[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[S. 1418 Introduced in Senate (IS)]








109th CONGRESS
  1st Session
                                S. 1418

     To enhance the adoption of a nationwide interoperable health 
information technology system and to improve the quality and reduce the 
               costs of health care in the United States.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             July 18, 2005

   Mr. Enzi (for himself, Mr. Kennedy, Mr. Frist, Mrs. Clinton, Mr. 
 Alexander, Mr. Dodd, Mr. Burr, Mr. Harkin, Mr. Isakson, Ms. Mikulski, 
 Mr. DeWine, Mr. Jeffords, Mr. Roberts, Mr. Bingaman, Mrs. Murray, Mr. 
Hagel, Mr. Martinez, Mr. Talent, Mr. Obama, Mr. Bond, and Mr. Nelson of 
   Florida) introduced the following bill; which was read twice and 
  referred to the Committee on Health, Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
     To enhance the adoption of a nationwide interoperable health 
information technology system and to improve the quality and reduce the 
               costs of health care in the United States.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Wired for Health Care Quality Act''.

SEC. 2. IMPROVING HEALTH CARE, QUALITY, SAFETY, AND EFFICIENCY.

    The Public Health Service Act (42 U.S.C. 201 et seq.) is amended by 
adding at the end the following:

              ``TITLE XXIX--HEALTH INFORMATION TECHNOLOGY

``SEC. 2901. DEFINITIONS.

    ``In this title:
            ``(1) Health care provider.--The term `health care 
        provider' means a hospital, skilled nursing facility, home 
        health entity, health care clinic, federally qualified health 
        center, group practice (as defined in section 1877(h)(4) of the 
        Social Security Act), a pharmacist, a pharmacy, a laboratory, a 
        physician (as defined in section 1861(r) of the Social Security 
        Act), a health facility operated by or pursuant to a contract 
        with the Indian Health Service, a rural health clinic, and any 
        other category of facility or clinician determined appropriate 
        by the Secretary.
            ``(2) Health information.--The term `health information' 
        has the meaning given such term in section 1171(4) of the 
        Social Security Act.
            ``(3) Health insurance plan.--The term `health insurance 
        plan' means--
                    ``(A) a health insurance issuer (as defined in 
                section 2791(b)(2));
                    ``(B) a group health plan (as defined in section 
                2791(a)(1)); and
                    ``(C) a health maintenance organization (as defined 
                in section 2791(b)(3)).
            ``(4) Laboratory.--The term `laboratory' has the meaning 
        given that term in section 353.
            ``(5) Pharmacist.--The term `pharmacist' has the meaning 
        given that term in section 804 of the Federal Food, Drug, and 
        Cosmetic Act.
            ``(6) Qualified health information technology.--The term 
        `qualified health information technology' means a computerized 
        system (including hardware, software, and training) that--
                    ``(A) protects the privacy and security of health 
                information;
                    ``(B) maintains and provides permitted access to 
                health information in an electronic format;
                    ``(C) incorporates decision support to reduce 
                medical errors and enhance health care quality;
                    ``(D) complies with the standards adopted by the 
                Federal Government under section 2903; and
                    ``(E) allows for the reporting of quality measures 
                under section 2908.
            ``(7) State.--The term `State' means each of the several 
        States, the District of Columbia, Puerto Rico, the Virgin 
        Islands, Guam, American Samoa, and the Northern Mariana 
        Islands.

``SEC. 2902. OFFICE OF THE NATIONAL COORDINATOR OF HEALTH INFORMATION 
              TECHNOLOGY.

    ``(a) Office of National Health Information Technology.--There is 
established within the Office of the Secretary an Office of the 
National Coordinator of Health Information Technology (referred to in 
this section as the `Office'). The Office shall be headed by a National 
Coordinator who shall be appointed by the President, in consultation 
with the Secretary, and shall report directly to the Secretary.
    ``(b) Purpose.--It shall be the purpose of the Office to carry out 
programs and activities to develop a nationwide interoperable health 
information technology infrastructure that--
            ``(1) ensures that patients' health information is secure 
        and protected;
            ``(2) improves health care quality, reduces medical errors, 
        and advances the delivery of patient-centered medical care;
            ``(3) reduces health care costs resulting from 
        inefficiency, medical errors, inappropriate care, and 
        incomplete information;
            ``(4) ensures that appropriate information to help guide 
        medical decisions is available at the time and place of care;
            ``(5) promotes a more effective marketplace, greater 
        competition, and increased choice through the wider 
        availability of accurate information on health care costs, 
        quality, and outcomes;
            ``(6) improves the coordination of care and information 
        among hospitals, laboratories, physician offices, and other 
        entities through an effective infrastructure for the secure and 
        authorized exchange of health care information;
            ``(7) improves public health reporting and facilitates the 
        early identification and rapid response to public health 
        threats and emergencies, including bioterror events and 
        infectious disease outbreaks;
            ``(8) facilitates health research; and
            ``(9) promotes prevention of chronic diseases.
    ``(c) Duties of the National Coordinator.--The National Coordinator 
shall--
            ``(1) serve as a member of the public-private American 
        Health Information Collaborative established under section 
        2903;
            ``(2) serve as the principal advisor to the Secretary 
        concerning the development, application, and use of health 
        information technology, and coordinate and oversee the health 
        information technology programs of the Department;
            ``(3) facilitate the adoption of a nationwide, 
        interoperable system for the electronic exchange of health 
        information;
            ``(4) ensure the adoption and implementation of standards 
        for the electronic exchange of health information to reduce 
        cost and improve health care quality;
            ``(5) ensure that health information technology policy and 
        programs of the Department are coordinated with those of 
        relevant executive branch agencies (including Federal 
        commissions) with a goal of avoiding duplication of efforts and 
        of helping to ensure that each agency undertakes health 
        information technology activities primarily within the areas of 
        its greatest expertise and technical capability;
            ``(6) to the extent permitted by law, coordinate outreach 
        and consultation by the relevant executive branch agencies 
        (including Federal commissions) with public and private parties 
        of interest, including consumers, payers, employers, hospitals 
        and other health care providers, physicians, community health 
        centers, laboratories, vendors and other stakeholders;
            ``(7) advise the President regarding specific Federal 
        health information technology programs; and
            ``(8) submit the reports described under section 2903(i) 
        (excluding paragraph (4) of such section).
    ``(d) Detail of Federal Employees.--
            ``(1) In general.--Upon the request of the National 
        Coordinator, the head of any Federal agency is authorized to 
        detail, with or without reimbursement from the Office, any of 
        the personnel of such agency to the Office to assist it in 
        carrying out its duties under this section.
            ``(2) Effect of detail.--Any detail of personnel under 
        paragraph (1) shall--
                    ``(A) not interrupt or otherwise affect the civil 
                service status or privileges of the Federal employee; 
                and
                    ``(B) be in addition to any other staff of the 
                Department employed by the National Coordinator.
            ``(3) Acceptance of detailees.--Notwithstanding any other 
        provision of law, the Office may accept detailed personnel from 
        other Federal agencies without regard to whether the agency 
        described under paragraph (1) is reimbursed.
    ``(e) Rule of Construction.--Nothing in this section shall be 
construed to require the duplication of Federal efforts with respect to 
the establishment of the Office, regardless of whether such efforts 
were carried out prior to or after the enactment of this title.
    ``(f) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out the activities 
of the Office under this section for each of fiscal years 2006 through 
2010.

