[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4157 Engrossed in House (EH)]


  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
109th CONGRESS
  2d Session
                                H. R. 4157

_______________________________________________________________________

                                 AN ACT


 
             To promote a better health information system.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE AND TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Health Information 
Technology Promotion Act of 2006''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title and table of contents.
Sec. 2. Preserving privacy and security laws.
TITLE I--COORDINATION FOR, PLANNING FOR, AND INTEROPERABILITY OF HEALTH 
                         INFORMATION TECHNOLOGY

Sec. 101. Office of the National Coordinator for Health Information 
                            Technology.
Sec. 102. Report on the American Health Information Community.
Sec. 103. Interoperability planning process; Federal information 
                            collection activities.
Sec. 104. Grants to integrated health systems to promote health 
                            information technologies to improve 
                            coordination of care for the uninsured, 
                            underinsured, and medically underserved.
Sec. 105. Small physician practice demonstration grants.
        TITLE II--TRANSACTION STANDARDS, CODES, AND INFORMATION

Sec. 201. Procedures to ensure timely updating of standards that enable 
                            electronic exchanges.
Sec. 202. Upgrading ASC X12 and NCPDP standards.
Sec. 203. Upgrading ICD codes; coding and documentation of non-medical 
                            information.
Sec. 204. Strategic plan for coordinating implementation of transaction 
                            standards and ICD codes.
Sec. 205. Study and report to determine impact of variation and 
                            commonality in State health information 
                            laws and regulations.
Sec. 206. Report on appropriateness of classification methodologies and 
                            codes for additional purposes.
TITLE III--PROMOTING THE USE OF HEALTH INFORMATION TECHNOLOGY TO BETTER 
                         COORDINATE HEALTH CARE

Sec. 301. Safe harbors to antikickback civil penalties and criminal 
                            penalties for provision of health 
                            information technology and training 
                            services.
Sec. 302. Exception to limitation on certain physician referrals (under 
                            Stark) for provision of health information 
                            technology and training services to health 
                            care professionals.
Sec. 303. Rules of construction regarding use of consortia.
                    TITLE IV--ADDITIONAL PROVISIONS

Sec. 401. Promotion of telehealth services.
Sec. 402. Study and report on expansion of home health-related 
                            telehealth services.
Sec. 403. Study and report on store and forward technology for 
                            telehealth.
Sec. 404. Ensuring health care providers participating in PHSA 
                            programs, Medicaid, SCHIP, or the MCH 
                            program may maintain health information in 
                            electronic form.
Sec. 405. Ensuring health care providers participating in the Medicare 
                            program may maintain health information in 
                            electronic form.
Sec. 406. Study and report on State, regional, and community health 
                            information exchanges.
Sec. 407. Promoting health information technology as a tool for chronic 
                            disease management.

SEC. 2. PRESERVING PRIVACY AND SECURITY LAWS.

    Nothing in this Act (or the amendments made by this Act) shall be 
construed to affect the scope, substance, or applicability of section 
264(c) of the Health Insurance Portability and Accountability Act of 
1996 and any regulation issued pursuant to such section.

TITLE I--COORDINATION FOR, PLANNING FOR, AND INTEROPERABILITY OF HEALTH 
                         INFORMATION TECHNOLOGY

SEC. 101. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION 
              TECHNOLOGY.

    (a) In General.--Title II of the Public Health Service Act is 
amended by adding at the end the following new part:

                ``PART D--HEALTH INFORMATION TECHNOLOGY

``SEC. 271. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION 
              TECHNOLOGY.

    ``(a) Establishment.--There is established within the Department of 
Health and Human Services an Office of the National Coordinator for 
Health Information Technology that shall be headed by the National 
Coordinator for Health Information Technology (referred to in this part 
as the `National Coordinator'). The National Coordinator shall be 
appointed by and report directly to the Secretary. The National 
Coordinator shall be paid at a rate equal to the rate of basic pay for 
level IV of the Executive Schedule.
    ``(b) Goals of Nationwide Interoperable Health Information 
Technology Infrastructure.--The National Coordinator shall perform the 
duties under subsection (c) in a manner consistent with the development 
of a nationwide interoperable health information technology 
infrastructure that--
            ``(1) improves health care quality, promotes data accuracy, 
        reduces medical errors, increases the efficiency of care, and 
        advances the delivery of appropriate, evidence-based health 
        care services;
            ``(2) promotes wellness, disease prevention, and management 
        of chronic illnesses by increasing the availability and 
        transparency of information related to the health care needs of 
        an individual for such individual;
            ``(3) promotes the availability of appropriate and accurate 
        information necessary to make medical decisions in a usable 
        form at the time and in the location that the medical service 
        involved is provided;
            ``(4) produces greater value for health care expenditures 
        by reducing health care costs that result from inefficiency, 
        medical errors, inappropriate care, and incomplete or 
        inaccurate information;
            ``(5) promotes a more effective marketplace, greater 
        competition, greater systems analysis, increased consumer 
        choice, enhanced quality, and improved outcomes in health care 
        services;
            ``(6) with respect to health information of consumers, 
        advances the portability of such information and the ability of 
        such consumers to share and use such information to assist in 
        the management of their health care;
            ``(7) improves the coordination of information and the 
        provision of such services through an effective infrastructure 
        for the secure and authorized exchange and use of health care 
        information;
            ``(8) provides for the confidentiality and security of 
        individually identifiable health information, consistent with 
        legally applicable requirements with respect to securing and 
        protecting the confidentiality of individually identifiable 
        health information of a patient;
            ``(9) promotes the creation and maintenance of 
        transportable, secure, Internet-based personal health records, 
        including promoting the efforts of health care payers and 
        health plan administrators for a health plan, such as Federal 
        agencies, private health plans, and third party administrators, 
        to provide for such records on behalf of members of such a 
        plan;
            ``(10) promotes access to and review of the electronic 
        health record of a patient by such patient;
            ``(11) promotes health research and health care quality 
        research and assessment;
            ``(12) promotes the efficient and streamlined development, 
        submission, and maintenance of electronic health care clinical 
        trial data; and
            ``(13) improves the availability of information and 
        resources for individuals with low or limited literacy or 
        language skills.
    ``(c) Duties of the National Coordinator.--
            ``(1) Strategic planner for interoperable health 
        information technology.--The National Coordinator shall provide 
        for a strategic plan for the nationwide implementation of 
        interoperable health information technology in both the public 
        and private health care sectors consistent with subsection (b).
            ``(2) Principal advisor to the secretary.--The National 
        Coordinator shall serve as the principal advisor to the 
        Secretary on the development, application, and use of health 
        information technology, and shall coordinate the policies and 
        programs of the Department of Health and Human Services for 
        promoting the use of health information technology.
            ``(3) Intragovernmental coordinator.--The National 
        Coordinator shall ensure that health information technology 
        policies and programs of the Department of Health and Human 
        Services are coordinated with those of relevant executive 
        branch agencies and departments with a goal to avoid 
        duplication of effort, to align the health information 
        architecture of each agency or department toward a common 
        approach, to ensure that each agency or department conducts 
        programs within the areas of its greatest expertise and its 
        mission in order to create a national interoperable health 
        information system capable of meeting national public health 
        needs effectively and efficiently, and to assist Federal 
        agencies and departments in security programs, policies, and 
        protections to prevent unauthorized access to individually 
        identifiable health information created, maintained, or in the 
        temporary possession of that agency or department. The 
        coordination authority provided to the National Coordinator 
        under the previous sentence shall supercede any such authority 
        otherwise provided to any other official of the Department of 
        Health and Human Services. For the purposes of this paragraph, 
        the term `unauthorized access' means access that is not 
        authorized by that agency or department including unauthorized 
        employee access.
            ``(4) Advisor to omb.--The National Coordinator shall 
        provide to the Director of the Office of Management and Budget 
        comments and advice with respect to specific Federal health 
        information technology programs.
            ``(5) Promoter of health information technology in 
        medically underserved communities.--The National Coordinator 
        shall--
                    ``(A) identify sources of funds that will be made 
                available to promote and support the planning and 
                adoption of health information technology in medically 
                underserved communities, including in urban and rural 
                areas, either through grants or technical assistance;
                    ``(B) coordinate with the funding sources to help 
                such communities connect to identified funding; and
                    ``(C) collaborate with the Agency for Healthcare 
                Research and Quality and the Health Services Resources 
                Administration and other Federal agencies to support 
                technical assistance, knowledge dissemination, and 
                resource development, to medically underserved 
                communities seeking to plan for and adopt technology 
                and establish electronic health information networks 
                across providers.''.
    (b) Treatment of Executive Order No. 13335.--Executive Order No. 
13335 shall not have any force or effect after the date of the 
enactment of this Act.
    (c) Transition From ONCHIT Under Executive Order.--
            (1) In general.--All functions, personnel, assets, 
        liabilities, administrative actions, and statutory reporting 
        requirements applicable to the old National Coordinator or the 
        Office of the old National Coordinator on the date before the 
        date of the enactment of this Act shall be transferred, and 
        applied in the same manner and under the same terms and 
        conditions, to the new National Coordinator and the Office of 
        the new National Coordinator as of the date of the enactment of 
        this Act.
            (2) Rule of construction.-- Nothing in this section or the 
        amendment made by this section shall be construed as requiring 
        the duplication of Federal efforts with respect to the 
        establishment of the Office of the National Coordinator for 
        Health Information Technology, regardless of whether such 
        efforts are carried out before or after the date of the 
        enactment of this Act.
            (3) Acting national coordinator.--Before the appointment of 
        the new National Coordinator, the old National Coordinator 
        shall act as the National Coordinator for Health Information 
        Technology until the office is filled as provided in section 
        271(a) of the Public Health Service Act, as added by subsection 
        (a). The Secretary of Health and Human Services may appoint the 
        old National Coordinator as the new National Coordinator.
            (4) Definitions.--For purposes of this subsection:
                    (A) New national coordinator.--The term ``new 
                National Coordinator'' means the National Coordinator 
                for Health Information Technology appointed under 
                section 271(a) of the Public Health Service Act, as 
                added by subsection (a).
                    (B) Old national coordinator.--The term ``old 
                National Coordinator'' means the National Coordinator 
                for Health Information Technology appointed under 
                Executive Order No. 13335.
    (d) Study of Health Information Technology in Medically Underserved 
Communities.--
            (1) Study.--The National Coordinator for Health Information 
        Technology shall conduct a study on the development and 
        implementation of health information technology in medically 
        underserved communities. The study shall--
                    (A) identify barriers to successful implementation 
                of health information technology in these communities;
                    (B) examine the impact of health information 
                technology on providing quality care and reducing the 
                cost of care to these communities;
                    (C) examine urban and rural community health 
                systems and determine the impact that health 
                information technology may have on the capacity of 
                primary health providers; and
                    (D) assess the feasibility and the costs of 
                associated with the use of health information 
                technology in these communities.
            (2) Report.--Not later than 18 months after the date of the 
        enactment of this Act, the National Coordinator shall submit to 
        Congress a report on the study conducted under paragraph (1) 
        and shall include in such report such recommendations for 
        legislation or administrative action as the Coordinator 
        determines appropriate.

