[Congressional Record Volume 155, Number 60 (Thursday, April 23, 2009)]
[Senate]
[Pages S4694-S4696]
From the Congressional Record Online through the Government Publishing Office [www.gpo.gov]

      By Mr. REID (for Mr. Rockefeller):
  S. 890. A bill to provide for the use of improved health information 
technology with respect to certain safety net health care providers; to 
the Committee on Health, Education, Labor, and Pensions.
  Mr. ROCKEFELLER. Mr. President, I rise today to introduce the Health 
Information Technology Public Utility Act, legislation I have recently 
introduced to facilitate nationwide adoption of electronic health 
records, EHRs, particularly among small, rural providers. This 
legislation will build on the successful open source models for EHRs 
developed by the Department of Veterans Affairs and the Indian Health 
Service--as well as the open source exchange model recently expanded 
among federal agencies through the Nationwide Health Information 
Network-Connect initiative.
  Health information technology, IT, that is interoperable and 
meaningful is a necessary tool to improve the quality of health care 
Americans receive and make our health care system more efficient. It is 
the cornerstone of health care communication and coordination between 
patients and providers and among providers in order delivery high-
quality medical care. Several of the mechanisms embedded in this 
technology--clinical decisions support, interoperability--achieve the 
long-term policy goals we are considering as part of our broader health 
reform discussions. It is clear that coordination and communication 
among providers, improved efficiencies in resource use, streamlined 
administration and billing, and increased access to meaningful data 
about quality improvement and improved health outcomes will not be 
possible without meaningful use of this technology among all providers.
  However, access to affordable technology is the primary reason why 
providers across the nation do not invest in this valuable tool. The 
licensing fees of proprietary software are expensive and beyond the 
reach of many of health care providers--particularly small, rural 
providers. Moreover, the federal government has spent substantial 
taxpayer dollars in the development of open source technology--with the 
Department of Veterans Affairs and the Indian Health Service, IHS, 
national leaders in open source electronic health record, EHR, 
development and implementation. Both the Veterans Health 
Administration's VistA software and the Indian Health Services' 
Resource and Patient Management System, RPMS, are affordable and 
dependable systems that have been in place for decades.
  Most recently, the health IT funding included in the American 
Recovery and Reinvestment Act, ARRA, although substantial, is likely to 
fall short of offering affordable options to all providers. In fact, 
CBO estimates that, even with funding and incentives in the ARRA, 30 
percent of hospitals and 10 percent of physicians will not have adopted 
health IT by 2019. And, there are some providers that are ineligible 
for funding under ARRA altogether.
  The Health Information Technology Public Utility Act will address 
this problem by increasing access to open source software through a 
public utility model. The public utility model proposed in this bill 
would be administered by a Federal Consolidated Health Information 
Technology Board under the umbrella of the ONCHIT, separate from the 
Policy and Standards Committees. Members of this Board would represent 
relevant agencies across the federal government. The Board would be 
responsible for linking efforts of current and new VistA and RPMS user 
groups, and updating VistA and RPMS open source software (including 
provider-based EHRs, personal health records, and other software 
modules) on a timely basis.
  The legislation also establishes a new 21st Century Health 
Information Technology Grant Program to provide funding to public and 
not-for-profit safety net providers to cover the costs of 
implementation and initial maintenance of VistA and/or RPMS systems. 
Grants will focus on eligible hospitals and clinics, with some 
additional funding for demonstrations in long-term care, home health, 
and hospice.
  The Health Information Technology Public Utility Act fills a crucial 
gap in health IT affordability and accessibility. This legislation does 
not replace commercial software; instead, it complements the private 
industry in this field--by making health information technology a 
realistic option for all providers and by making it possible for the 
benefits of health IT to accrue to all patients and I urge my 
colleagues to join me in support of this important policy.
  Mr. President, I ask unanimous consent that the text of the bill be 
printed in the Record.
  There being no objection, the text of the bill was ordered to be 
printed in the Record, as follows:

                                 S. 890

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

     SECTION 1. SHORT TITLE.

