II 110th CONGRESS 1st Session S. 1783 IN THE SENATE OF THE UNITED STATES July 12, 2007 Mr. Enzi introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To provide 10 steps to transform health care in America.

1.

Short title; table of contents

(a)

Short title

This Act may be cited as the Ten Steps to Transform Health Care in America Act. (b)

Table of contents

The table of contents of this Act is as follows: Sec. 1. Short title; table of contents. Sec. 2. Purposes. Sec. 3. Definitions. TITLE I—Affordable health insurance coverage Subtitle A—Individual coverage responsibility and availability of core plan options Sec. 101. Coverage responsibility. Sec. 102. Qualified core plans. Sec. 103. Qualified core compatible plans. Sec. 104. Certification. Sec. 105. State-based risk adjustments. Sec. 106. Relation to self-insured plans. Sec. 107. State flexibility and enforcement. Subtitle B—Standard deduction for health insurance and related provisions Sec. 121. Amendment of 1986 Code. Sec. 122. Standard deduction for health insurance. Sec. 123. Changes to existing tax preferences for medical coverage and costs for individuals eligible for standard deduction for health insurance. Sec. 124. Exclusion of standard deduction for health insurance from employment taxes. Sec. 125. Information reporting. Sec. 126. Reduction of phaseout for earned income credit. Subtitle C—Health insurance tax credit for the purchase of health insurance Part I—Refundable health insurance tax credit Sec. 131. Refundable credit for health insurance coverage. Sec. 132. Advance payment of credit for purchasers of qualified health insurance. Sec. 133. Designation of health insurance status required by individuals on Federal income tax returns. Subtitle D—Education and outreach Sec. 141. Notice to taxpayers of availability of standard deduction for health insurance and refundable health insurance credit. Sec. 142. Optional enrollment and outreach. TITLE II—Increasing insurance market portability and Affordability Subtitle A—Merging and improving insurance markets Sec. 201. Development of merged and improved State insurance market standards. Sec. 202. Modifications relating to self-funded group health plans. Sec. 203. Legislative proposals. Sec. 204. Enforcement. Subtitle B—Reduction in premium variation and health status discrimination Sec. 211. Development of standards for reduction in premium variation and health status discrimination among enrollees. Sec. 212. Enforcement. Subtitle C—Enhanced marketplace pooling and related market rating Part I—Enhanced marketplace pools Sec. 245. Rules governing enhanced marketplace pools. Sec. 246. Cooperation between Federal and State authorities. Sec. 247. Effective date and transitional and other rules. Part II—Market relief Sec. 251. Market relief. Part III—Harmonization of health insurance standards Sec. 261. Health Insurance Standards Harmonization. TITLE III—Affordable Access to Health Care for All Americans Subtitle A—Improving the Quality of Health Care by More Effectively Using Health Information Technology Sec. 300. Short title. Part I—Health information technology SUBPART A—Improving the interoperability of health information technology Sec. 301. Improving health care quality, safety, and efficiency. SUBPART B—Facilitating the widespread adoption of interoperable health information technology Sec. 305. Facilitating the widespread adoption of interoperable health information technology. SUBPART C—Improving the quality of health care Sec. 311. Consensus process for the adoption of quality measures for use in the nationwide interoperable health information technology infrastructure. SUBPART D—Privacy and security Sec. 321. Privacy and security. SUBPART E—Miscellaneous provisions Sec. 331. GAO study. Sec. 332. Health information technology resource center. Sec. 333. Facilitating the provision of telehealth services across State lines. Part II—Making health care more accessible for all Americans Sec. 341. Reauthorization of certain telehealth programs. Sec. 342. Quality improvement activities. Sec. 343. Sense of the senate regarding physician payments under medicare. Subtitle B—Increasing Access to Physicians and Nurses Sec. 351. Reauthorization of programs and miscellaneous amendments. Sec. 352. Nurse workforce enhancement. Sec. 353. Visas for registered nurses. Sec. 354. MedPAC study and report on the impact of payment caps for IME and GME. Subtitle C—Increasing Access to Primary Care Sec. 361. Reauthorization of the community health center programs. Sec. 362. Reauthorization of loan repayment programs of the National Health Service Corps. Sec. 363. Clarification of authority for convenient care clinics to participate in Medicaid and SCHIP. Subtitle D—Rural health care Sec. 371. Reathorization of rural health care programs. Subtitle E—Long term care Sec. 381. Sense of the Senate. Sec. 382. Living wills. Sec. 383. Increasing Senior Choice and Access to Community-Based Long Term Care. Subtitle F—Fair and Reliable Medical Justice Sec. 391. Short title. Sec. 392. Purposes. Sec. 393. State demonstration programs to evaluate alternatives to current medical tort litigation.

2.

Purposes

It is the purpose of this Act to— (1)eliminate unfair tax treatment of health insurance thereby expanding choices, coverage, and control over health care for all Americans; (2)increase affordable options for working families to purchase health insurance through a standard tax deduction; (3)ensure that affordable health insurance is available to low-income individuals through the provision of a refundable, advanceable, assignable tax-based subsidy; (4)provide cross-State pooling to reduce health care costs and increase accessibility for small business owners, unions, associations, and their workers, members, and families; (5)blend the individual and group health insurance markets to extend important Health Insurance Portability and Accountability Act portability protections to the individual market so that insurance security can better move with an individual from job to job; (6)emphasize preventive health care and help individuals with chronic diseases better manage their health so America will finally have health care and not sick care; (7)give individuals the choice to convert the value of Medicaid and SCHIP program benefits into private health insurance, putting Americans in control of their health care, not the Federal government; (8)save lives and money by better coordinating health information technology to improve health care delivery; (9)increase access to primary care in rural and frontier areas by helping future providers and nurses pay for their education, and giving seniors more options to receive care in their homes and communities; and (10)decrease the sky-rocketing cost of health care by restoring reliability in our medical justice system through State-based solutions.

3.

Definitions

Except as otherwise provided, in this Act: (1)

Adult individual

The term adult individual means an individual who— (A)is— (i)age 19 or older; (ii)a resident of a State; (iii)(I)a United States citizen; or (II)an alien with permanent residence; and (iv)not a dependent child; and (B)in the case of an incarcerated individual, such an individual who is incarcerated for less than 1 month. (2)

Alien with permanent residence

The term alien with permanent residence has the meaning given the term qualified alien in section 431 of the Personal Responsibility and Work Opportunity Reconciliation Act of 1996 (8 U.S.C. 1641). (3)

Applicable State law

The term applicable State law means the health insurance and related laws and regulations of a State. (4)

Dependent child

The term dependent child has the meaning given the term qualifying child in section 152(c) of the Internal Revenue Code of 1986. (5)

Health insurance issuer

The term health insurance issuer means an insurance company, insurance service, or insurance organization (including a health maintenance organization, as defined in paragraph (6)) which is licensed to engage in the business of insurance in a State and which is subject to State law which regulates insurance (within the meaning of section 514(b)(2) of the Employee Retirement Income Security Act of 1974). (6)

Health maintenance organization

The term health maintenance organization means— (A)a federally qualified health maintenance organization (as defined in section 1301(a) of the Public Health Service Act); (B)an organization recognized under State law as a health maintenance organization; or (C)a similar organization regulated under State law for solvency in the same manner and to the same extent as such a health maintenance organization. (7)

Qualified core compatible plan

The term qualified core compatible plan means a compatible qualified core plan that meets the requirements of section 103. (8)

Qualified core plan

The term qualified core plan means a qualified core plan described under section 102. (9)

Secretary

The term Secretary means the Secretary of Health and Human Services, unless expressly provided for otherwise in this Act. (10)

State

The term State means each of the several States of the United States, the District of Columbia, the Commonwealth of Puerto Rico, the Virgin Islands, American Samoa, Guam, the Commonwealth of the Northern Mariana Islands, and other territories of the United States. (11)

State of residence

The term State of residence, with respect to an individual, means the State in which the individual has primary residence.

. III

Harmonization of health insurance standards

261.

Health Insurance Standards Harmonization

Title XXIX of the Public Health Service Act (as added by section 201) is amended by adding at the end the following: B

Standards harmonization

2931.

