In the nature of a substitute.

SA 293. 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:

On page 270, strike lines 1 through 11, and insert the
following:
``(1) Standards.--The National Coordinator shall--
``(A) review and determine whether to endorse each
standard, implementation specification, and certification
criterion for the electronic exchange and use of health
information that is recommended by the HIT Standards
Committee under section 3003 for purposes of adoption under
section 3004;
``(B) make such determinations under subparagraph (A), and
report to the Secretary such determinations, not later than
45 days after the date the recommendation is received by the
Coordinator;
``(C) review Federal health information technology
investments to ensure that Federal health information
technology programs are meeting the objectives of the
strategic plan published under paragraph (3); and
``(D) provide comments and advice regarding specific
Federal health information technology programs, at the
request of Office of Management and Budget.''.
Beginning on page 273, strike line 21, and all that follows
through line 8 on page 274, and insert the following:
``(5) Harmonization.--The Secretary may recognize an entity
or entities for the purpose of harmonizing or updating
standards and implementation specifications in order to
achieve uniform and consistent implementation of the
standards and implementation specifications.
``(6) Certification.--
``(A) In general.--The National Coordinator, in
consultation with the Director of the National Institute of
Standards and Technology, shall recognize a program or
programs for the voluntary certification of health
information technology as being in compliance with applicable
certification criteria adopted under this subtitle. Such
program shall include, as appropriate, testing of the
technology in accordance with section 14201(b) of the Health
Information Technology for Economic and Clinical Health
Act.''.
On page 277, strike lines 8 through 11, and insert the
following:
``(8) Governance for nationwide health information
network.--The National Coordinator shall implement the
recommendations made by the HIT Policy Committee regarding
the governance of the nationwide health information
network.''.
On page 283, between lines 12 and 13, insert the following:
``(ix) Methods to facilitate secure access by an individual
to such individual's protected health information.
``(x) 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.''.
On page 284, strike lines 1 through 13, and insert the
following:
``(2) Membership.--The HIT Policy Committee shall be
composed of members to be appointed as follows:
``(A) One member shall be appointed by the Secretary.
``(B) One member shall be appointed by the Secretary of
Veterans Affairs who shall represent the Department of
Veterans Affairs.
``(C) One member shall be appointed by the Secretary of
Defense who shall represent the Department of Defense.
``(D) One member shall be appointed by the Majority Leader
of the Senate.
``(E) One member shall be appointed by the Minority Leader
of the Senate.
``(F) One member shall be appointed by the Speaker of the
House of Representatives.
``(G) One member shall be appointed by the Minority Leader
of the House of Representatives.
``(H) Eleven members shall be appointed by the Comptroller
General of the United States, 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.
``(3) Chairperson and vice chairperson.--The HIT Policy
Committee shall designate one member to serve as the
chairperson and one member to serve as the vice chairperson
of the Policy Committee.
``(4) National coordinator.--The National Coordinator shall
serve as a member of the HIT Policy Committee and act as a
liaison among the HIT Policy Committee, the HIT Standards
Committee, and the Federal Government.
``(5) Participation.--The members of the HIT Policy
Committee appointed under paragraph (2) shall represent a
balance among various sectors of the health care system so
that no single sector unduly influences the recommendations
of the Policy Committee.
``(6) Terms.--
``(A) In general.--The terms of the members of the HIT
Policy Committee shall be for 3 years, except that the
Comptroller General shall designate staggered terms for the
members first appointed.
``(B) Vacancies.--Any member appointed to fill a vacancy in
the membership of the HIT Policy Committee that occurs prior
to the expiration of the term for which the member's
predecessor was appointed shall be appointed only for the
remainder of that term. A member may serve after the
expiration of that member's term until a successor has been
appointed. A vacancy in the HIT Policy Committee shall be
filled in the manner in which the original appointment was
made.
``(7) Outside involvement.--The HIT 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 the measurement and 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.
``(8) Quorum.--Ten members of the HIT Policy Committee
shall constitute a quorum for purposes of voting, but a
lesser number of members may meet and hold hearings.
``(9) Failure of initial appointment.--If, on the date that
is 120 days after the date of enactment of this title, an
official authorized under paragraph (2) to appoint one or
more members of the HIT Policy Committee has not appointed
the full number of members that such paragraph authorizes
such official to appoint--
``(A) 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
``(B) the number prescribed in paragraph (8) 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.
``(10) Consideration.--The National Coordinator shall
ensure that the relevant recommendations and comments from
the National Committee on Vital and Health Statistics are
considered in the development of policies.''.
On page 287, between lines 16 and 17, insert the following:
``(5) Consideration.--The National Coordinator shall ensure
that the relevant recommendations and comments from the
National Committee on Vital and Health Statistics are
considered in the development of standards.''.
On page 288, strike lines 4 through 19 and insert the
following:

