[Congressional Record Volume 151, Number 143 (Wednesday, November 2, 2005)]
[Senate]
[Pages S12240-S12242]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. COLEMAN (for himself, Mr. Bayh, Mr. Cornyn, and Mr. 
        Lugar):
  S. 1952. A bill to provide grants for rural health information 
technology development activities; to the Committee on Health, 
Education, Labor, and Pensions.
  Mr. COLEMAN. Mr. President, as United States Senators, we are well 
aware of the rising cost of health care and the difficulty of health 
care access in rural areas. Through the improvement of health 
information technology, we will see overall productivity and quality 
improvements to our health care system. New technologies make the 
system more efficient and effective by diagnosing diseases sooner, 
providing preventive and ongoing managed care.
  Today, I am proud to be joined by my friends, Senators Bayh, Cornyn, 
and Lugar, in introducing the Critical Access to Health Information 
Technology Act to help Critical Access Hospitals compete for health 
information technology grants.
  Our legislation would give smaller rural health hospitals a 
competitive edge for health information technology grants. A health 
system technology infrastructure should be encouraged and facilitated 
as broadly and rapidly as possible to help reduce medical errors, 
improve quality of care and reduce rising health care costs.
  A recent American Hospitals Association study shows that while 9 out 
of 10 hospitals are using or considering using health information 
technology

[[Page S12241]]

for clinical uses, most cite cost as a major impediment to broader 
adoption, especially for small or rural hospitals. The study suggests 
that the use of health information technology in caring for patients is 
evolving as hospitals adopt specific technologies based on their needs 
and priorities, size and financial resources.
  The Critical Access to Health Information Technology Act creates a 
grant program administered by the Secretary of Health and Human 
Services in conjunction with State agencies for improving health 
information technology in our Nation's rural areas. In addition, this 
legislation supports the next generation of coding system, ICD-10, that 
will modernize and expand Centers for Medicare and Medicaid Services' 
capacity to keep pace with changes in medical practice and technology. 
ICD-10 was developed as an improvement to ICD-9 which has not been 
updated since 1980. The adoption of ICD-10 will allow for far more 
accurate, detailed and descriptive coding, and will allow the system to 
adapt as future changes are warranted. The transition to ICD-10 is 
time-sensitive, as the number of available ICD-9 codes is rapidly 
dwindling.
  Earlier this Congress, I, along with Senator Pryor, introduced the 
bipartisan ``Rural Renaissance II Act.'' This is a bipartisan piece of 
legislation, based on earlier legislation introduced last year, which 
would establish a private-public partnership to provide bonds that will 
finance grants that will fund key rural development projects to address 
critical rural infrastructure problems. I am pleased that Chairman 
Grassley has agreed to include our Rural Renaissance Act II in his tax 
reconciliation package later this year.
  These bonds will be made available to small rural communities of 
50,000 or fewer for: water and waste facilities, affordable housing, 
community facilities, including hospitals, fire and police stations, 
and nursing and assisted living facilities, farmer-owned value-added 
agriculture or renewable energy projects, including ethanol, biodiesel 
and wind, distance learning and telemedicine and high speed internet 
access and rural teleworks projects.
  I urge my fellow colleagues to join me in ensuring Critical Access 
Hospitals have the opportunity to keep pace with health information 
technology by supporting the Critical Access to Health Information 
Technology Act.
  I ask unanimous consent that the text of the bill be printed in the 
Record.
  There being no objection, the bill was ordered to be printed in the 
Record, as follows:

                                S. 1952

       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 ``Critical Access to Health 
     Information Technology Act of 2005''.

     SEC. 2. HEALTH INFORMATION TECHNOLOGY GRANT PROGRAM.

