Better Healthcare Through Information Technology Act - Amends the Public Health Service Act to establish the Office of the National Coordinator of Health Information Technology to develop a nationwide interoperable health information technology infrastructure.
Requires the Secretary of Health and Human Services to establish the public-private American Health Information Collaborative to recommend to the President uniform policies to support the widespread adoption of health information technology and modifications to standards for the electronic exchange of health information. Requires the President to review and, if appropriate, provide for the adoption of such standards.
Prohibits any federal agency from expending federal funds to purchase hardware, software, or support services that are inconsistent with adopted standards. Requires all federal agencies collecting health data to comply with the adopted standards.
Requires the Secretary to develop criteria to: (1) ensure uniform and consistent implementation of any standards voluntarily adopted by private entities; and (2) ensure and certify hardware, software, and support services compliance with adopted standards.
Allows the Secretary to award grants to: (1) facilitate the purchase and enhance the utilization of qualified health information technology systems; and (2) carry out demonstration projects to develop academic programs integrating qualified health information technology systems in the clinical education of health professionals.
Requires the Secretary to: (1) develop quality measurement systems for the purposes of measuring the quality of care patients receive; and (2) study methods to create efficient reimbursement incentives for improving health care quality.
Requires the Secretary, acting through the Director of the Agency for Healthcare Quality and Research (AHRQ), to develop a Center for Best Practices for the effective use health information technology.
Allows the Director of AHRQ to establish a demonstration program to award grants or contracts to support health information network planning, implementation, and evaluation activities.
Amends the Social Security Act to allow physicians to receive financial support regarding the electronic exchange of health information.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 1355 Introduced in Senate (IS)]
109th CONGRESS
1st Session
S. 1355
To enhance the adoption of health information technology and to improve
the quality and reduce the costs of healthcare in the United States.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
June 30, 2005
Mr. Enzi (for himself, Mr. Kennedy, Mr. Grassley, Mr. Baucus, Mr. Dodd,
Mr. Alexander, Mr. Harkin, Mr. Isakson, Ms. Mikulski, Mr. DeWine, Mr.
Jeffords, Mr. Hatch, Mrs. Murray, Mr. Reed, Mr. Allen, Mr. Burns, Mr.
Crapo, Mr. DeMint, Mr. Santorum, Mr. Thomas, and Ms. Cantwell)
introduced the following bill; which was read twice and referred to the
Committee on Health, Education, Labor, and Pensions
_______________________________________________________________________
A BILL
To enhance the adoption of health information technology and to improve
the quality and reduce the costs of healthcare 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 ``Better Healthcare Through
Information Technology Act''.
SEC. 2. IMPROVING HEALTHCARE, 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 XXIX--HEALTH INFORMATION TECHNOLOGY
``SEC. 2901. PURPOSES.
``It is the purpose of this title to improve the quality, safety,
and efficiency of healthcare by--
``(1) protecting the privacy and security of health
information;
``(2) fostering the widespread adoption of health
information technology;
``(3) establishing the public-private American Health
Information Collaborative to identify uniform national data
standards (including content, communication, and security) and
implementation policies for the widespread adoption of health
information technology;
``(4) establishing health information network demonstration
programs;
``(5) awarding competitive grants to facilitate the
purchase and enhance the utilization of qualified health
information technology; and
``(6) awarding competitive grants to States for the
development of State loan programs to facilitate the widespread
adoption of health information technology.
``SEC. 2902. DEFINITIONS.
``In this title:
``(1) Collaborative.--The term `Collaborative' means the
public-private American Health Information Collaborative
established under section 2904.
``(2) Healthcare provider.--The term `healthcare provider'
means a hospital, skilled nursing facility, home health entity,
healthcare clinic, community health center, group practice (as
defined in section 1877(h)(4) of the Social Security Act), a
pharmacist, a pharmacy, a laboratory, a physician (as defined
in section 1861(r) 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'
means any information, whether oral or recorded in any form or
medium, that--
``(A) is created or received by a health care
provider, health plan, public health authority,
employer, life insurer, school or university, or health
care clearinghouse; and
``(B) relates to the past, present, or future
physical or mental health or condition of an
individual, the provision of health care to an
individual, or the past, present, or future payment for
the provision of health care to an individual.
``(4) Health information network.--The term `health
information network' means an organization of health care
providers and other entities established for the purpose of
linking health information systems to enable the electronic
sharing of health information.
``(5) Health insurance issuer.--The term `health insurance
issuer' has the meaning given that term in section 2791.
``(6) Laboratory.--The term `laboratory' has the meaning
given that term in section 353.
