S. 1262Senate109th Congress (2005-2007)In Committee

Health TEQ Act of 2005

A bill to reduce healthcare costs, improve efficiency, and improve healthcare quality through the development of a nation-wide interoperable health information technology system, and for other purposes.

Also known as Health Technology to Enhance Quality Act of 2005

Introduced June 16, 2005

Legislative Activity

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4 earlier actions
SenateIntro Referral Latest Action

Sponsor introductory remarks on measure. (CR S8591)

July 21, 2005

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SenateIntro Referral

Introduced in Senate

June 16, 2005

SenateIntro Referral

Sponsor introductory remarks on measure. (CR S6752-6754)

June 16, 2005

SenateIntro Referral

Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (text of measure as introduced: CR S6754-6758)

June 16, 2005

SenateIntro Referral

Sponsor introductory remarks on measure. (CR S8393-8394)

July 18, 2005

SenateIntro Referral

Sponsor introductory remarks on measure. (CR S8591)

July 21, 2005

Floor Debate

20 members

What members said about S. 1262 on the floor

7 Republicans13 Democrats
Jeff Bingaman
Sen. Jeff BingamanD-NM · Jun 16, 2005

Yes. Mr. President, I send an amendment to the desk and ask for its immediate consideration. I ask unanimous consent that the reading of the amendment be dispensed with. Mr. President, this is a…

Pete V. Domenici
Sen. Pete V. DomeniciR-NM · Jun 16, 2005

The time has come to move back to this bill. I want to say to Senators it happens frequently, when things are going well, that nobody is very interested in moving along. So we have to push you along…

Lamar Alexander
Sen. Lamar AlexanderR-TN · Jun 16, 2005

Mr. President, I thank the Senator from New Mexico. While both Senators from New Mexico are in the Chamber, all of us appreciate the way they have brought this extremely important bill together. We…

Ken Salazar
Sen. Ken SalazarD-CO · Jun 16, 2005

Mr. President, I rise in support of Senator Bingaman's amendment, the renewable energy standard or, as we have come to know it, the renewable portfolio standard. When we consider the imperative with…

Richard J. Durbin
Sen. Richard J. DurbinD-IL · Jun 16, 2005

Mr. President, I would like to speak to the pending amendment, the Cantwell amendment, if it is appropriate, unless the chairman has some other business he wants to raise at this point? Maybe I could…

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Lamar Alexander
Sen. Lamar AlexanderR-TN · Jun 16, 2005

Mr. President, in case the President may be wondering, and I asked consent about this, these are 7,000 regulations. We have 6,000 autonomous institutions of higher education in the United States,…

Maria Cantwell
Sen. Maria CantwellD-WA · Jun 16, 2005

Mr. President, I ask unanimous consent to set aside the pending amendment and I call up amendment No. 784 and send a modification to the desk. Mr. President, I know the Senator from Michigan has…

Jon S. Corzine
Sen. Jon S. CorzineD-NJ · Jun 16, 2005

Mr. President, I would like to begin my remarks by thanking Chairman Domenici and Senator Bingaman, the ranking member, as well as their staffs, for the hard work and excellent effort they have made…

Larry E. Craig
Sen. Larry E. CraigR-ID · Jun 16, 2005

I am happy to speak. Mr. President, I yield myself such time as I may consume. Mr. President, in speaking to the Bingaman amendment, I believe renewable energy resources are an important part of our…

Jim Talent
Sen. Jim TalentR-MO · Jun 16, 2005

Mr. President, I rise in opposition to amendment No. 791, Senator Bingaman's amendment which would require a mandatory renewable portfolio standard, or ``RPS.'' I am a big supporter of new, clean…

Daniel K. Akaka
Sen. Daniel K. AkakaD-HI · Jun 16, 2005

Mr. President, I rise today with a profound sense of optimism and appreciation. We have not enacted a comprehensive energy bill since 1992. Many programs need reauthorization and many need revision.…

Frank R. Lautenberg
Sen. Frank R. LautenbergD-NJ · Jun 16, 2005

Mr. President, first let me say to my friend and colleague from New Jersey how much I admire his commitment to our State and to the things that protect our environment and our well-being. I am very…

William H. Frist
Sen. William H. FristR-TN · Jun 16, 2005

Mr. President, this morning I am pleased to be joined on the floor by my distinguished colleague from the State of New York. Together we share an important goal to improve health care quality and…

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William H. Frist
Sen. William H. FristR-TN · Jun 16, 2005

Mr. President, this morning I am pleased to be joined on the floor by my distinguished colleague from the State of New York. Together we share an important goal to improve health care quality and…

Joseph R. Biden Jr.
Sen. Joseph R. Biden Jr.D-DE · Jun 16, 2005

Mr. President, I rise today to introduce the Hazardous Materials Vulnerability Reduction Act of 2005. It is regretful that I am introducing this legislation, as the Department of Homeland Security…

Carl Levin
Sen. Carl LevinD-MI · Jun 16, 2005

Mr. President, I thank our friend from Washington for making this modification. This is a very important modification from my perspective. But for this modification, the language of the amendment…

George V. Voinovich
Sen. George V. VoinovichR-OH · Jun 16, 2005

Mr. President, today I rise to introduce the Generating Opportunity by Forgiving Educational Debt for Service Act of 2005, a bill that will help Federal agencies and the Armed Forces recruit talented…