       (a) In General.--The Secretary of Health and Human Services 
     (referred to in this section as the ``Secretary'') shall 
     establish and implement a program to award grants to increase 
     access to health care in rural areas by improving health 
     information technology, including the reporting, monitoring, 
     and evaluation required under this section.
       (b) State Grants.--The Secretary shall award grants to 
     States to be used to carry out the State plan under 
     subsection (e) through the awarding of subgrants to local 
     entities within the State. Amounts awarded under such a grant 
     may only be used in the fiscal year in which the grant is 
     awarded or in the immediately subsequent fiscal year.
       (c) Amount of Grant.--From amounts appropriated under 
     subsection (k) for each fiscal year, the Secretary shall 
     award a grant to each State that complies with subsection (e) 
     in an amount that is based on the total number of critical 
     access hospitals in the State (as certified by the Secretary 
     under section 1817(e) of the Social Security Act) bears to 
     the total number of critical access hospitals in all States 
     that comply with subsection (e).
       (d) Lead Agency.--A State that receives a grant under this 
     section shall designate a lead agency to--
       (1) administer, directly or through other governmental or 
     nongovernmental agencies, the financial assistance received 
     under the grant;
       (2) develop, in consultation with appropriate 
     representatives of units of general purpose local government 
     and the hospital association of the State, the State plan; 
     and
       (3) coordinate the expenditure of funds and provision of 
     services under the grant with other Federal and State health 
     care programs.
       (e) State Plan.--To be eligible for a grant under this 
     section, a State shall establish a State plan that shall--
       (1) identify the State's lead agency;
       (2) provide that the State shall use the amounts provided 
     to the State under the grant program to address health 
     information technology improvements and to pay administrative 
     costs incurred in connection with providing the assistance to 
     local grant recipients;
       (3) provide that benefits shall be available throughout the 
     entire State; and
       (4) require that the lead agency consult with the hospital 
     association of such State and rural hospitals located in such 
     State on the most appropriate ways to use the funds received 
     under the grant.
       (f) Awarding of Local Grants.--
       (1) In general.--The lead agency of a State shall use 
     amounts received under a grant under subsection (a) to award 
     local grants on a competitive basis. In determining whether a 
     local entity is eligible to receive a grant under this 
     subsection, the lead agency shall utilize the following 
     selection criteria:
       (A) The extent to which the entity demonstrates a need to 
     improve its health information reporting and health 
     information technology.
       (B) The extent to which the entity will serve a community 
     with a significant low-income or other medically underserved 
     population.
       (2) Application and approval.--To be eligible to receive a 
     local grant under this subsection, an entity shall be a 
     government-owned or private nonprofit hospital (including a 
     non-Federal short-term general acute care facility that is a 
     critical access hospital located outside a Metropolitan 
     Statistical Area, in a rural census tract of a Metropolitan 
     Statistical Area as determined under the most recent version 
     of the Goldsmith Modification or the Rural-Urban Commuting 
     Area codes, as determined by the Office of Rural Health 
     Policy of the Health Resources and Services Administration, 
     or is located in an area designated by any law or regulation 
     of the State in which the hospital is located as a rural area 
     (or is designated by such State as a rural hospital or 
     organization)) that submits an application to the lead agency 
     of the State that--
       (A) includes a description of how the hospital intends to 
     use the funds provided under the grant;
       (B) includes such information as the State lead agency may 
     require to apply the selection criteria described in 
     paragraph (1);
       (C) includes measurable objectives for the use of the funds 
     provided under the grant;
       (D) includes a description of the manner in which the 
     applicant will evaluate the effectiveness of the activities 
     carried out under the grant;
       (E) contains an agreement to maintain such records, make 
     such reports, and cooperate with such reviews or audits as 
     the lead agency and the Secretary may find necessary for 
     purposes of oversight of program activities and expenditures;
       (F) contains a plan for sustaining the activities after 
     Federal support for the activities has ended; and
       (G) contains such other information and assurances as the 
     Secretary may require.
       (3) Use of amounts.--
       (A) In general.--An entity shall use amounts received under 
     a local grant under this section to--
       (i) offset the costs incurred by the entity after December 
     31, 2005, that are related to clinical health care 
     information systems and health information technology 
     designed to improve quality of health care and patient 
     safety; and
       (ii) offset costs incurred by the entity after December 31, 
     2005, that are related to enabling health information 
     technology to be used for the collection and use of 
     clinically specific data, promoting the interoperability of 
     health care information across health care settings, 
     including reporting to Federal and State agencies, and 
     facilitating clinic decision support through the use of 
     health information technology.
       (B) Eligible costs.--Costs that are eligible to be offset 
     under subparagraph (A) shall include the cost of--
       (i) purchasing, leasing, and installing computer software 
     and hardware, including handheld computer technologies, and 
     related services;
       (ii) making improvements to existing computer software and 
     hardware;
       (iii) purchasing or leasing communications capabilities 
     necessary for clinical data access, storage, and exchange;
       (iv) services associated with acquiring, implementing, 
     operating, or optimizing the use of new or existing computer 
     software and hardware and clinical health care information 
     systems;
       (v) providing education and training to staff on 
     information systems and technology designed to improve 
     patient safety and quality of care; and
       (vi) purchasing, leasing, subscribing, integrating, or 
     servicing clinical decision support tools that integrate 
     patient-specific clinic data with well-established national 
     treatment guidelines, and provide ongoing continuous quality 
     improvement functions that allow providers to assess 
     improvement rates over time and against averages for similar 
     providers.
       (4) Grant limit.--The amount of a local grant under this 
     subsection shall not exceed $250,000.

