[House Report 109-603]
[From the U.S. Government Publishing Office]
109th Congress Report
HOUSE OF REPRESENTATIVES
2d Session 109-603
======================================================================
PROVIDING FOR CONSIDERATION OF H.R. 4157, HEALTH INFORMATION TECHNOLOGY
PROMOTION ACT OF 2006
_______
July 26, 2006.--Referred to the House Calendar and ordered to be
printed
_______
Mr. Lincoln Diaz-Balart, from the Committee on Rules, submitted the
following
R E P O R T
[To accompany H. Res. 952]
The Committee on Rules, having had under consideration
House Resolution 952, by a record vote of 9 to 4, report the
same to the House with the recommendation that the resolution
be adopted.
SUMMARY OF PROVISIONS OF THE RESOLUTION
The resolution provides for consideration of H.R. 4157, the
Health Information Technology Promotion Act of 2006, under a
structured rule. The rule provides one hour of general debate,
with 35 minutes equally divided and controlled by the chairman
and ranking minority member of the Committee on Energy and
Commerce, and 25 minutes equally divided and controlled by the
chairman and ranking minority member of the Committee on Ways
and Means.
The rule waives all points of order against consideration
of the bill. The rule provides that in lieu of the amendments
recommended by the Committees on Energy and Commerce and Ways
and Means now printed in the bill, the amendment in the nature
of a substitute printed in part A of this report, modified by
the amendment printed in part B of this report, shall be
considered as adopted in the House and in the Committee of the
Whole.
The rule provides that the bill, as amended, shall be
considered as the original bill for the purpose of further
amendment and shall be considered as read. The rule waives all
points of order against provisions in the bill as amended.
The rule makes in order only those further amendments
printed in part C of this report. The rule provides that the
amendments printed in part C of this report may be offered only
in the order printed in this report, may be offered only by a
Member designated in this report, shall be considered as read,
shall be debatable for the time specified in this report
equally divided and controlled by the proponent and an
opponent, shall not be subject to amendment, and shall not be
subject to a demand for division of the question in the House
or in the Committee of the Whole.
The rule waives all points of order against the amendments
printed in this report. The rule provides one motion to
recommit with or without instructions.
The rule further provides that after passage of H.R. 4157,
it shall be in order to consider in the House S. 1418. The rule
waives all points of order against the Senate bill and against
its consideration. The rule provides that it shall be in order
to move to strike all after the enacting clause of the Senate
bill and to insert in lieu thereof the provisions of H.R. 4157
as passed by the House. The rule waives all points of order
against that motion. The rule provides that if the motion is
adopted and the Senate bill, as amended, is passed, then it
shall be in order to move that the House insist on its
amendments to S. 1418 and request a conference with the Senate
thereon.
Finally, the rule provides that H. Res. 924 is laid on the
table.
EXPLANATION OF WAIVERS
The waiver of all points of order against consideration of
the bill includes a waiver of clause 4(a) of rule XIII
(requiring a three-day layover of the committee report). The
waiver is necessary because the Committee on Energy and
Commerce and the Committee on Ways and Means filed their
reports with the House on Wednesday, July 26, 2006 and the bill
may be considered by the House as early as Thursday, July 27,
2006.
The waiver of all points of order against consideration of
the bill also includes a waiver of section 302 of the
Congressional Budget Act (prohibiting consideration of
legislation which exceeds a committee's allocation of new
entitlement authority) and a waiver of section 303 of the
Congressional Budget Act (prohibiting consideration of
legislation, as reported, providing new budget authority,
change in revenues, change in public debt, new entitlement
authority, or new credit authority for a fiscal year until the
budget resolution for that year has been agreed to).
COMMITTEE VOTES
Pursuant to clause 3(b) of House rule XIII the results of
each record vote on an amendment or motion to report, together
with the names of those voting for and against, are printed
below:
Rules Committee record vote No. 238
Date: July 26, 2006.
Measure: H.R. 4157, Health Information Technology Promotion
Act of 2006.
Motion by: Mr. McGovern.
Summary of motion: To make in order en bloc and provide the
appropriate waivers for the amendments numbered 6, 7, and 8
offered by Representative Kennedy of Rhode Island.
Results: Defeated 4 to 9.
Vote by Members: Diaz-Balart--Nay; Hastings (WA)--Nay;
Sessions--Nay; Putnam--Nay; Capito--Nay; Cole--Nay; Bishop--
Nay; Gingrey--Nay; Slaughter--Yea; McGovern--Yea; Hastings
(FL)--Yea; Matsui--Yea; Dreier--Nay.
Rules Committee record vote No. 239
Date: July 26, 2006.
Measure: H.R. 4157, Health Information Technology Promotion
Act of 2006.
Motion by: Mr. Hastings of Florida.
Summary of motion: To make in order and provide the
appropriate waivers for the amendment in the nature of a
substitute offered by Representative Dingell, which is based on
the Senate-passed bipartisan bill introduced by Senators Frist,
Enzi, Kennedy, and Clinton. Also includes privacy protections
necessary where information will be more vulnerable to breach
by thieves and others. Promotes technology through greater
direct funding for providers, as opposed to changing the Stark
self-referral and anti-kickback fraud and abuse laws. Also
provides privacy protections beyond those in current law to
ensure that patients' health information is secure.
Results: Defeated 4 to 9.
Vote by Members: Diaz-Balart--Nay; Hastings (WA)--Nay;
Sessions--Nay; Putnam--Nay; Capito--Nay; Cole--Nay; Bishop--
Nay; Gingrey--Nay; Slaughter--Yea; McGovern--Yea; Hastings
(FL)--Yea; Matsui--Yea; Dreier--Nay.
Rules Committee record vote No. 240
Date: July 26, 2006.
Measure: H.R. 4157, Health Information Technology Promotion
Act of 2006.
Motion by: Mrs. Matsui.
Summary of motion: To make in order and provide the
appropriate waivers for the amendment offered by Representative
Markey, which gives patients the power to keep their medical
records out of electronic databases unless they first give
their permission. Requires patients to be notified if their
health information in the system is lost, stolen, or used for
an unauthorized purpose. Enables patients to seek damages from
individuals and entities that improperly obtain or disclose
individually-identifiable health information. Requires the use
of data safeguards such as encryption. Permits patients to
limit access to particularly sensitive information in their
medical records. Continues to allow States to have more
protective privacy laws.
Results: Defeated 4 to 9.
Vote by Members: Diaz-Balart--Nay; Hastings (WA)--Nay;
Sessions--Nay; Putnam--Nay; Capito--Nay; Cole--Nay; Bishop--
Nay; Gingrey--Nay; Slaughter--Yea; McGovern--Yea; Hastings
(FL)--Yea; Matsui--Yea; Dreier--Nay.
Rules Committee record vote No. 241
Date: July 26, 2006.
Measure: H.R. 4157, Health Information Technology Promotion
Act of 2006.
Motion by: Mr. Lincoln Diaz-Balart.
Summary of motion: To report the rule.
Results: Agreed to 9 to 4.
Vote by Members: Diaz-Balart--Yea; Hastings (WA)--Yea;
Sessions--Yea; Putnam--Yea; Capito--Yea; Cole--Yea; Bishop--
Yea; Gingrey--Yea; Slaughter--Nay; McGovern--Nay; Hastings
(FL)--Nay; Matsui--Nay; Dreier--Yea.
PART A--SUMMARY OF AMENDMENT IN THE NATURE OF A SUBSTITUTE CONSIDERED
AS ADOPTED
Codifies and expands the authorities and duties of the
National Coordinator for Health Information Technology
including responsibilities for endorsing interoperability
guidelines, conducting a National survey on the information
exchange capabilities, and reviewing Federal information
systems and security practices. Furthermore, Federal health
information collection systems must be consistent with
guidelines within three years of endorsement. The bill provides
grants to help integrated health systems coordinate the
delivery of care for uninsured, underinsured and medically
underserved populations and to demonstrate issues in the
adoption of health IT in the small physician setting. The bill
further modernizes billing code sets. The bill would also
create safe harbors for providing certain health IT or related
services under Antikickback and physician self-referral law to
improve coordination of care. The bill provides for a number of
studies and reports regarding privacy and security, telehealth,
health information exchanges, the American Health Information
Community. Finally, the bill contains provisions for pricing
transparency for inpatient hospital services.
PART B--SUMMARY OF THE AMENDMENT TO THE AMENDMENT IN THE NATURE OF A
SUBSTITUTE CONSIDERED AS ADOPTED
Strikes sections 404 (Methodology for reporting uniform
price data for inpatient and outpatient hospital services) and
405 (Inclusion of uniform price data). Eliminates a provision
in the underlying bill that would have expanded the types of
entities that could provide health IT without violating
Medicare anti-kickback laws, beginning in 2011.
