1.This Act may be cited as the Josie King Act of 2004
or the Quality, Efficiency, Standards, and Technology for Health Care Transformation Act of 2004
.
2.For purposes of this Act, the term Secretary means the Secretary of Health and Human Services.
3.The table of contents for this Act is as follows:
Sec. 1. Short title
Sec. 2. Definition
Sec. 3. Table of contents
Title I—National Health Information Infrastructure
Sec. 101. Purpose
Sec. 102. Health information technology grants
Sec. 103. Standards for interoperability of health information technology systems
Sec. 104. Loans
Sec. 105. Safe harbor for equipment and services provided for the development or implementation of a health information infrastructure
Sec. 106. Exception to medicare limitations on physician self-referral
Sec. 107. Adjustments to medicare payments to providers of service and suppliers participating in health information exchanges
Sec. 108. Medicaid payments for information infrastructure for health information exchange and information technology
Sec. 109. Definitions
Title II—Health Care Outcomes, Best Practices, and Efficiency
Sec. 201. Research on Outcomes of Health Care Items and Services
Sec. 202. Consortium for Health Outcomes Research Priorities
Sec. 203. Center for Clinical Decision-Support Technology
Sec. 204. Scholarships for study in health care quality and patient safety
Sec. 205. Standardized measures of health care provider performance
Sec. 206. Definitions
Title III—Incentives for health care quality
Sec. 301. Access to medicare health care claims databases
Sec. 302. Incorporation of measures of health care practitioner performance in Federal programs
Sec. 303. Interim claims-based practitioner performance database
Sec. 304. Clinical-based practitioner performance database
Sec. 305. Availability of performance measurements and data
Sec. 306. Use of health care provider performances measure for pay for performance
Sec. 307. Study comparing practitioner performance database
Sec. 308. Regulations on auditing
Sec. 309. AHRQ access to practitioner performance databases
<enum>I</enum><header>National Health Information Infrastructure</header>
<section id="H22E95A0016464D8496EC107BD36548F"><enum>101.</enum><header>Purpose</header><text display-inline="no-display-inline">The Secretary of Health and Human Services shall implement this title with a view to developing a national health information infrastructure. </text></section>
<section id="H325FFD448A3A47CD818E801FD769C7C0"><enum>102.</enum><header>Health information technology grants</header>
<subsection id="HA7AFD797B9E34016BDDA8ED3F1E924E6"><enum>(a)</enum><header>Phase I grants</header><text/>
<paragraph id="HB831494611B04C20A2B0E3287B1CDFB0"><enum>(1)</enum><header>Grants</header><text>The Secretary may make not more than 20 grants to health information infrastructure organizations to enable each grantee to develop and implement over a 4-year period a community health information technology plan that provides for a health information exchange to serve a geographic area in 1 or more States. </text></paragraph>
<paragraph id="HCA57BB886CC4497F93075003AC4D1926"><enum>(2)</enum><header>Use of funds</header><text>The Secretary may not make a grant to a health information infrastructure organization under this section unless the organization agrees to use the grant—</text>
<subparagraph id="H5D0F9B50418D4785A937EDDEAD80CC33"><enum>(A)</enum><text>in the first year of the grant, to develop a community health information technology plan described in paragraph (3) for submission to the Secretary under paragraph (4); and</text></subparagraph>
<subparagraph id="H33B217B9E7574337AF2349392714895D"><enum>(B)</enum><text>in each year of the grant, but not later than the second year of the grant, to implement a health information infrastructure, including a health information exchange, in accordance with the plan.</text></subparagraph></paragraph>
<paragraph id="HA07B11474A81405182034BCB6B861EC8"><enum>(3)</enum><header>Community health information technology plan</header><text/>
<subparagraph id="HB7C8487A4AB54AD7B9B964D5CFA000B6"><enum>(A)</enum><header>In general</header><text>A community health information technology plan shall provide for the establishment and implementation in a specified geographic area of a health information infrastructure that—</text>
<clause id="HC3518513A3DB49B4932FAE67AA00D16D"><enum>(i)</enum><text>includes a health information exchange that allows the seamless, secure, electronic sharing of health information among health care providers and other authorized users;</text></clause>
<clause id="H2AD5BB3B3A7E412CB11B7F566C885EF7"><enum>(ii)</enum><text>provides consumers with secure, electronic access to their own health information;</text></clause>
<clause id="H177F65489BDC4DD98B1F04C93351CDA1"><enum>(iii)</enum><text>meets data standards for interoperability adopted by the Secretary, including any standards providing for interoperability among health information exchanges;</text></clause>
<clause id="H4F8644EE67284F63AFE99CF05B68024E"><enum>(iv)</enum><text>meets the privacy requirements of subsection (d);</text></clause>
<clause id="H05DF95020C344F20AF8745FDDF6D3171"><enum>(v)</enum><text>provides such public health surveillance and reporting capability as the Secretary requires;</text></clause>
<clause id="H8F04F8E5FD0F47D49CE5E644AA9C00F2"><enum>(vi)</enum><text>allows for such reporting of, and access to, health information for purposes of research (other than individually identifiable health information) as the Secretary requires; and</text></clause>
<clause id="HA4C23CEE13294F559EBFA78A28C1FAE"><enum>(vii)</enum><text display-inline="yes-display-inline">allows for the reporting of health information (other than individually identifiable health information) to the database established under section 304 for the purpose of health care provider performance measurement in such form as required by the Secretary.</text></clause></subparagraph>
<subparagraph id="H401B6CDE57494625A47F368EA4C6F67"><enum>(B)</enum><header>Contents</header><text>A community health information technology plan shall—</text>
<clause id="H2EE3888AF1F147E08519A16F0632FA9C"><enum>(i)</enum><text>be developed with the participation and widespread support of the health care community, including all stakeholders (including small physician groups), of the geographic area to be served by the grantee’s health information exchange;</text></clause>
<clause id="HCB05DB69BCE24AEDA27D5396D36C9965"><enum>(ii)</enum><text>describe the technologies and systems, including interoperability data standards, that will be used to establish a health information exchange consistent with paragraph (A)(i) and the technological requirements and support that will be necessary for health care providers to participate in the health information exchange;</text></clause>
<clause id="HDFE3F61B0EF84C4000E2B9C6E37486C2"><enum>(iii)</enum><text>establish how health care stakeholders will share the costs of health information technology investments required by the community health information technology plan, including the costs of implementing and maintaining new systems in physicians offices, hospitals, laboratories, community health centers, pharmacies, and other facilities of health care providers;</text></clause>
<clause id="HA8BA14E8B0A44E259491C18108583395"><enum>(iv)</enum><text>establish how administrative and clinical savings resulting from widespread use of new health information technology will be accounted for and distributed among health care stakeholders;</text></clause>
<clause id="HA5ABE6DE17814BD9ADA1602D006D41CC"><enum>(v)</enum><text display-inline="yes-display-inline">explain how the health information infrastructure organization involved will ensure widespread participation by health care providers (especially small physician groups) in the grantee’s health information exchange and what support and assistance will be available to physicians seeking to integrate health information technologies into their practices;</text></clause>
<clause id="HE83BA94809324580979E74636FD69023"><enum>(vi)</enum><text display-inline="yes-display-inline">describe how patients and caregivers who are not health care providers will be able to access and utilize the health information infrastructure;</text></clause>
<clause id="H180AAF496AC44DA0979912306B5DF06C"><enum>(vii)</enum><text>establish how the health information infrastructure will be sustained over time, including anticipated sources of revenue;</text></clause>
<clause id="H9F319812B96641AAB991C920B0C8D500"><enum>(viii)</enum><text>explain how the grantee’s health information exchange will protect patient privacy and maintain security;</text></clause>
<clause id="H68F06B53853942B69146618DF5E661BF"><enum>(ix)</enum><text display-inline="yes-display-inline">explain how the grantee will ensure the participation of health care providers serving minority communities, including communities in which English is not the primary language spoken; and</text></clause>
<clause id="H2166094D649C4422AF32F184DF12B966"><enum>(x)</enum><text>require that the grantee’s health information exchange is certified by the Secretary under this section.</text></clause></subparagraph></paragraph>
<paragraph id="H8BE6E1E18F814B309EC62988F9DBD7C0"><enum>(4)</enum><header>Approval of plan</header>
<subparagraph id="H823116797F3949DA8071DC9F61B9783"><enum>(A)</enum><header>Submission</header><text>Not later than the end of the first year for which a health information infrastructure organization receives a grant under this subsection, the organization shall submit its community health information technology plan to the Secretary.</text></subparagraph>
<subparagraph id="H34A24844D44446F79456EDBC0B46BDA"><enum>(B)</enum><header>Approval</header><text>The Secretary shall approve or disapprove each community health information technology plan submitted to the Secretary under this paragraph based on whether the plan complies with the requirements of this subsection.</text></subparagraph>