SEC. 102. REPORT ON THE AMERICAN HEALTH INFORMATION COMMUNITY.

    Not later than one year after the date of the enactment of this 
Act, the Secretary of Health and Human Services shall submit to 
Congress a report on the work conducted by the American Health 
Information Community (in this section referred to as ``AHIC''), as 
established by the Secretary. Such report shall include the following:
            (1) A description of the accomplishments of AHIC, with 
        respect to the promotion of the development of national 
        guidelines, the development of a nationwide health information 
        network, and the increased adoption of health information 
        technology.
            (2) Information on how model privacy and security policies 
        may be used to protect confidentiality of health information, 
        and an assessment of how existing policies compare to such 
        model policies.
            (3) Information on the progress in--
                    (A) establishing uniform industry-wide health 
                information technology standards;
                    (B) achieving an internet-based nationwide health 
                information network;
                    (C) achieving interoperable electronic health 
                record adoption across health care providers; and
                    (D) creating technological innovations to promote 
                security and confidentiality of individually 
                identifiable health information.
            (4) Recommendations for the transition of AHIC to a longer-
        term or permanent advisory and facilitation entity, including--
                    (A) a schedule for such transition;
                    (B) options for structuring the entity as either a 
                public-private or private sector entity;
                    (C) the collaberative role of the Federal 
                Government in the entity;
                    (D) steps for--
                            (i) continued leadership in the 
                        facilitation of guidelines or standards;
                            (ii) the alignment of financial incentives; 
                        and
                            (iii) the long-term plan for health care 
                        transformation through information technology; 
                        and
                    (E) the elimination or revision of the functions of 
                AHIC during the development of the nationwide health 
                information network.
            (5) Recommendations on the inclusion of emergency contact 
        or next-of-kin information (including name and phone number) in 
        interoperable electronic health records.

SEC. 103. INTEROPERABILITY PLANNING PROCESS; FEDERAL INFORMATION 
              COLLECTION ACTIVITIES.

    Part D of title II of the Public Health Service Act, as added by 
section 101(a), is amended by adding at the end the following new 
section:

``SEC. 272. INTEROPERABILITY PLANNING PROCESS; FEDERAL INFORMATION 
              COLLECTION ACTIVITIES.

