[Congressional Bills 110th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6345 Introduced in House (IH)]







110th CONGRESS
  2d Session
                                H. R. 6345

To establish a demonstration program to provide financial incentives to 
 encourage the adoption and use of interactive personal health records 
and to encourage health information exchange networks to link clinical 
                 data to such personal health records.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                             June 23, 2008

 Mr. Boustany 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 establish a demonstration program to provide financial incentives to 
 encourage the adoption and use of interactive personal health records 
and to encourage health information exchange networks to link clinical 
                 data to such personal health records.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Patient-Controlled Health IT Act''.

SEC. 2. PERSONAL HEALTH RECORD (PHR) INCENTIVE DEMONSTRATION PROGRAM.

    (a) Establishment.--Not later than one year after the date of the 
enactment of this Act, the Secretary of Health and Human Services (in 
this section referred to as the ``Secretary'') shall establish a 
demonstration program (in this section referred to as the 
``demonstration program'') in not more than 5 States to provide 
financial incentives during a 5-year period for the use of qualifying 
personal health records by qualifying patients and qualifying providers 
to--
            (1) provide patients (or their authorized representatives) 
        access to and control over their personal health data so as to 
        become healthier and more informed and engaged health care 
        consumers;
            (2) make available to such qualifying providers an accurate 
        minimum data set of patient information (as described in 
        subsection (e)(1)(B)) at all points of care;
            (3) protect patient security and privacy, with respect to 
        their health care information;
            (4) improve patients' adherence to evidence-based health 
        care guidelines, medication guidelines, preventive care, and 
        screening protocols, thereby improving health outcomes and 
        lowering health care costs;
            (5) provide patients with more accurate, timely, and 
        appropriate information related to their health care benefits 
        and related administrative information;
            (6) improve the quality and efficiency of communication 
        between health care providers and patients;
            (7) create a direct communications channel to patients in 
        the event of emergencies;
            (8) provide access with appropriate privacy safeguards to 
        de-identified health care information to evaluate and advance 
        public health and health research goals; and
            (9) incentivize health information exchange networks to 
        plan for and implement methods to provide patient access to 
        clinical data through use of personal health records.
    (b) Incentive Payments.--
            (1) In general.--Under the demonstration program, subject 
        to paragraph (2), each qualifying provider (as defined in 
        subsection (c)) that furnishes services to a qualifying patient 
        (as defined in subsection (d)) and each health information 
        exchange network (as defined in subsection (g)) shall receive 
        an incentive payment, in accordance with this subsection, from 
        the PHR Incentive Fund established under subsection (i).
            (2) One payment for providers in same group practice.--In 
        the case of a qualifying patient who receives services during a 
        fiscal year from more than one qualified provider in the same 
        group practice, as defined by the Secretary, only one incentive 
        payment under paragraph (1) for such fiscal year shall be made 
        to such providers with respect to such patient.
            (3) Amount of incentive payment.--
                    (A) In general.--Except as otherwise provided, the 
                amount of the incentive payment under the demonstration 
                program for a fiscal year--
                            (i) paid to a qualifying provider shall 
                        be--
                                    (I) at least $3 for each qualifying 
                                patient not described in subclause 
                                (II); and
                                    (II) at least $5 for each 
                                qualifying patient with a covered 
                                chronic health condition described in 
                                subparagraph (C); and
                            (ii) paid to the health information 
                        exchange network shall be at least $3 for each 
                        qualifying patient for whom such network 
                        facilitates under subsection (g)(2) access to 
                        and retrieval of clinical data into a 
                        qualifying personal health record.
                    (B) Authority to increase amount of incentive 
                payments.--The Secretary may increase the amount of 
                incentive payments described in clause (i)(I), (i)(II) 
                (including for the case of qualifying patients with 
                more than one covered chronic health conditions 
                described in subparagraph (C)), or (ii) of subparagraph 
                (A) under the demonstration program for a fiscal year 
                so long as such increase will not result in--
                            (i) the total amount of such incentive 
                        payments under this paragraph (and the costs of 
                        other permissible uses described in subsection 
                        (i)(1) of funds in the PHR Incentive Fund under 
                        subsection (i)) for such fiscal year, exceeding
                            (ii) the total amount of funds in such PHR 
                        Incentive Fund for such fiscal year.
