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


                                                       Calendar No. 178
109th CONGRESS
  1st Session
                                S. 1418

                          [Report No. 109-111]

     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, Mr. Nelson of 
 Florida, Mr. Gregg, Mr. Ensign, Mr. Sessions, Mr. Reed, Ms. Landrieu, 
  Mr. Carper, and Mr.Durbin) introduced the following bill; which was 
 read twice and referred to the Committee on Health, Education, Labor, 
                              and Pensions

                             July 27, 2005

                Reported by Mr. Enzi, with an amendment
 [Strike out all after the enacting clause and insert the part printed 
                               in italic]

_______________________________________________________________________

                                 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,

<DELETED>SECTION 1. SHORT TITLE.</DELETED>

<DELETED>    This Act may be cited as the ``Wired for Health Care 
Quality Act''.</DELETED>

<DELETED>SEC. 2. IMPROVING HEALTH CARE, QUALITY, SAFETY, AND 
              EFFICIENCY.</DELETED>

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

     <DELETED>``TITLE XXIX--HEALTH INFORMATION TECHNOLOGY</DELETED>

<DELETED>``SEC. 2901. DEFINITIONS.</DELETED>

<DELETED>    ``In this title:</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Health information.--The term `health 
        information' has the meaning given such term in section 1171(4) 
        of the Social Security Act.</DELETED>
        <DELETED>    ``(3) Health insurance plan.--The term `health 
        insurance plan' means--</DELETED>
                <DELETED>    ``(A) a health insurance issuer (as 
                defined in section 2791(b)(2));</DELETED>
                <DELETED>    ``(B) a group health plan (as defined in 
                section 2791(a)(1)); and</DELETED>
                <DELETED>    ``(C) a health maintenance organization 
                (as defined in section 2791(b)(3)).</DELETED>
        <DELETED>    ``(4) Laboratory.--The term `laboratory' has the 
        meaning given that term in section 353.</DELETED>
        <DELETED>    ``(5) Pharmacist.--The term `pharmacist' has the 
        meaning given that term in section 804 of the Federal Food, 
        Drug, and Cosmetic Act.</DELETED>
        <DELETED>    ``(6) Qualified health information technology.--
        The term `qualified health information technology' means a 
        computerized system (including hardware, software, and 
        training) that--</DELETED>
                <DELETED>    ``(A) protects the privacy and security of 
                health information;</DELETED>
                <DELETED>    ``(B) maintains and provides permitted 
                access to health information in an electronic 
                format;</DELETED>
                <DELETED>    ``(C) incorporates decision support to 
                reduce medical errors and enhance health care 
                quality;</DELETED>
                <DELETED>    ``(D) complies with the standards adopted 
                by the Federal Government under section 2903; 
                and</DELETED>
                <DELETED>    ``(E) allows for the reporting of quality 
                measures under section 2908.</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 2902. OFFICE OF THE NATIONAL COORDINATOR OF HEALTH 
              INFORMATION TECHNOLOGY.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) ensures that patients' health information is 
        secure and protected;</DELETED>
        <DELETED>    ``(2) improves health care quality, reduces 
        medical errors, and advances the delivery of patient-centered 
        medical care;</DELETED>
        <DELETED>    ``(3) reduces health care costs resulting from 
        inefficiency, medical errors, inappropriate care, and 
        incomplete information;</DELETED>
        <DELETED>    ``(4) ensures that appropriate information to help 
        guide medical decisions is available at the time and place of 
        care;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(8) facilitates health research; and</DELETED>
        <DELETED>    ``(9) promotes prevention of chronic 
        diseases.</DELETED>
<DELETED>    ``(c) Duties of the National Coordinator.--The National 
Coordinator shall--</DELETED>
        <DELETED>    ``(1) serve as a member of the public-private 
        American Health Information Collaborative established under 
        section 2903;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(3) facilitate the adoption of a nationwide, 
        interoperable system for the electronic exchange of health 
        information;</DELETED>
        <DELETED>    ``(4) ensure the adoption and implementation of 
        standards for the electronic exchange of health information to 
        reduce cost and improve health care quality;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(7) advise the President regarding specific 
        Federal health information technology programs; and</DELETED>
        <DELETED>    ``(8) submit the reports described under section 
        2903(i) (excluding paragraph (4) of such section).</DELETED>
<DELETED>    ``(d) Detail of Federal Employees.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Effect of detail.--Any detail of personnel 
        under paragraph (1) shall--</DELETED>
                <DELETED>    ``(A) not interrupt or otherwise affect 
                the civil service status or privileges of the Federal 
                employee; and</DELETED>
                <DELETED>    ``(B) be in addition to any other staff of 
                the Department employed by the National 
                Coordinator.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 2903. AMERICAN HEALTH INFORMATION 
              COLLABORATIVE.</DELETED>