PART C--SUMMARY OF AMENDMENTS MADE IN ORDER
1. Hinojosa (TX):
Improves the availability of information and resources for
individuals with low literacy. (10 minutes)
2. Towns (NY): Creates a study that provides benchmarks for
best practices and cost effectiveness for the use of Health
Information Technology in medically underserved areas. (10
minutes)
3. Jackson (IL): Ensures that emergency contact information
or next of kin information is included in any process to
modernize medical records. (10 minutes)
4. Cuellar (TX): Focuses a priority of the integrated
health system grant program on the improved coordination of
care for the uninsured, underinsured, and medically underserved
residing in geographically isolated areas or underserved urban
areas. (10 minutes)
5. Price, Tom (GA): Requires the Secretary of Health and
Human Services to submit a report to Congress, which evaluates:
the applicability of health care classification methodologies
and codes for purposes beyond the coding services for
diagnostic documentation or billing purposes; the usefulness,
accuracy, and completeness of such methodologies and codes for
such purposes; and the capacity of such methodologies and codes
to produce erroneous or misleading information, with respect to
such purposes. (10 minutes)
6. McMorris (WA)/Smith, Adam (WA): Directs the Secretary of
Health and Human Services to establish a two year project to
demonstrate the impact of health information technology on
disease management for chronic disease sufferers within the
Medicaid population. There is no authorization of funding and
it requests a report at the conclusion of the demonstration.
(10 minutes)
PART A--TEXT OF THE AMENDMENT IN THE NATURE OF A SUBSTITUTE CONSIDERED
AS ADOPTED
Strike all after the enacting clause and insert the
following:
SECTION 1. SHORT TITLE AND TABLE OF CONTENTS.
(a) Short Title.--This Act may be cited as the ``Health
Information Technology Promotion Act of 2006''.
(b) Table of Contents.--The table of contents of this Act is
as follows:
Sec. 1. Short title and table of contents.
Sec. 2. Preserving privacy and security laws.
TITLE I--COORDINATION FOR, PLANNING FOR, AND INTEROPERABILITY OF HEALTH
INFORMATION TECHNOLOGY
Sec. 101. Office of the National Coordinator for Health Information
Technology.
Sec. 102. Report on the American Health Information Community.
Sec. 103. Interoperability planning process; Federal information
collection activities.
Sec. 104. Grants to integrated health systems to promote health
information technologies to improve coordination of care for
the uninsured, underinsured, and medically underserved.
Sec. 105. Small physician practice demonstration grants.
TITLE II--TRANSACTION STANDARDS, CODES, AND INFORMATION
Sec. 201. Procedures to ensure timely updating of standards that enable
electronic exchanges.
Sec. 202. Upgrading ASC X12 and NCPDP standards.
Sec. 203. Upgrading ICD codes; coding and documentation of non-medical
information.
Sec. 204. Strategic plan for coordinating implementation of transaction
standards and ICD codes.
Sec. 205. Study and report to determine impact of variation and
commonality in State health information laws and regulations.
TITLE III--PROMOTING THE USE OF HEALTH INFORMATION TECHNOLOGY TO BETTER
COORDINATE HEALTH CARE
Sec. 301. Safe harbors to antikickback civil penalties and criminal
penalties for provision of health information technology and
training services.
Sec. 302. Exception to limitation on certain physician referrals (under
Stark) for provision of health information technology and
training services to health care professionals.
Sec. 303. Rules of construction regarding use of consortia.
TITLE IV--ADDITIONAL PROVISIONS
Sec. 401. Promotion of telehealth services.
Sec. 402. Study and report on expansion of home health-related
telehealth services.
Sec. 403. Study and report on store and forward technology for
telehealth.
Sec. 404. Methodology for reporting uniform price data for inpatient and
outpatient hospital services.
Sec. 405. Inclusion of uniform price data.
Sec. 406. Ensuring health care providers participating in PHSA programs,
Medicaid, SCHIP, or the MCH program may maintain health
information in electronic form.
Sec. 407. Ensuring health care providers participating in the Medicare
program may maintain health information in electronic form.
Sec. 408. Study and report on State, regional, and community health
information exchanges.
SEC. 2. PRESERVING PRIVACY AND SECURITY LAWS.
Nothing in this Act (or the amendments made by this Act)
shall be construed to affect the scope, substance, or
applicability of section 264(c) of the Health Insurance
Portability and Accountability Act of 1996 and any regulation
issued pursuant to such section.
TITLE I--COORDINATION FOR, PLANNING FOR, AND INTEROPERABILITY OF HEALTH
INFORMATION TECHNOLOGY
SEC. 101. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION
TECHNOLOGY.
(a) In General.--Title II of the Public Health Service Act is
amended by adding at the end the following new part:
``PART D--HEALTH INFORMATION TECHNOLOGY
``SEC. 271. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION
TECHNOLOGY.
``(a) Establishment.--There is established within the
Department of Health and Human Services an Office of the
National Coordinator for Health Information Technology that
shall be headed by the National Coordinator for Health
Information Technology (referred to in this part as the
`National Coordinator'). The National Coordinator shall be
appointed by and report directly to the Secretary. The National
Coordinator shall be paid at a rate equal to the rate of basic
pay for level IV of the Executive Schedule.
``(b) Goals of Nationwide Interoperable Health Information
Technology Infrastructure.--The National Coordinator shall
perform the duties under subsection (c) in a manner consistent
with the development of a nationwide interoperable health
information technology infrastructure that--
``(1) improves health care quality, promotes data
accuracy, reduces medical errors, increases the
efficiency of care, and advances the delivery of
appropriate, evidence-based health care services;
``(2) promotes wellness, disease prevention, and
management of chronic illnesses by increasing the
availability and transparency of information related to
the health care needs of an individual for such
individual;
``(3) promotes the availability of appropriate and
accurate information necessary to make medical
decisions in a usable form at the time and in the
location that the medical service involved is provided;
``(4) produces greater value for health care
expenditures by reducing health care costs that result
from inefficiency, medical errors, inappropriate care,
and incomplete or inaccurate information;
``(5) promotes a more effective marketplace, greater
competition, greater systems analysis, increased
consumer choice, enhanced quality, and improved
outcomes in health care services;
``(6) with respect to health information of
consumers, advances the portability of such information
and the ability of such consumers to share and use such
information to assist in the management of their health
care;
``(7) improves the coordination of information and
the provision of such services through an effective
infrastructure for the secure and authorized exchange
and use of health care information;
``(8) is consistent with legally applicable
requirements with respect to securing and protecting
the confidentiality of individually identifiable health
information of a patient;
``(9) promotes the creation and maintenance of
transportable, secure, Internet-based personal health
records, including promoting the efforts of health care
payers and health plan administrators for a health
plan, such as Federal agencies, private health plans,
and third party administrators, to provide for such
records on behalf of members of such a plan;
``(10) promotes access to and review of the
electronic health record of a patient by such patient;
``(11) promotes health research and health care
quality research and assessment; and
``(12) promotes the efficient and streamlined
development, submission, and maintenance of electronic
health care clinical trial data.
``(c) Duties of the National Coordinator.--
``(1) Strategic planner for interoperable health
information technology.--The National Coordinator shall
provide for a strategic plan for the nationwide
implementation of interoperable health information
technology in both the public and private health care
sectors consistent with subsection (b).
``(2) Principal advisor to the secretary.--The
National Coordinator shall serve as the principal
advisor to the Secretary on the development,
application, and use of health information technology,
and shall coordinate the policies and programs of the
Department of Health and Human Services for promoting
the use of health information technology.
``(3) Intragovernmental coordinator.--The National
Coordinator shall ensure that health information
technology policies and programs of the Department of
Health and Human Services are coordinated with those of
relevant executive branch agencies and departments with
a goal to avoid duplication of effort, to align the
health information architecture of each agency or
department toward a common approach, to ensure that
each agency or department conducts programs within the
areas of its greatest expertise and its mission in
order to create a national interoperable health
information system capable of meeting national public
health needs effectively and efficiently, and to assist
Federal agencies and departments in security programs,
policies, and protections to prevent unauthorized
access to individually identifiable health information
created, maintained, or in the temporary possession of
that agency or department. The coordination authority
provided to the National Coordinator under the previous
sentence shall supercede any such authority otherwise
provided to any other official of the Department of
Health and Human Services. For the purposes of this
paragraph, the term `unauthorized access' means access
that is not authorized by that agency or department
including unauthorized employee access.
``(4) Advisor to omb.--The National Coordinator shall
provide to the Director of the Office of Management and
Budget comments and advice with respect to specific
Federal health information technology programs.
``(5) Promoter of health information technology in
medically underserved communities.--The National
Coordinator shall--
``(A) identify sources of funds that will be
made available to promote and support the
planning and adoption of health information
technology in medically underserved
communities, including in urban and rural
areas, either through grants or technical
assistance;
``(B) coordinate with the funding sources to
help such communities connect to identified
funding; and
``(C) collaborate with the Agency for
Healthcare Research and Quality and the Health
Services Resources Administration and other
Federal agencies to support technical
assistance, knowledge dissemination, and
resource development, to medically underserved
communities seeking to plan for and adopt
technology and establish electronic health
information networks across providers.''.
(b) Treatment of Executive Order 13335.--Executive Order
13335 shall not have any force or effect after the date of the
enactment of this Act.
