from a labor organization
representing health care workers;
``(iv) one member shall have expertise in privacy and
security;
``(v) one member shall have expertise in improving the
health of vulnerable populations;
``(vi) one member shall represent health plans or other
third party payers;
``(vii) one member shall represent information technology
vendors;
``(viii) one member shall represent purchasers or
employers; and
``(ix) one member shall have expertise in health care
quality measurement and reporting.
``(2) Chairperson and vice chairperson.--The Policy
Committee shall designate one member to serve as the
chairperson and one member to serve as the vice chairperson
of the Policy Committee.
``(3) National coordinator.--The National Coordinator shall
be a member of the Policy Committee and act as a liaison
among the Policy Committee, the Entity, and the Federal
Government.
``(4) Participation.--The members of the Policy Committee
appointed under paragraph (1) 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.
``(5) Terms.--
``(A) In general.--The terms of members of the 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 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 Policy Committee shall be filled in the manner in
which the original appointment was made.
``(6) Outside involvement.--The Policy Committee shall
ensure an adequate opportunity for the participation of
outside advisors, including individuals with expertise in--
``(A) health information privacy and security;
``(B) improving the health of vulnerable populations;
``(C) health care quality and patient safety, including
individuals with expertise in measurement and the use of
health information technology to capture data to improve
health care quality and patient safety;
``(D) long-term care and aging services;
``(E) medical and clinical research; and
``(F) data exchange and developing health information
technology standards and new health information technology.
``(7) Quorum.--Ten members of the Policy Committee shall
constitute a quorum for purposes of voting, but a lesser
number of members may meet and hold hearings.
``(8) Failure of initial appointment.--
``(A) Forfeiture of authority to appoint.--If, on the date
that is 120 days after the date of enactment of this title,
an official authorized under paragraph (1) to appoint one or
more members of the Policy Committee has not appointed the
full number of members that such paragraph authorizes such
official to appoint--
``(i) the number of members that such official is
authorized to appoint shall be reduced to the number that
such official has appointed as of that date; and
``(ii) the number prescribed in paragraph (7) as the quorum
shall be reduced to the smallest whole number that is greater
than one-half of the total number of members who have been
appointed as of that date.
``(B) Transition rule.--With respect to an official
authorized under paragraph (1) to appoint one or more members
of the Policy Committee and who has not appointed the full
number of members that such paragraph authorizes such
official to appoint within the 120-day period described in
subparagraph (A), upon a change in such official (resulting
from the convening of a new Congress or the swearing in of a
new President), a new 120-day period shall begin to run under
such subparagraph with respect to the remaining members to be
appointed by such official.
``(e) Federal Agencies.--
``(1) Staff of other federal agencies.--Upon the request of
the Policy Committee, the head of any Federal agency may
detail, without reimbursement, any of the personnel of such
agency to the Policy Committee to assist in carrying out the
duties of the Policy Committee. Any such detail shall not
interrupt or otherwise affect the civil service status or
privileges of the Federal employee involved.
``(2) Technical assistance.--Upon the request of the Policy
Committee, the head of a Federal agency shall provide such
technical assistance to the Policy Committee as the

[[Page S1568]]

Policy Committee determines to be necessary to carry out its
duties.
``(3) Other resources.--The Policy Committee shall have
reasonable access to materials, resources, statistical data,
and other information from the Library of Congress and
agencies and elected representatives of the executive and
legislative branches of the Federal Government. The
chairperson or vice chairperson of the Policy Committee shall
make requests for such access in writing when necessary.
``(f) Administrative Provisions.--
``(1) FACA.--The Federal Advisory Committee Act (5 U.S.C.
App.) shall apply to the Policy Committee, except that the
term provided for under section 14(a)(2) of such Act shall be
not longer than 7 years.
``(2) Charter.--
``(A) In general.--The Secretary shall file the Policy
Committee charter prescribed by section 9(c) of the Federal
Advisory Committee Act (5 U.S.C. App.) not later than 120
days after the date of enactment of this title.
``(B) Failure to file.--If the charter described in
subparagraph (A) has not been filed by the date specified in
such subparagraph, then the requirement under section 9(c) of
the Federal Advisory Committee Act (5 U.S.C. App.) shall be
deemed to have been met as of the day following the date
specified in such subparagraph.
``(g) Sunset.--The provisions of this section shall not
apply after September 30, 2014.
``(h) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section, $2,000,000 for
each of fiscal years 2009 and 2010.

``SEC. 3005. FEDERAL PURCHASING AND DATA COLLECTION.

``(a) Coordination of Federal Spending.--
``(1) In general.--Except as provided in paragraph (2), not
later than 2 years after the adoption by the President of a
recommendation under section 3003(c)(8), a Federal agency
shall not expend Federal funds for the purchase of any new
health information technology or health information
technology system for clinical care or for the electronic
retrieval, storage, or exchange of health information if such
technology or system is not consistent with applicable
standards and implementation specifications adopted by the
Federal Government under section 3003.
``(2) Exceptions.--The President may authorize an exception
to the requirement in paragraph (1) as determined necessary
by the Secretary for the efficient administration of the
Federal agency involved or for economic reasons, including a
case in which--
``(A) the purchasing cycles involved preclude modifying
specifications without significant costs; and
``(B) a new technology or system must interact with a
separate older technology or system whose replacement or
modification would impose significant costs.
``(3) Rule of construction.--Nothing in paragraph (1) shall
be construed to restrict the purchase of minor (as determined
by the Secretary) hardware or software components in order to
modify, correct a deficiency in, or extend the life of
existing hardware or software.
``(b) Voluntary Adoption.--Any standards and implementation
specifications adopted by the Federal Government under
section 3003(c)(8) shall be voluntary with respect to private
entities.
``(c) Coordination of Federal Data Collection.--Not later
than 3 years after the adoption by the Federal Government of
a recommendation as provided for in section 3003(c)(8), all
Federal agencies collecting health data in an electronic
format for the purposes of quality reporting, surveillance,
epidemiology, adverse event reporting, research, or for other
purposes determined appropriate by the Secretary, shall
comply with applicable standards and implementation
specifications adopted under such subsection. The
requirements of this subsection shall apply to the collection
of health data pursuant to programs authorized or required by
the Social Security Act only as authorized or required by
such Act.
``(d) Electronic Submission.--The Secretary shall implement
procedures to enable the Department of Health and Human
Services to accept the electronic submission of data for
activities described in this title and the Federal Food,
Drug, and Cosmetic Act.

``SEC. 3006. QUALITY AND EFFICIENCY REPORTS.

