[Congressional Record Volume 151, Number 97 (Monday, July 18, 2005)]
[Senate]
[Pages S8420-S8426]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. ENZI (for himself, Mr. Kennedy, Mr. Frist, Mrs. Clinton, 
        Mr. Alexander, Mr. Dodd, Mr. Burr, Mr. Harkin, Mr. Isakson, Ms. 
        Mikulski, Mr. DeWine, Mr. Jeffords, Mr. Roberts, Mr. Bingaman, 
        Mrs. Murray, Mr. Hagel, Mr. Martinez, Mr. Talent, Mr. Obama, 
        Mr. Bond, and Mr. Nelson of Florida):
  S. 1418. A bill to enhance the adoption of a nationwide inter 
operable health information technology system and to improve the 
quality and reduce the costs of health care in the United States; to 
the Committee on Health, Education, Labor, and Pensions.
  Mr. ENZI. Mr. President, I rise today to introduce a bipartisan bill 
to improve the quality and efficiency of health care by harnessing the 
potential of information technology. I am joined in this effort by 
Senators Kennedy, Frist and Clinton.
  In recent weeks, Senator Kennedy and I introduced legislation to move 
our health care system into the electronic information age to serve 
patients better. Separately, Senators Frist and Clinton also introduced 
a bill to spur the adoption of health information technology to improve 
health care quality.
  Both of our bills were referred to the Committee on Health, 
Education, Labor, and Pensions, which I chair and on which we all 
serve. All of us put a lot of time and effort into crafting our bills, 
and we quickly realized that if we took the best of both of our bills 
and combined them into one, the whole would be much more than the sum 
of its parts.
  All of us believe that if we move from a paper-based health care 
system to secure electronic medical records, we will reduce mistakes 
and save lives, time and money. And because we share this goal, we 
worked together to combine our bills into one piece of legislation that 
will bring the government and the private sector together to make 
healthcare better, safer and more efficient by accelerating the 
adoption of interoperable information technology across our healthcare 
system.
  The sponsors of this bill span the political spectrum, but we still 
have many things in common. One of our common bonds--in fact, one of 
the things we have in common with all Americans--is that all of us are, 
or have been, or will someday be patients. And all of us either have 
stories to tell about frustrating experiences we've had, or that our 
family or friends have had, with navigating our health care system.
  We have an outstanding health care system in the United States. 
That's doesn't mean there isn't room for improvement, though. And one 
of the most important things we need to do in healthcare is to put 
information technology to work for patients, improving quality while 
reducing costs.
  I want to thank Senators Kennedy, Frist and Clinton for working 
together in a spirit of bipartisan compromise to mold our separate 
bills into one measure that will advance our vision of the future of 
health care. We know President Bush shares our commitment, because he 
has called for every American to have his or her own electronic health 
record by the middle of the next decade, and he has his Secretary of 
Health and Human Services, Michael Leavitt, working assiduously toward 
this objective.
  So I look forward to working with Senators Kennedy, Frist, and 
Clinton and the rest of my fellow Senators in the coming weeks and 
months to send this legislation to the President so that we can meet 
the ambitious goals that we all share.

[[Page S8421]]

  I ask unanimous consent that the text of this bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1418

       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 ``Wired for Health Care 
     Quality Act''.

     SEC. 2. IMPROVING HEALTH CARE, QUALITY, SAFETY, AND 
                   EFFICIENCY.

       The Public Health Service Act (42 U.S.C. 201 et seq.) is 
     amended by adding at the end the following:

              ``TITLE XXIX--HEALTH INFORMATION TECHNOLOGY

     ``SEC. 2901. DEFINITIONS.

