Wired for Health Care Quality Act - (Sec. 2) Amends the Public Health Service Act to establish the Office of the National Coordinator of Health Information Technology to coordinate with relevant federal agencies and private entities and oversee programs and activities to develop a nationwide interoperable health information technology infrastructure.
Requires the National Coordinator to: (1) serve as the principal advisor to the Secretary of Health and Human Services (the Secretary) concerning the development, application, and use of health information technology and to coordinate and oversee the health information technology programs of the Department of Health and Human Services (HHS); (2) facilitate the adoption of a nationwide, interoperable system for the electronic exchange of health information; (3) ensure the adoption and implementation of standards for such exchange; (4) ensure that HHS health information technology policy and programs are coordinated with those of relevant executive branch agencies; (5) coordinate outreach and consultation by the relevant executive branch agencies with public and private parties of interest; and (6) advise the President regarding specific federal health information technology programs.
Requires the Secretary to establish the public-private American Health Information Collaborative to: (1) advise the Secretary and recommend actions to achieve a nationwide interoperable health information technology infrastructure; (2) serve as a forum for the participation of a broad range of stakeholders to provide input on achieving the interoperability of health information technology; and (3) recommend standards for the electronic exchange of health information by the federal government and private entities.
Requires the Collaborative to recommend to the Secretary uniform national policies to support the widespread adoption of health information technology, including: (1) protecting individually identifiable health information through privacy and security practices; (2) preventing unauthorized access to health information; (3) notifying patients if their individually identifiable health information is wrongfully disclosed; (4) facilitating secure patient access to health information; and (5) fostering the public understanding of health information technology.
Deems the standards adopted by the Consolidated Health Informatics Initiative as having been recommended by the Collaborative.
Requires the Collaborative to annually review existing standards, identify deficiencies, omissions, duplication, and overlap, and recommend modifications and/or new standards.
Requires the Secretaries of HHS, Veteran Affairs, and Defense to jointly review the Collaborative's recommendations. Requires the Secretary of HHS to provide for the adoption by the federal government of any recommended standards, if appropriate.
Prohibits any federal agency from expending federal funds to purchase any new health information technology that is inconsistent with adopted standards. Requires all federal agencies collecting health data to comply with the adopted standards within three years.
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 applicable adopted standards.
Allows the Secretary to award grants to: (1) facilitate the purchase and enhance the utilization of qualified health information technology systems; (2) implement regional or local health information plans; and (3) carry out demonstration projects to develop academic curricula integrating qualified health information technology systems in the clinical education of health professionals.
Requires the Secretary to develop measures of the quality of care patients receive and ensure that such measures: (1) are evidence based, reliable, and valid; (2) are consistent with the purposes of developing a nationwide interoperable health information technology infrastructure; (3) include measures of clinical processes and outcomes, patient experience, efficiency, and equity; and (4) include measures of overuse and underuse of health care items and services.
Requires the Secretary to: (1) adopt and utilize such quality measures; (2) implement procedures to accept the electronic submission of quality measurement data; and (3) disseminate recommendations and best practices derived from the analysis of quality measures.
(Sec. 3) Requires the Secretary to carry out a study that examines the impact that variations among state laws relating to licensure, registration, and certification of medical professionals have on the secure electronic exchange of health information.
(Sec. 5) Requires the Comptroller General to report on the necessity and workability of requiring health plans, health care clearinghouses, and health care providers who transmit health information in electronic form to notify patients if their individually identifiable health information is wrongfully disclosed.
(Sec. 6) Requires the Secretary to study methods to create efficient reimbursement incentives for improving health care quality in federally qualified health centers, rural health clinics, and free clinics.
(Sec. 7) Requires the Secretary, acting through the Director of the Agency for Healthcare Quality and Research (AHRQ), to develop a Health Information Technology Resource Center to provide technical assistance and develop best practices to support and accelerate efforts to adopt, implement, and effectively use interoperable health information technology. Requires the Secretary to establish a toll-free telephone number or Internet website to provide health care providers and patients with a single point of contact regarding health information technology.
(Sec. 8) Reauthorizes appropriations for grants to reduce statutory and regulatory barriers to telemedicine.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 1418 Introduced in Senate (IS)]
109th CONGRESS
1st Session
S. 1418
To enhance the adoption of a nationwide interoperable health
information technology system and to improve the quality and reduce the
costs of health care in the United States.
_______________________________________________________________________
IN THE SENATE OF THE UNITED STATES
July 18, 2005
Mr. Enzi (for himself, Mr. Kennedy, Mr. Frist, Mrs. Clinton, Mr.
Alexander, Mr. Dodd, Mr. Burr, Mr. Harkin, Mr. Isakson, Ms. Mikulski,
Mr. DeWine, Mr. Jeffords, Mr. Roberts, Mr. Bingaman, Mrs. Murray, Mr.