``(a) Purpose.--The purpose of this section is to provide
for the development of reports based on Federal health care
data and private data that is publicly available or is
provided by the entity making the request for the report in
order to--
``(1) improve the quality and efficiency of health care and
advance health care research;
``(2) enhance the education and awareness of consumers for
evaluating health care services; and
``(3) provide the public with reports on national,
regional, and provider- and supplier-specific performance,
which may be in a provider- or supplier-identifiable format.
``(b) Procedures for the Development of Reports.--
``(1) In general.--Notwithstanding section 552(b)(6) or
552a(b) of title 5, United States Code, subject to paragraph
(2)(A)(ii), not later than 12 months after the date of
enactment of this section, the Secretary, in accordance with
the purpose described in subsection (a), shall establish and
implement procedures under which an entity may submit a
request to a Quality Reporting Organization for the
Organization to develop a report based on--
``(A) Federal health care data disclosed to the
Organization under subsection (c);
``(B) private data that is publicly available or is
provided to the Organization by the entity making the request
for the report; and
``(C) clinical data, when available, used to improve the
quality of care, monitor chronic diseases and medical
procedures, and includes the following characteristics:
``(i) Has multi-institutional data sources.
``(ii) Is national in scope.
``(iii) Has publicly available protocols that encompass
common definitions, data collection, sampling size,
methodology, and standardized reporting format.
``(iv) Has an external audit process to ensure adequacy and
quality of data.
``(v) Is risk-adjusted to ensure appropriate data
comparison.
``(2) Definitions.--In this section:
``(A) Federal health care data.--
``(i) In general.--Subject to clause (ii), the term
`Federal health care data' means--

``(I) deidentified enrollment data and deidentified claims
data maintained by the Secretary or entities under programs,
contracts, grants, or memoranda of understanding administered
by the Secretary; and
``(II) where feasible, other deidentified enrollment data
and deidentified claims data maintained by the Federal
Government or entities under contract with the Federal
Government.

``(ii) Exception.--The term `Federal health care data'
includes data relating to programs administered by the
Secretary under the Social Security Act only to the extent
that the disclosure of such data is authorized or required
under such Act.
``(B) Quality reporting organization.--The term `Quality
Reporting Organization' means an entity with a contract under
subsection (d).
``(c) Access to Federal Health Care Data.--
``(1) In general.--The procedures established under
subsection (b)(1) shall provide for the secure disclosure of
Federal health care data to each Quality Reporting
Organization.
``(2) Update of information.--Not less than every 6 months,
the Secretary shall update the information disclosed under
paragraph (1) to Quality Reporting Organizations.
``(d) Quality Reporting Organizations.--
``(1) In general.--
``(A) Contracts.--Subject to subparagraph (B), the
Secretary shall enter into a contract with up to 3 private
entities to serve as Quality Reporting Organizations under
which an entity shall--
``(i) store the Federal health care data that is to be
disclosed under subsection (c); and
``(ii) develop and release reports pursuant to subsection
(e).
``(B) Additional contracts.--If the Secretary determines
that reports are not being developed and released within 6
months of the receipt of the request for the report, the
Secretary shall enter into contracts with additional private
entities in order to ensure that such reports are developed
and released in a timely manner.
``(2) Qualifications.--The Secretary shall enter into a
contract with an entity under paragraph (1) only if the
Secretary determines that the entity--
``(A) has the research capability to conduct and complete
reports under this section;
``(B) has in place--
``(i) an information technology infrastructure to support
the database of Federal health care data that is to be
disclosed to the entity; and
``(ii) operational standards to provide security for such
database;
``(C) has experience with, and expertise on, the
development of reports on health care quality and efficiency;
and
``(D) has a significant business presence in the United
States.
``(3) Contract requirements.--Each contract with an entity
under paragraph (1) shall contain the following requirements:
``(A) Ensuring beneficiary privacy.--
``(i) HIPAA.--The entity shall meet the requirements
imposed on a covered entity for purposes of applying part C
of title XI and all regulatory provisions promulgated
thereunder, including regulations (relating to privacy)
adopted pursuant to the authority of the Secretary under
section 264(c) of the Health Insurance Portability and
Accountability Act of 1996 (42 U.S.C. 1320d-2 note).
``(ii) Other statutory protections.--The entity shall be
required to refrain from disclosing data that could be
withheld by the Secretary under section 552 of title 5,
United States Code, or whose disclosure by the Secretary
would violate section 552a of such title.
``(B) Proprietary information.--The entity shall provide
assurances that the entity will not disclose any negotiated
price concessions, such as discounts, direct or indirect
subsidies, rebates, and direct or indirect remunerations,
obtained by health care providers or suppliers or health care
plans, or any other proprietary cost information.
``(C) Disclosure.--The entity shall disclose--
``(i) any financial, reporting, or contractual relationship
between the entity and any health care provider or supplier
or health care plan; and
``(ii) if applicable, the fact that the entity is managed,
controlled, or operated by any

[[Page S1569]]

health care provider or supplier or health care plan.
``(D) Component of another organization.--If the entity is
a component of another organization--
``(i) the entity shall maintain Federal health care data
and reports separately from the rest of the organization and
establish appropriate security measures to maintain the
confidentiality and privacy of the Federal health care data
and reports; and
``(ii) the entity shall not make an unauthorized disclosure
to the rest of the organization of Federal health care data
or reports in breach of such confidentiality and privacy
requirement.
``(E) Termination or nonrenewal.--If a contract under this
section is terminated or not renewed, the following
requirements shall apply:
``(i) Confidentiality and privacy protections.--The entity
shall continue to comply with the confidentiality and privacy
requirements under this section with respect to all Federal
health care data disclosed to the entity and each report
developed by the entity.
``(ii) Disposition of data and reports.--The entity shall--

``(I) return to the Secretary all Federal health care data
disclosed to the entity and each report developed by the
entity; or
``(II) if returning the Federal health care data and
reports is not practicable, destroy the reports and Federal
health care data.

