[Congressional Record Volume 152, Number 101 (Thursday, July 27, 2006)]
[House]
[Pages H5962-H5972]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]




PROVIDING FOR CONSIDERATION OF H.R. 4157, HEALTH INFORMATION TECHNOLOGY 
                         PROMOTION ACT OF 2006

  Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, by direction of the 
Committee on Rules, I call up House Resolution 952 and ask for its 
immediate consideration.
  The Clerk read the resolution, as follows:

                              H. Res. 952

       Resolved, That at any time after the adoption of this 
     resolution the Speaker may, pursuant to clause 2(b) of rule 
     XVIII, declare the House resolved into the Committee of the 
     Whole House on the state of the Union for consideration of 
     the bill (H.R. 4157) to amend the Social Security Act to 
     encourage the dissemination, security, confidentiality, and 
     usefulness of health information technology. The first 
     reading of the bill shall be dispensed with. All points of 
     order against consideration of the bill are waived. General 
     debate shall be confined to the bill and shall not exceed one 
     hour, with 35 minutes equally divided and controlled by the 
     chairman and ranking minority member of the Committee on 
     Energy and Commerce and 25 minutes equally divided and 
     controlled by the chairman and ranking minority member of the 
     Committee on Ways and Means. After general debate the bill 
     shall be considered for amendment under the five-minute rule. 
     In lieu of the amendments recommended by the Committees on 
     Energy and Commerce and Ways and Means now printed in the 
     bill, the amendment in the nature of a substitute printed in 
     part A of the report of the Committee on Rules accompanying 
     this resolution, modified by the amendment printed in part B 
     of such report, shall be considered as adopted in the House 
     and in the Committee of the Whole. The bill, as amended, 
     shall be considered as the original bill for the purpose of 
     further amendment under the five-minute rule and shall be 
     considered as read. All points of order against provisions in 
     the bill, as amended, are waived. Notwithstanding clause 11 
     of rule XVIII, no amendment to the bill, as amended, shall be 
     in order except those printed in part C of the report of the 
     Committee on Rules. Each such amendment may be offered only 
     in the order printed in the report, may be offered only by a 
     Member designated in the report, shall be considered as read, 
     shall be debatable for the time specified in the report 
     equally divided and controlled by the proponent and an 
     opponent, shall not be subject to amendment, and shall not be 
     subject to a demand for division of the question in the House 
     or in the Committee of the Whole. All points of order against 
     such amendments are waived. At the conclusion of 
     consideration of the bill for amendment the Committee shall 
     rise and report the bill, as amended, to the House with such 
     further amendments as may have been adopted. The previous 
     question shall be considered as ordered on the bill and 
     amendments thereto to final passage without intervening 
     motion except one motion to recommit with or without 
     instructions.
       Sec. 2. After passage of H.R. 4157, it shall be in order to 
     consider in the House S. 1418. All points of order against 
     the Senate bill and against its consideration are waived. It 
     shall be in order to move to strike all after the enacting 
     clause of the Senate bill and to insert in lieu thereof the 
     provisions of H.R. 4157 as passed by the House. All points of 
     order against that motion are waived. If the motion is 
     adopted and the Senate bill, as amended, is passed, then it 
     shall be in order to move that the House insist on its 
     amendments to S. 1418 and request a conference with the 
     Senate thereon.
       Sec. 3. House Resolution 924 is laid upon the table.

  The SPEAKER pro tempore. The gentleman from Florida (Mr. Lincoln 
Diaz-Balart) is recognized for 1 hour.
  Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, for the purpose of 
debate only, I yield the customary 30 minutes to the gentlewoman from 
California (Ms. Matsui), pending which I yield myself such time as I 
may consume. During consideration of this resolution, all time yielded 
is for the purpose of debate only.
  (Mr. LINCOLN DIAZ-BALART of Florida asked and was given permission to 
revise and extend his remarks.)
  Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, the rule provides 1 
hour of general debate with 35 minutes equally divided and controlled 
by the chairman and ranking minority member of the Committee on Energy 
and Commerce and 25 minutes equally divided and controlled by the 
chairman and ranking minority member on the Committee on Ways and 
Means. The rule also provides one motion to recommit with or without 
instructions.
  Mr. Speaker, the information age has greatly changed our economy by 
bringing about increased efficiencies in productivity. Virtually every 
sector of our economy benefits from the use of new information 
technologies.
  Right here in Congress, for example, the use of technology has opened 
up access to the workings of our democracy like never before. 
Technology allows our constituents to quickly view the status of a bill 
or to look up our voting records.
  Mr. Speaker, the health care industry has not fully embraced the 
advantages and benefits of information technology. According to a study 
by the RAND Corporation, only 15 percent of physicians and 20 percent 
of hospitals use computerized patient files.
  Broad use of information technology in the health care system would 
certainly improve the quality and efficiency of health care delivery.
  The use of health information technology is increasingly necessary to 
deliver the best care possible to individuals with chronic illnesses. 
The use of health care IT would also promote interoperability between 
providers and payers.
  Efficiencies from coordinated development of health IT will 
accelerate and advance private and public efforts to improve quality, 
lower costs, reduce fraud and abuse, and promote the coordination of 
care. The synergy of these efficiencies will help achieve better health 
outcomes for patients.
  The Health Information Technology Promotion Act, which we bring to 
the floor today, will improve the quality of care Americans receive 
through national adoption of electronic medical records and e-
prescribing systems.
  The legislation promotes the adoption and use of interoperable health 
information technology that prevents medical and prescription errors 
and costly duplicate tests, eliminates lost medical records, simplifies 
our administrative system, and improves medical care and the treatment 
of chronic illnesses.
  The legislation we bring to the floor today provides grants for the 
use of health information technology to coordinate care among the 
uninsured and to implement technology in small physician practices. It 
also updates diagnostic coding, systems for the digital age, and 
provides for an expedited process to update standards.
  Mr. Speaker, this legislation was introduced by Congresswoman Nancy 
Johnson, my dear friend, who is a true expert in the field of health 
care. It was reported out of the House Energy and Commerce Committee. 
We believe it is time that the health care industry moves to a digital 
future, and this legislation is an important step in seeing that to 
reality.
  Mr. Speaker, I would like to thank Congresswoman Johnson and Chairman 
Barton and Chairman Thomas for