``SEC. 2903. AMERICAN HEALTH INFORMATION COLLABORATIVE.

    ``(a) Purpose.--The Secretary shall establish the public-private 
American Health Information Collaborative (referred to in this section 
as the `Collaborative') to--
            ``(1) advise the Secretary and recommend specific actions 
        to achieve a nationwide interoperable health information 
        technology infrastructure;
            ``(2) serve as a forum for the participation of a broad 
        range of stakeholders to provide input on achieving the 
        interoperability of health information technology; and
            ``(3) recommend standards (including content, 
        communication, and security standards) for the electronic 
        exchange of health information for adoption by the Federal 
        Government and voluntary adoption by private entities.
    ``(b) Composition.--
            ``(1) In general.--The Collaborative shall be composed of--
                    ``(A) the Secretary, who shall serve as the 
                chairperson of the Collaborative;
                    ``(B) the Secretary of Defense, or his or her 
                designee;
                    ``(C) the Secretary of Veterans Affairs, or his or 
                her designee;
                    ``(D) the Secretary of Commerce, or his or her 
                designee;
                    ``(E) the National Coordinator for Health 
                Information Technology;
                    ``(F) representatives of other relevant Federal 
                agencies, as determined appropriate by the Secretary; 
                and
                    ``(G) representatives from each of the following 
                categories to be appointed by the Secretary from 
                nominations submitted by the public--
                            ``(i) consumer and patient organizations;
                            ``(ii) experts in health information 
                        privacy and security;
                            ``(iii) health care providers;
                            ``(iv) health insurance plans or other 
                        third party payors;
                            ``(v) standards development organizations;
                            ``(vi) information technology vendors;
                            ``(vii) purchasers or employers; and
                            ``(viii) State or local government agencies 
                        or Indian tribe or tribal organizations.
            ``(2) Considerations.--In appointing members under 
        paragraph (1)(G), the Secretary shall select individuals with 
        expertise in--
                    ``(A) health information privacy;
                    ``(B) health information security;
                    ``(C) health care quality and patient safety, 
                including those individuals with experience in 
                utilizing health information technology to improve 
                health care quality and patient safety;
                    ``(D) data exchange; and
                    ``(E) developing health information technology 
                standards and new health information technology.
            ``(3) Terms.--Members appointed under paragraph (1)(G) 
        shall serve for 2 year terms, except that any member appointed 
        to fill a vacancy for an unexpired term shall be appointed for 
        the remainder of such term. A member may serve for not to 
        exceed 180 days after the expiration of such member's term or 
        until a successor has been appointed.
    ``(c) Recommendations and Policies.--The Collaborative shall make 
recommendations to identify uniform national policies for adoption by 
the Federal Government and voluntary adoption by private entities to 
support the widespread adoption of health information technology, 
including--
            ``(1) protection of health information through privacy and 
        security practices;
            ``(2) measures to prevent unauthorized access to health 
        information;
            ``(3) methods to facilitate secure patient access to health 
        information;
            ``(4) the ongoing harmonization of industry-wide health 
        information technology standards;
            ``(5) recommendations for a nationwide interoperable health 
        information technology infrastructure;
            ``(6) the identification and prioritization of specific use 
        cases for which heath information technology is valuable, 
        beneficial, and feasible;
            ``(7) recommendations for the establishment of an entity to 
        ensure the continuation of the functions of the Collaborative; 
        and
            ``(8) other policies determined to be necessary by the 
        Collaborative.
    ``(d) Standards.--
            ``(1) Existing standards.--The standards adopted by the 
        Consolidated Health Informatics Initiative shall be deemed to 
        have been recommended by the Collaborative under this section.
            ``(2) First year review.--Not later than 1 year after the 
        date of enactment of this title, the Collaborative shall--
                    ``(A) review existing standards (including content, 
                communication, and security standards) for the 
                electronic exchange of health information, including 
                such standards adopted by the Secretary under paragraph 
                (2)(A);
                    ``(B) identify deficiencies and omissions in such 
                existing standards; and
                    ``(C) identify duplication and overlap in such 
                existing standards;
        and recommend modifications to such standards as necessary.
            ``(3) Ongoing review.--Beginning 1 year after the date of 
        enactment of this title, and annually thereafter, the 
        Collaborative shall--
                    ``(A) review existing standards (including content, 
                communication, and security standards) for the 
                electronic exchange of health information, including 
                such standards adopted by the Secretary under paragraph 
                (2)(A);
                    ``(B) identify deficiencies and omissions in such 
                existing standards; and
                    ``(C) identify duplication and overlap in such 
                existing standards;
        and recommend modifications to such standards as necessary.
            ``(4) Limitation.--The standards described in this section 
        shall be consistent with any standards developed pursuant to 
        the Health Insurance Portability and Accountability Act of 
        1996.
    ``(e) Federal Action.--Not later than 60 days after the issuance of 
a recommendation from the Collaborative under subsection (d)(2), the 
Secretary of Health and Human Services, the Secretary of Veterans 
Affairs, and the Secretary of Defense, in collaboration with 
representatives of other relevant Federal agencies, as determined 
appropriate by the Secretary, shall jointly review such 
recommendations. The Secretary shall provide for the adoption by the 
Federal Government of any standard or standards contained in such 
recommendation.
    ``(f) Coordination of Federal Spending.--Not later than 1 year 
after the adoption by the Federal Government of a recommendation as 
provided for in subsection (e), and in compliance with chapter 113 of 
title 40, United States Code, no Federal agency shall expend Federal 
funds for the purchase of any form of health information technology or 
health information technology system for clinical care or for the 
electronic retrieval, storage, or exchange of health information that 
is not consistent with applicable standards adopted by the Federal 
Government under subsection (e).
    ``(g) Coordination of Federal Data Collection.--Not later than 3 
years after the adoption by the Federal Government of a recommendation 
as provided for in subsection (e), all Federal agencies collecting 
health data for the purposes of surveillance, epidemiology, adverse 
event reporting, research, or for other purposes determined appropriate 
by the Secretary shall comply with standards adopted under subsection 
(e).
    ``(h) Voluntary Adoption.--Any standards adopted by the Federal 
Government under subsection (e) shall be voluntary with respect to 
private entities.
    ``(i) Reports.--The Secretary shall submit to the Committee on 
Health, Education, Labor, and Pensions and the Committee on Finance of 
the Senate and the Committee on Energy and Commerce and the Committee 
on Ways and Means of the House of Representatives, on an annual basis, 
a report that--
            ``(1) describes the specific actions that have been taken 
        by the Federal Government and private entities to facilitate 
        the adoption of an interoperable nationwide system for the 
        electronic exchange of health information;
            ``(2) describes barriers to the adoption of such a 
        nationwide system;
            ``(3) contains recommendations to achieve full 
        implementation of such a nationwide system; and
            ``(4) contains a plan and progress toward the establishment 
        of an entity to ensure the continuation of the functions of the 
        Collaborative.
    ``(j) Application of FACA.--The Federal Advisory Committee Act (5 
U.S.C. App.) shall apply to the Collaborative, except that the term 
provided for under section 14(a)(2) shall be 5 years.
    ``(k) Rule of Construction.--Nothing in this section shall be 
construed to require the duplication of Federal efforts with respect to 
the establishment of the Collaborative, regardless of whether such 
efforts were carried out prior to or after the enactment of this title.
    ``(l) Authorization of Appropriations.--There are authorized to be 
appropriated such sums as may be necessary to carry out this section 
for each of fiscal years 2006 through 2010.

