[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 3800 Introduced in House (IH)]
110th CONGRESS
1st Session
H. R. 3800
To advance the adoption of nationwide interoperable health information
technology and to improve health care quality and reduce health care
costs in the United States.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
October 10, 2007
Ms. Eshoo (for herself and Mr. Rogers of Michigan) introduced the
following bill; which was referred to the Committee on Energy and
Commerce
_______________________________________________________________________
A BILL
To advance the adoption of nationwide interoperable health information
technology and to improve health care quality and reduce health care
costs in the United States.
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 ``Promoting Health Information
Technology Act''.
SEC. 2. TABLE OF CONTENTS.
The table of contents of this Act is as follows:
Sec. 1. Short title.
Sec. 2. Table of contents.
TITLE I--IMPROVING THE INTEROPERABILITY OF HEALTH INFORMATION
TECHNOLOGY
Sec. 101. Improving health care quality, safety, and efficiency.
``TITLE XXX--HEALTH INFORMATION TECHNOLOGY AND QUALITY
``Sec. 3001. Definitions; reference.
``Sec. 3002. Office of the National Coordinator of Health
Information Technology.
``Sec. 3003. Partnership for Health Care Improvement--standards
and technology.
``Sec. 3004. American Health Information Community policies.
``Sec. 3005. Federal purchasing and data collection.
``Sec. 3006. Quality and efficiency reports.
``Sec. 3007. Research access to health care data and reporting
on performance.
TITLE II--FACILITATING THE WIDESPREAD ADOPTION OF INTEROPERABLE HEALTH
INFORMATION TECHNOLOGY
Sec. 201. Facilitating the widespread adoption of interoperable health
information technology.
``Sec. 3008. Facilitating the widespread adoption of
interoperable health information
technology.
``Sec. 3009. Demonstration program to integrate information
technology into clinical education.
TITLE III--IMPROVING THE QUALITY OF HEALTH CARE
Sec. 301. Consensus process for the adoption of quality measures for
use in the nationwide interoperable health
information technology infrastructure.
``Sec. 3010. Fostering development and use of health care
quality measures.
``Sec. 3011. Adoption and use of quality measures; reporting.
TITLE IV--PRIVACY AND SECURITY
Sec. 401. Privacy and security.
``Sec. 3012. Ensuring privacy and security.
TITLE V--MISCELLANEOUS PROVISIONS
Sec. 501. GAO study.
Sec. 502. Health Information Technology Resource Center.
Sec. 503. Facilitating the provision of telehealth services across
State lines.
``Sec. 330L Telemedicine; incentive grants regarding
coordination among States.
TITLE I--IMPROVING THE INTEROPERABILITY OF HEALTH INFORMATION
TECHNOLOGY
SEC. 101. IMPROVING HEALTH CARE QUALITY, SAFETY, AND EFFICIENCY.
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) Community.--The term `Community' means the American
Health Information Community established under section 3004.
``(2) Health care provider.--The term `health care
provider' means a hospital, skilled nursing facility, home
health entity, 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)(C) 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
the term `health plan' shall be deemed to be references
to a 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) Partnership.--The term `Partnership' means the
Partnership for Health Care Improvement established under
section 3003.
``(9) Qualified health information technology.--The term
`qualified health information technology' means a computerized
system (including hardware, software, or provision of service)
that--
``(A) protects the privacy and security of health
information;
``(B) maintains and provides permitted access to
health information in an electronic format;
``(C) complies with the standards adopted by the
Federal Government under section 3003;
``(D) has the ability to transmit and exchange
information to other health information technology
systems and, to the extent feasible, public health
information technology systems;
``(E) allows for the electronic capture and
reporting of quality measures adopted under section
3011; and
``(F) has been certified by the Secretary or a
designee of the Secretary to be in compliance with any
applicable standards and implementation specifications
adopted by the Secretary on or prior to the date of the
enactment of this title.