Hagel, Mr. Martinez, Mr. Talent, Mr. Obama, Mr. Bond, and Mr. Nelson of
Florida) 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 a nationwide interoperable health
information technology system and to improve the quality and reduce the
costs of health care 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 ``Wired for Health Care Quality Act''.
SEC. 2. IMPROVING HEALTH CARE, QUALITY, SAFETY, AND EFFICIENCY.
The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by
adding at the end the following:
``TITLE XXIX--HEALTH INFORMATION TECHNOLOGY
``SEC. 2901. DEFINITIONS.
``In this title:
``(1) Health care provider.--The term `health care
provider' means a hospital, skilled nursing facility, home
health entity, health care clinic, federally qualified health
center, group practice (as defined in section 1877(h)(4) of the
Social Security Act), a pharmacist, a pharmacy, a laboratory, a
physician (as defined in section 1861(r) of the Social Security
Act), a 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.
``(2) Health information.--The term `health information'
has the meaning given such term in section 1171(4) of the
Social Security Act.
``(3) Health insurance plan.--The term `health insurance
plan' means--
``(A) a health insurance issuer (as defined in
section 2791(b)(2));
``(B) a group health plan (as defined in section
2791(a)(1)); and
``(C) a health maintenance organization (as defined
in section 2791(b)(3)).
``(4) Laboratory.--The term `laboratory' has the meaning
given that term in section 353.
``(5) Pharmacist.--The term `pharmacist' has the meaning
given that term in section 804 of the Federal Food, Drug, and
Cosmetic Act.
``(6) 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;
``(B) maintains and provides permitted access to
health information in an electronic format;
``(C) incorporates decision support to reduce
medical errors and enhance health care quality;
``(D) complies with the standards adopted by the
Federal Government under section 2903; and
``(E) allows for the reporting of quality measures
under section 2908.
``(7) 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. 2902. OFFICE OF THE NATIONAL COORDINATOR OF HEALTH INFORMATION
TECHNOLOGY.
``(a) Office of National Health Information Technology.--There is
established within the Office of the Secretary an Office of the
National Coordinator of Health Information Technology (referred to in
this section as the `Office'). The Office shall be headed by a National
Coordinator who shall be appointed by the President, in consultation
with the Secretary, and shall report directly to the Secretary.
``(b) Purpose.--It shall be the purpose of the Office to carry out
programs and activities to develop a nationwide interoperable health
information technology infrastructure that--
``(1) ensures that patients' health information is secure
and protected;
``(2) improves health care quality, reduces medical errors,
and advances the delivery of patient-centered medical care;
``(3) reduces health care 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 health care 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 health care 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 Collaborative established under section
2903;
``(2) serve as the principal advisor to the Secretary
concerning the development, application, and use of health
information technology, and coordinate and oversee the health
information technology programs of the Department;
``(3) facilitate the adoption of a nationwide,
interoperable system for the electronic exchange of health
information;
``(4) ensure the adoption and implementation of standards
for the electronic exchange of health information to reduce
cost and improve health care quality;
``(5) ensure that health information technology policy and
programs of the Department are coordinated with those of
relevant executive branch agencies (including Federal
commissions) with a goal of avoiding duplication of efforts and
of helping to ensure that each agency undertakes health
information technology activities primarily within the areas of
its greatest expertise and technical capability;
``(6) to the extent permitted by law, coordinate outreach
and consultation by the relevant executive branch agencies
(including Federal commissions) with public and private parties
of interest, including consumers, payers, employers, hospitals
and other health care providers, physicians, community health
centers, laboratories, vendors and other stakeholders;
``(7) advise the President regarding specific Federal
health information technology programs; and
``(8) submit the reports described under section 2903(i)
(excluding paragraph (4) of such section).
``(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) Rule of Construction.--Nothing in this section shall be
construed to require the duplication of Federal efforts with respect to
the establishment of the Office, regardless of whether such efforts
were carried out prior to or after the enactment of this title.
``(f) Authorization of Appropriations.--There are authorized to be
appropriated such sums as may be necessary to carry out the activities
of the Office under this section for each of fiscal years 2006 through
2010.
``SEC. 2903. AMERICAN HEALTH INFORMATION COLLABORATIVE.
``(a) Purpose.--The Secretary shall establish the public-private
American Health Information Collaborative (referred to in this section
as the `Collaborative') to--
``(1) advise the Secretary and recommend specific actions
to achieve a nationwide interoperable health information
technology infrastructure;
``(2) serve as a forum for the participation of a broad
range of stakeholders to provide input on achieving the
interoperability of health information technology; and
``(3) recommend standards (including content,
communication, and security standards) for the electronic
exchange of health information for adoption by the Federal
Government and voluntary adoption by private entities.