[[Page S12242]]

       (g) Reporting, Monitoring, and Evaluation.--The lead agency 
     of a State that receives a grant under this section shall 
     annually report to the Secretary--
       (1) the amounts received under the grant;
       (2) the amounts allocated to State grant recipients under 
     the grant;
       (3) the breakdown of types of expenditures made by the 
     local grant recipients with such funds; and
       (4) such other information required by the Secretary to 
     assist the Secretary in monitoring the effectiveness of 
     activities carried out under this grant.
       (h) Review of Compliance With State Plan.--The Secretary 
     shall review and monitor State compliance with the 
     requirements of this section and the State plan submitted 
     under subsection (e). If the Secretary, after reasonable 
     notice to a State and opportunity for a hearing, finds that 
     there has been a failure by the State to comply substantially 
     with any provision or requirement set forth in the State plan 
     or the requirements of this section, the Secretary shall 
     notify the lead agency involved of such finding and that no 
     further payments to the State will be made with respect to 
     the grant until the Secretary is satisfied that the State is 
     in compliance or that the noncompliance will be promptly 
     corrected.
       (i) Preemption of Certain Laws.--The provisions of this 
     section shall preempt applicable Federal and State 
     procurement laws with respect to health information 
     technology purchased under this section.
       (j) Relation to Other Programs.--Amounts appropriated under 
     this section shall be in addition to appropriations for 
     Federal programs for Rural Hospital FLEX grants, Rural Health 
     Outreach grants, and Small Rural Hospital Improvement Program 
     grants.
       (k) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section, $10,000,000 for 
     each of fiscal years 2006 through 2008.

     SEC. 3. REPLACEMENT OF THE INTERNATIONAL STATISTICAL 
                   CLASSIFICATION OF DISEASES.