``(10) Interoperability.--The term `interoperability' means
the ability of different information technology systems and
software applications to communicate, exchange data accurately,
effectively, and consistently, and use the information that has
been exchanged.
``(11) 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 the enactment of this title.
``SEC. 3002. OFFICE OF THE NATIONAL COORDINATOR OF HEALTH INFORMATION
TECHNOLOGY.
``(a) Establishment.--There is established within the office of the
Secretary the Office of the National Coordinator of Health Information
Technology, to be headed by the National Coordinator of 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 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 of
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 Community and the Partnership.--The National
Coordinator shall--
``(1) serve as an ex officio member of the Community, and
act as a liaison between the Federal Government and the
Community;
``(2) serve as an ex officio member of the Partnership and
act as a liaison between the Federal Government and the
Partnership; and
``(3) serve as a liaison between the Partnership and the
Community.
``(d) Reports and Website.--The National Coordinator shall--
``(1) develop and publish 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 for significant use cases;
``(B) publishes the recommendations of the
Community;
``(C) publishes the recommendations of the
Partnership;
``(D) publishes quality measures;
``(E) identifies sources of funds that will be made
available to facilitate the purchase of, or enhance the
utilization of, 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 of
Health Information Technology 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 of
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 are authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2008 through 2012.
``(g) Sunset.--The provisions of this section shall not apply after
September 30, 2014.
``SEC. 3003. PARTNERSHIP FOR HEALTH CARE IMPROVEMENT--STANDARDS AND
TECHNOLOGY.
``(a) Establishment.--
``(1) In general.--There is established a public-private
Partnership for Health Care Improvement to--
``(A) provide advice to the Secretary and the
Nation and recommend specific actions to achieve a
nationwide interoperable health information technology
infrastructure;
``(B) make recommendations concerning standards,
implementation specifications, and certification
criteria for the electronic exchange of health
information (including for the reporting of quality
data under section 3011) for adoption by the Federal
Government and voluntary adoption by private entities;
``(C) 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; and
``(D) develop and maintain an Internet website
that--
``(i) publishes established governance
rules (including a subsequent appointment
process);
``(ii) publishes a business plan;
``(iii) publishes meeting notices at least
14 days prior to each meeting;
``(iv) publishes meeting agendas at least 7
days prior to each meeting; and
``(v) publishes meeting materials at least
3 days prior to each meeting.
``(2) Limitation.--The Partnership shall not meet or take
any action until an advisory committee charter has been filed
with the Secretary and with the appropriate committees of the
Senate and House of Representatives for the Community described
in section 3004.
``(b) Membership.--
``(1) Appointments.--
``(A) In general.--The Partnership shall be
composed of members to be appointed as follows:
``(i) 2 members shall be appointed by the
Secretary.
``(ii) 1 member shall be appointed by the
majority leader of the Senate.
``(iii) 1 member shall be appointed by the
minority leader of the Senate.
``(iv) 1 member shall be appointed by the
Speaker of the House of Representatives.
``(v) 1 member shall be appointed by the
minority leader of the House of
Representatives.
``(vi) 7 members shall be appointed by the
Comptroller General of the United States of
whom--
``(I) 1 member shall be a
representative of consumer or patient
organizations;
``(II) 1 member shall be a
representative of organizations with
expertise in privacy;
``(III) 1 member shall be a
representative of organizations with
expertise in security;
``(IV) 1 member shall be a
representative of health care
providers;
``(V) 1 member shall be a
representative of health plans or other
third party payers;
``(VI) 1 member shall be a
representative of information
technology vendors; and
``(VII) 1 member shall be a
representative of purchasers or
employers.
``(B) National coordinator.--The National
Coordinator shall be a member of the Partnership and
act as a liaison among the Partnership, the Community,
and the Federal Government.
``(2) Chairperson and vice chairperson.--The Partnership
shall designate 1 member to serve as the chairperson and 1
member to serve as the vice chairperson of the Partnership.