<subparagraph id="HA51C1FF02E7043B78E19FDFBA5A07D86"><enum>(C)</enum><header>Effect of failure to approve</header><text>The Secretary may not make any payment under this subsection to a health information infrastructure organization for the second, third, or fourth year for which the organization receives a grant unless the Secretary has approved the organization’s community health information technology plan.</text></subparagraph></paragraph>
<paragraph id="H553EE1748E5E492ABFF15C4258D688D4"><enum>(5)</enum><header>Selection</header><text display-inline="yes-display-inline">In selecting grant recipients under this section, the Secretary shall take into account the extent to which an applicant intends to develop a community health information technology plan that covers a complete medical market area (as defined by the Secretary), geographical diversity, extent of stakeholder participation, health care provider participation commitments, capacity to measure quality and efficiency improvements, and replicability.</text></paragraph></subsection>
<subsection id="H424763EEF4EA4180933F0662F9C3C1D9"><enum>(b)</enum><header>Phase II grants</header>
<paragraph id="HBE86E4967C85426CA14054AAF19D9C8C"><enum>(1)</enum><header>Grants</header><text>For the purpose described in paragraph (2), the Secretary shall make a grant under this subsection to each State that agrees to comply with the requirements of this subsection.</text></paragraph>
<paragraph id="H663BD8ECBAA04EA2B7D819D701F4CFF"><enum>(2)</enum><header>Purpose</header><text>A funding agreement for a grant under this subsection is that the State involved will use the grant only for making subgrants to health information infrastructure organizations for the purpose of—</text>
<subparagraph id="HE9308E1DE43E4E548F61A56B33625E95"><enum>(A)</enum><text>maintaining and upgrading existing health information exchanges;</text></subparagraph>
<subparagraph id="H394D66DDFAC14C79A61D155B1D55D882"><enum>(B)</enum><text>replicating existing health information exchanges to develop and implement new health information exchanges in areas not previously served by an exchange in accordance with the process and requirements described in subsection (a);</text></subparagraph>
<subparagraph id="HCE1958493EEE4B9CA6091CD53278504F"><enum>(C)</enum><text>including additional stakeholders in the health information exchanges;</text></subparagraph>
<subparagraph id="H17A7D36210F945529B87008FB129F1CE"><enum>(D)</enum><text>working with entities in neighboring States to expand health information exchanges on a regional basis; and</text></subparagraph>
<subparagraph id="H594D9D4C9B834BBABBA2961033D98785"><enum>(E)</enum><text>connecting health information exchanges with public health and bioterrorism surveillance programs, including those of the Centers for Disease Control and Prevention.</text></subparagraph></paragraph>
<paragraph id="H001F1983709F454C9047AD885800EAB5"><enum>(3)</enum><header>Privacy</header><text>A funding agreement for a grant under this subsection is that the State involved must require that any infrastructure funded in whole or in part under this subsection must meet the privacy requirements of subsection (d).</text></paragraph>
<paragraph id="H9D1D56F8610641268366473B24F34805"><enum>(4)</enum><header>Certification</header><text>A funding agreement for a grant under this subsection is that the State involved will require that each health information exchange funded with the grant is certified by the Secretary under this section.</text></paragraph>
<paragraph id="HF8894330DF7D4EEB00EE6226CB836947"><enum>(5)</enum><header>Reports</header><text>A funding agreement for a grant under this subsection is that the State involved will submit an annual report to the Secretary on the activities of the State under this subsection, including—</text>
<subparagraph id="H27C6D949BB6449E7B786C9172E00E526"><enum>(A)</enum><text>the status of existing health information exchanges in the State; and</text></subparagraph>
<subparagraph id="H4A53B95C0FFE4D46BDE528DBE4FB14E1"><enum>(B)</enum><text>the development and implementation of new health information exchanges in the State in areas not previously served by an exchange.</text></subparagraph></paragraph>
<paragraph id="H5AB1B3DB64FA43D0B926010004EDA785"><enum>(6)</enum><header>Allocation of funds</header><text>Of the amount appropriated for each fiscal year to carry out this subsection, the Secretary shall use such appropriated amount to award a grant to each State receiving a grant under this subsection in an amount that bears the same relation to the appropriated amount as the number of physicians and hospitals in the State bears to the total number of physicians and hospitals in all such States.</text></paragraph></subsection>
<subsection id="HD00BBFD9E018422EB599E11FE7ABC08F"><enum>(c)</enum><header>Phase III grants</header><text>The Secretary shall continue to make grants to States in accordance with the provisions of subsection (b), except that—</text>
<paragraph id="H20E7717181624708A548D7CD77761FB"><enum>(1)</enum><text>grants under this subsection shall be used primarily to maintain or upgrade existing health information exchanges; and</text></paragraph>
<paragraph id="H504D2E2C45EB43EB812FDDBCFECC1996"><enum>(2)</enum><text>the Secretary may not make a grant to a State under this subsection if less than 75 percent of the health care providers in the State are participating in a health information exchange.</text></paragraph></subsection>
<subsection id="H6880A609516D4E46A2A1B945C5DDAE2E"><enum>(d)</enum><header>Privacy</header><text display-inline="yes-display-inline">Any health information infrastructure funded in whole or in part under this section shall—</text>
<paragraph id="H48C6D14F2BB7453F9861DD963F613500"><enum>(1)</enum><text display-inline="yes-display-inline">comply with the regulations promulgated pursuant to section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (<external-xref legal-doc="usc" parsable-cite="usc/42/1320d-2">42 U.S.C. 1320d–2(d)</external-xref>);</text></paragraph>
<paragraph id="HC3D5704F4CDE4DACBFE6BF6E16DBE91"><enum>(2)</enum><text display-inline="yes-display-inline">allow patients to exclude their health information from the health information exchange;</text></paragraph>
<paragraph id="H22F2462CF11A41BEA526166514B0C102"><enum>(3)</enum><text display-inline="yes-display-inline">give patients the option of allowing only designated health care providers to access their personally identifiable information concerning diagnosis and treatment of sexually transmitted diseases, addiction, and mental illnesses;</text></paragraph>
<paragraph id="H82CF692A00DE49448B7DE200E175FE37"><enum>(4)</enum><text>allow health care providers to access individually identifiable health information through health information exchanges only for reasonable purposes related to diagnosis and treatment; </text></paragraph>
<paragraph id="HE86B8B934F064384A74B4B863BBFC61D"><enum>(5)</enum><text>allow other persons to access individually identifiable health information available through health information exchanges only with express patient consent; and</text></paragraph>
<paragraph id="HBD4CEF5CA0294D1F87EDA6523F7400FB"><enum>(6)</enum><text>require health care providers, in making a transmission of individually identifiable health information to payers through the health information infrastructure, to restrict the transmission to the minimum amount of information necessary for payment of the claim involved.</text></paragraph></subsection>
<subsection id="HE502104CD3894CBBBD7FE6734521D9CD"><enum>(e)</enum><header>Application</header><text>To seek a grant under this section, an applicant shall submit an application to the Secretary in such form, in such manner, and containing such information and assurances as the Secretary may require.</text></subsection>
<subsection id="H01AF00429CFF4C58A24B38CA6D5E000"><enum>(f)</enum><header>Technical assistance</header>
<paragraph id="H615B00F091BA436100E23D77EA00DEC7"><enum>(1)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall provide to health information infrastructure organizations such technical assistance as the Secretary deems appropriate to carry out this section, including assistance relating to questions of governance, financing, and technological approaches to the creation of health information infrastructure.</text></paragraph>
<paragraph id="H350B05A6C9A64F27BA04454E13A41D92"><enum>(2)</enum><header>National technical assistance center</header>
<subparagraph id="H2A65E10D273047459074F0959C065F07"><enum>(A)</enum><header>Establishment</header><text display-inline="yes-display-inline">The Director of the Agency for Healthcare Resources and Quality shall establish and maintain a national technical assistance center to provide assistance to physicians described in subparagraph (B) to facilitate successful adoption of health information technologies and participation in the development and implementation of community health information technology plans by such physicians.</text></subparagraph>
<subparagraph id="H4FE9C5A14F8540C49F960910EC7DCB0"><enum>(B)</enum><header>Physicians</header><text display-inline="yes-display-inline">The national technical assistance center shall provide assistance to physicians in geographical areas served by a health information infrastructure organization with a phase I grant under subsection (a).</text></subparagraph>
<subparagraph id="HE17B964971F14F01BCDDE945870042E0"><enum>(C)</enum><header>Priority</header><text>In providing assistance to physicians under this paragraph, the national technical assistance centers shall—</text>
<clause id="HE864326BFBC04809A06C61835909EF79"><enum>(i)</enum><text>give priority to physicians in small physician groups; and</text></clause>
<clause id="H846EF6EA2E9348539101E538F1BB5796"><enum>(ii)</enum><text>as resources allow, provide assistance to physicians in larger groups.</text></clause></subparagraph>
<subparagraph id="H3C47FA4266534C99B7E7C2ECACC6E96B"><enum>(D)</enum><header>Requirements</header><text>Technical assistance provided under this paragraph shall, at a minimum, include the following:</text>
<clause id="HE69B97FA5F664FB1B68884C7FD1DC072"><enum>(i)</enum><text>A clearinghouse of best practices, guidelines, and implementation strategies directed at the small medical practices that plan to adopt electronic medical records and other health information technologies.</text></clause>