                    (C) Covered chronic health condition described.--
                For purposes of subparagraph (A), a covered chronic 
                health condition is any of the following:
                            (i) Major mental disorder.
                            (ii) Diabetes.
                            (iii) Heart disease.
                            (iv) Asthma.
                            (v) Hypertension.
                            (vi) Cancer.
                The Secretary, in consultation with the United States 
                Preventive Services Task Force convened by the Public 
                Health Service, may add to or otherwise modify the list 
                of covered chronic health conditions specified under 
                this subparagraph.
                    (D) Authority to increase amount of incentive 
                payments or vary incentives according to practice size 
                and geographic location.--Subject to subparagraph (B), 
                the Secretary may increase the amount of incentive 
                payments described in clause (i)(I) or (i)(II) of 
                subparagraph (A) under the demonstration program (or 
                provide additional or different incentives) for a 
                fiscal year for qualifying providers specified by the 
                Secretary as providers with small practices and 
                qualifying providers located in rural areas.
            (4) Publication of names of qualifying providers and 
        patient and provider education about health information 
        exchange.--In order to assist patients in identifying health 
        care providers that use qualifying personal health records, and 
        to assist patients and health care providers in understanding 
        personal health records and health information exchange 
        networks, under the demonstration program the Secretary shall--
                    (A) provide for outreach activities, through the 
                use of local methods and Internet websites of the 
                Secretary's choosing, to provide patients residing in a 
                State participating in the demonstration program with a 
                list of qualifying providers who participate in the 
                program;
                    (B) in consultation with appropriate organizations 
                that represent health care consumers, as well as 
                organizations that represent health information 
                exchange organizations, provide for activities to 
                educate patients residing in a State participating in 
                the demonstration program about the health and 
                convenience benefits of qualifying personal health 
                records and the benefits of electronic health 
                information exchange networks;
                    (C) provide for activities to educate qualifying 
                providers about the patient, provider, and overall 
                health care benefits of using qualifying personal 
                health records and participating in electronic health 
                information exchange networks;
                    (D) in consultation with patient organizations, 
                nongovernmental organizations, and other agencies 
                specified by the Secretary, provide for activities that 
                inform patients of the benefits and risks associated 
                with their use of health information technology and 
                health information exchanges, including the affect that 
                such technology and exchanges may have on the quality 
                of care provided; and
                    (E) develop an interactive outreach and education 
                plan for patients and health care providers to 
                communicate the benefits and risks of health 
                information technology and health information 
                exchanges, how to evaluate and use health information 
                tools and services, and how patients could use such 
                technology and exchanges to participate more completely 
                in their health care.
    (c) Qualifying Provider Defined.--For purposes of this section, the 
term ``qualifying provider'' means a licensed physician (or other 
licensed health care provider designated by the Secretary) that meets 
the following requirements, with respect to a qualifying patient of 
that provider and the qualifying personal health record of that 
patient:
            (1) The physician (or provider), or authorized 
        representative, updates the diagnosis and medication list 
        (including all current medications and new medications 
        prescribed) in the QPHR after each patient encounter, if 
        appropriate and as authorized by the patient, either by direct 
        entry or through a data sharing arrangement using an 
        appropriate electronic means, such as an electronic medical 
        record, e-prescribing, or health information exchange network.
            (2) To the extent authorized by the patient, the physician 
        (or provider), or authorized representative ensures that the 
        name of the physician (or provider) is included in the QPHR of 
        the patient on a list of health care providers who furnish 
        services to the patient.
            (3) The physician (or provider), or authorized 
        representative complies with any security and privacy 
        standards, policies, and practices described under paragraphs 
        (1), (2), and (3) of subsection (h).
            (4) The physician (or provider), or authorized 
        representative meets other requirements as the Secretary may 
        establish.
    (d) Qualifying Patient Defined.--For purposes of this section, the 
term ``qualifying patient'' means an individual--
            (1) for whom a qualifying personal health record has been 
        established and is in operation under the demonstration 
        program; and
            (2) who is a Medicare beneficiary or is covered under a 
        health benefits or other plan the sponsor of which is 
        participating as a Fund partner under subsection (i).