       ``In this title:
       ``(1) Health care provider.--The term `health care 
     provider' means a hospital, skilled nursing facility, home 
     health entity, health care clinic, federally qualified health 
     center, group practice (as defined in section 1877(h)(4) of 
     the Social Security Act), a pharmacist, a pharmacy, a 
     laboratory, a physician (as defined in section 1861(r) of the 
     Social Security Act), a health facility operated by or 
     pursuant to a contract with the Indian Health Service, a 
     rural health clinic, and any other category of facility or 
     clinician determined appropriate by the Secretary.
       ``(2) Health information.--The term `health information' 
     has the meaning given such term in section 1171(4) of the 
     Social Security Act.
       ``(3) Health insurance plan.--The term `health insurance 
     plan' means--
       ``(A) a health insurance issuer (as defined in section 
     2791(b)(2));
       ``(B) a group health plan (as defined in section 
     2791(a)(1)); and
       ``(C) a health maintenance organization (as defined in 
     section 2791(b)(3)).
       ``(4) Laboratory.--The term `laboratory' has the meaning 
     given that term in section 353.
       ``(5) Pharmacist.--The term `pharmacist' has the meaning 
     given that term in section 804 of the Federal Food, Drug, and 
     Cosmetic Act.
       ``(6) Qualified health information technology.--The term 
     `qualified health information technology' means a 
     computerized system (including hardware, software, and 
     training) that--
       ``(A) protects the privacy and security of health 
     information;
       ``(B) maintains and provides permitted access to health 
     information in an electronic format;
       ``(C) incorporates decision support to reduce medical 
     errors and enhance health care quality;
       ``(D) complies with the standards adopted by the Federal 
     Government under section 2903; and
       ``(E) allows for the reporting of quality measures under 
     section 2908.
       ``(7) State.--The term `State' means each of the several 
     States, the District of Columbia, Puerto Rico, the Virgin 
     Islands, Guam, American Samoa, and the Northern Mariana 
     Islands.

     ``SEC. 2902. OFFICE OF THE NATIONAL COORDINATOR OF HEALTH 
                   INFORMATION TECHNOLOGY.

       ``(a) Office of National Health Information Technology.--
     There is established within the Office of the Secretary an 
     Office of the National Coordinator of Health Information 
     Technology (referred to in this section as the `Office'). The 
     Office shall be headed by a National Coordinator who shall be 
     appointed by the President, in consultation with the 
     Secretary, and shall report directly to the Secretary.
       ``(b) Purpose.--It shall be the purpose of the Office to 
     carry out programs and activities to develop a nationwide 
     interoperable health information technology infrastructure 
     that--
       ``(1) ensures that patients' health information is secure 
     and protected;
       ``(2) improves health care quality, reduces medical errors, 
     and advances the delivery of patient-centered medical care;
       ``(3) reduces health care costs resulting from 
     inefficiency, medical errors, inappropriate care, and 
     incomplete information;
       ``(4) ensures that appropriate information to help guide 
     medical decisions is available at the time and place of care;
       ``(5) promotes a more effective marketplace, greater 
     competition, and increased choice through the wider 
     availability of accurate information on health care costs, 
     quality, and outcomes;
       ``(6) improves the coordination of care and information 
     among hospitals, laboratories, physician offices, and other 
     entities through an effective infrastructure for the secure 
     and authorized exchange of health care information;
       ``(7) improves public health reporting and facilitates the 
     early identification and rapid response to public health 
     threats and emergencies, including bioterror events and 
     infectious disease outbreaks;
       ``(8) facilitates health research; and
       ``(9) promotes prevention of chronic diseases.
       ``(c) Duties of the National Coordinator.--The National 
     Coordinator shall--
       ``(1) serve as a member of the public-private American 
     Health Information Collaborative established under section 
     2903;
       ``(2) serve as the principal advisor to the Secretary 
     concerning the development, application, and use of health 
     information technology, and coordinate and oversee the health 
     information technology programs of the Department;
       ``(3) facilitate the adoption of a nationwide, 
     interoperable system for the electronic exchange of health 
     information;
       ``(4) ensure the adoption and implementation of standards 
     for the electronic exchange of health information to reduce 
     cost and improve health care quality;
       ``(5) ensure that health information technology policy and 
     programs of the Department are coordinated with those of 
     relevant executive branch agencies (including Federal 
     commissions) with a goal of avoiding duplication of efforts 
     and of helping to ensure that each agency undertakes health 
     information technology activities primarily within the areas 
     of its greatest expertise and technical capability;
       ``(6) to the extent permitted by law, coordinate outreach 
     and consultation by the relevant executive branch agencies 
     (including Federal commissions) with public and private 
     parties of interest, including consumers, payers, employers, 
     hospitals and other health care providers, physicians, 
     community health centers, laboratories, vendors and other 
     stakeholders;
       ``(7) advise the President regarding specific Federal 
     health information technology programs; and
       ``(8) submit the reports described under section 2903(i) 
     (excluding paragraph (4) of such section).
       ``(d) Detail of Federal Employees.--
       ``(1) In general.--Upon the request of the National 
     Coordinator, the head of any Federal agency is authorized to 
     detail, with or without reimbursement from the Office, any of 
     the personnel of such agency to the Office to assist it in 
     carrying out its duties under this section.
       ``(2) Effect of detail.--Any detail of personnel under 
     paragraph (1) shall--
       ``(A) not interrupt or otherwise affect the civil service 
     status or privileges of the Federal employee; and
       ``(B) be in addition to any other staff of the Department 
     employed by the National Coordinator.
       ``(3) Acceptance of detailees.--Notwithstanding any other 
     provision of law, the Office may accept detailed personnel 
     from other Federal agencies without regard to whether the 
     agency described under paragraph (1) is reimbursed.
       ``(e) Rule of Construction.--Nothing in this section shall 
     be construed to require the duplication of Federal efforts 
     with respect to the establishment of the Office, regardless 
     of whether such efforts were carried out prior to or after 
     the enactment of this title.
       ``(f) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as may be necessary 
     to carry out the activities of the Office under this section 
     for each of fiscal years 2006 through 2010.