<clause id="HE9D70CC7F9C94FE8A52FC8F231578771"><enum>(ii)</enum><text>A change management tool kit to enable physicians and their office staffs to successfully prepare practice workflows for electronic medical record adoption, to receive guidance in the selection of vendors of health information technology products and services that are appropriate within the context of the individual practice and the community setting, to implement health information technology solutions and manage the project at the practice level, and to address the ongoing need for upgrades, maintenance, and security of office-based health information technologies.</text></clause>
<clause id="H6DE03499008D449B9EFCA3287AC3792"><enum>(iii)</enum><text>The capability to provide consultations and advice to small medical practices to facilitate adoption of health information technologies.</text></clause></subparagraph></paragraph></subsection>
<subsection id="H71DE94AE08FF43D786F0A36884F29F3C"><enum>(g)</enum><header>Certification</header><text>Not later than the date that is 1 year after the date of the enactment of this Act, the Secretary shall establish a program of certifying health information infrastructures that are in compliance with the requirements of subsection (a)(3)(A) and any other requirements of the national health information infrastructure as established by the Secretary.</text></subsection>
<subsection id="HAF9A0424103F45D4BC9EE4F5D3A6A897"><enum>(h)</enum><header>Authorization of appropriations</header>
<paragraph id="HF7FA69F75FFC4F0C8B494EB7ED5359B4"><enum>(1)</enum><header>In general</header><text>To carry out the provisions of this section other than subsection (f)(2), there are authorized to be appropriated—</text>
<subparagraph id="H00DC3043ADDE476787723B9C07B42D4C"><enum>(A)</enum><text>for phase I grants under subsection (a), $55,000,000 for fiscal year 2005 and $167,000,000 for each of fiscal years 2006, 2007, and 2008;</text></subparagraph>
<subparagraph id="HD195F4D870744B35AA45DF96B5459B6E"><enum>(B)</enum><text>for phase II grants under subsection (b), $400,000,000 for each of fiscal years 2009 through 2013; and</text></subparagraph>
<subparagraph id="H6D2CA184A7194D94B7DA2765183EF200"><enum>(C)</enum><text>for phase III grants under subsection (c), such sums as may be necessary for fiscal year 2014 and each subsequent fiscal year.</text></subparagraph></paragraph>
<paragraph id="HB414A921A9DC412480D086822221966"><enum>(2)</enum><header>Technical assistance</header>
<subparagraph id="HB921784149EC402A8518EA1170353B07"><enum>(A)</enum><header>In general</header><text>Of the amount appropriated to carry out this section for a fiscal year, not more than than 10 percent of such amount or $5,000,000, whichever is lesser, may be used to provide technical assistance under subsection (f)(1).</text></subparagraph>
<subparagraph id="H6628F866B43E4FC5A4FCF8135183C2AE"><enum>(B)</enum><header>National technical assistance center</header><text>To carry out subsection (f)(2), there is authorized to be appropriated $2,500,000 for each of fiscal years 2005 through 2008.</text></subparagraph></paragraph></subsection></section>
<section id="HA8D03B8441BD4F4496FE9362A12EEB8"><enum>103.</enum><header>Standards for interoperability of health information technology systems</header>
<subsection id="H9DFB8B3E4D104E5894E5483F001B51EC"><enum>(a)</enum><header>Standards</header><text>Not later than 1 year after the date of the enactment of this Act, after considering the recommendations of the Working Group, the Secretary of Health and Human Services, the Secretary of Defense, and the Secretary of Veterans Affairs, acting jointly, shall adopt data standards for the interoperability of health information technology systems.</text></subsection>
<subsection id="HAA708F58AB684C1EA8D69B67BEF4B83E"><enum>(b)</enum><header>Periodic review</header><text>The Secretary of Health and Human Services, the Secretary of Defense, and the Secretary of Veterans Affairs, acting jointly, shall periodically review the data standards adopted under subsection (a) and, as appropriate, revise such standards.</text></subsection>
<subsection id="HBA6E1C4C4A934787942684BB3C44E08E"><enum>(c)</enum><header>Application</header><text display-inline="yes-display-inline">The Secretary of Health and Human Services, the Secretary of Defense, and the Secretary of Veterans Affairs shall require that each program using health information technology of the Department of Health and Human Services, the Department of Defense, and the Department of Veterans Affairs, respectively, complies with the data standards adopted under subsection (a).</text></subsection>
<subsection id="H970FF9E4ECFD415DB420625DDDDA5581"><enum>(d)</enum><header>Working Group</header>
<paragraph id="H2D96E932798645A49BF83EC7DBF96D21"><enum>(1)</enum><header>Establishment</header><text>The Secretary of Health and Human Services shall convene a Working Group to formulate recommendations on the adoption of data standards for the interoperability of health information technology systems.</text></paragraph>
<paragraph id="H2BA983A4E2114F77A620FF1DC97F0097"><enum>(2)</enum><header>Membership</header><text>The members of the Working Group shall include the following:</text>
<subparagraph id="HB85056FADA864449B4C5A35F45345CB0"><enum>(A)</enum><text>Health informatics experts from the Department of Defense, the Department of Health and Humans Services, the Department of Veterans Affairs, the Indian Health Service, and the private sector.</text></subparagraph>
<subparagraph id="HF90699BFECC24FDABD070530CBD06443"><enum>(B)</enum><text>Practicing physicians.</text></subparagraph>
<subparagraph id="H8741C05A217C4A01A3A64DD51AB7B23"><enum>(C)</enum><text>Nurses.</text></subparagraph>
<subparagraph id="HD5D2374020CA4822AAE7C388DB38CC9B"><enum>(D)</enum><text display-inline="yes-display-inline">Representatives of other health care providers.</text></subparagraph>
<subparagraph id="H69F6E97F487A4E40BBB208121FA3008E"><enum>(E)</enum><text display-inline="yes-display-inline">Hospital administrators and hospital chief information officers.</text></subparagraph>
<subparagraph id="HE39AF5B415BA4A1EB030762317824E9E"><enum>(F)</enum><text>Representatives of standards development organizations.</text></subparagraph>
<subparagraph id="H81B3B1CB6A14464D9361FE00934D54CA"><enum>(G)</enum><text>Representatives of standards development organizations.</text></subparagraph>
<subparagraph id="H12701AE2D54D43D2A55D3BC7C55DD427"><enum>(H)</enum><text>Representatives of the Agency for Healthcare Research and Quality.</text></subparagraph>
<subparagraph id="H22B2ADC22B034B028F41EA889407B9E5"><enum>(I)</enum><text>Representatives of the National Library of Medicine.</text></subparagraph>
<subparagraph id="H6B220DD26D8B4FFEB27810A9AAC3C340"><enum>(J)</enum><text>Other individuals, as determined appropriate by the Secretary, with expertise relevant to recommending data standards for the interoperability of health information technology systems.</text></subparagraph></paragraph>
<paragraph id="HBC13A5CEC06A4A42A41E01EEBADAF074"><enum>(3)</enum><header>Duties</header><text>The Working Group shall formulate recommendations to the Secretary of Health and Human Services, the Secretary of Defense, and the Secretary of Veterans Affairs on the adoption of data standards for the interoperability of health information technology systems, including recommendations on standards for each of the following:</text>
<subparagraph id="H132E1E5DACEA4DE1B166A6A79699772D"><enum>(A)</enum><text>Components of electronic medical records.</text></subparagraph>
<subparagraph id="H46276F7D431B4B94B671B6871DD3F3AD"><enum>(B)</enum><text>Interchange of clinical data, including, with a patient’s consent, the sharing of patient data—</text>
<clause id="H18BBB7565E4C48C700A534DA992125F5"><enum>(i)</enum><text>across health care provider and community boundaries; and</text></clause>
<clause id="H22A51554C25142C6AC7276B56592067"><enum>(ii)</enum><text>between health care providers and patients.</text></clause></subparagraph>
<subparagraph id="HC557D3C4B5E04EBE9DA5E110002C4292"><enum>(C)</enum><text>Terminologies.</text></subparagraph>
<subparagraph id="H3256E5E8FBE64F1D92724E4FC4503E79"><enum>(D)</enum><text>Medical knowledge representation.</text></subparagraph>
<subparagraph id="H17E1AB7BDE24406FA468B2FF45EF12E"><enum>(E)</enum><text>Computerized physician order entry.</text></subparagraph>
<subparagraph id="HAFF57D2B8D284E75A070B07D89E991AA"><enum>(F)</enum><text>Privacy, security, and authentication of health information.</text></subparagraph></paragraph></subsection>
<subsection id="HD44B854138B1462BA4A95450B18740D8"><enum>(e)</enum><header>Authorization of appropriations</header><text>There are authorized to be appropriated to carry out this section—</text>
<paragraph id="H30C5B8C6BE70417D891E87A084D25F54"><enum>(1)</enum><text>$5,000,000 for each of fiscal years 2005 and 2006; and</text></paragraph>
<paragraph id="H17E5399150E54E1C851304691B6602C0"><enum>(2)</enum><text>$2,000,000 for fiscal year 2007 and each subsequent fiscal year.</text></paragraph></subsection></section>
<section id="H92233140C33549FCA68E935E0180277E"><enum>104.</enum><header>Loans</header>
<subsection id="H9BB27B1F592E41739EE61F575800D003"><enum>(a)</enum><header>In general</header><text>The Secretary may make loans to health information infrastructure organizations that receive a phase I grant under section 102(a) or a phase II subgrant under section 102(b) to provide additional funding for activities under the grant, including funding for the costs of—</text>
<paragraph id="H2E5A3D5931F24F7CB3C10072D33C00F1"><enum>(1)</enum><text>developing a community health information technology plan under section 102(a)(3); and</text></paragraph>
<paragraph id="HE2C88D638A664715BE1E56A297FC5231"><enum>(2)</enum><text>implementing technology investments, training, and workflow reengineering under the plan.</text></paragraph></subsection>