``(4) Competitive procedures.--Competitive procedures (as
defined in section 4(5) of the Federal Procurement Policy
Act) shall be used to enter into contracts under paragraph
(1).
``(5) Review of contract in the event of a merger or
acquisition.--The Secretary shall review the contract with a
Quality Reporting Organization under this section in the
event of a merger or acquisition of the Organization in order
to ensure that the requirements under this section will
continue to be met.
``(e) Development and Release of Reports Based on
Requests.--
``(1) Request for a report.--
``(A) Request.--
``(i) In general.--The procedures established under
subsection (b)(1) shall include a process for an entity to
submit a request to a Quality Reporting Organization for a
report based on Federal health care data and private data
that is publicly available or is provided by the entity
making the request for the report. Such request shall comply
with the purpose described in subsection (a).
``(ii) Request for specific methodology.--The process
described in clause (i) shall permit an entity making a
request for a report to request that a specific methodology,
including appropriate risk adjustment, be used by the Quality
Reporting Organization in developing the report. The
Organization shall work with the entity making the request to
finalize the methodology to be used.
``(iii) Request for a specific qro.--The process described
in clause (i) shall permit an entity to submit the request
for a report to any Quality Reporting Organization.
``(B) Release to public.--The procedures established under
subsection (b)(1) shall provide that at the time a request
for a report is finalized under subparagraph (A) by a Quality
Reporting Organization, the Organization shall make available
to the public, through the Internet website of the Department
of Health and Human Services and other appropriate means, a
brief description of both the requested report and the
methodology to be used to develop such report.
``(2) Development and release of report.--
``(A) Development.--
``(i) In general.--If the request for a report complies
with the purpose described in subsection (a), the Quality
Reporting Organization may develop the report based on the
request.
``(ii) Requirement.--A report developed under clause (i)
shall include a detailed description of the standards,
methodologies, and measures of quality used in developing the
report.
``(iii) Risk adjustment.--A Quality Reporting Organization
shall ensure that the methodology used to develop a report
under clause (i) shall include acceptable risk adjustment and
case-mix adjustment developed in consultation with providers
as described in clause (iv).
``(iv) Provider consultation.--During the development of
the report under clause (i), the Quality Reporting
Organization shall consult with a group of not more than 5
providers of the relevant specialty who are appointed by the
providers' respective national associations, as to compliance
with clauses (ii) and (iii). The comments of the consulted
providers shall be included in the public release of the
report.
``(B) Review of report by secretary.--Prior to a Quality
Reporting Organization releasing a report under subparagraph
(C), and within 30 days of receiving a request for such a
release, the Secretary shall review the report to ensure that
the report was delivered using a scientifically valid
methodology including appropriate risk adjustment and case-
mix adjustment, and determine that the report does not
disclose--
``(i) information whose disclosure by a covered entity, as
such term is defined for purposes of the regulations issued
under section 264(c) of the Health Insurance Portability and
Accountability Act of 1996, would violate such regulations;
or
``(ii) information that could be withheld by the Department
of Health and Human Services under section 552 of title 5,
United States Code, or whose disclosure by the Department
would violate section 552(a) of such title.
``(C) Release of report.--
``(i) Release to entity making request.--If the Secretary
finds that the report complies with the provisions described
in subparagraph (B), the Quality Reporting Organization shall
release the report to the entity that made the request for
the report.
``(ii) Release to public.--The procedures established under
subsection (b)(1) shall provide for the following:

``(I) Updated description.--At the time of the release of a
report by a Quality Reporting Organization under clause (i),
the entity shall make available to the public, through the
Internet website of the Department of Health and Human
Services and other appropriate means, an updated brief
description of both the requested report and the methodology
used to develop such report.
``(II) Complete report.--Not later than 1 year after the
date of the release of a report under clause (i), the report
shall be made available to the public through the Internet
website of the Department of Health and Human Services and
other appropriate means.

``(f) Annual Review of Reports and Termination of
Contracts.--
``(1) Annual review of reports.--The Comptroller General of
the United States shall review reports released under
subsection (e)(2)(C) to ensure that such reports comply with
the purpose described in subsection (a) and annually submit a
report to the Secretary on such review.
``(2) Termination of contracts.--The Secretary may
terminate a contract with a Quality Reporting Organization if
the Secretary determines that there is a pattern of reports
being released by the Organization that do not comply with
the purpose described in subsection (a).
``(g) Fees.--
``(1) Fees for secretary.--The Secretary shall charge a
Quality Reporting Organization a fee for--
``(A) disclosing the data under subsection (c); and
``(B) conducting the review under subsection (e)(2)(B).
The Secretary shall ensure that such fees are sufficient to
cover the costs of the activities described in subparagraph
(A) and (B).
``(2) Fees for qro.--
``(A) In general.--Subject to subparagraphs (A) and (B), a
Quality Reporting Organization may charge an entity making a
request for a report a reasonable fee for the development and
release of the report.
``(B) Discount for small entities.--In the case of an
entity making a request for a report (including a not-for-
profit) that has annual revenue that does not exceed
$10,000,000, the Quality Reporting Organization shall reduce
the reasonable fee charged to such entity under subparagraph
(A) by an amount equal to 10 percent of such fee.
``(C) Increase for large entities that do not agree to
release reports within 6 months.--In the case of an entity
making a request for a report that is not described in
subparagraph (B) and that does not agree to the report being
released to the public under clause (ii)(II) of subsection
(e)(2)(C) within 6 months of the date of the release of the
report to the entity under clause (i) of such subsection, the
Quality Reporting Organization shall increase the reasonable
fee charged to such entity under subparagraph (A) by an
amount equal to 10 percent of such fee.
``(D) Rule of construction.--Nothing in this paragraph
shall be construed to effect the requirement that a report be
released to the public under clause (ii)(II) of subsection
(e)(2)(C)(ii)(II) by not later than 1 year after the date of
the release of the report to the requesting entity under
clause (i) of such subsection.
``(h) Regulations.--Not later than 6 months after the date
of enactment of this section, the Secretary shall prescribe
regulations to carry out this section.

``SEC. 3007. RESEARCH ACCESS TO HEALTH CARE DATA AND
REPORTING ON PERFORMANCE.

``The Secretary shall permit researchers that meet criteria
used to evaluate the appropriateness of the release data for
research purpose (as established by the Secretary) to--
``(1) have access to Federal health care data (as defined
in section 3006(b)(2)(A)); and
``(2) report on the performance of health care providers
and suppliers, including reporting in a provider- or
supplier-identifiable format.''.
(b) Coordination.--Not later than 1 year after the date of
enactment of this Act, the Secretary of Health and Human
Services shall submit a report (including recommendations) to
the appropriate committees of Congress concerning the
coordination of existing Federal health care quality
initiatives.

Subtitle B--Facilitating the Widespread Adoption of Interoperable
Health Information Technology

SEC. 13201. FACILITATING THE WIDESPREAD ADOPTION OF
INTEROPERABLE HEALTH INFORMATION TECHNOLOGY.

Title XXX of the Public Health Service Act, as added by
section 13101, is amended by adding at the end the following:

[[Page S1570]]

``SEC. 3008. FACILITATING THE WIDESPREAD ADOPTION OF
INTEROPERABLE HEALTH INFORMATION TECHNOLOGY.