     ``SEC. 2903. AMERICAN HEALTH INFORMATION COLLABORATIVE.

       ``(a) Purpose.--The Secretary shall establish the public-
     private American Health Information Collaborative (referred 
     to in this section as the `Collaborative') to--
       ``(1) advise the Secretary and recommend specific actions 
     to achieve a nationwide interoperable health information 
     technology infrastructure;
       ``(2) serve as a forum for the participation of a broad 
     range of stakeholders to provide input on achieving the 
     interoperability of health information technology; and
       ``(3) recommend standards (including content, 
     communication, and security standards) for the electronic 
     exchange of health information for adoption by the Federal 
     Government and voluntary adoption by private entities.
       ``(b) Composition.--
       ``(1) In general.--The Collaborative shall be composed of--
       ``(A) the Secretary, who shall serve as the chairperson of 
     the Collaborative;
       ``(B) the Secretary of Defense, or his or her designee;
       ``(C) the Secretary of Veterans Affairs, or his or her 
     designee;
       ``(D) the Secretary of Commerce, or his or her designee;
       ``(E) the National Coordinator for Health Information 
     Technology;
       ``(F) representatives of other relevant Federal agencies, 
     as determined appropriate by the Secretary; and
       ``(G) representatives from each of the following categories 
     to be appointed by the Secretary from nominations submitted 
     by the public--
       ``(i) consumer and patient organizations;
       ``(ii) experts in health information privacy and security;
       ``(iii) health care providers;
       ``(iv) health insurance plans or other third party payors;
       ``(v) standards development organizations;
       ``(vi) information technology vendors;
       ``(vii) purchasers or employers; and
       ``(viii) State or local government agencies or Indian tribe 
     or tribal organizations.
       ``(2) Considerations.--In appointing members under 
     paragraph (1)(G), the Secretary shall select individuals with 
     expertise in--
       ``(A) health information privacy;
       ``(B) health information security;
       ``(C) health care quality and patient safety, including 
     those individuals with experience in utilizing health 
     information technology to

[[Page S8422]]