    (e) Qualifying Personal Health Record Defined.--For purposes of 
this section, the terms ``qualifying personal health record'' and 
``QPHR'' mean a record of health care information, with respect to a 
patient, that meets the following requirements:
            (1) Content.--
                    (A) In general.--The record--
                            (i) shall contain at least the minimum data 
                        set of patient information described in 
                        subparagraph (B)(i); and
                            (ii) may consist of such additional 
                        personal health information, such as family 
                        health history, symptoms, use of over-the-
                        counter medication, diet, exercise, and other 
                        relevant health information and activities, as 
                        the patient may provide in accordance with 
                        paragraph (2)(A)(ii).
                    (B) Minimum data set of patient information.--A 
                minimum data set of patient information described in 
                this paragraph, with respect to a qualifying patient 
                and a qualifying provider authorized by the patient to 
                access the QPHR of the patient, is a data set that is 
                consistent with the following:
                            (i) The data set includes--
                                    (I) laboratory results in such a 
                                format as to enable the patient and 
                                qualifying provider to retrieve, store, 
                                graph, and share the results as 
                                authorized by the patient;
                                    (II) a list of health conditions 
                                and allergies as contained in records 
                                of health providers involved in the 
                                care of the patient (in such a format 
                                as to enable the patient and qualifying 
                                provider to retrieve and store lists of 
                                current and previous health conditions 
                                and allergies of the patient);
                                    (III) diagnosis codes, with respect 
                                to treatment for such a condition or 
                                allergy, in such a format as to enable 
                                the patient and qualifying provider to 
                                retrieve and store a list of such 
                                codes; and
                                    (IV) an updated list of health 
                                providers involved in the care of the 
                                patient to enable the patient and 
                                qualifying provider to communicate 
                                information about the patient to any 
                                provider on the list, as authorized by 
                                the patient, for care coordination.
                            (ii) The data set provides for the ability 
                        to access the results, conditions, allergies, 
                        diagnosis codes, and list described in clause 
                        (i) in layperson terms.
                            (iii) The data set is portable and enables 
                        the patient to move the data between personal 
                        health records of the patient.
            (2) Access to the record.--
                    (A) Access rights of patient.--
                            (i) In general.--Access to the record (and 
                        each portion of the record) shall be controlled 
                        solely by the patient (or the patient's 
                        authorized representative), with the patient 
                        (or the patient's authorized representative) 
                        able to access the record through the Internet, 
                        print the record, copy the record to electronic 
                        media, and provide online access to authorized 
                        third parties, including health care providers, 
                        to all individually identifiable health 
                        information held in the record at any time, in 
                        accordance with this paragraph.
                            (ii) Addition of personal information.--The 
                        patient may add personal health information to 
                        the record, except that such patient shall not 
                        alter information that is entered into the 
                        record by any qualifying provider. Such patient 
                        shall have the right to propose an amendment to 
                        information that is entered by a qualifying 
                        provider pursuant to standards prescribed by 
                        the Secretary for purposes of amending such 
                        information.
                            (iii) Identification of information entered 
                        by participant.--Any additions or amendments 
                        made by the patient to the record shall be 
                        identified and disclosed within such record as 
                        being made by such patient.
                    (B) Access by authorized individuals other than 
                patient.--
                            (i) Authorized access only.--Except as 
                        provided under subparagraphs (C) and (D), 
                        access to the record (or any portion of the 
                        record) by an individual other than the patient 
                        (or the patient's authorized representative)--
                                    (I) may be made only if the 
                                individual is a health care provider 
                                who is authorized by the patient to 
                                access the record;
                                    (II) may be made only to the 
                                minimum data set of the patient (as 
                                described in paragraph (1)(B)) and to 
                                such other portions of the QPHR as 
                                specified by the patient; and
                                    (III) may be limited by the patient 
                                for purposes of entering information 
                                into such record, retrieving 
                                information from such record, or both.
                            (ii) Identification of entity that enters 
                        information.--Any information that is added by 
                        a qualifying provider to the record shall be 
                        identified and disclosed within such record as 
                        being made by such provider. The record shall 
                        enable the patient to identify each individual 
                        that has been authorized by the patient to 
                        access the record, the portions of the record 
                        accessed, and the date of such access.
