[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1952 Introduced in House (IH)]







110th CONGRESS
  1st Session
                                H. R. 1952

  To amend title XI of the Social Security Act to achieve a national 
 health information infrastructure, and to amend the Internal Revenue 
   Code of 1986 to increase the deduction under section 179 for the 
  purchase of qualified health care information technology by medical 
                            care providers.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             April 19, 2007

  Mr. Gonzalez (for himself, Mr. Gingrey, Ms. Velazquez, and Mr. Gene 
 Green of Texas) introduced the following bill; which was referred to 
the Committee on Energy and Commerce, and in addition to the Committee 
 on Ways and Means, for a period to be subsequently determined by the 
  Speaker, in each case for consideration of such provisions as fall 
           within the jurisdiction of the committee concerned

_______________________________________________________________________

                                 A BILL


 
  To amend title XI of the Social Security Act to achieve a national 
 health information infrastructure, and to amend the Internal Revenue 
   Code of 1986 to increase the deduction under section 179 for the 
  purchase of qualified health care information technology by medical 
                            care providers.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as ``National Health Information Incentive 
Act of 2007''.

SEC. 2. FINDINGS AND PURPOSE.

    (a) Findings.--The Congress finds as follows:
            (1) A March 2001 Institute of Medicine (``IOM'') study 
        concludes that in order to improve quality, the nation must 
        have a national commitment to building an information 
        infrastructure to support healthcare delivery, consumer health, 
        quality measurement and improvement, public accountability, 
        clinical and health services research, and clinical education.
            (2) A November 2001 National Committee on Vital Health 
        Statistics study lauds the importance of a national health 
        information infrastructure to improve patient safety, improve 
        healthcare quality, improve bioterrorism detection, better 
        inform and empower healthcare consumers regarding their own 
        personal health information, and to better understand 
        healthcare costs.
            (3) An October 2002 IOM report calls on the federal 
        government to take steps to encourage and facilitate 
        development in the information technology infrastructure that 
        is critical to healthcare quality and safety enhancement.
            (4) A General Accounting Office October 2003 report found 
        that the benefits of an electronic healthcare information 
        system included improved quality of care, reduced costs 
        associated with medication errors, more accurate and complete 
        medical documentation, more accurate capture of codes and 
        charges, and improved communication among providers enabling 
        them to respond more quickly to patients' needs.
            (5) Other more recent studies and surveys show that 
        cultivating a national healthcare information infrastructure 
        and improving patient care will depend crucially on adoption of 
        uniform medical data standards and interoperability.
            (6) The ability of physicians to deliver patient-centered 
        care to patients, particularly those with multiple chronic 
        illnesses, will depend on having the electronic systems in 
        place at the practice level to enable them to track patients by 
        disease conditions, to have access to evidence-based clinical 
        decision support tools at the point of care, to share 
        information with patients and other health care professionals, 
        and to track, measure and report on the qualify of care 
        provided.
            (7) A Commonwealth Fund survey of physicians found that 
        there is a gap between physicians' support for and willingness 
        to provide such patient-centered services and having the 
        electronic systems in place to enable them to do, with the 
        costs of acquiring and maintaining such systems being 
        identified as a major barrier.
            (8) Acquisition costs, physician and staff time required to 
        transition from paper-based offices to electronic health 
        systems, and the lack of industry standards on interoperability 
        are the principle barriers to creating a national health 
        information infrastructure.
            (9) The success of a national health information 
        infrastructure depends on the widespread use and acceptance of 
        electronic health records and other health information 
        technologies in physician offices.
    (b) Purposes.--The purposes of this Act are as follows:
            (1) To create incentives that encourage physicians and 
        other health professionals to adopt interoperable electronic 
        health records, electronic prescribing systems, evidence-based 
        clinical decision tools, remote monitoring, patient registries, 
        secure email, and other health information technology as a key 
        component of a national health care information infrastructure 
        in the United States to ensure the rapid flow of secure, 
        private and digitized information relevant to all facets of 
        patient care.
            (2) To do so in a voluntary manner that does not become an 
        unfunded mandate on small physician practices.
            (3) To do so in a manner that does not compromise the 
        medical care provider's ability to make patient care decisions 
        based solely on his or her clinical expertise and experience, 
        and what the provider and patient concludes is the best for a 
        particular patient based upon scientific evidence and knowledge 
        of the patient's medical history.