``(7) Pharmacist.--The term `pharmacist' has the meaning
given that term in section 804 of the Federal Food, Drug, and
Cosmetic Act.
``(8) Qualified health information technology.--The term
`qualified health information technology' means a computerized
system (including hardware, software, and training) that--
``(A) protects the privacy and security of health
information and properly encrypts such health
information;
``(B) maintains and provides permitted access to
patients' health records in an electronic format;
``(C) incorporates decision support software to
reduce medical errors and enhance healthcare quality;
``(D) is consistent with the standards recommended
by the collaborative; and
``(E) allows for the reporting of quality measures.
``(9) 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.
``SEC. 2903. OFFICE OF THE NATIONAL COORDINATOR OF HEALTH INFORMATION
TECHNOLOGY.
``(a) Office of National Health Information Technology.--There is
established within the Office of the Secretary an Office of the
National Coordinator of Health Information Technology (referred to in
this section as the `Office'). The Office shall be headed by a National
Coordinator who shall be appointed by the Secretary and shall report
directly to the Secretary.
``(b) Purpose.--It shall be the purpose of the Office to carry out
programs and activities to develop a nationwide interoperable health
information technology infrastructure that--
``(1) ensures that patients' health information is secure
and protected;
``(2) improves healthcare quality, reduces medical errors,
and advances the delivery of patient-centered medical care;
``(3) reduces healthcare costs resulting from inefficiency,
medical errors, inappropriate care, and incomplete information;
``(4) ensures that appropriate information to help guide
medical decisions is available at the time and place of care;
``(5) promotes a more effective marketplace, greater
competition, and increased choice through the wider
availability of accurate information on healthcare costs,
quality, and outcomes;
``(6) improves the coordination of care and information
among hospitals, laboratories, physician offices, and other
entities through an effective infrastructure for the secure and
authorized exchange of healthcare information;
``(7) improves public health reporting and facilitates the
early identification and rapid response to public health
threats and emergencies, including bioterror events and
infectious disease outbreaks;
``(8) facilitates health research; and
``(9) promotes prevention of chronic diseases.
``(c) Duties of the National Coordinator.--The National Coordinator
shall--
``(1) serve as a member of the public-private American
Health Information Collaboration established under section
2904;
``(2) serve as the principal advisor to the Secretary
concerning the development, application, and use of health
information technology;
``(3) facilitate the adoption of a national system for the
electronic exchange of health information;
``(4) facilitate the adoption and implementation of
standards for the electronic exchange of health information to
reduce cost and improve healthcare quality; and
``(5) submit the reports described under section 2904(h).
``(d) Detail of Federal Employees.--
``(1) In general.--Upon the request of the National
Coordinator, the head of any Federal agency is authorized to
detail, with or without reimbursement from the Office, any of
the personnel of such agency to the Office to assist it in
carrying out its duties under this section.
``(2) Effect of detail.--Any detail of personnel under
paragraph (1) shall--
``(A) not interrupt or otherwise affect the civil
service status or privileges of the Federal employee;
and
``(B) be in addition to any other staff of the
Department employed by the National Coordinator.
``(3) Acceptance of detailees.--Notwithstanding any other
provision of law, the Office may accept detailed personnel from
other Federal agencies without regard to whether the agency
described under paragraph (1) is reimbursed.
``(e) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary to carry out the activities
of the Office under this section for each of fiscal years 2006 through
2010.
``SEC. 2904. AMERICAN HEALTH INFORMATION COLLABORATIVE.
``(a) Establishment.--Not later than 60 days after the date of
enactment of this title, and subject to the provisions of this title,
the Secretary shall establish the public-private American Health
Information Collaborative (referred to in this section as the
`Collaborative').
``(b) Composition.--The Collaborative shall be composed of--
``(1) the Secretary, who shall serve as the chairperson of
the Collaborative;
``(2) the Secretary of Defense, or his or her designee;
``(3) the Secretary of Veterans Affairs, or his or her
designee;
``(4) the National Coordinator for Health Information
Technology;
``(5) the Director of the National Institute of Standards
and Technology; and
``(6) one voting member from each of the following
categories to be appointed by the Secretary from nominations
submitted by the public:
``(A) Patient advocates.
``(B) Physicians.
``(C) Hospitals.
``(D) Pharmacists.
``(E) Health insurance plans.
``(F) Standards development organizations.
``(G) Technology vendors.
``(H) Public health entities.
``(I) Clinical research and academic entities.
``(J) Employers.
``(K) An Indian tribe or tribal organization.
``(L) State and local government agencies.