``(a) Competitive Grants for Adoption of Technology.--
``(1) In general.--The Secretary may award competitive
grants to eligible entities to facilitate the purchase and
enhance the utilization of qualified health information
technology systems to improve the quality and efficiency of
health care.
``(2) Eligibility.--To be eligible to receive a grant under
paragraph (1) an entity shall--
``(A) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require;
``(B) submit to the Secretary a strategic plan for the
implementation of data sharing and interoperability standards
and implementation specifications;
``(C) adopt the standards and implementation specifications
adopted by the Federal Government under section 3003;
``(D) implement the measures adopted under section 3010 and
report to the Secretary on such measures;
``(E) agree to notify individuals if their individually
identifiable health information is wrongfully disclosed;
``(F) take into account the input of employees and staff
who are directly involved in patient care of such health care
providers in the design, implementation, and use of qualified
health information technology systems;
``(G) demonstrate significant financial need;
``(H) provide matching funds in accordance with paragraph
(4); and
``(I) be a--
``(i) public or not for profit hospital;
``(ii) federally qualified health center (as defined in
section 1861(aa)(4) of the Social Security Act);
``(iii) individual or group practice (or a consortium
thereof); or
``(iv) another health care provider not described in clause
(i) or (ii);
that serves medically underserved communities.
``(3) Use of funds.--Amounts received under a grant under
this subsection shall be used to--
``(A) facilitate the purchase of qualified health
information technology systems;
``(B) train personnel in the use of such systems;
``(C) enhance the utilization of qualified health
information technology systems (which may include activities
to increase the awareness among consumers of health care
privacy protections); or
``(D) improve the prevention and management of chronic
disease.
``(4) Matching requirement.--To be eligible for a grant
under this subsection an entity shall contribute non-Federal
contributions to the costs of carrying out the activities for
which the grant is awarded in an amount equal to $1 for each
$3 of Federal funds provided under the grant.
``(5) Preference in awarding grants.--In awarding grants
under this subsection the Secretary shall give preference
to--
``(A) eligible entities that will improve the degree to
which such entity will link the qualified health information
system to local or regional health information plan or plans;
and
``(B) with respect to awards made for the purpose of
providing care in an outpatient medical setting, entities
that organize their practices as a patient-centered medical
home.
``(b) Competitive Grants for the Development of State Loan
Programs to Facilitate the Widespread Adoption of Health
Information Technology.--
``(1) In general.--The Secretary may award competitive
grants to States for the establishment of State programs for
loans to health care providers to facilitate the purchase and
enhance the utilization of qualified health information
technology.
``(2) Establishment of fund.--To be eligible to receive a
competitive grant under this subsection, a State shall
establish a qualified health information technology loan fund
(referred to in this subsection as a `State loan fund') and
comply with the other requirements contained in this
subsection. Amounts received under a grant under this
subsection shall be deposited in the State loan fund
established by the State. No funds authorized by other
provisions of this title to be used for other purposes
specified in this title shall be deposited in any such State
loan fund.
``(3) Eligibility.--To be eligible to receive a grant under
paragraph (1) a State shall--
``(A) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require;
``(B) submit to the Secretary a strategic plan in
accordance with paragraph (4);
``(C) establish a qualified health information technology
loan fund in accordance with paragraph (2);
``(D) require that health care providers receiving loans
under the grant--
``(i) link, to the extent practicable, the qualified health
information system to a local or regional health information
network;
``(ii) consult, as needed, with the Health Information
Technology Resource Center established in section 914(d) to
access the knowledge and experience of existing initiatives
regarding the successful implementation and effective use of
health information technology;
``(iii) agree to notify individuals if their individually
identifiable health information is wrongfully disclosed; and
``(iv) take into account the input of employees and staff
who are directly involved in patient care of such health care
providers in the design and implementation and use of
qualified health information technology systems;
``(E) require that health care providers receiving loans
under the grant adopt the standards adopted by the Federal
Government under section 3003;
``(F) require that health care providers receiving loans
under the grant implement the measures adopted under section
3010 and report to the Secretary on such measures; and
``(G) provide matching funds in accordance with paragraph
(8).
``(4) Strategic plan.--
``(A) In general.--A State that receives a grant under this
subsection shall annually prepare a strategic plan that
identifies the intended uses of amounts available to the
State loan fund of the State.
``(B) Contents.--A strategic plan under subparagraph (A)
shall include--
``(i) a list of the projects to be assisted through the
State loan fund in the first fiscal year that begins after
the date on which the plan is submitted;
``(ii) a description of the criteria and methods
established for the distribution of funds from the State loan
fund;
``(iii) a description of the financial status of the State
loan fund and the short-term and long-term goals of the State
loan fund; and
``(iv) a description of the strategies the State will use
to address challenges in the adoption of health information
technology due to limited broadband access.
``(5) Use of funds.--
``(A) In general.--Amounts deposited in a State loan fund,
including loan repayments and interest earned on such
amounts, shall be used only for awarding loans or loan
guarantees, or as a source of reserve and security for
leveraged loans, the proceeds of which are deposited in the
State loan fund established under paragraph (1). Loans under
this section may be used by a health care provider to--
``(i) facilitate the purchase of qualified health
information technology systems;
``(ii) enhance the utilization of qualified health
information technology systems (which may include activities
to increase the awareness among consumers of health care of
privacy protections and privacy rights); or
``(iii) train personnel in the use of such systems.
``(B) Limitation.--Amounts received by a State under this
subsection may not be used--
``(i) for the purchase or other acquisition of any health
information technology system that is not a qualified health
information technology system;
``(ii) to conduct activities for which Federal funds are
expended under this title, or the amendments made by the
Wired for Health Care Quality Act; or
``(iii) for any purpose other than making loans to eligible
entities under this section.
``(6) Types of assistance.--Except as otherwise limited by
applicable State law, amounts deposited into a State loan
fund under this subsection may only be used for the
following:
``(A) To award loans that comply with the following:
``(i) The interest rate for each loan shall be less than or
equal to the market interest rate.
``(ii) The principal and interest payments on each loan
shall commence not later than 1 year after the date on which
the loan was awarded, and each loan shall be fully amortized
not later than 10 years after such date.
``(iii) The State loan fund shall be credited with all
payments of principal and interest on each loan awarded from
the fund.
``(B) To guarantee, or purchase insurance for, a local
obligation (all of the proceeds of which finance a project
eligible for assistance under this subsection) if the
guarantee or purchase would improve credit market access or
reduce the interest rate applicable to the obligation
involved.
``(C) As a source of revenue or security for the payment of
principal and interest on revenue or general obligation bonds
issued by the State if the proceeds of the sale of the bonds
will be deposited into the State loan fund.
``(D) To earn interest on the amounts deposited into the
State loan fund.
``(7) Administration of state loan funds.--
``(A) Combined financial administration.--A State may (as a
convenience and to avoid unnecessary administrative costs)
combine, in accordance with State law, the financial
administration of a State loan fund established under this
subsection with the financial administration of any other
revolving fund established by the State if not otherwise
prohibited by the law under which the State loan fund was
established.
``(B) Cost of administering fund.--Each State may annually
use not to exceed 4 percent of the funds provided to the
State under a grant under this subsection to pay the
reasonable costs of the administration of the programs under
this section, including the recovery of reasonable costs
expended to establish a State loan fund which are incurred
after the date of enactment of this title.