SEC. 3. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION 
              TECHNOLOGY.

    (a) Establishment.--There is established within the Office of the 
Secretary of Health and Human Services an Office of the National 
Coordinator for Health Information Technology. The Office shall be 
headed by a National Coordinator appointed by the President, in 
consultation with the Secretary of Health and Human Services. The 
National Coordinator shall report directly to the Secretary.
    (b) Resources.--The President shall make available to the Office of 
the National Coordinator for Health Information Technology the 
resources, both financial and otherwise, necessary to enable the 
National Coordinator to carry out the purposes of, and perform the 
duties and responsibilities of, the Office.

SEC. 4. BUILDING THE NATIONAL HEALTH INFORMATION INFRASTRUCTURE.

    Title XI of the Social Security Act (42 U.S.C. 1301 et seq.) is 
amended by adding at the end the following part:

   ``Part D--Building the National Health Information Infrastructure

 ``financial incentive to small medical care providers and entities to 
         implement a national health information infrastructure

    ``Sec. 1181.  (a) In General.--The Secretary shall include 
additional Medicare payment incentives to assure small medical care 
providers have the capability to move toward a national health care 
information infrastructure by acquiring electronic health record 
systems and other health information technologies.
    ``(b) Conditions for Qualification.--As a condition of qualifying 
for financial incentives described in this section, the Secretary shall 
grant the use of financial incentives to assure that such technologies 
are consistent with the goals of creation of a national health 
information infrastructure, such as--
            ``(1) voluntary participation in studies or demonstration 
        projects to evaluate the use of such systems to measure and 
        report quality data based on accepted clinical performance 
        measures;
            ``(2) voluntary participation in studies to demonstrate the 
        impact of such technologies on improving patient care, reducing 
        costs and increasing efficiencies; and
            ``(3) voluntary participation in studies and demonstration 
        projects on providing patient-centered care coordinated by a 
        patient's personal physician (as defined by the Institute of 
        Medicine), using electronic systems that enable and facilitate 
        care coordination and sharing of information among the 
        physician and other treating health care professionals, family 
        caregivers, and the patient.
    ``(c) Additional Medicare Payment to Small Medical Care Providers 
and Entities for Expenditures Relating to the Implementation of 
Practice-Based Electronic Systems That Will Serve as the Foundation for 
a National Health Information Infrastructure.--
            ``(1) In general.--The Secretary shall provide for 
        additional payment to medical care providers in small practice 
        settings, including physicians and others in clinical practice, 
        for the purpose of assisting such entities to acquire and adopt 
        patient registries, evidence-based clinical decision support 
        tools at the point of care, electronic health records, secure 
        email, and other health information technologies defined by the 
        Secretary as a key component of a national health care 
        information infrastructure.
            ``(2) Types of reimbursement incentives.--In developing the 
        reimbursement incentives described in paragraph (1), the 
        Secretary shall consider inclusion of one or more of the 
        following types of incentives:
                    ``(A) Adds-ons to payments for evaluation and 
                management services.
                    ``(B) Care management fees that include an 
                allowance for the costs associated with acquiring the 
                electronic systems associated with providing 
                coordinated and patient-centered care to beneficiaries, 
                especially those with multiple chronic illnesses, as 
