[House Report 109-603]
[From the U.S. Government Publishing Office]



109th Congress                                                   Report
                        HOUSE OF REPRESENTATIVES
 2d Session                                                     109-603

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

                                _______
                                

   July 26, 2006.--Referred to the House Calendar and ordered to be 
                                printed

                                _______
                                

  Mr. Lincoln Diaz-Balart, from the Committee on Rules, submitted the 
                               following

                              R E P O R T

                       [To accompany H. Res. 952]

    The Committee on Rules, having had under consideration 
House Resolution 952, by a record vote of 9 to 4, report the 
same to the House with the recommendation that the resolution 
be adopted.

                SUMMARY OF PROVISIONS OF THE RESOLUTION

    The resolution provides for consideration of H.R. 4157, the 
Health Information Technology Promotion Act of 2006, under a 
structured rule. The rule provides one 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 of the Committee on Ways 
and Means.
    The rule waives all points of order against consideration 
of the bill. The rule provides that 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 this report, modified by 
the amendment printed in part B of this report, shall be 
considered as adopted in the House and in the Committee of the 
Whole.
    The rule provides that the bill, as amended, shall be 
considered as the original bill for the purpose of further 
amendment and shall be considered as read. The rule waives all 
points of order against provisions in the bill as amended.
    The rule makes in order only those further amendments 
printed in part C of this report. The rule provides that the 
amendments printed in part C of this report may be offered only 
in the order printed in this report, may be offered only by a 
Member designated in this report, shall be considered as read, 
shall be debatable for the time specified in this 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.
    The rule waives all points of order against the amendments 
printed in this report. The rule provides one motion to 
recommit with or without instructions.
    The rule further provides that after passage of H.R. 4157, 
it shall be in order to consider in the House S. 1418. The rule 
waives all points of order against the Senate bill and against 
its consideration. The rule provides that 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. The rule waives all points of order 
against that motion. The rule provides that 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.
    Finally, the rule provides that H. Res. 924 is laid on the 
table.

                         EXPLANATION OF WAIVERS

    The waiver of all points of order against consideration of 
the bill includes a waiver of clause 4(a) of rule XIII 
(requiring a three-day layover of the committee report). The 
waiver is necessary because the Committee on Energy and 
Commerce and the Committee on Ways and Means filed their 
reports with the House on Wednesday, July 26, 2006 and the bill 
may be considered by the House as early as Thursday, July 27, 
2006.
    The waiver of all points of order against consideration of 
the bill also includes a waiver of section 302 of the 
Congressional Budget Act (prohibiting consideration of 
legislation which exceeds a committee's allocation of new 
entitlement authority) and a waiver of section 303 of the 
Congressional Budget Act (prohibiting consideration of 
legislation, as reported, providing new budget authority, 
change in revenues, change in public debt, new entitlement 
authority, or new credit authority for a fiscal year until the 
budget resolution for that year has been agreed to).

                            COMMITTEE VOTES

    Pursuant to clause 3(b) of House rule XIII the results of 
each record vote on an amendment or motion to report, together 
with the names of those voting for and against, are printed 
below:

Rules Committee record vote No. 238

    Date: July 26, 2006.
    Measure: H.R. 4157, Health Information Technology Promotion 
Act of 2006.
    Motion by: Mr. McGovern.
    Summary of motion: To make in order en bloc and provide the 
appropriate waivers for the amendments numbered 6, 7, and 8 
offered by Representative Kennedy of Rhode Island.
    Results: Defeated 4 to 9.
    Vote by Members: Diaz-Balart--Nay; Hastings (WA)--Nay; 
Sessions--Nay; Putnam--Nay; Capito--Nay; Cole--Nay; Bishop--
Nay; Gingrey--Nay; Slaughter--Yea; McGovern--Yea; Hastings 
(FL)--Yea; Matsui--Yea; Dreier--Nay.

Rules Committee record vote No. 239

    Date: July 26, 2006.
    Measure: H.R. 4157, Health Information Technology Promotion 
Act of 2006.
    Motion by: Mr. Hastings of Florida.
    Summary of motion: To make in order and provide the 
appropriate waivers for the amendment in the nature of a 
substitute offered by Representative Dingell, which is based on 
the Senate-passed bipartisan bill introduced by Senators Frist, 
Enzi, Kennedy, and Clinton. Also includes privacy protections 
necessary where information will be more vulnerable to breach 
by thieves and others. Promotes technology through greater 
direct funding for providers, as opposed to changing the Stark 
self-referral and anti-kickback fraud and abuse laws. Also 
provides privacy protections beyond those in current law to 
ensure that patients' health information is secure.
    Results: Defeated 4 to 9.
    Vote by Members: Diaz-Balart--Nay; Hastings (WA)--Nay; 
Sessions--Nay; Putnam--Nay; Capito--Nay; Cole--Nay; Bishop--
Nay; Gingrey--Nay; Slaughter--Yea; McGovern--Yea; Hastings 
(FL)--Yea; Matsui--Yea; Dreier--Nay.

Rules Committee record vote No. 240

    Date: July 26, 2006.
    Measure: H.R. 4157, Health Information Technology Promotion 
Act of 2006.
    Motion by: Mrs. Matsui.
    Summary of motion: To make in order and provide the 
appropriate waivers for the amendment offered by Representative 
Markey, which gives patients the power to keep their medical 
records out of electronic databases unless they first give 
their permission. Requires patients to be notified if their 
health information in the system is lost, stolen, or used for 
an unauthorized purpose. Enables patients to seek damages from 
individuals and entities that improperly obtain or disclose 
individually-identifiable health information. Requires the use 
of data safeguards such as encryption. Permits patients to 
limit access to particularly sensitive information in their 
medical records. Continues to allow States to have more 
protective privacy laws.
    Results: Defeated 4 to 9.
    Vote by Members: Diaz-Balart--Nay; Hastings (WA)--Nay; 
Sessions--Nay; Putnam--Nay; Capito--Nay; Cole--Nay; Bishop--
Nay; Gingrey--Nay; Slaughter--Yea; McGovern--Yea; Hastings 
(FL)--Yea; Matsui--Yea; Dreier--Nay.

Rules Committee record vote No. 241

    Date: July 26, 2006.
    Measure: H.R. 4157, Health Information Technology Promotion 
Act of 2006.
    Motion by: Mr. Lincoln Diaz-Balart.
    Summary of motion: To report the rule.
    Results: Agreed to 9 to 4.
    Vote by Members: Diaz-Balart--Yea; Hastings (WA)--Yea; 
Sessions--Yea; Putnam--Yea; Capito--Yea; Cole--Yea; Bishop--
Yea; Gingrey--Yea; Slaughter--Nay; McGovern--Nay; Hastings 
(FL)--Nay; Matsui--Nay; Dreier--Yea.

 PART A--SUMMARY OF AMENDMENT IN THE NATURE OF A SUBSTITUTE CONSIDERED 
                               AS ADOPTED

    Codifies and expands the authorities and duties of the 
National Coordinator for Health Information Technology 
including responsibilities for endorsing interoperability 
guidelines, conducting a National survey on the information 
exchange capabilities, and reviewing Federal information 
systems and security practices. Furthermore, Federal health 
information collection systems must be consistent with 
guidelines within three years of endorsement. The bill provides 
grants to help integrated health systems coordinate the 
delivery of care for uninsured, underinsured and medically 
underserved populations and to demonstrate issues in the 
adoption of health IT in the small physician setting. The bill 
further modernizes billing code sets. The bill would also 
create safe harbors for providing certain health IT or related 
services under Antikickback and physician self-referral law to 
improve coordination of care. The bill provides for a number of 
studies and reports regarding privacy and security, telehealth, 
health information exchanges, the American Health Information 
Community. Finally, the bill contains provisions for pricing 
transparency for inpatient hospital services.

