[Congressional Bills 111th Congress]
[From the U.S. Government Publishing Office]
[S. 890 Introduced in Senate (IS)]

111th CONGRESS
  1st Session
                                 S. 890

 To provide for the use of improved health information technology with 
          respect to certain safety net health care providers.


_______________________________________________________________________


                   IN THE SENATE OF THE UNITED STATES

                             April 23, 2009

  Mr. Reid (for himself and Mr. Rockefeller) introduced the following 
  bill; which was read twice and referred to the Committee on Health, 
                     Education, Labor, and Pensions

_______________________________________________________________________

                                 A BILL


 
 To provide for the use of improved health information technology with 
          respect to certain safety net health care providers.

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

SECTION 1. SHORT TITLE.

    This Act may be cited as the ``Health Information Technology (IT) 
Public Utility Act of 2009''.

SEC. 2. DEFINITIONS.

    In this Act:
            (1) Board.--The term ``Board'' means the Federal 
        Consolidated Health Information Technology Board established 
        under section 3.
            (2) RPMS.--The term ``RPMS'' means the Resource and Patient 
        Management System of the Indian Health Service.
            (3) Secretary.--The term ``Secretary'' means the Secretary 
        of Veterans Affairs.
            (4) VistA.--The term ``VistA'' means the VistA software 
        program utilized by the Department of Veterans Affairs.

SEC. 3. FEDERAL CONSOLIDATED HEALTH INFORMATION TECHNOLOGY BOARD.

    (a) Establishment.--To facilitate the implementation of electronic 
health record systems among safety-net health care providers 
(particularly small, rural providers) there shall be established within 
the Office of the National Coordinator for Health Information 
Technology of the Department of Health and Human Services, a Federal 
Consolidated Health Information Technology Board.
    (b) Board of Directors.--The Board shall be administered by a board 
of directors that shall be composed of the following individuals or 
their designees:
            (1) The Secretary.
            (2) The Under Secretary for Health of the Department of 
        Veterans Affairs.
            (3) The Director of the Indian Health Service.
            (4) The Secretary of Defense.
            (5) The Secretary of Health and Human Services.
            (6) The Director of the Agency for Healthcare Research and 
        Quality.
            (7) The Administrator of the Health Resources and Services 
        Administration.
            (8) The Chairman of the Federal Communications Commission.
    (c) Duties.--The Board shall--
            (1) provide ongoing communication with existing VistA and 
        RPMS user groups to ensure that there is constant 
        interoperability between such groups and to provide for the 
        sharing of innovative ideas and technology;
            (2) update VistA and RPMS open source software (including 
        health care provider-based electronic health records, personal 
        health records, and other software modules) on a timely basis;
            (3) implement and administer the 21st Century HIT Grant 
        Program under section 4, including providing for notice in the 
        Federal Register as well as--
                    (A) determining specific health information 
                technology grant needs based on health care provider 
                settings;
                    (B) developing benchmarks for levels of 
                implementation in each year that 21st Century grant 
                funding is provided; and
                    (C) providing ongoing VistA and RPMS technical 
                assistance to grantees under such program (either 
                through the provision of direct technical support or 
                through the awarding of competitive contracts to other 
                qualified entities);
                    (D) develop mechanisms to integrate VistA and RPMS 
                with records and billing systems utilized under the 
                Medicaid and State children's health insurance programs 
                under titles XIX and XXI of the Social Security Act (42 
                U.S.C. 1396 and 1397aa et seq.);
            (4) establish a child-specific electronic health record, 
        consistent with the parameters to be set for child electronic 
        health records as provided for in the American Recovery and 
        Reinvestment Act of 2009, to be used in the Medicaid and State 
        children's health insurance programs under titles XIX and XXI 
        of the Social Security Act, and under other Federal children's 
        health programs determined appropriate by the board of 
        directors;
            (5) develop and integrate quality and performance 
        measurement into the VistA and RPMS modules;
            (6) integrate the 21st Century HIT Grant Program under 
        section 4 with the Federal Communications Commission's Rural 
        Health Care Pilot Program, with Department of Veterans Affairs 
        hospital systems, and with other Federal health information 
        technology health initiatives; and
            (7) carry out other activities determined appropriate by 
        the board of directors.
    (d) Annual Audits.--The Comptroller General of the United States 
shall annually conduct an audit of the activities of the Board during 
the year and submit the results of such audits to the appropriate 
committees of Congress.
    (e) Authorization of Appropriations.--There is authorized to be 
appropriated such sums as may be necessary to carry out this section.