Byron L. Dorgan
Sen. Byron L. DorganD-ND · Jun 16, 2005

Mr. President, first I thank Senator Bingaman for this amendment. I support the amendment. It advances, improves and strengthens the underlying energy bill. I know that the term ``renewable portfolio…

Jeff Bingaman
Sen. Jeff BingamanD-NM · Jun 16, 2005

Mr. President, our country is facing a crisis. Too many of our young people leave high school without the skills necessary to meet the demands of a global economy. According to a recent U.S. Chamber…

Harry Reid
Sen. Harry ReidD-NV · Jun 16, 2005

Mr. President, I ask unanimous consent that the order for the quorum call be rescinded. Mr. President, it is my understanding that the only time remaining is that of the majority. Is that right? Mr.…

Barack Obama
Sen. Barack ObamaD-IL · Jun 16, 2005

Mr. President, I support the amendment offered by the Senator from New Mexico, Mr. Bingaman. This amendment is a breath of fresh air in a bill that is filled with many stale concepts regarding our…

Hillary Rodham Clinton
Sen. Hillary Rodham ClintonD-NY · Jun 16, 2005

Mr. President, I wish to express my appreciation to Senator Frist for his leadership on this issue because we certainly do need to bring our health care system out of the information dark ages. I am…

Hillary Rodham Clinton
Sen. Hillary Rodham ClintonD-NY · Jun 16, 2005

Mr. President, I wish to express my appreciation to Senator Frist for his leadership on this issue because we certainly do need to bring our health care system out of the information dark ages. I am…

Richard Burr
Sen. Richard BurrR-NC · Jun 16, 2005

Mr. President, I am glad I stayed on the floor because I was a little dismayed when I heard Senator Cantwell describe her amendment. Senator Durbin helped to clear it up for me in the fact that if we…

Bill Text

Latest available legislative text

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Latest
Introduced in SenateIssued June 16, 2005
        [Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 1262 Introduced in Senate (IS)]

109th CONGRESS
1st Session
S. 1262

To reduce healthcare costs, improve efficiency, and improve healthcare
quality through the development of a nationwide interoperable health
information technology system, and for other purposes.

_______________________________________________________________________

IN THE SENATE OF THE UNITED STATES

June 16, 2005

Mr. Frist (for himself, Mrs. Clinton, Mr. Martinez, Mr. Bingaman, Mr.
Talent, Ms. Mikulski, Mr. Thune, and Mr. Obama) introduced the
following bill; which was read twice and referred to the
Committee on Health, Education, Labor, and PensionsYYYYYYYYYYYY

_______________________________________________________________________

A BILL

To reduce healthcare costs, improve efficiency, and improve healthcare
quality through the development of a nationwide interoperable health
information technology system, and for other purposes.

Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the ``Health Technology to Enhance Quality
Act of 2005'' or the ``Health TEQ Act of 2005''.

TITLE I--HEALTH INFORMATION TECHNOLOGY STANDARDS ADOPTION AND
INFRASTRUCTURE DEVELOPMENT

SEC. 101. ESTABLISHMENT OF NATIONAL COORDINATOR; RECOMMENDATION,
ADOPTION, AND IMPLEMENTATION OF HEALTH INFORMATION
ELECTRONIC EXCHANGE STANDARDS.

The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by
adding at the end the following:

``TITLE XXIX--HEALTH INFORMATION TECHNOLOGY

``SEC. 2901. DEFINITIONS.

``For purposes of this title:
``(1) Group health plan.--The term `group health plan' has
the meaning giving that term in section 2791.
``(2) Healthcare provider.--The term `healthcare provider'
means a hospital, skilled nursing facility, home health entity,
healthcare clinic, community health center, group practice (as
defined in section 1877(h)(4) of the Social Security Act), a
physician (as defined in section 1861(r)(1) of the Social
Security Act), a pharmacist, a pharmacy, a laboratory, and any
other category of facility or clinician determined appropriate
by the Secretary.
``(3) Health information.--The term `health information'
means any information, recorded in any form or medium, that
relates to the past, present, or future physical or mental
health or condition of an individual, the provision of
healthcare to an individual, or the past, present, or future
payment for the provision of healthcare to an individual.
``(4) Health insurance issuer.--The term `health insurance
issuer' has the meaning given that term in section 2791.
``(5) Laboratory.--The term `laboratory' has the meaning
given that term in section 353.
``(6) Pharmacist.--The term `pharmacist' has the meaning
given that term in section 804 of the Federal Food, Drug, and
Cosmetic Act.

``SEC. 2902. OFFICE OF THE NATIONAL COORDINATOR OF HEALTH INFORMATION
TECHNOLOGY.