 PART B--SUMMARY OF THE AMENDMENT TO THE AMENDMENT IN THE NATURE OF A 
                    SUBSTITUTE CONSIDERED AS ADOPTED

    Strikes sections 404 (Methodology for reporting uniform 
price data for inpatient and outpatient hospital services) and 
405 (Inclusion of uniform price data). Eliminates a provision 
in the underlying bill that would have expanded the types of 
entities that could provide health IT without violating 
Medicare anti-kickback laws, beginning in 2011.

              PART C--SUMMARY OF AMENDMENTS MADE IN ORDER

    1. Hinojosa (TX):
    Improves the availability of information and resources for 
individuals with low literacy. (10 minutes)
    2. Towns (NY): Creates a study that provides benchmarks for 
best practices and cost effectiveness for the use of Health 
Information Technology in medically underserved areas. (10 
minutes)
    3. Jackson (IL): Ensures that emergency contact information 
or next of kin information is included in any process to 
modernize medical records. (10 minutes)
    4. Cuellar (TX): Focuses a priority of the integrated 
health system grant program on the improved coordination of 
care for the uninsured, underinsured, and medically underserved 
residing in geographically isolated areas or underserved urban 
areas. (10 minutes)
    5. Price, Tom (GA): Requires the Secretary of Health and 
Human Services to submit a report to Congress, which evaluates: 
the applicability of health care classification methodologies 
and codes for purposes beyond the coding services for 
diagnostic documentation or billing purposes; the usefulness, 
accuracy, and completeness of such methodologies and codes for 
such purposes; and the capacity of such methodologies and codes 
to produce erroneous or misleading information, with respect to 
such purposes. (10 minutes)
    6. McMorris (WA)/Smith, Adam (WA): Directs the Secretary of 
Health and Human Services to establish a two year project to 
demonstrate the impact of health information technology on 
disease management for chronic disease sufferers within the 
Medicaid population. There is no authorization of funding and 
it requests a report at the conclusion of the demonstration. 
(10 minutes)

PART A--TEXT OF THE AMENDMENT IN THE NATURE OF A SUBSTITUTE CONSIDERED 
                               AS ADOPTED

  Strike all after the enacting clause and insert the 
following:

SECTION 1. SHORT TITLE AND TABLE OF CONTENTS.

  (a) Short Title.--This Act may be cited as the ``Health 
Information Technology Promotion Act of 2006''.
  (b) Table of Contents.--The table of contents of this Act is 
as follows:

Sec. 1. Short title and table of contents.
Sec. 2. Preserving privacy and security laws.

TITLE I--COORDINATION FOR, PLANNING FOR, AND INTEROPERABILITY OF HEALTH 
                         INFORMATION TECHNOLOGY

Sec. 101. Office of the National Coordinator for Health Information 
          Technology.
Sec. 102. Report on the American Health Information Community.
Sec. 103. Interoperability planning process; Federal information 
          collection activities.
Sec. 104. Grants to integrated health systems to promote health 
          information technologies to improve coordination of care for 
          the uninsured, underinsured, and medically underserved.
Sec. 105. Small physician practice demonstration grants.

         TITLE II--TRANSACTION STANDARDS, CODES, AND INFORMATION

Sec. 201. Procedures to ensure timely updating of standards that enable 
          electronic exchanges.
Sec. 202. Upgrading ASC X12 and NCPDP standards.
Sec. 203. Upgrading ICD codes; coding and documentation of non-medical 
          information.
Sec. 204. Strategic plan for coordinating implementation of transaction 
          standards and ICD codes.
Sec. 205. Study and report to determine impact of variation and 
          commonality in State health information laws and regulations.

TITLE III--PROMOTING THE USE OF HEALTH INFORMATION TECHNOLOGY TO BETTER 
                         COORDINATE HEALTH CARE

Sec. 301. Safe harbors to antikickback civil penalties and criminal 
          penalties for provision of health information technology and 
          training services.
Sec. 302. Exception to limitation on certain physician referrals (under 
          Stark) for provision of health information technology and 
          training services to health care professionals.
Sec. 303. Rules of construction regarding use of consortia.

                     TITLE IV--ADDITIONAL PROVISIONS

Sec. 401. Promotion of telehealth services.
Sec. 402. Study and report on expansion of home health-related 
          telehealth services.
Sec. 403. Study and report on store and forward technology for 
          telehealth.
Sec. 404. Methodology for reporting uniform price data for inpatient and 
          outpatient hospital services.
Sec. 405. Inclusion of uniform price data.
Sec. 406. Ensuring health care providers participating in PHSA programs, 
          Medicaid, SCHIP, or the MCH program may maintain health 
          information in electronic form.
Sec. 407. Ensuring health care providers participating in the Medicare 
          program may maintain health information in electronic form.
Sec. 408. Study and report on State, regional, and community health 
          information exchanges.

SEC. 2. PRESERVING PRIVACY AND SECURITY LAWS.

  Nothing in this Act (or the amendments made by this Act) 
shall be construed to affect the scope, substance, or 
applicability of section 264(c) of the Health Insurance 
Portability and Accountability Act of 1996 and any regulation 
issued pursuant to such section.

TITLE I--COORDINATION FOR, PLANNING FOR, AND INTEROPERABILITY OF HEALTH 
                         INFORMATION TECHNOLOGY

SEC. 101. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION 
                    TECHNOLOGY.

  (a) In General.--Title II of the Public Health Service Act is 
amended by adding at the end the following new part:

                ``PART D--HEALTH INFORMATION TECHNOLOGY

``SEC. 271. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH INFORMATION 
                    TECHNOLOGY.