Definitions

In this subtitle: (1)

Adopting state

The term adopting State means a State that has enacted the harmonized standards adopted under this subtitle in their entirety and as the exclusive laws of the State that relate to the harmonized standards. (2)

Eligible insurer

The term eligible insurer means a health insurance issuer that is licensed in a nonadopting State and that— (A)notifies the Secretary, not later than 30 days prior to the offering of coverage described in this subparagraph, that the issuer intends to offer health insurance coverage consistent with the harmonized standards in a nonadopting State; (B)notifies the insurance department of a nonadopting State (or other State agency), not later than 30 days prior to the offering of coverage described in this subparagraph, that the issuer intends to offer health insurance coverage in that State consistent with the harmonized standards published pursuant to section 2933(d), and provides with such notice a copy of any insurance policy that it intends to offer in the State, its most recent annual and quarterly financial reports, and any other information required to be filed with the insurance department of the State (or other State agency) by the Secretary in regulations; and (C)includes in the terms of the health insurance coverage offered in nonadopting States (including in the terms of any individual certificates that may be offered to individuals in connection with such health coverage) and filed with the State pursuant to subparagraph (B), a description of the harmonized standards published pursuant to section 2933(g)(2) and an affirmation that such standards are a term of the contract. (3)

Harmonized standards

The term harmonized standards means the standards certified by the Secretary under section 2933(d). (4)

Health insurance coverage

The term health insurance coverage means any coverage issued in the health insurance market, except that such term shall not include excepted benefits (as defined in section 2791(c). (5)

Nonadopting state

The term nonadopting State means a State that fails to enact, within 18 months of the date on which the Secretary certifies the harmonized standards under this subtitle, the harmonized standards in their entirety and as the exclusive laws of the State that relate to the harmonized standards. (6)

State law

The term State law means all laws, decisions, rules, regulations, or other State actions (including actions by a State agency) having the effect of law, of any State.

2932.

Harmonized standards

(a)

Board

(1)

Establishment

Not later than 3 months after the date of enactment of this title, the Secretary, in consultation with the NAIC, shall establish the Health Insurance Consensus Standards Board (referred to in this subtitle as the Board) to develop recommendations that harmonize inconsistent State health insurance laws in accordance with the procedures described in subsection (b). (2)

Composition

(A)

In general

The Board shall be composed of the following voting members to be appointed by the Secretary after considering the recommendations of professional organizations representing the entities and constituencies described in this paragraph: (i)Four State insurance commissioners as recommended by the National Association of Insurance Commissioners, of which 2 shall be Democrats and 2 shall be Republicans, and of which one shall be designated as the chairperson and one shall be designated as the vice chairperson. (ii)Four representatives of State government, two of which shall be governors of States and two of which shall be State legislators, and two of which shall be Democrats and two of which shall be Republicans. (iii)Four representatives of health insurers, of which one shall represent insurers that offer coverage in the small group market, one shall represent insurers that offer coverage in the large group market, one shall represent insurers that offer coverage in the individual market, and one shall represent carriers operating in a regional market. (iv)Two representatives of insurance agents and brokers. (v)Two independent representatives of the American Academy of Actuaries who have familiarity with the actuarial methods applicable to health insurance. (B)

Ex officio member

A representative of the Secretary shall serve as an ex officio member of the Board. (3)

Advisory panel

The Secretary shall establish an advisory panel to provide advice to the Board, and shall appoint its members after considering the recommendations of professional organizations representing the entities and constituencies identified in this paragraph: (A)Two representatives of small business health plans. (B)Two representatives of employers, of which one shall represent small employers and one shall represent large employers. (C)Two representatives of consumer organizations. (D)Two representatives of health care providers. (4)

Qualifications

The membership of the Board shall include individuals with national recognition for their expertise in health finance and economics, actuarial science, health plans, providers of health services, and other related fields, who provide a mix of different professionals, broad geographic representation, and a balance between urban and rural representatives. (5)

Ethical disclosure

The Secretary shall establish a system for public disclosure by members of the Board of financial and other potential conflicts of interest relating to such members. Members of the Board shall be treated as employees of Congress for purposes of applying title I of the Ethics in Government Act of 1978 (Public Law 95–521). (6)

Director and staff

Subject to such review as the Secretary deems necessary to assure the efficient administration of the Board, the chair and vice-chair of the Board may— (A)employ and fix the compensation of an Executive Director (subject to the approval of the Comptroller General) and such other personnel as may be necessary to carry out its duties (without regard to the provisions of title 5, United States Code, governing appointments in the competitive service); (B)seek such assistance and support as may be required in the performance of its duties from appropriate Federal departments and agencies; (C)enter into contracts or make other arrangements, as may be necessary for the conduct of the work of the Board (without regard to section 3709 of the Revised Statutes (41 U.S.C. 5)); (D)make advance, progress, and other payments which relate to the work of the Board; (E)provide transportation and subsistence for persons serving without compensation; and (F)prescribe such rules as it deems necessary with respect to the internal organization and operation of the Board. (7)

Terms

The members of the Board shall serve for the duration of the Board. Vacancies in the Board shall be filled as needed in a manner consistent with the composition described in paragraph (2). (b)

Development of harmonized standards

(1)

In general

In accordance with the process described in subsection (c), the Board shall identify and recommend nationally harmonized standards for each of the following process categories: (A)

Form filing and rate filing

Form and rate filing standards shall be established which promote speed to market and include the following defined areas for States that require such filings: (i)Procedures for form and rate filing pursuant to a streamlined administrative filing process. (ii)Timeframes for filings to be reviewed by a State if review is required before they are deemed approved. (iii)Timeframes for an eligible insurer to respond to State requests following its review. (iv)A process for an eligible insurer to self-certify. (v)State development of form and rate filing templates that include only non-preempted State law and Federal law requirements for eligible insurers with timely updates. (vi)Procedures for the resubmission of forms and rates. (vii)Disapproval rationale of a form or rate filing based on material omissions or violations of non-preempted State law or Federal law with violations cited and explained. (viii)For States that may require a hearing, a rationale for hearings based on violations of non-preempted State law or insurer requests. (B)

Market conduct review

Market conduct review standards shall be developed which provide for the following: (i)Mandatory participation in national databases. (ii)The confidentiality of examination materials. (iii)The identification of the State agency with primary responsibility for examinations. (iv)Consultation and verification of complaint data with the eligible insurer prior to State actions. (v)Consistency of reporting requirements with the recordkeeping and administrative practices of the eligible insurer. (vi)Examinations that seek to correct material errors and harmful business practices rather than infrequent errors. (vii)Transparency and publishing of the State's examination standards. (viii)Coordination of market conduct analysis. (ix)Coordination and nonduplication between State examinations of the same eligible insurer. (x)Rationale and protocols to be met before a full examination is conducted. (xi)Requirements on examiners prior to beginning examinations such as budget planning and work plans. (xii)Consideration of methods to limit examiners' fees such as caps, competitive bidding, or other alternatives. (xiii)Reasonable fines and penalties for material errors and harmful business practices. (C)

Prompt payment of claims

The Board shall establish prompt payment standards for eligible insurers based on standards similar to those applicable to the Social Security Act as set forth in section 1842(c)(2) of such Act (42 U.S.C. 1395u(c)(2)). Such prompt payment standards shall be consistent with the timing and notice requirements of the claims procedure rules to be specified under subparagraph (D), and shall include appropriate exceptions such as for fraud, nonpayment of premiums, or late submission of claims. (D)

Internal review

The Board shall establish standards for claims procedures for eligible insurers that are consistent with the requirements relating to initial claims for benefits and appeals of claims for benefits under the Employee Retirement Income Security Act of 1974 as set forth in section 503 of such Act (29 U.S.C. 1133) and the regulations thereunder. (2)

Recommendations

The Board shall recommend harmonized standards for each element of the categories described in subparagraph (A) through (D) of paragraph (1) within each such market. Notwithstanding the previous sentence, the Board shall not recommend any harmonized standards that disrupt, expand, or duplicate the benefit, service, or provider mandate standards provided in the Benefit Choice Standards pursuant to section 2922(a). (c)

Process for identifying harmonized standards

(1)

In general

The Board shall develop recommendations to harmonize inconsistent State insurance laws with respect to each of the process categories described in subparagraphs (A) through (D) of subsection (b)(1). (2)