[[Page H5963]]

their leadership on this important issue. I urge my colleagues to 
support the rule that brings this legislation forth as well as the 
underlying legislation.
  Mr. Speaker, I reserve the balance of my time.
  Ms. MATSUI. Mr. Speaker, I thank my good friend, the gentleman from 
Florida, for yielding me time; and I yield myself such time as I may 
consume.
  (Ms. MATSUI asked and was given permission to revise and extend her 
remarks.)
  Ms. MATSUI. Mr. Speaker, every Member of Congress recognizes the 
importance of health information technology. It holds the potential to 
save lives by reducing medical errors, and it can make our health care 
system more efficient by providing better care while keeping costs 
down.
  In short, we could revolutionize the way our health care is 
delivered. What exactly is the potential? Physicians could have access 
to every relevant part of a patient's medical history at the precise 
moment a life-or-death decision needs to be made.
  It is the tens of thousands of lives saved because of fewer medical 
errors. It means the newest ``Physicians Desks Reference'' and the most 
cutting-edge medical research on a hand-held device that a doctor can 
have at the patient's bedside.
  This is not pie-in-the-sky ambition. Some health care leaders have 
already begun to adopt these ideas with great success. In the year 
2000, the Veterans Administration implemented the most advanced 
electronic medical records system in the United States.
  A recent article in Business Week noted that ``while studies show 
that 3 to 8 percent of the Nation's prescriptions are filed 
erroneously, the VA's prescription accuracy rate is greater than 99.99 
percent, a level most hospitals only dream about.''
  It should not be surprising that while many patients lost their paper 
medical records in the terrible aftermath of Hurricane Katrina, 
veterans did not. Veterans living in New Orleans were able to access 
their medical records at other VA hospitals because of health 
information technology.
  Another example comes from my hometown of Sacramento. The UC Davis 
Medical Center has a world-renowned telemedicine program which connects 
patients in 80 rural areas across California to an immense amount of 
specialty care in Sacramento.
  Let me tell you the story of Levi, a child who lives on a ranch in a 
nine-person town 60 miles north of Sacramento. After accidentally 
suffering third-degree burns on his leg, his parents took him to the 
closest hospital. Because of UC Davis's telemedicine program, Levi was 
treated by one of the few pediatric burn specialists in this country 
remotely from Sacramento.
  Information technology could make this amazing program even better. 
Widespread adoption of this technology would enhance this expert advice 
by allowing the rural doctor to send Levi's medical history to the 
specialists at UC Davis instantly.
  UC Davis has begun to implement electronic medical records, but many 
of these outlying areas cannot afford this technology without seed 
money.
  That is the goal of establishing a national health information 
infrastructure. But we know such a comprehensive program isn't cheap. 
It could cost individual hospitals several million dollars and 
individual physicians $20,000 or $30,000 apiece.
  So the issue needs more than Federal guidelines. It needs Federal 
financial support, seed money in a sense. Unfortunately, the bill we 
will debate today falls far short. It provides only $40 million in 
Federal grants. In a $1.3 trillion health care system, this does not 
even scratch the service.
  In fact, the nonpartisan Congressional Budget Office, CBO, says the 
bill, as written, will do almost nothing to encourage health 
information technology. According to their analysis, it will not 
significantly influence the rate at which health information technology 
is adopted, nor will it ensure better quality technology.
  Democrats have proposed a more effective proposal, backed by Federal 
seed money, just like the bipartisan Senate bill does. We would also 
add new privacy laws to strengthen patient protections. This would 
prepare us for the health information age.
  It would require patients to give their consent before their health 
information could be shared with other people. It also requires data 
encryption to protect these health information networks from hackers.
  It sides with patients by making sure that everyone, every individual 
and every health entity, complies with privacy protections.
  Unfortunately, late last night the Rules Committee denied the House 
the opportunity to debate the Democratic alternative on the floor. As a 
result, I will be urging my colleagues to defeat the previous question 
and defeat this rule.

                              {time}  1100

  Mr. Speaker, information technology will bring our Nation's health 
care system tremendous benefits, but the devil is often in the details. 
This technology will not install itself. It will spread only with the 
right kind of Federal leadership. So, I urge my colleagues to support 
the Democratic substitute and support the responsible approach to 
national health information technology.
  Mr. Speaker, I reserve the balance of my time.
  Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, I reserve the 
balance of my time.
  Ms. MATSUI. Mr. Speaker, I yield 2 minutes to my good friend, the 
gentlewoman from California (Mrs. Capps).
  Mrs. CAPPS. I thank my colleague for yielding.
  Mr. Speaker, I rise in strong opposition to the rule for H.R. 4157. 
As a nurse, of course I want to see the expanded use of health 
information technology, such as electronic medical records. Expanded 
use of health IT holds great promise for facilitating better care, 
reducing medical errors, and eliminating burdensome paperwork, but the 
bill before us today has a glaring omission: It has no privacy 
protection for patients.
  A privacy amendment I sponsored along with Representatives Markey, 
Emanuel, Doggett, and Kennedy was killed by the Republicans on the 
Rules Committee even though there is bipartisan support for this 
measure. As usual, the House won't be voting on a measure because the 
Republican leadership opposes it but is afraid that if we debate and 
vote on it in the House, they might lose the vote.
  Let's be clear, there is no comprehensive privacy protection in this 
bill before us today. That means your personal sensitive health 
information is vulnerable. That means there is no recourse you could 
take to hold individuals accountable if they improperly obtain or 
disclose your most personal private information.
  Opponents of privacy protection will argue that current HIPAA 
regulations are adequate. That argument is flawed. The lack of 
enforcement of privacy protections is widely known in the health 
community. Because of that, surveys show fewer entities are complying 
with HIPAA because they fear no consequences for privacy violations. 
And, these violations are occurring. Our privacy amendment would have 
guaranteed that you would be notified if your information is improperly 
disclosed and it would have allowed you recourse.
  The amendment should have been made in order because its provisions 
are essential to protecting patients' rights during the nationwide 
adoption of health information technology. So I urge my colleagues to 
oppose the rule until we are allowed to consider a bill that protects 
our rights as patients and, indeed, the rights of all patients.
  Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, I reserve the 
balance of my time.
  Ms. MATSUI. Mr. Speaker, I yield 3 minutes to the gentlewoman from 
California, my good friend (Ms. Eshoo).
  Ms. ESHOO. I thank our distinguished member of the Rules Committee.
  Mr. Speaker, I rise this morning in opposition to the rule and in 
opposition to the bill, and I want to state very clearly why. I believe 
that this bill is deeply deficient. And I am very disappointed because 
I had high hopes for this bill. At one time I was a cosponsor of it, 
but I removed my name from the bill when I saw what the deficiencies 
were and that the majority would not address them.

