[Congressional Record (Bound Edition), Volume 155 (2009), Part 21]
[House]
[Pages 27993-27995]
[From the U.S. Government Publishing Office, www.gpo.gov]




       SMALL BUSINESS HEALTH INFORMATION TECHNOLOGY FINANCING ACT

  Ms. VELAZQUEZ. Mr. Speaker, I move to suspend the rules and pass the 
bill (H.R. 3014) to amend the Small Business Act to provide loan 
guarantees for the acquisition of health information technology by 
eligible professionals in solo and small group practices, and for other 
purposes, as amended.
  The Clerk read the title of the bill.
  The text of the bill is as follows:

                               H.R. 3014

       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 ``Small Business Health 
     Information Technology Financing Act''.

     SEC. 2. SMALL BUSINESS HEALTH INFORMATION TECHNOLOGY 
                   FINANCING PROGRAM.

       The Small Business Act (15 U.S.C. 631 et seq.) is amended 
     by redesignating section 44 as section 45 and by inserting 
     the following new section after section 43:

     ``SEC. 44. LOAN GUARANTEES FOR HEALTH INFORMATION TECHNOLOGY.

       ``(a) Definitions.--As used in this section:
       ``(1) The term `health information technology' means 
     computer hardware, software, and related technology that 
     supports the meaningful EHR use requirements set forth in 
     section 1848(o)(2)(A) of the Social Security Act (42 U.S.C. 
     1395w-4(o)(2)(A)) and is purchased by an eligible 
     professional to aid in the provision of health care in a 
     health care setting, including, but not limited to, 
     electronic medical records, and that provides for--
       ``(A) enhancement of continuity of care for patients 
     through electronic storage, transmission, and exchange of 
     relevant personal health data and information, such that this 
     information is accessible at the times and places where 
     clinical decisions will be or are likely to be made;
       ``(B) enhancement of communication between patients and 
     health care providers;
       ``(C) improvement of quality measurement by eligible 
     professionals enabling them to collect, store, measure, and 
     report on the processes and outcomes of individual and 
     population performance and quality of care;
       ``(D) improvement of evidence-based decision support; or
       ``(E) enhancement of consumer and patient empowerment.
     Such term shall not include information technology whose sole 
     use is financial management, maintenance of inventory of 
     basic supplies, or appointment scheduling.
       ``(2) The term `eligible professional' means any of the 
     following:
       ``(A) A physician (as defined in section 1861(r) of the 
     Social Security Act (42 U.S.C. 1395x(r))).
       ``(B) A practitioner described in section 1842(b)(18)(C) of 
     that Act.
       ``(C) A physical or occupational therapist or a qualified 
     speech-language pathologist.
       ``(D) A qualified audiologist (as defined in section 
     1861(ll)(3)(B)) of that Act.
       ``(E) A qualified medical transcriptionist who is either 
     certified by or registered with the Association for 
     Healthcare Documentation Integrity, or a successor 
     association thereto.
       ``(F) A State-licensed pharmacist.
       ``(G) A State-licensed supplier of durable medical 
     equipment, prosthetics, orthotics, or supplies.
       ``(H) A State-licensed, a State-certified, or a nationally 
     accredited home health care provider.
       ``(3) The term `qualified eligible professional' means an 
     eligible professional whose office can be classified as a 
     small business concern by the Administrator for purposes of 
     this Act under size standards established under section 3 of 
     this Act.
       ``(4) The term `qualified medical transcriptionist' means a 
     specialist in medical language and the healthcare 
     documentation process who interprets and transcribes 
     dictation by physicians and other healthcare professionals to 
     ensure accurate, complete, and consistent documentation of 
     healthcare encounters.
       ``(b) Loan Guarantees for Qualified Eligible 
     Professionals.--
       ``(1) In general.--Subject to paragraph (2), the 
     Administrator may guarantee up to 90 percent of the amount of 
     a loan made to a qualified eligible professional to be used 
     for the acquisition of health information technology for use 
     in such eligible professional's medical practice and for the 
     costs associated with the installation of such technology. 
     Except as otherwise provided in this section, the terms and 
     conditions that apply to loans made under section 7(a) of 
     this Act shall apply to loan guarantees made under this 
     section.
       ``(2) Limitations on guarantee amounts.--The maximum amount 
     of loan principal guaranteed under this subsection may not 
     exceed--
       ``(A) $350,000 with respect to any single qualified 
     eligible professional; and
       ``(B) $2,000,000 with respect to a single group of 
     affiliated qualified eligible professionals.
       ``(c) Fees.--(1) The Administrator may impose a guarantee 
     fee on the borrower for the purpose of reducing the cost (as 
     defined in section 502(5) of the Federal Credit Reform Act of 
     1990) of the guarantee to zero in an amount not to exceed 2 
     percent of the total guaranteed portion of any loan 
     guaranteed under this section. The Administrator may also 
     impose annual servicing fees on lenders not to exceed 0.5 
     percent of the outstanding balance of the guarantees on 
     lenders' books.