<subsection id="H9317F10C3F474BD1A31D59E30048FB4E"><enum>(b)</enum><header>Terms and conditions</header><text>Each loan under this section shall be subject to such terms and conditions as the Secretary deems appropriate, except that—</text>
<paragraph id="H0254194BD5F348B1948DE66B362FFDDF"><enum>(1)</enum><text>the repayment period of each such loan may not exceed 10 years;</text></paragraph>
<paragraph id="H987FFB8E85C248C0A82D29C87D149800"><enum>(2)</enum><text>any technology investments paid for in whole or in part with funds from the loan must comply with the data standards for the interoperability of health information technology systems adopted by the Secretary under section 103;</text></paragraph>
<paragraph id="H2112761C8D1B4B7CA7CC4022BE7B4CB"><enum>(3)</enum><text>any technology investments paid for in whole or in part with funds from the loan must comply with the privacy requirements of section 102(d); and</text></paragraph>
<paragraph id="HE4567B87961C4740BB243D37C1534FD8"><enum>(4)</enum><text>the Secretary shall require the health information infrastructure organization involved to provide to the Secretary an annual accounting of loan funds.</text></paragraph></subsection></section>
<section id="H16533641F67E47CB81C2FEA0A96B8473" section-type="subsequent-section" display-inline="no-display-inline"><enum>105.</enum><header>Safe harbor for equipment and services provided for the development or implementation of a health information infrastructure</header><text display-inline="no-display-inline">Paragraph (3) of section 1128B(b) of the Social Security Act (42 U.S.C. 1320a–7b(b)) is amended—</text>
<paragraph id="HE965A86677684E5FB4FC17961C5946C8"><enum>(1)</enum><text>by striking the period at the end of the first subparagraph (H) and inserting a semicolon;</text></paragraph>
<paragraph id="HA1A94260E25F4F67BC5F5F7999C85895"><enum>(2)</enum><text>by redesignating the second subparagraph (H) as subparagraph (I);</text></paragraph>
<paragraph id="H4031BCA9CEF2417E993FA492FCBF86FB"><enum>(3)</enum><text>by striking the period at the end of subparagraph (I) (as so redesignated) and inserting <quote>; and</quote>; and</text></paragraph>
<paragraph id="H47302D44AFAA4F9CB041D6D4A6007B98"><enum>(4)</enum><text>by adding at the end the following:</text>
<quoted-block id="H78F4A8F30EA445039D8FCA009200D91E" style="OLC">
<subparagraph id="H663E66E6BA1E43ECB05286A25000B2F1"><enum>(J)</enum><text>the provision of any equipment or services that are appropriate for the development or implementation of a health information infrastructure under section 102 of the Quality, Efficiency, Standards, and Technology for Health Care Transformation Act of 2004, including the provision of hardware, software, and services necessary to participate in a health information exchange so long as such equipment or services are not provided in any manner that takes into account the volume, or value, of referrals or other business generated between the parties.</text></subparagraph><after-quoted-block>.</after-quoted-block></quoted-block></paragraph></section>
<section id="H3C2CB2C599E34BC99640008CFA00C055" section-type="subsequent-section"><enum>106.</enum><header>Exception to medicare limitations on physician self-referral</header><text display-inline="no-display-inline">Section 1877(e) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395nn">42 U.S.C. 1395nn(e)</external-xref>) is amended by adding at the end the following new paragraph:</text>
<quoted-block style="OLC" id="H0F2A5BAFC468421B94CB6904D008F9E" display-inline="no-display-inline">
<paragraph id="H937EFE446FAB4259ABBCB3DE907ABD7"><enum>(9)</enum><header>Development or implementation of a health information infrastructure</header><text>The provision of any equipment or services as appropriate for the development or implementation of a health information infrastructure under section 102 of the Quality, Efficiency, Standards, and Technology for Health Care Transformation Act of 2004, including the provision of hardware, software, and services necessary to participate in a health information exchange so long as such equipment or services are not provided in any manner that takes into account the volume or value of referrals or other business generated between the parties.</text></paragraph><after-quoted-block>.</after-quoted-block></quoted-block></section>
<section id="HB0E06CDCA4CB4DCCB1A3E3E405007F09" section-type="subsequent-section" display-inline="no-display-inline"><enum>107.</enum><header>Adjustments to medicare payments to providers of service and suppliers participating in health information exchanges</header>
<subsection id="H9BCCAADAB4E043C9ADD8C783F832A30"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary shall establish a methodology for making adjustments in payment amounts under title XVIII of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395">42 U.S.C. 1395 et seq.</external-xref>) made to providers of services and suppliers who furnish items or services for which payment is made under that title who—</text>
<paragraph id="HB64902FF218841649FADE9E6F47F0089"><enum>(1)</enum><text>participate in a health information exchange certified by the Secretary under section 103(b); or </text></paragraph>
<paragraph id="H45C0CD3DBF0D417CAC67E6E22000B2BA"><enum>(2)</enum><text>in the course of furnishing items and services for which payment may be made under such title, use information technology with patient-specific applications that the Secretary determines improve the quality and accuracy of clinical decision-making (such as electronic medical records and computerized physician order entry).</text></paragraph></subsection>
<subsection id="HE4701ED369CA4782B5010826849CC00"><enum>(b)</enum><header>Establishment and modification of codes</header><text display-inline="yes-display-inline">The methodology under subsection (a) shall—</text>
<paragraph id="HD176CA5DFF034B9D8DF4023D6CD52B"><enum>(1)</enum><text>include the establishment of new codes, modification of existing codes, and adjustment of evaluation and management modifiers to such codes that take into account the costs of acquiring, using, and maintaining information technology with patient-specific applications; and</text></paragraph>
<paragraph id="HC869BE5B72184E13A69CC55957009C8E"><enum>(2)</enum><text display-inline="yes-display-inline">take into account estimated aggregate annual savings in overall payments under such title XVIII attributable to the use of information technology with patient-specific applications.</text></paragraph></subsection>
<subsection id="H176A407C0D6442FDB045E19C00FD2BC2"><enum>(c)</enum><header>Duration</header><text display-inline="yes-display-inline">The Secretary may reduce or eliminate adjustments established made to subsection (a) as payment methodologies under title XVIII of the Social Security Act are adjusted to reflect provider quality and efficiency.</text></subsection>
<subsection id="H4926787999914A11AF359CCDF6394480"><enum>(d)</enum><header>Rule of construction</header><text display-inline="yes-display-inline">In making national coverage determinations under section 1862(a) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395y">42 U.S.C. 1395y(a)</external-xref>) with respect to maintaining information technology with patient-specific applications, in determining whether the information technology is reasonable and necessary for the diagnosis or treatment of illness or injury or to improve the functioning of a malformed body member, the Secretary shall consider whether the information technology improves clinical outcomes or cost-effectiveness of treatment.</text></subsection>
<subsection id="HC48571823BE84BCFACE8A246DEB6DE6E"><enum>(e)</enum><header>Definitions</header><text>In this section:</text>
<paragraph id="H421B997646AE40BEBC1F36429919AAA7"><enum>(1)</enum><header>Provider of services</header><text>The term <term>provider of services</term> has the meaning given such term under section 1861(u) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(u)</external-xref>). </text></paragraph>
<paragraph id="HAF9ACE9750C94F51A74DB1FF50834F86"><enum>(2)</enum><header>Supplier</header><text>The term <term>supplier</term> has the meaning given such term under section 1861(d) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(d)</external-xref>).</text></paragraph></subsection></section>
<section id="HF5CC00029F0C44ECB8CF28A12026B233" display-inline="no-display-inline" section-type="subsequent-section"><enum>108.</enum><header>Medicaid payments for information infrastructure for health information exchange and information technology</header>
<subsection id="H3B163045BE6F4948B0CF732C2540CA4C"><enum>(a)</enum><header>Payment</header><text display-inline="yes-display-inline">In the case of a State that provides funding under a State plan under title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>) for the design, development, and installation of information infrastructure consisting of a health information exchange and information technology operated by health care providers pursuant to a community health information technology plan approved by the Secretary under section 102, the Secretary shall make matching payments to States under section 1903(a) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396b">42 U.S.C. 1396b(a)</external-xref>) for such funding.</text></subsection>
<subsection id="H48EB2709B6064C81AAFC609513E7AFD6"><enum>(b)</enum><header>90 percent FMAP for phase i grants</header><text display-inline="yes-display-inline">In addition to payment amounts provided for in subsection (a), for calendar quarters occurring during the first three years during which a State provides funding referred to in subsection (a), the Secretary shall provide for payment to such State at the rate provided for under section 1903(a)(3)(A)(i) of such Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396b">42 U.S.C. 1396b(a)(3)(A)(i)</external-xref>).</text></subsection></section>
<section id="HAB4D29D4BE104428BEADE500C94632CD"><enum>109.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text>