``(a) Office of National Health Information Technology.--There is
established within the Office of the Secretary an Office of the
National Coordinator of Health Information Technology (referred to in
this section as the `Office'). The Office shall be headed by a National
Coordinator who shall be appointed by the President in consultation
with the Secretary and shall report directly to the Secretary.
``(b) Purpose.--It shall be the purpose of the Office to carry out
programs and activities to develop a nationwide interoperable health
information technology infrastructure that--
``(1) improves healthcare quality, reduces medical errors,
and advances the delivery of patient-centered medical care;
``(2) reduces healthcare costs resulting from inefficiency,
medical errors, inappropriate care, and incomplete information;
``(3) ensures that appropriate information to help guide
medical decisions is available at the time and place of care;
``(4) promotes a more effective marketplace, greater
competition, and increased choice through the wider
availability of accurate information on healthcare costs,
quality, and outcomes;
``(5) improves the coordination of care and information
among hospitals, laboratories, physician offices, and other
entities through an effective infrastructure for the secure and
authorized exchange of healthcare information;
``(6) improves public health reporting and facilitates the
early identification and rapid response to public health
threats and emergencies, including bioterror events and
infectious disease outbreaks;
``(7) facilitates health research; and
``(8) ensures that patients' health information is secure
and protected.
``(c) Duties of National Coordinator.--
``(1) In general.--The National Coordinator shall--
``(A) facilitate the adoption of a national system
for the electronic exchange of health information;
``(B) serve as the principal advisor to the
Secretary on the development, application, and use of
health information technology, and coordinate and
oversee the health information technology programs of
the Department;
``(C) ensure the adoption and implementation of
standards for the electronic exchange of health
information, including coordinating the activities of
the Standards Working Group under section 2903;
``(D) carry out activities related to the
electronic exchange of health information that reduce
cost and improve healthcare quality;
``(E) ensure that health information technology
policy and programs of the Department are coordinated
with those of relevant executive branch agencies
(including Federal commissions) with a goal of avoiding
duplication of efforts and of helping to ensure that
each agency undertakes health information technology
activities primarily within the areas of its greatest
expertise and technical capability;
``(F) to the extent permitted by law, coordinate
outreach and consultation by the relevant executive
branch agencies (including Federal commissions) with
public and private parties of interest, including
consumers, payers, employers, hospitals and other
healthcare providers, physicians, community health
centers, laboratories, vendors and other stakeholders;
``(G) advise the President regarding specific
Federal health information technology programs; and
``(H) submit the reports described under paragraph
(2).
``(2) Reports to congress.--The National Coordinator shall
submit to Congress, on an annual basis, a report that
describes--
``(A) specific steps that have been taken to
facilitate the adoption of a nationwide system for the
electronic exchange of health information;
``(B) barriers to the adoption of such a nationwide
system; and
``(C) recommendations to achieve full
implementation of such a nationwide system.
``(d) Detail of Federal Employees.--
``(1) In general.--Upon the request of the National
Coordinator, the head of any Federal agency is authorized to
detail, with or without reimbursement from the Office, any of
the personnel of such agency to the Office to assist it in
carrying out its duties under this section.
``(2) Effect of detail.--Any such detail shall--
``(A) not interrupt or otherwise affect the civil
service status or privileges of the Federal employee;
and
``(B) be in addition to any other staff of the
Department employed by the National Coordinator.
``(3) Acceptance of Detailees.--Notwithstanding any other
provision of law, the Office may accept detailed personnel from
other Federal agencies without regard to whether the agency
described under paragraph (1) is reimbursed.
``(e) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary to carry out the activities
of the Office under this section for each of fiscal years 2006 through
2010.

``SEC. 2903. COLLABORATIVE PROCESS FOR THE RECOMMENDATION, ADOPTION,
AND IMPLEMENTATION OF HEALTH INFORMATION STANDARDS.

``(a) Establishment of Working Group.--Not later than 60 days after
the date of enactment of this title, the National Coordinator, in
consultation with the Director of the National Institute of Standards
and Technology (referred to in this section as the `Director'), shall
establish a permanent Electronic Health Information Standards
Development Working Group (referred to in this title as the `Standards
Working Group').
``(b) Composition.--The Standards Working Group shall be composed
of--
``(1) the National Coordinator, who shall serve as the
chairperson of the Standards Working Group;
``(2) the Director;
``(3) representatives of the relevant Federal agencies and
departments, as selected by the Secretary in consultation with
the National Coordinator, including representatives of the
Department of Veterans Affairs, the Department of Defense, the
Office of Management and Budget, the Department of Homeland
Security, and the Environmental Protection Agency;
``(4) private entities accredited by the American National
Standards Institute, as selected by the National Coordinator;
``(5) representatives, as selected by the National
Coordinator--
``(A) of group health plans or other health
insurance issuers;
``(B) of healthcare provider organizations;
``(C) with expertise in health information
security;
``(D) with expertise in health information privacy;
``(E) with experience in healthcare quality and
patient safety, including those with experience in
utilizing health information technology to improve
healthcare quality and patient safety;
``(F) of consumer and patient organizations;
``(G) of employers;
``(H) with experience in data exchange; and
``(I) with experience in developing health
information technology standards and new health
information technology; and
``(6) other representatives as determined appropriate by
the National Coordinator in consultation with the Secretary.
``(c) Standards Deemed Adopted.--On the date of enactment of this
title, the Secretary and the Standards Working Group shall deem as
adopted, for use by the Secretary and private entities, the standards
adopted by the Consolidated Health Informatics Initiative prior to such
date of enactment.
``(d) Duties.--
``(1) First year review.--Not later than 1 year after the
date of enactment of this title, the Standards Working Group
shall--
``(A) review existing standards (including content,
communication, and security standards) for the
electronic exchange of health information, including
such standards deemed adopted under subsection (c);
``(B) identify deficiencies and omissions in such
existing standards;
``(C) identity duplications and omissions in
existing standards, and recommend modifications to such
standards as necessary; and
``(D) submit a report to the Secretary recommending
for adoption by such Secretary and private entities--
``(i) modifications to the standards deemed
adopted under subsection (c); and
``(ii) any additional standards reviewed
pursuant to this paragraph.
``(2) Ongoing review.--Beginning 1 year after the date of
enactment of this title, and on an ongoing basis thereafter,
the Standards Working Group shall--
``(A) review existing standards (including content,
communication, and security standards) for the
electronic exchange of health information, including
such standards adopted by the Secretary under
subsections (c) and (e);
``(B) identify deficiencies and omissions in such
existing standards;
``(C) identity duplications and omissions in
existing standards, and recommend modifications to such
standards as necessary; and
``(D) submit reports to the Secretary recommending
for adoption by such Secretary and private entities--
``(i) modifications to any existing
standards; and
``(ii) any additional standards reviewed
pursuant to this paragraph.
``(3) Limitation.--The standards described under this
subsection shall not include any standards developed pursuant
the Health Insurance Portability and Accountability Act of
1996.
``(e) Adoption by Secretary.--Not later than 1 year after the
receipt of a report from the Standards Working Group under paragraph
(1)(D) or (2)(D) of subsection (d), the Secretary shall review and
provide for the adoption by the Federal Government of any modification
or standard recommended in such report.
``(f) Voluntary Adoption.--Any standards adopted by the Secretary
under this section shall be voluntary for private entities.
``(g) Application of FACA.--
``(1) In general.--The Federal Advisory Committee Act (5
U.S.C. App.) shall apply to the Standards Working Group
established under this section.
``(2) Limitation.--Notwithstanding paragraph (1), the 2-
year termination date under section 14 of the Federal Advisory
Committee Act shall not apply to the Standards Working Group.