    ``(a) Strategic Interoperability Planning Process.--
            ``(1) Assessment and endorsement of core strategic 
        guidelines.--
                    ``(A) In general.--Not later than December 31, 
                2006, the National Coordinator shall publish a 
                strategic plan, including a schedule, for the 
                assessment and the endorsement of core interoperability 
                guidelines for significant use cases consistent with 
                this subsection. The National Coordinator may update 
                such plan from time to time.
                    ``(B) Endorsement.--
                            ``(i) In general.--Consistent with the 
                        schedule under this paragraph and not later 
                        than one year after the publication of such 
                        schedule, the National Coordinator shall 
                        endorse a subset of core interoperability 
                        guidelines for significant use cases. The 
                        National Coordinator shall continue to endorse 
                        subsets of core interoperability guidelines for 
                        significant use cases annually consistent with 
                        the schedule published pursuant to this 
                        paragraph, with endorsement of all such 
                        guidelines completed not later than August 31, 
                        2009.
                            ``(ii) Consultation.--All such endorsements 
                        shall be in consultation with the American 
                        Health Information Community and other 
                        appropriate entities.
                            ``(iii) Voluntary compliance.--Compliance 
                        with such guidelines shall be voluntary, 
                        subject to subsection (b)(1).
                    ``(C) Consultation with other parties.--The 
                National Coordinator shall develop and implement such 
                strategic plan in consultation with the American Health 
                Information Community and other appropriate entities.
                    ``(D) Definitions.--For purposes of this section:
                            ``(i) Interoperability guideline.--The term 
                        `interoperability guideline' means a guideline 
                        to improve and promote the interoperability of 
                        health information technology for purposes of 
                        electronically accessing and exchanging health 
                        information. Such term includes named 
                        standards, architectures, software schemes for 
                        identification, authentication, and security, 
                        and other information needed to ensure the 
                        reproducible development of common solutions 
                        across disparate entities.
                            ``(ii) Core interoperability guideline.--
                        The term `core interoperability guideline' 
                        means an interoperability guideline that the 
                        National Coordinator determines is essential 
                        and necessary for purposes described in clause 
                        (i).
                            ``(iii) Significant use case.--The term 
                        `significant use case' means a category (as 
                        specified by the National Coordinator) that 
                        identifies a significant use or purpose for the 
                        interoperability of health information 
                        technology, such as for the exchange of 
                        laboratory information, drug prescribing, 
                        clinical research, and electronic health 
                        records.
            ``(2) National survey.--
                    ``(A) In general.--Not later than August 31, 2008, 
                the National Coordinator shall conduct one or more 
                surveys designed to measure the capability of entities 
                (including Federal agencies, State and local government 
                agencies, and private sector entities) to exchange 
                electronic health information by appropriate 
                significant use case. Such surveys shall identify the 
                extent to which the type of health information, the use 
                for such information, or any other appropriate 
                characterization of such information may relate to the 
                capability of such entities to exchange health 
                information in a manner that is consistent with methods 
                to improve the interoperability of health information 
                and with core interoperability guidelines.
                    ``(B) Dissemination of survey results.--The 
                National Coordinator shall disseminate the results of 
                such surveys in a manner so as to--
                            ``(i) inform the public on the capabilities 
                        of entities to exchange electronic health 
                        information;
                            ``(ii) assist in establishing a more 
                        interoperable information architecture; and
                            ``(iii) identify the status of health 
                        information systems used in Federal agencies 
                        and the status of such systems with respect to 
                        interoperability guidelines.
    ``(b) Federal Health Information Collection Activities.--
            ``(1) Requirements.--With respect to a core 
        interoperability guideline endorsed under subsection (a)(1)(B) 
        for a significant use case, the President shall take measures 
        to ensure that Federal activities involving the broad 
        collection and submission of health information are consistent 
        with such guideline within three years after the date of such 
        endorsement.
            ``(2) Promoting use of non-identifiable health information 
        to improve health research and health care quality.--
                    ``(A) In general.--Where feasible, and consistent 
                with applicable privacy or security or other laws, the 
                President, in consultation with the Secretary, shall 
                take measures to allow timely access to useful 
                categories of non-identifiable health information in 
                records maintained by the Federal government, or 
                maintained by entities under contract with the Federal 
                government, to advance health care quality and health 
                research where such information is in a form that can 
                be used in such research. The President shall consult 
                with appropriate Federal agencies, and solicit public 
                comment, on useful categories of information, and 
                appropriate measures to take. The President may 
                consider the administrative burden and the potential 
                for improvements in health care quality in determining 
                such appropriate measures. In addition, the President, 
                in consultation with the Secretary, shall encourage 
                voluntary private and public sector efforts to allow 
                access to such useful categories of non-identifiable 
                health information to advance health care quality and 
                health research.
                    ``(B) Non-identifiable health information 
                defined.--For purposes of this paragraph, the term 
                `non-identifiable health information' means information 
                that is not individually identifiable health 
                information as defined in rules promulgated pursuant to 
                section 264(c) of the Health Insurance Portability and 
                Accountability Act of 1996 (42 U.S.C. 1320d-2 note), 
                and includes information that has been de-identified so 
                that it is no longer individually identifiable health 
                information, as defined in such rules.
            ``(3) Annual review and report.--For each year during the 
        five-year period following the date of the enactment of this 
        section, the National Coordinator shall review the operation of 
        health information collection by and submission to the Federal 
        government and the purchases (and planned purchases) of health 
        information technology by the Federal government. For each such 
        year and based on the review for such year, the National 
        Coordinator shall submit to the President and Congress 
        recommendations on methods to--
                    ``(A) streamline (and eliminate redundancy in) 
                Federal systems used for the collection and submission 
                of health information;
                    ``(B) improve efficiency in such collection and 
                submission;
                    ``(C) increase the ability to assess health care 
                quality; and
                    ``(D) reduce health care costs.''.

SEC. 104. GRANTS TO INTEGRATED HEALTH SYSTEMS TO PROMOTE HEALTH 
              INFORMATION TECHNOLOGIES TO IMPROVE COORDINATION OF CARE 
              FOR THE UNINSURED, UNDERINSURED, AND MEDICALLY 
              UNDERSERVED.

    Subpart I of part D of title III of the Public Health Service Act 
(42 U.S.C. 254b et seq.) is amended by adding at the end the following:

``SEC. 330M. GRANTS FOR IMPROVEMENT OF THE COORDINATION OF CARE FOR THE 
              UNINSURED, UNDERINSURED, AND MEDICALLY UNDERSERVED.

    ``(a) In General.--The Secretary may make grants to integrated 
health care systems, in accordance with this section, for projects to 
better coordinate the provision of health care through the adoption of 
new health information technology, or the significant improvement of 
existing health information technology, to improve the provision of 
health care to uninsured, underinsured, and medically underserved 
individuals (including in urban and rural areas) through health-related 
information about such individuals, throughout such a system and at the 
point of service.
    ``(b) Eligibility.--
            ``(1) Application.--To be eligible to receive a grant under 
        this section, an integrated health care system shall prepare 
        and submit to the Secretary an application, at such time, in 
        such manner, and containing such information as the Secretary 
        may require, including--
                    ``(A) a description of the project that the system 
                will carry out using the funds provided under the 
                grant;
                    ``(B) a description of the manner in which the 
                project funded under the grant will advance the goal 
                specified in subsection (a); and
                    ``(C) a description of the populations to be served 
                by the adoption or improvement of health information 
                technology.
            ``(2) Optional reporting condition.--The Secretary may also 
        condition the provision of a grant to an integrated health care 
        system under this section for a project on the submission by 
        such system to the Secretary of a report on the impact of the 
        health information technology adopted (or improved) under such 
        project on the delivery of health care and the quality of care 
        (in accordance with applicable measures of such quality). Such 
        report shall be at such time and in such form and manner as 
        specified by the Secretary.
    ``(c) Integrated Health Care System Defined.--For purposes of this 
section, the term `integrated health care system' means a system of 
health care providers that is organized to provide care in a 
coordinated fashion and has a demonstrated commitment to provide 
uninsured, underinsured, and medically underserved individuals with 
access to such care.
    ``(d) Priorities.--In making grants under this section, the 
Secretary shall give priority to an integrated health care system--
            ``(1) that can demonstrate past successful community-wide 
        efforts to improve the quality of care provided and the 
        coordination of care for the uninsured, underinsured, and 
        medically underserved;
            ``(2) if the project to be funded through such a grant--
                    ``(A) will improve the delivery of health care and 
                the quality of care provided; and
                    ``(B) will demonstrate savings for State or Federal 
                health care benefits programs or entities legally 
                obligated under Federal law to provide health care from 
                the reduction of duplicative health care services, 
                administrative costs, and medical errors; or
            ``(3) if the project to be funded through such a grant will 
        emphasize the improvement of access to medical care and medical 
        care for medically underserved populations which are 
        geographically isolated or located in underserved urban areas.
    ``(e) Limitation, Matching Requirement, and Conditions.--
            ``(1) Limitation on use of funds.--None of the funds 
        provided under a grant made under this section may be used for 
        a project providing for the adoption or improvement of health 
        information technology that is used exclusively for financial 
        record keeping, billing, or other non-clinical applications.
            ``(2) Matching requirement.--To be eligible for a grant 
        under this section an integrated health care system shall 
        contribute non-Federal contributions to the costs of carrying 
        out the project for which the grant is awarded in an amount 
        equal to $1 for each $5 of Federal funds provided under the 
        grant.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $15,000,000 for each of fiscal 
years 2007 and 2008.''.

SEC. 105. SMALL PHYSICIAN PRACTICE DEMONSTRATION GRANTS.

    Part D of title II of the Public Health Service Act, as added by 
section 101(a) and amended by section 103, is amended by adding at the 
end the following new section:

``SEC. 273. SMALL PHYSICIAN PRACTICE DEMONSTRATION GRANTS.

    ``(a) In General.--The Secretary shall establish a demonstration 
program under which the Secretary makes grants to small physician 
practices (including such practices that furnish services to 
individuals with chronic illnesses) that are located in rural areas or 
medically underserved urban areas for the purchase and support of 
health information technology.
    ``(b) Eligibility.--To be eligible to receive a grant under this 
section, an applicant shall prepare and submit to the Secretary an 
application, at such time, in such manner, and containing such 
information, as the Secretary may require.
    ``(c) Reporting.--
            ``(1) Required reports by small physician practices.--A 
        small physician practice receiving a grant under subsection (a) 
        shall submit to the Secretary an evaluation on the health 
        information technology funded by such grant. Such evaluation 
        shall include information on--
                    ``(A) barriers to the adoption of health 
                information technology by the small physician practice;
                    ``(B) issues for such practice in the use of health 
                information technology;
                    ``(C) the effect health information technology will 
                have on the quality of health care furnished by such 
                practice; and
                    ``(D) the effect of any medical liability rules on 
                such practice.
            ``(2) Report to congress.--Not later than January 1, 2009, 
        the Secretary shall submit to Congress a report on the results 
        of the demonstration program under this section.
    ``(d) Authorization of Appropriations.--There are authorized to be 
appropriated to carry out this section $5,000,000 for each of fiscal 
years 2007 and 2008.''.