<paragraph display-inline="no-display-inline" id="HDCA4462CF97C420D94E3292557F965DC"><enum>(1)</enum><text>The term <term>health care provider</term> means an entity involved in consultation, prevention, diagnosis, and treatment, including but not limited to a physician group, physician in individual practice, hospital, community health center, skilled nursing facility, laboratory, imaging center, or pharmacy.</text></paragraph>
<paragraph id="HF2D9BB21E6364590947E4DFF9B4970C1"><enum>(2)</enum><text>The term <term>health information infrastructure organization</term> means an organization that—</text>
<subparagraph id="H67A3F123258C48D284E5F445211762B0"><enum>(A)</enum><text display-inline="yes-display-inline">facilitates the drafting and implementation of a community health information infrastructure plan for a given geographic area in 1 or more States;</text></subparagraph>
<subparagraph id="H9E3F6671E8994CD4B2A769CE9D9176A0"><enum>(B)</enum><text>with respect to each area to be served by the organization with a grant under this section, is designated by the Governors of the States involved as the exclusive health information infrastructure organization for that area; and</text></subparagraph>
<subparagraph id="H7E4BD9358D204BF39C05809CB57070E1"><enum>(C)</enum><text>is governed by a board that—</text>
<clause id="H74214E31CED045DFBBE776E852D39D7E"><enum>(i)</enum><text>includes representatives of health care insurers and other third party payors, government health care programs, employers, physicians and other health care providers, hospitals, and consumers; and</text></clause>
<clause id="HF6687AA66A60457C934500D97FB71054"><enum>(ii)</enum><text>may include representatives of organized labor.</text></clause></subparagraph></paragraph>
<paragraph id="H650FC5967F87479586BF158921FCFA0"><enum>(3)</enum><text>The term <term>physician</term> has the meaning given to that term in section 1861(r) of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1395x">42 U.S.C. 1395x(r)</external-xref>).</text></paragraph>
<paragraph id="HB0C2F86204CE444F81007F2E46DB72B6"><enum>(4)</enum><text>The term <term>small physician group</term> means a physician practice group of 10 or fewer physicians. </text></paragraph>
<paragraph id="HFC395F06679E4D1AA33BB70131907472"><enum>(5)</enum><text>The term <term>State</term> includes the 50 States and the District of Columbia.</text></paragraph>
<paragraph id="H0877627A63E748F694B9CE7D16FD5CB4"><enum>(6)</enum><text>The term <term>Working Group</term> means the working group convened under section 103. </text></paragraph></section>
<enum>II</enum><header>Health Care Outcomes, Best Practices, and Efficiency</header>
<section id="H9384D95FC2AC40AA88B8E9E73EF0073"><enum>201.</enum><header>Research on Outcomes of Health Care Items and Services</header><text display-inline="no-display-inline">Section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (<external-xref legal-doc="usc" parsable-cite="usc/42/299b-7">42 U.S.C. 299b–7</external-xref>) is amended—</text>
<paragraph id="H1DDFD4561FB5425094B61CE74595415D"><enum>(1)</enum><text>in subsection (a)—</text>
<subparagraph id="HB8D833B299B749B7BCC649BA5E4B4EEC"><enum>(A)</enum><text>in clause (i) of paragraph (1)(A), by inserting <quote>cost-effectiveness,</quote> before <quote>comparative clinical effectiveness,</quote>;</text></subparagraph>
<subparagraph id="HC62F3A30370E41B39F7D10C9D33E0049"><enum>(B)</enum><text>by striking paragraph (2) and inserting the following:</text>
<quoted-block style="OLC" id="HEF3A10DED0C9470A89D75EA1AA2C2673" display-inline="no-display-inline">
<paragraph id="H8F680BC497F94327B09E0000FD500CB"><enum>(2)</enum><header>Priorities</header><text>In carrying out this section, the Secretary shall adopt and implement the priorities established by the Consortium for Health Outcomes Research Priorities under section 202 of the Quality, Efficiency, Standards, and Technology for Health Care Transformation Act of 2004.</text></paragraph><after-quoted-block>; and</after-quoted-block></quoted-block></subparagraph>
<subparagraph id="H973432C5295D4DBD00CDD776B4A88BF"><enum>(C)</enum><text>in clause (i) of paragraph (3)(A), by inserting <quote>cost-effectiveness,</quote> before <quote>comparative clinical effectiveness,</quote>;</text></subparagraph></paragraph>
<paragraph id="HA225CE283E9A4F4CADA4F52242B3283"><enum>(2)</enum><text>by striking subsection (d);</text></paragraph>
<paragraph id="H99259F7CE8E244FFBF8C8140FD25F83F"><enum>(3)</enum><text>in subsection (e), by inserting <quote>$150,000,000 for fiscal year 2005, $250,000,000 for fiscal year 2006, $400,000,000 for fiscal year 2007, $750,000,000 for fiscal year 2008, $1,000,000,000 for fiscal year 2009,</quote> before <quote>and such sums as may be necessary for each fiscal year thereafter</quote>; and</text></paragraph>
<paragraph id="HF8509CA10BE34C92B032EFA7DFB9C64E"><enum>(4)</enum><text>by redesignating subsection (e) as subsection (d).</text></paragraph></section>
<section id="HEAEEA89C8244425E88574DE090F2CFE8"><enum>202.</enum><header>Consortium for Health Outcomes Research Priorities</header>
<subsection id="H4C0F5D53A09B4FBAAB00003972527EC2"><enum>(a)</enum><header>Establishment</header><text>The Director of the Agency for Healthcare Research and Quality shall enter into an agreement with the Institute of Medicine to establish the Consortium for Health Outcomes Research Priorities.</text></subsection>
<subsection id="HF23B6A3A5B6A4160A673A082B70049D"><enum>(b)</enum><header>Members</header>
<paragraph id="H3DB89AC6A1BC490DB3A883005F85C489"><enum>(1)</enum><header>In general</header><text>The Consortium shall be composed of the ex officio members listed in paragraph (2) and the members appointed by the Institute of Medicine under paragraph (3).</text></paragraph>
<paragraph id="HC9A851554D2A47608602AEAC008EDAF4"><enum>(2)</enum><header>Ex officio members</header><text>The ex officio members of the Consortium shall include the following:</text>
<subparagraph id="H67B87EC753564FB0846F75EC294D6DB1"><enum>(A)</enum><text>The Administrator of the Centers for Medicare and Medicaid Services.</text></subparagraph>
<subparagraph id="H8D18032B05DE4803977EBDE7B2835FA9"><enum>(B)</enum><text>The Commissioner of Food and Drugs.</text></subparagraph>
<subparagraph id="HC6B51CCD0F6D4901846F6D1E66BFEA20"><enum>(C)</enum><text>The Director of the Agency for Healthcare Research and Quality.</text></subparagraph>
<subparagraph id="HA7D8AE3834A1414AB9D6D5D4DC22212"><enum>(D)</enum><text>The Director of the Centers for Disease Control and Prevention.</text></subparagraph>
<subparagraph id="H28A529367C3F459E91A7830093360060"><enum>(E)</enum><text>The Director of the Indian Health Service.</text></subparagraph>
<subparagraph id="H887D5F17C55B4961941669772BBFC2D7"><enum>(F)</enum><text>The Director of the National Institutes of Health.</text></subparagraph>
<subparagraph id="H544221E157B44F6283FD67D4F2F284F1"><enum>(G)</enum><text>The Assistant Secretary of Defense for Health Affairs.</text></subparagraph>
<subparagraph id="H2339B3621DB74E65003E565CFBC82E98"><enum>(H)</enum><text>The Under Secretary for Health, Department of Veterans Affairs.</text></subparagraph></paragraph>
<paragraph id="H2AE772D9E2EC4BFA8B04B1D1AE74F7C6"><enum>(3)</enum><header>Appointed members</header><text>The members of the Consortium appointed by the Institute of Medicine shall include the following:</text>
<subparagraph id="H9FDBD4AA798245B19500A40074C2838D"><enum>(A)</enum><text>Academics.</text></subparagraph>
<subparagraph id="H92CD0CE32B9F4C87A0943E0040F076D4"><enum>(B)</enum><text>Practicing physicians.</text></subparagraph>
<subparagraph id="HE405BF2DE90F4BA700A61436D7C5FD1C"><enum>(C)</enum><text>Representatives of the following:</text>
<clause id="HDF86574AD9634FA58B2E415456849495"><enum>(i)</enum><text>Hospitals.</text></clause>
<clause id="H5894B150F0514A069B1074624215CC"><enum>(ii)</enum><text>Drug companies.</text></clause>
<clause id="H31BD3A7DA76F4C6397083700046225E7"><enum>(iii)</enum><text>Device companies.</text></clause>
<clause id="H317E1422B27E405BB534D0B818C400D1"><enum>(iv)</enum><text display-inline="yes-display-inline">Health care insurers, including State medicaid programs under title XIX of the Social Security Act (<external-xref legal-doc="usc" parsable-cite="usc/42/1396">42 U.S.C. 1396 et seq.</external-xref>).</text></clause>
<clause id="H1F0B4EF25C4F4F9A84BEA1B321ED1F07"><enum>(v)</enum><text>Employers or employer groups with a history of supporting health care quality initiatives.</text></clause>
<clause id="HFC34734DFCC145F2B77B9CEA4DB080CA"><enum>(vi)</enum><text>Patient advocacy groups.</text></clause>
<clause id="H8BDA1D26AC98453100192816EB3F593"><enum>(vii)</enum><text>Professional societies.</text></clause>
<clause id="HB6D7AC44456A460A8B9327593552D17D"><enum>(viii)</enum><text>Health foundations.</text></clause></subparagraph></paragraph>
<paragraph id="H67692EFBF9C043F9AA9ED20D73FEF32"><enum>(4)</enum><header>Majority of members</header><text display-inline="yes-display-inline">A majority of the members of the Consortium shall be appointed by the Institute of Medicine under paragraph (3).</text></paragraph></subsection>
<subsection id="H3B4F7A14848E4E3197D75DF09488F770"><enum>(c)</enum><header>Duties</header><text display-inline="yes-display-inline">The Consortium shall—</text>
<paragraph id="H2735202F90884E808B7EFB00CE4586A4"><enum>(1)</enum><text>establish research priorities under subsection (d); and</text></paragraph>
<paragraph id="H8A0077601EFC4D05AA5676F6EC4F4E44"><enum>(2)</enum><text>carry out section 205 (relating to standardized measures of health care provider performance).</text></paragraph></subsection>
<subsection id="HD88D0FB1E16543F4AA1C611B4DCC90C4"><enum>(d)</enum><header>Research priorities</header>
<paragraph id="H93BCA9F938D845E9BC8500F9FAEC2700"><enum>(1)</enum><header>Establishment</header><text display-inline="yes-display-inline">On an annual basis, the Consortium shall establish priorities for research conducted or supported by the Agency for Healthcare Research and Quality under section 1013 of the Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (<external-xref legal-doc="usc" parsable-cite="usc/42/299b-7">42 U.S.C. 299b–7</external-xref>) (relating to the effectiveness and efficiency of health care items and services).</text></paragraph>