``SEC. 2904. IMPLEMENTATION AND CERTIFICATION OF HEALTH INFORMATION
STANDARDS.

``(a) Implementation.--
``(1) In general.--The Secretary, in consultation with the
National Coordinator and the Director of the National Institute
of Standards and Technology, shall develop criteria to ensure
uniform and consistent implementation of any standards for the
electronic exchange of health information voluntarily adopted
by private entities in technical conformance with such
standards adopted under this title.
``(2) Implementation assistance.--The Secretary may
recognize a private entity or entities to assist private
entities in the implementation of the standards adopted under
this title.
``(b) Certification.--
``(1) In general.--The Secretary, in consultation with the
National Coordinator and the Director of the National Institute
of Standards and Technology shall develop criteria to ensure
and certify that hardware, software, and support services that
claim to be in compliance with any standard for the electronic
exchange of health information adopted under this title have
established and maintain such compliance in technical
conformance with such standard.
``(2) Certification assistance.--The Secretary may
recognize a private entity or entities to assist in the
certification described under paragraph (1).
``(c) Delegation authority.--The Secretary may delegate the
development of the criteria under subsection (a) and (b) to a private
entity.

``SEC. 2905. AUTHORITY FOR COORDINATION AND SPENDING.

``(a) In General.--The Secretary acting through the National
Coordinator--
``(1) shall direct and coordinate--
``(A) Federal spending related to the development,
adoption, and implementation of standards for the
electronic exchange of health information; and
``(B) the adoption of the recommendations submitted
to such Secretary by the Standards Working Group
established under section 2903; and
``(2) may utilize the entities recognized under section
2904 to assist in implementation and certification related to
the implementation by the Federal Government of the standards
adopted by the Secretary under this title.
``(b) Limitation.--
``(1) In general.--Notwithstanding any other provision of
law, no Federal agency shall expend Federal funds for the
purchase of hardware, software, or support services for the
purpose of implementing a standard related to the electronic
exchange of health information that is not a standard adopted
by the Secretary under section 2903.
``(2) Effective date.--The limitation under paragraph (1)
shall take effect not later than 1 year after the adoption by
the Secretary of such standards under section 2903.''.

SEC. 102. ENCOURAGING SECURE EXCHANGE OF HEALTH INFORMATION.

(a) Study and Grant Programs Related to State Health Information
Laws and Practices.--
(1) Study of state health information laws and practices.--
(A) In general.--The Secretary of Health and Human
Services (referred to in this Act as the ``Secretary'')
shall carry out, or contract with a private entity to
carry out, a study that examines--
(i) the variation among State laws and
practices that relate to the privacy,
confidentiality, and security of health
information;
(ii) how such variation among State laws
and practices may impact the electronic
exchange of health information (as defined in
section 2901 of the Public Health Service Act)
(as added by section 101)--
(I) among the States;
(II) between the States and the
Federal Government; and
(III) among private entities; and
(iii) how such laws and practices may be
harmonized to permit the secure electronic
exchange of health information.
(B) Report and recommendations.--Not later than 1
year after the date of enactment of this Act, the
Secretary shall submit to Congress a report that--
(i) describes the results of the study
carried out under subparagraph (A); and
(ii) makes recommendations based on the
results of such study.
(2) Secure exchange of health information; incentive
grants.--Title XXIX of the Public Health Service Act (as added
by section 101) is amended by adding at the end the following:

``SEC. 2906. SECURE EXCHANGE OF HEALTH INFORMATION; INCENTIVE GRANTS.