``SEC. 2904. IMPLEMENTATION AND CERTIFICATION OF HEALTH INFORMATION 
              STANDARDS.

    ``(a) Implementation.--
            ``(1) In general.--The Secretary, based upon the 
        recommendations of the Collaborative, shall develop criteria to 
        ensure uniform and consistent implementation of any standards 
        for the electronic exchange of health information voluntarily 
        adopted by private entities in technical conformance with such 
        standards adopted under this title.
            ``(2) Implementation assistance.--The Secretary may 
        recognize a private entity or entities to assist private 
        entities in the implementation of the standards adopted under 
        this title using the criteria developed by the Secretary under 
        this section.
    ``(b) Certification.--
            ``(1) In general.--The Secretary, based upon the 
        recommendations of the Collaborative, shall develop criteria to 
        ensure and certify that hardware, software, and support 
        services that claim to be in compliance with any standard for 
        the electronic exchange of health information adopted under 
        this title have established and maintained such compliance in 
        technical conformance with such standards.
            ``(2) Certification assistance.--The Secretary may 
        recognize a private entity or entities to assist in the 
        certification described under paragraph (1) using the criteria 
        developed by the Secretary under this section.
    ``(c) Delegation Authority.--The Secretary, through consultation 
with the Collaborative, may delegate the development of the criteria 
under subsections (a) and (b) to a private entity.

``SEC. 2905. GRANTS TO FACILITATE THE WIDESPREAD ADOPTION OF 
              INTEROPERABLE HEALTH INFORMATION TECHNOLOGY.