        TITLE II--TRANSACTION STANDARDS, CODES, AND INFORMATION

SEC. 201. PROCEDURES TO ENSURE TIMELY UPDATING OF STANDARDS THAT ENABLE 
              ELECTRONIC EXCHANGES.

    Section 1174(b) of the Social Security Act (42 U.S.C. 1320d-3(b)) 
is amended--
            (1) in paragraph (1)--
                    (A) in the first sentence, by inserting ``and in 
                accordance with paragraph (3)'' before the period; and
                    (B) by adding at the end the following new 
                sentence: ``For purposes of this subsection and section 
                1173(c)(2), the term `modification' includes a new 
                version or a version upgrade.''; and
            (2) by adding at the end the following new paragraph:
            ``(3) Expedited procedures for adoption of additions and 
        modifications to standards.--
                    ``(A) In general.--For purposes of paragraph (1), 
                the Secretary shall provide for an expedited upgrade 
                program (in this paragraph referred to as the `upgrade 
                program'), in accordance with this paragraph, to 
                develop and approve additions and modifications to the 
                standards adopted under section 1173(a) to improve the 
                quality of such standards or to extend the 
                functionality of such standards to meet evolving 
                requirements in health care.
                    ``(B) Publication of notices.--Under the upgrade 
                program:
                            ``(i) Voluntary notice of initiation of 
                        process.--Not later than 30 days after the date 
                        the Secretary receives a notice from a standard 
                        setting organization that the organization is 
                        initiating a process to develop an addition or 
                        modification to a standard adopted under 
                        section 1173(a), the Secretary shall publish a 
                        notice in the Federal Register that--
                                    ``(I) identifies the subject matter 
                                of the addition or modification;
                                    ``(II) provides a description of 
                                how persons may participate in the 
                                development process; and
                                    ``(III) invites public 
                                participation in such process.
                            ``(ii) Voluntary notice of preliminary 
                        draft of additions or modifications to 
                        standards.--Not later than 30 days after the 
                        date of the date the Secretary receives a 
                        notice from a standard setting organization 
                        that the organization has prepared a 
                        preliminary draft of an addition or 
                        modification to a standard adopted by section 
                        1173(a), the Secretary shall publish a notice 
                        in the Federal Register that--
                                    ``(I) identifies the subject matter 
                                of (and summarizes) the addition or 
                                modification;
                                    ``(II) specifies the procedure for 
                                obtaining the draft;
                                    ``(III) provides a description of 
                                how persons may submit comments in 
                                writing and at any public hearing or 
                                meeting held by the organization on the 
                                addition or modification; and
                                    ``(IV) invites submission of such 
                                comments and participation in such 
                                hearing or meeting without requiring 
                                the public to pay a fee to participate.
                            ``(iii) Notice of proposed addition or 
                        modification to standards.--Not later than 30 
                        days after the date of the date the Secretary 
                        receives a notice from a standard setting 
                        organization that the organization has a 
                        proposed addition or modification to a standard 
                        adopted under section 1173(a) that the 
                        organization intends to submit under 
                        subparagraph (D)(iii), the Secretary shall 
                        publish a notice in the Federal Register that 
                        contains, with respect to the proposed addition 
                        or modification, the information required in 
                        the notice under clause (ii) with respect to 
                        the addition or modification.
                            ``(iv) Construction.--Nothing in this 
                        paragraph shall be construed as requiring a 
                        standard setting organization to request the 
                        notices described in clauses (i) and (ii) with 
                        respect to an addition or modification to a 
                        standard in order to qualify for an expedited 
                        determination under subparagraph (C) with 
                        respect to a proposal submitted to the 
                        Secretary for adoption of such addition or 
                        modification.
                    ``(C) Provision of expedited determination.--Under 
                the upgrade program and with respect to a proposal by a 
                standard setting organization for an addition or 
                modification to a standard adopted under section 
                1173(a), if the Secretary determines that the standard 
                setting organization developed such addition or 
                modification in accordance with the requirements of 
                subparagraph (D) and the National Committee on Vital 
                and Health Statistics recommends approval of such 
                addition or modification under subparagraph (E), the 
                Secretary shall provide for expedited treatment of such 
                proposal in accordance with subparagraph (F).
                    ``(D) Requirements.--The requirements under this 
                subparagraph with respect to a proposed addition or 
                modification to a standard by a standard setting 
                organization are the following:
                            ``(i) Request for publication of notice.--
                        The standard setting organization submits to 
                        the Secretary a request for publication in the 
                        Federal Register of a notice described in 
                        subparagraph (B)(iii) for the proposed addition 
                        or modification.
                            ``(ii) Process for receipt and 
                        consideration of public comment.--The standard 
                        setting organization provides for a process 
                        through which, after the publication of the 
                        notice referred to under clause (i), the 
                        organization--
                                    ``(I) receives and responds to 
                                public comments submitted on a timely 
                                basis on the proposed addition or 
                                modification before submitting such 
                                proposed addition or modification to 
                                the National Committee on Vital and 
                                Health Statistics under clause (iii);
                                    ``(II) makes publicly available a 
                                written explanation for its response in 
                                the proposed addition or modification 
                                to comments submitted on a timely 
                                basis; and
                                    ``(III) makes public comments 
                                received under clause (I) available, or 
                                provides access to such comments, to 
                                the Secretary.
                            ``(iii) Submittal of final proposed 
                        addition or modification to ncvhs.--After 
                        completion of the process under clause (ii), 
                        the standard setting organization submits the 
                        proposed addition or modification to the 
                        National Committee on Vital and Health 
                        Statistics for review and consideration under 
                        subparagraph (E). Such submission shall include 
                        information on the organization's compliance 
                        with the notice and comment requirements (and 
                        responses to those comments) under clause (ii).
                    ``(E) Hearing and recommendations by national 
                committee on vital and health statistics.--Under the 
                upgrade program, upon receipt of a proposal submitted 
                by a standard setting organization under subparagraph 
                (D)(iii) for the adoption of an addition or 
                modification to a standard, the National Committee on 
                Vital and Health Statistics shall provide notice to the 
                public and a reasonable opportunity for public 
                testimony at a hearing on such addition or 
                modification. The Secretary may participate in such 
                hearing in such capacity (including presiding ex 
                officio) as the Secretary shall determine appropriate. 
                Not later than 120 days after the date of receipt of 
                the proposal, the Committee shall submit to the 
                Secretary its recommendation to adopt (or not adopt) 
                the proposed addition or modification.
                    ``(F) Determination by secretary to accept or 
                reject national committee on vital and health 
                statistics recommendation.--
                            ``(i) Timely determination.--Under the 
                        upgrade program, if the National Committee on 
                        Vital and Health Statistics submits to the 
                        Secretary a recommendation under subparagraph 
                        (E) to adopt a proposed addition or 
                        modification, not later than 90 days after the 
                        date of receipt of such recommendation the 
                        Secretary shall make a determination to accept 
                        or reject the recommendation and shall publish 
                        notice of such determination in the Federal 
                        Register not later than 30 days after the date 
                        of the determination.
                            ``(ii) Contents of notice.--If the 
                        determination is to reject the recommendation, 
                        such notice shall include the reasons for the 
                        rejection. If the determination is to accept 
                        the recommendation, as part of such notice the 
                        Secretary shall promulgate the modified 
                        standard (including the accepted proposed 
                        addition or modification accepted) as a final 
                        rule under this subsection without any further 
                        notice or public comment period.
                            ``(iii) Limitation on consideration.--The 
                        Secretary shall not consider a proposal under 
                        this subparagraph unless the Secretary 
                        determines that the requirements of 
                        subparagraph (D) (including publication of 
                        notice and opportunity for public comment) have 
                        been met with respect to the proposal.
                    ``(G) Exemption from paperwork reduction act.--
                Chapter 35 of title 44, United States Code, shall not 
                apply to a final rule promulgated under subparagraph 
                (F).
                    ``(H) Treatment as satisfying requirements for 
                notice-and-comment.--Any requirements under section 553 
                of title 5, United States Code, relating to notice and 
                an opportunity for public comment with respect to a 
                final rule promulgated under subparagraph (F) shall be 
                treated as having been met by meeting the requirements 
                of the notice and opportunity for public comment 
                provided under provisions of subparagraphs (B)(iii), 
                (D), and (E).
                    ``(I) No judicial review.--A final rule promulgated 
                under subparagraph (F) shall not be subject to judicial 
                review.''.

