1.This Act may be cited as
the Health Information Technology (IT)
Public Utility Act of 2009
.
2.In this Act:
(1)The
term Board means the Federal Consolidated Health Information
Technology Board established under section 3.
(2)The
term RPMS means the Resource and Patient Management System of the
Indian Health Service.
(3)The
term Secretary means the Secretary of Veterans Affairs.
(4)The
term VistA means the VistA software program utilized by the
Department of Veterans Affairs.
3.Federal
Consolidated Health Information Technology Board
(a)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)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)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)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 appropriationsThere is authorized to be appropriated such
sums as may be necessary to carry out this section.
4.21st Century
Health Information Technology (HIT) Grants
(a)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)
(1)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)
(A)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)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)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)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)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)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)
(1)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)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)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 appropriationsThere 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.
5.21st Century
Health Information Technology Demonstration Program for Ineligible
Entities
(a)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)
(1)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)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)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)A
grant under this section shall be for a period of not to exceed 3 years, as
determined appropriate by the Board.
(e)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.