                            (iii) Notification of limited access to 
                        record.--In the case that the patient (or the 
                        patient's authorized representative) authorizes 
                        access by a health care provider to only a 
                        portion of the record and that portion does not 
                        include the complete portion of the record, an 
                        indicator shall be included in the record to 
                        alert the provider that such authorized portion 
                        is not representative of the complete record 
                        relating to medications taken by the patient.
                    (C) Deemed authorization for access for emergency 
                health care.--With respect to the record of the 
                patient, the patient shall be deemed as providing 
                authorization (in the form of affirmative consent) for 
                health care providers to access, in connection with 
                providing emergency care services to the patient, a 
                limited, authenticated information set concerning the 
                patient for emergency response purposes, unless the 
                patient specifies that such information set (or any 
                portion of such information set) may not be so 
                accessed. Such limited information set shall include 
                the minimum data set of patient information described 
                in paragraph (1)(B) for the patient and any other 
                information specified by the patient for such purposes.
                    (D) Public health analysis and research.--
                            (i) In general.--A QPHR service provider 
                        operating or administering a QPHR may provide 
                        data included in the QPHR that has been de-
                        identified consistent with the applicable 
                        requirements of section 164.514 of title 45, 
                        Code of Federal Regulations, for public health 
                        analysis, post-market safety surveillance of 
                        prescription drugs, and for research purposes.
                            (ii) Required consultation to optimize 
                        public health capabilities.--The Secretary 
                        shall consult with the Commissioner of the Food 
                        and Drug Administration, the Director of the 
                        National Institutes of Health, the Director of 
                        the Centers for Disease Control and Prevention, 
                        and the Administrator of the Agency for 
                        Healthcare Research and Quality to optimize the 
                        public health and post-market surveillance 
                        capabilities of QPHRs.
                    (E) Termination rights.--
                            (i) In general.--The record shall allow the 
                        patient (or the patient's authorized 
                        representative) to terminate at any time during 
                        or after the period of the demonstration 
                        program--
                                    (I) the further use of the QPHR 
                                service provider operating or 
                                administering the record, including 
                                elimination of the patient's personal 
                                health information in the control of 
                                the QPHR service provider and including 
                                in the case of a QPHR service provider 
                                that terminates its participation in 
                                the demonstration program or ceases to 
                                be a QPHR service provider;
                                    (II) the further access to the 
                                record by a qualifying provider; or
                                    (III) the further use of a health 
                                information exchange network.
                            (ii) Clarification.--Nothing in this 
                        subparagraph shall require a health care 
                        provider to eliminate a patient's personal 
                        health information included in the QPHR that is 
                        in a medical record maintained by the provider.
                    (F) Transportability.--The patient's rights to 
                control access to the record under this paragraph shall 
                not be affected by changes in relationships with 
                particular providers or health plans.
            (3) Security.--The record shall at least meet minimum 
        security standards, including the regulations promulgated under 
        section 264(c) of the Health Insurance Portability and 
        Accountability Act of 1996 (HIPAA) (42 U.S.C. 1320d-2 note) and 
        other such minimum standards as identified by the Secretary 
        under subsection (h).
            (4) Web-based.--The record shall be web-based.
            (5) Authentication.--The record shall include functionality 
        to authenticate the patient's identity prior to the record's 
        use to receive electronic data of personal health information 
        (other than actual authentication information) from third party 
        sources, such as health information exchange networks, 
        pharmacies, pharmacy benefit managers, laboratories, and health 
        plans, including the Medicare program.
    (f) QPHR Service Provider.--
            (1) Definition.--For purposes of this section, the term 
        ``QPHR service provider'' means an entity that--
                    (A) operates or administers a QPHR or part of a 
                QPHR;
                    (B) has access to patients' individually 
                identifiable health information contained in the QPHR;
                    (C) complies with any security and privacy 
                standards, policies, and practices adopted under 
                subsection (h);
                    (D) not later than the date that is one year after 
                the date of the enactment of this Act, is able to 
                exchange standards-based clinical and patient data with 
                other sources and users of health data, including other 
                QPHRs and health information exchange organizations;
                    (E) is capable of exchanging information with a 
                health information exchange network and is capable of 
                sharing such information between the patient involved 
                and the health care providers of such patient and 
                enabling patient-provider communication; and
                    (F) meets the messaging requirements described in 
                paragraph (2) and disclosure requirement described in 
                paragraph (3).