[[Page 27994]]

       ``(2) No service fees, processing fees, origination fees, 
     application fees, points, brokerage fees, bonus points, or 
     other fees may be charged to a loan applicant or recipient by 
     a lender in the case of a loan guaranteed under this section.
       ``(d) Deferral Period.--Loans guaranteed under this section 
     shall carry a deferral period of not less than 1 year and not 
     more than 3 years. The Administrator shall have the authority 
     to subsidize interest during the deferral period.
       ``(e) Effective Date.--No loan may be guaranteed under this 
     section until the meaningful EHR use requirements have been 
     determined by the Secretary of Health and Human Services.
       ``(f) Sunset.--No loan may be guaranteed under this section 
     after the date that is 7 years after meaningful EHR use 
     requirements have been determined by the Secretary of Health 
     and Human Services.
       ``(g) Authorization of Appropriations.--There are 
     authorized to be appropriated such sums as are necessary for 
     the cost (as defined in section 502(5) of the Federal Credit 
     Reform Act of 1990) of guaranteeing $10,000,000,000 in loans 
     under this section. The Administrator shall determine such 
     program cost separately and distinctly from other programs 
     operated by the Administrator.''.

     SEC. 3. REGULATIONS.

       Except as otherwise provided in this Act or in amendments 
     made by this Act, after an opportunity for notice and 
     comment, but not later than 180 days after the date of the 
     enactment of this Act, the Administrator shall issue 
     regulations to carry out this Act and the amendments made by 
     this Act.

  The SPEAKER pro tempore. Pursuant to the rule, the gentlewoman from 
New York (Ms. Velazquez) and the gentleman from Missouri (Mr. Graves) 
each will control 20 minutes.
  The Chair recognizes the gentlewoman from New York.