``(3) Balance.--In appointing members under paragraph
(1)(A)(vi), the Comptroller General of the United States shall
ensure a balance among various sectors of the health care
system so that no single sector unduly influences the
recommendations of the Partnership.
``(4) Terms.--Members appointed under paragraph (1)(A)
shall serve for 3-year terms, except that any member appointed
to fill a vacancy for an unexpired term shall be appointed for
the remainder of such term. A member may serve for not to
exceed 180 days after the expiration of such member's term or
until a successor has been appointed.
``(5) Outside involvement.--The Partnership 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 health care
quality and patient safety;
``(D) medical and clinical research data exchange;
and
``(E) developing health information technology
standards and new health information technology.
``(6) Quorum.--Two-thirds of the members of the Partnership
shall constitute a quorum for the purpose of conducting votes.
``(c) Standards and Implementation Specifications.--
``(1) Schedule.--Not later than 90 days after the date of
the enactment of this title, the Partnership shall develop a
schedule for the assessment of standards and implementation
specifications under this section. The Partnership shall update
such schedule annually. The Secretary shall publish such
schedule in the Federal Register and on the Internet website of
the Department of Health and Human Services.
``(2) First year recommendations.--Consistent with the
schedule published under paragraph (1) and not later than 1
year after the date of the enactment of this title, the
Partnership shall recommend, and the Secretary shall review,
such standards and implementation specifications.
``(3) Ongoing recommendations.--The Partnership shall
review and modify, as appropriate but at least annually,
adopted standards and implementation specifications and
continue to recommend additional standards and implementation
specifications, consistent with the schedule published pursuant
to paragraph (1). The Secretary shall review such modifications
and recommendations.
``(4) Focus of recommendations.--The recommendations for
standards and implementation specifications under paragraphs
(2) and (3) shall focus on health care information technologies
that have the greatest potential to improve the quality and
efficiency of health care, including--
``(A) technologies that protect the privacy of
health information and promote security;
``(B) interoperable electronic health records;
``(C) replacement of paper forms with electronic
alternatives;
``(D) self-service technologies that facilitate the
provision of patient information and reduce wait times;
``(E) telemedicine technologies that reduce travel
requirements for patients in remote areas;
``(F) technologies that facilitate home health care
and the monitoring of patients recuperating at home;
``(G) technologies that help reduce medical errors;
``(H) technologies that facilitate the continuity
of care among health settings; and
``(I) any other technology that the Partnership
finds to be among the technologies with the greatest
potential to improve the quality and efficiency of
health care.
``(5) Recognition of private entities.--The Partnership, in
consultation with the Secretary, may recognize a private entity
or entities for the purpose of developing and updating
standards and implementation specifications to achieve uniform
and consistent implementation of the standards adopted by the
President under paragraph (9). Such entity or entities shall
make recommendations to the Partnership consistent with this
section.
``(6) Publication.--All recommendations made by the
Partnership pursuant to this section shall be published in the
Federal Register and on the Internet website of the Office of
the National Coordinator of Health Information Technology.
``(7) Pilot testing.--The Secretary may conduct, or
recognize a private entity or entities to conduct, a pilot
project to test the standards and implementation specifications
developed under this subsection before the Partnership issues
recommendations on such standards and implementation
specifications in order to provide for the efficient
implementation of such standards and implementation
specifications.
``(8) Public input.--The Partnership shall conduct open
public meetings and develop a process to allow for public
comment on the schedule and recommendations described in this
subsection. Such process shall ensure that such comments will
be submitted within 30 days after the publication of a
recommendation under this subsection.
``(9) Federal action.--Not later than 90 days after the
issuance of a recommendation from the Partnership 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 recommendation. If appropriate, the President shall
provide for the adoption by the Federal Government of any
standard or implementation specification contained in such
recommendation. Such determination shall be published in the
Federal Register and on the Internet website of the Office of
the National Coordinator of Health Information Technology
within 30 days after such determination is made.
``(10) Consistency.--The standards and implementation
specifications described in this subsection shall be consistent
with the standards for information transactions and data
elements developed pursuant to the regulations promulgated
under section 264(c) of the Health Insurance Portability and
Accountability Act of 1996.