<DELETED>    ``(a) Purpose.--The Secretary shall establish the public-
private American Health Information Collaborative (referred to in this 
section as the `Collaborative') to--</DELETED>
        <DELETED>    ``(1) advise the Secretary and recommend specific 
        actions to achieve a nationwide interoperable health 
        information technology infrastructure;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Composition.--</DELETED>
        <DELETED>    ``(1) In general.--The Collaborative shall be 
        composed of--</DELETED>
                <DELETED>    ``(A) the Secretary, who shall serve as 
                the chairperson of the Collaborative;</DELETED>
                <DELETED>    ``(B) the Secretary of Defense, or his or 
                her designee;</DELETED>
                <DELETED>    ``(C) the Secretary of Veterans Affairs, 
                or his or her designee;</DELETED>
                <DELETED>    ``(D) the Secretary of Commerce, or his or 
                her designee;</DELETED>
                <DELETED>    ``(E) the National Coordinator for Health 
                Information Technology;</DELETED>
                <DELETED>    ``(F) representatives of other relevant 
                Federal agencies, as determined appropriate by the 
                Secretary; and</DELETED>
                <DELETED>    ``(G) representatives from each of the 
                following categories to be appointed by the Secretary 
                from nominations submitted by the public--</DELETED>
                        <DELETED>    ``(i) consumer and patient 
                        organizations;</DELETED>
                        <DELETED>    ``(ii) experts in health 
                        information privacy and security;</DELETED>
                        <DELETED>    ``(iii) health care 
                        providers;</DELETED>
                        <DELETED>    ``(iv) health insurance plans or 
                        other third party payors;</DELETED>
                        <DELETED>    ``(v) standards development 
                        organizations;</DELETED>
                        <DELETED>    ``(vi) information technology 
                        vendors;</DELETED>
                        <DELETED>    ``(vii) purchasers or employers; 
                        and</DELETED>
                        <DELETED>    ``(viii) State or local government 
                        agencies or Indian tribe or tribal 
                        organizations.</DELETED>
        <DELETED>    ``(2) Considerations.--In appointing members under 
        paragraph (1)(G), the Secretary shall select individuals with 
        expertise in--</DELETED>
                <DELETED>    ``(A) health information 
                privacy;</DELETED>
                <DELETED>    ``(B) health information 
                security;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(D) data exchange; and</DELETED>
                <DELETED>    ``(E) developing health information 
                technology standards and new health information 
                technology.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) protection of health information through 
        privacy and security practices;</DELETED>
        <DELETED>    ``(2) measures to prevent unauthorized access to 
        health information;</DELETED>
        <DELETED>    ``(3) methods to facilitate secure patient access 
        to health information;</DELETED>
        <DELETED>    ``(4) the ongoing harmonization of industry-wide 
        health information technology standards;</DELETED>
        <DELETED>    ``(5) recommendations for a nationwide 
        interoperable health information technology 
        infrastructure;</DELETED>
        <DELETED>    ``(6) the identification and prioritization of 
        specific use cases for which heath information technology is 
        valuable, beneficial, and feasible;</DELETED>
        <DELETED>    ``(7) recommendations for the establishment of an 
        entity to ensure the continuation of the functions of the 
        Collaborative; and</DELETED>
        <DELETED>    ``(8) other policies determined to be necessary by 
        the Collaborative.</DELETED>
<DELETED>    ``(d) Standards.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) First year review.--Not later than 1 year 
        after the date of enactment of this title, the Collaborative 
        shall--</DELETED>
                <DELETED>    ``(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);</DELETED>
                <DELETED>    ``(B) identify deficiencies and omissions 
                in such existing standards; and</DELETED>
                <DELETED>    ``(C) identify duplication and overlap in 
                such existing standards;</DELETED>
        <DELETED>and recommend modifications to such standards as 
        necessary.</DELETED>
        <DELETED>    ``(3) Ongoing review.--Beginning 1 year after the 
        date of enactment of this title, and annually thereafter, the 
        Collaborative shall--</DELETED>
                <DELETED>    ``(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);</DELETED>
                <DELETED>    ``(B) identify deficiencies and omissions 
                in such existing standards; and</DELETED>
                <DELETED>    ``(C) identify duplication and overlap in 
                such existing standards;</DELETED>
        <DELETED>and recommend modifications to such standards as 
        necessary.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(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).</DELETED>
<DELETED>    ``(h) Voluntary Adoption.--Any standards adopted by the 
Federal Government under subsection (e) shall be voluntary with respect 
to private entities.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(2) describes barriers to the adoption of such a 
        nationwide system;</DELETED>
        <DELETED>    ``(3) contains recommendations to achieve full 
        implementation of such a nationwide system; and</DELETED>
        <DELETED>    ``(4) contains a plan and progress toward the 
        establishment of an entity to ensure the continuation of the 
        functions of the Collaborative.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 2904. IMPLEMENTATION AND CERTIFICATION OF HEALTH 
              INFORMATION STANDARDS.</DELETED>