Requirements

In adopting standards under this section, the Board shall consider the following: (A)Any model acts or regulations of the National Association of Insurance Commissioners in each of the process categories described in subparagraphs (A) through (D) of subsection (b)(1). (B)Substantially similar standards followed by a plurality of States, as reflected in existing State laws, relating to the specific process categories described in subparagraphs (A) through (D) of subsection (b)(1). (C)Any Federal law requirement related to specific process categories described in subparagraphs (A) through (D) of subsection (b)(1). (D)In the case of the adoption of any standard that differs substantially from those referred to in subparagraphs (A), (B), or (C), the Board shall provide evidence to the Secretary that such standard is necessary to protect health insurance consumers or promote speed to market or administrative efficiency. (E)The criteria specified in clauses (i) through (iii) of subsection (d)(2)(B). (d)

Recommendations and certification by Secretary

(1)

Recommendations

Not later than 18 months after the date on which all members of the Board are selected under subsection (a), the Board shall recommend to the Secretary the certification of the harmonized standards identified pursuant to subsection (c). (2)

Certification

(A)

In general

Not later than 120 days after receipt of the Board's recommendations under paragraph (1), the Secretary shall certify the recommended harmonized standards as provided for in subparagraph (B), and issue such standards in the form of an interim final regulation. (B)

Certification process

The Secretary shall establish a process for certifying the recommended harmonized standard, by category, as recommended by the Board under this section. Such process shall— (i)ensure that the certified standards for a particular process area achieve regulatory harmonization with respect to health plans on a national basis; (ii)ensure that the approved standards are the minimum necessary, with regard to substance and quantity of requirements, to protect health insurance consumers and maintain a competitive regulatory environment; and (iii)ensure that the approved standards will not limit the range of group health plan designs and insurance products, such as catastrophic coverage only plans, health savings accounts, and health maintenance organizations, that might otherwise be available to consumers. (3)

Application and effective date

The standards certified by the Secretary under paragraph (2) shall apply and become effective on the date that is 18 months after the date on which the Secretary certifies the harmonized standards. (e)

Termination

The Board shall terminate and be dissolved after making the recommendations to the Secretary pursuant to subsection (d)(1). (f)

Ongoing review

Not earlier than 3 years after the termination of the Board under subsection (e), and not earlier than every 3 years thereafter, the Secretary, in consultation with the National Association of Insurance Commissioners and the entities and constituencies represented on the Board and the Advisory Panel, shall prepare and submit to the appropriate committees of Congress a report that assesses the effect of the harmonized standards applied under this section on access, cost, and health insurance market functioning. The Secretary may, based on such report and applying the process established for certification under subsection (d)(2)(B), in consultation with the National Association of Insurance Commissioners and the entities and constituencies represented on the Board and the Advisory Panel, update the harmonized standards through notice and comment rulemaking. (g)

Publication

(1)

Listing

The Secretary shall maintain an up to date listing of all harmonized standards certified under this section on the Internet website of the Department of Health and Human Services. (2)

Sample contract language

The Secretary shall publish on the Internet website of the Department of Health and Human Services sample contract language that incorporates the harmonized standards certified under this section, which may be used by insurers seeking to qualify as an eligible insurer. The types of harmonized standards that shall be included in sample contract language are the standards that are relevant to the contractual bargain between the insurer and insured. (h)

State adoption and enforcement

Not later than 18 months after the certification by the Secretary of harmonized standards under this section, the States may adopt such harmonized standards (and become an adopting State) and, in which case, shall enforce the harmonized standards pursuant to State law.

2933.

Application and preemption

(a)

Superceding of state law

(1)

In general

The harmonized standards certified under this subtitle and applied as provided for in section 2933(d)(3), shall supersede any and all State laws of a non-adopting State insofar as such State laws relate to the areas of harmonized standards as applied to an eligible insurer, or health insurance coverage issued by a eligible insurer, including with respect to coverage issued to a small business health plan, in a nonadopting State. (2)

Nonadopting states

This subtitle shall supersede any and all State laws of a nonadopting State (whether enacted prior to or after the date of enactment of this title) insofar as they may— (A)prohibit an eligible insurer from offering, marketing, or implementing health insurance coverage consistent with the harmonized standards; or (B)have the effect of retaliating against or otherwise punishing in any respect an eligible insurer for offering, marketing, or implementing health insurance coverage consistent with the harmonized standards under this subtitle. (b)

Savings clause and construction

(1)

Nonapplication to adopting states

Subsection (a) shall not apply with respect to adopting States. (2)

Nonapplication to certain insurers

Subsection (a) shall not apply with respect to insurers that do not qualify as eligible insurers who offer health insurance coverage in a nonadopting State. (3)

Nonapplication where obtaining relief under state law

Subsection (a)(1) shall not supercede any State law of a nonadopting State to the extent necessary to permit individuals or the insurance department of the State (or other State agency) to obtain relief under State law to require an eligible insurer to comply with the harmonized standards under this subtitle. (4)

No effect on preemption

In no case shall this subtitle be construed to limit or affect in any manner the preemptive scope of sections 502 and 514 of the Employee Retirement Income Security Act of 1974. In no case shall this subtitle be construed to create any cause of action under Federal or State law or enlarge or affect any remedy available under the Employee Retirement Income Security Act of 1974. (c)

Effective date

This section shall apply beginning on the date that is 18 months after the date on harmonized standards are certified by the Secretary under this subtitle.

2934.

Civil actions and jurisdiction

(a)

In general

The district courts of the United States shall have exclusive jurisdiction over civil actions involving the interpretation of this subtitle. (b)

Actions

An eligible insurer may bring an action in the district courts of the United States for injunctive or other equitable relief against any officials or agents of a nonadopting State in connection with any conduct or action, or proposed conduct or action, by such officials or agents which violates, or which would if undertaken violate, section 2933. (c)

Direct filing in Court of Appeals

At the election of the eligible insurer, an action may be brought under subsection (b) directly in the United States Court of Appeals for the circuit in which the nonadopting State is located by the filing of a petition for review in such Court. (d)

Expedited review

(1)

District court

In the case of an action brought in a district court of the United States under subsection (b), such court shall complete such action, including the issuance of a judgment, prior to the end of the 120-day period beginning on the date on which such action is filed, unless all parties to such proceeding agree to an extension of such period. (2)

Court of Appeals

In the case of an action brought directly in a United States Court of Appeal under subsection (c), or in the case of an appeal of an action brought in a district court under subsection (b), such Court shall complete all action on the petition, including the issuance of a judgment, prior to the end of the 60-day period beginning on the date on which such petition is filed with the Court, unless all parties to such proceeding agree to an extension of such period. (e)

Standard of review

A court in an action filed under this section, shall render a judgment based on a review of the merits of all questions presented in such action and shall not defer to any conduct or action, or proposed conduct or action, of a nonadopting State.

2935.

Authorization of appropriations; rule of construction

(a)

Authorization of appropriations

There are authorized to be appropriated such sums as may be necessary to carry out this subtitle. (b)

Health savings accounts

Nothing in this subtitle shall be construed to create any mandates for coverage of any benefits below the deductible levels set for any health savings account-qualified health plan pursuant to section 223 of the Internal Revenue Code of 1986.

.

. B

Facilitating the widespread adoption of interoperable health information technology

305.

Facilitating the widespread adoption of interoperable health information technology

Title XXX of the Public Health Service Act, as added by section 301, is amended by adding at the end the following:

3008.