``(a) In General.--The Secretary may make grants to States to carry
out programs under which such States cooperate with other States to
develop and implement State policies that will facilitate the secure
electronic exchange of health information utilizing the standards
adopted under section 2903--
``(1) among the States;
``(2) between the States and the Federal Government; and
``(3) among private entities.
``(b) Priority.--In awarding grants under subsection (a), the
Secretary shall give priority to States that provide assurance that any
funding awarded under such a grant shall be used to harmonize privacy
laws and practices between the States, the States and the Federal
Government, and among private entities related to the privacy,
confidentiality, and security of health information.
``(c) Dissemination of Information.--The Secretary shall
disseminate information regarding the efficacy of efforts of a
recipient of a grant under this section.
``(d) Technical Assistance.--The Secretary may provide technical
assistance to recipients of a grant under this section.
``(e) 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 2006 through 2010.''.
(b) Study and Grant Programs Related to State Licensure Laws.--
(1) Study of state licensure laws.--
(A) In general.--The Secretary shall carry out, or
contract with a private entity to carry out, a study
that examines--
(i) the variation among State laws that
relate to the licensure, registration, and
certification of medical professionals; and
(ii) how such variation among State laws
impacts the secure electronic exchange of
health information (as defined in section 2901
of the Public Health Service Act) (as added by
section 101)--
(I) among the States; and
(II) between the States and the
Federal Government.
(B) Report and recommendations.--Not later than 1
year after the date of enactment of this Act, the
Secretary shall publish a report that--
(i) describes the results of the study
carried out under subparagraph (A); and
(ii) makes recommendations to States
regarding the harmonization of State laws based
on the results of such study.
(2) Reauthorization of incentive grants regarding
telemedicine.--Section 330L(b) of the Public Health Service Act
(42 U.S.C. 254c-18(b)) is amended by striking ``2002 through
2006'' and inserting ``2006 through 2010''.
(3) HIPAA application to electronic health information.--
Title XXIX of the Public Health Service Act (as added by
section 101 and amended by subsection (a)) is further amended
by adding at the end the following:

``SEC. 2907. APPLICABILITY OF PRIVACY AND SECURITY REGULATIONS.

``The regulations promulgated by the Secretary under part C of
title XI of the Social Security Act and sections 261, 262, 263, and 264
of the Health Insurance Portability and Accountability Act of 1996 with
respect to the privacy, confidentiality, and security of health
information shall--
``(1) apply to any health information stored or transmitted
in an electronic format as of the date of enactment of this
title; and
``(2) apply to the implementation of standards, programs,
and activities under this title.''.
(c) Study and report.--
(1) Study.--Not later than 2 years after the date of
enactment of this Act, the Secretary shall carry out, or
contract with a private entity to carry out, a study that
examines the integration of the standards adopted under the
amendments made by this Act with the standards adopted under
the Health Insurance Portability and Accountability Act of 1996
(Public Law 104-191).
(2) Plan; report.--
(A) Plan.--Not later than 3 years after the date of
enactment of this Act, the Secretary shall, based on
the results of the study carried out under paragraph
(1), develop a plan for the integration of the
standards described under such paragraph and submit a
report to Congress describing such plan.
(B) Periodic Reports.--The Secretary shall submit
periodic reports to Congress that describe the progress
of the integration described under subparagraph (A).

TITLE II--FACILITATING THE ADOPTION AND IMPLEMENTATION OF INTEROPERABLE
ELECTRONIC HEALTH INFORMATION

SEC. 201. GRANTS FOR THE IMPLEMENTATION OF REGIONAL OR LOCAL HEALTH
INFORMATION TECHNOLOGY PLANS.

Title XXIX of the Public Health Service Act (as amended by section
102) is further amended by adding at the end the following:

``SEC. 2908. GRANTS FOR THE IMPLEMENTATION OF REGIONAL OR LOCAL HEALTH
INFORMATION TECHNOLOGY PLANS.

``(a) In General.--The Secretary, in consultation with the National
Coordinator, may award competitive grants to eligible entities to
implement regional or local health information plans to improve
healthcare quality and efficiency through the electronic exchange of
health information pursuant to the standards, protocols, and other
requirements adopted by the Secretary under sections 2903 and 2910.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a) an entity shall--
``(1) demonstrate financial need to the Secretary;
``(2) demonstrate that one of its principal missions or
purposes is to use information technology to improve healthcare
quality and efficiency;
``(3) 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--
``(A) physicians (as defined in section 1861(r)(1)
of the Social Security Act), including physicians that
provide services to low income and underserved
populations;
``(B) hospitals (including hospitals that provide
services to low income and underserved populations);
``(C) group health plans or other health insurance
issuers;
``(D) 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);
``(E) rural health clinics (as defined in section
1861(aa) of the Social Security Act);
``(F) consumer organizations;
``(G) employers; and
``(H) any other healthcare providers or other
entities, as determined appropriate by the Secretary;
``(4) 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;
``(5) adopt the national health information technology
standards adopted by the Secretary under section 2903;
``(6) facilitate the electronic exchange of health
information within the local or regional area and among local
and regional areas;
``(7) prepare and submit to the Secretary an application in
accordance with subsection (c); and
``(8) agree to provide matching funds in accordance with
subsection (e).
``(c) Application.--
``(1) In general.--To be eligible to receive a grant under
subsection (a), an entity shall submit to the Secretary an
application at such time, in such manner, and containing such
information as the Secretary may require.
``(2) Required information.--At a minimum, an application
submitted under this subsection shall include--
``(A) clearly identified short-term and long-term
objectives of the regional or local health information
plan;
``(B) a technology plan that complies with the
standards adopted under section 2903 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;
``(C) a strategy that includes initiatives to
improve healthcare quality and efficiency, including
the use of healthcare quality measures adopted under
section 2910;
``(D) a plan that describes provisions to encourage
the implementation of the electronic exchange of health
information by all physicians, including single
physician practices and small physician groups
participating in the health information plan;
``(E) a plan to ensure the privacy and security of
personal health information that is consistent with
Federal and State law;
``(F) a governance plan that defines the manner in
which the stakeholders shall jointly make policy and
operational decisions on an ongoing basis; and
``(G) 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.
``(d) Use of Funds.--Amounts received under a grant under
subsection (a) shall be used to establish and implement a regional or
local health information plan in accordance with this section.
``(e) Matching Requirement.--
``(1) In general.--The Secretary may not make a grant under
this section 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 50
percent of such costs ($1 for each $2 of Federal funds provided
under the grant).
``(2) Determination of amount contributed.--Non-Federal
contributions required under paragraph (1) 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.
``(f) Authorization of Appropriations.--
``(1) In general.--There is authorized to be appropriated
to carry out this section, $125,000,000 for each of fiscal
years 2006 through 2010.
``(2) Availability.--Amounts appropriated under paragraph
(1) shall remain available for obligation until expended.