            (2) Messaging requirements.--
                    (A) In general.--Subject to subparagraph (B), the 
                messaging requirements described in this paragraph, 
                with respect to a QPHR service provider that operates 
                or administers a QPHR, are the following:
                            (i) Education reminders.--Subject to clause 
                        (v), the QPHR service provider shall have the 
                        capability of sending patient-specific patient 
                        education messages, reminders, and clinical 
                        messages to qualifying patients based upon data 
                        in the QPHR.
                            (ii) Federal reminders.--Subject to clause 
                        (v), the QPHR service provider shall provide 
                        for the sending on behalf of Federal agencies 
                        of objective, accurate, patient-specific 
                        messages to qualifying patients concerning 
                        their health care or benefits.
                            (iii) Fund partner messages.--Subject to 
                        clause (v), the QPHR service provider shall 
                        provide for the sending, on behalf of Fund 
                        partners who contribute to the Fund, 
                        appropriate patient-specific messages to 
                        qualifying patients (with whom such partners 
                        have pre-existing relationships) concerning the 
                        patients' health care, medications, treatments, 
                        medical devices or benefits. The QPHR service 
                        provider shall not allow a Fund partner to send 
                        a message to a patient about a product or 
                        service unless that product or service has 
                        already been prescribed or recommended to the 
                        patient by a health care provider.
                            (iv) Patient opt-in.--
                                    (I) In general.--Subject to 
                                subclause (II), the QPHR service 
                                provider shall not allow messages to be 
                                sent to a patient unless the provider 
                                has requested and received the 
                                permission of the patient (or patient's 
                                authorized representative).
                                    (II) Opt-out.--A patient may at any 
                                time opt out of receiving messages 
                                entirely or from a particular source.
                            (v) Limitation on commercial 
                        solicitation.--The QPHR service provider shall 
                        not allow messages to be sent to a patient 
                        unless--
                                    (I) the patient is a patient or 
                                beneficiary of the sender or source of 
                                the message, uses the sender's or 
                                source's product with a prescription or 
                                recommendation of a provider, or has 
                                some other health-related pre-existing 
                                relationship (as defined by the 
                                Secretary) with the sender or source, 
                                or the sender or source is a public 
                                health agency;
                                    (II) the message contains 
                                information directly related to the 
                                patient's health or health care and 
                                does not include marketing or 
                                commercial solicitations;
                                    (III) the message complies with 
                                standards adopted under subsection 
                                (h)(4); and
                                    (IV) the message clearly identifies 
                                the source of the content and the 
                                sender of the message.
                            (vi) Health plan notification.--The QPHR 
                        service provider shall notify, no less 
                        frequently than quarterly, each Fund partner 
                        that operates a health benefit plan of the 
                        individuals who have received messages sent on 
                        behalf of the Fund partner under this section.
                    (B) Alternative requirements.--For purposes of 
                paragraph (1)(F), the Secretary may develop and specify 
                requirements that a QPHR service provider may meet 
                instead of the requirements described in subparagraph 
                (A) so long as such requirements provide for a method 
                and incentives for private entities to contribute to 
                the PHR Incentive Fund.
            (3) Disclosure requirement.--The disclosure requirement 
        described in this paragraph with respect to a QPHR service 
        provider is that at the time of entering into an arrangement 
        with an individual to operate or administer a QPHR (or part of 
        a QPHR) of the individual, the QPHR service provider shall 
        provide to the individual a notice of the privacy policies of 
        the QPHR service provider, which shall be presented in a clear 
        and understandable manner, meet such standards as specified by 
        the Secretary of Health and Human Services and the Secretary of 
        Commerce, and include the following:
                    (A) Assurances not to sell individually 
                identifiable information.--Assurances, in a form and 
                manner specified by the Secretaries, that--
                            (i) the QPHR service provider will not sell 
                        any individually identifiable health 
                        information of such individual and the QPHR 
                        service provider will not sell or share any 
                        such information of such individual for the 
                        purposes of marketing or decisions related to 
                        employment or financial services; and
                            (ii) the QPHR service provider will 
                        disclose to the individual any possible 
                        secondary users of the individually 
                        identifiable health information of such 
                        individual, including business associates of 
                        the service provider who may have access to 
                        such information, and the purpose for such use 
                        or access.