     improve health care quality and patient safety;
       ``(D) data exchange; and
       ``(E) developing health information technology standards 
     and new health information technology.
       ``(3) Terms.--Members appointed under paragraph (1)(G) 
     shall serve for 2 year terms, except that any member 
     appointed to fill a vacancy for an unexpired term shall be 
     appointed for the remainder of such term. A member may serve 
     for not to exceed 180 days after the expiration of such 
     member's term or until a successor has been appointed.
       ``(c) Recommendations and Policies.--The Collaborative 
     shall make recommendations to identify uniform national 
     policies for adoption by the Federal Government and voluntary 
     adoption by private entities to support the widespread 
     adoption of health information technology, including--
       ``(1) protection of health information through privacy and 
     security practices;
       ``(2) measures to prevent unauthorized access to health 
     information;
       ``(3) methods to facilitate secure patient access to health 
     information;
       ``(4) the ongoing harmonization of industry-wide health 
     information technology standards;
       ``(5) recommendations for a nationwide interoperable health 
     information technology infrastructure;
       ``(6) the identification and prioritization of specific use 
     cases for which heath information technology is valuable, 
     beneficial, and feasible;
       ``(7) recommendations for the establishment of an entity to 
     ensure the continuation of the functions of the 
     Collaborative; and
       ``(8) other policies determined to be necessary by the 
     Collaborative.
       ``(d) Standards.--
       ``(1) Existing standards.--The standards adopted by the 
     Consolidated Health Informatics Initiative shall be deemed to 
     have been recommended by the Collaborative under this 
     section.
       ``(2) First year review.--Not later than 1 year after the 
     date of enactment of this title, the Collaborative shall--
       ``(A) review existing standards (including content, 
     communication, and security standards) for the electronic 
     exchange of health information, including such standards 
     adopted by the Secretary under paragraph (2)(A);
       ``(B) identify deficiencies and omissions in such existing 
     standards; and
       ``(C) identify duplication and overlap in such existing 
     standards;
     and recommend modifications to such standards as necessary.
       ``(3) Ongoing review.--Beginning 1 year after the date of 
     enactment of this title, and annually thereafter, the 
     Collaborative shall--
       ``(A) review existing standards (including content, 
     communication, and security standards) for the electronic 
     exchange of health information, including such standards 
     adopted by the Secretary under paragraph (2)(A);
       ``(B) identify deficiencies and omissions in such existing 
     standards; and
       ``(C) identify duplication and overlap in such existing 
     standards;
     and recommend modifications to such standards as necessary.
       ``(4) Limitation.--The standards described in this section 
     shall be consistent with any standards developed pursuant to 
     the Health Insurance Portability and Accountability Act of 
     1996.
       ``(e) Federal Action.--Not later than 60 days after the 
     issuance of a recommendation from the Collaborative under 
     subsection (d)(2), the Secretary of Health and Human 
     Services, the Secretary of Veterans Affairs, and the 
     Secretary of Defense, in collaboration with representatives 
     of other relevant Federal agencies, as determined appropriate 
     by the Secretary, shall jointly review such recommendations. 
     The Secretary shall provide for the adoption by the Federal 
     Government of any standard or standards contained in such 
     recommendation.
       ``(f) Coordination of Federal Spending.--Not later than 1 
     year after the adoption by the Federal Government of a 
     recommendation as provided for in subsection (e), and in 
     compliance with chapter 113 of title 40, United States Code, 
     no Federal agency shall expend Federal funds for the purchase 
     of any form of health information technology or health 
     information technology system for clinical care or for the 
     electronic retrieval, storage, or exchange of health 
     information that is not consistent with applicable standards 
     adopted by the Federal Government under subsection (e).
       ``(g) Coordination of Federal Data Collection.--Not later 
     than 3 years after the adoption by the Federal Government of 
     a recommendation as provided for in subsection (e), all 
     Federal agencies collecting health data for the purposes of 
     surveillance, epidemiology, adverse event reporting, 
     research, or for other purposes determined appropriate by the 
     Secretary shall comply with standards adopted under 
     subsection (e).
       ``(h) Voluntary Adoption.--Any standards adopted by the 
     Federal Government under subsection (e) shall be voluntary 
     with respect to private entities.
       ``(i) Reports.--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, on an annual basis, a report that--
       ``(1) describes the specific actions that have been taken 
     by the Federal Government and private entities to facilitate 
     the adoption of an interoperable nationwide system for the 
     electronic exchange of health information;
       ``(2) describes barriers to the adoption of such a 
     nationwide system;
       ``(3) contains recommendations to achieve full 
     implementation of such a nationwide system; and
       ``(4) contains a plan and progress toward the establishment 
     of an entity to ensure the continuation of the functions of 
     the Collaborative.
       ``(j) Application of FACA.--The Federal Advisory Committee 
     Act (5 U.S.C. App.) shall apply to the Collaborative, except 
     that the term provided for under section 14(a)(2) shall be 5 
     years.
       ``(k) Rule of Construction.--Nothing in this section shall 
     be construed to require the duplication of Federal efforts 
     with respect to the establishment of the Collaborative, 
     regardless of whether such efforts were carried out prior to 
     or after the enactment of this title.
       ``(l) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as may be necessary 
     to carry out this section for each of fiscal years 2006 
     through 2010.

     ``SEC. 2904. IMPLEMENTATION AND CERTIFICATION OF HEALTH 
                   INFORMATION STANDARDS.