``SEC. 2909. REPORTS.

``Not later than 1 year after the date on which the first grant is
awarded under section 2908, and annually thereafter during the grant
period, an entity that receives a grant under such section shall submit
to the Secretary, acting through the National Coordinator, 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
healthcare 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.''.

SEC. 202. EXCEPTION FOR THE PROVISION OF PERMITTED SUPPORT.

(a) Exemption From Criminal Penalties.--Section 1128B(b) of the
Social Security Act (42 U.S.C. 1320a-7b(b)(3)) is amended--
(1) in paragraph (3)--
(A) in subparagraph (G), by striking ``and'' at the
end;
(B) in subparagraph (H), as added by section 237(d)
of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173; 117
Stat. 2213)--
(i) by moving such subparagraph 2 ems to
the left; and
(ii) by striking the period at the end and
inserting a semicolon;
(C) by redesignating subparagraph (H), as added by
section 431(a) of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (Public Law
108-173; 117 Stat. 2287), as subparagraph (I);
(D) in subparagraph (I), as so redesignated--
(i) by moving such subparagraph 2 ems to
the left; and
(ii) by striking the period at the end and
inserting ``; and''; and
(E) by adding at the end the following new:
``(J) subject to paragraph (4), the provision, with
or without charge, of any permitted support (as defined
in paragraph (4)(A) and subject to the conditions in
paragraph (4)(B)) to an entity or individual for
developing, implementing, operating, or facilitating
the electronic exchange of health information (as
defined in section 2901 of the Public Health Service
Act), so long as such support is primarily designed to
promote the electronic exchange of health
information.''; and
(2) by adding at the end the following:
``(4) Permitted support.--
``(A) Definition of permitted support.--In this
section, the term `permitted support' means the
provision of, or funding used exclusively to provide or
pay for, any equipment, item, information, right,
license, intellectual property, software, or service,
regardless of whether any such support may have utility
or value to the recipient for any purpose beyond the
exchange of health information (as defined in section
2901 of the Public Health Service Act).
``(B) Conditions on permitted support.--Paragraph
(3)(J) shall not apply unless the following conditions
are met:
``(i) The provision of permitted support is
not conditioned on the recipient of such
support making any referral to, or generating
any business for, any entity or individual for
which any Federal health care program provides
reimbursement.
``(ii) The permitted support complies with
the standards for the electronic exchange of
health information adopted by the Secretary
under section 2903 of the Public Health Service
Act.
``(iii) The entity or network receiving
permitted support is able to document that such
support is used by the entity or the network
for the electronic exchange of health
information in accordance with the standards
adopted by the Secretary under section 2903 of
the Public Health Service Act.''.
(b) Exemption From Limitation on Certain Physician Referrals.--
Section 1877(e) of the Social Security Act (42 U.S.C. 1395nn(e)) is
amended by adding at the end the following:
``(9) Permitted support.--The provision of permitted
support (as described in section 1128B(b)(3)(J)).''.
(c) Effective Date.--The amendments made by this section shall
apply to permitted support provided on or after the date of enactment
of this Act.

SEC. 203. GROUP PURCHASING.

(a) In General.--Not later than 1 year after the date of enactment
of this Act, the Secretary shall establish a safe harbor for group
purchasing of hardware, software, and support services for the
electronic exchange of health information in compliance with section
2903 of the Public Health Service Act (as added by section 101).
(b) Conditions.--In establishing the safe harbor under subsection
(a), the Secretary shall establish conditions on such safe harbor
consistent with the purposes of--
(1) improving healthcare quality;
(2) reducing medical errors;
(3) reducing healthcare costs;
(4) improving the coordination of care;
(5) streamlining administrative processes; and
(6) promoting transparency and competition.

SEC. 204. PERMISSIBLE ARRANGEMENTS.

(a) In General.--Not later than 1 year after the date of enactment
of this Act and notwithstanding any other provision of law, the
Secretary shall establish guidelines in compliance with section 2903 of
the Public Health Service Act that permit certain arrangements between
group health plans and health insurance issuers (as defined in section
2791 of the Public Health Service Act (42 U.S.C. 300gg-91)) and between
healthcare providers (as defined in section 2901 of such Act, as added
by section 101) in accordance with subsection (b).
(b) Conditions.--In establishing the guidelines under subsection
(a), the Secretary shall establish conditions on such arrangements
consistent with the purposes of--
(1) improving healthcare quality;
(2) reducing medical errors;
(3) reducing healthcare costs;
(4) improving the coordination of care;
(5) streamlining administrative processes; and
(6) promoting transparency and competition.