    ``(a) Competitive Grants to Facilitate the Widespread Adoption of 
Health Information Technology.--
            ``(1) In general.--The Secretary may award competitive 
        grants to eligible entities to facilitate the purchase and 
        enhance the utilization of qualified health information 
        technology systems to improve the quality and efficiency of 
        health care.
            ``(2) Eligibility.--To be eligible to receive a grant under 
        paragraph (1) an entity shall--
                    ``(A) submit to the Secretary an application at 
                such time, in such manner, and containing such 
                information as the Secretary may require;
                    ``(B) submit to the Secretary a strategic plan for 
                the implementation of data sharing and interoperability 
                measures;
                    ``(C) be a--
                            ``(i) not for profit hospital;
                            ``(ii) group practice (including a single 
                        physician); or
                            ``(iii) another health care provider not 
                        described in clause (i) or (ii);
                    ``(D) adopt the standards adopted by the Federal 
                Government under section 2903;
                    ``(E) require that health care providers receiving 
                such grants implement the measurement system adopted 
                under section 2908 and report to the Secretary on such 
                measures;
                    ``(F) demonstrate significant financial need; and
                    ``(G) provide matching funds in accordance with 
                paragraph (4).
            ``(3) Use of funds.--Amounts received under a grant under 
        this subsection shall be used to facilitate the purchase and 
        enhance the utilization of qualified health information 
        technology systems.
            ``(4) Matching requirement.--To be eligible for a grant 
        under this subsection an entity shall contribute non-Federal 
        contributions to the costs of carrying out the activities for 
        which the grant is awarded in an amount equal to $1 for each $3 
        of Federal funds provided under the grant.
            ``(5) Preference in awarding grants.--In awarding grants 
        under this subsection the Secretary shall give preference to--
                    ``(A) eligible entities that are located in rural, 
                frontier, and other underserved areas as determined by 
                the Secretary; and
                    ``(B) eligible entities that will link, to the 
                extent practicable, the qualified health information 
                system to local or regional health information 
                networks.
    ``(b) Competitive Grants to States for the Development of State 
Loan Programs to Facilitate the Widespread Adoption of Health 
Information Technology.--
            ``(1) In general.--The Secretary may award competitive 
        grants to States for the establishment of State programs for 
        loans to health care providers to facilitate the purchase and 
        enhance the utilization of qualified health information 
        technology.
            ``(2) Establishment of fund.--To be eligible to receive a 
        competitive grant under this subsection, a State shall 
        establish a qualified health information technology loan fund 
        (referred to in this subsection as a `State loan fund') and 
        comply with the other requirements contained in this section. A 
        grant to a State under this subsection shall be deposited in 
        the State loan fund established by the State. No funds 
        authorized by other provisions of this title to be used for 
        other purposes specified in this title shall be deposited in 
        any State loan fund.
            ``(3) Eligibility.--To be eligible to receive a grant under 
        paragraph (1) a State shall--
                    ``(A) submit to the Secretary an application at 
                such time, in such manner, and containing such 
                information as the Secretary may require;
                    ``(B) submit to the Secretary a strategic plan in 
                accordance with paragraph (4);
                    ``(C) establish a qualified health information 
                technology loan fund in accordance with paragraph (2);
                    ``(D) require that health care providers receiving 
                such loans--
                            ``(i) link, to the extent practicable, the 
                        qualified health information system to a local 
                        or regional health information network; and
                            ``(ii) consult with the Center for Best 
                        Practices established in section 914(d) to 
                        access the knowledge and experience of existing 
                        initiatives regarding the successful 
                        implementation and effective use of health 
                        information technology;
                    ``(E) require that health care providers receiving 
                such loans adopt the standards adopted by the Federal 
                Government under section 2903(d);
                    ``(F) require that health care providers receiving 
                such loans implement the measurement system adopted 
                under section 2908 and report to the Secretary on such 
                measures; and
                    ``(G) provide matching funds in accordance with 
                paragraph (8).
            ``(4) Strategic plan.--
                    ``(A) In general.--A State that receives a grant 
                under this subsection shall annually prepare a 
                strategic plan that identifies the intended uses of 
                amounts available to the State loan fund of the State.
                    ``(B) Contents.--A strategic plan under 
                subparagraph (A) shall include--
                            ``(i) a list of the projects to be assisted 
                        through the State loan fund in the first fiscal 
                        year that begins after the date on which the 
                        plan is submitted;
                            ``(ii) a description of the criteria and 
                        methods established for the distribution of 
                        funds from the State loan fund; and
                            ``(iii) a description of the financial 
                        status of the State loan fund and the short-
                        term and long-term goals of the State loan 
                        fund.
            ``(5) Use of funds.--
                    ``(A) In general.--Amounts deposited in a State 
                loan fund, including loan repayments and interest 
                earned on such amounts, shall be used only for awarding 
                loans or loan guarantees, or as a source of reserve and 
                security for leveraged loans, the proceeds of which are 
                deposited in the State loan fund established under 
                paragraph (1). Loans under this section may be used by 
                a health care provider to facilitate the purchase and 
                enhance the utilization of qualified health information 
                technology.
                    ``(B) Limitation.--Amounts received by a State 
                under this subsection may not be used--
                            ``(i) for the purchase or other acquisition 
                        of any health information technology system 
                        that is not a qualified health information 
                        technology system;
                            ``(ii) to conduct activities for which 
                        Federal funds are expended under this title, or 
                        the amendments made by the Wired for Health 
                        Care Quality Act; or
                            ``(iii) for any purpose other than making 
                        loans to eligible entities under this section.
            ``(6) Types of assistance.--Except as otherwise limited by 
        applicable State law, amounts deposited into a State loan fund 
        under this subsection may only be used for the following:
                    ``(A) To award loans that comply with the 
                following:
                            ``(i) The interest rate for each loan shall 
                        be less than or equal to the market interest 
                        rate.
                            ``(ii) The principal and interest payments 
                        on each loan shall commence not later than 1 
                        year after the loan was awarded, and each loan 
                        shall be fully amortized not later than 10 
                        years after the date of the loan.
                            ``(iii) The State loan fund shall be 
                        credited with all payments of principal and 
                        interest on each loan awarded from the fund.
                    ``(B) To guarantee, or purchase insurance for, a 
                local obligation (all of the proceeds of which finance 
                a project eligible for assistance under this 
                subsection) if the guarantee or purchase would improve 
                credit market access or reduce the interest rate 
                applicable to the obligation involved.
                    ``(C) As a source of revenue or security for the 
                payment of principal and interest on revenue or general 
                obligation bonds issued by the State if the proceeds of 
                the sale of the bonds will be deposited into the State 
                loan fund.
                    ``(D) To earn interest on the amounts deposited 
                into the State loan fund.
            ``(7) Administration of state loan funds.--
                    ``(A) Combined financial administration.--A State 
                may (as a convenience and to avoid unnecessary 
                administrative costs) combine, in accordance with State 
                law, the financial administration of a State loan fund 
                established under this subsection with the financial 
                administration of any other revolving fund established 
                by the State if otherwise not prohibited by the law 
                under which the State loan fund was established.
                    ``(B) Cost of administering fund.--Each State may 
                annually use not to exceed 4 percent of the funds 
                provided to the State under a grant under this 
                subsection to pay the reasonable costs of the 
                administration of the programs under this section, 
                including the recovery of reasonable costs expended to 
                establish a State loan fund which are incurred after 
                the date of enactment of this title.
                    ``(C) Guidance and regulations.--The Secretary 
                shall publish guidance and promulgate regulations as 
                may be necessary to carry out the provisions of this 
                subsection, including--
                            ``(i) provisions to ensure that each State 
                        commits and expends funds allotted to the State 
                        under this subsection as efficiently as 
                        possible in accordance with this title and 
                        applicable State laws; and
                            ``(ii) guidance to prevent waste, fraud, 