  ``(a) Establishment.--There is established within the 
Department of Health and Human Services an Office of the 
National Coordinator for Health Information Technology that 
shall be headed by the National Coordinator for Health 
Information Technology (referred to in this part as the 
`National Coordinator'). The National Coordinator shall be 
appointed by and report directly to the Secretary. The National 
Coordinator shall be paid at a rate equal to the rate of basic 
pay for level IV of the Executive Schedule.
  ``(b) Goals of Nationwide Interoperable Health Information 
Technology Infrastructure.--The National Coordinator shall 
perform the duties under subsection (c) in a manner consistent 
with the development of a nationwide interoperable health 
information technology infrastructure that--
          ``(1) improves health care quality, promotes data 
        accuracy, reduces medical errors, increases the 
        efficiency of care, and advances the delivery of 
        appropriate, evidence-based health care services;
          ``(2) promotes wellness, disease prevention, and 
        management of chronic illnesses by increasing the 
        availability and transparency of information related to 
        the health care needs of an individual for such 
        individual;
          ``(3) promotes the availability of appropriate and 
        accurate information necessary to make medical 
        decisions in a usable form at the time and in the 
        location that the medical service involved is provided;
          ``(4) produces greater value for health care 
        expenditures by reducing health care costs that result 
        from inefficiency, medical errors, inappropriate care, 
        and incomplete or inaccurate information;
          ``(5) promotes a more effective marketplace, greater 
        competition, greater systems analysis, increased 
        consumer choice, enhanced quality, and improved 
        outcomes in health care services;
          ``(6) with respect to health information of 
        consumers, advances the portability of such information 
        and the ability of such consumers to share and use such 
        information to assist in the management of their health 
        care;
          ``(7) improves the coordination of information and 
        the provision of such services through an effective 
        infrastructure for the secure and authorized exchange 
        and use of health care information;
          ``(8) is consistent with legally applicable 
        requirements with respect to securing and protecting 
        the confidentiality of individually identifiable health 
        information of a patient;
          ``(9) promotes the creation and maintenance of 
        transportable, secure, Internet-based personal health 
        records, including promoting the efforts of health care 
        payers and health plan administrators for a health 
        plan, such as Federal agencies, private health plans, 
        and third party administrators, to provide for such 
        records on behalf of members of such a plan;
          ``(10) promotes access to and review of the 
        electronic health record of a patient by such patient;
          ``(11) promotes health research and health care 
        quality research and assessment; and
          ``(12) promotes the efficient and streamlined 
        development, submission, and maintenance of electronic 
        health care clinical trial data.
  ``(c) Duties of the National Coordinator.--
          ``(1) Strategic planner for interoperable health 
        information technology.--The National Coordinator shall 
        provide for a strategic plan for the nationwide 
        implementation of interoperable health information 
        technology in both the public and private health care 
        sectors consistent with subsection (b).
          ``(2) Principal advisor to the secretary.--The 
        National Coordinator shall serve as the principal 
        advisor to the Secretary on the development, 
        application, and use of health information technology, 
        and shall coordinate the policies and programs of the 
        Department of Health and Human Services for promoting 
        the use of health information technology.
          ``(3) Intragovernmental coordinator.--The National 
        Coordinator shall ensure that health information 
        technology policies and programs of the Department of 
        Health and Human Services are coordinated with those of 
        relevant executive branch agencies and departments with 
        a goal to avoid duplication of effort, to align the 
        health information architecture of each agency or 
        department toward a common approach, to ensure that 
        each agency or department conducts programs within the 
        areas of its greatest expertise and its mission in 
        order to create a national interoperable health 
        information system capable of meeting national public 
        health needs effectively and efficiently, and to assist 
        Federal agencies and departments in security programs, 
        policies, and protections to prevent unauthorized 
        access to individually identifiable health information 
        created, maintained, or in the temporary possession of 
        that agency or department. The coordination authority 
        provided to the National Coordinator under the previous 
        sentence shall supercede any such authority otherwise 
        provided to any other official of the Department of 
        Health and Human Services. For the purposes of this 
        paragraph, the term `unauthorized access' means access 
        that is not authorized by that agency or department 
        including unauthorized employee access.
          ``(4) Advisor to omb.--The National Coordinator shall 
        provide to the Director of the Office of Management and 
        Budget comments and advice with respect to specific 
        Federal health information technology programs.
          ``(5) Promoter of health information technology in 
        medically underserved communities.--The National 
        Coordinator shall--
                  ``(A) identify sources of funds that will be 
                made available to promote and support the 
                planning and adoption of health information 
                technology in medically underserved 
                communities, including in urban and rural 
                areas, either through grants or technical 
                assistance;
                  ``(B) coordinate with the funding sources to 
                help such communities connect to identified 
                funding; and
                  ``(C) collaborate with the Agency for 
                Healthcare Research and Quality and the Health 
                Services Resources Administration and other 
                Federal agencies to support technical 
                assistance, knowledge dissemination, and 
                resource development, to medically underserved 
                communities seeking to plan for and adopt 
                technology and establish electronic health 
                information networks across providers.''.
  (b) Treatment of Executive Order 13335.--Executive Order 
13335 shall not have any force or effect after the date of the 
enactment of this Act.
  (c) Transition From ONCHIT Under Executive Order.--
          (1) In general.--All functions, personnel, assets, 
        liabilities, administrative actions, and statutory 
        reporting requirements applicable to the old National 
        Coordinator or the Office of the old National 
        Coordinator on the date before the date of the 
        enactment of this Act shall be transferred, and applied 
        in the same manner and under the same terms and 
        conditions, to the new National Coordinator and the 
        Office of the new National Coordinator as of the date 
        of the enactment of this Act.
          (2) Rule of construction.-- Nothing in this section 
        or the amendment made by this section shall be 
        construed as requiring the duplication of Federal 
        efforts with respect to the establishment of the Office 
        of the National Coordinator for Health Information 
        Technology, regardless of whether such efforts are 
        carried out before or after the date of the enactment 
        of this Act.
          (3) Acting national coordinator.--Before the 
        appointment of the new National Coordinator, the old 
        National Coordinator shall act as the National 
        Coordinator for Health Information Technology until the 
        office is filled as provided in section 271(a) of the 
        Public Health Service Act, as added by subsection (a). 
        The Secretary of Health and Human Services may appoint 
        the old National Coordinator as the new National 
        Coordinator.
          (4) Definitions.--For purposes of this subsection:
                  (A) New national coordinator.--The term ``new 
                National Coordinator'' means the National 
                Coordinator for Health Information Technology 
                appointed under section 271(a) of the Public 
                Health Service Act, as added by subsection (a).
                  (B) Old national coordinator.--The term ``old 
                National Coordinator'' means the National 
                Coordinator for Health Information Technology 
                appointed under Executive Order 13335.

SEC. 102. REPORT ON THE AMERICAN HEALTH INFORMATION COMMUNITY.

  Not later than one year after the date of the enactment of 
this Act, the Secretary of Health and Human Services shall 
submit to Congress a report on the work conducted by the 
American Health Information Community (in this section referred 
to as ``AHIC''), as established by the Secretary. Such report 
shall include the following:
          (1) A description of the accomplishments of AHIC, 
        with respect to the promotion of the development of 
        national guidelines, the development of a nationwide 
        health information network, and the increased adoption 
        of health information technology.
          (2) Information on how model privacy and security 
        policies may be used to protect confidentiality of 
        health information, and an assessment of how existing 
        policies compare to such model policies.
          (3) Information on the progress in--
                  (A) establishing uniform industry-wide health 
                information technology standards;
                  (B) achieving an internet-based nationwide 
                health information network;
                  (C) achieving interoperable electronic health 
                record adoption across health care providers; 
                and
                  (D) creating technological innovations to 
                promote security and confidentiality of 
                individually identifiable health information.
          (4) Recommendations for the transition of AHIC to a 
        longer-term or permanent advisory and facilitation 
        entity, including--
                  (A) a schedule for such transition;
                  (B) options for structuring the entity as 
                either a public-private or private sector 
                entity;
                  (C) the collaberative role of the Federal 
                Government in the entity;
                  (D) steps for--
                          (i) continued leadership in the 
                        facilitation of guidelines or 
                        standards;
                          (ii) the alignment of financial 
                        incentives; and
                          (iii) the long-term plan for health 
                        care transformation through information 
                        technology; and
                  (E) the elimination or revision of the 
                functions of AHIC during the development of the 
                nationwide health information network.

SEC. 103. INTEROPERABILITY PLANNING PROCESS; FEDERAL INFORMATION 
                    COLLECTION ACTIVITIES.

  Part D of title II of the Public Health Service Act, as added 
by section 101(a), is amended by adding at the end the 
following new section:

``SEC. 272. INTEROPERABILITY PLANNING PROCESS; FEDERAL INFORMATION 
                    COLLECTION ACTIVITIES.