(c) Transition From ONCHIT Under Executive Order.--
(1) In general.--All functions, personnel, assets,
liabilities, administrative actions, and statutory
reporting requirements applicable to the old National
Coordinator or the Office of the old National
Coordinator on the date before the date of the
enactment of this Act shall be transferred, and applied
in the same manner and under the same terms and
conditions, to the new National Coordinator and the
Office of the new National Coordinator as of the date
of the enactment of this Act.
(2) Rule of construction.-- Nothing in this section
or the amendment made by this section shall be
construed as requiring the duplication of Federal
efforts with respect to the establishment of the Office
of the National Coordinator for Health Information
Technology, regardless of whether such efforts are
carried out before or after the date of the enactment
of this Act.
(3) Acting national coordinator.--Before the
appointment of the new National Coordinator, the old
National Coordinator shall act as the National
Coordinator for Health Information Technology until the
office is filled as provided in section 271(a) of the
Public Health Service Act, as added by subsection (a).
The Secretary of Health and Human Services may appoint
the old National Coordinator as the new National
Coordinator.
(4) Definitions.--For purposes of this subsection:
(A) New national coordinator.--The term ``new
National Coordinator'' means the National
Coordinator for Health Information Technology
appointed under section 271(a) of the Public
Health Service Act, as added by subsection (a).
(B) Old national coordinator.--The term ``old
National Coordinator'' means the National
Coordinator for Health Information Technology
appointed under Executive Order 13335.
SEC. 102. REPORT ON THE AMERICAN HEALTH INFORMATION COMMUNITY.
Not later than one year after the date of the enactment of
this Act, the Secretary of Health and Human Services shall
submit to Congress a report on the work conducted by the
American Health Information Community (in this section referred
to as ``AHIC''), as established by the Secretary. Such report
shall include the following:
(1) A description of the accomplishments of AHIC,
with respect to the promotion of the development of
national guidelines, the development of a nationwide
health information network, and the increased adoption
of health information technology.
(2) Information on how model privacy and security
policies may be used to protect confidentiality of
health information, and an assessment of how existing
policies compare to such model policies.
(3) Information on the progress in--
(A) establishing uniform industry-wide health
information technology standards;
(B) achieving an internet-based nationwide
health information network;
(C) achieving interoperable electronic health
record adoption across health care providers;
and
(D) creating technological innovations to
promote security and confidentiality of
individually identifiable health information.
(4) Recommendations for the transition of AHIC to a
longer-term or permanent advisory and facilitation
entity, including--
(A) a schedule for such transition;
(B) options for structuring the entity as
either a public-private or private sector
entity;
(C) the collaberative role of the Federal
Government in the entity;
(D) steps for--
(i) continued leadership in the
facilitation of guidelines or
standards;
(ii) the alignment of financial
incentives; and
(iii) the long-term plan for health
care transformation through information
technology; and
(E) the elimination or revision of the
functions of AHIC during the development of the
nationwide health information network.
SEC. 103. INTEROPERABILITY PLANNING PROCESS; FEDERAL INFORMATION
COLLECTION ACTIVITIES.
Part D of title II of the Public Health Service Act, as added
by section 101(a), is amended by adding at the end the
following new section:
``SEC. 272. INTEROPERABILITY PLANNING PROCESS; FEDERAL INFORMATION
COLLECTION ACTIVITIES.
``(a) Strategic Interoperability Planning Process.--
``(1) Assessment and endorsement of core strategic
guidelines.--
``(A) In general.--Not later than December
31, 2006, the National Coordinator shall
publish a strategic plan, including a schedule,
for the assessment and the endorsement of core
interoperability guidelines for significant use
cases consistent with this subsection. The
National Coordinator may update such plan from
time to time.
``(B) Endorsement.--
``(i) In general.--Consistent with
the schedule under this paragraph and
not later than one year after the
publication of such schedule, the
National Coordinator shall endorse a
subset of core interoperability
guidelines for significant use cases.
The National Coordinator shall continue
to endorse subsets of core
interoperability guidelines for
significant use cases annually
consistent with the schedule published
pursuant to this paragraph, with
endorsement of all such guidelines
completed not later than August 31,
2009.
``(ii) Consultation.--All such
endorsements shall be in consultation
with the American Health Information
Community and other appropriate
entities.
``(iii) Voluntary compliance.--
Compliance with such guidelines shall
be voluntary, subject to subsection
(b)(1).
``(C) Consultation with other parties.--The
National Coordinator shall develop and
implement such strategic plan in consultation
with the American Health Information Community
and other appropriate entities.
``(D) Definitions.--For purposes of this
section:
``(i) Interoperability guideline.--
The term `interoperability guideline'
means a guideline to improve and
promote the interoperability of health
information technology for purposes of
electronically accessing and exchanging
health information. Such term includes
named standards, architectures,
software schemes for identification,
authentication, and security, and other
information needed to ensure the
reproducible development of common
solutions across disparate entities.
``(ii) Core interoperability
guideline.--The term `core
interoperability guideline' means an
interoperability guideline that the
National Coordinator determines is
essential and necessary for purposes
described in clause (i).
``(iii) Significant use case.--The
term `significant use case' means a
category (as specified by the National
Coordinator) that identifies a
significant use or purpose for the
interoperability of health information
technology, such as for the exchange of
laboratory information, drug
prescribing, clinical research, and
electronic health records.
``(2) National survey.--
``(A) In general.--Not later than August 31,
2008, the National Coordinator shall conduct
one or more surveys designed to measure the
capability of entities (including Federal
agencies, State and local government agencies,
and private sector entities) to exchange
electronic health information by appropriate
significant use case. Such surveys shall
identify the extent to which the type of health
information, the use for such information, or
any other appropriate characterization of such
information may relate to the capability of
such entities to exchange health information in
a manner that is consistent with methods to
improve the interoperability of health
information and with core interoperability
guidelines.
``(B) Dissemination of survey results.--The
National Coordinator shall disseminate the
results of such surveys in a manner so as to--
``(i) inform the public on the
capabilities of entities to exchange
electronic health information;
``(ii) assist in establishing a more
interoperable information architecture;
and
``(iii) identify the status of health
information systems used in Federal
agencies and the status of such systems
with respect to interoperability
guidelines.
``(b) Federal Health Information Collection Activities.--
``(1) Requirements.--With respect to a core
interoperability guideline endorsed under subsection
(a)(1)(B) for a significant use case, the President
shall take measures to ensure that Federal activities
involving the broad collection and submission of health
information are consistent with such guideline within
three years after the date of such endorsement.
``(2) Promoting use of non-identifiable health
information to improve health research and health care
quality.--
``(A) In general.--Where feasible, and
consistent with applicable privacy or security
or other laws, the President, in consultation
with the Secretary, shall take measures to
allow timely access to useful categories of
non-identifiable health information in records
maintained by the Federal government, or
maintained by entities under contract with the
Federal government, to advance health care
quality and health research where such
information is in a form that can be used in
such research. The President shall consult with
appropriate Federal agencies, and solicit
public comment, on useful categories of
information, and appropriate measures to take.
The President may consider the administrative
burden and the potential for improvements in
health care quality in determining such
appropriate measures. In addition, the
President, in consultation with the Secretary,
shall encourage voluntary private and public
sector efforts to allow access to such useful
categories of non-identifiable health
information to advance health care quality and
health research.
``(B) Non-identifiable health information
defined.--For purposes of this paragraph, the
term `non-identifiable health information'
means information that is not individually
identifiable health information as defined in
rules promulgated pursuant to section 264(c) of
the Health Insurance Portability and
Accountability Act of 1996 (42 U.S.C. 1320d-2
note), and includes information that has been
de-identified so that it is no longer
individually identifiable health information,
as defined in such rules.
``(3) Annual review and report.--For each year during
the five-year period following the date of the
enactment of this section, the National Coordinator
shall review the operation of health information
collection by and submission to the Federal government
and the purchases (and planned purchases) of health
information technology by the Federal government. For
each such year and based on the review for such year,
the National Coordinator shall submit to the President
and Congress recommendations on methods to--
``(A) streamline (and eliminate redundancy
in) Federal systems used for the collection and
submission of health information;
``(B) improve efficiency in such collection
and submission;
``(C) increase the ability to assess health
care quality; and
``(D) reduce health care costs.''.
SEC. 104. GRANTS TO INTEGRATED HEALTH SYSTEMS TO PROMOTE HEALTH
INFORMATION TECHNOLOGIES TO IMPROVE COORDINATION OF
CARE FOR THE UNINSURED, UNDERINSURED, AND MEDICALLY
UNDERSERVED.
Subpart I of part D of title III of the Public Health Service
Act (42 U.S.C. 254b et seq.) is amended by adding at the end
the following:
``SEC. 330M. GRANTS FOR IMPROVEMENT OF THE COORDINATION OF CARE FOR THE
UNINSURED, UNDERINSURED, AND MEDICALLY UNDERSERVED.
``(a) In General.--The Secretary may make grants to
integrated health care systems, in accordance with this
section, for projects to better coordinate the provision of
health care through the adoption of new health information
technology, or the significant improvement of existing health
information technology, to improve the provision of health care
to uninsured, underinsured, and medically underserved
individuals (including in urban and rural areas) through
health-related information about such individuals, throughout
such a system and at the point of service.