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

     SEC. 2. DEFINITIONS.

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

     SEC. 3. FEDERAL CONSOLIDATED HEALTH INFORMATION TECHNOLOGY 
                   BOARD.

       (a) Establishment.--To facilitate the implementation of 
     electronic health record systems among safety-net health care 
     providers (particularly small, rural providers) there shall 
     be established within the Office of the National Coordinator 
     for Health Information Technology of the Department of Health 
     and Human Services, a Federal Consolidated Health Information 
     Technology Board.
       (b) Board of Directors.--The Board shall be administered by 
     a board of directors that shall be composed of the following 
     individuals or their designees:
       (1) The Secretary.
       (2) The Under Secretary for Health of the Department of 
     Veterans Affairs.
       (3) The Director of the Indian Health Service.
       (4) The Secretary of Defense.
       (5) The Secretary of Health and Human Services.
       (6) The Director of the Agency for Healthcare Research and 
     Quality.
       (7) The Administrator of the Health Resources and Services 
     Administration.

[[Page S4695]]

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

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

       (a) Establishment.--The Board shall establish a grant 
     program, to be known as the 21st Century Health Information 
     Technology (HIT) Grant program, to award competitive grants 
     to eligible safety-net health care providers to enable such 
     providers to fully implement VistA or RPMS with respect to 
     the patients served by such providers.
       (b) Eligibility.--
       (1) In general.--To be eligible to receive a grant under 
     subsection (a), an entity shall--
       (A) be--
       (i) a public or nonprofit health care provider (as defined 
     in section 254(h)(7)(B) of the Communications Act of 1934 (47 
     U.S.C. 254(h)(7)(B)), including--

       (I) post-secondary educational institutions offering health 
     care instruction, teaching hospitals, and medical schools;
       (II) a community health center receiving a grant under 
     section 330 of the Public Health Service Act (42 U.S.C. 254) 
     or a health center that provides health care to migrants;
       (III) a local health department or agency, including a 
     dedicated emergency department of rural for-profit hospitals;
       (IV) a community mental health center;
       (V) a nonprofit hospitals;
       (VI) a rural health clinics, including a mobile clinic;
       (VII) a consortia of health care providers, that consists 
     of 1 or more of the entities described in clauses (i) through 
     (vi); and
       (VIII) a part-time eligible entity that is located in an 
     otherwise ineligible facility (as described in section 5(b); 
     or

       (ii) a free clinic (as defined in paragraph (4); and
       (B) submit to the Board as application at such time, in 
     such manner, and containing such information as the Board may 
     require.
       (2) Non-eligible entities.--
       (A) In general.--An entity shall not be eligible to receive 
     a grant under this section if such entity is a for-profit 
     health care entity (except as provided for in paragraph 
     (1)(A)), or any other type of entity that is not described in 
     such paragraph, including--
       (i) an entity described in paragraph (1)(A) that is 
     implementing an existing electronic health records system;
       (ii) an entity that is receiving grant funding under the 
     Federal Communication Commission Rural Health Pilot Program;
       (iii) an entity receiving funding for health information 
     technology through a Medicaid transformation grant under 
     title XIX of the Social Security Act (42 U.S.C. 1936 et 
     seq.);
       (iv) a private physician office or clinic;
       (v) a nursing home or other long-term care facility (such 
     as an assisted living facility);
       (vi) an emergency medical service facility;
       (vii) a residential substance abuse treatment facility;
       (viii) a hospice;
       (ix) a for-profit hospital;
       (x) a home health agency;
       (xi) a blood bank;
       (xii) a social service agency; and
       (xiii) a community center, vocational rehabilitation 
     center, or youth center.
       (B) Other entities.--An entity shall not be eligible to 
     receive a grant under this section if such entity is 
     receiving Medicare or Medicaid incentive funding under any of 
     the amendments made by title IV of division B of the American 
     Recovery and Reinvestment Act of 2009.
       (3) Preference.--In awarding grant under this section the 
     Board shall give preference to applicants that--
       (A) are located in geographical areas that have a greater 
     likelihood of serving the same patients and utilizing 
     interoperability to promote coordinated care management; or
       (B) demonstrate the greatest need for such award (as 
     determined by the Secretary).
       (4) Definition.--In this subsection, the term ``free 
     clinic'' means a safety-net health care organization that--
       (A) utilizes volunteers to provide a range of medical, 
     dental, pharmacy, or behavioral health services to 
     economically disadvantaged individuals the majority of whom 
     are uninsured or underinsured; and
       (B) is a community-based tax-exempt organization under 
     section 501(c)(3) of the Internal Revenue Code of 1986, or 
     that operates as a program component or affiliate of such a 
     501(c)(3) organization.