  ``(a) Strategic Interoperability Planning Process.--
          ``(1) Assessment and endorsement of core strategic 
        guidelines.--
                  ``(A) In general.--Not later than December 
                31, 2006, the National Coordinator shall 
                publish a strategic plan, including a schedule, 
                for the assessment and the endorsement of core 
                interoperability guidelines for significant use 
                cases consistent with this subsection. The 
                National Coordinator may update such plan from 
                time to time.
                  ``(B) Endorsement.--
                          ``(i) In general.--Consistent with 
                        the schedule under this paragraph and 
                        not later than one year after the 
                        publication of such schedule, the 
                        National Coordinator shall endorse a 
                        subset of core interoperability 
                        guidelines for significant use cases. 
                        The National Coordinator shall continue 
                        to endorse subsets of core 
                        interoperability guidelines for 
                        significant use cases annually 
                        consistent with the schedule published 
                        pursuant to this paragraph, with 
                        endorsement of all such guidelines 
                        completed not later than August 31, 
                        2009.
                          ``(ii) Consultation.--All such 
                        endorsements shall be in consultation 
                        with the American Health Information 
                        Community and other appropriate 
                        entities.
                          ``(iii) Voluntary compliance.--
                        Compliance with such guidelines shall 
                        be voluntary, subject to subsection 
                        (b)(1).
                  ``(C) Consultation with other parties.--The 
                National Coordinator shall develop and 
                implement such strategic plan in consultation 
                with the American Health Information Community 
                and other appropriate entities.
                  ``(D) Definitions.--For purposes of this 
                section:
                          ``(i) Interoperability guideline.--
                        The term `interoperability guideline' 
                        means a guideline to improve and 
                        promote the interoperability of health 
                        information technology for purposes of 
                        electronically accessing and exchanging 
                        health information. Such term includes 
                        named standards, architectures, 
                        software schemes for identification, 
                        authentication, and security, and other 
                        information needed to ensure the 
                        reproducible development of common 
                        solutions across disparate entities.
                          ``(ii) Core interoperability 
                        guideline.--The term `core 
                        interoperability guideline' means an 
                        interoperability guideline that the 
                        National Coordinator determines is 
                        essential and necessary for purposes 
                        described in clause (i).
                          ``(iii) Significant use case.--The 
                        term `significant use case' means a 
                        category (as specified by the National 
                        Coordinator) that identifies a 
                        significant use or purpose for the 
                        interoperability of health information 
                        technology, such as for the exchange of 
                        laboratory information, drug 
                        prescribing, clinical research, and 
                        electronic health records.
          ``(2) National survey.--
                  ``(A) In general.--Not later than August 31, 
                2008, the National Coordinator shall conduct 
                one or more surveys designed to measure the 
                capability of entities (including Federal 
                agencies, State and local government agencies, 
                and private sector entities) to exchange 
                electronic health information by appropriate 
                significant use case. Such surveys shall 
                identify the extent to which the type of health 
                information, the use for such information, or 
                any other appropriate characterization of such 
                information may relate to the capability of 
                such entities to exchange health information in 
                a manner that is consistent with methods to 
                improve the interoperability of health 
                information and with core interoperability 
                guidelines.
                  ``(B) Dissemination of survey results.--The 
                National Coordinator shall disseminate the 
                results of such surveys in a manner so as to--
                          ``(i) inform the public on the 
                        capabilities of entities to exchange 
                        electronic health information;
                          ``(ii) assist in establishing a more 
                        interoperable information architecture; 
                        and
                          ``(iii) identify the status of health 
                        information systems used in Federal 
                        agencies and the status of such systems 
                        with respect to interoperability 
                        guidelines.
  ``(b) Federal Health Information Collection Activities.--
          ``(1) Requirements.--With respect to a core 
        interoperability guideline endorsed under subsection 
        (a)(1)(B) for a significant use case, the President 
        shall take measures to ensure that Federal activities 
        involving the broad collection and submission of health 
        information are consistent with such guideline within 
        three years after the date of such endorsement.
          ``(2) Promoting use of non-identifiable health 
        information to improve health research and health care 
        quality.--
                  ``(A) In general.--Where feasible, and 
                consistent with applicable privacy or security 
                or other laws, the President, in consultation 
                with the Secretary, shall take measures to 
                allow timely access to useful categories of 
                non-identifiable health information in records 
                maintained by the Federal government, or 
                maintained by entities under contract with the 
                Federal government, to advance health care 
                quality and health research where such 
                information is in a form that can be used in 
                such research. The President shall consult with 
                appropriate Federal agencies, and solicit 
                public comment, on useful categories of 
                information, and appropriate measures to take. 
                The President may consider the administrative 
                burden and the potential for improvements in 
                health care quality in determining such 
                appropriate measures. In addition, the 
                President, in consultation with the Secretary, 
                shall encourage voluntary private and public 
                sector efforts to allow access to such useful 
                categories of non-identifiable health 
                information to advance health care quality and 
                health research.
                  ``(B) Non-identifiable health information 
                defined.--For purposes of this paragraph, the 
                term `non-identifiable health information' 
                means information that is not individually 
                identifiable health information as defined in 
                rules promulgated pursuant to section 264(c) of 
                the Health Insurance Portability and 
                Accountability Act of 1996 (42 U.S.C. 1320d-2 
                note), and includes information that has been 
                de-identified so that it is no longer 
                individually identifiable health information, 
                as defined in such rules.
          ``(3) Annual review and report.--For each year during 
        the five-year period following the date of the 
        enactment of this section, the National Coordinator 
        shall review the operation of health information 
        collection by and submission to the Federal government 
        and the purchases (and planned purchases) of health 
        information technology by the Federal government. For 
        each such year and based on the review for such year, 
        the National Coordinator shall submit to the President 
        and Congress recommendations on methods to--
                  ``(A) streamline (and eliminate redundancy 
                in) Federal systems used for the collection and 
                submission of health information;
                  ``(B) improve efficiency in such collection 
                and submission;
                  ``(C) increase the ability to assess health 
                care quality; and
                  ``(D) reduce health care costs.''.

SEC. 104. GRANTS TO INTEGRATED HEALTH SYSTEMS TO PROMOTE HEALTH 
                    INFORMATION TECHNOLOGIES TO IMPROVE COORDINATION OF 
                    CARE FOR THE UNINSURED, UNDERINSURED, AND MEDICALLY 
                    UNDERSERVED.

  Subpart I of part D of title III of the Public Health Service 
Act (42 U.S.C. 254b et seq.) is amended by adding at the end 
the following:

``SEC. 330M. GRANTS FOR IMPROVEMENT OF THE COORDINATION OF CARE FOR THE 
                    UNINSURED, UNDERINSURED, AND MEDICALLY UNDERSERVED.