[[Page H5964]]

  My colleague, Mrs. Capps, has just eloquently outlined the deep 
deficiency relative to privacy. If you ask any American about privacy 
and if they want it protected in their financial records and their 
medical records, there will be a resounding yes. This bill has no 
protection for the American people relative to privacy.
  The second point, which is really a shame, that an HIT, health 
information technology bill, does not assure interoperability. My 
colleague from Florida mentioned this in his statement. There isn't 
going to be any point, it won't matter if every doctor, every hospital 
in our country has invested in robust IT technology if they can't 
communicate with one another. What this bill provides is that down the 
road, down the road 3 years, 5 years there may be interoperability. 
Does the majority not understand that in the market in terms of 
information technology that products change 6 months, 8 months. And so 
there isn't anything in the bill that assures that interoperability is 
going to take place.
  I offered an amendment in the Rules Committee that was turned down. 
It ensured that purchasers and vendors in the HIT marketplace will be 
able to rely on representations about compliance with the 
interoperability standards adopted under this legislation by creating a 
voluntary certification process for HIT products.
  Dr. David Brailer, the first national coordinator for health IT, said 
last month that if the government does not immediately employ 
interoperability standards in its purchasing, the adoption of the 
standards in the marketplace could take 5 to 7 years instead of 1 or 2 
to implement.
  So this is a wonderful vehicle, it sounds terrific, it is all shiny 
and waxed up. Everyone looks at it and says, doesn't this look 
terrific? I hate to dampen your spirits, but there isn't any gas in the 
engine and this dog is not going to hunt. It is an opportunity that has 
been squandered, and I reluctantly oppose the rule and the bill.
  Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, I reserve the 
balance of my time.
  Ms. MATSUI. Mr. Speaker, I yield 4\1/2\ minutes to my good friend the 
gentleman from Massachusetts (Mr. Markey).
  Mr. MARKEY. I thank the gentlewoman. The great Irish poet, William 
Butler Yeats, used to say that, ``In dreams begins responsibility.''
  There is a dream here that we can place all of the medical records of 
all Americans online, that can have an IT world where for the sake of 
patients we can move medical information across hundreds, thousands of 
miles to save the patient's life. And that is great. That is a great 
dream. But that dream will replace something that exists today, which 
is that when each of us goes in to visit a physician, when our family 
member's private medical records are inside a cabinet with a nurse that 
has a key that can open that drawer and pull out your family's private 
records, that you have confidence that that physician, that that nurse 
is not going to tell everyone else in town what the secrets are of your 
husband, of your wife, of your child, of your mother or your father, 
that there are protections, that privacy is sacred, that your physician 
is a privacy keeper and not a data mining information seeker.
  As we move to this new era where information is being abrogated by 
medical insurance companies, HMOs, medical consultants, medical data 
mining companies, that we build in at the beginning of this era the 
privacy protections, the guarantees that each individual's family has a 
right to say, ``I don't want my family's psychiatric records, I don't 
want my child's medical records, I don't want this information, mental 
health, prescription drug records or other personal medical data put 
online without my permission. I just don't want it spread around 
without my permission, without my family's permission.''
  So I went to the Rules Committee, and Congressmen Kennedy, Emanuel, 
Doggett, Capps, we requested that we have that debate here on the House 
floor, and the Republican leadership said no. No, we are just going to 
listen to the insurance industry. We are going to listen to the HMO 
industry. We are not going to allow a debate on medical privacy on the 
House floor as we move to this new era.
  And I will tell you something, this is about as serious an issue as 
people can imagine affecting their family, and there are 84 million 
good reasons why we should have this debate: Because 84 million is the 
number of times over the last 2 years we have seen the compromise of 
the financial records of American people, from the ChoicePoint scandal, 
these you can go right down the whole line. But now we have the big 
enchilada, and that is the medical records of people's families.
  And, by the way, this is not an issue that divides along Democrat or 
Republican lines, liberal or conservative lines. It polls out at over 
80 percent of all Americans that want the right to be able to protect 
their own personal medical records.
  So what has happened then? Well, what has happened is the Republican 
party is ignoring the fact that it polls out at 80 percent Democrat and 
Republican. And what they decided to do is to side with the insurance 
industry, side with the HMOs who want to use our personal medical 
records as a product, as something that allows them to go through and 
to identify useful information for the insurance industry, for HMOs.
  William Butler Yeats once said that, ``In dreams begins 
responsibility.'' That should happen here on the House floor today. But 
the Republicans are abdicating that responsibility. They are saying, 
let's give the HMOs, let's give the data miners, let's give these 
consultants, let's give these insurance companies what they want now, 
and we will come back and revisit the privacy issue after there is a 
catastrophic compromise of privacy affecting millions of American 
families. That is not exercising the responsibility that should be 
exercised. Vote ``no'' on this rule. Vote ``no'' on this bill.
  Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, I yield myself such 
time as I may consume.
  Mr. Speaker, Yeats wrote many wonderful, beautiful things. We in the 
Rules Committee deal with reality. The reality of the rule that we 
bring to the floor today in order to bring the underlying legislation 
on information technology for the health care industry brings forth and 
authorizes six amendments, six amendments to be debated by this House.
  Our function is to listen, and we listened hour after hour after hour 
after hour, with great respect, in the Rules Committee to our 
colleagues who come forth with multiple ideas. We bring forth six 
amendments for the consideration of this entire body today. Of the six 
amendments, four are authored by Members of the opposition, of the 
Democrat Party; one is a bipartisan amendment, Republican and Democrat; 
and one is a Republican amendment. We think we are being fair, Mr. 
Speaker.
  So we seek not to bring forth the beauty of Yeats, but in dealing 
with reality, in dealing with listening to hours of testimony from our 
colleagues, in authorizing four amendments of Democrats, one of a 
Republican, one of a bipartisan nature, we think we have done a fair 
job. And that is what we have authorized for consideration, for debate 
by this House in the rule that brings forward this very important 
legislation that we will be hearing about, and we will be hearing about 
as the authors of the legislation explain it in detail.
  I am very proud to be a supporter of the legislation. It is important 
that information technology reach as much of the health care industry, 
patients, as possible so that mistakes are avoided, and so that access 
to the great advances of technology are made available to the largest 
number of people. There are important issues that this legislation is 
going to be bringing forth and dealing with and that this debate will 
entail.

                              {time}  1115

  Now, obviously in order for debate to begin, we have to pass the rule 
which sets the terms of the debate. We are proud of those terms of 
debate, the extraordinarily fair nature of the terms of that debate. As 
I have said, Mr. Speaker, four amendments made in order are Democrat 
amendments, one is a Republican amendment, one is a bipartisan 
amendment.
  Mr. Speaker, I reserve the balance of my time.
  Ms. MATSUI. Mr. Speaker, I yield 4 minutes to my good friend, the 
gentleman from Rhode Island (Mr. Kennedy).