                    (B) Fund partner information.--Information 
                identifying the Fund partners on behalf of which the 
                QPHR service provider sends messages under paragraph 
                (2)(C) and the types of information that would 
                potentially be available to such Fund partners.
    (g) Health Information Exchange Network Defined.--For purposes of 
this section, the term ``health information exchange network'' means 
any State-based or local entity--
            (1) the governance of which formally involves health care 
        consumers, employers, health plans, hospitals, and practicing 
        clinicians;
            (2) which facilitates private and secure access to and 
        retrieval of clinical data, including laboratory test results 
        and medication-related information, to provide safer, more 
        timely, efficient, effective, and equitable patient-centered 
        care;
            (3) which meets data standards for interoperability, as 
        specified by the Secretary;
            (4) which meets applicable requirements for privacy, 
        confidentiality, and security as specified by the Secretary, 
        including requirements and standards described in subsection 
        (h); and
            (5) that provides to each patient participating in such 
        network (at the initiation of such participation) a notice of 
        the privacy policies and other consumer protection policies of 
        the network, which shall be presented in a clear and 
        understandable manner and meet such standards as specified by 
        the Secretary of Health and Human Services and the Secretary of 
        Commerce and include assurances, in a form and manner specified 
        by the Secretaries, that--
                    (A) the entity will not sell any individually 
                identifiable health information of such individual and 
                the entity will not sell or share any such information 
                of such individual for the purposes of marketing or 
                decisions related to employment or financial services; 
                and
                    (B) the entity will disclose to the individual any 
                possible secondary users of the individually 
                identifiable health information of such individual, 
                including business associates of the service provider 
                who may have access to such information, and the 
                purpose for such use or access.
    (h) Privacy and Consumer Protection Standards.--
            (1) Security and privacy standards, policies, and 
        practices.--For purposes of the demonstration program, the 
        security and privacy standards, policies, and practices 
        described in this paragraph include--
                    (A) the standards required under regulations 
                promulgated under section 264(c) of the Health 
                Insurance Portability and Accountability Act of 1996 
                (HIPAA);
                    (B) standards to require plain language notice of 
                patients' rights with respect to personal health 
                records; and
                    (C) any additional standards specified by the 
                Secretary to optimally protect and safeguard patient 
                health care information, as long as such standards are 
                consistent with the standards described in subparagraph 
                (A).
            (2) Notification of breach.--
                    (A) In general.--In accordance with the minimum 
                criteria established under subparagraph (B), a QPHR 
                service provider must disclose any breach of the 
                security of individually identifiable health 
                information contained in a QPHR to any individual whose 
                individually identifiable health information was, or is 
                reasonably believed to have been, acquired by an 
                unauthorized person and to the Secretary in a manner 
                specified by the Secretary.
                    (B) Minimum criteria.--The Secretary, in 
                consultation with relevant agencies and appropriate 
                entities in the private sector, shall establish minimum 
                criteria for which notifications of wrongful 
                disclosures are required under subparagraph (A).
            (3) Availability of individual health information in 
        electronic form.--Effective beginning on January 1, 2010, an 
        individual who requests a copy of the individual's individually 
        identifiable health information pursuant to the HIPAA 
        regulations referred to in paragraph (1) shall be entitled to 
        receive that information in electronic form capable of being 
        imported into a QPHR, if such information is maintained in 
        electronic form by the entity from which the information is 
        requested.
            (4) Message standards.--The Secretary shall establish 
        minimum standards to ensure the objectivity, accuracy, and 
        relevance of messages sent to individual patients under 
        subsection (f)(2) from a QPHR and to protect against the use of 
        such messages by Fund partners for commercial solicitations or 
        marketing. Such standards shall incorporate existing standards 
        governing communications to consumers established by the Food 
        and Drug Administration, the Federal Trade Commission, or other 
        Federal agencies.