SEC. 4. 21ST CENTURY HEALTH INFORMATION TECHNOLOGY (HIT) GRANTS.

    (a) Establishment.--The Board shall establish a grant program, to 
be known as the 21st Century Health Information Technology (HIT) Grant 
program, to award competitive grants to eligible safety-net health care 
providers to enable such providers to fully implement VistA or RPMS 
with respect to the patients served by such providers.
    (b) Eligibility.--
            (1) In general.--To be eligible to receive a grant under 
        subsection (a), an entity shall--
                    (A) be--
                            (i) a public or nonprofit health care 
                        provider (as defined in section 254(h)(7)(B) of 
                        the Communications Act of 1934 (47 U.S.C. 
                        254(h)(7)(B)), including--
                                    (I) post-secondary educational 
                                institutions offering health care 
                                instruction, teaching hospitals, and 
                                medical schools;
                                    (II) a community health center 
                                receiving a grant under section 330 of 
                                the Public Health Service Act (42 
                                U.S.C. 254) or a health center that 
                                provides health care to migrants;
                                    (III) a local health department or 
                                agency, including a dedicated emergency 
                                department of rural for-profit 
                                hospitals;
                                    (IV) a community mental health 
                                center;
                                    (V) a nonprofit hospitals;
                                    (VI) a rural health clinics, 
                                including a mobile clinic;
                                    (VII) a consortia of health care 
                                providers, that consists of 1 or more 
                                of the entities described in clauses 
                                (i) through (vi); and
                                    (VIII) a part-time eligible entity 
                                that is located in an otherwise 
                                ineligible facility (as described in 
                                section 5(b); or
                            (ii) a free clinic (as defined in paragraph 
                        (4); and
                    (B) submit to the Board as application at such 
                time, in such manner, and containing such information 
                as the Board may require.
            (2) Non-eligible entities.--
                    (A) In general.--An entity shall not be eligible to 
                receive a grant under this section if such entity is a 
                for-profit health care entity (except as provided for 
                in paragraph (1)(A)), or any other type of entity that 
                is not described in such paragraph, including--
                            (i) an entity described in paragraph (1)(A) 
                        that is implementing an existing electronic 
                        health records system;
                            (ii) an entity that is receiving grant 
                        funding under the Federal Communication 
                        Commission Rural Health Pilot Program;
                            (iii) an entity receiving funding for 
                        health information technology through a 
                        Medicaid transformation grant under title XIX 
                        of the Social Security Act (42 U.S.C. 1936 et 
                        seq.);
                            (iv) a private physician office or clinic;
                            (v) a nursing home or other long-term care 
                        facility (such as an assisted living facility);
                            (vi) an emergency medical service facility;
                            (vii) a residential substance abuse 
                        treatment facility;
                            (viii) a hospice;
                            (ix) a for-profit hospital;
                            (x) a home health agency;
                            (xi) a blood bank;
                            (xii) a social service agency; and
                            (xiii) a community center, vocational 
                        rehabilitation center, or youth center.
                    (B) Other entities.--An entity shall not be 
                eligible to receive a grant under this section if such 
                entity is receiving Medicare or Medicaid incentive 
                funding under any of the amendments made by title IV of 
                division B of the American Recovery and Reinvestment 
                Act of 2009.
            (3) Preference.--In awarding grant under this section the 
        Board shall give preference to applicants that--
                    (A) are located in geographical areas that have a 
                greater likelihood of serving the same patients and 
                utilizing interoperability to promote coordinated care 
                management; or
                    (B) demonstrate the greatest need for such award 
                (as determined by the Secretary).
            (4) Definition.--In this subsection, the term ``free 
        clinic'' means a safety-net health care organization that--
                    (A) utilizes volunteers to provide a range of 
                medical, dental, pharmacy, or behavioral health 
                services to economically disadvantaged individuals the 
                majority of whom are uninsured or underinsured; and
                    (B) is a community-based tax-exempt organization 
                under section 501(c)(3) of the Internal Revenue Code of 
                1986, or that operates as a program component or 
                affiliate of such a 501(c)(3) organization.
        An entity that is otherwise a free clinic under this paragraph, 
        but that charge a nominal fee to patients, shall still be 
        considered to be a free clinics if the entity delivers 
        essential services regardless of the patient's ability to pay.
    (c) Use of Funds.--An entity shall use amounts received under a 
grant under this section to fully implement the VistA or RPMS with 
respect to the patients served by such entity. Such implementation 
shall include at least the meaningful use (as defined by the Secretary 
of Health and Human Services) of such systems, including any ongoing 
updates and changes to such definition.
    (d) Term and Renewal.--A grant under this section shall be for a 
period of not to exceed 5 years and may be renewed, as determined 
appropriate by the Board, based on the achievement of benchmarks 
required by the Board.
    (e) Annual Reporting.--
            (1) By grantees.--Not later than 1 year after the date on 
        which an entity receives a grant under this section, and 
        annually during each year in which such entity has received 
        funds under such grant, such entity shall submit to the Board a 
        report concerning the activities carried out under the grant.
            (2) By board.--Not later than 2 years after the date of 
        enactment of this Act, and annually thereafter, the Board shall 
        submit to the appropriate committees of Congress a report 
        concerning the activities carried out under this section, 
        including--
                    (A) a description of the grants that have been 
                awarded under this section and the purposes of such 
                grants;
                    (B) specific implementation information with 
                respect to activities carried out by grantees;
                    (C) the costs and savings achieved under the 
                program under this section;
                    (D) a description of any innovations developed by 
                health care providers as a result of the implementation 
                of activities under this grant;
                    (E) a description of the results of grant 
                activities on patient care quality measurement 
                (including reductions in medication errors and the 
                provision of care management);
                    (F) a description of the extent of electronic 
                health record use across health care provider settings;
                    (G) a description of the extent to which 
                integration of VistA and RPMS with Medicaid and State 
                children's health insurance program billing has been 
                achieved; and
                    (H) any other information determined necessary by 
                the Board.
    (f) Annual Audits.--The Comptroller General of the United States 
shall annually conduct an audit of the grant program carried out under 
this section and submit the results of such audits to the Board and the 
appropriate committees of Congress.
    (g) Authorization of Appropriations.--There is authorized to be 
appropriated to carry out this section--
            (1) $2,000,000,000 for each of fiscal years 2010 and 2011; 
        and
            (2) $1,000,000,000 for each of fiscal years 2012 through 
        2014.