                        and abuse.
                    ``(D) Private sector contributions.--
                            ``(i) In general.--A State loan fund 
                        established under this subsection may accept 
                        contributions from private sector entities, 
                        except that such entities may not specify the 
                        recipient or recipients of any loan issued 
                        under this subsection.
                            ``(ii) Availability of information.--A 
                        State shall make publically available the 
                        identity of, and amount contributed by, any 
                        private sector entity under clause (i) and may 
                        issue letters of commendation or make other 
                        awards (that have no financial value) to any 
                        such entity.
            ``(8) Matching requirements.--
                    ``(A) In general.--The Secretary may not make a 
                grant under paragraph (1) to a State unless the State 
                agrees to make available (directly or through donations 
                from public or private entities) non-Federal 
                contributions in cash toward the costs of the State 
                program to be implemented under the grant in an amount 
                equal to not less than $1 for each $1 of Federal funds 
                provided under the grant.
                    ``(B) Determination of amount of non-federal 
                contribution.--In determining the amount of non-Federal 
                contributions that a State has provided pursuant to 
                subparagraph (A), the Secretary may not include any 
                amounts provided to the State by the Federal 
                Government.
            ``(9) Preference in awarding grants.--The Secretary may 
        give a preference in awarding grants under this subsection to 
        States that adopt value-based purchasing programs to improve 
        health care quality.
            ``(10) Reports.--The Secretary shall annually submit to the 
        Committee on Health, Education, Labor, and Pensions and the 
        Committee on Finance of the Senate, and the Committee on Energy 
        and Commerce and the Committee on Ways and Means of the House 
        of Representatives, a report summarizing the reports received 
        by the Secretary from each State that receives a grant under 
        this subsection.
    ``(c) Grants for the Implementation of Regional or Local Health 
Information Technology Plans.--
            ``(1) In general.--The Secretary may award competitive 
        grants to eligible entities to implement regional or local 
        health information plans to improve health care quality and 
        efficiency through the electronic exchange of health 
        information pursuant to the standards, protocols, and other 
        requirements adopted by the Secretary under sections 2903 and 
        2908.
            ``(2) Eligibility.--To be eligible to receive a grant under 
        paragraph (1) an entity shall--
                    ``(A) demonstrate financial need to the Secretary;
                    ``(B) demonstrate that one of its principal 
                missions or purposes is to use information technology 
                to improve health care quality and efficiency;
                    ``(C) adopt bylaws, memoranda of understanding, or 
                other charter documents that demonstrate that the 
                governance structure and decisionmaking processes of 
                such entity allow for participation on an ongoing basis 
                by multiple stakeholders within a community, 
                including--
                            ``(i) physicians (as defined in section 
                        1861(r) of the Social Security Act), including 
                        physicians that provide services to low income 
                        and underserved populations;
                            ``(ii) hospitals (including hospitals that 
                        provide services to low income and underserved 
                        populations);
                            ``(iii) pharmacists or pharmacies;
                            ``(iv) health insurance plans;
                            ``(v) health centers (as defined in section 
                        330(b)) and Federally qualified health centers 
                        (as defined in section 1861(aa)(4) of the 
                        Social Security Act);
                            ``(vi) rural health clinics (as defined in 
                        section 1861(aa) of the Social Security Act);
                            ``(vii) patient or consumer organizations;
                            ``(viii) employers; and
                            ``(ix) any other health care providers or 
                        other entities, as determined appropriate by 
                        the Secretary;
                    ``(D) adopt nondiscrimination and conflict of 
                interest policies that demonstrate a commitment to 
                open, fair, and nondiscriminatory participation in the 
                health information plan by all stakeholders;
                    ``(E) adopt the standards adopted by the Secretary 
                under section 2903;
                    ``(F) require that health care providers receiving 
                such loans implement the measurement system adopted 
                under section 2908 and report to the Secretary on such 
                measures;
                    ``(G) facilitate the electronic exchange of health 
                information within the local or regional area and among 
                local and regional areas;
                    ``(H) prepare and submit to the Secretary an 
                application in accordance with paragraph (3); and
                    ``(I) agree to provide matching funds in accordance 
                with paragraph (5).
            ``(3) Application.--
                    ``(A) In general.--To be eligible to receive a 
                grant under paragraph (1), an entity shall submit to 
                the Secretary an application at such time, in such 
                manner, and containing such information as the 
                Secretary may require.
                    ``(B) Required information.--At a minimum, an 
                application submitted under this paragraph shall 
                include--
                            ``(i) clearly identified short-term and 
                        long-term objectives of the regional or local 
                        health information plan;
                            ``(ii) a technology plan that complies with 
                        the standards adopted under section 2903 and 
                        that includes a descriptive and reasoned 
                        estimate of costs of the hardware, software, 
                        training, and consulting services necessary to 
                        implement the regional or local health 
                        information plan;
                            ``(iii) a strategy that includes 
                        initiatives to improve health care quality and 
                        efficiency, including the use and reporting of 
                        health care quality measures adopted under 
                        section 2908;
                            ``(iv) a plan that describes provisions to 
                        encourage the implementation of the electronic 
                        exchange of health information by all 
                        physicians, including single physician 
                        practices and small physician groups 
                        participating in the health information plan;
                            ``(v) a plan to ensure the privacy and 
                        security of personal health information that is 
                        consistent with Federal and State law;
                            ``(vi) a governance plan that defines the 
                        manner in which the stakeholders shall jointly 
                        make policy and operational decisions on an 
                        ongoing basis; and
                            ``(vii) a financial or business plan that 
                        describes--
                                    ``(I) the sustainability of the 
                                plan;
                                    ``(II) the financial costs and 
                                benefits of the plan; and
                                    ``(III) the entities to which such 
                                costs and benefits will accrue.
            ``(4) Use of funds.--Amounts received under a grant under 
        paragraph (1) shall be used to establish and implement a 
        regional or local health information plan in accordance with 
        this subsection.
            ``(5) Matching requirement.--
                    ``(A) In general.--The Secretary may not make a 
                grant under this subsection to an entity unless the 
                entity agrees that, with respect to the costs to be 
                incurred by the entity in carrying out the 
                infrastructure program for which the grant was awarded, 
                the entity will make available (directly or through 
                donations from public or private entities) non-Federal 
                contributions toward such costs in an amount equal to 
                not less than 50 percent of such costs ($1 for each $2 
                of Federal funds provided under the grant).
                    ``(B) Determination of amount contributed.--Non-
                Federal contributions required under subparagraph (A) 
                may be in cash or in kind, fairly evaluated, including 
                equipment, technology, or services. Amounts provided by 
                the Federal Government, or services assisted or 
                subsidized to any significant extent by the Federal 
                Government, may not be included in determining the 
                amount of such non-Federal contributions.
    ``(d) Reports.--Not later than 1 year after the date on which the 
first grant is awarded under this section, and annually thereafter 
during the grant period, an entity that receives a grant under this 
section shall submit to the Secretary a report on the activities 
carried out under the grant involved. Each such report shall include--
            ``(1) a description of the financial costs and benefits of 
        the project involved and of the entities to which such costs 
        and benefits accrue;
            ``(2) an analysis of the impact of the project on health 
        care quality and safety;
            ``(3) a description of any reduction in duplicative or 
        unnecessary care as a result of the project involved;
            ``(4) a description of the efforts of recipients under this 
        section to facilitate secure patient access to health 
        information; and
            ``(5) other information as required by the Secretary.
    ``(e) Authorization of Appropriations.--
            ``(1) In general.--For the purpose of carrying out this 
        section, there is authorized to be appropriated $125,000,000 
        for fiscal year 2006, $150,000,000 for fiscal year 2007, and 
        such sums as may be necessary for each of fiscal years 2008 
        through 2010.
            ``(2) Availability.--Amounts appropriated under paragraph 
        (1) shall remain available through fiscal year 2010.