[[Page S1571]]

``(C) Guidance and regulations.--The Secretary shall
publish guidance and promulgate regulations as may be
necessary to carry out the provisions of this subsection,
including--
``(i) provisions to ensure that each State commits and
expends funds allotted to the State under this subsection as
efficiently as possible in accordance with this title and
applicable State laws; and
``(ii) guidance to prevent waste, fraud, and abuse.
``(D) Private sector contributions.--
``(i) In general.--A State loan fund established under this
subsection may accept contributions from private sector
entities, except that such entities may not specify the
recipient or recipients of any loan issued under this
subsection.
``(ii) Availability of information.--A State shall make
publicly available the identity of, and amount contributed
by, any private sector entity under clause (i) and may issue
letters of commendation or make other awards (that have no
financial value) to any such entity.
``(8) Matching requirements.--
``(A) In general.--The Secretary may not make a grant under
paragraph (1) to a State unless the State agrees to make
available (directly or through donations from public or
private entities) non-Federal contributions in cash toward
the costs of the State program to be implemented under the
grant in an amount equal to not less than $1 for each $1 of
Federal funds provided under the grant.
``(B) Determination of amount of non-federal
contribution.--In determining the amount of non-Federal
contributions that a State has provided pursuant to
subparagraph (A), the Secretary may not include any amounts
provided to the State by the Federal Government.
``(9) Preference in awarding grants.--The Secretary may
give a preference in awarding grants under this subsection to
States that adopt value-based purchasing programs to improve
health care quality.
``(10) Reports.--The Secretary shall annually 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 and the Committee on Ways and Means of
the House of Representatives, a report summarizing the
reports received by the Secretary from each State that
receives a grant under this subsection.
``(c) Competitive Grants for the Implementation of Regional
or Local Health Information Technology Plans.--
``(1) In general.--The Secretary may award competitive
grants to eligible entities to implement regional or local
health information plans to improve health care quality and
efficiency through the electronic exchange of health
information pursuant to the standards, implementation
specifications and certification criteria, and other
requirements adopted by the Secretary under section 3010.
``(2) Eligibility.--To be eligible to receive a grant under
paragraph (1) an entity shall--
``(A) demonstrate financial need to the Secretary;
``(B) demonstrate that one of its principal missions or
purposes is to use information technology to improve health
care quality and efficiency;
``(C) adopt bylaws, memoranda of understanding, or other
charter documents that demonstrate that the governance
structure and decisionmaking processes of such entity allow
for participation on an ongoing basis by multiple
stakeholders within a community, including--
``(i) health care providers (including health care
providers that provide services to low income and underserved
populations);
``(ii) pharmacists or pharmacies;
``(iii) health plans;
``(iv) health centers (as defined in section 330(b)) and
federally qualified health centers (as defined in section
1861(aa)(4) of the Social Security Act) and rural health
clinics (as defined in section 1861(aa) of the Social
Security Act), if such centers or clinics are present in the
community served by the entity;
``(v) patient or consumer organizations;
``(vi) organizations dedicated to improving the health of
vulnerable populations;
``(vii) employers;
``(viii) State or local health departments; and
``(ix) any other health care providers or other entities,
as determined appropriate by the Secretary;
``(D) demonstrate the participation, to the extent
practicable, of stakeholders in the electronic exchange of
health information within the local or regional plan pursuant
to subparagraph (C);
``(E) adopt nondiscrimination and conflict of interest
policies that demonstrate a commitment to open, fair, and
nondiscriminatory participation in the health information
plan by all stakeholders;
``(F) adopt the standards and implementation specifications
adopted by the Secretary under section 3003;
``(G) require that health care providers receiving such
grants--
``(i) implement the measures adopted under section 3010 and
report to the Secretary on such measures; and
``(ii) take into account the input of employees and staff
who are directly involved in patient care of such health care
providers in the design, implementation, and use of health
information technology systems;
``(H) agree to notify individuals if their individually
identifiable health information is wrongfully disclosed;
``(I) facilitate the electronic exchange of health
information within the local or regional area and among local
and regional areas;
``(J) prepare and submit to the Secretary an application in
accordance with paragraph (3);
``(K) agree to provide matching funds in accordance with
paragraph (5); and
``(L) reduce barriers to the implementation of health
information technology by providers.
``(3) Application.--
``(A) In general.--To be eligible to receive a grant under
paragraph (1), an entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require.
``(B) Required information.--At a minimum, an application
submitted under this paragraph shall include--
``(i) clearly identified short-term and long-term
objectives of the regional or local health information plan;
``(ii) a technology plan that complies with the standards,
implementation specifications, and certification criteria
adopted under section 3003(c)(8) and that includes a
descriptive and reasoned estimate of costs of the hardware,
software, training, and consulting services necessary to
implement the regional or local health information plan;
``(iii) a strategy that includes initiatives to improve
health care quality and efficiency, including the use and
reporting of health care quality measures adopted under
section 3010;
``(iv) a plan that describes provisions to encourage the
implementation of the electronic exchange of health
information by all health care providers participating in the
health information plan;
``(v) a plan to ensure the privacy and security of
individually identifiable health information that is
consistent with Federal and State law;
``(vi) a governance plan that defines the manner in which
the stakeholders shall jointly make policy and operational
decisions on an ongoing basis;
``(vii) a financial or business plan that describes--

``(I) the sustainability of the plan;
``(II) the financial costs and benefits of the plan; and
``(III) the entities to which such costs and benefits will
accrue;

``(viii) a description of whether the State in which the
entity resides has received a grant under section 319D, alone
or as a part of a consortium, and if the State has received
such a grant, how the entity will coordinate the activities
funded under such section 319D with the system under this
section; and
``(ix) in the case of an applicant entity that is unable to
demonstrate the participation of all stakeholders pursuant to
paragraph (2)(C), the justification from the entity for any
such nonparticipation.
``(4) Use of funds.--Amounts received under a grant under
paragraph (1) shall be used to establish and implement a
regional or local health information plan in accordance with
this subsection.
``(5) Matching requirement.--
``(A) In general.--The Secretary may not make a grant under
this subsection to an entity unless the entity agrees that,
with respect to the costs to be incurred by the entity in
carrying out the infrastructure program for which the grant
was awarded, the entity will make available (directly or
through donations from public or private entities) non-
Federal contributions toward such costs in an amount equal to
not less than $1 for each $2 of Federal funds provided under
the grant.
``(B) Determination of amount contributed.--Non-Federal
contributions required under subparagraph (A) may be in cash
or in kind, fairly evaluated, including equipment,
technology, or services. Amounts provided by the Federal
Government, or services assisted or subsidized to any
significant extent by the Federal Government, may not be
included in determining the amount of such non-Federal
contributions.
``(d) Reports.--Not later than 1 year after the date on
which the first grant is awarded under this section, and
annually thereafter during the grant period, an entity that
receives a grant under this section shall submit to the
Secretary a report on the activities carried out under the
grant involved. Each such report shall include--
``(1) a description of the financial costs and benefits of
the project involved and of the entities to which such costs
and benefits accrue;
``(2) an analysis of the impact of the project on health
care quality and safety;
``(3) a description of any reduction in duplicative or
unnecessary care as a result of the project involved; and
``(4) other information as required by the Secretary.
``(e) Requirement To Achieve Quality Improvement.--The
Secretary shall annually evaluate the activities conducted
under this section and shall, in awarding grants, implement
the lessons learned from such evaluations in a manner so that
awards made subsequent to each such evaluation are made in a
manner that, in the determination of the Secretary, will
result in the greatest improvement in quality measures under
section

[[Page S1572]]

3010. The Secretary shall ensure that such evaluation take
into account differences in patient health status, patient
characteristics, and geographic location, as appropriate.
``(f) Limitations.--
``(1) Eligible entities.--An eligible entity may only
receive 1 non-renewable grant under subsection (a) and one
non-renewable grant under subsection (c).
``(2) Loan recipients.--A health care provider may only
receive 1 non-renewable loan awarded or guaranteed with funds
provided under subsection (b),
``(g) Authorization of Appropriations.--
``(1) In general.--For the purpose of carrying out this
section, there is authorized to be appropriated $139,000,000
for fiscal year 2009 and $139,000,000 for fiscal year 2010.
``(2) Availability.--Amounts appropriated under paragraph
(1) shall remain available through fiscal year 2012.