  ``(a) In General.--The Secretary may make grants to 
integrated health care systems, in accordance with this 
section, for projects to better coordinate the provision of 
health care through the adoption of new health information 
technology, or the significant improvement of existing health 
information technology, to improve the provision of health care 
to uninsured, underinsured, and medically underserved 
individuals (including in urban and rural areas) through 
health-related information about such individuals, throughout 
such a system and at the point of service.
  ``(b) Eligibility.--
          ``(1) Application.--To be eligible to receive a grant 
        under this section, an integrated health care system 
        shall prepare and submit to the Secretary an 
        application, at such time, in such manner, and 
        containing such information as the Secretary may 
        require, including--
                  ``(A) a description of the project that the 
                system will carry out using the funds provided 
                under the grant;
                  ``(B) a description of the manner in which 
                the project funded under the grant will advance 
                the goal specified in subsection (a); and
                  ``(C) a description of the populations to be 
                served by the adoption or improvement of health 
                information technology.
          ``(2) Optional reporting condition.--The Secretary 
        may also condition the provision of a grant to an 
        integrated health care system under this section for a 
        project on the submission by such system to the 
        Secretary of a report on the impact of the health 
        information technology adopted (or improved) under such 
        project on the delivery of health care and the quality 
        of care (in accordance with applicable measures of such 
        quality). Such report shall be at such time and in such 
        form and manner as specified by the Secretary.
  ``(c) Integrated Health Care System Defined.--For purposes of 
this section, the term `integrated health care system' means a 
system of health care providers that is organized to provide 
care in a coordinated fashion and has a demonstrated commitment 
to provide uninsured, underinsured, and medically underserved 
individuals with access to such care.
  ``(d) Priorities.--In making grants under this section, the 
Secretary shall give priority to an integrated health care 
system--
          ``(1) that can demonstrate past successful community-
        wide efforts to improve the quality of care provided 
        and the coordination of care for the uninsured, 
        underinsured, and medically underserved; or
          ``(2) if the project to be funded through such a 
        grant--
                  ``(A) will improve the delivery of health 
                care and the quality of care provided; and
                  ``(B) will demonstrate savings for State or 
                Federal health care benefits programs or 
                entities legally obligated under Federal law to 
                provide health care from the reduction of 
                duplicative health care services, 
                administrative costs, and medical errors.
  ``(e) Limitation, Matching Requirement, and Conditions.--
          ``(1) Limitation on use of funds.--None of the funds 
        provided under a grant made under this section may be 
        used for a project providing for the adoption or 
        improvement of health information technology that is 
        used exclusively for financial record keeping, billing, 
        or other non-clinical applications.
          ``(2) Matching requirement.--To be eligible for a 
        grant under this section an integrated health care 
        system shall contribute non-Federal contributions to 
        the costs of carrying out the project for which the 
        grant is awarded in an amount equal to $1 for each $5 
        of Federal funds provided under the grant.
  ``(f) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section $15,000,000 for 
each of fiscal years 2007 and 2008.''.

SEC. 105. SMALL PHYSICIAN PRACTICE DEMONSTRATION GRANTS.

  Part D of title II of the Public Health Service Act, as added 
by section 101(a) and amended by section 103, is amended by 
adding at the end the following new section:

``SEC. 273. SMALL PHYSICIAN PRACTICE DEMONSTRATION GRANTS.

  ``(a) In General.--The Secretary shall establish a 
demonstration program under which the Secretary makes grants to 
small physician practices (including such practices that 
furnish services to individuals with chronic illnesses) that 
are located in rural areas or medically underserved urban areas 
for the purchase and support of health information technology.
  ``(b) Eligibility.--To be eligible to receive a grant under 
this section, an applicant shall prepare and submit to the 
Secretary an application, at such time, in such manner, and 
containing such information, as the Secretary may require.
  ``(c) Reporting.--
          ``(1) Required reports by small physician 
        practices.--A small physician practice receiving a 
        grant under subsection (a) shall submit to the 
        Secretary an evaluation on the health information 
        technology funded by such grant. Such evaluation shall 
        include information on--
                  ``(A) barriers to the adoption of health 
                information technology by the small physician 
                practice;
                  ``(B) issues for such practice in the use of 
                health information technology;
                  ``(C) the effect health information 
                technology will have on the quality of health 
                care furnished by such practice; and
                  ``(D) the effect of any medical liability 
                rules on such practice.
          ``(2) Report to congress.--Not later than January 1, 
        2009, the Secretary shall submit to Congress a report 
        on the results of the demonstration program under this 
        section.
  ``(d) Authorization of Appropriations.--There are authorized 
to be appropriated to carry out this section $5,000,000 for 
each of fiscal years 2007 and 2008.''.

        TITLE II--TRANSACTION STANDARDS, CODES, AND INFORMATION

SEC. 201. PROCEDURES TO ENSURE TIMELY UPDATING OF STANDARDS THAT ENABLE 
                    ELECTRONIC EXCHANGES.