     An entity that is otherwise a free clinic under this 
     paragraph, but that charge a nominal fee to patients, shall 
     still be considered to be a free clinics if the entity 
     delivers essential services regardless of the patient's 
     ability to pay.
       (c) Use of Funds.--An entity shall use amounts received 
     under a grant under this section to fully implement the VistA 
     or RPMS with respect to the patients served by such entity. 
     Such implementation shall include at least the meaningful use 
     (as defined by the Secretary of Health and Human Services) of 
     such systems, including any ongoing updates and changes to 
     such definition.
       (d) Term and Renewal.--A grant under this section shall be 
     for a period of not to exceed 5 years and may be renewed, as 
     determined appropriate by the Board, based on the achievement 
     of benchmarks required by the Board.
       (e) Annual Reporting.--
       (1) By grantees.--Not later than 1 year after the date on 
     which an entity receives a grant under this section, and 
     annually during each year in which such entity has received 
     funds under such grant, such entity shall submit to the Board 
     a report concerning the activities carried out under the 
     grant.
       (2) By board.--Not later than 2 years after the date of 
     enactment of this Act, and annually thereafter, the Board 
     shall submit to the appropriate committees of Congress a 
     report concerning the activities carried out under this 
     section, including--
       (A) a description of the grants that have been awarded 
     under this section and the purposes of such grants;
       (B) specific implementation information with respect to 
     activities carried out by grantees;
       (C) the costs and savings achieved under the program under 
     this section;
       (D) a description of any innovations developed by health 
     care providers as a result of the implementation of 
     activities under this grant;
       (E) a description of the results of grant activities on 
     patient care quality measurement (including reductions in 
     medication errors and the provision of care management);
       (F) a description of the extent of electronic health record 
     use across health care provider settings;
       (G) a description of the extent to which integration of 
     VistA and RPMS with Medicaid and State children's health 
     insurance program billing has been achieved; and
       (H) any other information determined necessary by the 
     Board.
       (f) Annual Audits.--The Comptroller General of the United 
     States shall annually conduct an audit of the grant program 
     carried out under this section and submit the results of such 
     audits to the Board and the appropriate committees of 
     Congress.
       (g) Authorization of Appropriations.--There is authorized 
     to be appropriated to carry out this section--
       (1) $2,000,000,000 for each of fiscal years 2010 and 2011; 
     and
       (2) $1,000,000,000 for each of fiscal years 2012 through 
     2014.

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

       (a) In General.--The Board may use not to exceed 10 percent 
     of the amount appropriate for each fiscal year under section 
     4(g) to award competitive grants to eligible long-term care 
     providers for the conduct of demonstration projects to 
     implement VistA or RPMS with respect to the individuals 
     served by such providers.
       (b) Eligibility.--
       (1) In general.--To be eligible to receive a grant under 
     subsection (a), an entity shall--
       (A) be a--
       (i) nursing home or other long-term care facility (such as 
     an assisted living facility);

[[Page S4696]]

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