``SEC. 2906. DEMONSTRATION PROGRAM TO INTEGRATE INFORMATION TECHNOLOGY 
              INTO CLINICAL EDUCATION.

    ``(a) In General.--The Secretary may award grants under this 
section to carry out demonstration projects to develop academic 
curricula integrating qualified health information technology systems 
in the clinical education of health professionals. Such awards shall be 
made on a competitive basis and pursuant to peer review.
    ``(b) Eligibility.--To be eligible to receive a grant under 
subsection (a), an entity shall--
            ``(1) submit to the Secretary an application at such time, 
        in such manner, and containing such information as the 
        Secretary may require;
            ``(2) submit to the Secretary a strategic plan for 
        integrating qualified health information technology in the 
        clinical education of health professionals and for ensuring the 
        consistent utilization of decision support software to reduce 
        medical errors and enhance health care quality;
            ``(3) be--
                    ``(A) a health professions school;
                    ``(B) a school of nursing; or
                    ``(C) a graduate medical education program;
            ``(4) provide for the collection of data regarding the 
        effectiveness of the demonstration project to be funded under 
        the grant in improving the safety of patients, the efficiency 
        of health care delivery, and in increasing the likelihood that 
        graduates of the grantee will adopt and incorporate health 
        information technology in the delivery of health care services; 
        and
            ``(5) provide matching funds in accordance with subsection 
        (c).
    ``(c) Use of Funds.--
            ``(1) In general.--With respect to a grant under subsection 
        (a), an eligible entity shall--
                    ``(A) use grant funds in collaboration with 2 or 
                more disciplines; and
                    ``(B) use grant funds to integrate qualified health 
                information technology into community-based clinical 
                education.
            ``(2) Limitation.--An eligible entity shall not use amounts 
        received under a grant under subsection (a) to purchase 
        hardware, software, or services.
    ``(d) Matching Funds.--
            ``(1) In general.--The Secretary may award a grant to an 
        entity under this section only if the entity agrees to make 
        available non-Federal contributions toward the costs of the 
        program to be funded under the grant in an amount that is not 
        less than $1 for each $2 of Federal funds provided under the 
        grant.
            ``(2) Determination of amount contributed.--Non-Federal 
        contributions under paragraph (1) may be in cash or in kind, 
        fairly evaluated, including equipment or services. Amounts 
        provided by the Federal Government, or services assisted or 
        subsidized to any significant extent by the Federal Government, 
        may not be included in determining the amount of such 
        contributions.
    ``(e) Evaluation.--The Secretary shall take such action as may be 
necessary to evaluate the projects funded under this section and 
publish, make available, and disseminate the results of such 
evaluations on as wide a basis as is practicable.
    ``(f) Reports.--Not later than 1 year after the date of enactment 
of this title, and annually thereafter, the Secretary shall submit to 
the Committee on Health, Education, Labor, and Pensions and the 
Committee on Finance of the Senate, and the Committee on Energy and 
Commerce and the Committee on Ways and Means of the House of 
Representatives a report that--
            ``(1) describes the specific projects established under 
        this section; and
            ``(2) contains recommendations for Congress based on the 
        evaluation conducted under subsection (e).
    ``(g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section, $5,000,000 for fiscal year 
2007, and such sums as may be necessary for each of fiscal years 2008 
through 2010.
    ``(h) Sunset.--This section shall not apply after September 30, 
2010.

``SEC. 2907. LICENSURE AND THE ELECTRONIC EXCHANGE OF HEALTH 
              INFORMATION.

    ``(a) In General.--The Secretary shall carry out, or contract with 
a private entity to carry out, a study that examines--
            ``(1) the variation among State laws that relate to the 
        licensure, registration, and certification of medical 
        professionals; and
            ``(2) how such variation among State laws impacts the 
        secure electronic exchange of health information--
                    ``(A) among the States; and
                    ``(B) between the States and the Federal 
                Government.
    ``(b) Report and Recommendations.--Not later than 1 year after the 
date of enactment of this title, the Secretary shall publish a report 
that--
            ``(1) describes the results of the study carried out under 
        subsection (a); and
            ``(2) makes recommendations to States regarding the 
        harmonization of State laws based on the results of such study.