       ``(a) Implementation.--
       ``(1) In general.--The Secretary, based upon the 
     recommendations of the Collaborative, shall develop criteria 
     to ensure uniform and consistent implementation of any 
     standards for the electronic exchange of health information 
     voluntarily adopted by private entities in technical 
     conformance with such standards adopted under this title.
       ``(2) Implementation assistance.--The Secretary may 
     recognize a private entity or entities to assist private 
     entities in the implementation of the standards adopted under 
     this title using the criteria developed by the Secretary 
     under this section.
       ``(b) Certification.--
       ``(1) In general.--The Secretary, based upon the 
     recommendations of the Collaborative, shall develop criteria 
     to ensure and certify that hardware, software, and support 
     services that claim to be in compliance with any standard for 
     the electronic exchange of health information adopted under 
     this title have established and maintained such compliance in 
     technical conformance with such standards.
       ``(2) Certification assistance.--The Secretary may 
     recognize a private entity or entities to assist in the 
     certification described under paragraph (1) using the 
     criteria developed by the Secretary under this section.
       ``(c) Delegation Authority.--The Secretary, through 
     consultation with the Collaborative, may delegate the 
     development of the criteria under subsections (a) and (b) to 
     a private entity.

     ``SEC. 2905. GRANTS TO FACILITATE THE WIDESPREAD ADOPTION OF 
                   INTEROPERABLE HEALTH INFORMATION TECHNOLOGY.

       ``(a) Competitive Grants to Facilitate the Widespread 
     Adoption of Health Information 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) be a--
       ``(i) not for profit hospital;
       ``(ii) group practice (including a single physician); or
       ``(iii) another health care provider not described in 
     clause (i) or (ii);
       ``(D) adopt the standards adopted by the Federal Government 
     under section 2903;
       ``(E) require that health care providers receiving such 
     grants implement the measurement system adopted under section 
     2908 and report to the Secretary on such measures;
       ``(F) demonstrate significant financial need; and
       ``(G) provide matching funds in accordance with paragraph 
     (4).
       ``(3) Use of funds.--Amounts received under a grant under 
     this subsection shall be used to facilitate the purchase and 
     enhance the utilization of qualified health information 
     technology systems.
       ``(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 are located in rural, 
     frontier, and other underserved areas as determined by the 
     Secretary; and
       ``(B) eligible entities that will link, to the extent 
     practicable, the qualified health information system to local 
     or regional health information networks.
       ``(b) Competitive Grants to States for the Development of 
     State Loan Programs to Facilitate the Widespread Adoption of 
     Health Information Technology.--

[[Page S8423]]

       ``(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 section. 
     A grant to a State 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 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 such 
     loans--
       ``(i) link, to the extent practicable, the qualified health 
     information system to a local or regional health information 
     network; and
       ``(ii) consult with the Center for Best Practices 
     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;
       ``(E) require that health care providers receiving such 
     loans adopt the standards adopted by the Federal Government 
     under section 2903(d);
       ``(F) require that health care providers receiving such 
     loans implement the measurement system adopted under section 
     2908 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; and
       ``(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.
       ``(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 
     facilitate the purchase and enhance the utilization of 
     qualified health information technology.
       ``(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 loan was 
     awarded, and each loan shall be fully amortized not later 
     than 10 years after the date of the loan.
       ``(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 otherwise not 
     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 
     publically 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) 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, protocols, and other 
     requirements adopted by the Secretary under sections 2903 and 
     2908.
       ``(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) physicians (as defined in section 1861(r) of the 
     Social Security Act), including physicians that provide 
     services to low income and underserved populations;
       ``(ii) hospitals (including hospitals that provide services 
     to low income and underserved populations);
       ``(iii) pharmacists or pharmacies;
       ``(iv) health insurance plans;
       ``(v) 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);
       ``(vi) rural health clinics (as defined in section 1861(aa) 
     of the Social Security Act);
       ``(vii) patient or consumer organizations;
       ``(viii) employers; and
       ``(ix) any other health care providers or other entities, 
     as determined appropriate by the Secretary;
       ``(D) 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;
       ``(E) adopt the standards adopted by the Secretary under 
     section 2903;

[[Page S8424]]

       ``(F) require that health care providers receiving such 
     loans implement the measurement system adopted under section 
     2908 and report to the Secretary on such measures;
       ``(G) facilitate the electronic exchange of health 
     information within the local or regional area and among local 
     and regional areas;
       ``(H) prepare and submit to the Secretary an application in 
     accordance with paragraph (3); and
       ``(I) agree to provide matching funds in accordance with 
     paragraph (5).
       ``(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 
     adopted under section 2903 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 2908;
       ``(iv) a plan that describes provisions to encourage the 
     implementation of the electronic exchange of health 
     information by all physicians, including single physician 
     practices and small physician groups participating in the 
     health information plan;
       ``(v) a plan to ensure the privacy and security of personal 
     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; and
       ``(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.