``SEC. 3009. DEMONSTRATION PROGRAM TO INTEGRATE INFORMATION
TECHNOLOGY INTO CLINICAL EDUCATION.

``(a) In General.--The Secretary may award grants to
eligible entities or consortia under this section to carry
out demonstration projects to develop academic curricula
integrating qualified health information technology systems
in the clinical education of health professionals or analyze
clinical data sets from electronic health records to discover
quality measures. Such awards shall be made on a competitive
basis and pursuant to peer review.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a), an entity or consortium shall--
``(1) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require;
``(2) be or include--
``(A) a health professions school;
``(B) a school of public health;
``(C) a school of nursing; or
``(D) an institution with a graduate medical education
program;
``(3) provide for the collection of data regarding the
effectiveness of the demonstration project to be funded under
the grant in improving the safety of patients and the
efficiency of health care delivery; and
``(4) 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 or consortium shall use amounts
received under the grant in collaboration with 2 or more
disciplines.
``(2) Limitation.--An eligible entity or consortium shall
not award a grant under subsection (a) to purchase hardware,
software, or services.
``(d) Matching Funds.--
``(1) In general.--The Secretary may award a grant to an
entity or consortium under this section only if the entity or
consortium agrees to make available non-Federal contributions
toward the costs of the program to be funded under the grant
in an amount that is not less than $1 for each $2 of Federal
funds provided under the grant.
``(2) Determination of amount contributed.--Non-Federal
contributions under paragraph (1) may be in cash or in kind,
fairly evaluated, including equipment or services. Amounts
provided by the Federal Government, or services assisted or
subsidized to any significant extent by the Federal
Government, may not be included in determining the amount of
such contributions.
``(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 and the
Committee on Ways and Means 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).
``(g) Authorization of Appropriations.--There is authorized
to be appropriated to carry out this section, $2,000,000 for
each of fiscal years 2009 and 2010.
``(h) Sunset.--This provisions of this section shall not
apply after September 30, 2012.''.

Subtitle C--Improving the Quality of Health Care

SEC. 13301. CONSENSUS PROCESS FOR THE ADOPTION OF QUALITY
MEASURES FOR USE IN THE NATIONWIDE
INTEROPERABLE HEALTH INFORMATION TECHNOLOGY
INFRASTRUCTURE.

Title XXX of the Public Health Service Act, as amended by
section 13201, is further amended by adding at the end the
following:

``SEC. 3010. FOSTERING DEVELOPMENT AND USE OF HEALTH CARE
QUALITY MEASURES.

``(a) In General.--Only for purposes of activities
conducted under this title, and excluding all programs
authorized under the Social Security Act, the Secretary shall
provide for the endorsement and use of health care quality
measures (referred to in this title as `quality measures')
for the purpose of measuring the quality and efficiency of
health care that patients receive pursuant to programs
authorized under this title.
``(b) Designation of, and Arrangement With, Organization.--
``(1) In general.--Not later than 90 days after the date of
enactment of this title, the Secretary shall designate, and
have in effect an arrangement with, a single organization
that meets the requirements of subsection (c) under which
such organization shall promote the development of quality
measures by a variety of quality measurement development
organizations, including the Physician Consortium for
Performance Improvement, the National Committee for Quality
Assurance, and others, only for purposes of activities
conducted under this title and provide the Secretary with
advice and recommendations on the key elements and priorities
of a national system for health care quality measurement for
purposes of activities conducted under this title.
``(2) Responsibilities.--The responsibilities to be
performed by the organization designated under paragraph (1)
(in this title referred to as the `designated organization')
shall include--
``(A) establishing and managing an integrated strategy and
process for setting priorities and goals in establishing
quality measures only for purposes of activities conducted
under this title;
``(B) coordinating and harmonizing the development and
testing of such measures;
``(C) establishing standards for the development and
testing of such measures;
``(D) endorsing national consensus quality measures;
``(E) recommending, in collaboration with multi-stakeholder
groups, quality measures to the Secretary for adoption and
use only for purposes of activities conducted under this
title;
``(F) promoting the development and use of electronic
health records that contain the functionality for automated
collection, aggregation, and transmission of performance
measurement information; and
``(G) providing recommendations and advice to the Entity
regarding the integration of quality measures into the
standards, implementation specification, and certification
criteria adoption process outlined under section 3003 and the
Policy Committee regarding national policies outlined under
section 3004.
``(c) Requirements Described.--The requirements described
in this subsection are the following:
``(1) Private entity.--The organization shall be a private
nonprofit entity that is governed by a board of directors and
an individual who is designated as president and chief
executive officer.
``(2) Board membership.--The members of the board of
directors of the entity shall include representatives of--
``(A) health care providers or groups representing
providers;
``(B) health plans or groups representing health plans;
``(C) patients or consumers enrolled in such plans or
groups representing individuals enrolled in such plans;
``(D) health care purchasers and employers or groups
representing purchasers or employers; and
``(E) organizations that develop health information
technology standards and new health information technology.
``(3) Other membership requirements.--The membership of the
board of directors of the entity shall be representative of
individuals with experience with--
``(A) urban health care issues;
``(B) safety net health care issues;
``(C) rural or frontier health care issues;
``(D) quality and safety issues;
``(E) State or local health programs;
``(F) individuals or entities skilled in the conduct and
interpretation of biomedical, health services, and health
economics research and with expertise in outcomes and
effectiveness research and technology assessment; and
``(G) individuals or entities involved in the development
and establishment of standards and certification for health
information technology systems and clinical data.
``(4) Open and transparent.--With respect to matters
related to the arrangement with the Secretary under
subsection (a)(1), the organization shall conduct its
business in an open and transparent manner, and provide the
opportunity for public comment and ensure a balance among
disparate stakeholders, so that no member organization unduly
influences the work of the organization.
``(5) Voluntary consensus standards setting
organizations.--The organization shall operate as a voluntary
consensus standards setting organization as defined for
purposes of section 12(d) of the National Technology Transfer
and Advancement Act of 1995 (Public Law 104-113) and Office
of Management and Budget Revised Circular A-119 (published in
the Federal Register on February 10, 1998).
``(6) Participation.--If the organization requires a fee
for membership, the organization shall ensure that such fee
is not a substantial barrier to participation in the entity's
activities related to the arrangement with the Secretary.
``(d) Requirements for Measures.--The quality measures
developed under this title only for purposes of activities
conducted under this title shall comply with the following:
``(1) Measures.--The designated organization, in promoting
the development of quality measures under this title, shall
ensure that such measures--
``(A) are evidence-based, reliable, and valid;