[[Page H5965]]

  Mr. KENNEDY of Rhode Island. Mr. Speaker, I thank the gentlewoman for 
yielding me this time.
  Mr. Speaker, I have been working on this issue for several years. I 
have met with countless groups across this country. I have forged 
bipartisan relationships to bring a solid piece of legislation before 
this House, and today I am disappointed to say that this legislation 
does not meet the mark.
  The Congressional Budget Office itself has said this legislation, 
quote, would not significantly affect either the rate at which the use 
of health technology will grow or how well that technology will be 
designed and implemented.
  So what is the point? If we cannot get this technology in the hands 
of the providers, what are we doing here? This legislation does not 
require us to adopt standards that are interoperability standards for 
all on a date certain. We need to do this within the next year and a 
half. We could do this within the next year.
  We should be taking this opportunity and passing real health care 
information technology legislation; but, instead, we are passing a 
shadow of a bill that misses the opportunity to pass real opportunities 
for savings, both in people's lives and in countless dollars across 
this country.
  Mr. Speaker, we spend twice what every other industrialized nation 
spends on health care. It is the worst system when it comes to 
employers paying incredible premiums. We see employees paying 
incredible premiums. We are seeing providers complain. Nobody is happy 
with the current health care system; and, yet, what are we doing about 
it? We are missing the opportunity today.
  We could provide technology today that would help us implement 
quality standards so that when you are being treated, whether it is in 
Iowa or Rhode Island or New York, you get the same standard of care. 
But are those quality provisions in this bill? No, they are not.
  We can make sure that we have provisions in this bill to have the 
privacy protections in place, as Mr. Markey just talked about. Are they 
in this bill? No, they are not.
  How can we have an IT bill that does not set a date certain for 
technology, that does not have quality provisions in place so that we 
can use technology to bring the best and evidence-based medicines to 
the bedside? How can we not have provisions to protect privacy in an 
age when we are going electronic in health care records?
  Mr. Speaker, this bill falls way short of our opportunities to make a 
fundamental change in our health care system. I am sorry I am going to 
have to oppose this rule. I am going to have to oppose this bill 
because I think it falls way short of the opportunities we have been 
given to make the most of this chance to get a better health care 
system today. We are squandering that chance. For that reason, I will 
oppose the rule and oppose the underlying bill.
  Ms. MATSUI. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I am asking Members to vote ``no'' on the previous 
question so I can amend this rule and allow the House to consider the 
Dingell-Rangel substitute. This substitute was offered in the Rules 
Committee last night, but was blocked on a straight party-line vote.
  Mr. Speaker, I ask unanimous consent to print the text of the 
amendment and extraneous materials immediately prior to the vote on the 
previous question.
  The SPEAKER pro tempore (Mr. Price of Georgia). Is there objection to 
the request of the gentlewoman from California?
  There was no objection.
  Ms. MATSUI. Mr. Speaker, I believe the Dingell-Rangel substitute 
offers Members a far better choice than the underlying bill.
  This substitute is based on the bipartisan bill that was introduced 
by Senators Frist, Enzi, Kennedy and Clinton and passed unanimously by 
the Senate last November. This substitute also contains important 
privacy protections necessary in this new electronic world.
  The Democratic substitute requires the Federal Government to take a 
leading role in the adoption of standards for technology and adopting 
technology that will permit providers and others to communicate to each 
other electronically. This substitute will provide $257 million in 
grants and loans for providers and regional collaboratives to buy and 
implement health information technology.
  This substitute also provides privacy protections beyond those in 
current law to ensure that patients' health information is secure. It 
requires that all individuals and entities with access to personal 
health information must comply with privacy protections to maintain 
patient confidentiality. The substitute also requires data encryption 
to prevent security breaches and the notification of patients in case 
of a security breach. Finally, it allows patients to seek redress when 
their privacy is breached.
  I want Members to be aware that a ``no'' vote will not stop us from 
considering H.R. 4157. A ``no'' vote will simply allow the Dingell-
Rangel substitute to be considered by this House by an up-or-down vote.
  Vote ``no'' on the previous question so we can consider this 
important and responsible substitute.
  Mr. Speaker, I yield back the balance of my time.
  Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, I yield myself such 
time as I may consume.
  I thank all of my colleagues who have participated in this very 
interesting debate today. Much has been made by opponents of the 
legislation of arguments with regard to privacy protections. I think it 
is relevant and should be pointed out that the very significant and 
extensive privacy protections contained in the Health Insurance 
Portability and Accountability Act of 1996 are not reduced in any way 
by this legislation that we bring forth to the floor today.
  In fact, the American Psychiatric Association, the American 
Psychological Association, the National Association of Social Workers, 
the National Mental Health Association have said in a letter to the 
Energy and Commerce Committee, ``The Energy and Commerce language 
ensures that the current protections in the Health Insurance 
Portability and Accountability Act of 1996 are maintained, and we wish 
to commend the approach to privacy protections that the Energy and 
Commerce Committee proposes to take.''
  I mean, it is relevant to point this out because much has been said 
that would seem or could be interpreted to contradict what I have just 
read from the American Psychiatric Association, the American 
Psychological Association, the National Association of Social Workers, 
the National Mental Health Association, very responsible entities that 
look out for the interests of many citizens who receive health care.
  So, Mr. Speaker, urging the support of the underlying legislation, I 
also urge all of my colleagues to support this rule, which is very 
fair, makes more than twice as many amendments by Democrats than by 
Republicans in order. It is precisely in our interest to go the extra 
mile for fairness.
  Mr. DINGELL. Mr. Speaker, I rise in strong opposition to this rule. 
There once was a time when we considered legislation under open rules. 
Any Member could offer an amendment. That was the way I, as chairman of 
the Committee on Energy and Commerce, brought bills to the House floor.
  Eventually amendments were limited, perhaps under the guise of 
efficiency. But certainly the minority should be allowed to offer an 
alternative. Democrats brought an alternative to the Committee on 
Rules. It was supported by every Democrat on our committee.
  It was not a radical alternative. It was identical to the bill that 
passed the Senate unanimously, with the addition of language to protect 
patient privacy. Yet this rule blocks the offering of our proposal.
  If my Republican colleagues disagree with this substitute, fine--vote 
against it, but don't hide behind a rule that prevents us from offering 
it.
  If we had an open rule, we could fairly debate this important issue. 
All of us want to improve health information technology. One hundred 
Senators voted for a bill to do so, but under this closed rule, if a 
Member of the House wanted to offer that Senate bill, which was 
sponsored by Republican Majority Leader Frist, along with Senator Enzi, 
Kennedy, and Clinton, he or she could not do so.
  That's right--my rubber stamp Republican colleagues are about to pass 
a rule that makes sure that a bill that passed unanimously in the 
Senate cannot even get a vote in the House. It is a closed rule and 
that

[[Page H5966]]

means only amendments that the Republican leaders can accept will get a 
vote.
  I have read that many of my Republican colleagues are trying to 
distance themselves from the policies of the House Republican 
leadership. Well, here is your chance. Reject a rule that prohibits 
Members from offering a substitute that consists of a bill passed 
unanimously by 100 Senators. Reject a rule that prohibits an amendment 
dealing with the privacy of personal medical records.
  But we know the fix is in. Why else did not a single Republican 
Member go to the Rules Committee to ask for a rule to allow them to 
offer a bill supported by 100 Senators? Why else did not a single 
Republican Member care to offer an amendment to protect the privacy of 
medical records?
  A vote for this closed rule is, quite simply, a vote against 
bipartisanship. It is a vote against privacy protections for Americans. 
And it is a vote against getting a bill signed into law this Congress.
  The material previously referred to by Ms. Matsui is as follows:

    Previous Question for H. Res. 952--H.R. 4157 Health Information 
                    Technology Promotion Act of 2006