``(d) Certification.--
``(1) Developing criteria.--The Partnership, in
consultation with the Secretary, may recognize a private entity
or entities for the purpose of developing and recommending to
the Partnership criteria to certify that appropriate categories
of health information technology products that claim to be in
compliance with applicable standards and implementation
specifications adopted under this title have established such
compliance.
``(2) Adoption of criteria.--The Secretary, based upon the
recommendations of the Partnership, shall review and, if
appropriate, adopt such criteria.
``(3) Conducting certification.--The Secretary may
recognize a private entity or entities to conduct the
certifications described in paragraph (1) using the criteria
adopted by the Secretary under this subsection.
``(e) Rule of Construction.--Nothing in this section shall be
construed as disrupting existing activities described in subsection (c)
or (d).
``(f) Requirement to Consider Recommendations.--In carrying out the
activities described in subsections (c) and (d), the Partnership shall
adopt and integrate the recommendations of the Community that are
adopted by the Secretary.
``(g) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, such sums as may be necessary
for each of fiscal years 2008 through 2012.
``SEC. 3004. AMERICAN HEALTH INFORMATION COMMUNITY POLICIES.
``(a) Establishment.--There is established a committee to be known
as the American Health Information Community. The Community shall--
``(1) provide advice to the Secretary and the heads of any
relevant Federal agencies concerning the policy considerations
related to health information technology;
``(2) not later than 1 year after the date of the enactment
of this title, and annually thereafter, make recommendations
concerning a policy framework for the development and adoption
of a nationwide interoperable health information technology
infrastructure;
``(3) not later than 1 year after the date of the 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) 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;
``(E) fostering the public understanding of health
information technology;
``(F) strategies to enhance the use of health
information technology in preventing and managing
chronic disease;
``(G) policies to incorporate the input of
employees of health care providers in the design and
implementation of health information technology
systems; and
``(H) other policies determined to be necessary by
the Community; and
``(4) 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.
``(b) Publication.--All recommendations made by the Community
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 such recommendations, determine which such
recommendations should be endorsed by the Federal Government, and
publish such determinations on the Internet website of the Office of
the National Coordinator of Health Information Technology within 30
days after the date on which each such determination is made.
``(c) Membership.--
``(1) In general.--The Community shall be composed of
members to be appointed as follows:
``(A) 3 members shall be appointed by the
Secretary, 1 of whom shall be appointed to represent
the Department of Health and Human Services.
``(B) 1 member shall be appointed by the Secretary
of Veterans Affairs to represent the Department of
Veterans Affairs.
``(C) 1 member shall be appointed by the Secretary
of Defense to 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) 9 members shall be appointed by the
Comptroller General of the United States of whom--
``(i) 1 member shall be an advocate for
patients or consumers;
``(ii) 1 member shall represent health care
providers;
``(iii) 1 member shall be from a labor
organization representing health care workers;
``(iv) 1 member shall have expertise in
privacy and security;
``(v) 1 member shall have expertise in
improving the health of vulnerable populations;
``(vi) 1 member shall represent health
plans or other third-party payers;
``(vii) 1 member shall represent
information technology vendors;
``(viii) 1 member shall represent
purchasers or employers; and
``(ix) 1 member shall have expertise in
health care quality measurement and reporting.
``(2) Chairperson and vice chairperson.--The Community
shall designate 1 member to serve as the chairperson and 1
member to serve as the vice chairperson of the Community.
``(3) National coordinator.--The National Coordinator shall
be a member of the Community and act as a liaison among the
Community, the partnership, and the Federal Government.
``(4) Participation.--The members of the Community
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 Community.
``(5) Terms.--
``(A) In general.--The terms of members of the
Community shall be 3 years except that the Comptroller
General of the United States shall designate staggered
terms for the members first appointed under paragraph
(1)(H).