<paragraph id="H89F040A790F146E9A9C27000EDAB8BE6"><enum>(2)</enum><header>Consideration</header><text>In establishing research priorities under subsection (c)(1), the Consortium shall take into consideration—</text>
<subparagraph id="H0B7CA260DC854230B799424E8F92EF49"><enum>(A)</enum><text>the extent to which health care items and services—</text>
<clause id="H73A1114C00424E56B6CE4EC4EFC6AF08"><enum>(i)</enum><text>impact large numbers of people; or</text></clause>
<clause id="H6568D69F93014919ADBCC21055A63E45"><enum>(ii)</enum><text>impose high health care costs; and</text></clause></subparagraph>
<subparagraph id="H1C4119035F0D4E228ECCAD226852B51E"><enum>(B)</enum><text>the extent of the need for data with respect to diseases or conditions affected by those health care items and services.</text></subparagraph></paragraph>
<paragraph id="H7710D7A2DBA24C8AB382779E2D9676CE"><enum>(3)</enum><header>Transparency</header><text>In carrying out this section, the Consortium shall ensure that research priorities are established in a manner that is publicly transparent.</text></paragraph></subsection></section>
<section id="H3CAFDD4A68BA47E087B8B71241BED1BD"><enum>203.</enum><header>Center for Clinical Decision-Support Technology</header>
<subsection id="HB508994AB6F54D9F8F9133AB78FF1E38"><enum>(a)</enum><header>Establishment</header><text display-inline="yes-display-inline">The Director, in collaboration with the National Library of Medicine, shall establish and support by grant or contract a Center for Clinical Decision-Support Technology to enable health care providers across the United States to more efficiently and rapidly embed knowledge-based elements in their clinical information systems.</text></subsection>
<subsection id="H2CA91360B8A34B8E81F5267DA5E599BB"><enum>(b)</enum><header>Duties</header><text>The Center for Clinical Decision-Support Technology shall—</text>
<paragraph id="H7FD55E0137BE42A1845CF503B488E81"><enum>(1)</enum><text>design and develop new approaches to knowledge organization, modeling, and decision support;</text></paragraph>
<paragraph id="H0D4427A9048941D48FE67600E0102500"><enum>(2)</enum><text>develop standards and promote existing standards for guideline models, standard data sets, vocabularies, and interfaces among components of the decision-support system;</text></paragraph>
<paragraph id="HF2290787709B42258F00A92883DBAE3D"><enum>(3)</enum><text>build tools to facilitate the encoding of medical knowledge in a structured form to enable such knowledge to be used in patient-specific decision support, associated with other relevant evidence, updated and maintained, and adapted to local systems and environments;</text></paragraph>
<paragraph id="H0EC1D76CE6FC498B9D4F9831B34C00A0"><enum>(4)</enum><text>define and regularly update methods to determine the effectiveness of such tools, including the appropriateness of the knowledge, the ease of adaptation to local environments, and the success of the intended application in achieving specific goals;</text></paragraph>
<paragraph id="H7CABA265C3C54666B097000012F58FB1"><enum>(5)</enum><text>generalize or abstract the features of specific applications in the systems of the affiliated health care delivery organizations that have been found to be successful, but for which sharing and dissemination are not easily achieved, due to system-specific designs; and</text></paragraph>
<paragraph id="H9DBF8BE186E04C2BBE300745E914AF00"><enum>(6)</enum><text>explore optimal interface approaches to access and use of knowledge resources for health care providers and consumers.</text></paragraph></subsection>
<subsection id="H8F697320C0DB4DBEA48C29AF2573AF1E"><enum>(c)</enum><header>Authorization of appropriations</header><text display-inline="yes-display-inline">To carry out this section, there are authorized to be appropriated $2,000,000 for fiscal year 2005 and such sums as may be necessary for each subsequent fiscal year.</text></subsection></section>
<section id="H349062CED086422283B9982BD44D4270"><enum>204.</enum><header>Scholarships for study in health care quality and patient safety</header>
<subsection id="HF6F5D186988748EEA9F74FEFF84B72D0"><enum>(a)</enum><header>Purposes</header><text>The purposes of this section are to improve health care quality and patient safety and to achieve a corresponding reduction in health care costs by providing scholarships to future health care leaders for study in the fields of health care quality and patient safety. </text></subsection>
<subsection id="H4DB764E9607942AC88781EBCF0528635"><enum>(b)</enum><header>Scholarships</header><text>For the purposes described in subsection (a), the Director may make grants to eligible institutions for the awarding of scholarships to physicians, nurses, other health care personnel, and administrators to enable such individuals to obtain a master’s degree or a doctoral degree in the field of health care quality and patient safety.</text></subsection>
<subsection id="H4821C13419EC4086AA4383258B4B6340"><enum>(c)</enum><header>Priority</header><text>A condition on the receipt of a grant under this section is that the eligible institution, in awarding scholarships, will give priority to applicants whose studies will focus on—</text>
<paragraph id="H25396152447B47379C32CBB9A8595217"><enum>(1)</enum><text>measuring, monitoring, and improving the clinical and financial performance of health care service organizations; or</text></paragraph>
<paragraph id="HE21F750BC0BC49DD9DB494BA6BBDD100"><enum>(2)</enum><text>providing leadership for organizational change within the health care system.</text></paragraph></subsection>
<subsection id="H7C8CE5DFF72B4542A26885457CFE6EEF"><enum>(d)</enum><header>Use of scholarships</header><text>A scholarship under this section may be used to pay the costs of all reasonable educational expenses, including tuition, fees, and books, and such stipends as the Director determines to be appropriate.</text></subsection>
<subsection id="H16EE2F2A45DA437DBF1DF9D7B44B6699"><enum>(e)</enum><header>Flexibility</header><text>A condition on the receipt of a grant under this section is that the eligible institution will offer flexibility to scholarship recipients who desire to continue clinical practice while pursuing a course of study, including by allowing such recipients to pursue a course of study on a part-time basis.</text></subsection>
<subsection id="H7DC2D605A589443084D39060000F377"><enum>(f)</enum><header>Definition</header><text>In this section:</text>
<paragraph id="HCCB2D66EEB464353BC53A2674DC4A334"><enum>(1)</enum><text>The terms <term>accredited</term> and <term>school of public health</term> have the meanings given to those terms in section 799B of the Public Health Service Act (<external-xref legal-doc="usc" parsable-cite="usc/42/295p">42 U.S.C. 295p</external-xref>).</text></paragraph>
<paragraph id="HC55BC2A9E49146BCB4B8E5640577B565"><enum>(2)</enum><text display-inline="yes-display-inline">The term <term>eligible institution</term> means an accredited school of public health offering a master’s degree or a doctoral degree in the field of health care quality and patient safety with a curriculum that—</text>
<subparagraph id="H900CADA2784C439EB403ED451F85FD4C"><enum>(A)</enum><text>is interdisciplinary;</text></subparagraph>
<subparagraph id="HCC0E8C0F53CC40838B76BA17A89BBC02"><enum>(B)</enum><text>includes coursework and training in—</text>
<clause id="H9D305D870A7E44E38797FD737CED20F2"><enum>(i)</enum><text>health services research;</text></clause>
<clause id="HAAC17F9B9791478891A83D8DE37B7C95"><enum>(ii)</enum><text>health care quality;</text></clause>
<clause id="H0B23998CDE934205B54BF41125727FF0"><enum>(iii)</enum><text>decision analysis;</text></clause>
<clause id="H414C17B19C80472CA07E92B1FE223CCA"><enum>(iv)</enum><text>cost-benefit and cost-effectiveness analysis; and</text></clause>
<clause id="HFF77DDDA7A7E40ECB4200062F75D8F73"><enum>(v)</enum><text>management skills and leadership; and</text></clause></subparagraph>
<subparagraph id="H9B141A15E9E24A9AB9C1894ECCE900F6"><enum>(C)</enum><text>includes fieldwork in a health care facility.</text></subparagraph></paragraph></subsection>
<subsection id="H5A685EA3C5EF4E7587D70078EA8E048B"><enum>(g)</enum><header>Authorization of appropriations</header><text>To carry out this section, there are authorized to be appropriated $2,000,000 for fiscal year 2005 and such sums as may be necessary for each subsequent fiscal year.</text></subsection></section>
<section id="H2CCA65012E4C4B0AAD62C74D311E1B19"><enum>205.</enum><header>Standardized measures of health care provider performance</header>
<subsection id="H3739929828634508A4B159484F6CC0D7"><enum>(a)</enum><header>Priorities</header><text>Not later than 1 year after the date of the enactment of this Act, the Consortium shall identify priorities for developing, updating, and endorsing standardized measures of health care provider performance under this section. Such priorities shall—</text>
<paragraph id="H52C4237C9CA543D88D873028D9FF1136" display-inline="no-display-inline"><enum>(1)</enum><text>first be developed for each of the 20 priority areas for improvement in health care quality specified in the report by the Institute of Medicine entitled <quote>Priority Areas for National Action: Transforming Health Care Quality</quote>; </text></paragraph>
<paragraph id="H7DDD355135574F988926293864EF9F79"><enum>(2)</enum><text>include priorities for measures of health care provider performance based on adherence to evidence-based medicine, patient outcomes, efficiency, and patient satisfaction;</text></paragraph>
<paragraph id="H2E9A880BE9434C3EBD233030E9D5323F"><enum>(3)</enum><text display-inline="yes-display-inline">include priorities for measures specific to a range of practice settings, including individual doctors and small physician groups;</text></paragraph>
<paragraph id="H706A8719A0A04B08AE9B515B39B32C15"><enum>(4)</enum><text>emphasize the development of reliable, risk-adjusted outcome measures; and</text></paragraph>
<paragraph id="HD63BAD5619DE44EC98BDBC2C2F91E0CE"><enum>(5)</enum><text>be updated on an annual basis.</text></paragraph></subsection>