SEC. 202. UPGRADING ASC X12 AND NCPDP STANDARDS.

    (a) In General.--The Secretary of Health and Human Services shall 
provide by notice published in the Federal Register for the following 
replacements of standards to apply to transactions occurring on or 
after April 1, 2009:
            (1) Accredited standards committee x12 (asc x12) 
        standard.--The replacement of the Accredited Standards 
        Committee X12 (ASC X12) version 4010 adopted under section 
        1173(a) of such Act (42 U.S.C. 1320d-2(a)) with the ASC X12 
        version 5010, as reviewed by the National Committee on Vital 
        Health Statistics.
            (2) National council for prescription drug programs (ncpdp) 
        telecommunications standards.--The replacement of the National 
        Council for Prescription Drug Programs (NCPDP) 
        Telecommunications Standards version 5.1 adopted under section 
        1173(a) of such Act (42 U.S.C. 1320d-2(a)) with whichever is 
        the latest version of the NCPDP Telecommunications Standards 
        that has been approved by such Council and reviewed by the 
        National Committee on Vital Health Statistics as of April 1, 
        2007.
    (b) No Judicial Review.--The implementation of subsection (a), 
including the determination of the latest version under subsection 
(a)(2), shall not be subject to judicial review.

SEC. 203. UPGRADING ICD CODES; CODING AND DOCUMENTATION OF NON-MEDICAL 
              INFORMATION.

    (a) Upgrading ICD Codes.--
            (1) In general.--The Secretary of Health and Human Services 
        shall provide by notice published in the Federal Register for 
        the replacement of the International Classification of 
        Diseases, 9th revision, Clinical Modification (ICD-9-CM) under 
        the regulation promulgated under section 1173(c) of the Social 
        Security Act (42 U.S.C. 1320d-2(c)), including for purposes of 
        part A of title XVIII of such Act, with both of the following:
                    (A) The International Classification of Diseases, 
                10th revision, Clinical Modification (ICD-10-CM).
                    (B) The International Classification of Diseases, 
                10th revision, Procedure Coding System (ICD-10-PCS).
            (2) Application.--The replacement made by paragraph (1) 
        shall apply, for purposes of section 1175(b)(2) of the Social 
        Security Act (42 U.S.C. 1320d-4(b)(2)), to services furnished 
        on or after October 1, 2010.
            (3) Rules of construction.--Nothing in paragraph (1) shall 
        be construed--
                    (A) as affecting the application of classification 
                methodologies or codes, such as CPT or HCPCS codes, 
                other than under the International Classification of 
                Diseases (ICD); or
                    (B) as superseding the authority of the Secretary 
                of Health and Human Services to maintain and modify the 
                coding set for ICD-10-CM and ICD-10-PCS, including 
                under the amendments made by section 201.
    (b) Coding and Documentation of Non-Medical Information.--In any 
regulation or other action implementing the International 
Classification of Diseases, 10th revision, Clinical Modification (ICD-
10-CM), the International Classification of Diseases, 10th revision, 
Procedure Coding System (ICD-10-PCS), or other version of the 
International Classification of Diseases, 10th revision, the Secretary 
of Health and Human Services shall ensure that no health care provider 
is required to code to a level of specificity that would require 
documentation of non-medical information on the external cause of any 
given type of injury.

SEC. 204. STRATEGIC PLAN FOR COORDINATING IMPLEMENTATION OF TRANSACTION 
              STANDARDS AND ICD CODES.

    Not later than the date that is 180 days after the date of the 
enactment of this Act, the Secretary of Health and Human Services, in 
consultation with relevant public and private entities, shall develop a 
strategic plan with respect to the need for coordination in the 
implementation of--
            (1) transaction standards under section 1173(a) of the 
        Social Security Act, including modifications to such standards 
        under section 1174(b)(3) of such Act, as added by section 201; 
        and
            (2) any updated versions of the International 
        Classification of Diseases (ICD), including the replacement of 
        ICD-9 provided for under section 203(a).

SEC. 205. STUDY AND REPORT TO DETERMINE IMPACT OF VARIATION AND 
              COMMONALITY IN STATE HEALTH INFORMATION LAWS AND 
              REGULATIONS.

    Part C of title XI of the Social Security Act is amended by adding 
at the end the following new section:

``study and report to determine impact of variation and commonality in 
             state health information laws and regulations

    ``Sec. 1180.  (a) Study.--For purposes of promoting the development 
of a nationwide interoperable health information technology 
infrastructure consistent with section 271(b) of the Public Health 
Service Act, the Secretary shall conduct a study of the impact of 
variation in State security and confidentiality laws and current 
Federal security and confidentiality standards on the timely exchanges 
of health information in order to ensure the availability of health 
information necessary to make medical decisions at the location in 
which the medical care involved is provided. Such study shall examine--
            ``(1)(A) the degree of variation and commonality among the 
        requirements of such laws for States; and
            ``(B) the degree of variation and commonality between the 
        requirements of such laws and the current Federal standards;
            ``(2) insofar as there is variation among and between such 
        requirements, the strengths and weaknesses of such 
        requirements; and
            ``(3) the extent to which such variation may adversely 
        impact the secure, confidential, and timely exchange of health 
        information among States, the Federal government, and public 
        and private entities, or may otherwise impact the reliability 
        of such information.
    ``(b) Report.--Not later than 18 months after the date of the 
enactment of this section, the Secretary shall submit to Congress a 
report on the study under subsection (a) and shall include in such 
report the following:
            ``(1) Analysis of need for greater commonality.--A 
        determination by the Secretary on the extent to which there is 
        a need for greater commonality of the requirements of State 
        security and confidentiality laws and current Federal security 
        and confidentiality standards to better protect, strengthen, or 
        otherwise improve the secure, confidential, and timely exchange 
        of health information among States, the Federal government, and 
        public and private entities.
            ``(2) Recommendations for greater commonality.--Insofar as 
        the Secretary determines under paragraph (1) that there is a 
        need for greater commonality of such requirements, 
        recommendations on the extent to which (and how) the current 
        Federal security and confidentiality standards should be 
        changed in order to provide the commonality needed to better 
        protect, strengthen, or otherwise improve the secure, 
        confidential, and timely exchange of health information.
            ``(3) Specific recommendation on legislative changes for 
        greater commonality.--A specific recommendation on the extent 
        to which and how such standards should supersede State laws, in 
        order to provide the commonality needed to better protect or 
        strengthen the security and confidentiality of health 
        information in the timely exchange of such information and 
        legislative language in the form of a bill to effectuate such 
        specific recommendation.
    ``(c) Congressional Consideration of Legislation Providing for 
Greater Commonality.--
            ``(1) Rules of house of representatives and senate.--This 
        subsection is enacted by the Congress--
                    ``(A) as an exercise of the rulemaking power of the 
                House of Representatives and the Senate, respectively, 
                and as such they are deemed a part of the rules of each 
                House, respectively, but applicable only with respect 
                to the procedure to be followed in that House in the 
                case of a greater commonality bill defined in paragraph 
                (4), and they supersede other rules only to the extent 
                that they are inconsistent therewith; and
                    ``(B) with full recognition of the constitutional 
                right of either House to change the rules (so far as 
                relating to the procedure of that House) at any time, 
                in the same manner and to the same extent as in the 
                case of any other rule of that House.
            ``(2) Introduction.--On the date on which the final report 
        is submitted under subsection (b)(3)--
                    ``(A) a greater commonality bill shall be 
                introduced (by request) in the House by the majority 
                leader of the House, for himself and the minority 
                leader of the House, or by Members of the House 
                designated by the majority leader and minority leader 
                of the House; and
                    ``(B) a greater commonality bill shall be 
                introduced (by request) in the Senate by the majority 
                leader of the Senate, for himself and the minority 
                leader of the Senate, or by Members of the Senate 
                designated by the majority leader and minority leader 
                of the Senate.
        If either House is not in session on the day on which such a 
        report is submitted, the greater commonality bill shall be 
        introduced in that House, as provided in the preceding 
        sentence, on the first day thereafter on which the House is in 
        session.
            ``(3) Referral.--A greater commonality bill shall be 
        referred by the Presiding Officers of the respective House to 
        the appropriate committee (or committees) of such House, in 
        accordance with the rules of that House.
            ``(4) Greater commonality bill defined.--For purposes of 
        this section, the term `greater commonality bill' means a 
        bill--
                    ``(A) the title of which is the following: `A Bill 
                to provide the commonality needed to better protect, 
                strengthen, or otherwise improve the secure, 
                confidential, and timely exchange of health 
                information'; and
                    ``(B) the text of which, as introduced, consists of 
                the text of the bill included in the report submitted 
                under subsection (b)(3).
    ``(d) Definitions.--For purposes of this section:
            ``(1) Current federal security and confidentiality 
        standards.--The term `current Federal security and 
        confidentiality standards' means the Federal privacy standards 
        established pursuant to section 264(c) of the Health Insurance 
        Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2 
        note) and security standards established under section 1173(d) 
        of the Social Security Act.
            ``(2) State.--The term `State' has the meaning given such 
        term when used in title XI of the Social Security Act, as 
        provided under section 1101(a) of such Act (42 U.S.C. 1301(a)).
            ``(3) State security and confidentiality laws.--The term 
        `State security and confidentiality laws' means State laws and 
        regulations relating to the privacy and confidentiality of 
        health information or to the security of such information.''.