       At the end of the resolution, add the following:
       Sec. 4. Notwithstanding any other provision of this 
     resolution the amendment specified in section 5 shall be in 
     order as though printed after the amendment numbered 6 in the 
     report of the Committee on Rules if offered by Representative 
     Dingell of Michigan or Representative Rangel of New York or a 
     designee. That amendment shall be debatable for 30 minutes 
     equally divided and controlled by the proponent and an 
     opponent.
       Sec. 5. The amendment referred to in section 2 is as 
     follows:

   Amendment in the Nature of a Substitute to H.R. 4157, as Reported

       Strike all after the enacting clause and insert the 
     following:

     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 AND QUALITY

     ``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 practitioner (as defined in section 
     1842(b)(18)(CC) 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) Individually identifiable health information.--The 
     term `individually identifiable health information' has the 
     meaning given such term in section 1171 of the Social 
     Security Act.
       ``(5) Laboratory.--The term `laboratory' has the meaning 
     given that term in section 353.
       ``(6) Pharmacist.--The term `pharmacist' has the meaning 
     given that term in section 804 of the Federal Food, Drug, and 
     Cosmetic Act.
       ``(7) Qualified health information technology.--The term 
     `qualified health information technology' means a 
     computerized system (including hardware and software) 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.
       ``(8) 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 Secretary and shall report directly to the 
     Secretary.
       ``(b) Purpose.--It shall be the purpose of the Office to 
     coordinate with relevant Federal agencies and private 
     entities and oversee programs and activities to develop a 
     nationwide interoperable health information technology 
     infrastructure that--
       ``(1) ensures that patients' individually identifiable 
     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 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;
       ``(2) facilitate the adoption of a nationwide, 
     interoperable system for the electronic exchange of health 
     information;
       ``(3) ensure the adoption and implementation of standards 
     for the electronic exchange of health information to reduce 
     cost and improve health care quality;
       ``(4) 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;
       ``(5) 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;
       ``(6) advise the President regarding specific Federal 
     health information technology programs; and
       ``(7) prepare 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 to carry out this section, 
     $5,000,000 for fiscal year 2007, $5,000,000 for fiscal year 
     2008, and such sums as may be necessary for each of fiscal 
     years 2009 through 2011.

     ``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

[[Page H5967]]

       ``(3) recommend standards (including content, 
     communication, and security standards) for the electronic 
     exchange of health information (including for the reporting 
     of quality data under section 2908) for adoption by the 
     Federal Government and voluntary adoption by private 
     entities.
       ``(b) Composition.--
       ``(1) In general.--The Collaborative shall be composed of 
     members of the public and private sectors to be appointed by 
     the Secretary, including representatives from--
       ``(A) consumer or patient organizations;
       ``(B) organizations with expertise in privacy and security;
       ``(C) health care providers;
       ``(D) health insurance plans or other third party payors;
       ``(E) information technology vendors; and
       ``(F) purchasers or employers.
       ``(2) Participation.--In appointing members under paragraph 
     (1), and in developing the procedures for conducting the 
     activities of the Collaborative, the Secretary shall ensure a 
     balance among various sectors of the health care system so 
     that no single sector unduly influences the recommendations 
     of the Collaborative.
       ``(3) Terms.--Members appointed under paragraph (1) 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.
       ``(4) Outside involvement.--With respect to the functions 
     of the Collaborative, the Secretary shall ensure an adequate 
     opportunity for the participation of outside advisors, 
     including individuals with expertise in--
       ``(A) health information privacy;
       ``(B) health information security;
       ``(C) health care quality and patient safety, including 
     individuals with expertise in utilizing health information 
     technology to improve health care quality and patient safety;
       ``(D) data exchange; and
       ``(E) developing health information technology standards 
     and new health information technology.
       ``(c) Recommendations and Policies.--Not later than 1 year 
     after the date of enactment of this title, and annually 
     thereafter, the Collaborative shall recommend to the 
     Secretary 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 individually identifiable health 
     information through privacy and security practices;
       ``(2) measures to prevent unauthorized access to health 
     information, including unauthorized access through the use of 
     certain peer-to-peer file-sharing applications;
       ``(3) methods to notify patients if their individually 
     identifiable health information is wrongfully disclosed;
       ``(4) methods to facilitate secure patient access to health 
     information;
       ``(5) fostering the public understanding of health 
     information technology;
       ``(6) the ongoing harmonization of industry-wide health 
     information technology standards;
       ``(7) recommendations for a nationwide interoperable health 
     information technology infrastructure;
       ``(8) the identification and prioritization of specific use 
     cases for which health information technology is valuable, 
     beneficial, and feasible;
       ``(9) recommendations for the establishment of an entity to 
     ensure the continuation of the functions of the 
     Collaborative; and
       ``(10) other policies (including recommendations for 
     incorporating health information technology into the 
     provision of care and the organization of the health care 
     workplace) 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;
       ``(B) identify deficiencies and omissions in such existing 
     standards; and
       ``(C) identify duplication and overlap in such existing 
     standards;

     and recommend new standards and modifications to such 
     existing 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;
       ``(B) identify deficiencies and omissions in such existing 
     standards; and
       ``(C) identify duplication and overlap in such existing 
     standards;
     and recommend new standards and modifications to such 
     existing standards as necessary.
       ``(4) Limitation.--The standards and timeframe for adoption 
     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 90 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. 
     If appropriate, 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.--
       ``(1) In general.--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 new 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).
       ``(2) Rule of construction.--Nothing in paragraph (1) shall 
     be construed to restrict the purchase of minor (as determined 
     by the Secretary) hardware or software components in order to 
     modify, correct a deficiency in, or extend the life of 
     existing hardware or software.
       ``(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 
     quality reporting, 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.--
       ``(1) In general.--Any standards adopted by the Federal 
     Government under subsection (e) shall be voluntary with 
     respect to private entities.
       ``(2) Rule of construction.--Nothing in this section shall 
     be construed to require that a private entity that enters 
     into a contract with the Federal Government adopt the 
     standards adopted by the Federal Government under this 
     section with respect to activities not related to the 
     contract.
       ``(3) Limitation.--Private entities that enter into a 
     contract with the Federal Government shall adopt the 
     standards adopted by the Federal Government under this 
     section for the purpose of activities under such Federal 
     contract.
       ``(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 to carry out this section, 
     $4,000,000 for fiscal year 2007, $4,000,000 for fiscal year 
     2008, and such sums as may be necessary for each of fiscal 
     years 2009 through 2011.

     ``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 and software that claim 
     to be in compliance with applicable standards for the 
     electronic exchange of

[[Page H5968]]

     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) Outside Involvement.--The Secretary, through 
     consultation with the Collaborative, may accept 
     recommendations on the development of the criteria under 
     subsections (a) and (b) from a Federal agency or private 
     entity.

     ``SEC. 2905. PRIVACY AND SECURITY PROTECTIONS.