       (a) In General.--Not later than October 1, 2006, the 
     Secretary of Health and Human Services shall promulgate a 
     final rule concerning the replacement of the International 
     Statistical Classification of Diseases, 9th revision, 
     Clinical Modification (referred to in this section as the 
     ``ICD-9-CM''), under the regulation promulgated under section 
     1173(c) of the Social Security Act (42 U.S.C. 1320d-2(c)), 
     including for purposes of part A of title XVIII, or part B 
     where appropriate, of such Act, with the use of each of the 
     following:
       (1) The International Statistical Classification of 
     Diseases and Related Health Problems, 10th revision, Clinical 
     Modification (referred to in this section as ``ICD-10-CM''.
       (2) The International Statistical Classification of 
     Diseases and Related Health Problems, 10th revision, Clinical 
     Modification Coding System (referred to in this section as 
     ``ICD-10-PCS'').
       (b) Implementation.--
       (1) In general.--The Secretary of Health and Human Services 
     shall ensure that the rule promulgated under subsection (a) 
     is implemented by not later than October 1, 2009. In carrying 
     out the preceding sentence, the Secretary shall ensure that 
     such rule ensure that Accredited Standards Committee X12 
     HIPAA transactions version (v) 4010 is upgraded to a newer 
     version 5010, and that the National Council for Prescription 
     Drug Programs Telecommunications Standards version 5.1 is 
     updated to a newer version (to be released by the named by 
     the National Council for Prescription Drug Programs 
     Telecommunications Standards) that supersedes, in part, 
     existing legislation and regulations under the Health 
     Insurance Portability and Accountability Act of 1996.
       (2) Authority.--The Secretary of Health and Human Services 
     shall have the authority to adopt, without notice and comment 
     rulemaking, standards for electronic health care transactions 
     under section 1173 of the Social Security Act (42 U.S.C. 
     1320d-2) that are recommended to the Secretary by the 
     Accredited Standards Committee X12 of the American National 
     Standards Institute in relation to the replacement of ICD-9-
     CM with ICD-10-CM and ICD-10-PCS. Such modifications shall be 
     published in the Federal Register.
       (c) Notice of Intent.--Not later than 30 days after the 
     date of enactment of this Act, the Secretary of Health and 
     Human Services shall issue and publish in the Federal 
     Register a Notice of Intent that--
       (1) adoption of Accredited Standards Committee X12 HIPAA 
     transactions version (v) 5010 shall occur not later than 
     April 1, 2007, and compliance with such rule shall apply to 
     transactions occurring on or after April 1, 2009;
       (2) adoption of the National Council for Prescription Drug 
     Programs Telecommunications Standards version 5.1 with a new 
     version will occur not later than April 1, 2007, and 
     compliance with such rule shall apply to transactions 
     occurring on or after April 1, 2009;
       (3) adoption of ICD-10-CM and ICD-10-PCS will occur not 
     later than October 1, 2006, and compliance with such rules 
     shall apply to transactions occurring on or after October 1, 
     2009; and
       (4) covered entities and health technology vendors under 
     the Health Insurance Potability and Accountability Act of 
     1996 shall begin the process of planning for and implementing 
     the updating of the new versions and editions referred to in 
     this subsection.
       (d) Assurances of Code Availability.--The Secretary of 
     Health and Human Services shall take such action as may be 
     necessary to ensure that procedure codes are promptly 
     available for assignment and use under ICD-9-CM until such 
     time as ICD-9-CM is replaced as a code set standard under 
     section 1173(c) of the Social Security Act with ICD-10 PCS.
       (e) Deadline.--Notwithstanding section 1172(f) of the 
     Social Security Act (42 U.S.C. 1320d-1(f)), the Secretary of 
     Health and Human Services shall adopt the modifications 
     provided for in this section without a recommendation of the 
     National Committee on Vital and Health Statistics unless such 
     recommendation is made to the Secretary on or before a date 
     specified by the Secretary as consistent with the 
     implementation of the replacement of ICD-9-CM with ICD-10-CM 
     and ICD-10-PCS for transactions occurring on or after October 
     1, 2009.
       (f) Limitation on Judicial Review.--The rule promulgated 
     under subsection (a) shall not be subject to judicial review.
       (g) Application.--The rule promulgated under subsection (a) 
     shall apply to transactions occurring on or after October 1, 
     2009.
       (h) Rule of Construction.--Nothing in this section shall be 
     construed as effecting the application of classification 
     methodologies or codes, such as the Current Procedural 
     Terminology (CPT) as maintained and distributed by the 
     American Medical Association and the Healthcare Common 
     Procedure Coding System (HCPCS) as maintained and distributed 
     by the Department of Health and Human Services, other than 
     under the International Statistical Classification of Disease 
     and Related Health Problems.
                                 ______