SEC. 206. REPORT ON APPROPRIATENESS OF CLASSIFICATION METHODOLOGIES AND 
              CODES FOR ADDITIONAL PURPOSES.

    Not later than the date that is 180 days after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
submit to Congress a report that evaluates--
            (1) the applicability of health care classification 
        methodologies and codes for purposes beyond the coding of 
        services for diagnostic documentation or billing purposes;
            (2) the usefulness, accuracy, and completeness of such 
        methodologies and codes for such purposes; and
            (3) the capacity of such methodologies and codes to produce 
        erroneous or misleading information, with respect to such 
        purposes.

TITLE III--PROMOTING THE USE OF HEALTH INFORMATION TECHNOLOGY TO BETTER 
                         COORDINATE HEALTH CARE

SEC. 301. SAFE HARBORS TO ANTIKICKBACK CIVIL PENALTIES AND CRIMINAL 
              PENALTIES FOR PROVISION OF HEALTH INFORMATION TECHNOLOGY 
              AND TRAINING SERVICES.

    (a) For Civil Penalties.--Section 1128A of the Social Security Act 
(42 U.S.C. 1320a-7a) is amended--
            (1) in subsection (b), by adding at the end the following 
        new paragraph:
    ``(4) For purposes of this subsection, inducements to reduce or 
limit services described in paragraph (1) shall not include the 
practical or other advantages resulting from health information 
technology or related installation, maintenance, support, or training 
services.''; and
            (2) in subsection (i), by adding at the end the following 
        new paragraph:
            ``(8) The term `health information technology' means 
        hardware, software, license, right, intellectual property, 
        equipment, or other information technology (including new 
        versions, upgrades, and connectivity) designed or provided 
        primarily for the electronic creation, maintenance, or exchange 
        of health information to better coordinate care or improve 
        health care quality, efficiency, or research.''.
    (b) For Criminal Penalties.--Section 1128B of such Act (42 U.S.C. 
1320a-7b) is amended--
            (1) in subsection (b)(3)--
                    (A) in subparagraph (G), by striking ``and'' at the 
                end;
                    (B) in the subparagraph (H) added by section 237(d) 
                of the Medicare Prescription Drug, Improvement, and 
                Modernization Act of 2003 (Public Law 108-173; 117 
                Stat. 2213)--
                            (i) by moving such subparagraph 2 ems to 
                        the left; and
                            (ii) by striking the period at the end and 
                        inserting a semicolon;
                    (C) in the subparagraph (H) added by section 431(a) 
                of such Act (117 Stat. 2287)--
                            (i) by redesignating such subparagraph as 
                        subparagraph (I);
                            (ii) by moving such subparagraph 2 ems to 
                        the left; and
                            (iii) by striking the period at the end and 
                        inserting ``; and''; and
                    (D) by adding at the end the following new 
                subparagraph:
            ``(J) any nonmonetary remuneration (in the form of health 
        information technology, as defined in section 1128A(i)(8), or 
        related installation, maintenance, support or training 
        services) made to a person by a specified entity (as defined in 
        subsection (g)) if--
                    ``(i) the provision of such remuneration is without 
                an agreement between the parties or legal condition 
                that--
                            ``(I) limits or restricts the use of the 
                        health information technology to services 
                        provided by the physician to individuals 
                        receiving services at the specified entity;
                            ``(II) limits or restricts the use of the 
                        health information technology in conjunction 
                        with other health information technology; or
                            ``(III) conditions the provision of such 
                        remuneration on the referral of patients or 
                        business to the specified entity;
                    ``(ii) such remuneration is arranged for in a 
                written agreement that is signed by the parties 
                involved (or their representatives) and that specifies 
                the remuneration solicited or received (or offered or 
                paid) and states that the provision of such 
                remuneration is made for the primary purpose of better 
                coordination of care or improvement of health quality, 
                efficiency, or research; and
                    ``(iii) the specified entity providing the 
                remuneration (or a representative of such entity) has 
                not taken any action to disable any basic feature of 
                any hardware or software component of such remuneration 
                that would permit interoperability.''; and
            (2) by adding at the end the following new subsection:
    ``(g) Specified Entity Defined.--For purposes of subsection 
(b)(3)(J), the term `specified entity' means an entity that is a 
hospital, group practice, prescription drug plan sponsor, a Medicare 
Advantage organization, or any other such entity specified by the 
Secretary, considering the goals and objectives of this section, as 
well as the goals to better coordinate the delivery of health care and 
to promote the adoption and use of health information technology.''.
    (c) Effective Date and Effect on State Laws.--
            (1) Effective date.--The amendments made by subsections (a) 
        and (b) shall take effect on the date that is 120 days after 
        the date of the enactment of this Act.
            (2) Preemption of state laws.--No State (as defined in 
        section 1101(a) of the Social Security Act (42 U.S.C. 1301(a)) 
        for purposes of title XI of such Act) shall have in effect a 
        State law that imposes a criminal or civil penalty for a 
        transaction described in section 1128A(b)(4) or section 
        1128B(b)(3)(J) of such Act, as added by subsections (a)(1) and 
        (b), respectively, if the conditions described in the 
        respective provision, with respect to such transaction, are 
        met.
    (d) Study and Report to Assess Effect of Safe Harbors on Health 
System.--
            (1) In general.--The Secretary of Health and Human Services 
        shall conduct a study to determine the impact of each of the 
        safe harbors described in paragraph (3). In particular, the 
        study shall examine the following:
                    (A) The effectiveness of each safe harbor in 
                increasing the adoption of health information 
                technology.
                    (B) The types of health information technology 
                provided under each safe harbor.
                    (C) The extent to which the financial or other 
                business relationships between providers under each 
                safe harbor have changed as a result of the safe harbor 
                in a way that adversely affects or benefits the health 
                care system or choices available to consumers.
                    (D) The impact of the adoption of health 
                information technology on health care quality, cost, 
                and access under each safe harbor.
            (2) Report.--Not later than three years after the effective 
        date described in subsection (c)(1), the Secretary of Health 
        and Human Services shall submit to Congress a report on the 
        study under paragraph (1).
            (3) Safe harbors described.--For purposes of paragraphs (1) 
        and (2), the safe harbors described in this paragraph are--
                    (A) the safe harbor under section 1128A(b)(4) of 
                such Act (42 U.S.C. 1320a-7a(b)(4)), as added by 
                subsection (a)(1); and
                    (B) the safe harbor under section 1128B(b)(3)(J) of 
                such Act (42 U.S.C. 1320a-7b(b)(3)(J)), as added by 
                subsection (b).