<DELETED>    ``(a) Implementation.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Certification.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 2905. GRANTS TO FACILITATE THE WIDESPREAD ADOPTION OF 
              INTEROPERABLE HEALTH INFORMATION TECHNOLOGY.</DELETED>

<DELETED>    ``(a) Competitive Grants to Facilitate the Widespread 
Adoption of Health Information Technology.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Eligibility.--To be eligible to receive a 
        grant under paragraph (1) an entity shall--</DELETED>
                <DELETED>    ``(A) submit to the Secretary an 
                application at such time, in such manner, and 
                containing such information as the Secretary may 
                require;</DELETED>
                <DELETED>    ``(B) submit to the Secretary a strategic 
                plan for the implementation of data sharing and 
                interoperability measures;</DELETED>
                <DELETED>    ``(C) be a--</DELETED>
                        <DELETED>    ``(i) not for profit 
                        hospital;</DELETED>
                        <DELETED>    ``(ii) group practice (including a 
                        single physician); or</DELETED>
                        <DELETED>    ``(iii) another health care 
                        provider not described in clause (i) or 
                        (ii);</DELETED>
                <DELETED>    ``(D) adopt the standards adopted by the 
                Federal Government under section 2903;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(F) demonstrate significant financial 
                need; and</DELETED>
                <DELETED>    ``(G) provide matching funds in accordance 
                with paragraph (4).</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(5) Preference in awarding grants.--In awarding 
        grants under this subsection the Secretary shall give 
        preference to--</DELETED>
                <DELETED>    ``(A) eligible entities that are located 
                in rural, frontier, and other underserved areas as 
                determined by the Secretary; and</DELETED>
                <DELETED>    ``(B) eligible entities that will link, to 
                the extent practicable, the qualified health 
                information system to local or regional health 
                information networks.</DELETED>
<DELETED>    ``(b) Competitive Grants to States for the Development of 
State Loan Programs to Facilitate the Widespread Adoption of Health 
Information Technology.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(3) Eligibility.--To be eligible to receive a 
        grant under paragraph (1) a State shall--</DELETED>
                <DELETED>    ``(A) submit to the Secretary an 
                application at such time, in such manner, and 
                containing such information as the Secretary may 
                require;</DELETED>
                <DELETED>    ``(B) submit to the Secretary a strategic 
                plan in accordance with paragraph (4);</DELETED>
                <DELETED>    ``(C) establish a qualified health 
                information technology loan fund in accordance with 
                paragraph (2);</DELETED>
                <DELETED>    ``(D) require that health care providers 
                receiving such loans--</DELETED>
                        <DELETED>    ``(i) link, to the extent 
                        practicable, the qualified health information 
                        system to a local or regional health 
                        information network; and</DELETED>
                        <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(E) require that health care providers 
                receiving such loans adopt the standards adopted by the 
                Federal Government under section 2903(d);</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(G) provide matching funds in accordance 
                with paragraph (8).</DELETED>
        <DELETED>    ``(4) Strategic plan.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(B) Contents.--A strategic plan under 
                subparagraph (A) shall include--</DELETED>
                        <DELETED>    ``(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;</DELETED>
                        <DELETED>    ``(ii) a description of the 
                        criteria and methods established for the 
                        distribution of funds from the State loan fund; 
                        and</DELETED>
                        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(5) Use of funds.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(B) Limitation.--Amounts received by a 
                State under this subsection may not be used--</DELETED>
                        <DELETED>    ``(i) for the purchase or other 
                        acquisition of any health information 
                        technology system that is not a qualified 
                        health information technology system;</DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(iii) for any purpose other than 
                        making loans to eligible entities under this 
                        section.</DELETED>
        <DELETED>    ``(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:</DELETED>
                <DELETED>    ``(A) To award loans that comply with the 
                following:</DELETED>
                        <DELETED>    ``(i) The interest rate for each 
                        loan shall be less than or equal to the market 
                        interest rate.</DELETED>
                        <DELETED>    ``(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.</DELETED>
                        <DELETED>    ``(iii) The State loan fund shall 
                        be credited with all payments of principal and 
                        interest on each loan awarded from the 
                        fund.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(D) To earn interest on the amounts 
                deposited into the State loan fund.</DELETED>
        <DELETED>    ``(7) Administration of state loan funds.--
        </DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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--</DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(ii) guidance to prevent waste, 
                        fraud, and abuse.</DELETED>
                <DELETED>    ``(D) Private sector contributions.--
                </DELETED>
                        <DELETED>    ``(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.</DELETED>
                        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(8) Matching requirements.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(c) Grants for the Implementation of Regional or Local 
Health Information Technology Plans.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Eligibility.--To be eligible to receive a 
        grant under paragraph (1) an entity shall--</DELETED>
                <DELETED>    ``(A) demonstrate financial need to the 
                Secretary;</DELETED>
                <DELETED>    ``(B) demonstrate that one of its 
                principal missions or purposes is to use information 
                technology to improve health care quality and 
                efficiency;</DELETED>
                <DELETED>    ``(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--</DELETED>
                        <DELETED>    ``(i) physicians (as defined in 
                        section 1861(r) of the Social Security Act), 
                        including physicians that provide services to 
                        low income and underserved 
                        populations;</DELETED>
                        <DELETED>    ``(ii) hospitals (including 
                        hospitals that provide services to low income 
                        and underserved populations);</DELETED>
                        <DELETED>    ``(iii) pharmacists or 
                        pharmacies;</DELETED>
                        <DELETED>    ``(iv) health insurance 
                        plans;</DELETED>
                        <DELETED>    ``(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);</DELETED>
                        <DELETED>    ``(vi) rural health clinics (as 
                        defined in section 1861(aa) of the Social 
                        Security Act);</DELETED>
                        <DELETED>    ``(vii) patient or consumer 
                        organizations;</DELETED>
                        <DELETED>    ``(viii) employers; and</DELETED>
                        <DELETED>    ``(ix) any other health care 
                        providers or other entities, as determined 
                        appropriate by the Secretary;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(E) adopt the standards adopted by the 
                Secretary under section 2903;</DELETED>
                <DELETED>    ``(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;</DELETED>
                <DELETED>    ``(G) facilitate the electronic exchange 
                of health information within the local or regional area 
                and among local and regional areas;</DELETED>
                <DELETED>    ``(H) prepare and submit to the Secretary 
                an application in accordance with paragraph (3); 
                and</DELETED>
                <DELETED>    ``(I) agree to provide matching funds in 
                accordance with paragraph (5).</DELETED>
        <DELETED>    ``(3) Application.--</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(B) Required information.--At a minimum, 
                an application submitted under this paragraph shall 
                include--</DELETED>
                        <DELETED>    ``(i) clearly identified short-
                        term and long-term objectives of the regional 
                        or local health information plan;</DELETED>
                        <DELETED>    ``(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;</DELETED>
                        <DELETED>    ``(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;</DELETED>
                        <DELETED>    ``(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;</DELETED>
                        <DELETED>    ``(v) a plan to ensure the privacy 
                        and security of personal health information 
                        that is consistent with Federal and State 
                        law;</DELETED>
                        <DELETED>    ``(vi) a governance plan that 
                        defines the manner in which the stakeholders 
                        shall jointly make policy and operational 
                        decisions on an ongoing basis; and</DELETED>
                        <DELETED>    ``(vii) a financial or business 
                        plan that describes--</DELETED>
                                <DELETED>    ``(I) the sustainability 
                                of the plan;</DELETED>
                                <DELETED>    ``(II) the financial costs 
                                and benefits of the plan; and</DELETED>
                                <DELETED>    ``(III) the entities to 
                                which such costs and benefits will 
                                accrue.</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(5) Matching requirement.--</DELETED>
                <DELETED>    ``(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).</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) a description of the financial costs and 
        benefits of the project involved and of the entities to which 
        such costs and benefits accrue;</DELETED>
        <DELETED>    ``(2) an analysis of the impact of the project on 
        health care quality and safety;</DELETED>
        <DELETED>    ``(3) a description of any reduction in 
        duplicative or unnecessary care as a result of the project 
        involved;</DELETED>
        <DELETED>    ``(4) a description of the efforts of recipients 
        under this section to facilitate secure patient access to 
        health information; and</DELETED>
        <DELETED>    ``(5) other information as required by the 
        Secretary.</DELETED>
<DELETED>    ``(e) Authorization of Appropriations.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Availability.--Amounts appropriated under 
        paragraph (1) shall remain available through fiscal year 
        2010.</DELETED>