``(B) Vacancies.--Any member appointed to fill a
vacancy in the membership of the Community 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
Community shall be filled in the manner in which the
original appointment was made.
``(6) Outside involvement.--The Community 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) medical ethics;
``(E) medical and clinical research data exchange;
and
``(F) developing health information technology
standards and new health information technology.
``(7) Quorum.--Ten members of the Community shall
constitute a quorum for purposes of voting, but a lesser number
of members may meet and hold hearings.
``(d) Federal Agencies.--
``(1) Staff of other federal agencies.--Upon the request of
the Community, the head of any Federal agency may detail,
without reimbursement, any of the personnel of such agency to
the Community to assist in carrying out the duties of the
Community. 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
Community, the head of a Federal agency shall provide such
technical assistance to the Community as the Community
determines to be necessary to carry out its duties.
``(3) Other resources.--The Community 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 Community shall make requests for such
access in writing when necessary.
``(e) Application of FACA.--The Federal Advisory Committee Act (5
U.S.C. App.) shall apply to the Community, except that the term
provided for under section 14(a)(2) of such Act shall be not longer
than 7 years.
``(f) Sunset.--The provisions of this section shall not apply after
September 20, 2014.
``(g) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2008 through 2012.
``SEC. 3005. FEDERAL PURCHASING AND DATA COLLECTION.
``(a) Coordination of Federal Spending.--
``(1) In general.--Not later than 1 year after the adoption
by the President of a recommendation under section 3003(c)(9),
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 adopted by the Federal Government under
such section.
``(2) 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.--
``(1) In general.--Any standards and implementation
specifications adopted by the Federal Government under section
3003(c)(9) shall be voluntary with respect to private entities.
``(2) Requirement.--Private entities that enter into a
contract with the Federal Government shall adopt the standards
and implementation specifications adopted by the Federal
Government under section 3003 for the purpose of activities
under such Federal contract.
``(3) Rule of construction.--Nothing in this section shall
be construed to require that a private entity that enters into
a contract with the Federal Government adopt the standards and
implementation specifications adopted by the Federal Government
under this section with respect to activities not related to
the contract.
``(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)(9), 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 the standards and implementation
specifications adopted under such section.
``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, not later than 12
months after the date of the enactment of this title, 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 Health Quality
Organization for the Organization to develop a report based
on--
``(A) Federal health care data disclosed to the
Organization under subsection (c); and
``(B) private data that is publicly available or is
provided to the Organization by the entity making the
request for the report.
``(2) Definitions.--In this section:
``(A) Federal health care data.--The term `Federal
health care data' means--
``(i) de-identified patient enrollment
data, reimbursement claims, and survey data
maintained by the Secretary or entities under
programs, contracts, grants, or memoranda of
understanding administered by the Secretary;
and
``(ii) where feasible, other de-identified
patient enrollment data, reimbursement claims,
and survey data maintained by the Federal
Government or entities under contract with the
Federal Government.
``(B) Health quality organization.--The term
`Health Quality 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 Health Quality Organization.
``(2) Update of information.--Not less than every 6 months,
the Secretary shall update the information disclosed under
paragraph (1) to Health Quality Organizations.
``(d) Health Quality Organizations.--
``(1) In general.--
``(A) Three contracts.--Subject to subparagraph
(B), the Secretary shall enter into a contract with 3
private entities to serve as Health Quality
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 of the
Social Security Act 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.
``(ii) Privacy.--The entity shall provide
assurances that the entity will not use the
Federal health care data disclosed under
subsection (c) in a manner that violates
sections 552 or 552a of title 5, United States
Code, with regard to the privacy of
individually identifiable health information.
``(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 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
Health Quality 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 Health Quality 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 Health Quality 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 health
quality organization.--The process described in
clause (i) shall permit an entity to submit the
request for a report to any Health Quality
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 Health Quality 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 Health Quality 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.