Facilitating the widespread adoption of interoperable health information technology

(a)

Competitive grants for adoption of 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)adopt the standards adopted by the Federal Government under section 3005; (D)implement the measures adopted under section 3010 and report to the Secretary on such measures; (E)agree to notify individuals if their individually identifiable health information is wrongfully disclosed; (F)take into account the input of employees and staff who are directly involved in patient care of such health care providers in the design, implementation, and use of qualified health information technology systems; (G)demonstrate significant financial need; (H)provide matching funds in accordance with paragraph (4); and (I)be a— (i)public or not for profit hospital; (ii)federally qualified health center (as defined in section 1861(aa)(4) of the Social Security Act); (iii)individual or group practice (or a consortium thereof); or (iv)another health care provider not described in clause (i) or (ii); that serves medically underserved communities.(3)

Use of funds

Amounts received under a grant under this subsection shall be used to— (A)facilitate the purchase of qualified health information technology systems; (B)train personnel in the use of such systems; (C)enhance the utilization of qualified health information technology systems (which may include activities to increase the awareness among consumers of health care privacy protections); or (D)improve the prevention and management of chronic disease. (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 will improve the degree to which such entity will link the qualified health information system to local or regional health information plan or plans; and (B)with respect to awards made for the purpose of providing care in an outpatient medical setting, entities that organize their practices as a patient-centered medical home. (b)

Competitive grants 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 subsection. Amounts received under a grant 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 such 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 loans under the grant— (i)link, to the extent practicable, the qualified health information system to a local or regional health information network; (ii)consult, as needed, 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; (iii)agree to notify individuals if their individually identifiable health information is wrongfully disclosed; and (iv)take into account the input of employees and staff who are directly involved in patient care of such health care providers in the design and implementation and use of qualified health information technology systems; (E)require that health care providers receiving loans under the grant adopt the standards adopted by the Federal Government under section 3005; (F)require that health care providers receiving loans under the grant implement the measures adopted under section 3010 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; (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; and (iv)a description of the strategies the State will use to address challenges in the adoption of health information technology due to limited broadband access. (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— (i)facilitate the purchase of qualified health information technology systems; (ii)enhance the utilization of qualified health information technology systems (which may include activities to increase the awareness among consumers of health care of privacy protections and privacy rights); or (iii)train personnel in the use of such systems. (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 date on which the loan was awarded, and each loan shall be fully amortized not later than 10 years after such date. (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 not otherwise 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, implementation specifications and certification criteria, and other requirements adopted by the Secretary under section 3010. (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)health care providers (including health care providers that provide services to low income and underserved populations); (ii)pharmacists or pharmacies; (iii)health plans; (iv)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) and rural health clinics (as defined in section 1861(aa) of the Social Security Act), if such centers or clinics are present in the community served by the entity; (v)patient or consumer organizations; (vi)organizations dedicated to improving the health of vulnerable populations; (vii)employers; (viii)State or local health departments; 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 subparagraph (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 3005; (G)require that health care providers receiving such grants— (i)implement the measures adopted under section 3010 and report to the Secretary on such measures; and (ii)take into account the input of employees and staff who are directly involved in patient care of such health care providers in the design, implementation, and use of health information technology systems; (H)agree to notify individuals if their individually identifiable health information is wrongfully disclosed; (I)facilitate the electronic exchange of health information within the local or regional area and among local and regional areas; (J)prepare and submit to the Secretary an application in accordance with paragraph (3); (K)agree to provide matching funds in accordance with paragraph (5); and (L)reduce barriers to the implementation of health information technology by providers. (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, implementation specifications, and certification criteria adopted under section 3003(c)(6) 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 3010; (iv)a plan that describes provisions to encourage the implementation of the electronic exchange of health information by all health care providers participating in the health information plan; (v)a plan to ensure the privacy and security of individually identifiable 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; (viii)a description of whether the State in which the entity resides has received a grant under section 319D, alone or as a part of a consortium, and if the State has received such a grant, how the entity will coordinate the activities funded under such section 319D with the system under this section; and (ix)in 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; and (4)other information as required by the Secretary. (e)

Authorization of appropriations

(1)

In general

For the purpose of carrying out this section, there is authorized to be appropriated $139,000,000 for fiscal year 2008 and $139,000,000 for fiscal year 2009. (2)

Availability

Amounts appropriated under paragraph (1) shall remain available through fiscal year 2012.

3009.

Demonstration program to integrate information technology into clinical education

(a)

In general

The Secretary may award grants to eligible entities or consortia 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 or analyze clinical data sets to discover quality measures. 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 or consortium shall— (1)submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require; (2)be or include— (A)a health professions school; (B)a school of nursing; or (C)an institution with a graduate medical education program; (3)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 and the efficiency of health care delivery; and (4)provide matching funds in accordance with subsection (d). (c)

Use of funds

(1)

In general

With respect to a grant under subsection (a), an eligible entity or consortium shall use amounts received under the grant in collaboration with 2 or more disciplines. (2)

Limitation

An eligible entity or consortium shall not award 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 or consortium this section only if the entity of consortium 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, $2,000,000 for each of fiscal years 2008 and 2009. (h)

Sunset

This provisions of this section shall not apply after September 30, 2012.

.

C

Improving the quality of health care

311.

Consensus process for the adoption of quality measures for use in the nationwide interoperable health information technology infrastructure

Title XXX of the Public Health Service Act, as amended by section 305, is further amended by adding at the end the following:

3010.

Fostering development and use of health care quality measures

(a)

In general

The Secretary shall provide for the development and use of health care quality measures (referred to in this title as quality measures) for the purpose of measuring the quality and efficiency of health care that patients receive. (b)

Designation of, and arrangement with, organization

(1)

In general

Not later than 90 days after the date of enactment of this title, the Secretary shall designate, and have in effect an arrangement with, a single organization that meets the requirements of subsection (c) under which such organization shall promote the development of quality measures and provide the Secretary with advice and recommendations on the key elements and priorities of a national system for healthcare performance measurement. (2)

Responsibilities

The responsibilities to be performed by the organization designated under paragraph (1) (in this title referred to as the designated organization) shall include— (A)establishing and managing an integrated national strategy and process for setting priorities and goals in establishing quality measures; (B)coordinating and harmonizing the development and testing of such measures; (C)establishing standards for the development and testing of such measures; (D)endorsing national consensus quality measures; (E)recommending, in collaboration with multi-stakeholder groups, quality measures to the Secretary for adoption and use; (F)promoting the development and use of electronic health records that contain the functionality for automated collection, aggregation, and transmission of performance measurement information; and (G)providing recommendations and advice to the Partnership regarding the integration of quality measures into the certification process outlined under section 3003 and the Community regarding national policies outlined under section 3004. (c)

Requirements described

The requirements described in this subsection are the following: (1)

Private entity

The organization shall be a private nonprofit entity that is governed by a board of directors and an individual who is designated as president and chief executive officer. (2)

Board membership

The members of the board of directors of the entity shall include representatives of— (A)health care providers or groups representing providers; (B)health plans or groups representing health plans; (C)patients or consumers enrolled in such plans or groups representing individuals enrolled in such plans; (D)health care purchasers and employers or groups representing purchasers or employers; and (E)organizations that develop health information technology standards and new health information technology. (3)

Other membership requirements

The membership of the board of directors of the entity shall be representative of individuals with experience with— (A)urban health care issues; (B)safety net health care issues; (C)rural or frontier health care issues; (D)quality and safety issues; (E)State or local health programs; (F)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 (G)individuals or entities involved in the development and establishment of standards and certification for health information technology systems and clinical data. (4)

Open and transparent

With respect to matters related to the arrangement with the Secretary under subsection (a)(1), the organization shall conduct its business in an open and transparent manner, and provide the opportunity for public comment and ensure a balance among disparate stakeholders, so that no member organization unduly influences the work of the organization. (5)

Voluntary consensus standards setting organizations

The organization shall operate 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). (6)

Participation

If the organization requires a fee for membership, the organization shall ensure that such fee is not a substantial barrier to participation in the entity’s activities related to the arrangement with the Secretary. (d)

Requirements for measures

The quality measures developed under this title shall comply with the following: (1)

Measures

The designated organization, in promoting the development of quality measures under this title, shall ensure that such measures— (A)are evidence-based, reliable, and valid; (B)include— (i)measures of clinical processes and outcomes, patient experience, efficiency, and equity; and (ii)measures to assess effectiveness, timeliness, patient self-management, patient centeredness, and safety; and (C)include measures of underuse and overuse. (2)

Priorities

In carrying out its responsibilities under this section, the designated organization shall ensure that priority is given to— (A)measures with the greatest potential impact for improving the performance and efficiency of care; (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; (C)measures which may inform health care decisions made by consumers and patients; (D)measures that apply to multiple services furnished by different providers during an episode of care; (E)measures that can be integrated into certification process described in section 3003; and (F)measures that may be integrated into the decision support function of qualified health information technology as defined by this title. (3)

Risk adjustment

The designated organization, in consultation with performance measure developers and other stakeholders, shall establish procedures to ensure that quality measures take into account differences in patient health status, patient characteristics, and geographic location, as appropriate. (4)

Maintenance

The designated organization, in consultation with owners and developers of quality measures, shall require the owners or developers of quality measures to update and enhance such measures, including the development of more accurate and precise specifications, and retire existing outdated measures. Such updating shall occur not more often than once during each 12-month period, except in the case of emergency circumstances requiring a more immediate update to a measure. (e)

Grants for performance measure development

The Secretary, acting through the Agency for Healthcare Research and Quality, may award grants, in amounts not to exceed $50,000 each, to organizations to support the development and testing of quality measures that meet the standards established by the designated organization.