``SEC. 2908. QUALITY MEASUREMENT SYSTEMS.

    ``(a) In General.--The Secretary of Health and Human Services, the 
Secretary of Veterans Affairs, the Secretary of Defense, and 
representatives of other relevant Federal agencies, as determined 
appropriate by the Secretary, (referred to in the section as the 
`Secretaries') shall jointly develop a quality measurement system for 
the purpose of measuring the quality of care patients receive.
    ``(b) Requirements.--The Secretaries shall ensure that the quality 
measurement system developed under subsection (a) comply with the 
following:
            ``(1) Measures.--
                    ``(A) In general.--Subject to subparagraph (B), the 
                Secretaries shall select measures of quality to be used 
                by the Secretaries under the systems.
                    ``(B) Requirements.--In selecting the measures to 
                be used under each system pursuant to subparagraph (A), 
                the Secretaries shall, to the extent feasible, ensure 
                that--
                            ``(i) such measures are evidence based, 
                        reliable and valid;
                            ``(ii) such measures include measures of 
                        process, structure, patient experience, 
                        efficiency, and equity; and
                            ``(iii) such measures include measures of 
                        overuse, underuse, and misuse of health care 
                        items and services.
            ``(2) Priorities.--In developing the system under 
        subsection (a), the Secretaries shall ensure that priority is 
        given to--
                    ``(A) measures with the greatest potential impact 
                for improving the quality and efficiency of care 
                provided under Federal programs;
                    ``(B) measures that may be rapidly implemented by 
                group health plans, health insurance issuers, 
                physicians, hospitals, nursing homes, long-term care 
                providers, and other providers; and
                    ``(C) measures which may inform health care 
                decisions made by consumers and patients.
            ``(3) Weights of measures.--The Secretaries shall assign 
        weights to the measures used by the Secretaries under each 
        system established under subsection (a).
            ``(4) Risk adjustment.--The Secretaries shall establish 
        procedures to account for differences in patient health status, 
        patient characteristics, and geographic location. To the extent 
        practicable, such procedures shall recognize existing 
        procedures.
            ``(5) Maintenance.--The Secretaries shall, as determined 
        appropriate, but in no case more often than once during each 
        12-month period, update the quality measurement systems 
        developed under subsection (a), including through--
                    ``(A) the addition of more accurate and precise 
                measures under the systems and the retirement of 
                existing outdated measures under the systems; and
                    ``(B) the refinement of the weights assigned to 
                measures under the systems.
    ``(c) Required Considerations in Developing and Updating the 
Systems.--In developing and updating the quality measurement systems 
under this section, the Secretaries shall--
            ``(1) consult with, and take into account the 
        recommendations of, the entity that the Secretaries has an 
        arrangement with under subsection (e);
            ``(2) consult with representatives of health care 
        providers, consumers, employers, and other individuals and 
        groups that are interested in the quality of health care; and
            ``(3) take into account--
                    ``(A) any demonstration or pilot program conducted 
                by the Secretaries relating to measuring and rewarding 
                quality and efficiency of care;
                    ``(B) any existing activities conducted by the 
                Secretaries relating to measuring and rewarding quality 
                and efficiency;
                    ``(C) any existing activities conducted by private 
                entities including health insurance plans and payors; 
                and
                    ``(D) the report by the Institute of Medicine of 
                the National Academy of Sciences under section 238(b) 
                of the Medicare Prescription Drug, Improvement, and 
                Modernization Act of 2003.
    ``(d) Required Considerations in Implementing the Systems.--In 
implementing the quality measurement systems under this section, the 
Secretaries shall take into account the recommendations of public-
private entities--
            ``(1) that are established to examine issues of data 
        collection and reporting, including the feasibility of 
        collecting and reporting data on measures; and
            ``(2) that involve representatives of health care 
        providers, consumers, employers, and other individuals and 
        groups that are interested in quality of care.
    ``(e) Arrangement With an Entity to Provide Advice and 
Recommendations.--
            ``(1) Arrangement.--On and after July 1, 2006, the 
        Secretaries shall have in place an arrangement with an entity 
        that meets the requirements described in paragraph (2) under 
        which such entity provides the Secretaries with advice on, and 
        recommendations with respect to, the development and updating 
        of the quality measurement systems under this section, 
        including the assigning of weights to the measures under 
        subsection (b)(2).
            ``(2) Requirements described.--The requirements described 
        in this paragraph are the following:
                    ``(A) The entity is a private nonprofit entity 
                governed by an executive director and a board.
                    ``(B) The members of the entity include 
                representatives of--
                            ``(i) health insurance plans and providers 
                        with experience in the care of individuals with 
                        multiple complex chronic conditions or groups 
                        representing such health insurance plans and 
                        providers;
                            ``(ii) groups representing patients and 
                        consumers;
                            ``(iii) purchasers and employers or groups 
                        representing purchasers or employers;
                            ``(iv) organizations that focus on quality 
                        improvement as well as the measurement and 
                        reporting of quality measures;
                            ``(v) State government health programs;
                            ``(vi) individuals or entities skilled in 
                        the conduct and interpretation of biomedical, 
                        health services, and health economics research 
                        and with expertise in outcomes and 
                        effectiveness research and technology 
                        assessment; and
                            ``(vii) individuals or entities involved in 
                        the development and establishment of standards 
                        and certification for health information 
                        technology systems and clinical data.
                    ``(C) The membership of the entity is 
                representative of individuals with experience with 
                urban health care issues and individuals with 
                experience with rural and frontier health care issues.
                    ``(D) If the entity requires a fee for membership, 
                the entity shall provide assurances to the Secretaries 
                that such fees are not a substantial barrier to 
                participation in the entity's activities related to the 
                arrangement with the Secretaries.
                    ``(E) The entity--
                            ``(i) permits any member described in 
                        subparagraph (B) to vote on matters of the 
                        entity related to the arrangement with the 
                        Secretary under paragraph (1); and
                            ``(ii) ensures that member voting provides 
                        a balance among disparate stakeholders, so that 
                        no member organization described in 
                        subparagraph (B) unduly influences the outcome.
                    ``(F) With respect to matters related to the 
                arrangement with the Secretary under paragraph (1), the 
                entity conducts its business in an open and transparent 
                manner and provides the opportunity for public comment.
                    ``(G) The entity operates as a voluntary consensus 
                standards setting organization as defined for purposes 
                of section 12(d) of the National Technology Transfer 
                and Advancement Act of 1995 (Public Law 104-113) and 
                Office of Management and Budget Revised Circular A-119 
                (published in the Federal Register on February 10, 
                1998).
    ``(f) Use of Quality Measurement System.--
            ``(1) In general.--For purposes of activities conducted or 
        supported by the Secretary under this Act, the Secretary shall, 
        to the extent practicable, adopt and utilize the measurement 
        system developed under this section.
            ``(2) Collaborative agreements.--With respect to activities 
        conducted or supported by the Secretary under this Act, the 
        Secretary may establish collaborative agreements with private 
        entities, including group health plans and health insurance 
        issuers, providers, purchasers, consumer organizations, and 
        entities receiving a grant under section 2908, to--
                    ``(A) encourage the use of the health care quality 
                measures adopted by the Secretary under this section; 
                and
                    ``(B) foster uniformity between the health care 
                quality measures utilized by private entities.
    ``(g) Dissemination of Information.--Beginning on January 1, 2008, 
in order to make comparative quality information available to health 
care consumers, health professionals, public health officials, 
researchers, and other appropriate individuals and entities, the 
Secretary shall provide for the aggregation and analysis of quality 
measures collected under section 2905 and the dissemination of 
recommendations and best practices derived in part from such analysis.
    ``(h) Technical Assistance.--The Secretary shall provide technical 
assistance to public and private entities to enable such entities to--
            ``(1) implement and use evidence-based guidelines with the 
        greatest potential to improve health care quality, efficiency, 
        and patient safety; and
            ``(2) establish mechanisms for the rapid dissemination of 
        information regarding evidence-based guidelines with the 
        greatest potential to improve health care quality, efficiency, 
        and patient safety.