TITLE III--ADOPTION, IMPLEMENTATION, AND USE OF HEALTHCARE QUALITY
MEASURES

SEC. 301. STANDARDIZED MEASURES.

Title XXIX of the Public Health Service Act (as amended by section
201) is further amended by adding at the end the following:

``SEC. 2910. COLLABORATIVE PROCESS FOR THE DEVELOPMENT, RECOMMENDATION,
AND ADOPTION OF STANDARDIZED MEASURES OF QUALITY
HEALTHCARE.

``(a) In General.--
``(1) Collaboration.--The Secretary, the Secretary of
Defense, the Secretary of Veterans Affairs, and any other heads
of relevant Federal agencies as determined appropriate by the
President, (referred to in this section as the `Secretaries')
shall adopt, on an ongoing basis, uniform healthcare quality
measures to assess the effectiveness, timeliness, patient self-
management, patient-centeredness, efficiency, and safety of
care delivered by healthcare providers across Federal
healthcare programs, including those in titles XVIII, XIX, and
XXI of the Social Security Act.
``(2) Review of measures adopted.--The Secretaries shall
conduct an ongoing review of the measures adopted under
paragraph (1).
``(3) Existing activities--Notwithstanding any other
provision of law, the measures and reporting activities
described in this subsection shall replace, to the extent
practicable and appropriate, any duplicative or redundant
existing measurement and reporting activities currently
utilized by Federal healthcare programs, including those in
titles XVIII, XIX, and XXI of the Social Security Act.
``(b) Priority Measures.--
``(1) In general.--In determining the measures to be
adopted under subsection (a), and the timing of any such
adoption, the Secretaries shall give priority to--
``(A) measures with the greatest potential impact
for improving the quality and efficiency of care
provided under Federal programs;
``(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; and
``(C) measures which may inform healthcare
decisions made by consumers and patients.
``(2) National Quality Forum Measures; Quality of care
indicators.--To the extent determined feasible and appropriate
by the Secretaries, the Secretaries shall adopt--
``(A) measures endorsed by the National Quality
Forum, subject to compliance with the amendments made
by the National Technology Transfer and Advancement Act
of 1995; and
``(B) indicators relating to the quality of care
data submitted to the Secretary by hospitals under
section 1886(b)(3)(B)(vii)(II) of the Social Security
Act.
``(c) Collaboration With Private Entities.--
``(1) In general.--The Secretaries may establish
collaborative agreements with private entities, including group
health plans and health insurance issuers, providers,
purchasers, consumer organizations, and entities receiving a
grant under section 2908, to--
``(A) encourage the use of the healthcare quality
measures adopted by the Secretary under this section;
and
``(B) foster uniformity between the healthcare
quality measures utilized in Federal programs and
private entities.
``(2) Use of measures.--The measures adopted by the
Secretaries under this section may apply in one or more disease
areas and across delivery settings, in order to improve the
quality of care provided or delivered by private entities.
``(d) Comparative Quality Reports.--Beginning on January 1, 2008,
in order to make comparative quality information available to
healthcare consumers, health professionals, public health officials,
researchers, and other appropriate individuals and entities, the
Secretaries and other relevant agencies shall provide for the
aggregation, analysis, and dissemination of quality measures collected
under this section. Nothing in this section shall be construed as
modifying the privacy standards under the Health Insurance Portability
and Accountability Act of 1996 (Public Law 104-191).
``(e) Evaluations.--
``(1) Ongoing evaluations of use.--The Secretary shall
ensure the ongoing evaluation of the use of the healthcare
quality measures adopted under this section.
``(2) Evaluation and Report.--
``(A) Evaluation.--The Secretary shall, directly or
indirectly through a contract with another entity,
conduct an evaluation of the collaborative efforts of
the Secretaries to adopt uniform healthcare quality
measures and reporting requirements for federally
supported healthcare delivery programs as required
under this section.
``(B) Report.--Not later than 2 years after the
date of enactment of this title, the Secretary shall
submit a report to the appropriate committees of
Congress concerning the results of the evaluation under
subparagraph (A).''.

SEC. 302. VALUE BASED PURCHASING PROGRAMS; SENSE OF THE SENATE.