``(c) Recommendations and Policies.--The Collaborative shall make
recommendations to identify uniform national policies to the Federal
Government and private entities to support the widespread adoption of
health information technology, including--
``(1) protecting the privacy and security of personal
health information;
``(2) measures to prevent unauthorized access to health
information;
``(3) measures to ensure accurate patient identification;
``(4) methods to facilitate secure patient access to health
information;
``(5) recommendations for a nationwide architecture that
achieves interoperability of health information technology
systems; and
``(6) other policies determined to be necessary by the
Collaborative.
``(d) Standards.--
``(1) In general.--The Collaborative shall, on an ongoing
basis--
``(A) review existing standards (including content,
communication, and security standards) for the
electronic exchange of health information, including
such standards adopted by the Secretary under paragraph
(2)(A);
``(B) identify deficiencies and omissions in such
existing standards; and
``(C) identify duplications and omissions in such
existing standards;
and recommend modifications to such standards as necessary.
``(2) Recommendations.--The Collaborative shall recommend
to the President the adoption by the Federal Government of--
``(A) the standards adopted by the Consolidated
Health Informatics Initiative as of the date of
enactment of this title; and
``(B) on an ongoing basis as appropriate, any
additional standards or modifications recommended
pursuant to the review described in paragraph (1).
``(3) Limitation.--The standards described in this section
shall not include any standards developed pursuant to the
Health Insurance Portability and Accountability Act of 1996.
``(e) Action by the President.--Upon receipt of a recommendation
from the Collaborative under subsection (d)(2), the President shall
review and if appropriate, provide for the adoption by the Federal
Government of such recommended standards.
``(f) Coordination of Federal Spending.--Not later than 1 year
after the adoption by the Federal Government of a recommendation as
provided for in subsection (e), and in compliance with chapter 113 of
title 40, United States Code, no Federal agency shall expend Federal
funds for the purchase of hardware, software, or support services for
the electronic exchange of health information that is not consistent
with applicable standards adopted by the Federal Government under
subsection (e).
``(g) Coordination of Federal Data Collection.--Not later than 2
years after the adoption by the Federal Government of a recommendation
as provided for in subsection (e), all Federal agencies collecting
health data for the purposes of surveillance, epidemiology, adverse
event reporting, or research shall comply with standards adopted under
subsection (e).
``(h) Voluntary Adoption.--Any standards adopted by the Federal
Government under subsection (e) shall be voluntary with respect to
private entities.
``(i) Reports.--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, on an annual basis,
a report that--
``(1) describes the specific actions that have been taken
to facilitate the adoption of a nationwide system for the
electronic exchange of health information;
``(2) describes barriers to the adoption of such a
nationwide system; and
``(3) contains recommendations to achieve full
implementation of such a nationwide system.
``(j) Application of FACA.--The Federal Advisory Committee Act (5
U.S.C. App.) shall apply to the Collaborative, except that the term
provided for under section 14(a)(2) shall be 5 years.
``(k) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary to carry out this section
for each of fiscal years 2006 through 2010.
``SEC. 2905. IMPLEMENTATION AND CERTIFICATION OF HEALTH INFORMATION
STANDARDS.
``(a) Implementation.--
``(1) In general.--The Secretary, based upon the
recommendations of the Collaborative, shall develop criteria to
ensure uniform and consistent implementation of any standards
for the electronic exchange of health information voluntarily
adopted by private entities in technical conformance with such
standards adopted under this title.
``(2) Implementation assistance.--The Secretary may
recognize a private entity or entities to assist private
entities in the implementation of the standards adopted under
this title.
``(b) Certification.--
``(1) In general.--The Secretary, based upon the
recommendations of the Collaborative, shall develop criteria to
ensure and certify that hardware, software, and support
services that claim to be in compliance with any standard for
the electronic exchange of health information adopted under
this title have established and maintained such compliance in
technical conformance with such standards.
``(2) Certification assistance.--The Secretary may
recognize a private entity or entities to assist in the
certification described under paragraph (1).
``SEC. 2906. COMPETITIVE GRANTS TO FACILITATE THE WIDESPREAD ADOPTION
OF HEALTH INFORMATION TECHNOLOGY.
``(a) 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 healthcare.
``(b) Eligibility.--To be eligible to receive a grant under
subsection (a) an entity shall--
``(1) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require;
``(2) submit to the Secretary a strategic plan for the
implementation of data sharing and interoperability measures;
``(3) be a--
``(A) not for profit hospital;
``(B) group practice (including a single
physician); or
``(C) another healthcare provider not described in
subparagraph (A) or (B);
``(4) adopt the standards adopted by the Federal Government
under section 2904;
``(5) submit to the Secretary a report on the degree to
which such entity has achieved the measures adopted under
section 2909;
``(6) demonstrate significant financial need; and
``(7) provide matching funds in accordance with subsection
(d).