    (i) PHR Incentive Fund.--
            (1) In general.--The Secretary shall establish a PHR 
        Incentive Fund (in this section referred to as the ``PHR 
        Incentive Fund'' or ``Fund''). The Fund may receive 
        contributions from Fund partners for the sole purpose of paying 
        PHR incentives under the demonstration program, conducting the 
        study under subsection (j), and otherwise carrying out the 
        demonstration program.
            (2) Fund partners.--
                    (A) In general.--The Secretary may enter into 
                contracts with public or private payers, drug 
                manufacturers, device manufacturers, or other public or 
                private entities (in this section referred to as ``Fund 
                partners'') to allow the Fund to receive contributions 
                in accordance with this subsection and other terms 
                determined by the Secretary.
                    (B) Federal partners.--The Secretary shall seek the 
                involvement and contributions of the Food and Drug 
                Administration, the Centers for Disease Control and 
                Prevention, the Agency for Healthcare Research and 
                Quality, and the Department of Homeland Security to 
                maximize the effectiveness of the QPHRs in meeting the 
                health, national security, emergency response, 
                biosurveillance, and research goals of the Federal 
                government in a manner consistent with this section. A 
                Federal agency described in the previous sentence is 
                authorized to make a contribution to the Fund to the 
                extent provided in appropriation Acts.
                    (C) Partner accounts.--
                            (i) In general.--The Fund shall include an 
                        account for each Fund partner, including the 
                        Medicare program, separately accounting for 
                        each Fund partner's contributions to the Fund. 
                        Contribution levels under subparagraph (D) 
                        shall be made to each account at the beginning 
                        of each fiscal year of the demonstration 
                        program for incentive payments under this 
                        section for services furnished during such 
                        fiscal year. Incentive payments shall be 
                        debited from each account in accordance with 
                        this subsection.
                            (ii) Remaining amounts.--Amounts in the 
                        account of a Fund partner that are not paid in 
                        a fiscal year (before the last fiscal year of 
                        the demonstration program) shall remain 
                        available for payment from such account in the 
                        subsequent fiscal year. Amounts in the account 
                        of a Fund partner that are not paid in the last 
                        fiscal year of the demonstration program shall 
                        be refunded to the Fund partner.
                    (D) Contribution levels.--Contribution levels to 
                the Fund by Fund partners shall be set annually, by the 
                Secretary, except that the contribution level for the 
                first year shall be as follows:
                            (i) Medicare contribution.--The Secretary 
                        shall contribute--
                                    (I) $3 for each qualifying patient 
                                described in subsection 
                                (b)(3)(A)(i)(I), with respect to a 
                                qualifying provider, who is a Medicare 
                                beneficiary for whom any PHR incentive 
                                payment may be made under subsection 
                                (b)(1) during such fiscal year to such 
                                provider;
                                    (II) $5 for each qualifying patient 
                                described in subsection 
                                (b)(3)(A)(i)(II), with respect to a 
                                qualifying provider, who is a Medicare 
                                beneficiary for whom any PHR incentive 
                                payment may be made under subsection 
                                (b)(1) during such fiscal year to such 
                                provider; and
                                    (III) $3 for each qualifying 
                                patient who is a Medicare beneficiary 
                                for whom an incentive payment may be 
                                made under subsection (b)(1) during 
                                such fiscal year to a health 
                                information exchange network.
                        The contribution amounts described in this 
                        clause shall be transferred from the Federal 
                        Hospital Insurance Trust Fund (established 
                        under section 1817 of the Social Security Act) 
                        and from the Federal Supplementary Medical 
                        Insurance Trust Fund (established under section 
                        1841 of such Act) in such proportion as the 
                        Secretary may specify.
                            (ii) Other payer contributions.--Any Fund 
                        partner that is a health care payer other than 
                        the Medicare program (and is not an agency 
                        described in subparagraph (B)) shall 
                        contribute--
                                    (I) at least $3 for each qualifying 
                                patient described in subsection 
                                (b)(3)(A)(i)(I), with respect to a 
                                qualifying provider, who is covered 
                                under a health benefits or other plan 
                                the sponsor of which is the Fund 
                                partner and for whom a PHR incentive 
                                payment may be made under subsection 
                                (b)(1) during the fiscal year to such 
                                provider;
                                    (II) at least $5 for each 
                                qualifying patient described in 
                                subsection (b)(3)(A)(i)(II), with 
                                respect to a qualifying provider, who 
                                is covered under a health benefits or 
                                other plan the sponsor of which is the 
                                Fund partner and for whom a PHR 
                                incentive payment may be made under 
                                subsection (b)(1) during the fiscal 
                                year to such provider; and
                                    (III) at least $3 for each 
                                qualifying patient who is covered under 
                                a health benefits or other plan the 
                                sponsor of which is the Fund partner 
                                and for whom an incentive payment may 
                                be made under subsection (b)(1) during 
                                such fiscal year to a health 
                                information exchange network.