``(b) Composition.--
``(1) In general.--The Collaborative shall be composed of--
``(A) the Secretary, who shall serve as the
chairperson of the Collaborative;
``(B) the Secretary of Defense, or his or her
designee;
``(C) the Secretary of Veterans Affairs, or his or
her designee;
``(D) the Secretary of Commerce, or his or her
designee;
``(E) the National Coordinator for Health
Information Technology;
``(F) representatives of other relevant Federal
agencies, as determined appropriate by the Secretary;
and
``(G) representatives from each of the following
categories to be appointed by the Secretary from
nominations submitted by the public--
``(i) consumer and patient organizations;
``(ii) experts in health information
privacy and security;
``(iii) health care providers;
``(iv) health insurance plans or other
third party payors;
``(v) standards development organizations;
``(vi) information technology vendors;
``(vii) purchasers or employers; and
``(viii) State or local government agencies
or Indian tribe or tribal organizations.
``(2) Considerations.--In appointing members under
paragraph (1)(G), the Secretary shall select individuals with
expertise in--
``(A) health information privacy;
``(B) health information security;
``(C) health care quality and patient safety,
including those individuals with experience in
utilizing health information technology to improve
health care quality and patient safety;
``(D) data exchange; and
``(E) developing health information technology
standards and new health information technology.
``(3) Terms.--Members appointed under paragraph (1)(G)
shall serve for 2 year terms, except that any member appointed
to fill a vacancy for an unexpired term shall be appointed for
the remainder of such term. A member may serve for not to
exceed 180 days after the expiration of such member's term or
until a successor has been appointed.
``(c) Recommendations and Policies.--The Collaborative shall make
recommendations to identify uniform national policies for adoption by
the Federal Government and voluntary adoption by private entities to
support the widespread adoption of health information technology,
including--
``(1) protection of health information through privacy and
security practices;
``(2) measures to prevent unauthorized access to health
information;
``(3) methods to facilitate secure patient access to health
information;
``(4) the ongoing harmonization of industry-wide health
information technology standards;
``(5) recommendations for a nationwide interoperable health
information technology infrastructure;
``(6) the identification and prioritization of specific use
cases for which heath information technology is valuable,
beneficial, and feasible;
``(7) recommendations for the establishment of an entity to
ensure the continuation of the functions of the Collaborative;
and
``(8) other policies determined to be necessary by the
Collaborative.
``(d) Standards.--
``(1) Existing standards.--The standards adopted by the
Consolidated Health Informatics Initiative shall be deemed to
have been recommended by the Collaborative under this section.
``(2) First year review.--Not later than 1 year after the
date of enactment of this title, the Collaborative shall--
``(A) review existing standards (including content,
communication, and security standards) for the
electronic exchange of health information, including
such standards adopted by the Secretary under paragraph
(2)(A);
``(B) identify deficiencies and omissions in such
existing standards; and
``(C) identify duplication and overlap in such
existing standards;
and recommend modifications to such standards as necessary.
``(3) Ongoing review.--Beginning 1 year after the date of
enactment of this title, and annually thereafter, the
Collaborative shall--
``(A) review existing standards (including content,
communication, and security standards) for the
electronic exchange of health information, including
such standards adopted by the Secretary under paragraph
(2)(A);
``(B) identify deficiencies and omissions in such
existing standards; and
``(C) identify duplication and overlap in such
existing standards;
and recommend modifications to such standards as necessary.
``(4) Limitation.--The standards described in this section
shall be consistent with any standards developed pursuant to
the Health Insurance Portability and Accountability Act of
1996.
``(e) Federal Action.--Not later than 60 days after the issuance of
a recommendation from the Collaborative under subsection (d)(2), the
Secretary of Health and Human Services, the Secretary of Veterans
Affairs, and the Secretary of Defense, in collaboration with
representatives of other relevant Federal agencies, as determined
appropriate by the Secretary, shall jointly review such
recommendations. The Secretary shall provide for the adoption by the
Federal Government of any standard or standards contained in such
recommendation.
``(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 any form of health information technology or
health information technology system for clinical care or for the
electronic retrieval, storage, or 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 3
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, research, or for other purposes determined appropriate
by the Secretary 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
by the Federal Government and private entities to facilitate
the adoption of an interoperable nationwide system for the
electronic exchange of health information;
``(2) describes barriers to the adoption of such a
nationwide system;
``(3) contains recommendations to achieve full
implementation of such a nationwide system; and
``(4) contains a plan and progress toward the establishment
of an entity to ensure the continuation of the functions of the
Collaborative.