3011.

Adoption and use of quality measures; reporting

(a)

In general

For purposes of carrying out activities authorized or required by this title to ensure the use of quality measures and to foster uniformity between health care quality measures utilized by private entities, the Secretary shall— (1)select quality measures for adoption and use, from quality measures recommended by multi-stakeholder groups and endorsed by the designated organization; and (2)ensure that standards adopted under section 3005 integrate the quality measures endorsed, adopted, and utilized under this section. (b)

Relationship with programs under the Social Security Act

The Secretary shall ensure that the quality measures adopted under this section— (1)complement quality measures developed by the Secretary under programs administered by the Secretary under the Social Security Act, including programs under titles XVIII, XIX, and XXI of such Act; and (2)do not conflict with the needs and priorities of the programs under titles XVIII, XIX, and XXI of such Act, as set forth by the Administrator of the Centers for Medicare & Medicaid Services. (c)

Reporting

The Secretary shall implement procedures, consistent with generally accepted standards, to enable the Department of Health and Human Services to accept the electronic submission of data for purposes of performance measurement, including at the provider level, using the quality measures developed, endorsed, and adopted pursuant to this title. (d)

Dissemination of information

In order to make comparative performance information available to health care consumers, health professionals, public health officials, oversight organizations, researchers, and other appropriate individuals and entities, after consultation with multi-stakeholder groups, the Secretary shall promulgate regulations to provide for the dissemination, aggregation, and analysis of quality measures collected pursuant to this title.

.

D

Privacy and security

321.

Privacy and security

Title XXX of the Public Health Service Act, as amended by section 311, is further amended by adding at the end the following:

3013.

Ensuring privacy and security

(a)

Privacy protections apply to health information electronic databases

An operator of a health information electronic database shall be deemed to be a covered entity for purposes of sections 1171 through 1179 of the Social Security Act and the regulations promulgated under section 264(c) of the Health Insurance Portability and Accountability Act of 1996 (42 U.S.C. 1320d-2 note) (referred to in this section as the HIPAA privacy regulations. (b)

Health information electronic database defined

In this section, the term operator of a health information electronic database means an entity that— (1)is constituted, organized, or chartered for the primary purpose of maintaining or transmitting protected health information in a designated record set or sets; (2)receives valuable consideration for maintaining or transmitting protected health information in a designated record set or sets; and (3)is not a health plan, healthcare clearinghouse, or healthcare provider who transmits any health information in electronic form in connection with a transaction referred to in section 1173(a)(1) of the Social Security Act. (c)

Right of individuals To inspect their medical records maintained in electronic format

To the extent provided for under the HIPAA privacy regulations with respect to protected health information, an individual shall have a right of access to inspect and obtain a copy of protected health information about the individual stored in electronic format. (d)

Rights of individuals who are victims of medical fraud

To the extent provided for under the HIPAA privacy regulations and under the conditions specified in such regulations, with respect to protected health information, an individual who is a victim of medical fraud or who believes that there is an error in their protected health information stored in an electronic format shall have the right— (1)to have access to inspect and obtain a copy of protected health information about the individual, including the information fraudulently entered, in a designated record set; and (2)to have a covered entity amend protected health information or a record about the individual, including information fraudulently entered, in a designated electronic record set for as long as the protected health information is maintained in the designated electronic record set to ensure that fraudulent and inaccurate health information is not shared or re-reported. (e)

Rule of construction

Nothing in this section shall be construed to supercede or otherwise limit the provisions of any contract that provides for the application of privacy protections that are greater than the privacy protections provided for under the regulations promulgated under section 264 of the Health Insurance Portability and Accountability Act of 1996.

.

E

Miscellaneous provisions

331.

GAO study

Not later than 12 months after the date of enactment of this Act, the Comptroller General of the United States shall submit to Congress a report on the circumstances in which it is necessary and workable to require health plans (as defined in section 1171 of the Social Security Act (42 U.S.C. 1320d)), health care clearinghouses (as defined in such section 1171), and health care providers (as defined in such section 1171) who transmit health information in electronic form, to notify individuals if their individually identifiable health information (as defined in such section 1171) is wrongfully disclosed.

332.

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 (referred to in this subsection as the 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 sections 3003 and 3010. (2)

Purposes

The purposes of the Center are to— (A)provide a forum for the exchange of knowledge and experience; (B)accelerate the transfer of lessons learned from existing public and private sector initiatives, including those currently receiving Federal financial support; (C)assemble, analyze, and widely disseminate evidence and experience related to the adoption, implementation, and effective use of interoperable health information technology; (D)provide 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; (E)provide for the development of solutions to barriers to the exchange of electronic health information; and (F)conduct 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. (3)

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. (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. (e)

Authorization of appropriations

There is authorized to be appropriated, such sums as may be necessary for each of fiscal years 2008 and 2009 to carry out this section. .

333.

Facilitating the provision of telehealth services across State lines

Section 330L of the Public Health Service Act (42 U.S.C. 254c–18) is amended to read as follows:

330L.

Telemedicine; incentive grants regarding coordination among States

(a)

Facilitating the provision of telehealth services across State lines

The Secretary may make grants to States that have adopted regional State reciprocity agreements for practitioner licensure, in order to expedite the provision of telehealth services across State lines. (b)

Authorization of appropriations

For the purpose of carrying out subsection (a), there are authorized to be appropriated such sums as may be necessary for each of the fiscal years 2008 and 2009.

.

II

Making health care more accessible for all Americans

341.

Reauthorization of certain telehealth programs

(a)

Telehealth network and telehealth resource centers grant programs

Section 330I(s) of the Public Health Service Act (42 U.S.C. 254c-14(s)) is amended— (1)in paragraph (1), by striking 2006 and inserting 2012; and (2)in paragraph (2), by striking 2006 and inserting 2012. (b)

Rural emergency medical service training and equipment assistance program

Section 330J(g)(1) of the Public Health Service Act (42 U.S.C. 254c–15(g)(1)) is amended by striking 2006 and inserting 2012. (c)

Mental health services delivered via telehealth

Section 330K(g) of the Public Health Service Act (42 U.S.C. 254c–16(g)) is amended by striking 2006 and inserting 2012.

342.

Quality improvement activities

Section 1154(a) of the Social Security Act (42 U.S.C. 1320c–3(a)) is amended by adding at the end the following new paragraph: (18)The organization shall offer quality improvement assistance to providers, practitioners, Medicare Advantage organizations offering Medicare Advantage plans under part C of title XVIII, and prescription drug sponsors offering prescription drug plans under part D of such title, including the following: (A)Education on quality improvement initiatives, strategies, and techniques. (B)Instruction on how to collect, submit, aggregate, and interpret data on measures that may be used for quality improvement, public reporting, and payment. (C)Technical assistance for providers and practitioners in beneficiary education to facilitate patient self-management. (D)Guidance on redesigning clinical processes, including the adoption and effective use of health information technology, to improve the coordination, effectiveness, and safety of care. (E)Assistance in improving the quality of care delivered in rural and frontier areas, including efforts to prevent or address any inconsistencies or delays in the rate of adoption of health information technology and in the effective use of such technology among entities that furnish such services in rural areas. (F)Assistance in improving coordination of care as patients transition between providers and practitioners, including developing the capacity to securely exchange electronic health information and helping providers and practitioners to effectively use secure electronic health information to improve quality. .

343.

Sense of the senate regarding physician payments under medicare

It is the sense of the Senate that modifications to the Medicare fee schedule for physicians’ services under section 1848 of the Social Security Act (42 U.S.C. 1395w–4) should include provisions based on the reporting of quality measures pursuant to those adopted in section 3010 of the Public Health Service Act (as added by section 305) and the overall improvement of health care quality through the use of the electronic exchange of health information pursuant to the standards adopted under section 3003 of such Act (as added by section 301.

B

Increasing Access to Physicians and Nurses

351.

Reauthorization of programs and miscellaneous amendments

(a)

Health professions education programs

Part F of title VII of the Public Health Service Act (42 U.S.C. 295j et seq.) is amended by adding at the end the following:

799C.