``(B) Review of report by secretary to ensure
compliance with privacy requirement.--Prior to a Health
Quality Organization releasing a report under
subparagraph (C), the Secretary shall review the report
to ensure that the report complies with the Federal
regulations (concerning the privacy of individually
identifiable beneficiary health information)
promulgated under section 264(c) of the Health
Insurance Portability and Accountability Act of 1996
and sections 552 or 552a of title 5, United States
Code, with regard to the privacy of individually
identifiable beneficiary health information. The
Secretary shall act within 30 business days of
receiving such report.
``(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 Health Quality 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
Health Quality 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 Health Quality 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
Health Quality 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 subparagraphs
(A) and (B).
``(2) Fees for hqo.--
``(A) In general.--Subject to subparagraphs (B) and
(C), a Health Quality 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 entity) that has annual revenue that
does not exceed $10,000,000, the Health Quality
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 Health Quality
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) 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) Coordination.--Not later than 1 year after the date of the
enactment of this title, the Secretary shall submit a report (including
recommendations) to the appropriate committees of Congress concerning
the coordination of existing Federal health care quality initiatives.
``(i) Regulations.--Not later than 6 months after the date of the
enactment of this title, 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 purposes
(as established by the Secretary) to--
``(1) have access to all 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.''.
TITLE II--FACILITATING THE WIDESPREAD ADOPTION OF INTEROPERABLE HEALTH
INFORMATION TECHNOLOGY
SEC. 201. FACILITATING THE WIDESPREAD ADOPTION OF INTEROPERABLE HEALTH
INFORMATION TECHNOLOGY.
Title XXX of the Public Health Service Act, as added by section
101, is amended by adding at the end the following:
``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
measures;
``(C) adopt the standards adopted by the Federal
Government under section 3003;
``(D) implement the measures adopted under section
3011 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 3011 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 other
provisions of this title or the amendments made
by the Promoting Health Information Technology
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 the enactment of this title.
``(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 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 3011.
``(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 adopted by the Secretary
under section 3003;
``(G) require that health care providers receiving
such grants--
``(i) implement the measures adopted under
section 3011 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)(7) and that includes a
descriptive and reasoned estimate of the 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 3011;
``(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 will 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 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 50 percent of such costs ($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) Authorization of Appropriations.--
``(1) In general.--For the purpose of carrying out this
section, there are authorized to be appropriated $163,000,000
for fiscal year 2008, $163,000,000 for fiscal year 2009, and
such sums as may be necessary for each of fiscal years 2010
through 2012.
``(2) Availability.--Amounts appropriated pursuant to
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 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 nursing; or
``(C) 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 of
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 the
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 are authorized to be
appropriated to carry out this section such sums as may be necessary
for each of fiscal years 2008 through 2011.
``(h) Sunset.--The provisions of this section shall not apply after
September 30, 2012.''.
TITLE III--IMPROVING THE QUALITY OF HEALTH CARE
SEC. 301. 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
201, is further amended by adding at the end the following:
``SEC. 3010. FOSTERING DEVELOPMENT AND USE OF HEALTH CARE QUALITY
MEASURES.
``(a) In General.--The Secretary shall provide for the development
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.
``(b) Designation of, and Arrangement With, Organization.--
``(1) In general.--Not later than 90 days after the date of
the 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 will promote the development of quality measures
and provide the Secretary with advice and recommendations on
the key elements and priorities of a national system for health
care performance measurement.
``(2) Responsibilities.--The responsibilities to be
performed by the organization designated under paragraph (1)
(referred to in this title as the `designated organization')
shall include--
``(A) establishing and managing an integrated
national strategy and process for setting priorities
and goals in establishing quality measures;
``(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;
``(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
Partnership regarding the integration of quality
measures into the certification process outlined under
section 3003 and the Community 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 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;
``(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
certification process described in section 3003; and
``(F) measures that may be integrated into the
decision support function of qualified health
information technology.
``(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 require the owners or developers of quality measures to
update and enhance such measures, including the development of
more accurate and precise specifications, and retire existing
outdated measures. Such updating shall occur not more often
than once during each 12-month period, except in the case of
emergency circumstances requiring a more immediate update to a
measure.