                            (iii) Messaging contributions.--
                                    (I) In general.--Subject to 
                                subclause (II), the Secretary may 
                                establish contribution levels for Fund 
                                partners that employ messages sent 
                                under subsection (f)(2)(C) in the 
                                fiscal year.
                                    (II) FDA-messaging contributions.--
                                The amount of the contribution of a 
                                drug manufacturer that is a Fund 
                                partner is equal to at least $3 for 
                                each qualifying patient for each 
                                medication adherence program for which 
                                one or more messages are sent under 
                                subsection (f)(2)(C) in the fiscal 
                                year.
                    (E) Debiting fund partners' accounts.--The Medicare 
                program's account shall be debited for each incentive 
                payment made under subsection (b)(1), with respect to a 
                qualifying patient who is a Medicare beneficiary. Each 
                other Fund partner's account shall be debited for each 
                incentive payment made under subsection (b)(1), with 
                respect to a qualifying patient who is covered under a 
                health benefits or other plan the sponsor of which is 
                such Fund partner. Each Fund partner's account shall be 
                debited for messages sent under subsection (f)(2)(C) 
                for such partner in accordance with a methodology 
                specified by the Secretary. In the event that a Fund 
                partner's account does not have a sufficient balance to 
                cover the Fund partner's liability, the Fund partner 
                shall make a supplemental contribution to the Fund to 
                cover the shortfall.
                    (F) Limitation on benefits.--Contributions by a 
                Fund partner to the Fund shall confer no preferential 
                access to data or information or any other benefit to 
                the partner other than public acknowledgment under 
                paragraph (3) and the ability to have messages sent to 
                qualifying patients under subsection (f)(2)(C).
            (3) Publication of fund contributors.--The Secretary shall 
        publish on the official public website of the Centers for 
        Medicare & Medicaid Services a list of Fund partners that have 
        contributed to the Fund.
    (j) Study and Reports.--
            (1) Interim report.--Not later than 3 years after the 
        initiation of the demonstration program, the Secretary shall 
        submit to Congress a report on the following, with respect to 
        the demonstration program:
                    (A) The extent to which privacy protections are 
                sufficient under the demonstration program and 
                recommendations for any additional privacy protections 
                that may be necessary.
                    (B) The extent to which use of data in QPHRs by 
                qualifying providers varies based on the size of the 
                practice of the qualifying providers and based on 
                whether the qualifying providers are located in a rural 
                or urban area.
                    (C) The effectiveness of patient and provider 
                outreach and education efforts to increase the 
                utilization and utility of QPHRs.
                    (D) The measurable benefits and concerns of 
                qualifying providers, with respect to use of QPHRs and 
                potential adoption of personal health record 
                technology.
            (2) Study and final report.--
                    (A) Study.--At the conclusion of the demonstration 
                program, the Secretary shall provide for a study to 
                assess the level of patients' use of their QPHR, the 
                type of data transmitted by health information exchange 
                networks, the impact of the standards used in 
                transmitting the data, the utility of such data to 
                health care providers in delivering patient care and to 
                patients in managing their health (including adherence 
                to prescribed medications and recommended preventive 
                care), any changes in health outcomes, and any cost 
                savings resulting from implementation of the program. 
                The study shall include collection of aggregate data 
                documenting the number of qualifying patients, the 
                number of providers using the QPHR, the number of 
                patients using the QPHR, the type of data presented in 
                the QPHR, and other measures of the program's 
                effectiveness.
                    (B) Final report.--Not later than 2 years after the 
                last day of the demonstration program, the Secretary 
                shall submit to Congress a report on the results of the 
                study under paragraph (1).
                                 <all>