General authorization of appropriations

(a)

In general

Notwithstanding any other provision of this title, beginning with fiscal year 2008, there is authorized to be appropriated to carry out this title, such sums as may be necessary for each of fiscal years 2008 through 2012. (b)

References

Any reference in this title to a provision of this title providing for an authorization of appropriation for a fiscal year beginning with fiscal year 2008, shall be deemed to be a reference to subsection (a).

. (b)

Nursing workforce development programs

Part A of title VIII of the Public Health Service Act (42 U.S.C. 296 et seq.) is amended by adding at the end the following:

809.

General authorization of appropriations

(a)

In general

Notwithstanding any other provision of this title, beginning with fiscal year 2008, there is authorized to be appropriated to carry out this title, such sums as may be necessary for each of fiscal years 2008 through 2012. (b)

References

Any reference in this title to a provision of this title providing for an authorization of appropriation for a fiscal year beginning with fiscal year 2008, shall be deemed to be a reference to subsection (a).

. (c)

Development of metrics to measure effectiveness

(1)

Health professions programs

Part F of title VII of the Public Health Service Act (42 U.S.C. 295j et seq.), as amended by subsection (a), is further amended by adding at the end the following:

799D.

Development of measures of effectiveness

The Secretary shall develop and publish in the Federal Register measures of effectiveness for each of the programs carried out under this title. The Secretary shall use such measures to annually submit to the Committee on Health, Education, Labor, and Pension of the Senate and the Committee on Energy and Commerce of the House of Representatives a report concerning the effectiveness of such programs.

. (2)

Nursing workforce development

Part A of title VIII of the Public Health Service Act (42 U.S.C. 296 et seq.), as amended by subsection (b), is further amended by adding at the end the following:

810.

Development of measures of effectiveness

The Secretary shall develop and publish in the Federal Register measures of effectiveness for each of the programs carried out under this title. The Secretary shall use such measures to annually submit to the Committee on Health, Education, Labor, and Pension of the Senate and the Committee on Energy and Commerce of the House of Representatives a report concerning the effectiveness of such programs.

. (d)

Provision of information to students

Section 726 of the Public Health Service Act (42 U.S.C. 292v) is amended by adding at the end the following: (c)

Provision of information to incoming students

Each school shall provide to each student, at the time the school provides such student with a letter of acceptance to attend the school, a statement of the amount of the average aggregate amount of debt incurred by graduating students during their period of attendance at the school and the national average for such debt at all schools for the previous year (as determined by the Secretary). . (e)

Enhanced competitiveness

Section 738(b)(2) of the Public Health Service Act (42 U.S.C. 293b(b)(2)) is amended— (1)by striking that— and all that follows through amounts in subparagraph (A), and inserting that amounts; (2)in subparagraph (A), by striking ; and and inserting a period; and (3)by striking subparagraph (B).

352.

Nurse workforce enhancement

(a)

Reauthorization of practice and retention grant program

Section 831(h) of the Public Health Service Act (42 U.S.C. 296p(h)) is amended by striking 2003 through 2007 and inserting 2008 through 2012. (b)

State Demonstration Projects To provide incentives for Nurses to Reenter the Workforce

Part D of title VIII of the Public Health Service Act (42 U.S.C. 296p et seq.) is amended by adding at the end the following:

832.

State Demonstration Projects to provide incentives for Nurses to Reenter the Workforce

(a)

In general

The Secretary shall award not to exceed 15 grants to States for the conduct of demonstration projects to evaluate incentives to encourage nurses to reenter the nursing profession at positions in healthcare facilities. For purposes of projects under this section, a nurse shall be deemed to have reentered the workforce if such nurse is licensed and had not practiced nursing for the 3-year period prior to their return to the workforce under a project under this section. (b)

Application

To be eligible to receive a grant under subsection (a), a State shall submit to the Secretary an application at such time, in such manner, and containing such information as the Secretary may require, including— (1)a description of the activities to be conducted under the grant, including— (A)how retraining will be encouraged to update skills; (B)how license renewal will be encouraged; (C)how loan repayment under programs under this title will be monitored; (D)how healthcare facilities with a critical shortage of nurses will be identified and the shortage will be alleviated by the program; (E)how the performance of reentry nurses will be monitored and evaluated; and (F)how part-time positions will be created to utilize nurses reentering the profession; (2)an assurance that the State will provide matching funds in accordance with subsection (c); (3)an assurance that the State will conduct an evaluation in accordance with subsection (d); and (4)any other assurances required by the Secretary. (c)

Matching requirement

The Secretary may not make grants to a State under this section unless the State involved agrees, with respect to the costs of carrying out the program under the grant, to make available non-Federal contributions (in cash or in kind) toward such costs in an amount equal to not less than $1 for each $1 of Federal funds provided under the grant. (d)

Evaluations

A State that receives a grant under this section shall reserve 5 percent of the amount received under this grant to carry out activities to evaluate the project carried out under the grant. A State shall report to the Secretary the results of such evaluation, including the number of nurses reentering the profession in the State in years prior to the project and the number reentering such profession after the initiation of the project, and the number of such reentering nurses that serve in areas deemed underserved. (e)

Amount and length of grants

A grant under this section shall not exceed $2,000,000 for each fiscal year for up to 5 years. Grants may be extended for an additional 5-year period. (f)

Definitions

In this section: (1)

Healthcare facility

The term healthcare facility means those facilities that regularly dispense healthcare, including hospitals, public health departments, nursing homes, community health centers, rural health clinics, and Indian health service centers. (2)

Nurse

The term nurse includes Registered Nurses. (3)

Position

The term position means a full-time or part-time position that includes teaching or delivery of health care to patients. (g)

Authorization of appropriations

There is authorized to be appropriated such sums as may be necessary to carry out this section.

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353.

Visas for registered nurses

Paragraph (4) of section 212(m) of the Immigration and Nationality Act (8 U.S.C. 1182(m)) is amended in the matter preceding subparagraph (A) by striking 500 and inserting 600.

354.

MedPAC study and report on the impact of payment caps for IME and GME

(a)

Study

The Medicare Payment Advisory Commission shall conduct a study— (1)to analyze the impact that the limitation on the number of residents in allopathic and osteopathic medicine under subsections (d)(5)(B)(v) and (h)(4)(F) of section 1886 of the Social Security Act (42 U.S.C. 1395ww) has had with respect to— (A)the national supply of general practitioners and specialty healthcare providers; (B)the development of new teaching hospitals and medical schools; (C)the ability to support residents in institutions (such as children’s hospitals and advanced practice nurse training facilities) that are not eligible for payments for indirect medical education costs and direct graduate medical education costs under the Medicare program under title XVIII of the Social Security Act (42 U.S.C. 1395 et seq.); (D)the recruitment and retention of healthcare providers in areas designated as health professional shortage areas (as defined in section 332(a)(1) of the Public Health Service Act) or in areas designated as medically underserved areas, with particular focus on States that do not have a medical school located in the State; and (E)the practice of sharing or purchasing residency positions among institutions; and (2)to analyze the payment system for indirect medical education costs and direct graduate medical education costs under the Medicare program under such title with respect to— (A)the accuracy of payments for indirect graduate medical education costs under such system compared with the actual costs incurred by teaching hospitals in providing indirect medical education; (B)the range and variance in reimbursable direct graduate medical education costs and the cause of such range and variance; and (C)the commitment of healthcare payers, other than the Medicare program under such title, to reimburse teaching hospitals and other healthcare facilities with qualified medical education components at increased rates to offset graduate medical education costs that are incurred in such settings and are not paid under such program. (b)

Report

Not later than 2 years after the date of enactment of this Act, the Medicare Payment Advisory Commission shall submit a report to the Secretary of Health and Human Services and to Congress containing the results of the study conducted under subsection (a), together with such recommendations regarding alternatives and revisions to the payment system for indirect medical education costs and direct graduate medical education costs under the Medicare program under title XVIII of the Social Security Act as the Medicare Payment Advisory Commission determines appropriate.

C

Increasing Access to Primary Care

361.