``(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) Rule of Construction.--Nothing in this section shall be
construed to require the duplication of Federal efforts with respect to
the establishment of the Collaborative, regardless of whether such
efforts were carried out prior to or after the enactment of this title.
``(l) 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. 2904. 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 using the criteria developed by the Secretary under
this section.
``(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) using the criteria
developed by the Secretary under this section.
``(c) Delegation Authority.--The Secretary, through consultation
with the Collaborative, may delegate the development of the criteria
under subsections (a) and (b) to a private entity.
``SEC. 2905. GRANTS TO FACILITATE THE WIDESPREAD ADOPTION OF
INTEROPERABLE HEALTH INFORMATION TECHNOLOGY.
``(a) Competitive Grants to Facilitate the Widespread Adoption of
Health Information Technology.--
``(1) In general.--The Secretary may award competitive
grants to eligible entities to facilitate the purchase and
enhance the utilization of qualified health information
technology systems to improve the quality and efficiency of
health care.
``(2) Eligibility.--To be eligible to receive a grant under
paragraph (1) an entity shall--
``(A) submit to the Secretary an application at
such time, in such manner, and containing such
information as the Secretary may require;
``(B) submit to the Secretary a strategic plan for
the implementation of data sharing and interoperability
measures;
``(C) be a--
``(i) not for profit hospital;
``(ii) group practice (including a single
physician); or
``(iii) another health care provider not
described in clause (i) or (ii);
``(D) adopt the standards adopted by the Federal
Government under section 2903;
``(E) require that health care providers receiving
such grants implement the measurement system adopted
under section 2908 and report to the Secretary on such
measures;
``(F) demonstrate significant financial need; and
``(G) provide matching funds in accordance with
paragraph (4).
``(3) Use of funds.--Amounts received under a grant under
this subsection shall be used to facilitate the purchase and
enhance the utilization of qualified health information
technology systems.
``(4) Matching requirement.--To be eligible for a grant
under this subsection an entity shall contribute non-Federal
contributions to the costs of carrying out the activities for
which the grant is awarded in an amount equal to $1 for each $3
of Federal funds provided under the grant.
``(5) Preference in awarding grants.--In awarding grants
under this subsection the Secretary shall give preference to--
``(A) eligible entities that are located in rural,
frontier, and other underserved areas as determined by
the Secretary; and
``(B) eligible entities that will link, to the
extent practicable, the qualified health information
system to local or regional health information
networks.
``(b) Competitive Grants to States for the Development of State
Loan Programs to Facilitate the Widespread Adoption of Health
Information Technology.--
``(1) In general.--The Secretary may award competitive
grants to States for the establishment of State programs for
loans to health care providers to facilitate the purchase and
enhance the utilization of qualified health information
technology.
``(2) Establishment of fund.--To be eligible to receive a
competitive grant under this subsection, a State shall
establish a qualified health information technology loan fund
(referred to in this subsection as a `State loan fund') and
comply with the other requirements contained in this section. A
grant to a State under this subsection shall be deposited in
the State loan fund established by the State. No funds
authorized by other provisions of this title to be used for
other purposes specified in this title shall be deposited in
any State loan fund.
``(3) Eligibility.--To be eligible to receive a grant under
paragraph (1) a State shall--
``(A) submit to the Secretary an application at
such time, in such manner, and containing such
information as the Secretary may require;
``(B) submit to the Secretary a strategic plan in
accordance with paragraph (4);
``(C) establish a qualified health information
technology loan fund in accordance with paragraph (2);
``(D) require that health care providers receiving
such loans--
``(i) link, to the extent practicable, the
qualified health information system to a local
or regional health information network; and
``(ii) 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;
``(E) require that health care providers receiving
such loans adopt the standards adopted by the Federal
Government under section 2903(d);
``(F) require that health care providers receiving
such loans implement the measurement system adopted
under section 2908 and report to the Secretary on such
measures; and
``(G) provide matching funds in accordance with
paragraph (8).
``(4) Strategic plan.--
``(A) In general.--A State that receives a grant
under this subsection shall annually prepare a
strategic plan that identifies the intended uses of
amounts available to the State loan fund of the State.
``(B) Contents.--A strategic plan under
subparagraph (A) shall include--
``(i) a list of the projects to be assisted
through the State loan fund in the first fiscal
year that begins after the date on which the
plan is submitted;
``(ii) a description of the criteria and
methods established for the distribution of
funds from the State loan fund; and
``(iii) a description of the financial
status of the State loan fund and the short-
term and long-term goals of the State loan
fund.