[[Page S1573]]

``(B) include--
``(i) measures of clinical processes and outcomes, patient
experience, efficiency, and equity; and
``(ii) measures to assess effectiveness, timeliness,
patient self-management, patient centeredness, and safety;
and
``(C) include measures of underuse and overuse.
``(2) Priorities.--In carrying out its responsibilities
under this section, the designated organization shall ensure
that priority is given to--
``(A) measures with the greatest potential impact for
improving the performance and efficiency of care;
``(B) measures that may be rapidly implemented by group
health plans, health insurance issuers, physicians,
hospitals, nursing homes, long-term care providers, and other
providers;
``(C) measures which may inform health care decisions made
by consumers and patients;
``(D) measures that apply to multiple services furnished by
different providers during an episode of care;
``(E) measures that can be integrated into the standards,
implementation specifications, and the certification criteria
adoption process described in section 3003; and
``(F) measures that may be integrated into the decision
support function of qualified health information technology
as defined by this title.
``(3) Risk adjustment.--The designated organization, in
consultation with performance measure developers and other
stakeholders, shall establish procedures to ensure that
quality measures take into account differences in patient
health status, patient characteristics, and geographic
location, as appropriate.
``(4) Maintenance.--The designated organization, in
consultation with owners and developers of quality measures,
shall have in place protocols designed to ensure that such
measures are current and reflect the most recent available
evidence and clinical guidelines.
``(e) Grants for Performance Measure Development.--The
Secretary, acting through the Agency for Healthcare Research
and Quality, may award grants, in amounts not to exceed
$50,000 each, to organizations to support the development and
testing of quality measures that meet the standards
established by the designated organization.
``(f) Adoption and Use of Quality Measures.--For purposes
of carrying out activities authorized or required under this
title to ensure the use of quality measures and to foster
uniformity between health care quality measures utilized by
private entities, the Secretary shall--
``(1) select quality measures for adoption and use, from
quality measures recommended by multi-stakeholder groups and
endorsed by the designated organization; and
``(2) ensure that the standards and implementation
specifications adopted under section 3003 integrate the
quality measures endorsed, adopted, and utilized under this
section.

``SEC. 3011. RELATIONSHIP WITH PROGRAMS UNDER THE SOCIAL
SECURITY ACT.

``(a) In General.--For purposes of carrying out activities
authorized or required under this title, the Secretary shall
ensure that the quality measures not described in subsection
(b) and adopted under this title--
``(1) complement quality measures developed by the
Secretary under programs administered by the Secretary under
the Social Security Act, including programs under titles
XVIII, XIX, and XXI of such Act; and
``(2) do not conflict with the needs, priorities, and
activities of programs authorized or required under titles
XVIII, XIX, and XXI of such Act, as set forth by the
Administrator of the Centers for Medicare & Medicaid
Services.
``(b) Adoption of Medicare, Medicaid, and SCHIP Measures.--
Where quality measures developed and endorsed through a
multi-stakeholder consensus process under title XVIII, XIX,
or XXI of the Social Security Act are available and
appropriate, the Secretary shall adopt such measures for
activities under this title.
``(c) Nonduplication of Social Security Act Reporting
Requirements.--If a grantee under section 3008 reports on
quality measures to the Secretary under title XVII, XIX, or
XXI of the Social Security Act, such grantee is deemed to
have met the quality reporting requirement under such section
3008, provided that such reporting is conducted utilizing a
qualified health information technology system.''.

Subtitle D--Privacy and Security

SEC. 13401. PRIVACY AND SECURITY.

Title XXX of the Public Health Service Act, as amended by
section 13301, is further amended by adding at the end the
following:

``SEC. 3012. PRIVACY AND SECURITY.

``(a) Privacy and Security of Personal Health Records.--Not
later than 180 days after the date of enactment of this
title, the Secretary shall submit to the Committee on Health,
Education, Labor, and Pensions of the Senate, the Committee
on the Judiciary of the Senate, the Committee on the
Judiciary of the House of Representatives, and the Committee
on Energy and Commerce of the House of Representatives, a
report containing recommendations for privacy and security
protections for personal health records, including whether it
is appropriate to apply any provisions of subpart E of part
164 of title 45, Code of Federal Regulations, to such records
and the extent to which the implementation of separate
privacy and security measures is necessary. In making such
recommendations, the Secretary shall to the maximum extent
practicable avoid the application of new regulations that
would be inconsistent, or conflict, with privacy regulations
that are in effect on the date of enactment of this title.
``(b) Definition.--In this section, the term `personal
health record' means an electronic, cumulative record of
health-related information concerning an individual that is
often drawn from multiple sources, that is offered by an
entity that is not a covered entity or a business associate
acting pursuant to a business associate agreement under the
Health Insurance Portability and Accountability Act of 1996
(and the regulations promulgated under such Act) and that is
primarily intended to be used and managed by the individual.
``(c) Marketing.--For purposes of the regulations
promulgated pursuant to part C of title XI of the Social
Security Act and section 264(c) of the Health Insurance
Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2
note), referred to in this title as the `HIPAA Privacy Rule',
the term `marketing' means, in addition to the activities
described in section 164.501 of the HIPAA Privacy Rule (45
C.F.R. 164.501) and any comparable provision in any amended
or superseding rule, an arrangement whereby a covered entity,
in exchange for remuneration, makes a communication described
in clause (i), (ii), or (iii) of paragraph (1) of the
definition of marketing in section 164.501 of the HIPAA
Privacy Rule (45 C.F.R. 164.501) as in effect on the date of
enactment of this title, except that the Secretary shall
promulgate regulations establishing the terms and conditions
under which covered entities may charge an appropriate fee
for making such communications. This subsection shall become
effective on the date that is 90 days after the date on which
the Secretary has promulgated such regulations.
``(d) Right of Individuals to Electronic Access.--With
respect to the right of access to inspect and obtain a copy
of health information under the HIPAA Privacy Rule, effective
not later than 180 days after the later of the date of
enactment of this title or the issuance of guidance by the
Secretary, any entity that maintains health information in an
electronic form shall, to the extent readily producible,
provide an individual access to that information in the form
or format requested, and upon request, an electronic copy of
such records. The Secretary shall issue such guidance as is
necessary to implement this subsection.
``(e) Rights of Individuals Who Are Victims of Medical
Fraud.--To the extent provided for under the HIPAA privacy
regulations and under the conditions specified in such
regulations, with respect to protected health information, an
individual who is a victim of medical fraud or who believes
that there is an error in their protected health information
stored in an electronic format shall have the right--
``(1) to have access to inspect and obtain a copy of
protected health information about the individual, including
the information fraudulently entered, in a designated record
set; and
``(2) to have a covered entity amend protected health
information or a record about the individual, including
information fraudulently entered, in a designated electronic
record set for as long as the protected health information is
maintained in the designated electronic record set to ensure
that fraudulent and inaccurate health information is not
shared or re-reported.
``(f) Rule of Construction.--Nothing in this section shall
be construed to supercede or otherwise limit the provisions
of any contract that provides for the application of privacy
protections that are greater than the privacy protections
provided for under the regulations promulgated under section
264 of the Health Insurance Portability and Accountability
Act of 1996.