                determined by the Secretary and that is included in the 
                top 5 percent of claims (determined on the basis of 
                cost).
                    ``(C) Payments for structured e-mail consults and 
                other technologies that will facilitate care 
                coordination that are separately identifiable medical 
                services from other evaluation and management services.
                    ``(D) Any other method deemed appropriate by the 
                Secretary to encourage participation.
            ``(3) Amount of reimbursement.--The amount of reimbursement 
        made to small medical care providers and entities to implement 
        a national health care information infrastructure shall be in a 
        manner determined by the Secretary that takes into account the 
        costs of implementation, training, and complying with 
        applicable standards. Such reimbursement amounts shall be 
        calculated on a sliding scale, in a manner determined by the 
        Secretary, to reward qualifying practices using more functional 
        and comprehensive health information systems that meet the 
        certification guidelines under paragraph (4) based on the 
        following weighted-structure:
                    ``(A) Basic.--The maintenance of patient registries 
                for the purpose of identifying and following up with 
                at-risk patients and for the provision of educational 
                resources to patients.
                    ``(B) Intermediate.--In addition to complying with 
                subparagraph (A), the use of three or more of the 
                following:
                            ``(i) An electronic systems to maintain 
                        patient records (EHRs).
                            ``(ii) Clinical-decision support tools.
                            ``(iii) Electronic order for prescriptions 
                        and lab tests (e-prescribing).
                            ``(iv) Patient reminders.
                            ``(v) E-consults (communication between 
                        patient-physician or other provider) when an 
                        identifiable medical service is provided.
                            ``(vi) Managing patients with multiple 
                        chronic illnesses.
                    ``(C) Advanced.--In addition to complying with 
                subparagraphs (A) and (B), the use by a practice of an 
                electronic system that--
                            ``(i) is interconnected and is 
                        interoperable with other electronic systems;
                            ``(ii) uses nationally accepted medical 
                        code sets; and
                            ``(iii) can automatically send, receive, 
                        and integrate data, such as lab results and 
                        medical histories, from other organizations' 
                        systems.
            ``(4) Certification of technology.--The technology used 
        under paragraph (3) must meet such guidelines for functionality 
        as may be developed by the Secretary. In the case of technology 
        for electronic health records (EHRs), technology that has been 
        certified by the Certification Commission for Healthcare 
        Information Technology (CCHIT) shall be considered as having 
        met such guidelines.
            ``(5) Exemption from budget neutrality under the physician 
        fee schedule.--Any increased expenditures pursuant to this 
        section shall be treated as additional allowed expenditures for 
        purposes of computing any update under section 1848(d).
    ``(d) Small Medicare Care Provider Defined.--In this part, the term 
`small medical care provider' means a medical care provider (as defined 
in section 179(e)(2)(B) of the Internal Revenue Code of 1986) that has 
an average of 10 or fewer full-time equivalent employees during the 
period involved.

  ``optional financial incentives to small medical care providers and 
   entities to implement a national health information infrastructure