``(5) Use of funds.--
``(A) In general.--Amounts deposited in a State
loan fund, including loan repayments and interest
earned on such amounts, shall be used only for awarding
loans or loan guarantees, or as a source of reserve and
security for leveraged loans, the proceeds of which are
deposited in the State loan fund established under
paragraph (1). Loans under this section may be used by
a health care provider to facilitate the purchase and
enhance the utilization of qualified health information
technology.
``(B) Limitation.--Amounts received by a State
under this subsection may not be used--
``(i) for the purchase or other acquisition
of any health information technology system
that is not a qualified health information
technology system;
``(ii) to conduct activities for which
Federal funds are expended under this title, or
the amendments made by the Wired for Health
Care Quality Act; or
``(iii) for any purpose other than making
loans to eligible entities under this section.
``(6) Types of assistance.--Except as otherwise limited by
applicable State law, amounts deposited into a State loan fund
under this subsection may only be used for the following:
``(A) To award loans that comply with the
following:
``(i) The interest rate for each loan shall
be less than or equal to the market interest
rate.
``(ii) The principal and interest payments
on each loan shall commence not later than 1
year after the loan was awarded, and each loan
shall be fully amortized not later than 10
years after the date of the loan.
``(iii) The State loan fund shall be
credited with all payments of principal and
interest on each loan awarded from the fund.
``(B) To guarantee, or purchase insurance for, a
local obligation (all of the proceeds of which finance
a project eligible for assistance under this
subsection) if the guarantee or purchase would improve
credit market access or reduce the interest rate
applicable to the obligation involved.
``(C) As a source of revenue or security for the
payment of principal and interest on revenue or general
obligation bonds issued by the State if the proceeds of
the sale of the bonds will be deposited into the State
loan fund.
``(D) To earn interest on the amounts deposited
into the State loan fund.
``(7) Administration of state loan funds.--
``(A) Combined financial administration.--A State
may (as a convenience and to avoid unnecessary
administrative costs) combine, in accordance with State
law, the financial administration of a State loan fund
established under this subsection with the financial
administration of any other revolving fund established
by the State if otherwise not prohibited by the law
under which the State loan fund was established.
``(B) Cost of administering fund.--Each State may
annually use not to exceed 4 percent of the funds
provided to the State under a grant under this
subsection to pay the reasonable costs of the
administration of the programs under this section,
including the recovery of reasonable costs expended to
establish a State loan fund which are incurred after
the date of enactment of this title.
``(C) Guidance and regulations.--The Secretary
shall publish guidance and promulgate regulations as
may be necessary to carry out the provisions of this
subsection, including--
``(i) provisions to ensure that each State
commits and expends funds allotted to the State
under this subsection as efficiently as
possible in accordance with this title and
applicable State laws; and
``(ii) guidance to prevent waste, fraud,
and abuse.
``(D) Private sector contributions.--
``(i) In general.--A State loan fund
established under this subsection may accept
contributions from private sector entities,
except that such entities may not specify the
recipient or recipients of any loan issued
under this subsection.
``(ii) Availability of information.--A
State shall make publically available the
identity of, and amount contributed by, any
private sector entity under clause (i) and may
issue letters of commendation or make other
awards (that have no financial value) to any
such entity.
``(8) Matching requirements.--
``(A) In general.--The Secretary may not make a
grant under paragraph (1) to a State unless the State
agrees to make available (directly or through donations
from public or private entities) non-Federal
contributions in cash toward the costs of the State
program to be implemented under the grant in an amount
equal to not less than $1 for each $1 of Federal funds
provided under the grant.
``(B) Determination of amount of non-federal
contribution.--In determining the amount of non-Federal
contributions that a State has provided pursuant to
subparagraph (A), the Secretary may not include any
amounts provided to the State by the Federal
Government.
``(9) Preference in awarding grants.--The Secretary may
give a preference in awarding grants under this subsection to
States that adopt value-based purchasing programs to improve
health care quality.
``(10) Reports.--The Secretary shall annually submit to the
Committee on Health, Education, Labor, and Pensions and the
Committee on Finance of the Senate, and the Committee on Energy
and Commerce and the Committee on Ways and Means of the House
of Representatives, a report summarizing the reports received
by the Secretary from each State that receives a grant under
this subsection.
``(c) Grants for the Implementation of Regional or Local Health
Information Technology Plans.--
``(1) In general.--The Secretary may award competitive
grants to eligible entities to implement regional or local
health information plans to improve health care quality and
efficiency through the electronic exchange of health
information pursuant to the standards, protocols, and other
requirements adopted by the Secretary under sections 2903 and
2908.