``(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.
``SEC. 3011. ADOPTION AND USE OF QUALITY MEASURES; REPORTING.
``(a) In General.--For purposes of carrying out activities
authorized or required by 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 standards adopted under section 3003
integrate the quality measures endorsed, adopted, and utilized
under this section.
``(b) Relationship With Programs Under the Social Security Act.--
The Secretary shall ensure that the quality measures adopted under this
section--
``(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 and priorities of the
programs under titles XVIII, XIX, and XXI of such Act, as set
forth by the Administrator of the Centers for Medicare &
Medicaid Services.
``(c) Reporting.--The Secretary shall implement procedures,
consistent with generally accepted standards, to enable the Department
of Health and Human Services to accept the electronic submission of
data for purposes of performance measurement, including at the provider
level, using the quality measures developed, endorsed, and adopted
pursuant to this title.
``(d) Dissemination of Information.--In order to make comparative
performance information available to health care consumers, health
professionals, public health officials, oversight organizations,
researchers, and other appropriate individuals and entities, after
consultation with multi-stakeholder groups, the Secretary shall
promulgate regulations to provide for the dissemination, aggregation,
and analysis of quality measures collected pursuant to this title.''.
TITLE IV--PRIVACY AND SECURITY
SEC. 401. PRIVACY AND SECURITY.
Title XXX of the Public Health Service Act, as amended by section
301, is further amended by adding at the end the following:
``SEC. 3012. ENSURING PRIVACY AND SECURITY.
``(a) Privacy Protections Apply to Health Information Electronic
Databases.--An operator of a health information electronic database
shall be deemed to be a `covered entity' for purposes of sections 1171
through 1179 of the Social Security Act and the regulations promulgated
under section 264(c) of the Health Insurance Portability and
Accountability Act of 1996 (referred to in this section as the `HIPAA
privacy regulations').
``(b) Health Information Electronic Database Defined.--In this
section, the term `operator of a health information electronic
database' means an entity that--
``(1) is constituted, organized, or chartered for the
primary purpose of maintaining or transmitting protected health
information in a designated record set or sets;
``(2) receives valuable consideration for maintaining or
transmitting protected health information in a designated
record set or sets; and
``(3) is not a provider, a payer, a health care
clearinghouse or business associate of a covered entity as such
terms are defined in the HIPAA privacy regulations.
``(c) Right of Individuals To Inspect Their Medical Records
Maintained in Electronic Format.--To the extent provided for under the
HIPAA privacy regulations with respect to protected health information,
an individual shall have a right of access to inspect and obtain a copy
of protected health information about the individual stored in
electronic format.
``(d) 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.
``(e) Right of Individuals To Be Notified Following Wrongful
Disclosure.--In a manner consistent with the HIPAA privacy regulations
with respect to accounting for disclosures of protected health
information, an individual shall have the right to be notified by a
covered entity if that covered entity wrongfully discloses protected
health information and the wrongful disclosure is materially expected
to result in medical fraud or identity theft. The Secretary shall
promulgate rules as necessary to carry out this subsection.
``(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.''.
TITLE V--MISCELLANEOUS PROVISIONS
SEC. 501. GAO STUDY.
Not later than 9 months after the date of the enactment of this
Act, the Comptroller General of the United States shall submit to
Congress a report on the circumstances in which it is necessary and
workable to require health plans (as defined in section 1171 of the
Social Security Act (42 U.S.C. 1320d)), health care clearinghouses (as
defined in such section 1171), and health care providers (as defined in
such section 1171) who transmit health information in electronic form,
to notify individuals if their individually identifiable health
information (as defined in such section 1171) is wrongfully disclosed.
SEC. 502. 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 3011.
``(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 are authorized to be
appropriated such sums as may be necessary for each of fiscal years
2008 and 2009 to carry out this section.''.
SEC. 503. 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 fiscal years 2008 through 2012.''.
<all>