<DELETED>``SEC. 2906. DEMONSTRATION PROGRAM TO INTEGRATE INFORMATION 
              TECHNOLOGY INTO CLINICAL EDUCATION.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Eligibility.--To be eligible to receive a grant 
under subsection (a), an entity shall--</DELETED>
        <DELETED>    ``(1) submit to the Secretary an application at 
        such time, in such manner, and containing such information as 
        the Secretary may require;</DELETED>
        <DELETED>    ``(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;</DELETED>
        <DELETED>    ``(3) be--</DELETED>
                <DELETED>    ``(A) a health professions 
                school;</DELETED>
                <DELETED>    ``(B) a school of nursing; or</DELETED>
                <DELETED>    ``(C) a graduate medical education 
                program;</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(5) provide matching funds in accordance with 
        subsection (c).</DELETED>
<DELETED>    ``(c) Use of Funds.--</DELETED>
        <DELETED>    ``(1) In general.--With respect to a grant under 
        subsection (a), an eligible entity shall--</DELETED>
                <DELETED>    ``(A) use grant funds in collaboration 
                with 2 or more disciplines; and</DELETED>
                <DELETED>    ``(B) use grant funds to integrate 
                qualified health information technology into community-
                based clinical education.</DELETED>
        <DELETED>    ``(2) Limitation.--An eligible entity shall not 
        use amounts received under a grant under subsection (a) to 
        purchase hardware, software, or services.</DELETED>
<DELETED>    ``(d) Matching Funds.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) describes the specific projects established 
        under this section; and</DELETED>
        <DELETED>    ``(2) contains recommendations for Congress based 
        on the evaluation conducted under subsection (e).</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(h) Sunset.--This section shall not apply after 
September 30, 2010.</DELETED>