       ``(a) In General.--The Secretary shall provide for 
     standards for health information technology (as such term is 
     used in this title) that include the following privacy and 
     security protections:
       ``(1) Except as provided in succeeding paragraphs, each 
     entity must--
       ``(A) expressly recognize the individual's right to privacy 
     and security with respect to the electronic disclosure of 
     such information;
       ``(B) permit individuals to exercise their right to privacy 
     and security in the electronic disclosure of such information 
     to another entity by obtaining the individual's written or 
     electronic informed consent, which consent may authorize 
     multiple disclosures;
       ``(C) permit an individual to prohibit access to certain 
     categories of individuals (as defined by the Secretary) of 
     particularly sensitive information, including data relating 
     to infection with the human immunodeficiency virus (HIV), to 
     mental health, to sexually transmitted diseases, to 
     reproductive health, to domestic violence, to substance abuse 
     treatment, to genetic testing or information, to diabetes, 
     and other information as defined by the Secretary after 
     consent has been provided under subparagraph (B).
       ``(2) Informed consent may be inferred, in the absence of a 
     contrary indication by the individual--
       ``(A) to the extent necessary to provide treatment and 
     obtain payment for health care in emergency situations;
       ``(B) to the extent necessary to provide treatment and 
     payment where the health care provider is required by law to 
     treat the individual;
       ``(C) if the health care provider is unable to obtain 
     consent due to substantial barriers to communicating with the 
     individual and the provider reasonably infers from the 
     circumstances, based upon the exercise of professional 
     judgment, that the individual does not object to the 
     disclosure or that the disclosure is in the best interest of 
     the individual; and
       ``(D) to the extent that the information is necessary to 
     carry out or otherwise implement a medical practitioner's 
     order or prescription for health services, medical devices or 
     supplies, or pharmaceuticals.
       ``(3) The protections must prohibit the improper use and 
     disclosure of individually identifiable health information by 
     any entity.
       ``(4) The protections must provide any individual a right 
     to obtain damages and other relief against any entity for the 
     entity's improper use or disclosure of individually 
     identifiable health information.
       ``(5) The protections must require the use of reasonable 
     safeguards, including audit capabilities, encryption and 
     other technologies that make data unusable to unauthorized 
     persons, and other measures, against the risk of loss or 
     unauthorized access, destruction, use, modification, or 
     disclosure of individually identifiable health information.
       ``(6) The protections must provide for notification to any 
     individual whose individually identifiable health information 
     has been lost, stolen, or used for an unauthorized purpose by 
     the entity responsible for the information and notification 
     by the entity to the Secretary.
       ``(b) List of Entities.--The Secretary shall maintain a 
     public list identifying entities whose health information has 
     been lost, stolen, or used in an unauthorized purpose as 
     described in subsection (a)(6) and how many patients were 
     affected by such action.
       ``(c) Construction.--Nothing in this section shall be 
     construed as superseding, altering, or affecting (in whole or 
     in part) any statute, regulation, order, or interpretation in 
     effect in any State that affords any person privacy and 
     security protections greater than that the privacy and 
     security protections described in subsection (a), as 
     determined by the Secretary.

     ``SEC. 2906. 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, including a federally 
     qualified health center (as defined in section 1861(aa)(4) of 
     the Social Security Act);
       ``(ii) individual or group practice; 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) implement the measures adopted under section 2908 and 
     report to the Secretary on such measures;
       ``(F) agree to notify patients if their individually 
     identifiable health information is wrongfully disclosed;
       ``(G) demonstrate significant financial need; and
       ``(H) 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 and training personnel in the use of such 
     technology.
       ``(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;
       ``(B) eligible entities that will link, to the extent 
     practicable, the qualified health information system to local 
     or regional health information plan or plans; and
       ``(C) with respect to an entity described in subsection 
     (a)(2)(C)(iii), a nonprofit health care provider.
       ``(b) Competitive Grants to States for the Development of 
     State Loan Programs To Facilitate the Widespread Adoption of 
     Health Information Technology.--
       ``(1) In general.--The Secretary may award competitive 
     grants to States for the establishment of State programs for 
     loans to health care providers to facilitate the purchase and 
     enhance the utilization of qualified health information 
     technology.
       ``(2) Establishment of fund.--To be eligible to receive a 
     competitive grant under this subsection, a State shall 
     establish a qualified health information technology loan fund 
     (referred to in this subsection as a `State loan fund') and 
     comply with the other requirements contained in this 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;
       ``(ii) consult with the Health Information Technology 
     Resource Center established in section 914(d) to access the 
     knowledge and experience of existing initiatives regarding 
     the successful implementation and effective use of health 
     information technology; and
       ``(iii) agree to notify patients if their individually 
     identifiable health information is wrongfully disclosed;
       ``(E) require that health care providers receiving such 
     loans adopt the standards adopted by the Federal Government 
     under section 2903;
       ``(F) require that health care providers receiving such 
     loans implement the measures 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

[[Page H5969]]

     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 
     and training of personnel in the use of such 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 
     publicly available the identity of, and amount contributed 
     by, any private sector entity under clause (i) and may issue 
     letters of commendation or make other awards (that have no 
     financial value) to any such entity.
       ``(8) Matching requirements.--
       ``(A) In general.--The Secretary may not make a grant under 
     paragraph (1) to a State unless the State agrees to make 
     available (directly or through donations from public or 
     private entities) non-Federal contributions in cash toward 
     the costs of the State program to be implemented under the 
     grant in an amount equal to not less than $1 for each $1 of 
     Federal funds provided under the grant.
       ``(B) Determination of amount of non-federal 
     contribution.--In determining the amount of non-Federal 
     contributions that a State has provided pursuant to 
     subparagraph (A), the Secretary may not include any amounts 
     provided to the State by the Federal Government.
       ``(9) Preference in awarding grants.--The Secretary may 
     give a preference in awarding grants under this subsection to 
     States that adopt value-based purchasing programs to improve 
     health care quality.
       ``(10) Reports.--The Secretary shall annually submit to the 
     Committee on Health, Education, Labor, and Pensions and the 
     Committee on Finance of the Senate, and the Committee on 
     Energy and Commerce and the Committee on Ways and Means of 
     the House of Representatives, a report summarizing the 
     reports received by the Secretary from each State that 
     receives a grant under this subsection.
       ``(c) Competitive Grants for the Implementation of Regional 
     or Local Health Information Technology Plans.--
       ``(1) In general.--The Secretary may award competitive 
     grants to eligible entities to implement regional or local 
     health information plans to improve health care quality and 
     efficiency through the electronic exchange of health 
     information pursuant to the standards, 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) demonstrate the participation, to the extent 
     practicable, of stakeholders in the electronic exchange of 
     health information within the local or regional plan pursuant 
     to paragraph (2)(C);
       ``(E) adopt nondiscrimination and conflict of interest 
     policies that demonstrate a commitment to open, fair, and 
     nondiscriminatory participation in the health information 
     plan by all stakeholders;
       ``(F) adopt the standards adopted by the Secretary under 
     section 2903;
       ``(G) require that health care providers receiving such 
     grants implement the measures adopted under section 2908 and 
     report to the Secretary on such measures;
       ``(H) agree to notify patients if their individually 
     identifiable health information is wrongfully disclosed;
       ``(I) facilitate the electronic exchange of health 
     information within the local or regional area and among local 
     and regional areas;
       ``(J) prepare and submit to the Secretary an application in 
     accordance with paragraph (3); and
       ``(K) 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;
       ``(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; and