Reauthorization of the community health center programs

(a)

In general

Section 330(r) of the Public Health Service Act (42 U.S.C. 254b(r)) is amended by striking paragraph (1) and inserting the following: (1)

In general

For the purpose of carrying out this section, in addition to the amounts authorized to be appropriated under subsection (d), there are authorized to be appropriated— (A)$2,048,670 for fiscal year 2008; (B)$2,110,130 for fiscal year 2009; (C)$2,173,434 for fiscal year 2010; (D)$2,244,637 for fiscal year 2011; and (E)$2,311,976 for fiscal year 2012. . (b)

Medical residency training programs

Section 330 of the Public Health Service Act (42 U.S.C. 254b) is amended— (1)by redesignating subsections (k) through (r) as subsections (l) through (s), respectively; and (2)by inserting after subsection (j), the following: (k)

Grants To expand medical residency training programs at community health centers

(1)

Program authorized

The Secretary may make grants to community health centers— (A)to establish, at the centers, new or alternative-campus accredited medical residency training programs affiliated with a hospital or other health care facility; or (B)to fund new residency positions within existing accredited medical residency training programs at the centers and their affiliated partners. (2)

Use of funds

Amounts awarded under a grant under this subsection shall be used to cover the costs of establishing or expanding a medical residency training program described in paragraph (1), including costs associated with— (A)curriculum development; (B)equipment acquisition; (C)recruitment, training, and retention of residents and faculty; and (D)residency stipends. (3)

Applications

A community health center seeking a grant under this subsection shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may require. (4)

Preference

In selecting recipients for a grant under this subsection, the Secretary shall give preference to funding medical residency training programs focusing on primary health care. (5)

Definition

In this subsection, the term accredited, as applied to a new or alternative-campus medical residency training program, means a program that is accredited by a recognized body or bodies approved for such purpose by the Accreditation Council for Graduate Medical Education, except that a new medical residency training program that, by reason of an insufficient period of operation, is not eligible for accreditation on or before the date of submission of an application under paragraph (3) shall be deemed accredited if the Accreditation Council for Graduate Medical Education finds, after consultation with the appropriate accreditation body or bodies, that there is reasonable assurance that the program will meet the accreditation standards of such body or bodies prior to the date of graduation of the first entering class in that program. .

362.

Reauthorization of loan repayment programs of the National Health Service Corps

(a)

In general

Section 338H(a) of the Public Health Service Act (42 U.S.C. 254q(a)) is amended to read as follows: (a)

Authorization of appropriations

For the purposes of carrying out this subpart, there are authorized to be appropriated $129,271,790 for fiscal year 2008, $133,150,393 for fiscal year 2009, $137,145,355 for fiscal year 2010, $141,260,166 for fiscal year 2011, and $145,498,421 for fiscal year 2012. Amounts appropriated under this subsection shall not be used to carry out section 338A. . (b)

State loan repayment program

Section 338I(i)(1) of the Public Health Service Act (42 U.S.C. 254q-1(i)(1)) is amended by striking $12,000,000 and all that follows through the end and inserting $15,000,000 for each of fiscal years 2008 through 2012..

363.

Clarification of authority for convenient care clinics to participate in Medicaid and SCHIP

(a)

Medicaid

(1)

State plan amendment

Section 1902(a)(23)(A) of the Social Security Act (42 U.S.C. 1396a(a)(23)(A)) is amended— (A)by inserting , and a convenient care clinic, as defined in section 1905(y) after prepayment basis; and (B)by inserting (other than with respect to the ability of an individual to obtain medical assistance from a convenient care clinic (as so defined)) after Guam. (2)

Definition

Section 1905 of the Social Security Act (42 U.S.C. 1396d) is amended by adding at the end the following: (y)For purposes of this title, the term convenient care clinic means a health care facility located in a retail outlet that provides affordable and accessible, non-emergency health care (as defined by the Secretary) to consumers that is open 7 days a week, for extended hours (as so defined) and is primarily staffed by advanced practice nurses (including nurse practitioners), as well as by physician assistants or physicians, who have advanced education in providing quality health care for common episodic ailments (as so defined). . (b)

SCHIP

Section 2107(e)(1) of the Social Security Act (42 U.S.C. 1397gg(e)(1)) is amended— (1)by redesignating subparagraphs (B) through (D) as subparagraphs (C) through (E), respectively; and (2)by inserting after subparagraph (A), the following: (B)Section 1902(a)(23)(A) (but only with respect to the ability of an individual to obtain assistance from a convenient care clinic, as defined in section 1905(y)). . (c)

Effective date

(1)

In general

Subject to paragraph (2), the amendments made by this section take effect on October 1, 2007. (2)

Delay if state legislation required

In the case of a State plan under title XIX or XXI of the Social Security Act or a waiver of such plan under section 1115 of such Act which the Secretary of Health and Human Services determines requires State legislation (other than legislation appropriating funds) in order for the plan or waiver to meet the additional requirements imposed by the amendments made by this section, the State plan or waiver shall not be regarded as failing to comply with the requirements of such title solely on the basis of its failure to meet such additional requirements before the first day of the first calendar quarter beginning after the close of the first regular session of the State legislature that begins after the date of the enactment of this Act. For purposes of the previous sentence, in the case of a State that has a 2-year legislative session, each year of such session shall be deemed to be a separate regular session of the State legislature.

D

Rural health care

371.

Reathorization of rural health care programs

Section 330A(j) of the Public Health Service Act (42 U.S.C. 254c(j)) is amended by striking $40,000,000 and all that follows and inserting $45,000,000 for each of fiscal years 2008 through 2010..

E

Long term care

381.

Sense of the Senate

It is the Sense of the Senate that all Americans should establish an advance directive.

382.

Living wills

The Secretary of Health and Human Service shall provide for the development of an Internet website (at www.livingwill.gov) to provide all Americans with access to information on advance directives and a website on which to store and access such directives.

383.

Increasing Senior Choice and Access to Community-Based Long Term Care

Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.) is amended by adding at the end the following:

399R.

Increasing Senior Choice and Access to Community-Based Long Term Care

(a)

In general

The Secretary may award one-time grants to eligible entities, as defined by the Secretary, for the conduct of demonstration projects to plan and develop the entity's transitions from institutional settings of skilled nursing care to residential or community-based settings of integrated skilled nursing care, which shall include— (1)the provision of housing units and staff meeting all Federal and State qualifications and licensure requirements, as applicable to the level of care to be provided; (2)eligibility and qualification assistance for reimbursement under applicable State Medicaid programs; (3)the provision of a residential or home environment which encourages independent living, privacy, and community engagement; (4)encouraging a sense of community by having a number of low-occupancy housing units arranged with similarly structured housing units specializing in long term care; (5)an emphasis on building relationships between care providers and clients by encouraging teams to remain with a set of patients throughout their stay; (6)the direct involvement by the clients in developing activities and structuring care needs; and (7)the formation of an integrated, self-managed clinical and personal care team, including healthcare providers, specialists and appropriate personnel, available to the community as needed. (b)

Application

An eligible entity desiring a grant under this section shall submit an application to the Secretary at such time, in such manner, and containing such information as the Secretary may reasonably require. (c)

Report

Not later than 3 years after the date on which the first grant is awarded under this section, the Secretary shall submit to the appropriate committees of Congress a report concerning the efficacy of the model carried out under this section in improving quality of life indicators, employee satisfaction, and clinical outcomes. (d)

Priority

In making grants under this section, the Secretary shall give priority to entities providing services to a medically undeserved area. (e)

Authorization of appropriations

For the purpose of awarding grants under this section, there is authorized to be appropriated $5,000,000 for each of fiscal years 2008 through 2013.

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F

Fair and Reliable Medical Justice

391.

Short title

This subtitle may be cited as the Fair and Reliable Medical Justice Act.

392.

Purposes

The purposes of this subtitle are— (1)to restore fairness and reliability to the medical justice system by fostering alternatives to current medical tort litigation that promote early disclosure of health care errors and provide prompt, fair, and reasonable compensation to patients who are injured by health care errors; (2)to promote patient safety through disclosure of health care errors; and (3)to support and assist States in developing such alternatives.

393.

State demonstration programs to evaluate alternatives to current medical tort litigation

Part P of title III of the Public Health Service Act (42 U.S.C. 280g et seq.) is amended by adding at the end the following:

399R.