    ``Sec. 1182.  (a) In General.--The Secretary may utilize any, all, 
or a combination of financial incentives thereof, to assure small 
medical care providers have the capability to move toward a national 
health care information infrastructure by acquiring electronic health 
record systems and other health information technologies that meet the 
standards adopted or modified by the Secretary.
    ``(b) Conditions for Qualification.--As a condition of qualifying 
for financial incentives described in this section, the Secretary shall 
grant the use of financial incentives to assure that such technologies 
are consistent with the goals of creation of a national health 
information infrastructure, such as--
            ``(1) voluntary participation in studies or demonstration 
        projects to evaluate the use of such systems to measure and 
        report quality data based on accepted clinical performance 
        measures;
            ``(2) voluntary participation in studies to demonstrate the 
        impact of such technologies on improving patient care, reducing 
        costs and increasing efficiencies; and
            ``(3) voluntary participation in studies and demonstration 
        projects on providing patient-centered care coordinated by a 
        patient's personal physician (as defined by the Institute of 
        Medicine), using electronic systems that enable and facilitate 
        care coordination and sharing of information among the 
        physician and other treating health care professionals, family 
        caregivers, and the patient.
    ``(c) Grants to Small Medical Care Providers and Entities for 
Expenditures Relating to the Implementation of a National Health 
Information Infrastructure.--
            ``(1) In general.--The Secretary is authorized to make 
        grants to small medical care providers, including physicians 
        and others in clinical practice, for the purpose of assisting 
        such entities to acquire and adopt patient registries, 
        evidence-based clinical decision support tools at the point of 
        care, electronic health records, secure email, and other health 
        information technologies defined by the Secretary as a key 
        component of a national health care information infrastructure.
            ``(2) Amount of grant.--The grant amount made to small 
        medical care providers and entities to implement a national 
        health care information infrastructure shall be in a manner 
        determined by the Secretary that takes into account the costs 
        of implementation, training, and complying with applicable 
        standards.
            ``(3) Application.--No grant may be made under this 
        subsection except pursuant to a grant application that is 
        submitted in a time, manner, and form approved by the 
        Secretary.
            ``(4) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this subsection such 
        sums as may be necessary for each fiscal year.
    ``(d) Revolving Loans to Small Medical Care Providers and Entities 
for Expenditures Relating to the Implementation of a National Health 
Information Infrastructure.--
            ``(1) In general.--The Secretary is authorized to make and 
        guarantee loans to small medical care providers, including 
        physicians and others in clinical practice, for the purpose of 
        assisting such entities to acquire and adopt patient 
        registries, evidence-based clinical decision support tools at 
        the point of care, electronic health records, secure email, and 
        other health information technologies defined by the Secretary 
        as a key component of a national health care information 
        infrastructure.
            ``(2) Amount of loan.--The loan amount made to small 
        medical care providers and entities to implement a national 
        health care information infrastructure shall be in a manner 
        determined by the Secretary that takes into account the costs 
        of implementation, training, and complying with standards.
            ``(3) Application.--No loan may be made under this 
        subsection except pursuant to a loan application that is 
        submitted in a time, manner, and form approved by the 
        Secretary.
            ``(4) Authorization of appropriations.--There are 
        authorized to be appropriated to carry out this subsection such 
        sums as may be necessary for each fiscal year.''.

SEC. 5. ELECTION TO EXPENSE QUALIFIED HEALTH CARE INFORMATION 
              TECHNOLOGY.

    (a) In General.--Section 179 of the Internal Revenue Code of 1986 
(relating to election to expense certain depreciable assets) is amended 
by adding at the end the following new subsection:
    ``(e) Health Care Information Technology.--
            ``(1) In general.--In the case of qualified health care 
        information technology purchased by a medical care provider and 
        placed in service during a taxable year--
                    ``(A) subsection (b)(1) shall be applied by 
                substituting `$250,000' for `$100,000',
                    ``(B) subsection (b)(2) shall be applied by 
                substituting `$600,000' for `$400,000', and
                    ``(C) subsection (b)(5)(A) shall be applied by 
                substituting `$250,000 and $600,000' for `$100,000 and 
                $400,000'.
            ``(2) Definitions.--For purposes of this subsection--
                    ``(A) Qualified health care information 
                technology.--The term `qualified health care 
                information technology' means section 179 property 
                which--
                            ``(i) meets such guidelines for 
                        functionality as may be developed by the 
                        Secretary of Health and Human Services under 
                        section 1181(c)(4) of the Social Security Act, 
                        and
                            ``(ii) is used primarily for the electronic 
                        creation, maintenance, and exchange of medical 
                        care information to improve the quality or 
                        efficiency of medical care.
                    ``(B) Medical care provider.--The term `medical 
                care provider' means any person engaged in the trade or 
                business of providing medical care.
                    ``(C) Medical care.--The term `medical care' has 
                the meaning given such term by section 213(d).''.
    (b) Effective Date.--The amendment made by this section shall apply 
to property placed in service after December 31, 2006.
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