<subsection id="H0514F3AA19DB432E92747752FA5FC67C"><enum>(b)</enum><header>Development</header><text>The Director shall enter into agreements with medical specialty societies, private accrediting organizations, and other appropriate organizations to develop and update measures of health care provider performance in accordance with the priorities identified under subsection (a).</text></subsection>
<subsection id="H7D1339F9907B4AEC905D1E4679A64BD"><enum>(c)</enum><header>Endorsement</header>
<paragraph id="H96E5B562551B4B03B7ACBE09005113D0"><enum>(1)</enum><header>In general</header><text>The Director shall enter into an agreement with the National Quality Forum for the endorsement by such entity of standardized measures of health care provider performance.</text></paragraph>
<paragraph id="H8793E041F1B2460AA432FCE58FE451DF"><enum>(2)</enum><header>Requirements</header><text>The agreement entered into under this subsection shall require the National Quality Forum—</text>
<subparagraph id="H9BFB34356EDF4D0E8C1BA5BD5068005E"><enum>(A)</enum><text>to endorse standardized measures of health care provider performance for each of the 20 priority areas described in subsection (a)(1);</text></subparagraph>
<subparagraph id="H45C96DCCC0954F9CBF015EB254F81B25"><enum>(B)</enum><text>to endorse other such measures over time consistent with the priorities identified under subsection (a); and</text></subparagraph>
<subparagraph id="HDE244F3EF29B48A0A1227D7B6F6201C7"><enum>(C)</enum><text>to recommend aggregate measures of health care provider performance to create simplified comparisons of health care provider performance.</text></subparagraph></paragraph></subsection></section>
<section id="H4146681334AF41460021DAF2398707D"><enum>206.</enum><header>Definitions</header><text display-inline="no-display-inline">In this title:</text>
<paragraph display-inline="no-display-inline" id="H2367D7079D9242858FDDDC5CA87DF55"><enum>(1)</enum><text display-inline="yes-display-inline">The term <term>Consortium</term> means the Consortium for Health Outcomes Research Priorities established under section 202.</text></paragraph>
<paragraph id="HAB6A5CE394F5440393E9FDA9E2712656"><enum>(2)</enum><text>The term <term>Director</term> means the Director of the Agency for Healthcare Research and Quality. </text></paragraph></section>
<enum>III</enum><header>Incentives for health care quality</header>
<section id="HA13C5C8C2564464D95F68E7C8DA74261"><enum>301.</enum><header>Access to medicare health care claims databases</header>
<subsection id="H8FCCCFAC31BC43DAA035FF0084D9D859"><enum>(a)</enum><header>Access by health plans</header>
<paragraph id="HDBBAD6CA71394A2781AE156055C2AEC"><enum>(1)</enum><header>In general</header><text>The Center for Medicare and Medicaid Services shall make available to a group health plan, that meets the condition under paragraph (2), all data in the possession of the Secretary with respect to the most recent claims submitted to the Secretary for items and services furnished to medicare beneficiaries for which payment is made under title XVIII of the Social Security Act.</text></paragraph>
<paragraph id="HCABCF85562434C90AB438D30414D2F00"><enum>(2)</enum><header>Condition of access</header><text>The condition referred to in paragraph (1) for a group health plan to have access to data under that paragraph is that the group health plan contribute claims-based health care provider performance data to the health care provider performance database established under section 303.</text></paragraph></subsection>
<subsection id="H4252690D7ADF402EAC2E70399B9D3369"><enum>(b)</enum><header>Privacy protections</header>
<paragraph id="H10BF391DAF6049EE92128E696B57B3BC"><enum>(1)</enum><header>In general</header><text>A request under subsection (a) is subject to the provisions of the Health Insurance Portability and Accountability Act and the Privacy Act.</text></paragraph>
<paragraph id="H05898D7EBC7F42EF92DAE831F314B403"><enum>(2)</enum><header>Specific protections</header>
<subparagraph id="H0C12CDBF56374C92ADFA31429820F368"><enum>(A)</enum><header>Encryption</header><text>The Secretary shall ensure that any identification number of a beneficiary to which a claim relates is encrypted in a consistent fashion in order to access data with respect to that beneficiary for claims for items and services under each applicable part of title XVIII.</text></subparagraph>
<subparagraph id="H529C73C5C55E44F1BD3E0950A3363136"><enum>(B)</enum><header>Deletion of personal identifying information</header><text>The Secretary shall ensure that the data omits the name, date of birth, street address and the last two applicable postal codes of each of the beneficiaries.</text></subparagraph></paragraph>
<paragraph id="H4BC35493017348ACAB048435029C294E"><enum>(3)</enum><header>Exclusion of certain data</header><text>In the case of a provider of services or a supplier that submits a low volume of claims to the Secretary for items or services furnished to medicare beneficiaries, or in the case of certain rare medical conditions or treatments, the Secretary may exclude data with respect to such claims, conditions, or treatment from a request under subsection (a) in order to protect patient privacy.</text></paragraph></subsection>
<subsection id="H17B8468F2E8543FF9503C7146869D3DE"><enum>(c)</enum><header>Form of request</header><text>Requests under subsection (a) shall require such information, and be in such form, as the Secretary determines appropriate. Such a request shall include the applicable period and areas for which such claims data is requested.</text></subsection>
<subsection id="H658A175546A64E239276FDE09DBEBD5B"><enum>(d)</enum><header>Fee</header><text>The Secretary may require the payment of a fee by each group health plan that submits a request under subsection (a) to offset administrative costs incurred by the Secretary in carrying out this section.</text></subsection>
<subsection id="HA8C5FD1D9AF14F2D00917D01B5CF1D52"><enum>(e)</enum><header>Authority to contract</header><text>If the Secretary determines that data could be made available more promptly, the Secretary may enter into arrangements with private entities to merge data for claims under each part of title XVIII of the Social Security Act. The Secretary shall ensure that a unique encryption applies to each beneficiary encryption.</text></subsection></section>
<section id="H87FABF7AD487465BB5F00072D5891596"><enum>302.</enum><header>Incorporation of measures of health care practitioner performance in Federal programs</header>
<subsection id="H0C25DE5475F34C269B7F342638B8F2F7"><enum>(a)</enum><header>In general</header><text>Not later than 1 year after the date of the enactment of this Act, the Secretary of Defense, the Secretary of Health and Human Services, the Secretary of Veterans Affairs, and the Director of the Indian Health Service shall incorporate, to the extent practicable, measures of health care practitioner performance endorsed by the National Quality Forum into the health care programs of the Department of Defense, the Department of Health and Human Services, the Department of Veterans Affairs, and the Indian Health Service, respectively for the purpose of improving program quality and efficiency. </text></subsection>
<subsection id="H615B712D7F5B42F499D0D74F394476A6"><enum>(b)</enum><header>Report to Congress</header><text>Not later than 18 months after the date of the enactment of this Act, each Federal official specified in subsection (a) shall submit a report to the Congress on the results of the official’s activities under this section.</text></subsection></section>
<section id="H07E18837892345A9AEB76185C7C48900" display-inline="no-display-inline" section-type="subsequent-section"><enum>303.</enum><header>Interim claims-based practitioner performance database</header>
<subsection id="H02A220BC6306458FBBB29C2E5007464B"><enum>(a)</enum><header>In general</header><text>Not later than the date that is 18 months after the date of the enactment of this Act, the Secretary shall establish a claims-based practitioner performance database that comprises de-indentified claims data under the medicare program under title XVIII of the Social Security Act and claims data from any group health plan that voluntarily submits de-identified health care claims data to the Secretary for such purpose.</text></subsection>
<subsection id="H39E83971C4D946A49025D692835895A2"><enum>(b)</enum><header>Requirement for participation by FEHB plans</header><text>The Director of the Office of Personnel Management shall require, as a condition under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/89">chapter 89</external-xref> of title 5, United States Code, that each plan under contract with the Director under such chapter submit de-identified claims data to practitioner performance database.</text></subsection>
<subsection id="HEBE62BFE18D6462D9693EBB4D3002081"><enum>(c)</enum><header>Performance measurements</header><text display-inline="yes-display-inline">Not later than 1 year after the date specified in subsection (a), and not less frequently than annually thereafter, the Secretary, from data in the database established under this section, shall prepare practitioner performance measurements. Such measurements shall—</text>
<paragraph id="HAADB0ED54993437AB10044E194EA33FF"><enum>(1)</enum><text display-inline="yes-display-inline">be based on performance measures endorsed by the National Quality Forum;</text></paragraph>
<paragraph id="H4C67C88028A3408F9638A032B31E54FE"><enum>(2)</enum><text>measure—</text>
<subparagraph id="H30D5DB32A6C94CE28CA82D7E3CCA5182"><enum>(A)</enum><text display-inline="yes-display-inline">the performance of individual physicians, physician groups (if any), and hospitals; or</text></subparagraph>
<subparagraph id="HEECFD37B6F8C4AC4B500E46800EAEB0"><enum>(B)</enum><text>if records are not available for measuring such performance, the performance of the smallest practitioner unit for which records are available; and</text></subparagraph></paragraph>