       ``(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;
       ``(4) a description of the efforts of recipients under this 
     section to facilitate secure patient access to health 
     information; and
       ``(5) 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 $125,000,000 
     for fiscal year 2006, $150,000,000 for fiscal year 2007, and 
     such sums as may be necessary for each of fiscal years 2008 
     through 2010.
       ``(2) Availability.--Amounts appropriated under paragraph 
     (1) shall remain available through fiscal year 2010.

     ``SEC. 2906. DEMONSTRATION PROGRAM TO INTEGRATE INFORMATION 
                   TECHNOLOGY INTO CLINICAL EDUCATION.

       ``(a) In General.--The Secretary may award grants 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. 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 shall--
       ``(1) submit to the Secretary an application at such time, 
     in such manner, and containing such information as the 
     Secretary may require;
       ``(2) submit to the Secretary a strategic plan for 
     integrating qualified health information technology in the 
     clinical education of health professionals and for ensuring 
     the consistent utilization of decision support software to 
     reduce medical errors and enhance health care quality;
       ``(3) be--
       ``(A) a health professions school;
       ``(B) a school of nursing; or
       ``(C) a graduate medical education program;
       ``(4) 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, the efficiency 
     of health care delivery, and in increasing the likelihood 
     that graduates of the grantee will adopt and incorporate 
     health information technology in the delivery of health care 
     services; and
       ``(5) provide matching funds in accordance with subsection 
     (c).
       ``(c) Use of Funds.--
       ``(1) In general.--With respect to a grant under subsection 
     (a), an eligible entity shall--
       ``(A) use grant funds in collaboration with 2 or more 
     disciplines; and
       ``(B) use grant funds to integrate qualified health 
     information technology into community-based clinical 
     education.
       ``(2) Limitation.--An eligible entity shall not use amounts 
     received under 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 this section only if the entity 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, $5,000,000 for 
     fiscal year 2007, and such sums as may be necessary for each 
     of fiscal years 2008 through 2010.
       ``(h) Sunset.--This section shall not apply after September 
     30, 2010.

     ``SEC. 2907. LICENSURE AND THE ELECTRONIC EXCHANGE OF HEALTH 
                   INFORMATION.

       ``(a) In General.--The Secretary shall carry out, or 
     contract with a private entity to carry out, a study that 
     examines--
       ``(1) the variation among State laws that relate to the 
     licensure, registration, and certification of medical 
     professionals; and
       ``(2) how such variation among State laws impacts the 
     secure electronic exchange of health information--
       ``(A) among the States; and
       ``(B) between the States and the Federal Government.
       ``(b) Report and Recommendations.--Not later than 1 year 
     after the date of enactment of this title, the Secretary 
     shall publish a report that--
       ``(1) describes the results of the study carried out under 
     subsection (a); and
       ``(2) makes recommendations to States regarding the 
     harmonization of State laws based on the results of such 
     study.

     ``SEC. 2908. QUALITY MEASUREMENT SYSTEMS.

       ``(a) In General.--The Secretary of Health and Human 
     Services, the Secretary of Veterans Affairs, the Secretary of 
     Defense, and representatives of other relevant Federal 
     agencies, as determined appropriate by the Secretary, 
     (referred to in the section as the `Secretaries') shall 
     jointly develop a quality measurement system for the purpose 
     of measuring the quality of care patients receive.
       ``(b) Requirements.--The Secretaries shall ensure that the 
     quality measurement system developed under subsection (a) 
     comply with the following:
       ``(1) Measures.--
       ``(A) In general.--Subject to subparagraph (B), the 
     Secretaries shall select measures of quality to be used by 
     the Secretaries under the systems.
       ``(B) Requirements.--In selecting the measures to be used 
     under each system pursuant to subparagraph (A), the 
     Secretaries shall, to the extent feasible, ensure that--

[[Page S8425]]