<DELETED>``SEC. 2907. LICENSURE AND THE ELECTRONIC EXCHANGE OF HEALTH 
              INFORMATION.</DELETED>

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

<DELETED>``SEC. 2908. QUALITY MEASUREMENT SYSTEMS.</DELETED>

<DELETED>    ``(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.</DELETED>
<DELETED>    ``(b) Requirements.--The Secretaries shall ensure that the 
quality measurement system developed under subsection (a) comply with 
the following:</DELETED>
        <DELETED>    ``(1) Measures.--</DELETED>
                <DELETED>    ``(A) In general.--Subject to subparagraph 
                (B), the Secretaries shall select measures of quality 
                to be used by the Secretaries under the 
                systems.</DELETED>
                <DELETED>    ``(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--</DELETED>
                        <DELETED>    ``(i) such measures are evidence 
                        based, reliable and valid;</DELETED>
                        <DELETED>    ``(ii) such measures include 
                        measures of process, structure, patient 
                        experience, efficiency, and equity; 
                        and</DELETED>
                        <DELETED>    ``(iii) such measures include 
                        measures of overuse, underuse, and misuse of 
                        health care items and services.</DELETED>
        <DELETED>    ``(2) Priorities.--In developing the system under 
        subsection (a), the Secretaries shall ensure that priority is 
        given to--</DELETED>
                <DELETED>    ``(A) measures with the greatest potential 
                impact for improving the quality and efficiency of care 
                provided under Federal programs;</DELETED>
                <DELETED>    ``(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</DELETED>
                <DELETED>    ``(C) measures which may inform health 
                care decisions made by consumers and 
                patients.</DELETED>
        <DELETED>    ``(3) Weights of measures.--The Secretaries shall 
        assign weights to the measures used by the Secretaries under 
        each system established under subsection (a).</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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--
        </DELETED>
                <DELETED>    ``(A) the addition of more accurate and 
                precise measures under the systems and the retirement 
                of existing outdated measures under the systems; 
                and</DELETED>
                <DELETED>    ``(B) the refinement of the weights 
                assigned to measures under the systems.</DELETED>
<DELETED>    ``(c) Required Considerations in Developing and Updating 
the Systems.--In developing and updating the quality measurement 
systems under this section, the Secretaries shall--</DELETED>
        <DELETED>    ``(1) consult with, and take into account the 
        recommendations of, the entity that the Secretaries has an 
        arrangement with under subsection (e);</DELETED>
        <DELETED>    ``(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</DELETED>
        <DELETED>    ``(3) take into account--</DELETED>
                <DELETED>    ``(A) any demonstration or pilot program 
                conducted by the Secretaries relating to measuring and 
                rewarding quality and efficiency of care;</DELETED>
                <DELETED>    ``(B) any existing activities conducted by 
                the Secretaries relating to measuring and rewarding 
                quality and efficiency;</DELETED>
                <DELETED>    ``(C) any existing activities conducted by 
                private entities including health insurance plans and 
                payors; and</DELETED>
                <DELETED>    ``(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.</DELETED>
<DELETED>    ``(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--</DELETED>
        <DELETED>    ``(1) that are established to examine issues of 
        data collection and reporting, including the feasibility of 
        collecting and reporting data on measures; and</DELETED>
        <DELETED>    ``(2) that involve representatives of health care 
        providers, consumers, employers, and other individuals and 
        groups that are interested in quality of care.</DELETED>
<DELETED>    ``(e) Arrangement With an Entity to Provide Advice and 
Recommendations.--</DELETED>
        <DELETED>    ``(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).</DELETED>
        <DELETED>    ``(2) Requirements described.--The requirements 
        described in this paragraph are the following:</DELETED>
                <DELETED>    ``(A) The entity is a private nonprofit 
                entity governed by an executive director and a 
                board.</DELETED>
                <DELETED>    ``(B) The members of the entity include 
                representatives of--</DELETED>
                        <DELETED>    ``(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;</DELETED>
                        <DELETED>    ``(ii) groups representing 
                        patients and consumers;</DELETED>
                        <DELETED>    ``(iii) purchasers and employers 
                        or groups representing purchasers or 
                        employers;</DELETED>
                        <DELETED>    ``(iv) organizations that focus on 
                        quality improvement as well as the measurement 
                        and reporting of quality measures;</DELETED>
                        <DELETED>    ``(v) State government health 
                        programs;</DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(vii) individuals or entities 
                        involved in the development and establishment 
                        of standards and certification for health 
                        information technology systems and clinical 
                        data.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(E) The entity--</DELETED>
                        <DELETED>    ``(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</DELETED>
                        <DELETED>    ``(ii) ensures that member voting 
                        provides a balance among disparate 
                        stakeholders, so that no member organization 
                        described in subparagraph (B) unduly influences 
                        the outcome.</DELETED>
                <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(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).</DELETED>
<DELETED>    ``(f) Use of Quality Measurement System.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) encourage the use of the health care 
                quality measures adopted by the Secretary under this 
                section; and</DELETED>
                <DELETED>    ``(B) foster uniformity between the health 
                care quality measures utilized by private 
                entities.</DELETED>
<DELETED>    ``(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.</DELETED>
<DELETED>    ``(h) Technical Assistance.--The Secretary shall provide 
technical assistance to public and private entities to enable such 
entities to--</DELETED>
        <DELETED>    ``(1) implement and use evidence-based guidelines 
        with the greatest potential to improve health care quality, 
        efficiency, and patient safety; and</DELETED>
        <DELETED>    ``(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.</DELETED>