SEC. 5. 21ST CENTURY HEALTH INFORMATION TECHNOLOGY DEMONSTRATION 
              PROGRAM FOR INELIGIBLE ENTITIES.

    (a) In General.--The Board may use not to exceed 10 percent of the 
amount appropriate for each fiscal year under section 4(g) to award 
competitive grants to eligible long-term care providers for the conduct 
of demonstration projects to implement VistA or RPMS with respect to 
the individuals served by such providers.
    (b) Eligibility.--
            (1) In general.--To be eligible to receive a grant under 
        subsection (a), an entity shall--
                    (A) be a--
                            (i) nursing home or other long-term care 
                        facility (such as an assisted living facility);
                            (ii) a hospice; or
                            (iii) a home health agency; and
                    (B) submit to the Board as application at such 
                time, in such manner, and containing such information 
                as the Board may require, including a description of 
                the manner in which the applicant will use grant funds 
                to implement VistA or RPMS with respect to the 
                individuals served by such applicant to achieve one or 
                more of the following:
                            (i) Improve care coordination and chronic 
                        disease management.
                            (ii) Reduce hospitalizations.
                            (iii) Reduce patient churning between the 
                        hospital, nursing home, hospice, and home 
                        health entity.
                            (iv) Increase the ability of long-term care 
                        patients to remain in their homes and 
                        communities.
                            (v) Improve patient completion, and 
                        provider execution, of advance directives.
            (2) Noneligibility.--An entity shall not be eligible to 
        receive a grant under this section if such entity is receiving 
        Medicare or Medicaid incentive funding under any of the 
        amendments made by title IV of division B of the American 
        Recovery and Reinvestment Act of 2009.
    (c) Use of Funds.--An entity shall use amounts received under a 
grant under this section to implement the VistA or RPMS with respect to 
the individuals served by such entity. Such implementation shall 
include at least the meaningful use (as defined by the Secretary of 
Health and Human Services) of such systems, including any ongoing 
updates and changes to such definition.
    (d) Duration.--A grant under this section shall be for a period of 
not to exceed 3 years, as determined appropriate by the Board.
    (e) Reporting.--The Board, as part of the report submitted under 
section 4(e)(2), shall provide comprehensive information on the 
activities conducted under grants awarded under this section.
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