``(c) Use of Funds.--Amounts received under a grant under this
section shall be used to facilitate the purchase and enhance the
utilization of qualified health information technology systems.
``(d) Matching Requirement.--To be eligible for a grant under this
section 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.
``(e) Preference in Awarding Grants.--In awarding grants under this
section the Secretary shall give preference to--
``(1) eligible entities that are located in rural,
frontier, and other underserved areas as determined by the
Secretary;
``(2) eligible entities that will use grant funds to
enhance secure data sharing across various health care settings
or enhance interoperability with regional or national health
information networks; and
``(3) with respect to an entity described in subsection
(b)(3)(C), a not for profit healthcare provider.
``(f) Authorization of Appropriations.--There are authorized to be
appropriated to carry out this section, $25,000,000 for fiscal year
2006, $75,000,000 for fiscal year 2007, and such sums as may be
necessary for each of fiscal years 2008 through 2010.
``SEC. 2907. COMPETITIVE GRANTS TO STATES FOR THE DEVELOPMENT OF STATE
LOAN PROGRAMS TO FACILITATE THE WIDESPREAD ADOPTION OF
HEALTH INFORMATION TECHNOLOGY.
``(a) In General.--The Secretary may award competitive grants to
States for the establishment of State programs for loans to healthcare
providers to facilitate the purchase and enhance the utilization of
qualified health information technology.
``(b) Establishment of Fund.--To be eligible to receive a
competitive grant under this section, a State shall establish a
qualified health information technology loan fund (referred to in this
section as a `State loan fund') and comply with the other requirements
contained in this section. A grant to a State under this section 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 State loan
fund.
``(c) Eligibility.--To be eligible to receive a grant under
subsection (a) a State shall--
``(1) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require;
``(2) submit to the Secretary a strategic plan in
accordance with subsection (d);
``(3) establish a qualified health information technology
loan fund in accordance with subsection (b);
``(4) require that healthcare providers receiving such
loans consult with the Center for Best Practices 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;
``(5) require that healthcare providers receiving such
loans adopt the standards adopted by the Federal Government
under section 2904(d);
``(6) submit to the Secretary a report on the degree to
which the State has achieved the measures under section 2909;
and
``(7) provide matching funds in accordance with subsection
(h).
``(d) Strategic Plan.--
``(1) In general.--A State that receives a grant under this
section shall annually prepare a strategic plan that identifies
the intended uses of amounts available to the State loan fund
of the State.
``(2) Contents.--A strategic plan under paragraph (1) shall
include--
``(A) 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;
``(B) a description of the criteria and methods
established for the distribution of funds from the
State loan fund; and
``(C) a description of the financial status of the
State loan fund and the short-term and long-term goals
of the State loan fund.
``(e) Use of Funds.--
``(1) 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 subsection (a). Loans under this section may
be used by a healthcare provider to facilitate the purchase and
enhance the utilization of qualified health information
technology.
``(2) Limitation.--Amounts received by a State under this
section may not be used--
``(A) for the purchase or other acquisition of any
health information technology system that is not a
qualified health information technology system;
``(B) to conduct activities for which Federal funds
are expended under this title, or the amendments made
by the Better Healthcare Through Information Technology
Act; or
``(C) for any purpose other than making loans to
eligible entities under this section.
``(f) Types of Assistance.--Except as otherwise limited by
applicable State law, amounts deposited into a State loan fund under
this section may only be used for the following:
``(1) To award loans that comply with the following:
``(A) The interest rate for each loan shall be less
than or equal to the market interest rate.
``(B) The principal and interest payments on each
loan shall commence not later than 1 year after the
loan was awarded, and each loan shall be fully
amortized not later than 10 years after the date of the
loan.
``(C) The State loan fund shall be credited with
all payments of principal and interest on each loan
awarded from the fund.
``(2) To guarantee, or purchase insurance for, a local
obligation (all of the proceeds of which finance a project
eligible for assistance under this section) if the guarantee or
purchase would improve credit market access or reduce the
interest rate applicable to the obligation involved.
``(3) 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.
``(4) To earn interest on the amounts deposited into the
State loan fund.
``(g) Administration of State Loan Funds.--
``(1) 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
section with the financial administration of any other
revolving fund established by the State if otherwise not
prohibited by the law under which the State loan fund was
established.
``(2) 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 section to pay the reasonable costs of
the administration of the programs under this section,
including the recovery of reasonable costs expended to
establish a State loan fund which are incurred after the date
of enactment of this title.