<DELETED>``SEC. 2909. APPLICABILITY OF PRIVACY AND SECURITY 
              REGULATIONS.</DELETED>

<DELETED>    ``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--</DELETED>
        <DELETED>    ``(1) apply to any health information stored or 
        transmitted in an electronic format on or after the date of 
        enactment of this title; and</DELETED>
        <DELETED>    ``(2) apply to the implementation of standards, 
        programs, and activities under this title.</DELETED>

<DELETED>``SEC. 2910. STUDY OF REIMBURSEMENT INCENTIVES.</DELETED>

<DELETED>    ``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.''.</DELETED>

<DELETED>SEC. 3. HEALTH INFORMATION TECHNOLOGY RESOURCE 
              CENTER.</DELETED>

<DELETED>    Section 914 of the Public Health Service Act (42 U.S.C. 
299b-3) is amended by adding at the end the following:</DELETED>
<DELETED>    ``(d) Center for Best Practices.--</DELETED>
        <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(2) Center for best practices.--</DELETED>
                <DELETED>    ``(A) In general.--The Center shall 
                support activities to meet goals, including--</DELETED>
                        <DELETED>    ``(i) providing for the widespread 
                        adoption of interoperable health information 
                        technology;</DELETED>
                        <DELETED>    ``(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;</DELETED>
                        <DELETED>    ``(iii) the development of 
                        solutions to barriers to the exchange of 
                        electronic health information; or</DELETED>
                        <DELETED>    ``(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.</DELETED>
                <DELETED>    ``(B) Purposes.--The purpose of the Center 
                is to--</DELETED>
                        <DELETED>    ``(i) provide a forum for the 
                        exchange of knowledge and experience;</DELETED>
                        <DELETED>    ``(ii) accelerate the transfer of 
                        lessons learned from existing public and 
                        private sector initiatives, including those 
                        currently receiving Federal financial 
                        support;</DELETED>
                        <DELETED>    ``(iii) assemble, analyze, and 
                        widely disseminate evidence and experience 
                        related to the adoption, implementation, and 
                        effective use of interoperable health 
                        information technology; and</DELETED>
                        <DELETED>    ``(iv) assure the timely provision 
                        of technical and expert assistance from the 
                        Agency and its contractors.</DELETED>
                <DELETED>    ``(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.</DELETED>
        <DELETED>    ``(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--</DELETED>
                <DELETED>    ``(A) learn about Federal grants and 
                technical assistance services related to interoperable 
                health information technology;</DELETED>
                <DELETED>    ``(B) learn about qualified health 
                information technology and the quality measurement 
                system adopted by the Federal Government under sections 
                2903 and 2908;</DELETED>
                <DELETED>    ``(C) learn about regional and local 
                health information networks for assistance with health 
                information technology; and</DELETED>
                <DELETED>    ``(D) disseminate additional information 
                determined by the Secretary.</DELETED>
        <DELETED>    ``(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.''.</DELETED>

<DELETED>SEC. 4. REAUTHORIZATION OF INCENTIVE GRANTS REGARDING 
              TELEMEDICINE.</DELETED>

<DELETED>    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''.</DELETED>

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 AND QUALITY

``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 and software) 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 coordinate 
and oversee 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 to carry out this section, $5,000,000 for fiscal year 
2006, $5,000,000 for fiscal year 2007, and such sums as may be 
necessary for each of fiscal years 2008 through 2010.