       ``(viii) in the case of an applicant entity that is unable 
     to demonstrate the participation of all stakeholders pursuant 
     to paragraph (2)(C), the justification from the entity for 
     any such nonparticipation.
       ``(4) Use of funds.--Amounts received under a grant under 
     paragraph (1) shall be used to establish and implement a 
     regional or local health information plan in accordance with 
     this subsection.
       ``(5) Matching requirement.--

[[Page H5970]]

       ``(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) Requirement To Achieve Quality Improvement.--The 
     Secretary shall annually evaluate the activities conducted 
     under this section and shall, in awarding grants, implement 
     the lessons learned from such evaluation in a manner so that 
     awards made subsequent to each such evaluation are made in a 
     manner that, in the determination of the Secretary, will 
     result in the greatest improvement in quality measures under 
     section 2908.
       ``(f) Limitation.--An eligible entity may only receive one 
     non-renewable grant under subsection (a), one non-renewable 
     grant under subsection (b), and one non-renewable grant under 
     subsection (c).
       ``(g) Authorization of Appropriations.--
       ``(1) In general.--For the purpose of carrying out this 
     section, there is authorized to be appropriated $116,000,000 
     for fiscal year 2007, $141,000,000 for fiscal year 2008, and 
     such sums as may be necessary for each of fiscal years 2009 
     through 2011.
       ``(2) Availability.--Amounts appropriated under paragraph 
     (1) shall remain available through fiscal year 2011.

     ``SEC. 2907. 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) an institution with 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, and implement the quality 
     measures adopted under section 2908, 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. 2908. QUALITY MEASURES.

       ``(a) In General.--The Secretary shall develop quality 
     measures, including measures to assess the effectiveness, 
     timeliness, patient self-management, patient centeredness, 
     efficiency, and safety, for the purpose of measuring the 
     quality of care patients receive.
       ``(b) Requirements.--The Secretary shall ensure that the 
     quality measures developed under this section comply with the 
     following:
       ``(1) Measures.--
       ``(A) Requirements.--In developing the quality measures 
     under this section, the Secretary shall, to the extent 
     feasible, ensure that--
       ``(i) such measures are evidence based, reliable, and 
     valid;
       ``(ii) such measures are consistent with the purposes 
     described in section 2902(b);
       ``(iii) such measures include measures of clinical 
     processes and outcomes, patient experience, efficiency, and 
     equity; and
       ``(iv) such measures include measures of overuse and 
     underuse of health care items and services.
       ``(2) Priorities.--In developing the quality measures under 
     this section, the Secretary shall ensure that priority is 
     given to--
       ``(A) measures with the greatest potential impact for 
     improving the quality and efficiency of care provided under 
     this Act;
       ``(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) Risk adjustment.--The Secretary 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.
       ``(4) Maintenance.--The Secretary shall, as determined 
     appropriate, but in no case more often than once during each 
     12-month period, update the quality measures, including 
     through the addition of more accurate and precise measures 
     and the retirement of existing outdated measures.
       ``(5) Relationship with programs under the social security 
     act.--The Secretary shall ensure that the quality measures 
     developed under this section--
       ``(A) complement quality measures developed by the 
     Secretary under programs administered by the Secretary under 
     the Social Security Act, including programs under titles 
     XVIII, XIX, and XXI of such Act; and
       ``(B) do not conflict with the needs and priorities of the 
     programs under titles XVIII, XIX, and XXI of such Act, as set 
     forth by the Administrator of the Centers for Medicare & 
     Medicaid Services.
       ``(c) Required Considerations in Developing and Updating 
     the Measures.--In developing and updating the quality 
     measures under this section, the Secretary may take into 
     account--
       ``(1) any demonstration or pilot program conducted by the 
     Secretary relating to measuring and rewarding quality and 
     efficiency of care;
       ``(2) any existing activities conducted by the Secretary 
     relating to measuring and rewarding quality and efficiency;
       ``(3) any existing activities conducted by private 
     entities, including health insurance plans and payors;
       ``(4) 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; and
       ``(5) issues of data collection and reporting, including 
     the feasibility of collecting and reporting data on measures.
       ``(d) Solicitation of Advice and Recommendations.--On and 
     after July 1, 2007,

[[Page H5971]]

     the Secretary shall consult with the following regarding the 
     development, updating, and use of quality measures developed 
     under this section:
       ``(1) Health insurance plans and health care providers, 
     including such plans and providers with experience in the 
     care of the frail elderly and individuals with multiple 
     complex chronic conditions, or groups representing such 
     health insurance plans and providers.
       ``(2) Groups representing patients and consumers.
       ``(3) Purchasers and employers or groups representing 
     purchasers or employers.
       ``(4) Organizations that focus on quality improvement as 
     well as the measurement and reporting of quality measures.
       ``(5) Organizations that certify and license health care 
     providers.
       ``(6) State government public health programs.
       ``(7) 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.
       ``(8) Individuals or entities involved in the development 
     and establishment of standards and certification for health 
     information technology systems and clinical data.
       ``(9) Individuals or entities with experience with--
       ``(A) urban health care issues;
       ``(B) safety net health care issues; and
       ``(C) rural and frontier health care issues.
       ``(e) Use of Quality Measures.--
       ``(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 
     quality measures 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 2906, to--
       ``(A) encourage the use of the quality measures adopted by 
     the Secretary under this section; and
       ``(B) foster uniformity between the health care quality 
     measures utilized by private entities.
       ``(3) Reporting.--The Secretary shall implement procedures 
     to enable the Department of Health and Human Services to 
     accept the electronic submission of data for purposes of--
       ``(A) quality measurement using the quality measures 
     developed under this section and using the standards adopted 
     by the Federal Government under section 2903; and
       ``(B) for reporting measures used to make value-based 
     payments under programs under the Social Security Act.
       ``(f) 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 
     dissemination, aggregation, and analysis of quality measures 
     collected under section 2906 and the dissemination of 
     recommendations and best practices derived in part from such 
     analysis.
       ``(g) 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.
       ``(h) Rule of Construction.--Nothing in this title shall be 
     construed as prohibiting the Secretary, acting through the 
     Administrator of the Centers for Medicare & Medicaid 
     Services, from developing quality measures (and timing 
     requirements for reporting such measures) for use under 
     programs administered by the Secretary under the Social 
     Security Act, including programs under titles XVIII, XIX, and 
     XXI of such Act.''.

     SEC. 3. LICENSURE AND THE ELECTRONIC EXCHANGE OF HEALTH 
                   INFORMATION.

       (a) In General.--The Secretary of Health and Human Services 
     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 Act, the Secretary of 
     Health and Human Services 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. 4. ENSURING PRIVACY AND SECURITY.