``(2) Eligibility.--To be eligible to receive a grant under
paragraph (1) an entity shall--
``(A) demonstrate financial need to the Secretary;
``(B) demonstrate that one of its principal
missions or purposes is to use information technology
to improve health care quality and efficiency;
``(C) adopt bylaws, memoranda of understanding, or
other charter documents that demonstrate that the
governance structure and decisionmaking processes of
such entity allow for participation on an ongoing basis
by multiple stakeholders within a community,
including--
``(i) physicians (as defined in section
1861(r) of the Social Security Act), including
physicians that provide services to low income
and underserved populations;
``(ii) hospitals (including hospitals that
provide services to low income and underserved
populations);
``(iii) pharmacists or pharmacies;
``(iv) health insurance plans;
``(v) health centers (as defined in section
330(b)) and Federally qualified health centers
(as defined in section 1861(aa)(4) of the
Social Security Act);
``(vi) rural health clinics (as defined in
section 1861(aa) of the Social Security Act);
``(vii) patient or consumer organizations;
``(viii) employers; and
``(ix) any other health care providers or
other entities, as determined appropriate by
the Secretary;
``(D) adopt nondiscrimination and conflict of
interest policies that demonstrate a commitment to
open, fair, and nondiscriminatory participation in the
health information plan by all stakeholders;
``(E) adopt the standards adopted by the Secretary
under section 2903;
``(F) require that health care providers receiving
such loans implement the measurement system adopted
under section 2908 and report to the Secretary on such
measures;
``(G) facilitate the electronic exchange of health
information within the local or regional area and among
local and regional areas;
``(H) prepare and submit to the Secretary an
application in accordance with paragraph (3); and
``(I) agree to provide matching funds in accordance
with paragraph (5).
``(3) Application.--
``(A) In general.--To be eligible to receive a
grant under paragraph (1), an entity shall submit to
the Secretary an application at such time, in such
manner, and containing such information as the
Secretary may require.
``(B) Required information.--At a minimum, an
application submitted under this paragraph shall
include--
``(i) clearly identified short-term and
long-term objectives of the regional or local
health information plan;
``(ii) a technology plan that complies with
the standards adopted under section 2903 and
that includes a descriptive and reasoned
estimate of costs of the hardware, software,
training, and consulting services necessary to
implement the regional or local health
information plan;
``(iii) a strategy that includes
initiatives to improve health care quality and
efficiency, including the use and reporting of
health care quality measures adopted under
section 2908;
``(iv) a plan that describes provisions to
encourage the implementation of the electronic
exchange of health information by all
physicians, including single physician
practices and small physician groups
participating in the health information plan;
``(v) a plan to ensure the privacy and
security of personal health information that is
consistent with Federal and State law;
``(vi) a governance plan that defines the
manner in which the stakeholders shall jointly
make policy and operational decisions on an
ongoing basis; and
``(vii) a financial or business plan that
describes--
``(I) the sustainability of the
plan;
``(II) the financial costs and
benefits of the plan; and
``(III) the entities to which such
costs and benefits will accrue.
``(4) Use of funds.--Amounts received under a grant under
paragraph (1) shall be used to establish and implement a
regional or local health information plan in accordance with
this subsection.
``(5) Matching requirement.--
``(A) In general.--The Secretary may not make a
grant under this subsection to an entity unless the
entity agrees that, with respect to the costs to be
incurred by the entity in carrying out the
infrastructure program for which the grant was awarded,
the entity will make available (directly or through
donations from public or private entities) non-Federal
contributions toward such costs in an amount equal to
not less than 50 percent of such costs ($1 for each $2
of Federal funds provided under the grant).
``(B) Determination of amount contributed.--Non-
Federal contributions required under subparagraph (A)
may be in cash or in kind, fairly evaluated, including
equipment, technology, or services. Amounts provided by
the Federal Government, or services assisted or
subsidized to any significant extent by the Federal
Government, may not be included in determining the
amount of such non-Federal contributions.
``(d) Reports.--Not later than 1 year after the date on which the
first grant is awarded under this section, and annually thereafter
during the grant period, an entity that receives a grant under this
section shall submit to the Secretary a report on the activities
carried out under the grant involved. Each such report shall include--
``(1) a description of the financial costs and benefits of
the project involved and of the entities to which such costs
and benefits accrue;
``(2) an analysis of the impact of the project on health
care quality and safety;
``(3) a description of any reduction in duplicative or
unnecessary care as a result of the project involved;
``(4) a description of the efforts of recipients under this
section to facilitate secure patient access to health
information; and
``(5) other information as required by the Secretary.
``(e) Authorization of Appropriations.--
``(1) In general.--For the purpose of carrying out this
section, there is authorized to be appropriated $125,000,000
for fiscal year 2006, $150,000,000 for fiscal year 2007, and
such sums as may be necessary for each of fiscal years 2008
through 2010.
``(2) Availability.--Amounts appropriated under paragraph
(1) shall remain available through fiscal year 2010.