``(b) Eligibility.--
``(1) Application.--To be eligible to receive a grant
under this section, an integrated health care system
shall prepare and submit to the Secretary an
application, at such time, in such manner, and
containing such information as the Secretary may
require, including--
``(A) a description of the project that the
system will carry out using the funds provided
under the grant;
``(B) a description of the manner in which
the project funded under the grant will advance
the goal specified in subsection (a); and
``(C) a description of the populations to be
served by the adoption or improvement of health
information technology.
``(2) Optional reporting condition.--The Secretary
may also condition the provision of a grant to an
integrated health care system under this section for a
project on the submission by such system to the
Secretary of a report on the impact of the health
information technology adopted (or improved) under such
project on the delivery of health care and the quality
of care (in accordance with applicable measures of such
quality). Such report shall be at such time and in such
form and manner as specified by the Secretary.
``(c) Integrated Health Care System Defined.--For purposes of
this section, the term `integrated health care system' means a
system of health care providers that is organized to provide
care in a coordinated fashion and has a demonstrated commitment
to provide uninsured, underinsured, and medically underserved
individuals with access to such care.
``(d) Priorities.--In making grants under this section, the
Secretary shall give priority to an integrated health care
system--
``(1) that can demonstrate past successful community-
wide efforts to improve the quality of care provided
and the coordination of care for the uninsured,
underinsured, and medically underserved; or
``(2) if the project to be funded through such a
grant--
``(A) will improve the delivery of health
care and the quality of care provided; and
``(B) will demonstrate savings for State or
Federal health care benefits programs or
entities legally obligated under Federal law to
provide health care from the reduction of
duplicative health care services,
administrative costs, and medical errors.
``(e) Limitation, Matching Requirement, and Conditions.--
``(1) Limitation on use of funds.--None of the funds
provided under a grant made under this section may be
used for a project providing for the adoption or
improvement of health information technology that is
used exclusively for financial record keeping, billing,
or other non-clinical applications.
``(2) Matching requirement.--To be eligible for a
grant under this section an integrated health care
system shall contribute non-Federal contributions to
the costs of carrying out the project for which the
grant is awarded in an amount equal to $1 for each $5
of Federal funds provided under the grant.
``(f) Authorization of Appropriations.--There are authorized
to be appropriated to carry out this section $15,000,000 for
each of fiscal years 2007 and 2008.''.
SEC. 105. SMALL PHYSICIAN PRACTICE DEMONSTRATION GRANTS.
Part D of title II of the Public Health Service Act, as added
by section 101(a) and amended by section 103, is amended by
adding at the end the following new section:
``SEC. 273. SMALL PHYSICIAN PRACTICE DEMONSTRATION GRANTS.
``(a) In General.--The Secretary shall establish a
demonstration program under which the Secretary makes grants to
small physician practices (including such practices that
furnish services to individuals with chronic illnesses) that
are located in rural areas or medically underserved urban areas
for the purchase and support of health information technology.
``(b) Eligibility.--To be eligible to receive a grant under
this section, an applicant shall prepare and submit to the
Secretary an application, at such time, in such manner, and
containing such information, as the Secretary may require.
``(c) Reporting.--
``(1) Required reports by small physician
practices.--A small physician practice receiving a
grant under subsection (a) shall submit to the
Secretary an evaluation on the health information
technology funded by such grant. Such evaluation shall
include information on--
``(A) barriers to the adoption of health
information technology by the small physician
practice;
``(B) issues for such practice in the use of
health information technology;
``(C) the effect health information
technology will have on the quality of health
care furnished by such practice; and
``(D) the effect of any medical liability
rules on such practice.
``(2) Report to congress.--Not later than January 1,
2009, the Secretary shall submit to Congress a report
on the results of the demonstration program under this
section.
``(d) Authorization of Appropriations.--There are authorized
to be appropriated to carry out this section $5,000,000 for
each of fiscal years 2007 and 2008.''.
TITLE II--TRANSACTION STANDARDS, CODES, AND INFORMATION
SEC. 201. PROCEDURES TO ENSURE TIMELY UPDATING OF STANDARDS THAT ENABLE
ELECTRONIC EXCHANGES.
Section 1174(b) of the Social Security Act (42 U.S.C. 1320d-
3(b)) is amended--
(1) in paragraph (1)--
(A) in the first sentence, by inserting ``and
in accordance with paragraph (3)'' before the
period; and
(B) by adding at the end the following new
sentence: ``For purposes of this subsection and
section 1173(c)(2), the term `modification'
includes a new version or a version upgrade.'';
and
(2) by adding at the end the following new paragraph:
``(3) Expedited procedures for adoption of additions
and modifications to standards.--
``(A) In general.--For purposes of paragraph
(1), the Secretary shall provide for an
expedited upgrade program (in this paragraph
referred to as the `upgrade program'), in
accordance with this paragraph, to develop and
approve additions and modifications to the
standards adopted under section 1173(a) to
improve the quality of such standards or to
extend the functionality of such standards to
meet evolving requirements in health care.
``(B) Publication of notices.--Under the
upgrade program:
``(i) Voluntary notice of initiation
of process.--Not later than 30 days
after the date the Secretary receives a
notice from a standard setting
organization that the organization is
initiating a process to develop an
addition or modification to a standard
adopted under section 1173(a), the
Secretary shall publish a notice in the
Federal Register that--
``(I) identifies the subject
matter of the addition or
modification;
``(II) provides a description
of how persons may participate
in the development process; and
``(III) invites public
participation in such process.
``(ii) Voluntary notice of
preliminary draft of additions or
modifications to standards.--Not later
than 30 days after the date of the date
the Secretary receives a notice from a
standard setting organization that the
organization has prepared a preliminary
draft of an addition or modification to
a standard adopted by section 1173(a),
the Secretary shall publish a notice in
the Federal Register that--
``(I) identifies the subject
matter of (and summarizes) the
addition or modification;
``(II) specifies the
procedure for obtaining the
draft;
``(III) provides a
description of how persons may
submit comments in writing and
at any public hearing or
meeting held by the
organization on the addition or
modification; and
``(IV) invites submission of
such comments and participation
in such hearing or meeting
without requiring the public to
pay a fee to participate.
``(iii) Notice of proposed addition
or modification to standards.--Not
later than 30 days after the date of
the date the Secretary receives a
notice from a standard setting
organization that the organization has
a proposed addition or modification to
a standard adopted under section
1173(a) that the organization intends
to submit under subparagraph (D)(iii),
the Secretary shall publish a notice in
the Federal Register that contains,
with respect to the proposed addition
or modification, the information
required in the notice under clause
(ii) with respect to the addition or
modification.
``(iv) Construction.--Nothing in this
paragraph shall be construed as
requiring a standard setting
organization to request the notices
described in clauses (i) and (ii) with
respect to an addition or modification
to a standard in order to qualify for
an expedited determination under
subparagraph (C) with respect to a
proposal submitted to the Secretary for
adoption of such addition or
modification.
``(C) Provision of expedited determination.--
Under the upgrade program and with respect to a
proposal by a standard setting organization for
an addition or modification to a standard
adopted under section 1173(a), if the Secretary
determines that the standard setting
organization developed such addition or
modification in accordance with the
requirements of subparagraph (D) and the
National Committee on Vital and Health
Statistics recommends approval of such addition
or modification under subparagraph (E), the
Secretary shall provide for expedited treatment
of such proposal in accordance with
subparagraph (F).
``(D) Requirements.--The requirements under
this subparagraph with respect to a proposed
addition or modification to a standard by a
standard setting organization are the
following:
``(i) Request for publication of
notice.--The standard setting
organization submits to the Secretary a
request for publication in the Federal
Register of a notice described in
subparagraph (B)(iii) for the proposed
addition or modification.
``(ii) Process for receipt and
consideration of public comment.--The
standard setting organization provides
for a process through which, after the
publication of the notice referred to
under clause (i), the organization--
``(I) receives and responds
to public comments submitted on
a timely basis on the proposed
addition or modification before
submitting such proposed
addition or modification to the
National Committee on Vital and
Health Statistics under clause
(iii);
``(II) makes publicly
available a written explanation
for its response in the
proposed addition or
modification to comments
submitted on a timely basis;
and
``(III) makes public comments
received under clause (I)
available, or provides access
to such comments, to the
Secretary.
``(iii) Submittal of final proposed
addition or modification to ncvhs.--
After completion of the process under
clause (ii), the standard setting
organization submits the proposed
addition or modification to the
National Committee on Vital and Health
Statistics for review and consideration
under subparagraph (E). Such submission
shall include information on the
organization's compliance with the
notice and comment requirements (and
responses to those comments) under
clause (ii).
``(E) Hearing and recommendations by national
committee on vital and health statistics.--
Under the upgrade program, upon receipt of a
proposal submitted by a standard setting
organization under subparagraph (D)(iii) for
the adoption of an addition or modification to
a standard, the National Committee on Vital and
Health Statistics shall provide notice to the
public and a reasonable opportunity for public
testimony at a hearing on such addition or
modification. The Secretary may participate in
such hearing in such capacity (including
presiding ex officio) as the Secretary shall
determine appropriate. Not later than 120 days
after the date of receipt of the proposal, the
Committee shall submit to the Secretary its
recommendation to adopt (or not adopt) the
proposed addition or modification.