  Section 1174(b) of the Social Security Act (42 U.S.C. 1320d-
3(b)) is amended--
          (1) in paragraph (1)--
                  (A) in the first sentence, by inserting ``and 
                in accordance with paragraph (3)'' before the 
                period; and
                  (B) by adding at the end the following new 
                sentence: ``For purposes of this subsection and 
                section 1173(c)(2), the term `modification' 
                includes a new version or a version upgrade.''; 
                and
          (2) by adding at the end the following new paragraph:
          ``(3) Expedited procedures for adoption of additions 
        and modifications to standards.--
                  ``(A) In general.--For purposes of paragraph 
                (1), the Secretary shall provide for an 
                expedited upgrade program (in this paragraph 
                referred to as the `upgrade program'), in 
                accordance with this paragraph, to develop and 
                approve additions and modifications to the 
                standards adopted under section 1173(a) to 
                improve the quality of such standards or to 
                extend the functionality of such standards to 
                meet evolving requirements in health care.
                  ``(B) Publication of notices.--Under the 
                upgrade program:
                          ``(i) Voluntary notice of initiation 
                        of process.--Not later than 30 days 
                        after the date the Secretary receives a 
                        notice from a standard setting 
                        organization that the organization is 
                        initiating a process to develop an 
                        addition or modification to a standard 
                        adopted under section 1173(a), the 
                        Secretary shall publish a notice in the 
                        Federal Register that--
                                  ``(I) identifies the subject 
                                matter of the addition or 
                                modification;
                                  ``(II) provides a description 
                                of how persons may participate 
                                in the development process; and
                                  ``(III) invites public 
                                participation in such process.
                          ``(ii) Voluntary notice of 
                        preliminary draft of additions or 
                        modifications to standards.--Not later 
                        than 30 days after the date of the date 
                        the Secretary receives a notice from a 
                        standard setting organization that the 
                        organization has prepared a preliminary 
                        draft of an addition or modification to 
                        a standard adopted by section 1173(a), 
                        the Secretary shall publish a notice in 
                        the Federal Register that--
                                  ``(I) identifies the subject 
                                matter of (and summarizes) the 
                                addition or modification;
                                  ``(II) specifies the 
                                procedure for obtaining the 
                                draft;
                                  ``(III) provides a 
                                description of how persons may 
                                submit comments in writing and 
                                at any public hearing or 
                                meeting held by the 
                                organization on the addition or 
                                modification; and
                                  ``(IV) invites submission of 
                                such comments and participation 
                                in such hearing or meeting 
                                without requiring the public to 
                                pay a fee to participate.
                          ``(iii) Notice of proposed addition 
                        or modification to standards.--Not 
                        later than 30 days after the date of 
                        the date the Secretary receives a 
                        notice from a standard setting 
                        organization that the organization has 
                        a proposed addition or modification to 
                        a standard adopted under section 
                        1173(a) that the organization intends 
                        to submit under subparagraph (D)(iii), 
                        the Secretary shall publish a notice in 
                        the Federal Register that contains, 
                        with respect to the proposed addition 
                        or modification, the information 
                        required in the notice under clause 
                        (ii) with respect to the addition or 
                        modification.
                          ``(iv) Construction.--Nothing in this 
                        paragraph shall be construed as 
                        requiring a standard setting 
                        organization to request the notices 
                        described in clauses (i) and (ii) with 
                        respect to an addition or modification 
                        to a standard in order to qualify for 
                        an expedited determination under 
                        subparagraph (C) with respect to a 
                        proposal submitted to the Secretary for 
                        adoption of such addition or 
                        modification.
                  ``(C) Provision of expedited determination.--
                Under the upgrade program and with respect to a 
                proposal by a standard setting organization for 
                an addition or modification to a standard 
                adopted under section 1173(a), if the Secretary 
                determines that the standard setting 
                organization developed such addition or 
                modification in accordance with the 
                requirements of subparagraph (D) and the 
                National Committee on Vital and Health 
                Statistics recommends approval of such addition 
                or modification under subparagraph (E), the 
                Secretary shall provide for expedited treatment 
                of such proposal in accordance with 
                subparagraph (F).
                  ``(D) Requirements.--The requirements under 
                this subparagraph with respect to a proposed 
                addition or modification to a standard by a 
                standard setting organization are the 
                following:
                          ``(i) Request for publication of 
                        notice.--The standard setting 
                        organization submits to the Secretary a 
                        request for publication in the Federal 
                        Register of a notice described in 
                        subparagraph (B)(iii) for the proposed 
                        addition or modification.
                          ``(ii) Process for receipt and 
                        consideration of public comment.--The 
                        standard setting organization provides 
                        for a process through which, after the 
                        publication of the notice referred to 
                        under clause (i), the organization--
                                  ``(I) receives and responds 
                                to public comments submitted on 
                                a timely basis on the proposed 
                                addition or modification before 
                                submitting such proposed 
                                addition or modification to the 
                                National Committee on Vital and 
                                Health Statistics under clause 
                                (iii);
                                  ``(II) makes publicly 
                                available a written explanation 
                                for its response in the 
                                proposed addition or 
                                modification to comments 
                                submitted on a timely basis; 
                                and
                                  ``(III) makes public comments 
                                received under clause (I) 
                                available, or provides access 
                                to such comments, to the 
                                Secretary.
                          ``(iii) Submittal of final proposed 
                        addition or modification to ncvhs.--
                        After completion of the process under 
                        clause (ii), the standard setting 
                        organization submits the proposed 
                        addition or modification to the 
                        National Committee on Vital and Health 
                        Statistics for review and consideration 
                        under subparagraph (E). Such submission 
                        shall include information on the 
                        organization's compliance with the 
                        notice and comment requirements (and 
                        responses to those comments) under 
                        clause (ii).
                  ``(E) Hearing and recommendations by national 
                committee on vital and health statistics.--
                Under the upgrade program, upon receipt of a 
                proposal submitted by a standard setting 
                organization under subparagraph (D)(iii) for 
                the adoption of an addition or modification to 
                a standard, the National Committee on Vital and 
                Health Statistics shall provide notice to the 
                public and a reasonable opportunity for public 
                testimony at a hearing on such addition or 
                modification. The Secretary may participate in 
                such hearing in such capacity (including 
                presiding ex officio) as the Secretary shall 
                determine appropriate. Not later than 120 days 
                after the date of receipt of the proposal, the 
                Committee shall submit to the Secretary its 
                recommendation to adopt (or not adopt) the 
                proposed addition or modification.
                  ``(F) Determination by secretary to accept or 
                reject national committee on vital and health 
                statistics recommendation.--
                          ``(i) Timely determination.--Under 
                        the upgrade program, if the National 
                        Committee on Vital and Health 
                        Statistics submits to the Secretary a 
                        recommendation under subparagraph (E) 
                        to adopt a proposed addition or 
                        modification, not later than 90 days 
                        after the date of receipt of such 
                        recommendation the Secretary shall make 
                        a determination to accept or reject the 
                        recommendation and shall publish notice 
                        of such determination in the Federal 
                        Register not later than 30 days after 
                        the date of the determination.
                          ``(ii) Contents of notice.--If the 
                        determination is to reject the 
                        recommendation, such notice shall 
                        include the reasons for the rejection. 
                        If the determination is to accept the 
                        recommendation, as part of such notice 
                        the Secretary shall promulgate the 
                        modified standard (including the 
                        accepted proposed addition or 
                        modification accepted) as a final rule 
                        under this subsection without any 
                        further notice or public comment 
                        period.
                          ``(iii) Limitation on 
                        consideration.--The Secretary shall not 
                        consider a proposal under this 
                        subparagraph unless the Secretary 
                        determines that the requirements of 
                        subparagraph (D) (including publication 
                        of notice and opportunity for public 
                        comment) have been met with respect to 
                        the proposal.
                  ``(G) Exemption from paperwork reduction 
                act.--Chapter 35 of title 44, United States 
                Code, shall not apply to a final rule 
                promulgated under subparagraph (F).
                  ``(H) Treatment as satisfying requirements 
                for notice-and-comment.--Any requirements under 
                section 553 of title 5, United States Code, 
                relating to notice and an opportunity for 
                public comment with respect to a final rule 
                promulgated under subparagraph (F) shall be 
                treated as having been met by meeting the 
                requirements of the notice and opportunity for 
                public comment provided under provisions of 
                subparagraphs (B)(iii), (D), and (E).
                  ``(I) No judicial review.--A final rule 
                promulgated under subparagraph (F) shall not be 
                subject to judicial review.''.

SEC. 202. UPGRADING ASC X12 AND NCPDP STANDARDS.

  (a) In General.--The Secretary of Health and Human Services 
shall provide by notice published in the Federal Register for 
the following replacements of standards to apply to 
transactions occurring on or after April 1, 2009:
          (1) Accredited standards committee x12 (asc x12) 
        standard.--The replacement of the Accredited Standards 
        Committee X12 (ASC X12) version 4010 adopted under 
        section 1173(a) of such Act (42 U.S.C. 1320d-2(a)) with 
        the ASC X12 version 5010, as reviewed by the National 
        Committee on Vital Health Statistics.
          (2) National council for prescription drug programs 
        (ncpdp) telecommunications standards.--The replacement 
        of the National Council for Prescription Drug Programs 
        (NCPDP) Telecommunications Standards version 5.1 
        adopted under section 1173(a) of such Act (42 U.S.C. 
        1320d-2(a)) with whichever is the latest version of the 
        NCPDP Telecommunications Standards that has been 
        approved by such Council and reviewed by the National 
        Committee on Vital Health Statistics as of April 1, 
        2007.
  (b) No Judicial Review.--The implementation of subsection 
(a), including the determination of the latest version under 
subsection (a)(2), shall not be subject to judicial review.

SEC. 203. UPGRADING ICD CODES; CODING AND DOCUMENTATION OF NON-MEDICAL 
                    INFORMATION.

  (a) Upgrading ICD Codes.--
          (1) In general.--The Secretary of Health and Human 
        Services shall provide by notice published in the 
        Federal Register for the replacement of the 
        International Classification of Diseases, 9th revision, 
        Clinical Modification (ICD-9-CM) under the regulation 
        promulgated under section 1173(c) of the Social 
        Security Act (42 U.S.C. 1320d-2(c)), including for 
        purposes of part A of title XVIII of such Act, with 
        both of the following:
                  (A) The International Classification of 
                Diseases, 10th revision, Clinical Modification 
                (ICD-10-CM).
                  (B) The International Classification of 
                Diseases, 10th revision, Procedure Coding 
                System (ICD-10-PCS).
          (2) Application.--The replacement made by paragraph 
        (1) shall apply, for purposes of section 1175(b)(2) of 
        the Social Security Act (42 U.S.C. 1320d-4(b)(2)), to 
        services furnished on or after October 1, 2010.
          (3) Rules of construction.--Nothing in paragraph (1) 
        shall be construed--
                  (A) as affecting the application of 
                classification methodologies or codes, such as 
                CPT or HCPCS codes, other than under the 
                International Classification of Diseases (ICD); 
                or
                  (B) as superseding the authority of the 
                Secretary of Health and Human Services to 
                maintain and modify the coding set for ICD-10-
                CM and ICD-10-PCS, including under the 
                amendments made by section 201.
  (b) Coding and Documentation of Non-Medical Information.--In 
any regulation or other action implementing the International 
Classification of Diseases, 10th revision, Clinical 
Modification (ICD-10-CM), the International Classification of 
Diseases, 10th revision, Procedure Coding System (ICD-10-PCS), 
or other version of the International Classification of 
Diseases, 10th revision, the Secretary of Health and Human 
Services shall ensure that no health care provider is required 
to code to a level of specificity that would require 
documentation of non-medical information on the external cause 
of any given type of injury.