``(3) Guidance and regulations.--The Secretary shall
publish guidance and promulgate regulations as may be necessary
to carry out the provisions of this section, including--
``(A) provisions to ensure that each State commits
and expends funds allotted to the State under this
section as efficiently as possible in accordance with
this title and applicable State laws; and
``(B) guidance to prevent waste, fraud, and abuse.
``(4) Private sector contributions.--
``(A) In general.--A State loan fund established
under this section may accept contributions from
private sector entities, except that such entities may
not specify the recipient or recipients of any loan
issued under this section.
``(B) Availability of information.--A State shall
make publically available the identity of, and amount
contributed by, any private sector entity under
subparagraph (A) and may issue letters of commendation
or make other awards (that have no financial value) to
any such entity.
``(5) Reservation of amounts.--A State may reserve not to
exceed 40 percent of amounts in the State loan fund to issue
loans to recipients who serve medically underserved areas.
``(h) Matching Requirements.--
``(1) In general.--The Secretary may not make a grant under
subsection (a) 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.
``(2) Determination of amount of non-federal
contribution.--In determining the amount of non-Federal
contributions that a State has provided pursuant to paragraph
(1), the Secretary may not include any amounts provided to the
State by the Federal Government.
``(i) Preference in Awarding Grants.--The Secretary may give a
preference in awarding grants under this section to States that adopt
value-based purchasing programs to improve healthcare quality.
``(j) 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 section.
``(k) Authorization of Appropriations.--
``(1) In general.--For the purpose of making grants under
subsection (a), there is authorized to be appropriated
$50,000,000 for fiscal year 2006, $100,000,000 for fiscal year
2007, and such sums as may be necessary for each of fiscal
years 2008 through 2010.
``(l) Availability.--Amounts appropriated under paragraph (1) shall
remain available through fiscal year 2010.
``SEC. 2908. DEMONSTRATION PROGRAM TO INTEGRATE INFORMATION TECHNOLOGY
INTO CLINICAL EDUCATION.
``(a) In General.--The Secretary may award grants under this
section to carry out demonstration projects to develop academic
programs integrating qualified health information technology systems in
the clinical education of health professionals. 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 shall--
``(1) submit to the Secretary an application at such time,
in such manner, and containing such information as the
Secretary may require;
``(2) submit to the Secretary a strategic plan for
integrating qualified health information technology in the
clinical education of health professionals and for ensuring the
consistent utilization of decision support software to reduce
medical errors and enhance healthcare quality;
``(3) be--
``(A) a health professions school; or
``(B) an academic health center;
``(4) 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, the efficiency
of health care delivery, and in increasing the likelihood that
graduates of the grantee will adopt and incorporate health
information technology in the delivery of health care services;
and
``(5) provide matching funds in accordance with subsection
(c).
``(c) Matching Funds.--
``(1) In general.--The Secretary may award a grant to an
entity under this section only if the entity 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.
``(d) Preference in Awarding Grants.--In awarding grants under
subsection (a), the Secretary shall give preference to applicants
that--
``(1) will use grant funds in collaboration with 2 or more
disciplines; and
``(2) will use grant funds to integrate qualified health
information technology into community-based clinical education
experiences.
``(e) Evaluation.--The Secretary shall take such action as may be
necessary to evaluate the projects funded under this section and
publish, make available, and disseminate the results of such
evaluations on as wide a basis as is practicable.
``(f) Reports.--Not later than 1 year after the date of enactment
of this title, and annually thereafter, the Secretary shall submit to
the Committee on Health, Education, Labor, and Pensions and the
Committee on Finance of the Senate, and the Committee on Energy and
Commerce and the Committee on Ways and Means of the House of
Representatives a report that--
``(1) describes the specific projects established under
this section; and
``(2) contains recommendations for Congress based on the
evaluation conducted under subsection (e).
``(g) Limitation.--Not more than 10 percent of amounts received
under a grant awarded under this section may be used for administrative
expenses.
``(h) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, such sums as may be necessary
for fiscal year 2006, $5,000,000 for fiscal year 2007, and such sums as
may be necessary for each of fiscal years 2008 through 2010.
``(i) Sunset.--This section shall not apply after September 30,
2008.
``SEC. 2909. QUALITY MEASUREMENT SYSTEMS.
``(a) In General.--The Secretary shall develop quality measurement
systems for the purposes of measuring the quality of care patients
receive.
``(b) Requirements.--The Secretary shall ensure that the quality
measurement systems developed under subsection (a) comply with the
following:
``(1) Measures.--
``(A) In general.--Subject to subparagraph (B), the
Secretary shall select measures of quality to be used
by the Secretary under the systems.