State demonstration programs to evaluate alternatives to current medical tort litigation

(a)

In general

The Secretary is authorized to award demonstration grants to States for the development, implementation, and evaluation of alternatives to current tort litigation for resolving disputes over injuries allegedly caused by health care providers or health care organizations. In awarding such grants, the Secretary shall ensure the diversity of the alternatives so funded. (b)

Duration

The Secretary may award up to 10 grants under subsection (a) and each grant awarded under such subsection may not exceed a period of 5 years. (c)

Conditions for demonstration grants

(1)

Requirements

Each State desiring a grant under subsection (a) shall— (A)develop an alternative to current tort litigation for resolving disputes over injuries allegedly caused by health care providers or health care organizations; and (B)promote a reduction of health care errors by allowing for patient safety data related to disputes resolved under subparagraph (A) to be collected and analyzed by organizations that engage in efforts to improve patient safety and the quality of health care. (2)

Alternative to current tort litigation

Each State desiring a grant under subsection (a) shall demonstrate how the proposed alternative described in paragraph (1)(A)— (A)makes the medical liability system more reliable through prompt and fair resolution of disputes; (B)encourages the disclosure of health care errors; (C)enhances patient safety by detecting, analyzing, and reducing medical errors and adverse events; (D)maintains access to liability insurance; and (E)provides patients the opportunity to opt out of or voluntarily withdraw from participating in the alternative. (3)

Sources of compensation

Each State desiring a grant under subsection (a) shall identify the sources from and methods by which compensation would be paid for claims resolved under the proposed alternative to current tort litigation, which may include public or private funding sources, or a combination of such sources. Funding methods shall to the extent practicable provide financial incentives for activities that improve patient safety. (4)

Scope

(A)

In general

Each State desiring a grant under subsection (a) may establish a scope of jurisdiction (such as a designated geographic region, a designated area of health care practice, or a designated group of health care providers or health care organizations) for the proposed alternative to current tort litigation that is sufficient to evaluate the effects of the alternative. (B)

Notification of patients

A State proposing a scope of jurisdiction under subparagraph (A) shall demonstrate how patients would be notified that they are receiving health care services that fall within such scope, and that they may opt out of or voluntarily withdraw from participating in the alternative. (5)

Preference in awarding demonstration grants

In awarding grants under subsection (a), the Secretary shall give preference to States— (A)that have developed the proposed alternative through substantive consultation with relevant stakeholders, including patient advocates, health care providers and health care organizations, attorneys with expertise in representing patients and health care providers, medical malpractice insurers, and patient safety experts; (B)that make proposals that are likely to enhance patient safety by detecting, analyzing, and reducing medical errors and adverse events; and (C)in which State law at the time of the application would not prohibit the adoption of an alternative to current tort litigation. (d)

Application

(1)

In general

Each State desiring a grant under subsection (a) shall submit to the Secretary an application, at such time, in such manner, and containing such information as the Secretary may require. (2)

Review panel

(A)

In general

In reviewing applications under paragraph (1), the Secretary shall consult with a review panel composed of relevant experts appointed by the Comptroller General. (B)

Composition

(i)

Nominations

The Comptroller General shall solicit nominations from the public for individuals to serve on the review panel. (ii)

Appointment

The Comptroller General shall appoint, at least 14 but not more than 19, highly qualified and knowledgeable individuals to serve on the review panel and shall ensure that the following entities receive fair representation on such panel: (I)Patient advocates. (II)Health care providers and health care organizations. (III)Attorneys with expertise in representing patients and health care providers. (IV)Medical malpractice insurers. (V)State officials. (VI)Patient safety experts. (C)

Chairperson

The Comptroller General, or an individual within the Government Accountability Office designated by the Comptroller General, shall be the chairperson of the review panel. (D)

Availability of information

The Comptroller General shall make available to the review panel such information, personnel, and administrative services and assistance as the review panel may reasonably require to carry out its duties. (E)

Information from agencies

The review panel may request directly from any department or agency of the United States any information that such panel considers necessary to carry out its duties. To the extent consistent with applicable laws and regulations, the head of such department or agency shall furnish the requested information to the review panel. (e)

Reports

(1)

By State

Each State receiving a grant under subsection (a) shall submit to the Secretary an annual report evaluating the effectiveness of activities funded with grants awarded under such subsection. (2)

By Secretary

The Secretary shall submit to Congress an annual compendium of the reports submitted under paragraph (1). (f)

Technical assistance

(1)

In general

The Secretary shall provide technical assistance to the States applying for or awarded grants under subsection (a). (2)

Requirements

Technical assistance under paragraph (1) shall include— (A)guidance on non-economic damages, including the consideration of individual facts and circumstances in determining appropriate payment, guidance on identifying avoidable injuries, and guidance on disclosure to patients of health care errors and adverse events; and (B)the development, in consultation with States, of common definitions, formats, and data collection infrastructure for States receiving grants under this section to use in reporting to facilitate aggregation and analysis of data both within and between States. (3)

Use of common definitions, formats, and data collection infrastructure

States not receiving grants under this section may also use the common definitions, formats, and data collection infrastructure developed under paragraph (2)(B). (g)

Evaluation

(1)

In general

The Secretary, in consultation with the review panel established under subsection (d)(2), shall enter into a contract with an appropriate research organization to conduct an overall evaluation of the effectiveness of grants awarded under subsection (a) and to annually prepare and submit a report to Congress. Such an evaluation shall begin not later than 18 months following the date of implementation of the first program funded by a grant under subsection (a). (2)

Contents

The evaluation under paragraph (1) shall include— (A)an analysis of the effects of the grants awarded under subsection (a) on the measures described in paragraph (3); (B)a comparison between and among the alternatives approved under subsection (a) of the measures described in paragraph (3); and (C)a comparison between and among States receiving grants approved under subsection (a) and similar States not receiving such grants of the measures described in paragraph (3). (3)

Measures

The evaluations under paragraph (2) shall analyze and make comparisons on the basis of— (A)the nature and number of disputes over injuries allegedly caused by health care providers or health care organizations; (B)the nature and number of claims in which tort litigation was pursued despite the existence of an alternative under subsection (a); (C)the disposition of disputes and claims described in clauses (i) and (ii), including the length of time and estimated costs to all parties; (D)the medical liability environment; (E)health care quality; (F)patient safety in terms of detecting, analyzing, and reducing medical errors and adverse events; and (G)patient and health care provider and organization satisfaction with the alternative under subsection (a) and with the medical liability environment. (4)

Funding

The Secretary shall reserve 5 percent of the amount appropriated in each fiscal year under subsection (j) to carry out this subsection. (h)

Option To provide for initial planning grants

Of the funds appropriated pursuant to subsection (j), the Secretary may use a portion not to exceed $500,000 per State to provide planning grants to such States for the development of demonstration project applications meeting the criteria described in subsection (c). In selecting States to receive such planning grants, the Secretary shall give preference to those States in which State law at the time of the application would not prohibit the adoption of an alternative to current tort litigation. (i)

Definitions

In this section: (1)

Health care services

The term health care services means any services provided by a health care provider, or by any individual working under the supervision of a health care provider, that relate to— (A)the diagnosis, prevention, or treatment of any human disease or impairment; or (B)the assessment of the health of human beings. (2)

Health care organization

The term health care organization means any individual or entity which is obligated to provide, pay for, or administer health benefits under any health plan. (3)

Health care provider

The term health care provider means any individual or entity— (A)licensed, registered, or certified under Federal or State laws or regulations to provide health care services; or (B)required to be so licensed, registered, or certified but that is exempted by other statute or regulation. (4)

Net economic loss

The term net economic loss means— (A)reasonable expenses incurred for products, services, and accommodations needed for health care, training, and other remedial treatment and care of an injured individual; (B)reasonable and appropriate expenses for rehabilitation treatment and occupational training; (C)100 percent of the loss of income from work that an injured individual would have performed if not injured, reduced by any income from substitute work actually performed; and (D)reasonable expenses incurred in obtaining ordinary and necessary services to replace services an injured individual would have performed for the benefit of the individual or the family of such individual if the individual had not been injured. (5)

Non-economic damages

The term non-economic damages means losses for physical and emotional pain, suffering, inconvenience, physical impairment, mental anguish, disfigurement, loss of enjoyment of life, loss of society and companionship, loss of consortium (other than loss of domestic service), injury to reputation, and all other non-pecuniary losses of any kind or nature, to the extent permitted under State law. (j)

Authorization of appropriations

There are authorized to be appropriated to carry out this section such sums as may be necessary. Amounts appropriated pursuant to this subsection shall remain available until expended.

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