``SEC. 2906. 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
curricula 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 health care quality;
``(3) be--
``(A) a health professions school;
``(B) a school of nursing; or
``(C) a graduate medical education program;
``(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) Use of Funds.--
``(1) In general.--With respect to a grant under subsection
(a), an eligible entity shall--
``(A) use grant funds in collaboration with 2 or
more disciplines; and
``(B) use grant funds to integrate qualified health
information technology into community-based clinical
education.
``(2) Limitation.--An eligible entity shall not use amounts
received under a grant under subsection (a) to purchase
hardware, software, or services.
``(d) Matching Funds.--
``(1) In general.--The Secretary may award a grant to an
entity 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.
``(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) Authorization of Appropriations.--There is authorized to be
appropriated to carry out this section, $5,000,000 for fiscal year
2007, and such sums as may be necessary for each of fiscal years 2008
through 2010.
``(h) Sunset.--This section shall not apply after September 30,
2010.
``SEC. 2907. LICENSURE AND THE ELECTRONIC EXCHANGE OF HEALTH
INFORMATION.
``(a) In General.--The Secretary shall carry out, or contract with
a private entity to carry out, a study that examines--
``(1) the variation among State laws that relate to the
licensure, registration, and certification of medical
professionals; and
``(2) how such variation among State laws impacts the
secure electronic exchange of health information--
``(A) among the States; and
``(B) between the States and the Federal
Government.
``(b) Report and Recommendations.--Not later than 1 year after the
date of enactment of this title, the Secretary shall publish a report
that--
``(1) describes the results of the study carried out under
subsection (a); and
``(2) makes recommendations to States regarding the
harmonization of State laws based on the results of such study.
``SEC. 2908. QUALITY MEASUREMENT SYSTEMS.
``(a) In General.--The Secretary of Health and Human Services, the
Secretary of Veterans Affairs, the Secretary of Defense, and
representatives of other relevant Federal agencies, as determined
appropriate by the Secretary, (referred to in the section as the
`Secretaries') shall jointly develop a quality measurement system for
the purpose of measuring the quality of care patients receive.
``(b) Requirements.--The Secretaries shall ensure that the quality
measurement system developed under subsection (a) comply with the
following:
``(1) Measures.--
``(A) In general.--Subject to subparagraph (B), the
Secretaries shall select measures of quality to be used
by the Secretaries under the systems.
``(B) Requirements.--In selecting the measures to
be used under each system pursuant to subparagraph (A),
the Secretaries shall, to the extent feasible, ensure
that--
``(i) such measures are evidence based,
reliable and valid;
``(ii) such measures include measures of
process, structure, patient experience,
efficiency, and equity; and
``(iii) such measures include measures of
overuse, underuse, and misuse of health care
items and services.
``(2) Priorities.--In developing the system under
subsection (a), the Secretaries shall ensure that priority is
given to--
``(A) measures with the greatest potential impact
for improving the quality and efficiency of care
provided under Federal programs;
``(B) measures that may be rapidly implemented by
group health plans, health insurance issuers,
physicians, hospitals, nursing homes, long-term care
providers, and other providers; and
``(C) measures which may inform health care
decisions made by consumers and patients.
``(3) Weights of measures.--The Secretaries shall assign
weights to the measures used by the Secretaries under each
system established under subsection (a).
``(4) Risk adjustment.--The Secretaries shall establish
procedures to account for differences in patient health status,
patient characteristics, and geographic location. To the extent
practicable, such procedures shall recognize existing
procedures.
``(5) Maintenance.--The Secretaries 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 Secretaries shall--
``(1) consult with, and take into account the
recommendations of, the entity that the Secretaries has an
arrangement with under subsection (e);
``(2) consult with representatives of health care
providers, consumers, employers, and other individuals and
groups that are interested in the quality of health care; and
``(3) take into account--
``(A) any demonstration or pilot program conducted
by the Secretaries relating to measuring and rewarding
quality and efficiency of care;
``(B) any existing activities conducted by the
Secretaries relating to measuring and rewarding quality
and efficiency;
``(C) any existing activities conducted by private
entities including health insurance plans and payors;
and
``(D) 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
Secretaries 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
Secretaries shall have in place an arrangement with an entity
that meets the requirements described in paragraph (2) under
which such entity provides the Secretaries 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) health insurance plans and providers
with experience in the care of individuals with
multiple complex chronic conditions or groups
representing such health insurance plans and
providers;
``(ii) groups representing patients and
consumers;
``(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 or entities skilled in
the conduct and interpretation of biomedical,
health services, and health economics research
and with expertise in outcomes and
effectiveness research and technology
assessment; and
``(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) If the entity requires a fee for membership,
the entity shall provide assurances to the Secretaries
that such fees are not a substantial barrier to
participation in the entity's activities related to the
arrangement with the Secretaries.