``(F) Determination by secretary to accept or
reject national committee on vital and health
statistics recommendation.--
``(i) Timely determination.--Under
the upgrade program, if the National
Committee on Vital and Health
Statistics submits to the Secretary a
recommendation under subparagraph (E)
to adopt a proposed addition or
modification, not later than 90 days
after the date of receipt of such
recommendation the Secretary shall make
a determination to accept or reject the
recommendation and shall publish notice
of such determination in the Federal
Register not later than 30 days after
the date of the determination.
``(ii) Contents of notice.--If the
determination is to reject the
recommendation, such notice shall
include the reasons for the rejection.
If the determination is to accept the
recommendation, as part of such notice
the Secretary shall promulgate the
modified standard (including the
accepted proposed addition or
modification accepted) as a final rule
under this subsection without any
further notice or public comment
period.
``(iii) Limitation on
consideration.--The Secretary shall not
consider a proposal under this
subparagraph unless the Secretary
determines that the requirements of
subparagraph (D) (including publication
of notice and opportunity for public
comment) have been met with respect to
the proposal.
``(G) Exemption from paperwork reduction
act.--Chapter 35 of title 44, United States
Code, shall not apply to a final rule
promulgated under subparagraph (F).
``(H) Treatment as satisfying requirements
for notice-and-comment.--Any requirements under
section 553 of title 5, United States Code,
relating to notice and an opportunity for
public comment with respect to a final rule
promulgated under subparagraph (F) shall be
treated as having been met by meeting the
requirements of the notice and opportunity for
public comment provided under provisions of
subparagraphs (B)(iii), (D), and (E).
``(I) No judicial review.--A final rule
promulgated under subparagraph (F) shall not be
subject to judicial review.''.
SEC. 202. UPGRADING ASC X12 AND NCPDP STANDARDS.
(a) In General.--The Secretary of Health and Human Services
shall provide by notice published in the Federal Register for
the following replacements of standards to apply to
transactions occurring on or after April 1, 2009:
(1) Accredited standards committee x12 (asc x12)
standard.--The replacement of the Accredited Standards
Committee X12 (ASC X12) version 4010 adopted under
section 1173(a) of such Act (42 U.S.C. 1320d-2(a)) with
the ASC X12 version 5010, as reviewed by the National
Committee on Vital Health Statistics.
(2) National council for prescription drug programs
(ncpdp) telecommunications standards.--The replacement
of the National Council for Prescription Drug Programs
(NCPDP) Telecommunications Standards version 5.1
adopted under section 1173(a) of such Act (42 U.S.C.
1320d-2(a)) with whichever is the latest version of the
NCPDP Telecommunications Standards that has been
approved by such Council and reviewed by the National
Committee on Vital Health Statistics as of April 1,
2007.
(b) No Judicial Review.--The implementation of subsection
(a), including the determination of the latest version under
subsection (a)(2), shall not be subject to judicial review.
SEC. 203. UPGRADING ICD CODES; CODING AND DOCUMENTATION OF NON-MEDICAL
INFORMATION.
(a) Upgrading ICD Codes.--
(1) In general.--The Secretary of Health and Human
Services shall provide by notice published in the
Federal Register for the replacement of the
International Classification of Diseases, 9th revision,
Clinical Modification (ICD-9-CM) under the regulation
promulgated under section 1173(c) of the Social
Security Act (42 U.S.C. 1320d-2(c)), including for
purposes of part A of title XVIII of such Act, with
both of the following:
(A) The International Classification of
Diseases, 10th revision, Clinical Modification
(ICD-10-CM).
(B) The International Classification of
Diseases, 10th revision, Procedure Coding
System (ICD-10-PCS).
(2) Application.--The replacement made by paragraph
(1) shall apply, for purposes of section 1175(b)(2) of
the Social Security Act (42 U.S.C. 1320d-4(b)(2)), to
services furnished on or after October 1, 2010.
(3) Rules of construction.--Nothing in paragraph (1)
shall be construed--
(A) as affecting the application of
classification methodologies or codes, such as
CPT or HCPCS codes, other than under the
International Classification of Diseases (ICD);
or
(B) as superseding the authority of the
Secretary of Health and Human Services to
maintain and modify the coding set for ICD-10-
CM and ICD-10-PCS, including under the
amendments made by section 201.
(b) Coding and Documentation of Non-Medical Information.--In
any regulation or other action implementing the International
Classification of Diseases, 10th revision, Clinical
Modification (ICD-10-CM), the International Classification of
Diseases, 10th revision, Procedure Coding System (ICD-10-PCS),
or other version of the International Classification of
Diseases, 10th revision, the Secretary of Health and Human
Services shall ensure that no health care provider is required
to code to a level of specificity that would require
documentation of non-medical information on the external cause
of any given type of injury.
SEC. 204. STRATEGIC PLAN FOR COORDINATING IMPLEMENTATION OF TRANSACTION
STANDARDS AND ICD CODES.
Not later than the date that is 180 days after the date of
the enactment of this Act, the Secretary of Health and Human
Services, in consultation with relevant public and private
entities, shall develop a strategic plan with respect to the
need for coordination in the implementation of--
(1) transaction standards under section 1173(a) of
the Social Security Act, including modifications to
such standards under section 1174(b)(3) of such Act, as
added by section 201; and
(2) any updated versions of the International
Classification of Diseases (ICD), including the
replacement of ICD-9 provided for under section 203(a).
SEC. 205. STUDY AND REPORT TO DETERMINE IMPACT OF VARIATION AND
COMMONALITY IN STATE HEALTH INFORMATION LAWS AND
REGULATIONS.
Part C of title XI of the Social Security Act is amended by
adding at the end the following new section:
``STUDY AND REPORT TO DETERMINE IMPACT OF VARIATION AND COMMONALITY IN
STATE HEALTH INFORMATION LAWS AND REGULATIONS
``Sec. 1180. (a) Study.--For purposes of promoting the
development of a nationwide interoperable health information
technology infrastructure consistent with section 271(b) of the
Public Health Service Act, the Secretary shall conduct a study
of the impact of variation in State security and
confidentiality laws and current Federal security and
confidentiality standards on the timely exchanges of health
information in order to ensure the availability of health
information necessary to make medical decisions at the location
in which the medical care involved is provided. Such study
shall examine--
``(1)(A) the degree of variation and commonality
among the requirements of such laws for States; and
``(B) the degree of variation and commonality between
the requirements of such laws and the current Federal
standards;
``(2) insofar as there is variation among and between
such requirements, the strengths and weaknesses of such
requirements; and
``(3) the extent to which such variation may
adversely impact the secure, confidential, and timely
exchange of health information among States, the
Federal government, and public and private entities, or
may otherwise impact the reliability of such
information.
``(b) Report.--Not later than 18 months after the date of the
enactment of this section, the Secretary shall submit to
Congress a report on the study under subsection (a) and shall
include in such report the following:
``(1) Analysis of need for greater commonality.--A
determination by the Secretary on the extent to which
there is a need for greater commonality of the
requirements of State security and confidentiality laws
and current Federal security and confidentiality
standards to better protect, strengthen, or otherwise
improve the secure, confidential, and timely exchange
of health information among States, the Federal
government, and public and private entities.
``(2) Recommendations for greater commonality.--
Insofar as the Secretary determines under paragraph (1)
that there is a need for greater commonality of such
requirements, recommendations on the extent to which
(and how) the current Federal security and
confidentiality standards should be changed in order to
provide the commonality needed to better protect,
strengthen, or otherwise improve the secure,
confidential, and timely exchange of health
information.
``(3) Specific recommendation on legislative changes
for greater commonality.--A specific recommendation on
the extent to which and how such standards should
supersede State laws, in order to provide the
commonality needed to better protect or strengthen the
security and confidentiality of health information in
the timely exchange of such information and legislative
language in the form of a bill to effectuate such
specific recommendation.
``(c) Congressional Consideration of Legislation Providing
for Greater Commonality.--
``(1) Rules of house of representatives and senate.--
This subsection is enacted by the Congress--
``(A) as an exercise of the rulemaking power
of the House of Representatives and the Senate,
respectively, and as such they are deemed a
part of the rules of each House, respectively,
but applicable only with respect to the
procedure to be followed in that House in the
case of a greater commonality bill defined in
paragraph (4), and they supersede other rules
only to the extent that they are inconsistent
therewith; and
``(B) with full recognition of the
constitutional right of either House to change
the rules (so far as relating to the procedure
of that House) at any time, in the same manner
and to the same extent as in the case of any
other rule of that House.
``(2) Introduction.--On the date on which the final
report is submitted under subsection (b)(3)--
``(A) a greater commonality bill shall be
introduced (by request) in the House by the
majority leader of the House, for himself and
the minority leader of the House, or by Members
of the House designated by the majority leader
and minority leader of the House; and
``(B) a greater commonality bill shall be
introduced (by request) in the Senate by the
majority leader of the Senate, for himself and
the minority leader of the Senate, or by
Members of the Senate designated by the
majority leader and minority leader of the
Senate.