``(B) Requirements.--In selecting the measures to
be used under each system pursuant to subparagraph (A),
the Secretary shall, to the extent feasible, ensure
that--
``(i) such measures are evidence based,
reliable and valid, and feasible to collect and
report;
``(ii) such measures include measures of
process, structure, beneficiary experience,
efficiency, and equity;
``(iii) such measures include measures of
overuse, underuse, and misuse of healthcare
items and services; and
``(iv) such measures include--
``(I) with respect to the initial
year in which such measures are used,
one or more elements of a qualified
health information technology system as
defined in section 2901; and
``(II) with respect to subsequent
years, additional elements of qualified
health information technology systems
as defined in section 2901.
``(2) Weights of measures.--The Secretary shall assign
weights to the measures used by the Secretary under each system
established under subsection (a).
``(3) Maintenance.--The Secretary shall, as determined
appropriate, but in no case more often than once during each
12-month period, update the quality measurement systems
developed under subsection (a), including through--
``(A) the addition of more accurate and precise
measures under the systems and the retirement of
existing outdated measures under the systems; and
``(B) the refinement of the weights assigned to
measures under the systems.
``(c) Required Considerations in Developing and Updating the
Systems.--In developing and updating the quality measurement systems
under this section, the Secretary shall--
``(1) consult with, and take into account the
recommendations of, the entity that the Secretary has an
arrangement with under subsection (e);
``(2) consult with provider-based groups and clinical
specialty societies; and
``(3) take into account--
``(A) the demonstrations required under this Act;
``(B) the demonstration program under section 1866A
of the Social Security Act;
``(C) the demonstration program under section 1866C
of such Act;
``(D) any other demonstration or pilot program
conducted by the Secretary relating to measuring and
rewarding quality and efficiency of care; and
``(E) the report by the Institute of Medicine of
the National Academy of Sciences under section 238(b)
of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003.
``(d) Required Considerations in Implementing the Systems.--In
implementing the quality measurement systems under this section, the
Secretary shall take into account the recommendations of public-private
entities--
``(1) that are established to examine issues of data
collection and reporting, including the feasibility of
collecting and reporting data on measures; and
``(2) that involve representatives of health care
providers, consumers, employers, and other individuals and
groups that are interested in quality of care.
``(e) Arrangement With an Entity to Provide Advice and
Recommendations.--
``(1) Arrangement.--On and after July 1, 2006, the
Secretary shall have in place an arrangement with an entity
that meets the requirements described in paragraph (2) under
which such entity provides the Secretary with advice on, and
recommendations with respect to, the development and updating
of the quality measurement systems under this section,
including the assigning of weights to the measures under
subsection (b)(2).
``(2) Requirements described.--The requirements described
in this paragraph are the following:
``(A) The entity is a private nonprofit entity
governed by an executive director and a board.
``(B) The members of the entity include
representatives of--
``(i)(I) health plans and providers
receiving reimbursement under this title for
the provision of items and services, including
health plans and providers with experience in
the care of frail elderly and individuals with
multiple complex chronic conditions; or
``(II) groups representing such health
plans and providers;
``(ii) groups representing individuals
entitled to benefits under part A of title
XVIII of the Social Security Act or enrolled
under part B of such title;
``(iii) purchasers and employers or groups
representing purchasers or employers;
``(iv) organizations that focus on quality
improvement as well as the measurement and
reporting of quality measures;
``(v) State government health programs;
``(vi) individuals 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
``(vii) individuals or entities involved in
the development and establishment of standards
and certification for health information
technology systems and clinical data.
``(C) The membership of the entity is
representative of individuals with experience with
urban health care issues and individuals with
experience with rural and frontier health care issues.
``(D) The entity does not charge a fee for
membership for participation in the work of the entity
related to the arrangement with the Secretary under
paragraph (1). If the entity does require a fee for
membership for participation in other functions of the
entity, there shall be no linkage between such fee and
participation in the work of the entity related to such
arrangement with the Secretary.
``(E) The entity--
``(i) permits any member described in
subparagraph (B) to vote on matters of the
entity related to the arrangement with the
Secretary under paragraph (1); and
``(ii) ensures that such members have an
equal vote on such matters.
``(F) With respect to matters related to the
arrangement with the Secretary under paragraph (1), the
entity conducts its business in an open and transparent
manner and provides the opportunity for public comment.
``(G) The entity operates 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).
``SEC. 2910. APPLICABILITY OF PRIVACY AND SECURITY REGULATIONS.
``The regulations promulgated by the Secretary under part C of
title XI of the Social Security Act and sections 261, 262, 263, and 264
of the Health Insurance Portability and Accountability Act of 1996 with
respect to the privacy, confidentiality, and security of health
information shall--
``(1) apply to any health information stored or transmitted
in an electronic format on or after the date of enactment of
this title; and
``(2) apply to the implementation of standards, programs,
and activities under this title.