SEC. 204. STRATEGIC PLAN FOR COORDINATING IMPLEMENTATION OF TRANSACTION 
                    STANDARDS AND ICD CODES.

  Not later than the date that is 180 days after the date of 
the enactment of this Act, the Secretary of Health and Human 
Services, in consultation with relevant public and private 
entities, shall develop a strategic plan with respect to the 
need for coordination in the implementation of--
          (1) transaction standards under section 1173(a) of 
        the Social Security Act, including modifications to 
        such standards under section 1174(b)(3) of such Act, as 
        added by section 201; and
          (2) any updated versions of the International 
        Classification of Diseases (ICD), including the 
        replacement of ICD-9 provided for under section 203(a).

SEC. 205. STUDY AND REPORT TO DETERMINE IMPACT OF VARIATION AND 
                    COMMONALITY IN STATE HEALTH INFORMATION LAWS AND 
                    REGULATIONS.

  Part C of title XI of the Social Security Act is amended by 
adding at the end the following new section:

``STUDY AND REPORT TO DETERMINE IMPACT OF VARIATION AND COMMONALITY IN 
             STATE HEALTH INFORMATION LAWS AND REGULATIONS

  ``Sec. 1180.  (a) Study.--For purposes of promoting the 
development of a nationwide interoperable health information 
technology infrastructure consistent with section 271(b) of the 
Public Health Service Act, the Secretary shall conduct a study 
of the impact of variation in State security and 
confidentiality laws and current Federal security and 
confidentiality standards on the timely exchanges of health 
information in order to ensure the availability of health 
information necessary to make medical decisions at the location 
in which the medical care involved is provided. Such study 
shall examine--
          ``(1)(A) the degree of variation and commonality 
        among the requirements of such laws for States; and
          ``(B) the degree of variation and commonality between 
        the requirements of such laws and the current Federal 
        standards;
          ``(2) insofar as there is variation among and between 
        such requirements, the strengths and weaknesses of such 
        requirements; and
          ``(3) the extent to which such variation may 
        adversely impact the secure, confidential, and timely 
        exchange of health information among States, the 
        Federal government, and public and private entities, or 
        may otherwise impact the reliability of such 
        information.
  ``(b) Report.--Not later than 18 months after the date of the 
enactment of this section, the Secretary shall submit to 
Congress a report on the study under subsection (a) and shall 
include in such report the following:
          ``(1) Analysis of need for greater commonality.--A 
        determination by the Secretary on the extent to which 
        there is a need for greater commonality of the 
        requirements of State security and confidentiality laws 
        and current Federal security and confidentiality 
        standards to better protect, strengthen, or otherwise 
        improve the secure, confidential, and timely exchange 
        of health information among States, the Federal 
        government, and public and private entities.
          ``(2) Recommendations for greater commonality.--
        Insofar as the Secretary determines under paragraph (1) 
        that there is a need for greater commonality of such 
        requirements, recommendations on the extent to which 
        (and how) the current Federal security and 
        confidentiality standards should be changed in order to 
        provide the commonality needed to better protect, 
        strengthen, or otherwise improve the secure, 
        confidential, and timely exchange of health 
        information.
          ``(3) Specific recommendation on legislative changes 
        for greater commonality.--A specific recommendation on 
        the extent to which and how such standards should 
        supersede State laws, in order to provide the 
        commonality needed to better protect or strengthen the 
        security and confidentiality of health information in 
        the timely exchange of such information and legislative 
        language in the form of a bill to effectuate such 
        specific recommendation.
  ``(c) Congressional Consideration of Legislation Providing 
for Greater Commonality.--
          ``(1) Rules of house of representatives and senate.--
        This subsection is enacted by the Congress--
                  ``(A) as an exercise of the rulemaking power 
                of the House of Representatives and the Senate, 
                respectively, and as such they are deemed a 
                part of the rules of each House, respectively, 
                but applicable only with respect to the 
                procedure to be followed in that House in the 
                case of a greater commonality bill defined in 
                paragraph (4), and they supersede other rules 
                only to the extent that they are inconsistent 
                therewith; and
                  ``(B) with full recognition of the 
                constitutional right of either House to change 
                the rules (so far as relating to the procedure 
                of that House) at any time, in the same manner 
                and to the same extent as in the case of any 
                other rule of that House.
          ``(2) Introduction.--On the date on which the final 
        report is submitted under subsection (b)(3)--
                  ``(A) a greater commonality bill shall be 
                introduced (by request) in the House by the 
                majority leader of the House, for himself and 
                the minority leader of the House, or by Members 
                of the House designated by the majority leader 
                and minority leader of the House; and
                  ``(B) a greater commonality bill shall be 
                introduced (by request) in the Senate by the 
                majority leader of the Senate, for himself and 
                the minority leader of the Senate, or by 
                Members of the Senate designated by the 
                majority leader and minority leader of the 
                Senate.
        If either House is not in session on the day on which 
        such a report is submitted, the greater commonality 
        bill shall be introduced in that House, as provided in 
        the preceding sentence, on the first day thereafter on 
        which the House is in session.
          ``(3) Referral.--A greater commonality bill shall be 
        referred by the Presiding Officers of the respective 
        House to the appropriate committee (or committees) of 
        such House, in accordance with the rules of that House.
          ``(4) Greater commonality bill defined.--For purposes 
        of this section, the term `greater commonality bill' 
        means a bill--
                  ``(A) the title of which is the following: `A 
                Bill to provide the commonality needed to 
                better protect, strengthen, or otherwise 
                improve the secure, confidential, and timely 
                exchange of health information'; and
                  ``(B) the text of which, as introduced, 
                consists of the text of the bill included in 
                the report submitted under subsection (b)(3).
  ``(d) Definitions.--For purposes of this section:
          ``(1) Current federal security and confidentiality 
        standards.--The term `current Federal security and 
        confidentiality standards' means the Federal privacy 
        standards established pursuant to section 264(c) of the 
        Health Insurance Portability and Accountability Act of 
        1996 (42 U.S.C. 1320d-2 note) and security standards 
        established under section 1173(d) of the Social 
        Security Act.
          ``(2) State.--The term `State' has the meaning given 
        such term when used in title XI of the Social Security 
        Act, as provided under section 1101(a) of such Act (42 
        U.S.C. 1301(a)).
          ``(3) State security and confidentiality laws.--The 
        term `State security and confidentiality laws' means 
        State laws and regulations relating to the privacy and 
        confidentiality of health information or to the 
        security of such information.''.

TITLE III--PROMOTING THE USE OF HEALTH INFORMATION TECHNOLOGY TO BETTER 
                         COORDINATE HEALTH CARE

SEC. 301. SAFE HARBORS TO ANTIKICKBACK CIVIL PENALTIES AND CRIMINAL 
                    PENALTIES FOR PROVISION OF HEALTH INFORMATION 
                    TECHNOLOGY AND TRAINING SERVICES.