``SEC. 2909. APPLICABILITY OF PRIVACY AND SECURITY REGULATIONS.

    ``The regulations promulgated by the Secretary under part C of 
title XI of the Social Security Act and sections 261, 262, 263, and 264 
of the Health Insurance Portability and Accountability Act of 1996 with 
respect to the privacy, confidentiality, and security of health 
information shall--
            ``(1) apply to any health information stored or transmitted 
        in an electronic format on or after the date of enactment of 
        this title; and
            ``(2) apply to the implementation of standards, programs, 
        and activities under this title.

``SEC. 2910. STUDY OF REIMBURSEMENT INCENTIVES.

    ``The Secretary shall carry out, or contract with a private entity 
to carry out, a study that examines methods to create efficient 
reimbursement incentives for improving health care quality in Federally 
qualified health centers, rural health clinics, and free clinics.''.

SEC. 3. HEALTH INFORMATION TECHNOLOGY RESOURCE CENTER.

    Section 914 of the Public Health Service Act (42 U.S.C. 299b-3) is 
amended by adding at the end the following:
    ``(d) Center for Best Practices.--
            ``(1) In general.--The Secretary, acting through the 
        Director, shall develop a Center for Best Practices to provide 
        technical assistance and develop best practices to support and 
        accelerate efforts to adopt, implement, and effectively use 
        interoperable health information technology in compliance with 
        section 2903 and 2908.
            ``(2) Center for best practices.--
                    ``(A) In general.--The Center shall support 
                activities to meet goals, including--
                            ``(i) providing for the widespread adoption 
                        of interoperable health information technology;
                            ``(ii) providing for the establishment of 
                        regional and local health information networks 
                        to facilitate the development of 
                        interoperability across health care settings 
                        and improve the quality of health care;
                            ``(iii) the development of solutions to 
                        barriers to the exchange of electronic health 
                        information; or
                            ``(iv) other activities identified by the 
                        States, local or regional health information 
                        networks, or health care stakeholders as a 
                        focus for developing and sharing best 
                        practices.
                    ``(B) Purposes.--The purpose of the Center is to--
                            ``(i) provide a forum for the exchange of 
                        knowledge and experience;
                            ``(ii) accelerate the transfer of lessons 
                        learned from existing public and private sector 
                        initiatives, including those currently 
                        receiving Federal financial support;
                            ``(iii) assemble, analyze, and widely 
                        disseminate evidence and experience related to 
                        the adoption, implementation, and effective use 
                        of interoperable health information technology; 
                        and
                            ``(iv) assure the timely provision of 
                        technical and expert assistance from the Agency 
                        and its contractors.
                    ``(C) Support for activities.--To provide support 
                for the activities of the Center, the Director shall 
                modify the requirements, if necessary, that apply to 
                the National Resource Center for Health Information 
                Technology to provide the necessary infrastructure to 
                support the duties and activities of the Center and 
                facilitate information exchange across the public and 
                private sectors.
            ``(3) Technical assistance telephone number or website.--
        The Secretary shall establish a toll-free telephone number or 
        Internet website to provide health care providers and patients 
        with a single point of contact to--
                    ``(A) learn about Federal grants and technical 
                assistance services related to interoperable health 
                information technology;
                    ``(B) learn about qualified health information 
                technology and the quality measurement system adopted 
                by the Federal Government under sections 2903 and 2908;
                    ``(C) learn about regional and local health 
                information networks for assistance with health 
                information technology; and
                    ``(D) disseminate additional information determined 
                by the Secretary.
            ``(4) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this subsection, 
        such sums as may be necessary for each of fiscal years 2006 
        through 2010.''.

SEC. 4. REAUTHORIZATION OF INCENTIVE GRANTS REGARDING TELEMEDICINE.

    Section 330L(b) of the Public Health Service Act (42 U.S.C. 254c-
18(b)) is amended by striking ``2002 through 2006'' and inserting 
``2006 through 2010''.
                                 <all>