SEC. 302. EXCEPTION TO LIMITATION ON CERTAIN PHYSICIAN REFERRALS (UNDER 
              STARK) FOR PROVISION OF HEALTH INFORMATION TECHNOLOGY AND 
              TRAINING SERVICES TO HEALTH CARE PROFESSIONALS.

    (a) In General.--Section 1877(b) of the Social Security Act (42 
U.S.C. 1395nn(b)) is amended by adding at the end the following new 
paragraph:
            ``(6) Information technology and training services.--
                    ``(A) In general.--Any nonmonetary remuneration (in 
                the form of health information technology or related 
                installation, maintenance, support or training 
                services) made by a specified entity to a physician 
                if--
                            ``(i) the provision of such remuneration is 
                        without an agreement between the parties or 
                        legal condition that--
                                    ``(I) limits or restricts the use 
                                of the health information technology to 
                                services provided by the physician to 
                                individuals receiving services at the 
                                specified entity;
                                    ``(II) limits or restricts the use 
                                of the health information technology in 
                                conjunction with other health 
                                information technology; or
                                    ``(III) conditions the provision of 
                                such remuneration on the referral of 
                                patients or business to the specified 
                                entity;
                            ``(ii) such remuneration is arranged for in 
                        a written agreement that is signed by the 
                        parties involved (or their representatives) and 
                        that specifies the remuneration made and states 
                        that the provision of such remuneration is made 
                        for the primary purpose of better coordination 
                        of care or improvement of health quality, 
                        efficiency, or research; and
                            ``(iii) the specified entity (or a 
                        representative of such entity) has not taken 
                        any action to disable any basic feature of any 
                        hardware or software component of such 
                        remuneration that would permit 
                        interoperability.
                    ``(B) Health information technology defined.--For 
                purposes of this paragraph, the term `health 
                information technology' means hardware, software, 
                license, right, intellectual property, equipment, or 
                other information technology (including new versions, 
                upgrades, and connectivity) designed or provided 
                primarily for the electronic creation, maintenance, or 
                exchange of health information to better coordinate 
                care or improve health care quality, efficiency, or 
                research.
                    ``(C) Specified entity defined.--For purposes of 
                this paragraph, the term `specified entity' means an 
                entity that is a hospital, group practice, prescription 
                drug plan sponsor, a Medicare Advantage organization, 
                or any other such entity specified by the Secretary, 
                considering the goals and objectives of this section, 
                as well as the goals to better coordinate the delivery 
                of health care and to promote the adoption and use of 
                health information technology.''.
    (b) Effective Date; Effect on State Laws.--
            (1) Effective date.--The amendment made by subsection (a) 
        shall take effect on the date that is 120 days after the date 
        of the enactment of this Act.
            (2) Preemption of state laws.--No State (as defined in 
        section 1101(a) of the Social Security Act (42 U.S.C. 1301(a)) 
        for purposes of title XI of such Act) shall have in effect a 
        State law that imposes a criminal or civil penalty for a 
        transaction described in section 1877(b)(6) of such Act, as 
        added by subsection (a), if the conditions described in such 
        section, with respect to such transaction, are met.
    (c) Study and Report to Assess Effect of Exception on Health 
System.--
            (1) In general.--The Secretary of Health and Human Services 
        shall conduct a study to determine the impact of the exception 
        under section 1877(b)(6) of such Act (42 U.S.C. 1395nn(b)(6)), 
        as added by subsection (a). In particular, the study shall 
        examine the following:
                    (A) The effectiveness of the exception in 
                increasing the adoption of health information 
                technology.
                    (B) The types of health information technology 
                provided under the exception.
                    (C) The extent to which the financial or other 
                business relationships between providers under the 
                exception have changed as a result of the exception in 
                a way that adversely affects or benefits the health 
                care system or choices available to consumers.
                    (D) The impact of the adoption of health 
                information technology on health care quality, cost, 
                and access under the exception.
            (2) Report.--Not later than three years after the effective 
        date described in subsection (b)(1), the Secretary of Health 
        and Human Services shall submit to Congress a report on the 
        study under paragraph (1).

SEC. 303. RULES OF CONSTRUCTION REGARDING USE OF CONSORTIA.

    (a) Application to Safe Harbor From Criminal Penalties.--Section 
1128B(b)(3) of the Social Security Act (42 U.S.C. 1320a-7b(b)(3)) is 
amended by adding after and below subparagraph (J), as added by section 
301(b)(1), the following: ``For purposes of subparagraph (J), nothing 
in such subparagraph shall be construed as preventing a specified 
entity, consistent with the specific requirements of such subparagraph, 
from forming a consortium composed of health care providers, payers, 
employers, and other interested entities to collectively purchase and 
donate health information technology, or from offering health care 
providers a choice of health information technology products in order 
to take into account the varying needs of such providers receiving such 
products.''.
    (b) Application to Stark Exception.--Paragraph (6) of section 
1877(b) of the Social Security Act (42 U.S.C. 1395nn(b)), as added by 
section 302(a), is amended by adding at the end the following new 
subparagraph:
                    ``(D) Rule of construction.--For purposes of 
                subparagraph (A), nothing in such subparagraph shall be 
                construed as preventing a specified entity, consistent 
                with the specific requirements of such subparagraph, 
                from--
                            ``(i) forming a consortium composed of 
                        health care providers, payers, employers, and 
                        other interested entities to collectively 
                        purchase and donate health information 
                        technology; or
                            ``(ii) offering health care providers a 
                        choice of health information technology 
                        products in order to take into account the 
                        varying needs of such providers receiving such 
                        products.''.

                    TITLE IV--ADDITIONAL PROVISIONS

SEC. 401. PROMOTION OF TELEHEALTH SERVICES.

    (a) Facilitating the Provision of Telehealth Services Across State 
Lines.--The Secretary of Health and Human Services shall, in 
coordination with physicians, health care practitioners, patient 
advocates, and representatives of States, encourage and facilitate the 
adoption of State reciprocity agreements for practitioner licensure in 
order to expedite the provision across State lines of telehealth 
services.
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
submit to Congress a report on the actions taken to carry out 
subsection (a).
    (c) State Defined.--For purposes of this subsection, the term 
``State'' has the meaning given that term for purposes of title XVIII 
of the Social Security Act.

SEC. 402. STUDY AND REPORT ON EXPANSION OF HOME HEALTH-RELATED 
              TELEHEALTH SERVICES.