``SEC. 3013. NOTICE OF PRIVACY PRACTICES.

``Not later than 1 year after the date of enactment of this
title, and after notice and comment, the Secretary shall
develop and disseminate a model summary notice of privacy
practices for use with the privacy notice required under the
HIPAA Privacy Rule. Such summary notice shall be suitable for
printing on one page and shall include separate statements on
any marketing uses for which authorization is sought, shall
describe the right to object to such uses in an way that is
easily understood, and shall otherwise describe the elements
of the right to privacy and security in a clear and concise
manner. Such summary notice shall be provided in a form
separate from any other notice or consent requests.

``SEC. 3014. REPORTING.

``Not later than 180 days after the date of enactment of
this title, and every year thereafter for the next 5 years,
the Secretary shall submit to the Committee on Health,
Education, Labor, and Pensions of the Senate, the Committee
on the Judiciary of the Senate, the Committee on the
Judiciary of the House of Representatives, and the Committee
on Energy and Commerce of the House of Representatives, a
report on compliance and enforcement under the HIPAA Privacy
Rule. Such report shall include--
``(1) the number of complaints filed;
``(2) the resolution or disposition of each complaint;
``(3) the amount of civil money penalties imposed;

[[Page S1574]]

``(4) the number of compliance reviews conducted and the
outcome of each such review;
``(5) the number of subpoenas or closed cases; and
``(6) the Secretary's plan for improving compliance and
enforcement in the coming year.

``SEC. 3015. NOTIFICATION OF PRIVACY BREACH.

``Not later than 1 year after the date of enactment of this
title, and after notice and comment, the Secretary shall
provide for the development of standards and protections and
determine appropriate protocols regarding the notification
trigger, methods, and contents of the notification by the
entity responsible for the protected health information to an
individual whose protected health information has been lost,
stolen, or otherwise disclosed for an unauthorized purpose.
Such notification shall be made within 60 days of the
discovery that such information has been lost, stolen, or
otherwise disclosed. The Secretary shall include exemptions
to such standards and protection for law enforcement and
national security purposes. The Secretary shall determine
penalties to be imposed on entities that fail to comply with
this section in accordance with sections 1176 and 1177 of the
Social Security Act.

``SEC. 3016. ACCOUNTABILITY.

``(a) Subcontracting and Outsourcing Overseas.--In the
event an entity subject to this title contracts with service
providers that are not subject to this title, including
service providers operating in a foreign country, such entity
shall--
``(1) take reasonable steps to select and retain third
party service providers capable of maintaining appropriate
safeguards for the security, privacy, and integrity of
protected health information; and
``(2) require by contract that such service providers
implement and maintain appropriate measures designed to meet
the requirements of entities subject to this title.
``(b) Compliance Assistance.--The Secretary shall ensure
there is a capacity to assist covered entities to determine
the appropriate elements to be considered in arranging
contracts with service providers who are not subject to this
title.
``(c) Effective Date.--This section shall take effect on
the date that is 30 days after the date on which the
Secretary transmits to the Committee on Health, Education,
Labor, and Pension of the Senate and the Committee on Energy
and Commerce of the House of Representatives a statement that
the Secretary has complied with the requirements of
subsection (b).''.

Subtitle E--Miscellaneous Provisions

SEC. 13501. GAO STUDY.

Not later than 18 months after the date of enactment of
this Act, the Comptroller General of the United States shall
submit to the Committee on Health, Education, Labor, and
Pensions of the Senate, the Committee on the Judiciary of the
Senate, the Committee on the Judiciary of the House of
Representatives, and the Committee on Energy and Commerce of
the House of Representatives, a report on the overall
effectiveness and compliance of the efforts of the Secretary
of Health and Human Services to implement health privacy
safeguards provided for in this title, and any
recommendations on how to improve effectiveness and
compliance, if any.

SEC. 13502. HEALTH INFORMATION TECHNOLOGY RESOURCE CENTER.

Section 914 of the Public Health Service Act (42 U.S.C.
299b-3) is amended by adding at the end the following:
``(d) Health Information Technology Resource Center.--
``(1) In general.--The Secretary, acting through the
Director, shall develop a Health Information Technology
Resource Center (referred to in this subsection as the
`Center') to provide technical assistance and develop best
practices to support and accelerate efforts to adopt,
implement, and effectively use interoperable health
information technology in compliance with sections 3003 and
3010.
``(2) 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 evidence
and experience related to the adoption, implementation, and
effective use of interoperable health information technology;
``(D) provide for the establishment of regional and local
health information networks to facilitate the development of
interoperability across health care settings and improve the
quality of health care;
``(E) provide for the development of solutions to barriers
to the exchange of electronic health information; and
``(F) conduct other activities identified by the States,
local, or regional health information networks, or health
care stakeholders as a focus for developing and sharing best
practices.
``(3) Support for activities.--To provide support for the
activities of the Center, the Director shall modify the
requirements, if necessary, that apply to the National
Resource Center for Health Information Technology to provide
the necessary infrastructure to support the duties and
activities of the Center and facilitate information exchange
across the public and private sectors.
``(4) Rule of construction.--Nothing in this subsection
shall be construed to require the duplication of Federal
efforts with respect to the establishment of the Center,
regardless of whether such efforts were carried out prior to
or after the enactment of this subsection.
``(e) Authorization of Appropriations.--There is authorized
to be appropriated, such sums as may be necessary for each of
fiscal years 2009 and 2010 to carry out this section.''.

SEC. 13503. FACILITATING THE PROVISION OF TELEHEALTH SERVICES
ACROSS STATE LINES.

Section 330L of the Public Health Service Act (42 U.S.C.
254c-18) is amended to read as follows:

``SEC. 330L. TELEMEDICINE; INCENTIVE GRANTS REGARDING
COORDINATION AMONG STATES.

``(a) Facilitating the Provision of Telehealth Services
Across State Lines.--The Secretary may make grants to States
that have adopted regional State reciprocity agreements for
practitioner licensure, in order to expedite the provision of
telehealth services across State lines.
``(b) Authorization of Appropriations.--For the purpose of
carrying out subsection (a), there are authorized to be
appropriated such sums as may be necessary for each of the
fiscal years 2009 and 2010.''.
Beginning on page 648, strike line 1 and all that follows
through line 9 on page 713.
______