(a) Medicare Value Based Purchasing Pilot Program.--
(1) In general.--The Secretary shall establish under title
XVIII of the Social Security Act (42 U.S.C. 1395 et seq.) a
value based purchasing pilot program based on the reporting of
quality measures pursuant to those adopted in section 2910 of
the Public Health Service Act (as added by section 301) and the
overall improvement of healthcare quality through the use of
the electronic exchange of health information by entities
(including Federally qualified health centers, as defined in
section 1861(aa)(4) of the Social Security Act (42 U.S.C.
1395x(aa)(4))) pursuant to the standards adopted under section
2903 of the Public Health Service Act (as added by section
101). Such pilot program should be based on experience gained
through previous demonstration projects conducted by the
Secretary, including demonstration projects conducted under
sections 1866A and 1866C of the Social Security Act (42 U.S.C.
1395cc-1; 1395cc-3), section 649 of the Medicare Prescription
Drug, Improvement, and Modernization Act of 2003 (Public Law
108-173; 117 Stat. 2322), and other relevant work conducted by
private entities.
(2) Expansion.--After conducting the pilot program under
paragraph (1) for not less than 2 years, the Secretary may
transition and implement such program on a national basis.
(3) Funding.--
(A) In general.--Payments for the costs of carrying
out the provisions of this subsection shall be made
from the Federal Hospital Insurance Trust Fund under
section 1817 of the Social Security Act (42 U.S.C.
1395i) and the Federal Supplementary Insurance Trust
Fund under section 1841 of such Act (42 U.S.C. 1395t)
(in this subsection referred to as the ``Trust
Funds''), as determined appropriate by the Secretary.
(B) Limitation to ensure budget neutrality.--The
Secretary shall ensure that the total amount of
expenditures from the Trust Funds in a year does not
exceed the total amount of expenditures from the Trust
Funds that would have been made in such year if this
subsection had not been enacted.
(C) Monitoring and reports.--
(i) Ongoing monitoring by the secretary to
ensure funding limitation is not violated.--The
Secretary shall continually monitor
expenditures made from the Trust Funds by
reason of the provisions of this subsection to
ensure that the limitation described in
subparagraph (B) is not violated.
(ii) Reports.--Not later than April 1 of
each year (beginning in the year following the
year in which the pilot program under paragraph
(1) is implemented), the Secretary shall submit
a report to Congress and the Comptroller
General of the United States that includes--
(I) a detailed description of--
(aa) the total amount
expended from the Trust Funds
(including all amounts expended
as a result of the provisions
of this subsection) during the
previous year compared to the
total amount that would have
been expended from the Trust
Funds during such year if this
subsection had not been
enacted;
(bb) the projections of the
total amount that will be
expended from the Trust Funds
(including all amounts that
will be expended as a result of
the provisions of this
subsection) during the year in
which the report is submitted
compared to the total amount
that would have been expended
from the Trust Funds during the
year if this subsection had not
been enacted; and
(cc) specify the steps (if
any) that the Secretary will
take pursuant to subparagraph
(D) to ensure that the
limitation described in
subparagraph (B) will not be
violated; and
(II) a certification from the Chief
Actuary of the Centers for Medicare &
Medicaid Services that the descriptions
under items (aa), (bb), and (cc) of
subclause (I) are reasonable, accurate,
and based on generally accepted
actuarial principles and methodologies,
including that the steps described in
subclause (I)(cc) will be adequate to
avoid violating the limitation
described in subparagraph (B).
(D) Application of Limitation.--If the Secretary
determines that the provisions of this subsection will
result in the limitation described in subparagraph (B)
being violated in any year, the Secretary shall take
appropriate steps to reduce spending that is occurring
by reason of such provisions, including through
reducing the scope, site, and duration of the pilot
project.
(E) Authority.--The Secretary shall make necessary
spending adjustments under the medicare program to
recoup amounts so that the limitation described in
subparagraph (B) is not violated in any year.
(b) Sense of the Senate Regarding Physician Payments Under
Medicare.--It is the sense of the Senate that modifications to the
medicare fee schedule for physicians' services under section 1848 of
the Social Security Act (42 U.S.C. 1394w-4) should include provisions
based on the reporting of quality measures pursuant to those adopted in
section 2910 of the Public Health Service Act (as added by section 301)
and the overall improvement of healthcare quality through the use of
the electronic exchange of health information pursuant to the standards
adopted under section 2903 of such Act (as added by section 101).
(c) Medicaid Value Based Purchasing Programs.--
(1) In general.--The Secretary shall authorize waivers
under section 1115 of the Social Security Act (42 U.S.C. 1315)
for States to establish value based purchasing programs for
State medicaid programs established under title XIX of such Act
(42 U.S.C. 1396 et seq.). Such programs shall be based on the
reporting of quality measures pursuant to those adopted in
section 2910 of the Public Health Service Act (as added by
section 301) and the overall improvement of healthcare quality
through the use of the electronic exchange of health
information pursuant to the standards adopted under section
2903 of the Public Health Service Act (as added by section
101).
(2) Waiver.--In authorizing such waivers, the Secretary
shall waive any provisions of title XI or XIX of the Social
Security Act that would otherwise prevent a State from
establishing a value based purchasing program in accordance
with paragraph (1).
(d) Quality Information Sharing.--
(1) Review of medicare claims data.--
(A) Procedures.--In order to improve the quality
and efficiency of items and services furnished to
medicare beneficiaires under title XVIII of the Social
Security Act, the Secretary shall establish procedures
to review claims data submitted under such title with
respect to items and services furnished or ordered by
physicians.
(B) Use of most recent medicare claims data.--In
conducting the review under subparagraph (A), the
Secretary shall use the most recent claims data that is
available to the Secretary.
(2) Sharing of data.--Beginning in 2006, the Secretary
shall periodically provide physicians with comparative
information on the utilization of items and services under such
title XVIII based upon the review of claims data under
paragraph (1).

SEC. 303. QUALITY IMPROVEMENT ORGANIZATION ASSISTANCE.

(a) In General.--Section 1154(a) of the Social Security Act (42
U.S.C. 1320c-3(a)) is amended by adding at the end the following:
``(18) The organization shall assist, at such time and in
such manner as the Secretary may require, healthcare providers
(as defined in section 2901 of the Public Health Service Act)
in implementing the electronic exchange of health information
(as defined in such section 2901).''.
(b) Effective Date.--The amendment made by this section shall apply
to contracts entered into on or after the date of enactment of this
Act.
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