``SEC. 2911. STUDY OF REIMBURSEMENT INCENTIVES.
``The Secretary shall carry out, or contract with a private entity
to carry out, a study that examines methods to create efficient
reimbursement incentives for improving healthcare quality in community
health centers and other federally qualified health centers, rural
health clinics, free clinics, and other programs reimbursed primarily
on a cost basis deemed appropriate by the Secretary.''.
SEC. 3. CENTER FOR BEST PRACTICES.
Section 914 of the Public Health Service Act (42 U.S.C. 299b-3) is
amended by adding at the end the following:
``(d) Center for Best Practices.--
``(1) In general.--The Secretary, acting through the
Director, shall develop a Center for Best Practices to provide
technical assistance and develop best practices to support and
accelerate the efforts of States and healthcare providers to
adopt, implement, and effectively use health information
technology.
``(2) Center for best practices.--
``(A) In general.--In carrying out paragraph (1),
the Director shall establish a voluntary Center for
Best Practices (referred to in this subsection as the
`Center') for States and healthcare stakeholders
seeking to facilitate mutual learning and accelerate
the pace of innovation in, and implementation of,
health information technology. The Center shall support
activities to meet goals, including--
``(i) providing for the widespread adoption
of interoperable health information technology;
``(ii) providing for the establishment of
regional and local health information networks
to facilitate the development of
interoperability across healthcare settings;
``(iii) the development of solutions to
barriers to the exchange of electronic health
information; or
``(iv) other activities identified by the
States or health care stakeholders as a focus
for developing and sharing best practices.
``(B) Purposes.--The purpose of the Center is to--
``(i) provide a forum for the exchange of
knowledge and experience;
``(ii) accelerate the transfer of lessons
learned from existing public and private sector
initiatives, including those currently
receiving Federal financial support;
``(iii) assemble, analyze, and widely
disseminate evidence and experience related to
the adoption, implementation, and effective use
of health information technology;
``(iv) assure the timely provision of
technical and expert assistance from the Agency
and its contractors;
``(v) accelerate the pace of health
information technology innovation; and
``(vi) provide technical assistance to
entities developing applications for
demonstration grants under subsection (b).
``(C) Support for activities.--To provide support
for the activities of the Center, the Director shall--
``(i) 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 Network and
facilitate information exchange across the
public and private sectors;
``(ii) expand the Agency's focus on the
adoption, implementation, and effective use of
health information technology through the
development of practical implementation
guidance based upon existing knowledge and
support for rapid-cycle implementation research
to address questions for which existing
knowledge is insufficient; and
``(iii) develop the capacity to identify
and widely share in a timely manner innovative
approaches to advancing health information
technology and its ultimate goal, the
improvement of the quality, safety, and
efficiency of health care.
``(3) Technical assistance telephone number or website.--
The Secretary shall establish a toll-free telephone number or
Internet website to provide healthcare providers with a single
point of contact to--
``(A) learn about Federal grants and technical
assistance services related to health information
technology;
``(B) learn about qualified health information
software that has been certified to be in compliance
with the standards adopted by the Federal Government
under section 2904 and is available for commercial use;
``(C) receive referrals to regional and local
health information networks for assistance with health
information technology;
``(D) provide information regarding--
``(i) the electronic submission of health
data collected by Federal agencies; and
``(ii) the uniform and consistent
implementation of standards; and
``(E) disseminate additional information determined
by the Secretary to be helpful to such providers.
``(4) Authorization of appropriations.--There are
authorized to be appropriated to carry out this subsection,
such sums as may be necessary for each of fiscal years 2006
through 2010.''.
SEC. 4. HEALTH INFORMATION NETWORK DEMONSTRATION PROGRAM.
Section 914 of the Public Health Service Act (42 U.S.C. 299b-3), as
amended by subsection (b), is further amended by adding at the end the
following:
``(e) Health Information Network Demonstration Program.--
``(1) In general.--The Director may establish a
demonstration program under which grants or contracts shall be
awarded to support health information network planning,
implementation, and evaluation activities.