                             General Leave

  Ms. VELAZQUEZ. Mr. Speaker, I ask unanimous consent that all Members 
may have 5 legislative days to revise and extend their remarks and 
include extraneous material on the bill under consideration.
  The SPEAKER pro tempore. Is there objection to the request of the 
gentlewoman from New York?
  There was no objection.
  Ms. VELAZQUEZ. Mr. Speaker, I rise in support of H.R. 3014, important 
legislation authored by Mrs. Dahlkemper to assist our Nation's small 
health care providers.
  The passage of America's Affordable Health Choices Act earlier this 
month marked a turning point in our journey toward lasting health care 
reform. That legislation promises to break from the status quo, 
delivering solutions that not only reduce costs but also increase 
efficiency. These are changes our current system sorely needs. And, Mr. 
Speaker, reduced costs and enhanced efficiency are two benefits that 
health information technology already offers.
  In big hospitals across the country, electronic medical records are 
revolutionizing health care. They are streamlining the flow of data, 
minimizing errors, and improving communication between medical 
professionals, and they are doing it all with a click of a mouse. But 
while HIT offers a myriad of obvious benefits, small medical practices 
have struggled to adopt this technology. This is because the 
technology, like most groundbreaking new products, is extraordinarily 
expensive.
  For your average small practice, implementation of HIT runs close to 
$100,000. As a result, only 13 percent of single-doctor practices have 
chosen to purchase technology. This bill ensures all medical practices, 
regardless of size, can afford HIT. To begin, it blunts product and 
installation costs by making capital more affordable. It also allows 
small practices to defer loan payments. That way, these practitioners 
have the flexibility to bring this system online and reap the benefits 
before having to shoulder the implementation costs.
  Access to capital has always been a key concern for small firms even 
during the best of times. The current trend in tightening credit and 
restricting lending has compounded that challenge. Like all small 
businesses, small health practitioners are feeling the pinch of these 
tightening credit conditions. This is why this bill is so important. 
Without it, small practices will be unable to afford HIT. And because 
the vast majority of Americans patronize small practices, countless 
patients will miss out on the benefits of a streamlined system.
  Only days ago, this body took historic action to overhaul our broken 
health care system. As we continue to work towards lasting reform, HIT 
will play a critical role. With this bill, we can increase adoption 
within the small business community, reducing costs and improving 
quality for all Americans.
  Mr. Speaker, this is an important piece of legislation. It is 
supported by 23 of the most prominent medical organizations, including 
the American Medical Association, the American Academy of Pediatrics, 
the American Osteopathic Association, and the American College of 
Surgeons.
  I thank Representative Dahlkemper for her work on this bill. I urge 
my colleagues to vote ``yes.''
  Mr. Speaker, I reserve the balance of my time.
  Mr. GRAVES. Mr. Speaker, I yield myself such time as I may consume.
  Mr. Speaker, I rise today in support of the request to suspend the 
rules and pass H.R. 3014, a bill to provide financial assistance in the 
form of loans to install health information technology systems.
  Two weeks ago, there was significant disagreement about the health 
care reform bill offered by the Democrats. Those concerns included the 
cost impact on small businesses and whether the bill actually will 
improve the efficiency and efficacy of the health care system at a time 
of skyrocketing health insurance premiums. One way to improve the 
efficiency of the health care system is for physicians and other 
providers of health care, such as pharmacists, physical therapists, and 
providers of durable medical equipment, to install health information 
technology systems.

                              {time}  1130

  Electronic medical records have proven to be an effective tool in 
reducing medical errors and eliminating unnecessary medical procedures. 
However, health information technology systems are extremely expensive, 
particularly for the numerous small businesses such as solo physician 
practitioners in rural areas to purchase and install such systems.
  H.R. 3014 addresses this issue by providing loan guarantees by the 
Small Business Administration to health care providers that install 
health information technology systems. The loan process will operate in 
a manner identical to that of the SBA's 7(a) loan guarantee program. 
Thus, fees will be charged to borrowers and lenders as they are in the 
7(a) loan program.
  Testimony before the committee revealed that it takes anywhere from 1 
to 3 years for physicians and other health care providers to reach the 
level of efficiency that they operated with under handwritten systems. 
Recognizing this, H.R. 3014 authorizes a deferral period in repayment 
of 1 to 3 years. While there is an additional cost associated with such 
deferral, this small incentive will pay for itself many times through 
an increase in efficiency of the health care system without undertaking 
a government capture of the health care market.
  Mr. Speaker, I reserve the balance of my time.
  Ms. VELAZQUEZ. Mr. Speaker, I yield as much time as she may consume 
to the lead sponsor of this bill, the gentlelady from Pennsylvania 
(Mrs. Dahlkemper).
  Mrs. DAHLKEMPER. Mr. Speaker, I rise today in support of the Small 
Business Health Information Technology Financing Act. This legislation 
is a vital piece to lowering the health care costs of our country, and 
a key to making health technology accessible to small business health 
companies.
  While we talk about the high price of health care to hospitals and 
consumers, we often forget that most doctors and pharmacists work in 
small groups or as individual health care providers. These small 
medical businesses are dramatically affected by administrative burdens, 
which can translate to higher health care costs for their patients.
  My legislation creates an affordable path for these providers to make 
the investment in health information technologies that lower the cost 
of health