If either House is not in session on the day on which
such a report is submitted, the greater commonality
bill shall be introduced in that House, as provided in
the preceding sentence, on the first day thereafter on
which the House is in session.
``(3) Referral.--A greater commonality bill shall be
referred by the Presiding Officers of the respective
House to the appropriate committee (or committees) of
such House, in accordance with the rules of that House.
``(4) Greater commonality bill defined.--For purposes
of this section, the term `greater commonality bill'
means a bill--
``(A) the title of which is the following: `A
Bill to provide the commonality needed to
better protect, strengthen, or otherwise
improve the secure, confidential, and timely
exchange of health information'; and
``(B) the text of which, as introduced,
consists of the text of the bill included in
the report submitted under subsection (b)(3).
``(d) Definitions.--For purposes of this section:
``(1) Current federal security and confidentiality
standards.--The term `current Federal security and
confidentiality standards' means the Federal privacy
standards established pursuant to section 264(c) of the
Health Insurance Portability and Accountability Act of
1996 (42 U.S.C. 1320d-2 note) and security standards
established under section 1173(d) of the Social
Security Act.
``(2) State.--The term `State' has the meaning given
such term when used in title XI of the Social Security
Act, as provided under section 1101(a) of such Act (42
U.S.C. 1301(a)).
``(3) State security and confidentiality laws.--The
term `State security and confidentiality laws' means
State laws and regulations relating to the privacy and
confidentiality of health information or to the
security of such information.''.
TITLE III--PROMOTING THE USE OF HEALTH INFORMATION TECHNOLOGY TO BETTER
COORDINATE HEALTH CARE
SEC. 301. SAFE HARBORS TO ANTIKICKBACK CIVIL PENALTIES AND CRIMINAL
PENALTIES FOR PROVISION OF HEALTH INFORMATION
TECHNOLOGY AND TRAINING SERVICES.
(a) For Civil Penalties.--Section 1128A of the Social
Security Act (42 U.S.C. 1320a-7a) is amended--
(1) in subsection (b), by adding at the end the
following new paragraph:
``(4) For purposes of this subsection, inducements to reduce
or limit services described in paragraph (1) shall not include
the practical or other advantages resulting from health
information technology or related installation, maintenance,
support, or training services.''; and
(2) in subsection (i), by adding at the end the
following new paragraph:
``(8) The term `health information technology' means
hardware, software, license, right, intellectual
property, equipment, or other information technology
(including new versions, upgrades, and connectivity)
designed or provided primarily for the electronic
creation, maintenance, or exchange of health
information to better coordinate care or improve health
care quality, efficiency, or research.''.
(b) For Criminal Penalties.--Section 1128B of such Act (42
U.S.C. 1320a-7b) is amended--
(1) in subsection (b)(3)--
(A) in subparagraph (G), by striking ``and''
at the end;
(B) in the subparagraph (H) 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) in the subparagraph (H) added by section
431(a) of such Act (117 Stat. 2287)--
(i) by redesignating such
subparagraph as subparagraph (I);
(ii) by moving such subparagraph 2
ems to the left; and
(iii) by striking the period at the
end and inserting ``; and''; and
(D) by adding at the end the following new
subparagraph:
``(J) any nonmonetary remuneration (in the form of
health information technology, as defined in section
1128A(i)(8), or related installation, maintenance,
support or training services) made to a person by a
specified entity (as defined in subsection (g)) if--
``(i) the provision of such remuneration is
without an agreement between the parties or
legal condition that--
``(I) limits or restricts the use of
the health information technology to
services provided by the physician to
individuals receiving services at the
specified entity;
``(II) limits or restricts the use of
the health information technology in
conjunction with other health
information technology; or
``(III) conditions the provision of
such remuneration on the referral of
patients or business to the specified
entity;
``(ii) such remuneration is arranged for in a
written agreement that is signed by the parties
involved (or their representatives) and that
specifies the remuneration solicited or
received (or offered or paid) and states that
the provision of such remuneration is made for
the primary purpose of better coordination of
care or improvement of health quality,
efficiency, or research; and
``(iii) the specified entity providing the
remuneration (or a representative of such
entity) has not taken any action to disable any
basic feature of any hardware or software
component of such remuneration that would
permit interoperability.''; and
(2) by adding at the end the following new
subsection:
``(g) Specified Entity Defined.--For purposes of subsection
(b)(3)(J), the term `specified entity'--
``(1) means an entity that is a hospital, group
practice, prescription drug plan sponsor, a Medicare
Advantage organization, or any other such entity
specified by the Secretary, considering the goals and
objectives of this section, as well as the goals to
better coordinate the delivery of health care and to
promote the adoption and use of health information
technology; and
``(2) includes, effective October 1, 2011, any
entity.''.
(c) Effective Date and Effect on State Laws.--
(1) Effective date.--The amendments made by
subsections (a) and (b) shall take effect on the date
that is 120 days after the date of the enactment of
this Act.
(2) Preemption of state laws.--No State (as defined
in section 1101(a) of the Social Security Act (42
U.S.C. 1301(a)) for purposes of title XI of such Act)
shall have in effect a State law that imposes a
criminal or civil penalty for a transaction described
in section 1128A(b)(4) or section 1128B(b)(3)(J) of
such Act, as added by subsections (a)(1) and (b),
respectively, if the conditions described in the
respective provision, with respect to such transaction,
are met.
(d) Study and Report to Assess Effect of Safe Harbors on
Health System.--
(1) In general.--The Secretary of Health and Human
Services shall conduct a study to determine the impact
of each of the safe harbors described in paragraph (3).
In particular, the study shall examine the following:
(A) The effectiveness of each safe harbor in
increasing the adoption of health information
technology.
(B) The types of health information
technology provided under each safe harbor.
(C) The extent to which the financial or
other business relationships between providers
under each safe harbor have changed as a result
of the safe harbor in a way that adversely
affects or benefits the health care system or
choices available to consumers.
(D) The impact of the adoption of health
information technology on health care quality,
cost, and access under each safe harbor.
(2) Report.--Not later than three years after the
effective date described in subsection (c)(1), the
Secretary of Health and Human Services shall submit to
Congress a report on the study under paragraph (1).
(3) Safe harbors described.--For purposes of
paragraphs (1) and (2), the safe harbors described in
this paragraph are--
(A) the safe harbor under section 1128A(b)(4)
of such Act (42 U.S.C. 1320a-7a(b)(4)), as
added by subsection (a)(1); and
(B) the safe harbor under section
1128B(b)(3)(J) of such Act (42 U.S.C. 1320a-
7b(b)(3)(J)), as added by subsection (b).
SEC. 302. EXCEPTION TO LIMITATION ON CERTAIN PHYSICIAN REFERRALS (UNDER
STARK) FOR PROVISION OF HEALTH INFORMATION
TECHNOLOGY AND TRAINING SERVICES TO HEALTH CARE
PROFESSIONALS.
(a) In General.--Section 1877(b) of the Social Security Act
(42 U.S.C. 1395nn(b)) is amended by adding at the end the
following new paragraph:
``(6) Information technology and training services.--
``(A) In general.--Any nonmonetary
remuneration (in the form of health information
technology or related installation,
maintenance, support or training services) made
by a specified entity to a physician if--
``(i) the provision of such
remuneration is without an agreement
between the parties or legal condition
that--
``(I) limits or restricts the
use of the health information
technology to services provided
by the physician to individuals
receiving services at the
specified entity;
``(II) limits or restricts
the use of the health
information technology in
conjunction with other health
information technology; or
``(III) conditions the
provision of such remuneration
on the referral of patients or
business to the specified
entity;
``(ii) such remuneration is arranged
for in a written agreement that is
signed by the parties involved (or
their representatives) and that
specifies the remuneration made and
states that the provision of such
remuneration is made for the primary
purpose of better coordination of care
or improvement of health quality,
efficiency, or research; and
``(iii) the specified entity (or a
representative of such entity) has not
taken any action to disable any basic
feature of any hardware or software
component of such remuneration that
would permit interoperability.
``(B) Health information technology
defined.--For purposes of this paragraph, the
term `health information technology' means
hardware, software, license, right,
intellectual property, equipment, or other
information technology (including new versions,
upgrades, and connectivity) designed or
provided primarily for the electronic creation,
maintenance, or exchange of health information
to better coordinate care or improve health
care quality, efficiency, or research.
``(C) Specified entity defined.--For purposes
of this paragraph, the term `specified
entity'--
``(i) means an entity that is a
hospital, group practice, prescription
drug plan sponsor, a Medicare Advantage
organization, or any other such entity
specified by the Secretary, considering
the goals and objectives of this
section, as well as the goals to better
coordinate the delivery of health care
and to promote the adoption and use of
health information technology; and
``(ii) includes, effective October 1,
2011, any entity.''.
(b) Effective Date; Effect on State Laws.--
(1) Effective date.--The amendment made by subsection
(a) shall take effect on the date that is 120 days
after the date of the enactment of this Act.