[[Page S1587]]

``(3) Broad participation.--There is broad participation in
the HIT Standards Committee by a variety of public and
private stakeholders, either through membership in the
Committee or through another means.
``(4) Chairperson; vice chairperson.--The HIT Standards
Committee may designate one member to serve as the
chairperson and one member to serve as the vice chairperson.
``(5) Department membership.--The Secretary shall be a
member of the HIT Standards Committee. The National
Coordinator shall act as a liaison among the HIT Standards
Committee, the HIT Policy Committee, and the Federal
Government.
``(6) Balance among sectors.--In developing the procedures
for conducting the activities of the HIT Standards Committee,
the HIT Standards Committee shall act to ensure a balance
among various sectors of the health care system so that no
single sector unduly influences the actions of the HIT
Standards Committee.
``(7) Assistance.--For the purposes of carrying out this
section, the Secretary may provide or ensure that financial
assistance is provided by the HIT Standards Committee to
defray in whole or in part any membership fees or dues
charged by such Committee to those consumer advocacy groups
and not for profit entities that work in the public interest
as a part of their mission.
``(d) Open and Public Process.--In providing for the
establishment of the HIT Standards Committee pursuant to
subsection (a), the Secretary shall ensure the following:
``(1) Consensus approach; open process.--The HIT Standards
Committee 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 HIT Standards
Committee 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 HIT Standards Committee (or
established subgroups thereof) shall be open to the public.
``(4) Publication of meeting notices and materials prior to
meetings.--The HIT Standards Committee shall develop and
maintain 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 HIT Standards
Committee shall develop a process that allows for public
comment during the process by which the Entity develops,
harmonizes, or recognizes standards and implementation
specifications.
``(e) Voluntary Consensus Standard Body.--The provisions of
section 12(d) of the National Technology Transfer and
Advancement Act of 1995 (15 U.S.C. 272 note) and Office of
Management and Budget circular 119 shall apply to the HIT
Standards Committee.''.
On page 290, line 14, strike ``Initial Set of''.
On page 291, between lines 6 and 7, insert the following:
``(3) Subsequent standards activity.--The Secretary shall
adopt additional standards, implementation specifications,
and certification criteria as necessary and consistent with
the schedule published under section 3003(b)(2).''.
Beginning on page 293, strike line 7 and all that follows
through line 2 on page 295, and insert the following:

SEC. 3008. TRANSITIONS.

``(a) ONCHIT.--Nothing in section 3001 shall be construed
as requiring the creation of a new entity to the extent that
the Office of the National Coordinator for Health Information
Technology established pursuant to Executive Order 13335 is
consistent with the provisions of section 3001.
``(b) National EHealth Collaborative.--Nothing in sections
3002 or 3003 or this subsection shall be construed as
prohibiting the National eHealth Collaborative from modifying
its charter, duties, membership, and any other structure or
function required to be consistent with the requirements of a
voluntary consensus standards body so as to allow the
Secretary to recognize the National eHealth Collaborative as
the HIT Standards Committee.
``(c) Consistency of Recommendations.--In carrying out
section 3003(b)(1)(A), until recommendations are made by the
HIT Policy Committee, recommendations of the HIT Standards
Committee shall be consistent with the most recent
recommendations made by such AHIC Successor, Inc.''.
On page 294, strike lines 10 through 16.
305, line 5, strike ``shall coordinate'' and insert ``may
review''.
______