``(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 member voting provides
a balance among disparate stakeholders, so that
no member organization described in
subparagraph (B) unduly influences the outcome.
``(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).
``(f) Use of Quality Measurement System.--
``(1) In general.--For purposes of activities conducted or
supported by the Secretary under this Act, the Secretary shall,
to the extent practicable, adopt and utilize the measurement
system developed under this section.
``(2) Collaborative agreements.--With respect to activities
conducted or supported by the Secretary under this Act, the
Secretary may establish collaborative agreements with private
entities, including group health plans and health insurance
issuers, providers, purchasers, consumer organizations, and
entities receiving a grant under section 2908, to--
``(A) encourage the use of the health care quality
measures adopted by the Secretary under this section;
and
``(B) foster uniformity between the health care
quality measures utilized by private entities.
``(g) Dissemination of Information.--Beginning on January 1, 2008,
in order to make comparative quality information available to health
care consumers, health professionals, public health officials,
researchers, and other appropriate individuals and entities, the
Secretary shall provide for the aggregation and analysis of quality
measures collected under section 2905 and the dissemination of
recommendations and best practices derived in part from such analysis.
``(h) Technical Assistance.--The Secretary shall provide technical
assistance to public and private entities to enable such entities to--
``(1) implement and use evidence-based guidelines with the
greatest potential to improve health care quality, efficiency,
and patient safety; and
``(2) establish mechanisms for the rapid dissemination of
information regarding evidence-based guidelines with the
greatest potential to improve health care quality, efficiency,
and patient safety.
``SEC. 2909. 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. 2910. 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 health care quality in Federally
qualified health centers, rural health clinics, and free clinics.''.
SEC. 3. HEALTH INFORMATION TECHNOLOGY RESOURCE CENTER.
Section 914 of the Public Health Service Act (42 U.S.C. 299b-3) is
amended by adding at the end the following:
``(d) 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 efforts to adopt, implement, and effectively use
interoperable health information technology in compliance with
section 2903 and 2908.
``(2) Center for best practices.--
``(A) In general.--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 health care settings
and improve the quality of health care;
``(iii) the development of solutions to
barriers to the exchange of electronic health
information; or
``(iv) other activities identified by the
States, local or regional health information
networks, or health care stakeholders as a
focus for developing and sharing best
practices.
``(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 interoperable health information technology;
and
``(iv) assure the timely provision of
technical and expert assistance from the Agency
and its contractors.
``(C) Support for activities.--To provide support
for the activities of the Center, the Director shall
modify the requirements, if necessary, that apply to
the National Resource Center for Health Information
Technology to provide the necessary infrastructure to
support the duties and activities of the Center and
facilitate information exchange across the public and
private sectors.
``(3) Technical assistance telephone number or website.--
The Secretary shall establish a toll-free telephone number or
Internet website to provide health care providers and patients
with a single point of contact to--
``(A) learn about Federal grants and technical
assistance services related to interoperable health
information technology;
``(B) learn about qualified health information
technology and the quality measurement system adopted
by the Federal Government under sections 2903 and 2908;
``(C) learn about regional and local health
information networks for assistance with health
information technology; and
``(D) disseminate additional information determined
by the Secretary.
``(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. REAUTHORIZATION OF INCENTIVE GRANTS REGARDING TELEMEDICINE.
Section 330L(b) of the Public Health Service Act (42 U.S.C. 254c-
18(b)) is amended by striking ``2002 through 2006'' and inserting
``2006 through 2010''.
<all>
Introduced in Senate
Sponsor introductory remarks on measure. (CR S8420-8421)
Read twice and referred to the Committee on Health, Education, Labor, and Pensions. (text of measure as introduced: CR S8421-8426)
Committee on Health, Education, Labor, and Pensions. Ordered to be reported with an amendment in the nature of a substitute favorably.
Committee on Health, Education, Labor, and Pensions. Reported by Senator Enzi with an amendment in the nature of a substitute. With written report No. 109-111.
Committee on Health, Education, Labor, and Pensions. Reported by Senator Enzi with an amendment in the nature of a substitute. With written report No. 109-111.
Placed on Senate Legislative Calendar under General Orders. Calendar No. 178.
Measure laid before Senate by unanimous consent. (consideration: CR 11/17/2005 S13260-13277; text of measure as reported in Senate: CR 11/17/2005 S13261-13271)
Passed/agreed to in Senate: Passed Senate with an amendment by Unanimous Consent.
Passed Senate with an amendment by Unanimous Consent.
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Received in the House.
Message on Senate action sent to the House.
Referred to the House Committee on Energy and Commerce.
Referred to the Subcommittee on Health.