(2) Preemption of state laws.--No State (as defined
in section 1101(a) of the Social Security Act (42
U.S.C. 1301(a)) for purposes of title XI of such Act)
shall have in effect a State law that imposes a
criminal or civil penalty for a transaction described
in section 1877(b)(6) of such Act, as added by
subsection (a), if the conditions described in such
section, with respect to such transaction, are met.
(c) Study and Report to Assess Effect of Exception on Health
System.--
(1) In general.--The Secretary of Health and Human
Services shall conduct a study to determine the impact
of the exception under section 1877(b)(6) of such Act
(42 U.S.C. 1395nn(b)(6)), as added by subsection (a).
In particular, the study shall examine the following:
(A) The effectiveness of the exception in
increasing the adoption of health information
technology.
(B) The types of health information
technology provided under the exception.
(C) The extent to which the financial or
other business relationships between providers
under the exception have changed as a result of
the exception in a way that adversely affects
or benefits the health care system or choices
available to consumers.
(D) The impact of the adoption of health
information technology on health care quality,
cost, and access under the exception.
(2) Report.--Not later than three years after the
effective date described in subsection (b)(1), the
Secretary of Health and Human Services shall submit to
Congress a report on the study under paragraph (1).
SEC. 303. RULES OF CONSTRUCTION REGARDING USE OF CONSORTIA.
(a) Application to Safe Harbor From Criminal Penalties.--
Section 1128B(b)(3) of the Social Security Act (42 U.S.C.
1320a-7b(b)(3)) is amended by adding after and below
subparagraph (J), as added by section 301(b)(1), the
following:``For purposes of subparagraph (J), nothing in such
subparagraph shall be construed as preventing a specified
entity, consistent with the specific requirements of such
subparagraph, from forming a consortium composed of health care
providers, payers, employers, and other interested entities to
collectively purchase and donate health information technology,
or from offering health care providers a choice of health
information technology products in order to take into account
the varying needs of such providers receiving such products.''.
(b) Application to Stark Exception.--Paragraph (6) of section
1877(b) of the Social Security Act (42 U.S.C. 1395nn(b)), as
added by section 302(a), is amended by adding at the end the
following new subparagraph:
``(D) Rule of construction.--For purposes of
subparagraph (A), nothing in such subparagraph
shall be construed as preventing a specified
entity, consistent with the specific
requirements of such subparagraph, from--
``(i) forming a consortium composed
of health care providers, payers,
employers, and other interested
entities to collectively purchase and
donate health information technology;
or
``(ii) offering health care providers
a choice of health information
technology products in order to take
into account the varying needs of such
providers receiving such products.''.
TITLE IV--ADDITIONAL PROVISIONS
SEC. 401. PROMOTION OF TELEHEALTH SERVICES.
(a) Facilitating the Provision of Telehealth Services Across
State Lines.--The Secretary of Health and Human Services shall,
in coordination with physicians, health care practitioners,
patient advocates, and representatives of States, encourage and
facilitate the adoption of State reciprocity agreements for
practitioner licensure in order to expedite the provision
across State lines of telehealth services.
(b) Report.--Not later than 18 months after the date of the
enactment of this Act, the Secretary of Health and Human
Services shall submit to Congress a report on the actions taken
to carry out subsection (a).
(c) State Defined.--For purposes of this subsection, the term
``State'' has the meaning given that term for purposes of title
XVIII of the Social Security Act.
SEC. 402. STUDY AND REPORT ON EXPANSION OF HOME HEALTH-RELATED
TELEHEALTH SERVICES.
(a) Study.--The Secretary of Health and Human Services shall
conduct a study to determine the feasibility, advisability, and
the costs of--
(1) including coverage and payment for home health-
related telehealth services as part of home health
services under title XVIII of the Social Security Act;
and
(2) expanding the list of sites described in
paragraph (4)(C)(ii) of section 1834(m) of the Social
Security Act (42 U.S.C. 1395m(m)) to include county
mental health clinics or other publicly funded mental
health facilities for the purpose of payment under such
section for the provision of telehealth services at
such clinics or facilities.
(b) Specifics of Study.--Such study shall demonstrate whether
the changes described in paragraphs (1) and (2) of subsection
(a) will result in the following:
(1) Enhanced health outcomes for individuals with one
or more chronic conditions.
(2) Health outcomes for individuals furnished
telehealth services or home health-related telehealth
services that are at least comparable to the health
outcomes for individuals furnished similar items and
services by a health care provider at the same location
of the individual or at the home of the individual,
respectively.
(3) Facilitation of communication of more accurate
clinical information between health care providers.
(4) Closer monitoring of individuals by health care
providers.
(5) Overall reduction in expenditures for health care
items and services.
(6) Improved access to health care.
(c) Home Health-Related Telehealth Services Defined.--For
purposes of this section, the term ``home health-related
telehealth services'' means technology-based professional
consultations, patient monitoring, patient training services,
clinical observation, patient assessment, and any other health
services that utilize telecommunications technologies. Such
term does not include a telecommunication that consists solely
of a telephone audio conversation, facsimile, electronic text
mail, or consultation between two health care providers.
(d) Report.--Not later than 18 months after the date of the
enactment of this Act, the Secretary of Health and Human
Services shall submit to Congress a report on the study
conducted under subsection (a) and shall include in such report
such recommendations for legislation or administration action
as the Secretary determines appropriate.
SEC. 403. STUDY AND REPORT ON STORE AND FORWARD TECHNOLOGY FOR
TELEHEALTH.
(a) Study.--The Secretary of Health and Human Services,
acting through the Director of the Office for the Advancement
of Telehealth, shall conduct a study on the use of store and
forward technologies (that provide for the asynchronous
transmission of health care information in single or multimedia
formats) in the provision of telehealth services. Such study
shall include an assessment of the feasibility, advisability,
and the costs of expanding the use of such technologies for use
in the diagnosis and treatment of certain conditions.
(b) Report.--Not later than 18 months after the date of the
enactment of this Act, the Secretary of Health and Human
Services shall submit to Congress a report on the study
conducted under subsection (a) and shall include in such report
such recommendations for legislation or administration action
as the Secretary determines appropriate.
SEC. 404. METHODOLOGY FOR REPORTING UNIFORM PRICE DATA FOR INPATIENT
AND OUTPATIENT HOSPITAL SERVICES.
(a) In General.--The Secretary of Health and Human Services
shall develop a method for the reporting of uniform price data
for inpatient and outpatient hospital services. Such method
shall provide for the reporting by each hospital of such data
for selected procedures or services based on a range of charges
and a range of prices actually paid for inpatient and
outpatient hospital services grouped by type of payer, with
each of the following treated as a separate type of payer: the
Medicare program, the Medicaid program, other public health
insurance coverage (including public group health plan
coverage), private health insurance coverage (including private
group health plan coverage), other insurance coverage, and
self-pay.
(b) GAO Study and Report.--
(1) Study.--The Comptroller General of the United
States shall conduct a study to assess the structure
and methodology for permanent uniform reporting of
price data for health care services.
(2) Report.--Not later than January 1, 2008, the
Comptroller General shall submit to Congress a report
on the study under paragraph (1). Such report shall
include the following:
(A) Recommendations on a structure and
methodology, for timely reporting of charges
and prices actually paid for health care
services, that minimize administrative
requirements for providers and maximize
efficient reporting utilizing health
information technology.
(B) Options for facilitating public
disclosure of such information in a manner
accessible and useful to consumers.
(C) Review of the strengths and weaknesses of
the reporting requirements imposed beginning
with fiscal year 2008 under section 405.
SEC. 405. INCLUSION OF UNIFORM PRICE DATA.
Data required to be submitted pursuant to section
1886(b)(3)(B)(viii) of the Social Security Act (42 U.S.C.
1395ww(b)(3)(B)(viii)) shall include, effective with fiscal
year 2008, the data described in section 404(a), with respect
to inpatient hospital services, submitted in accordance with
the method developed under such section, as well as the
aggregate volume of selected procedures or services for which
the data are reported.
SEC. 406. ENSURING HEALTH CARE PROVIDERS PARTICIPATING IN PHSA
PROGRAMS, MEDICAID, SCHIP, OR THE MCH PROGRAM MAY
MAINTAIN HEALTH INFORMATION IN ELECTRONIC FORM.
Part D of title II of the Public Health Service Act, as added
by section 101(a) and amended by sections 103 and 105, is
further amended by adding at the end the following new section:
``SEC. 274. ENSURING HEALTH CARE PROVIDERS MAY MAINTAIN HEALTH
INFORMATION IN ELECTRONIC FORM.
``(a) In General.--Any health care provider that participates
in a health care program that receives Federal funds under this
Act, or under title V, XIX, or XXI of the Social Security Act,
shall be deemed as meeting any requirement for the maintenance
of data in paper form under such program (whether or not for
purposes of management, billing, reporting, reimbursement, or
otherwise) if the required data is maintained in an electronic
form.
``(b) Relation to State Laws.--Beginning on the date that is
one year after the date of the enactment of this section,
subsection (a) shall supersede any contrary provision of State
law.
``(c) Construction.--Nothing in this section shall be
construed as--
``(1) requiring health care providers to maintain or
submit data in electronic form;
``(2) preventing a State from permitting health care
providers to maintain or submit data in paper form; or
``(3) preventing a State from requiring health care
providers to maintain or submit data in electronic
form.''.