       Nothing in this Act (or the amendments made by this Act) 
     shall be construed to affect the scope, substance, or 
     applicability of--
       (1) section 264 of the Health Insurance Portability and 
     Accountability Act of 1996;
       (2) sections 1171 through 1179 of the Social Security Act; 
     and
       (3) any regulation issued pursuant to any such section.

     SEC. 5. GAO STUDY.

       Not later than 6 months after the date of enactment of this 
     Act, the Comptroller General of the United States shall 
     submit to Congress a report on the necessity and workability 
     of requiring health plans (as defined in section 1171 of the 
     Social Security Act (42 U.S.C. 1320d)), health care 
     clearinghouses (as defined in such section 1171), and health 
     care providers (as defined in such section 1171) who transmit 
     health information in electronic form, to notify patients if 
     their individually identifiable health information (as 
     defined in such section 1171) is wrongfully disclosed.

     SEC. 6. STUDY OF REIMBURSEMENT INCENTIVES.

       The Secretary of Health and Human Services 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. 7. HEALTH INFORMATION TECHNOLOGY RESOURCE CENTER.

       Section 914 of the Public Health Service Act (42 U.S.C. 
     299b-3) is amended by adding at the end the following:
       ``(d) Health Information Technology Resource Center.--
       ``(1) In general.--The Secretary, acting through the 
     Director, shall develop a Health Information Technology 
     Resource Center 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) Purposes.--The purpose of the Center is to--
       ``(A) provide a forum for the exchange of knowledge and 
     experience;
       ``(B) accelerate the transfer of lessons learned from 
     existing public and private sector initiatives, including 
     those currently receiving Federal financial support;
       ``(C) assemble, analyze, and widely disseminate evidence 
     and experience related to the adoption, implementation, and 
     effective use of interoperable health information technology.
       ``(D) provide for the establishment of regional and local 
     health information networks to facilitate the development of 
     interoperability across health care settings and improve the 
     quality of health care;
       ``(E) provide for the development of solutions to barriers 
     to the exchange of electronic health information; and
       ``(F) conduct other activities identified by the States, 
     local or regional health information networks, or health care 
     stakeholders as a focus for developing and sharing best 
     practices.
       ``(3) Support for activities.--To provide support for the 
     activities of the Center, the Director shall modify the 
     requirements, if necessary, that apply to the National 
     Resource Center for Health Information Technology to provide 
     the necessary infrastructure to support the duties and 
     activities of the Center and facilitate information exchange 
     across the public and private sectors.
       ``(4) Rule of construction.--Nothing in this subsection 
     shall be construed to require the duplication of Federal 
     efforts with respect to the establishment of the Center, 
     regardless of whether such efforts were carried out prior to 
     or after the enactment of this subsection.
       ``(e) 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--
       ``(1) learn about Federal grants and technical assistance 
     services related to interoperable health information 
     technology;
       ``(2) learn about qualified health information technology 
     and the quality measures adopted by the Federal Government 
     under sections 2903 and 2908;
       ``(3) learn about regional and local health information 
     networks for assistance with health information technology; 
     and
       ``(4) disseminate additional information determined by the 
     Secretary.
       ``(f) Authorization of Appropriations.--There is authorized 
     to be appropriated, such sums as may be necessary for each of 
     fiscal years 2007 and 2008 to carry out this subsection.''.

     SEC. 8. 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 ``2007 through 2011''.
                                  ____


        The Vote on the Previous Question: What it Really Means

       This vote, the vote on whether to order the previous 
     question on a special rule, is not merely a procedural vote. 
     A vote against ordering the previous question is a vote 
     against the Republican majority agenda and a vote to allow 
     the opposition, at least for the moment, to offer an 
     alternative plan. It is a vote about what the House should be 
     debating.

[[Page H5972]]

       Mr. Clarence Cannon's Precedents of the House of 
     Representatives, (VI, 308-311) describes the vote on the 
     previous question on the rule as ``a motion to direct or 
     control the consideration of the subject before the House 
     being made by the Member in charge.'' To defeat the previous 
     question is to give the opposition a chance to decide the 
     subject before the House. Cannon cites the Speaker's ruling 
     of January 13, 1920, to the effect that ``the refusal of the 
     House to sustain the demand for the previous question passes 
     the control of the resolution to the opposition'' in order to 
     offer an amendment. On March 15, 1909, a member of the 
     majority party offered a rule resolution. The House defeated 
     the previous question and a member of the opposition rose to 
     a parliamentary inquiry, asking who was entitled to 
     recognition. Speaker Joseph G. Cannon (R-Illinois) said: 
     ``The previous question having been refused, the gentleman 
     from New York, Mr. Fitzgerald, who had asked the gentleman to 
     yield to him for an amendment, is entitled to the first 
     recognition.''
       Because the vote today may look bad for the Republican 
     majority they will say ``the vote on the previous question is 
     simply a vote on whether to proceed to an immediate vote on 
     adopting the resolution . . . [and] has no substantive 
     legislative or policy implications whatsoever.'' But that is 
     not what they have always said. Listen to the Republican 
     Leadership Manual on the Legislative Process in the United 
     States House of Representatives, (6th edition, page 135). 
     Here's how the Republicans describe the previous question 
     vote in their own manual: Although it is generally not 
     possible to amend the rule because the majority Member 
     controlling the time will not yield for the purpose of 
     offering an amendment, the same result may be achieved by 
     voting down the previous question on the rule . . . When the 
     motion for the previous question is defeated, control of the 
     time passes to the Member who led the opposition to ordering 
     the previous question. That Member, because he then controls 
     the time, may offer an amendment to the rule, or yield for 
     the purpose of amendment.''
       Deschler's Procedure in the U.S. House of Representatives, 
     the subchapter titled ``Amending Special Rules'' states: ``a 
     refusal to order the previous question on such a rule [a 
     special rule reported from the Committee on Rules] opens the 
     resolution to amendment and further debate.'' (Chapter 21, 
     section 21.2) Section 21.3 continues: Upon rejection of the 
     motion for the previous question on a resolution reported 
     from the Committee on Rules, control shifts to the Member 
     leading the opposition to the previous question, who may 
     offer a proper amendment or motion and who controls the time 
     for debate thereon.''
       Clearly, the vote on the previous question on a rule does 
     have substantive policy implications. It is one of the only 
     available tools for those who oppose the Republican 
     majority's agenda to offer an alternative plan.

  Mr. LINCOLN DIAZ-BALART of Florida. Mr. Speaker, I yield back the 
balance of my time, and I move the previous question on the resolution.
  The SPEAKER pro tempore. The question is on ordering the previous 
question.
  The question was taken; and the Speaker pro tempore announced that 
the ayes appeared to have it.
  Ms. MATSUI. Mr. Speaker, on that I demand the yeas and nays.
  The yeas and nays were ordered.
  The SPEAKER pro tempore. Pursuant to clause 8 of rule XX, further 
proceedings on this question will be postponed.

                          ____________________