    (a) Study.--The Secretary of Health and Human Services shall 
conduct a study to determine the feasibility, advisability, and the 
costs of--
            (1) including coverage and payment for home health-related 
        telehealth services as part of home health services under title 
        XVIII of the Social Security Act; and
            (2) expanding the list of sites described in paragraph 
        (4)(C)(ii) of section 1834(m) of the Social Security Act (42 
        U.S.C. 1395m(m)) to include county mental health clinics or 
        other publicly funded mental health facilities for the purpose 
        of payment under such section for the provision of telehealth 
        services at such clinics or facilities.
    (b) Specifics of Study.--Such study shall demonstrate whether the 
changes described in paragraphs (1) and (2) of subsection (a) will 
result in the following:
            (1) Enhanced health outcomes for individuals with one or 
        more chronic conditions.
            (2) Health outcomes for individuals furnished telehealth 
        services or home health-related telehealth services that are at 
        least comparable to the health outcomes for individuals 
        furnished similar items and services by a health care provider 
        at the same location of the individual or at the home of the 
        individual, respectively.
            (3) Facilitation of communication of more accurate clinical 
        information between health care providers.
            (4) Closer monitoring of individuals by health care 
        providers.
            (5) Overall reduction in expenditures for health care items 
        and services.
            (6) Improved access to health care.
    (c) Home Health-Related Telehealth Services Defined.--For purposes 
of this section, the term ``home health-related telehealth services'' 
means technology-based professional consultations, patient monitoring, 
patient training services, clinical observation, patient assessment, 
and any other health services that utilize telecommunications 
technologies. Such term does not include a telecommunication that 
consists solely of a telephone audio conversation, facsimile, 
electronic text mail, or consultation between two health care 
providers.
    (d) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
submit to Congress a report on the study conducted under subsection (a) 
and shall include in such report such recommendations for legislation 
or administration action as the Secretary determines appropriate.

SEC. 403. STUDY AND REPORT ON STORE AND FORWARD TECHNOLOGY FOR 
              TELEHEALTH.

    (a) Study.--The Secretary of Health and Human Services, acting 
through the Director of the Office for the Advancement of Telehealth, 
shall conduct a study on the use of store and forward technologies 
(that provide for the asynchronous transmission of health care 
information in single or multimedia formats) in the provision of 
telehealth services. Such study shall include an assessment of the 
feasibility, advisability, and the costs of expanding the use of such 
technologies for use in the diagnosis and treatment of certain 
conditions.
    (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Secretary of Health and Human Services shall 
submit to Congress a report on the study conducted under subsection (a) 
and shall include in such report such recommendations for legislation 
or administration action as the Secretary determines appropriate.

SEC. 404. ENSURING HEALTH CARE PROVIDERS PARTICIPATING IN PHSA 
              PROGRAMS, MEDICAID, SCHIP, OR THE MCH PROGRAM MAY 
              MAINTAIN HEALTH INFORMATION IN ELECTRONIC FORM.

    Part D of title II of the Public Health Service Act, as added by 
section 101(a) and amended by sections 103 and 105, is further amended 
by adding at the end the following new section:

``SEC. 274. ENSURING HEALTH CARE PROVIDERS MAY MAINTAIN HEALTH 
              INFORMATION IN ELECTRONIC FORM.

    ``(a) In General.--Any health care provider that participates in a 
health care program that receives Federal funds under this Act, or 
under title V, XIX, or XXI of the Social Security Act, shall be deemed 
as meeting any requirement for the maintenance of data in paper form 
under such program (whether or not for purposes of management, billing, 
reporting, reimbursement, or otherwise) if the required data is 
maintained in an electronic form.
    ``(b) Relation to State Laws.--Beginning on the date that is one 
year after the date of the enactment of this section, subsection (a) 
shall supersede any contrary provision of State law.
    ``(c) Construction.--Nothing in this section shall be construed 
as--
            ``(1) requiring health care providers to maintain or submit 
        data in electronic form;
            ``(2) preventing a State from permitting health care 
        providers to maintain or submit data in paper form; or
            ``(3) preventing a State from requiring health care 
        providers to maintain or submit data in electronic form.''.

SEC. 405. ENSURING HEALTH CARE PROVIDERS PARTICIPATING IN THE MEDICARE 
              PROGRAM MAY MAINTAIN HEALTH INFORMATION IN ELECTRONIC 
              FORM.

    Section 1871 of the Social Security Act (42 U.S.C. 1395hh) is 
amended by adding at the end the following new subsection:
    ``(g)(1) Any provider of services or supplier shall be deemed as 
meeting any requirement for the maintenance of data in paper form under 
this title (whether or not for purposes of management, billing, 
reporting, reimbursement, or otherwise) if the required data is 
maintained in an electronic form.
    ``(2) Nothing in this subsection shall be construed as requiring 
health care providers to maintain or submit data in electronic form.''.

SEC. 406. STUDY AND REPORT ON STATE, REGIONAL, AND COMMUNITY HEALTH 
              INFORMATION EXCHANGES.

    (a) Study.--The Secretary of Health and Human Services shall 
conduct a study on issues related to the development, operation, and 
implementation of State, regional, and community health information 
exchanges. Such study shall include the following, with respect to such 
health information exchanges:
            (1) Profiles detailing the current stages of such health 
        information exchanges with respect to the progression of the 
        development, operation, implementation, organization, and 
        governance of such exchanges.
            (2) The impact of such exchanges on healthcare quality, 
        safety, and efficiency, including--
                    (A) any impact on the coordination of health 
                information and services across healthcare providers 
                and other organizations relevant to health care;
                    (B) any impact on the availability of health 
                information at the point-of-care to make timely medical 
                decisions;
                    (C) any benefits with respect to the promotion of 
                wellness, disease prevention, and chronic disease 
                management;
                    (D) any improvement with respect to public health 
                preparedness and response;
                    (E) any impact on the widespread adoption of 
                interoperable health information technology, including 
                electronic health records;
                    (F) any contributions to achieving an Internet-
                based national health information network;
                    (G) any contribution of health information 
                exchanges to consumer access and to consumers' use of 
                their health information; and
                    (H) any impact on the operation of--
                            (i) the Medicaid and Medicare programs;
                            (ii) the State Children's Health Insurance 
                        Program (SCHIP);
                            (iii) disproportionate share hospitals 
                        described in section 1923 of the Social 
                        Security Act;
                            (iv) Federally-qualified health centers; or
                            (v) managed care plans, if a significant 
                        number of the plan's enrollees are 
                        beneficiaries in the Medicaid program or SCHIP.
            (3) Best practice models for financing, incentivizing, and 
        sustaining such health information exchanges.
            (4) Information identifying the common principles, 
        policies, tools, and standards used (or proposed) in the public 
        and private sectors to support the development, operation, and 
        implementation of such health information exchanges.
            (5) A description of any areas in which Federal government 
        leadership is needed to support growth and sustainability of 
        such health information exchanges.
    (b) Report.--Not later than one year after the date of enactment of 
this Act, the Secretary of Health and Human Services shall submit to 
Congress a report on the study described in subsection (a), including 
such recommendations as the Secretary determines appropriate to 
facilitate the development, operation, and implementation of health 
information exchanges.

SEC. 407. PROMOTING HEALTH INFORMATION TECHNOLOGY AS A TOOL FOR CHRONIC 
              DISEASE MANAGEMENT.

    (a) In General.--The Secretary of Health and Human Services shall 
establish a two-year project to demonstrate the impact of health 
information technology on disease management for individuals entitled 
to medical assistance under a State plan under title XIX of the Social 
Security Act.
    (b) Structure of Project.--The project under subsection (a) shall--
            (1) create a web-based virtual case management tool that 
        provides access to best practices for managing chronic disease; 
        and
            (2) provide chronic disease patients and caregivers access 
        to their own medical records and to a single source of 
        information on chronic disease.
    (c) Competition.--Not later than the date that is 90 days after the 
date of the enactment of this Act, the Secretary of Health and Human 
Services shall seek proposals from States to carry out the project 
under subsection (a). The Secretary shall select not less than four of 
such proposals submitted, and at least one proposal selected shall 
include a regional approach that features access to an integrated 
hospital information system in at least two adjoining States and that 
permits the measurement of health outcomes.
    (d) Report.--Not later than the date that is 90 days after the last 
day of the project under subsection (a), the Secretary of Health and 
Human Services shall submit to Congress a report on such project and 
shall include in such report the amount of any cost-savings resulting 
from the project and such recommendations for legislation or 
administrative action as the Secretary determines appropriate.

            Passed the House of Representatives July 27, 2006.

            Attest:

                                                                 Clerk.
109th CONGRESS

  2d Session

                               H. R. 4157

_______________________________________________________________________

                                 AN ACT

             To promote a better health information system.