``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 (including for the reporting of 
        quality data under section 2908) 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 expertise 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) Participation.--Membership and procedures of the 
        Collaborative shall ensure a balance among various sectors of 
        the healthcare system so that no single sector unduly 
        influences the recommendations of the Collaborative.
            ``(4) 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.--Not later than 1 year after 
the date of enactment of this title, and annually thereafter, the 
Collaborative shall recommend to the Secretary 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) fostering the public understanding of health 
        information technology;
            ``(5) the ongoing harmonization of industry-wide health 
        information technology standards;
            ``(6) recommendations for a nationwide interoperable health 
        information technology infrastructure;
            ``(7) the identification and prioritization of specific use 
        cases for which health information technology is valuable, 
        beneficial, and feasible;
            ``(8) recommendations for the establishment of an entity to 
        ensure the continuation of the functions of the Collaborative; 
        and
            ``(9) other policies (including recommendations for 
        incorporating health information technology into the provision 
        of care and the organization of the health care workplace) 
        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 new standards and modifications to such existing 
        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 new standards and modifications to such existing 
        standards as necessary.
            ``(4) Limitation.--The standards and timeframe for adoption 
        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 quality reporting, 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.--
            ``(1) In general.--Any standards adopted by the Federal 
        Government under subsection (e) shall be voluntary with respect 
        to private entities.
            ``(2) Rule of construction.--Nothing in this section shall 
        be construed to require that a private entity that enters into 
        a contract with the Federal Government adopt the standards 
        adopted by the Federal Government under section 2903 with 
        respect to activities not related to the contract.
            ``(3) Limitation.--Private entities that enter into a 
        contract with the Federal Government shall adopt the standards 
        adopted by the Federal Government under section 2903 for the 
        purpose of activities under such Federal contract.
    ``(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 to carry out this section, $4,000,000 for fiscal year 
2006, $4,000,000 for fiscal year 2007, and such sums as may be 
necessary for each of fiscal years 2008 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 and software 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 accept recommendations on the development 
of the criteria under subsections (a) and (b) from a Federal agency or 
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) individual or group practice; 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) 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 and training personnel in the use of such 
        technology.
            ``(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;
                    ``(B) eligible entities that will link, to the 
                extent practicable, the qualified health information 
                system to local or regional health information plan or 
                plans; and
                    ``(C) with respect to an entity described in 
                subsection (a)(2)(C)(iii), a nonprofit health care 
                provider.
    ``(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 Health Information 
                        Technology Resource Center 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;
                    ``(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 and training of personnel in the use of such 
                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 publicly 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) Competitive 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) demonstrate the participation, to the extent 
                practicable, of stakeholders in the electronic exchange 
                of health information within the local or regional plan 
                pursuant to paragraph (2)(C);
                    ``(E) 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;
                    ``(F) adopt the standards adopted by the Secretary 
                under section 2903;
                    ``(G) require that health care providers receiving 
                such grants implement the measurement system adopted 
                under section 2908 and report to the Secretary on such 
                measures;
                    ``(H) facilitate the electronic exchange of health 
                information within the local or regional area and among 
                local and regional areas;
                    ``(I) prepare and submit to the Secretary an 
                application in accordance with paragraph (3); and
                    ``(J) 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;
                            ``(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; and
                            ``(viii) if the case of an applicant entity 
                        that is unable to demonstrate the participation 
                        of all stakeholders pursuant to paragraph 
                        (2)(C), the justification from the entity for 
                        any such nonparticipation.
            ``(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) Requirement to Achieve Quality Improvement.--The Secretary 
shall annually evaluate the activities conducted under this section and 
shall, in awarding grants, implement the lessons learned from such 
evaluation in a manner so that awards made subsequent to each such 
evaluation are made in a manner that, in the determination of the 
Secretary, will result in the greatest improvement in quality 
measurement systems under section 2908.
    ``(f) Limitation.--An eligible entity may only receive one non-
renewable grant under subsection (a), one non-renewable grant under 
subsection (b), and one non-renewable grant under subsection (c).
    ``(g) Authorization of Appropriations.--
            ``(1) In general.--For the purpose of carrying out this 
        section, there is authorized to be appropriated $116,000,000 
        for fiscal year 2006, $141,000,000 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) an institution with 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, and implement the quality measurement 
        system adopted under section 2908, 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 SYSTEM.