SEC. 407. ENSURING HEALTH CARE PROVIDERS PARTICIPATING IN THE MEDICARE
PROGRAM MAY MAINTAIN HEALTH INFORMATION IN
ELECTRONIC FORM.
Section 1871 of the Social Security Act (42 U.S.C. 1395hh) is
amended by adding at the end the following new subsection:
``(g)(1) Any provider of services or supplier shall be deemed
as meeting any requirement for the maintenance of data in paper
form under this title (whether or not for purposes of
management, billing, reporting, reimbursement, or otherwise) if
the required data is maintained in an electronic form.
``(2) Nothing in this subsection shall be construed as
requiring health care providers to maintain or submit data in
electronic form.''.
SEC. 408. STUDY AND REPORT ON STATE, REGIONAL, AND COMMUNITY HEALTH
INFORMATION EXCHANGES.
(a) Study.--The Secretary of Health and Human Services shall
conduct a study on issues related to the development,
operation, and implementation of State, regional, and community
health information exchanges. Such study shall include the
following, with respect to such health information exchanges:
(1) Profiles detailing the current stages of such
health information exchanges with respect to the
progression of the development, operation,
implementation, organization, and governance of such
exchanges.
(2) The impact of such exchanges on healthcare
quality, safety, and efficiency, including--
(A) any impact on the coordination of health
information and services across healthcare
providers and other organizations relevant to
health care;
(B) any impact on the availability of health
information at the point-of-care to make timely
medical decisions;
(C) any benefits with respect to the
promotion of wellness, disease prevention, and
chronic disease management;
(D) any improvement with respect to public
health preparedness and response;
(E) any impact on the widespread adoption of
interoperable health information technology,
including electronic health records;
(F) any contributions to achieving an
Internet-based national health information
network;
(G) any contribution of health information
exchanges to consumer access and to consumers'
use of their health information; and
(H) any impact on the operation of--
(i) the Medicaid and Medicare
programs;
(ii) the State Children's Health
Insurance Program (SCHIP);
(iii) disproportionate share
hospitals described in section 1923 of
the Social Security Act;
(iv) Federally-qualified health
centers; or
(v) managed care plans, if a
significant number of the plan's
enrollees are beneficiaries in the
Medicaid program or SCHIP.
(3) Best practice models for financing,
incentivizing, and sustaining such health information
exchanges.
(4) Information identifying the common principles,
policies, tools, and standards used (or proposed) in
the public and private sectors to support the
development, operation, and implementation of such
health information exchanges.
(5) A description of any areas in which Federal
government leadership is needed to support growth and
sustainability of such health information exchanges.
(b) Report.--Not later than one year after the date of
enactment of this Act, the Secretary of Health and Human
Services shall submit to Congress a report on the study
described in subsection (a), including such recommendations as
the Secretary determines appropriate to facilitate the
development, operation, and implementation of health
information exchanges.
Amend the title so as to read: ``A Bill to promote a better
health information system.''.
PART B--TEXT OF THE AMENDMENT IN THE AMENDMENT IN THE NATURE OF A
SUBSTITUTE CONSIDERED AS ADOPTED
In section 1128B of the Social Security Act, amend subsection
(g), as added by section 301(b)(2) of the bill, to read as
follows:
``(g) Specified Entity Defined.--For purposes of subsection
(b)(3)(J), the term `specified entity' means an entity that is
a hospital, group practice, prescription drug plan sponsor, a
Medicare Advantage organization, or any other such entity
specified by the Secretary, considering the goals and
objectives of this section, as well as the goals to better
coordinate the delivery of health care and to promote the
adoption and use of health information technology.''.
In paragraph (6) of section 1877(b) of the Social Security
Act, as added by section 302(a) of the bill, amend subparagraph
(C) to read as follows:
``(C) Specified entity defined.--For purposes
of this paragraph, the term `specified entity'
means an entity that is a hospital, group
practice, prescription drug plan sponsor, a
Medicare Advantage organization, or any other
such entity specified by the Secretary,
considering the goals and objectives of this
section, as well as the goals to better
coordinate the delivery of health care and to
promote the adoption and use of health
information technology.''.
Strike section 404 (relating to methodology for reporting
uniform price data for inpatient and outpatient hospital
services) and section 405 (relating to inclusion of uniform
price data), and redesignate the succeeding sections
accordingly.
PART C--TEXT OF THE AMENDMENTS MADE IN ORDER
1. An Amendment To Be Offered by Representative Hinojosa of Texas, or
His Designee, Debatable for 10 Minutes
In section 271(b)(8) of the Public Health Service Act, as
added by section 101(a) of the Bill, strike ``is consistent''
and insert ``provides for the confidentiality and security of
individually identifiable health information, consistent''.
In section 271(b) of the Public Health Service Act, as added
by section 101(a) of the Bill, strike ``and'' at the end of
paragraph (11), strike the period at the end of paragraph (12)
and insert ``; and'', and add at the end the following new
paragraph:
``(13) improves the availability of information and
resources for individuals with low or limited literacy
or language skills.''.
----------
2. An Amendment To Be Offered by Representative Towns of New York, or
His Designee, Debatable for 10 Minutes
Add at the end of section 101 the following:
(d) Study of Health Information Technology in Medically
Underserved Communities.--
(1) Study.--The National Coordinator for Health
Information Technology shall conduct a study on the
development and implementation of health information
technology in medically underserved communities. The
study shall--
(A) identify barriers to successful
implementation of health information technology
in these communities;
(B) examine the impact of health information
technology on providing quality care and
reducing the cost of care to these communities;
(C) examine urban and rural community health
systems and determine the impact that health
information technology may have on the capacity
of primary health providers; and
(D) assess the feasibility and the costs of
associated with the use of health information
technology in these communities.
(2) Report.--Not later than 18 months after the date
of the enactment of this Act, the National Coordinator
shall submit to Congress a report on the study
conducted under paragraph (1) and shall include in such
report such recommendations for legislation or
administrative action as the Coordinator determines
appropriate.
----------
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3. An Amendment To Be Offered by Representative Jackson of Illinois, or
His Designee, Debatable for 10 Minutes
In section 102, add at the end the following new paragraph:
(5) Recommendations on the inclusion of
emergency contact or next-of-kin information
(including name and phone number) in
interoperable electronic health records.
----------
4. An Amendment To Be Offered by Representative Cuellar of Texas, or
His Designee, Debatable for 10 Minutes
In section 330M(d) of the Public Health Service Act, as added
by section 104 of the Bill, strike ``or'' at the end of
paragraph (1), strike the period at the end of paragraph (2)
and insert ``; or'', and add at the end the following new
paragraph:
``(3) if the project to be funded through such a
grant will emphasize the improvement of access to
medical care and medical care for medically underserved
populations which are geographically isolated or
located in underserved urban areas.''.
----------
5. An Amendment To Be Offered by Representative Price of Georgia, or
His Designee, Debatable for 10 Minutes
Add at the end of title II the following new section:
SEC. 206. REPORT ON APPROPRIATENESS OF CLASSIFICATION METHODOLOGIES AND
CODES FOR ADDITIONAL PURPOSES.
Not later than the date that is 180 days after the date of
the enactment of this Act, the Secretary of Health and Human
Services shall submit to Congress a report that evaluates--
(1) the applicability of health care classification
methodologies and codes for purposes beyond the coding
of services for diagnostic documentation or billing
purposes;
(2) the usefulness, accuracy, and completeness of
such methodologies and codes for such purposes; and
(3) the capacity of such methodologies and codes to
produce erroneous or misleading information, with
respect to such purposes.
----------
6. An Amendment To Be Offered by Representative McMorris of Washington,
or His Designee, Debatable for 10 Minutes
At the end of title IV, insert the following new section:
SEC. 409. PROMOTING HEALTH INFORMATION TECHNOLOGY AS A TOOL FOR CHRONIC
DISEASE MANAGEMENT.
(a) In General.--The Secretary of Health and Human Services
shall establish a two-year project to demonstrate the impact of
health information technology on disease management for
individuals entitled to medical assistance under a State plan
under title XIX of the Social Security Act.
(b) Structure of Project.--The project under subsection (a)
shall--
(1) create a web-based virtual case management tool
that provides access to best practices for managing
chronic disease; and
(2) provide chronic disease patients and caregivers
access to their own medical records and to a single
source of information on chronic disease.
(c) Competition.--Not later than the date that is 90 days
after the date of the enactment of this Act, the Secretary of
Health and Human Services shall seek proposals from States to
carry out the project under subsection (a). The Secretary shall
select not less than four of such proposals submitted, and at
least one proposal selected shall include a regional approach
that features access to an integrated hospital information
system in at least two adjoining States and that permits the
measurement of health outcomes.
(d) Report.--Not later than the date that is 90 days after
the last day of the project under subsection (a), the Secretary
of Health and Human Services shall submit to Congress a report
on such project and shall include in such report the amount of
any cost-savings resulting from the project and such
recommendations for legislation or administrative action as the
Secretary determines appropriate.