       ``(i) such measures are evidence based, reliable and valid;
       ``(ii) such measures include measures of process, 
     structure, patient experience, efficiency, and equity; and
       ``(iii) such measures include measures of overuse, 
     underuse, and misuse of health care items and services.
       ``(2) Priorities.--In developing the system under 
     subsection (a), the Secretaries shall ensure that priority is 
     given to--
       ``(A) measures with the greatest potential impact for 
     improving the quality and efficiency of care provided under 
     Federal programs;
       ``(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; and
       ``(C) measures which may inform health care decisions made 
     by consumers and patients.
       ``(3) Weights of measures.--The Secretaries shall assign 
     weights to the measures used by the Secretaries under each 
     system established under subsection (a).
       ``(4) Risk adjustment.--The Secretaries shall establish 
     procedures to account for differences in patient health 
     status, patient characteristics, and geographic location. To 
     the extent practicable, such procedures shall recognize 
     existing procedures.
       ``(5) Maintenance.--The Secretaries shall, as determined 
     appropriate, but in no case more often than once during each 
     12-month period, update the quality measurement systems 
     developed under subsection (a), including through--
       ``(A) the addition of more accurate and precise measures 
     under the systems and the retirement of existing outdated 
     measures under the systems; and
       ``(B) the refinement of the weights assigned to measures 
     under the systems.
       ``(c) Required Considerations in Developing and Updating 
     the Systems.--In developing and updating the quality 
     measurement systems under this section, the Secretaries 
     shall--
       ``(1) consult with, and take into account the 
     recommendations of, the entity that the Secretaries has an 
     arrangement with under subsection (e);
       ``(2) consult with representatives of health care 
     providers, consumers, employers, and other individuals and 
     groups that are interested in the quality of health care; and
       ``(3) take into account--
       ``(A) any demonstration or pilot program conducted by the 
     Secretaries relating to measuring and rewarding quality and 
     efficiency of care;
       ``(B) any existing activities conducted by the Secretaries 
     relating to measuring and rewarding quality and efficiency;
       ``(C) any existing activities conducted by private entities 
     including health insurance plans and payors; and
       ``(D) the report by the Institute of Medicine of the 
     National Academy of Sciences under section 238(b) of the 
     Medicare Prescription Drug, Improvement, and Modernization 
     Act of 2003.
       ``(d) Required Considerations in Implementing the 
     Systems.--In implementing the quality measurement systems 
     under this section, the Secretaries shall take into account 
     the recommendations of public-private entities--
       ``(1) that are established to examine issues of data 
     collection and reporting, including the feasibility of 
     collecting and reporting data on measures; and
       ``(2) that involve representatives of health care 
     providers, consumers, employers, and other individuals and 
     groups that are interested in quality of care.
       ``(e) Arrangement With an Entity to Provide Advice and 
     Recommendations.--
       ``(1) Arrangement.--On and after July 1, 2006, the 
     Secretaries shall have in place an arrangement with an entity 
     that meets the requirements described in paragraph (2) under 
     which such entity provides the Secretaries with advice on, 
     and recommendations with respect to, the development and 
     updating of the quality measurement systems under this 
     section, including the assigning of weights to the measures 
     under subsection (b)(2).
       ``(2) Requirements described.--The requirements described 
     in this paragraph are the following:
       ``(A) The entity is a private nonprofit entity governed by 
     an executive director and a board.
       ``(B) The members of the entity include representatives 
     of--
       ``(i) health insurance plans and providers with experience 
     in the care of individuals with multiple complex chronic 
     conditions or groups representing such health insurance plans 
     and providers;
       ``(ii) groups representing patients and consumers;
       ``(iii) purchasers and employers or groups representing 
     purchasers or employers;
       ``(iv) organizations that focus on quality improvement as 
     well as the measurement and reporting of quality measures;
       ``(v) State government health programs;
       ``(vi) 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
       ``(vii) individuals or entities involved in the development 
     and establishment of standards and certification for health 
     information technology systems and clinical data.
       ``(C) The membership of the entity is representative of 
     individuals with experience with urban health care issues and 
     individuals with experience with rural and frontier health 
     care issues.
       ``(D) If the entity requires a fee for membership, the 
     entity shall provide assurances to the Secretaries that such 
     fees are not a substantial barrier to participation in the 
     entity's activities related to the arrangement with the 
     Secretaries.
       ``(E) The entity--
       ``(i) permits any member described in subparagraph (B) to 
     vote on matters of the entity related to the arrangement with 
     the Secretary under paragraph (1); and
       ``(ii) ensures that member voting provides a balance among 
     disparate stakeholders, so that no member organization 
     described in subparagraph (B) unduly influences the outcome.
       ``(F) With respect to matters related to the arrangement 
     with the Secretary under paragraph (1), the entity conducts 
     its business in an open and transparent manner and provides 
     the opportunity for public comment.
       ``(G) The entity operates 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 10409113) and Office of 
     Management and Budget Revised Circular A09119 (published in 
     the Federal Register on February 10, 1998).
       ``(f) Use of Quality Measurement System.--
       ``(1) In general.--For purposes of activities conducted or 
     supported by the Secretary under this Act, the Secretary 
     shall, to the extent practicable, adopt and utilize the 
     measurement system developed under this section.
       ``(2) Collaborative agreements.--With respect to activities 
     conducted or supported by the Secretary under this Act, the 
     Secretary may establish collaborative agreements with private 
     entities, including group health plans and health insurance 
     issuers, providers, purchasers, consumer organizations, and 
     entities receiving a grant under section 2908, to--
       ``(A) encourage the use of the health care quality measures 
     adopted by the Secretary under this section; and
       ``(B) foster uniformity between the health care quality 
     measures utilized by private entities.
       ``(g) Dissemination of Information.--Beginning on January 
     1, 2008, in order to make comparative quality information 
     available to health care consumers, health professionals, 
     public health officials, researchers, and other appropriate 
     individuals and entities, the Secretary shall provide for the 
     aggregation and analysis of quality measures collected under 
     section 2905 and the dissemination of recommendations and 
     best practices derived in part from such analysis.
       ``(h) Technical Assistance.--The Secretary shall provide 
     technical assistance to public and private entities to enable 
     such entities to--
       ``(1) implement and use evidence-based guidelines with the 
     greatest potential to improve health care quality, 
     efficiency, and patient safety; and
       ``(2) establish mechanisms for the rapid dissemination of 
     information regarding evidence-based guidelines with the 
     greatest potential to improve health care quality, 
     efficiency, and patient safety.