<paragraph id="H458EEC6A4C6C48AFB523FFD1FBAFEC02"><enum>(3)</enum><text display-inline="yes-display-inline">be presented in such manner as the Secretary determines will accurately and clearly represent the comparative performance quality and efficiency of physicians, physician groups, and hospitals.</text></paragraph></subsection>
<subsection id="HD7D04C07DED94987B2B02DF92C768D57"><enum>(d)</enum><header>Privacy protections</header><text>The Secretary shall ensure that—</text>
<paragraph id="HBA31A73A4946434E96F8CE8567F9A6C9"><enum>(1)</enum><text>any patient identifier is encrypted or omitted in a consistent fashion;</text></paragraph>
<paragraph id="H0269293DF06E4EFCBFCEC829DEED18BC"><enum>(2)</enum><text>the data omits the name, date of birth, street address and the last two applicable postal codes of each patient; and</text></paragraph>
<paragraph id="H5DE800A2E43D49F4AAF5DF58D33CFA"><enum>(3)</enum><text>the amount of the charge for services furnished is omitted.</text></paragraph></subsection>
<subsection id="HF0A219CED15D49A19BFABA42F40111A2"><enum>(e)</enum><header>Requirement for submission of data by all group health plans</header><text>Not later than four years after the date referred to in subsection (a), each group health plan shall contribute de-indentified claims data necessary for performance measurement to the practitioner performance database established under subsection (a). As soon as practicable, the Secretary shall make available annual performance measures to the public.</text></subsection>
<subsection id="H951704D4385E4F0AADA8F6668F7DCE5"><enum>(f)</enum><header>Termination</header><text display-inline="yes-display-inline">Beginning on the date that is 10 years after the date referred to in subsection (a), the Secretary shall discontinue the collection of data under this section.</text></subsection></section>
<section id="H5F678DE54417483F8CB614F71EB35190" display-inline="no-display-inline"><enum>304.</enum><header>Clinical-based practitioner performance database</header>
<subsection id="HE81B8E4508C343A2BE610901A746105"><enum>(a)</enum><header>Establishment</header><text display-inline="yes-display-inline">Not later than 18 months after the date of the enactment of this Act, the Secretary shall establish a practitioner performance database that comprises data from any health care practitioner that voluntarily submits de-indentified health care data to the Secretary for such purpose.</text></subsection>
<subsection id="H09D231F1466540F49843CF66E49733AE" display-inline="no-display-inline"><enum>(b)</enum><header>Privacy protections</header><text display-inline="yes-display-inline">The Secretary shall require health care practitioners to encrypt or omit all individually identifiable patient information from data submitted to the Secretary under this section, including by ensuring that—</text>
<paragraph id="H29E3451C7EB74895BE26901B62DAEA00"><enum>(1)</enum><text>any patient identifier is encrypted or omitted in a consistent fashion;</text></paragraph>
<paragraph id="HBD880A483F514AE2B2D62178168073B0"><enum>(2)</enum><text>the data omits the name, date of birth, street address, and the last 2 applicable postal codes of each patient; and</text></paragraph>
<paragraph id="H5D26722F5E6741BA8200092DC6459400"><enum>(3)</enum><text>the amount of the charge for services furnished is omitted.</text></paragraph></subsection>
<subsection id="HEDF91DB3C71F450CBC94124D215076CE"><enum>(c)</enum><header>Performance measurements</header><text display-inline="yes-display-inline">Not later than 1 year after the date specified in subsection (a), and not less frequently than annually thereafter, the Secretary, from data in the database established under this section, shall prepare practitioner performance measurements. Such measurements shall—</text>
<paragraph id="H361FF854F19D47A88ED63EFB1552DCAB"><enum>(1)</enum><text display-inline="yes-display-inline">be based on performance measures endorsed by the National Quality Forum;</text></paragraph>
<paragraph id="H2E577328EF8C429DBBA7D665784DE299"><enum>(2)</enum><text>measure—</text>
<subparagraph id="HB49F244F3079456A86FC269CCFDECC"><enum>(A)</enum><text display-inline="yes-display-inline">the performance of individual physicians, physician groups (if any), and hospitals; or</text></subparagraph>
<subparagraph id="H7EB082ACA38142D88B598CBC1788C5D5"><enum>(B)</enum><text>if records are not available for measuring such performance, the performance of the smallest practitioner unit for which records are available; and</text></subparagraph></paragraph>
<paragraph id="H7624B81D7A0F4C14834B4C0155F3C58F"><enum>(3)</enum><text display-inline="yes-display-inline">be presented in such manner as the Secretary determines will accurately and clearly represent the comparative performance quality and efficiency of physicians, physician groups, and hospitals.</text></paragraph></subsection>
<subsection id="H49A19220E2D34B1A9748003E387619F"><enum>(d)</enum><header>Certain practitioners</header><text>As a condition on any grant or subgrant awarded to a health information infrastructure organization under section 102, the Secretary shall require the organization to agree that the organization will not allow any health care practitioner to participate in a health information exchange established or implemented with the grant unless the practitioner submits claims data to the Secretary in accordance with this section.</text></subsection></section>
<section id="H3A35A7FCD69443CCA2718449A688C132"><enum>305.</enum><header>Availability of performance measurements and data</header>
<subsection id="H4115E33659DD4AB09F57BF00B48C12A4"><enum>(a)</enum><header>Performance measures</header><text display-inline="yes-display-inline">The Secretary shall make publicly available the practitioner performance measurements prepared under sections 303 and 304.</text></subsection>
<subsection id="HE56F914B3B1E4149839222837FB56BA4"><enum>(b)</enum><header>Data</header><text>The Secretary shall restrict access to the data in the databases under sections 303 and 304 to individuals requesting such information in connection with research conducted or supported by the Agency for Healthcare Research and Quality. </text></subsection></section>
<section id="H07D47F43CC334D42B0D1D000C73899C8" display-inline="no-display-inline"><enum>306.</enum><header>Use of health care provider performances measure for pay for performance</header>
<subsection id="H6E6BB3D5880D4AA19BB42DB26318C300"><enum>(a)</enum><header>In general</header><text display-inline="yes-display-inline">The Secretary may provide for adjustments to payment systems under title XVIII of the Social Security Act based on performance measurements of physicians, physician groups, and institutional providers of services. Insofar as the Secretary exercises the authority under the preceding sentence, in the case of providers with both claims-based and clinical-based measurements, the Secretary shall use the clinical-based measurements for any pay-for-performance unless the provider elects to use claims-based measurements. In no case may an election under the preceding sentence be in effect after the date that is 6 years after the date of the enactment of this Act.</text></subsection>
<subsection id="H65399C5782DE449F9445DEB92B66482C"><enum>(b)</enum><header>MedPAC recommendations</header><text>The Medicare Payment Advisory Commission shall include in the March 2007 report to Congress, and annually thereafter, specific recommendations for the amount of adjustments to payment systems and beneficiary cost-sharing under title XVIII of the Social Security Act based on performance measurements in order to share savings under such title attributable to quality improvement with practitioners, to create incentives for better practitioner performance, and shift medicare beneficiary caseload to higher quality, more efficient practitioners.</text></subsection>
<subsection id="H9ABB188E237E4CA4A8CBC900612C5DDF"><enum>(c)</enum><header>Sense of Congress</header><text>It is the sense of the Congress that the Director of the Office of Personnel Management should encourage plans with contracts under <external-xref legal-doc="usc-chapter" parsable-cite="usc-chapter/5/89">chapter 89</external-xref> of title 5, United States Code, to include differential payments, differential cost-sharing, or both based on HHS practitioner performance measurements under section 303.</text></subsection></section>
<section id="HDC805CC758DC4B0E8DF0D366CC44AFC"><enum>307.</enum><header>Study comparing practitioner performance database</header><text display-inline="no-display-inline">Not later than 54 months after the date of the enactment of this Act, the Director of the Agency for Healthcare Research and Quality shall—</text>
<paragraph id="H1BE50BB91C444CC6B167DCA87B1F84E0"><enum>(1)</enum><text>conduct a study to compare the interim claims-based practitioner performance database established under section 303 with the clinical-based practitioner performance database established under section 304, including by assessing the scope, cause, and import of any differences between the 2 databases in practitioner performance measurement; and</text></paragraph>
<paragraph id="H268DD849E5C648C3BBF3B12411000013"><enum>(2)</enum><text>submit a report to the Congress on the results of the study.</text></paragraph></section>
<section id="HCC992A514CB34C33B2CD5750114961B0" display-inline="no-display-inline" section-type="subsequent-section"><enum>308.</enum><header>Regulations on auditing</header><text display-inline="no-display-inline">The Secretary shall establish regulations governing the audit of group health plans that submit data under section 303 and health care practitioners that submit data under section 304 for compliance with such sections.</text></section>
<section id="HEB73C92B820B450E8BF74B535E66F1C1" display-inline="no-display-inline"><enum>309.</enum><header>AHRQ access to practitioner performance databases</header><text display-inline="no-display-inline">The Director of the Agency for Healthcare Research and Quality shall have access to the data in the databases established under sections 303 and 304 for health outcomes research, including research conducted internally or by external researchers.</text></section>