``(2) Eligibility.--To be eligible to receive a grant or
contract under the demonstration program under paragraph (1),
an entity shall--
``(A) submit to the Director an application at such
time, in such manner, and containing such information
as the Director may require;
``(B) submit to the Director a strategic plan for
the implementation of data sharing and interoperability
measures across the various health care settings within
the proposed network;
``(C) be a public or nonprofit private entity that
is or represents a network or potential network that
includes healthcare providers and group health plans in
a defined area of geographic proximity or
organizational affinity, and that may include for
profit entities so long as such an entity is not the
grantee;
``(D) demonstrate, where appropriate, the
involvement and commitment of the appropriate State or
States;
``(E) specify a defined area of geographic
proximity or organizational affinity that the health
information network will encompass;
``(F) demonstrate active participation in the best
practice network described in subsection (d);
``(G) demonstrate compliance with the data
standards and technical policies adopted by the Federal
Government under section 2904(e);
``(H) submit to the Secretary a report on the
degree to which such entity has achieved the measures
under section 2909;
``(I) demonstrate financial need; and
``(J) agree to provide matching funds in accordance
with paragraph (4).
``(3) Use of funds.--
``(A) In general.--Amounts received under a grant
under this subsection shall be used to establish and
implement a regional or local health information
network.
``(B) Limitation.--Amounts received under a grant
under this subsection may not be used to purchase a
health information technology system that is not a
qualified health information technology system.
``(4) Matching requirement.--To be eligible to receive a
grant or contract under this subsection an entity shall
contribute non-Federal funds to the costs of carrying out the
activities for which the grant or contract is awarded in an
amount equal to $1 for each of $2 of Federal funds, provided
under the grant.
``(5) Authorization of appropriations.--There are
authorized to be appropriated to carry out this subsection,
$50,000,000 for fiscal year 2006, $70,000,000 for fiscal year
2007, and such sums as may be necessary for each of fiscal
years 2008 through 2010.''.
SEC. 5. EXCEPTION TO FEDERAL ANTI-KICKBACK AND STARK LAWS FOR THE
PROVISION OF PERMITTED SUPPORT.
(a) Anti-Kickback.--Section 1128B(b) of the Social Security Act (42
U.S.C. 1320a-7b(b)(3)) is amended--
(1) in paragraph (3)--
(A) in subparagraph (G), by striking ``and'' at the
end;
(B) in subparagraph (H), as added by section 237(d)
of the Medicare Prescription Drug, Improvement, and
Modernization Act of 2003 (Public Law 108-173; 117
Stat. 2213)--
(i) by moving such subparagraph 2 ems to
the left; and
(ii) by striking the period at the end and
inserting a semicolon;
(C) by redesignating subparagraph (H), as added by
section 431(a) of the Medicare Prescription Drug,
Improvement, and Modernization Act of 2003 (Public Law
108-173; 117 Stat. 2287), as subparagraph (I);
(D) in subparagraph (I), as so redesignated--
(i) by moving such subparagraph 2 ems to
the left; and
(ii) by striking the period at the end and
inserting ``; and''; and
(E) by adding at the end the following new:
``(J) during the 5-year period beginning on the
date the Secretary issues the interim final rule under
section 5(c)(1) of the Better Healthcare Through
Information Technology Act, the provision, with or
without charge, of any permitted support (as defined in
paragraph (4)).''; and
(2) by adding at the end the following new paragraph:
``(4) Permitted support.--
``(A) Definition of permitted support.--Subject to
subparagraph (B), in this section, the term `permitted
support' means the provision of any equipment, item,
information, right, license, intellectual property,
software, training, or service used for developing,
implementing, operating, or facilitating the use of
systems designed to improve the quality of health care
and to promote the electronic exchange of health
information.
``(B) Exception.--The term `permitted support'
shall not include the provision of--
``(i) any support that is determined in a
manner that is related to the volume or value
of any referrals or other business generated
between the parties for which payment may be
made in whole or in part under a Federal health
care program;
``(ii) any support that has more than
incidental utility or value to the recipient
beyond the exchange of health care information;
or
``(iii) any health information technology
system, product, or service that is not in
compliance with data standards adopted by the
Federal Government under section 2904 of the
Public Health Service Act.''.
(b) Stark.--Section 1877(e) of the Social Security Act (42 U.S.C.
1395nn(e)) is amended by adding at the end the following new paragraph:
``(9) Permitted support.--During the 5-year period
beginning on the date the Secretary issues the interim final
rule under section 5(c)(1) of the Better Healthcare Through
Information Technology Act, the provision, with or without
charge, of any permitted support (as defined in section
1128B(b)(4)).''.
(c) Regulations.--In order to carry out the amendments made by this
section--
(1) the Secretary of Health and Human Services shall issue
an interim final rule with comment period by not later than the
date that is 180 days after the date of enactment of this Act;
and
(2) the Secretary shall issue a final rule by not later
than the date that is 180 days after the date that the interim
final rule under paragraph (1) is issued.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR 7/1/2005 S7840-7841)
Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (text of measure as introduced: CR 7/1/2005 S7842-7846)
Sponsor introductory remarks on measure. (CR S8420)
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