     ``SEC. 2909. APPLICABILITY OF PRIVACY AND SECURITY 
                   REGULATIONS.

       ``The regulations promulgated by the Secretary under part C 
     of title XI of the Social Security Act and sections 261, 262, 
     263, and 264 of the Health Insurance Portability and 
     Accountability Act of 1996 with respect to the privacy, 
     confidentiality, and security of health information shall--
       ``(1) apply to any health information stored or transmitted 
     in an electronic format on or after the date of enactment of 
     this title; and
       ``(2) apply to the implementation of standards, programs, 
     and activities under this title.

     ``SEC. 2910. STUDY OF REIMBURSEMENT INCENTIVES.

       ``The Secretary shall carry out, or contract with a private 
     entity to carry out, a study that examines methods to create 
     efficient reimbursement incentives for improving health care 
     quality in Federally qualified health centers, rural health 
     clinics, and free clinics.''.

     SEC. 3. 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) Center for Best Practices.--
       ``(1) In general.--The Secretary, acting through the 
     Director, shall develop a Center for Best Practices 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 section 2903 and 2908.
       ``(2) Center for best practices.--
       ``(A) In general.--The Center shall support activities to 
     meet goals, including--
       ``(i) providing for the widespread adoption of 
     interoperable health information technology;
       ``(ii) providing 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;
       ``(iii) the development of solutions to barriers to the 
     exchange of electronic health information; or

[[Page S8426]]

       ``(iv) 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.
       ``(B) Purposes.--The purpose of the Center is to--
       ``(i) provide a forum for the exchange of knowledge and 
     experience;
       ``(ii) accelerate the transfer of lessons learned from 
     existing public and private sector initiatives, including 
     those currently receiving Federal financial support;
       ``(iii) assemble, analyze, and widely disseminate evidence 
     and experience related to the adoption, implementation, and 
     effective use of interoperable health information technology; 
     and
       ``(iv) assure the timely provision of technical and expert 
     assistance from the Agency and its contractors.
       ``(C) 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.
       ``(3) Technical assistance telephone number or website.--
     The Secretary shall establish a toll-free telephone number or 
     Internet website to provide health care providers and 
     patients with a single point of contact to--
       ``(A) learn about Federal grants and technical assistance 
     services related to interoperable health information 
     technology;
       ``(B) learn about qualified health information technology 
     and the quality measurement system adopted by the Federal 
     Government under sections 2903 and 2908;
       ``(C) learn about regional and local health information 
     networks for assistance with health information technology; 
     and
       ``(D) disseminate additional information determined by the 
     Secretary.
       ``(4) Authorization of appropriations.--There are 
     authorized to be appropriated to carry out this subsection, 
     such sums as may be necessary for each of fiscal years 2006 
     through 2010.''.

     SEC. 4. REAUTHORIZATION OF INCENTIVE GRANTS REGARDING 
                   TELEMEDICINE.

       Section 330L(b) of the Public Health Service Act (42 U.S.C. 
     254c-18(b)) is amended by striking ``2002 through 2006'' and 
     inserting ``2006 through 2010''

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