    ``(a) In General.--The Secretary, in consultation with the 
Secretary of Veterans Affairs, the Secretary of Defense, and 
representatives of other relevant Federal agencies, as determined 
appropriate by the Secretary, shall develop or adopt a quality 
measurement system, including measures to assess that effectiveness, 
timeliness, patient self-management, patient centeredness, efficiency, 
and safety, for the purpose of measuring the quality of care patients 
receive.
    ``(b) Requirements.--The Secretary 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 
                Secretary shall select measures of quality to be used 
                by the Secretary under the systems.
                    ``(B) Requirements.--In selecting the measures to 
                be used under each system pursuant to subparagraph (A), 
                the Secretary shall, to the extent feasible, ensure 
                that--
                            ``(i) such measures are evidence based, 
                        reliable and valid;
                            ``(ii) such measures include measures of 
                        clinical processes and outcomes, patient 
                        experience, efficiency, and equity; and
                            ``(iii) such measures include measures of 
                        overuse and underuse of health care items and 
                        services.
            ``(2) Priorities.--In developing the system under 
        subsection (a), the Secretary 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 Secretary shall assign 
        weights to the measures used by the Secretary under each system 
        established under subsection (a).
            ``(4) Risk adjustment.--The Secretary 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 Secretary shall, as determined 
        appropriate, but in no case more often than once during each 
        12-month period, update the quality measurement systems 
        developed under subsection (a), including through--
                    ``(A) the addition of more accurate and precise 
                measures under the systems and the retirement of 
                existing outdated measures under the systems; and
                    ``(B) the refinement of the weights assigned to 
                measures under the systems.
    ``(c) Required Considerations in Developing and Updating the 
Systems.--In developing and updating the quality measurement systems 
under this section, the Secretary shall--
            ``(1) consult with, and take into account the 
        recommendations of, the entity that the Secretary has an 
        arrangement with under subsection (e);
            ``(2) consult with representatives of health care providers 
        (including physicians, pharmacists, nurses, and other health 
        care professionals), 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 Secretary relating to measuring and rewarding 
                quality and efficiency of care;
                    ``(B) any existing activities conducted by the 
                Secretary 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 
Secretary shall take into account the recommendations of public-private 
entities--
            ``(1) that are established to examine issues of data 
        collection and reporting, including the feasibility of 
        collecting and reporting data on measures; and
            ``(2) that involve representatives of health care providers 
        (including physicians, pharmacists, nurses, and other health 
        care professionals), consumers, employers, and other 
        individuals and groups that are interested in quality of care.
    ``(e) Arrangement With an Entity to Provide Advice and 
Recommendations.--
            ``(1) Arrangement.--On and after July 1, 2006, the 
        Secretary shall have in place an arrangement with an entity 
        that meets the requirements described in paragraph (2) under 
        which such entity provides the Secretary with advice on, and 
        recommendations with respect to, the development and updating 
        of the quality measurement systems under this section, 
        including the assigning of weights to the measures under 
        subsection (b)(2).
            ``(2) Requirements described.--The requirements described 
        in this paragraph are the following:
                    ``(A) The entity is a private nonprofit entity 
                governed by an executive director and a board.
                    ``(B) The members of the entity include 
                representatives of--
                            ``(i) health insurance plans and health 
                        care 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 Secretary 
                that such fees are not a substantial barrier to 
                participation in the entity's activities related to the 
                arrangement with the Secretary.
                    ``(E) The entity--
                            ``(i) permits any member described in 
                        subparagraph (B) to vote on matters of the 
                        entity related to the arrangement with the 
                        Secretary under paragraph (1); and
                            ``(ii) ensures that 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 2905, 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.
            ``(3) Reporting.--The Secretary shall implement procedures 
        to enable the Department of Health and Human Services to accept 
        the electronic submission of data for purposes of quality 
        measurement using the quality measurement system adopted under 
        this section and using the standards adopted by the Federal 
        Government under section 2903.
    ``(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 dissemination, 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. ENSURING PRIVACY AND SECURITY.

    ``Nothing in this title shall be construed to affect the scope or 
substance of--
            ``(1) section 264 of the Health Insurance Portability and 
        Accountability Act of 1996;
            ``(2) sections 1171 through 1179 of the Social Security 
        Act; and
            ``(3) any regulation issued pursuant to any such section;
and such sections shall remain in effect.

``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) Health information technology resource center.--
            ``(1) In general.--The Secretary, acting through the 
        Director, shall develop a Health Information Technology 
        Resource Center to provide technical assistance and develop 
        best practices to support and accelerate efforts to adopt, 
        implement, and effectively use interoperable health information 
        technology in compliance with section 2903 and 2908.
            ``(2) Health information technology resource center.--
                    ``(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; and
                            ``(iii) assemble, analyze, and widely 
                        disseminate evidence and experience related to 
                        the adoption, implementation, and effective use 
                        of interoperable health information technology.
                    ``(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) Rule of construction.--Nothing in this subsection 
        shall be construed to require the duplication of Federal 
        efforts with respect to the establishment of the Center, 
        regardless of whether such efforts were carried out prior to or 
        after the enactment of this subsection.''.

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''.
                                                       Calendar No. 178

109th CONGRESS

  1st Session

                                S. 1418

                          [Report No. 109-111]

_______________________________________________________________________

                                 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.

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                             July 27, 2005

                       Reported with an amendment