[[Page 27995]]

care for their patients and for their businesses.
  Rural communities, like many of those in my district, often rely on 
only a few health care providers in the area. These providers--
independent pharmacists, doctors and allied health professionals--
struggle to continue providing their services when they do not have the 
infrastructure and support of bigger hospitals or other facilities. 
Doctors and practitioners with small practices work tirelessly to keep 
communities healthy at the most basic level, but the costs to do so can 
be overwhelming.
  The Small Business Health Information Technology Financing Act 
creates a new loan guarantee program at the SBA that would allow these 
small pharmacies, small doctors and allied professional offices to 
purchase health information technology that would drastically improve 
their businesses and potentially lower the costs to patients. The loan 
guarantee programs provides a 90 percent guarantee on loan amounts up 
to $350,000 for an individual practitioner and $2 million for a group 
to purchase cost-saving information technologies which are often too 
expensive an investment for a small business.
  Mr. Speaker, the Small Business Health Information Technology 
Financing Act will not only lower the administrative costs of health 
care, it will help bolster small businesses by allowing them access to 
modern and efficient technologies. My legislation creates an affordable 
loan program for these providers to make the investment in health 
information technologies that lower the cost of health care for 
everyone and improve the health of all. I urge my colleagues on both 
sides of the aisle to support this small business legislation.
  Mr. GRAVES. Mr. Speaker, I don't have any other speakers. I would 
just like to say that I appreciate the chairwoman's work on this bill 
and incorporating ideas from our side into this bill. As always, the 
bipartisan work of the committee is very much noticed and I appreciate 
that.
  I would yield back the balance of my time.
  Ms. VELAZQUEZ. I have an additional speaker. I will yield as much 
time as he may consume to the gentleman from Rhode Island (Mr. 
Langevin).
  Mr. LANGEVIN. Mr. Speaker, I thank the gentlelady for yielding, and I 
want to commend the sponsor of this act before us today.
  Mr. Speaker, I rise in strong support of H.R. 3014, the Small 
Business Health Information Technology Financing Act. As this Congress 
is moving aggressively to solve our Nation's health care crisis by 
establishing universal health care, we are going to have to move 
aggressively also to look at ways of controlling costs. That really is 
one of the vital reasons why we have to overhaul our Nation's health 
care system. Health information technology will be a vital part of the 
effort to both improve quality and cut costs.
  But, of course, with this there will be an up-front cost that many 
doctors, in particular, are going to have to absorb. We have to work 
aggressively, I believe, to try to support them in this transition to 
adopt these new health information technologies. Again, many of these 
doctors are just, if you will, small businesses themselves. Today, the 
Congress is debating several bills supporting small business.
  In order to create jobs we absolutely have to look to small 
businesses. In many ways they are the backbone of our economy. 
Certainly in my home State of Rhode Island that's true, with 96 percent 
of employers being small businesses. My constituents right now are 
struggling with a heavy burden of 13 percent unemployment in a State 
whose recession began almost a year earlier than most of its neighbors, 
and the need for job creation could not be more urgent.
  Many of the new jobs we need will be created through new business 
endeavors, and that's why this legislation and other pieces of small 
business legislation that we're debating today are so important. By 
looking at new business models, we will better target the needs of our 
communities. We need to help our small businesses grow, keep people 
employed, and train them for new, sustainable jobs. American prosperity 
clearly depends on the success of small businesses and the innovative 
spirit of the American people. I'm certainly committed to bringing 
relief to Main Street and small businesses that are struggling in our 
State. Certainly, doctors, as I said, many of them are small businesses 
themselves, and helping them with the up-front cost of adopting this 
health information technology will assist them to stay in business. And 
particularly, as we try to grow our primary care system, this will 
become more and more important.
  I commend the gentlelady for introducing the legislation. I am proud 
to support it, as I am proud to support all of our small businesses and 
helping them to stay in business and grow jobs.
  Ms. VELAZQUEZ. Mr. Speaker, I yield back the balance of my time.
  The SPEAKER pro tempore. The question is on the motion offered by the 
gentlewoman from New York (Ms. Velazquez) that the House suspend the 
rules and pass the bill, H.R. 3014, as amended.
  The question was taken; and (two-thirds being in the affirmative) the 
rules were suspended and the bill, as amended, was passed.
  A motion to reconsider was laid on the table.

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