  (a) For Civil Penalties.--Section 1128A of the Social 
Security Act (42 U.S.C. 1320a-7a) is amended--
          (1) in subsection (b), by adding at the end the 
        following new paragraph:
  ``(4) For purposes of this subsection, inducements to reduce 
or limit services described in paragraph (1) shall not include 
the practical or other advantages resulting from health 
information technology or related installation, maintenance, 
support, or training services.''; and
          (2) in subsection (i), by adding at the end the 
        following new paragraph:
          ``(8) The term `health information technology' means 
        hardware, software, license, right, intellectual 
        property, equipment, or other information technology 
        (including new versions, upgrades, and connectivity) 
        designed or provided primarily for the electronic 
        creation, maintenance, or exchange of health 
        information to better coordinate care or improve health 
        care quality, efficiency, or research.''.
  (b) For Criminal Penalties.--Section 1128B of such Act (42 
U.S.C. 1320a-7b) is amended--
          (1) in subsection (b)(3)--
                  (A) in subparagraph (G), by striking ``and'' 
                at the end;
                  (B) in the subparagraph (H) added by section 
                237(d) of the Medicare Prescription Drug, 
                Improvement, and Modernization Act of 2003 
                (Public Law 108-173; 117 Stat. 2213)--
                          (i) by moving such subparagraph 2 ems 
                        to the left; and
                          (ii) by striking the period at the 
                        end and inserting a semicolon;
                  (C) in the subparagraph (H) added by section 
                431(a) of such Act (117 Stat. 2287)--
                          (i) by redesignating such 
                        subparagraph as subparagraph (I);
                          (ii) by moving such subparagraph 2 
                        ems to the left; and
                          (iii) by striking the period at the 
                        end and inserting ``; and''; and
                  (D) by adding at the end the following new 
                subparagraph:
          ``(J) any nonmonetary remuneration (in the form of 
        health information technology, as defined in section 
        1128A(i)(8), or related installation, maintenance, 
        support or training services) made to a person by a 
        specified entity (as defined in subsection (g)) if--
                  ``(i) the provision of such remuneration is 
                without an agreement between the parties or 
                legal condition that--
                          ``(I) limits or restricts the use of 
                        the health information technology to 
                        services provided by the physician to 
                        individuals receiving services at the 
                        specified entity;
                          ``(II) limits or restricts the use of 
                        the health information technology in 
                        conjunction with other health 
                        information technology; or
                          ``(III) conditions the provision of 
                        such remuneration on the referral of 
                        patients or business to the specified 
                        entity;
                  ``(ii) such remuneration is arranged for in a 
                written agreement that is signed by the parties 
                involved (or their representatives) and that 
                specifies the remuneration solicited or 
                received (or offered or paid) and states that 
                the provision of such remuneration is made for 
                the primary purpose of better coordination of 
                care or improvement of health quality, 
                efficiency, or research; and
                  ``(iii) the specified entity providing the 
                remuneration (or a representative of such 
                entity) has not taken any action to disable any 
                basic feature of any hardware or software 
                component of such remuneration that would 
                permit interoperability.''; and
          (2) by adding at the end the following new 
        subsection:
  ``(g) Specified Entity Defined.--For purposes of subsection 
(b)(3)(J), the term `specified entity'--
          ``(1) means an entity that is a hospital, group 
        practice, prescription drug plan sponsor, a Medicare 
        Advantage organization, or any other such entity 
        specified by the Secretary, considering the goals and 
        objectives of this section, as well as the goals to 
        better coordinate the delivery of health care and to 
        promote the adoption and use of health information 
        technology; and
          ``(2) includes, effective October 1, 2011, any 
        entity.''.
  (c) Effective Date and Effect on State Laws.--
          (1) Effective date.--The amendments made by 
        subsections (a) and (b) shall take effect on the date 
        that is 120 days after the date of the enactment of 
        this Act.
          (2) Preemption of state laws.--No State (as defined 
        in section 1101(a) of the Social Security Act (42 
        U.S.C. 1301(a)) for purposes of title XI of such Act) 
        shall have in effect a State law that imposes a 
        criminal or civil penalty for a transaction described 
        in section 1128A(b)(4) or section 1128B(b)(3)(J) of 
        such Act, as added by subsections (a)(1) and (b), 
        respectively, if the conditions described in the 
        respective provision, with respect to such transaction, 
        are met.
  (d) Study and Report to Assess Effect of Safe Harbors on 
Health System.--
          (1) In general.--The Secretary of Health and Human 
        Services shall conduct a study to determine the impact 
        of each of the safe harbors described in paragraph (3). 
        In particular, the study shall examine the following:
                  (A) The effectiveness of each safe harbor in 
                increasing the adoption of health information 
                technology.
                  (B) The types of health information 
                technology provided under each safe harbor.
                  (C) The extent to which the financial or 
                other business relationships between providers 
                under each safe harbor have changed as a result 
                of the safe harbor in a way that adversely 
                affects or benefits the health care system or 
                choices available to consumers.
                  (D) The impact of the adoption of health 
                information technology on health care quality, 
                cost, and access under each safe harbor.
          (2) Report.--Not later than three years after the 
        effective date described in subsection (c)(1), the 
        Secretary of Health and Human Services shall submit to 
        Congress a report on the study under paragraph (1).
          (3) Safe harbors described.--For purposes of 
        paragraphs (1) and (2), the safe harbors described in 
        this paragraph are--
                  (A) the safe harbor under section 1128A(b)(4) 
                of such Act (42 U.S.C. 1320a-7a(b)(4)), as 
                added by subsection (a)(1); and
                  (B) the safe harbor under section 
                1128B(b)(3)(J) of such Act (42 U.S.C. 1320a-
                7b(b)(3)(J)), as added by subsection (b).

SEC. 302. EXCEPTION TO LIMITATION ON CERTAIN PHYSICIAN REFERRALS (UNDER 
                    STARK) FOR PROVISION OF HEALTH INFORMATION 
                    TECHNOLOGY AND TRAINING SERVICES TO HEALTH CARE 
                    PROFESSIONALS.

  (a) In General.--Section 1877(b) of the Social Security Act 
(42 U.S.C. 1395nn(b)) is amended by adding at the end the 
following new paragraph:
          ``(6) Information technology and training services.--
                  ``(A) In general.--Any nonmonetary 
                remuneration (in the form of health information 
                technology or related installation, 
                maintenance, support or training services) made 
                by a specified entity to a physician if--
                          ``(i) the provision of such 
                        remuneration is without an agreement 
                        between the parties or legal condition 
                        that--
                                  ``(I) limits or restricts the 
                                use of the health information 
                                technology to services provided 
                                by the physician to individuals 
                                receiving services at the 
                                specified entity;
                                  ``(II) limits or restricts 
                                the use of the health 
                                information technology in 
                                conjunction with other health 
                                information technology; or
                                  ``(III) conditions the 
                                provision of such remuneration 
                                on the referral of patients or 
                                business to the specified 
                                entity;
                          ``(ii) such remuneration is arranged 
                        for in a written agreement that is 
                        signed by the parties involved (or 
                        their representatives) and that 
                        specifies the remuneration made and 
                        states that the provision of such 
                        remuneration is made for the primary 
                        purpose of better coordination of care 
                        or improvement of health quality, 
                        efficiency, or research; and
                          ``(iii) the specified entity (or a 
                        representative of such entity) has not 
                        taken any action to disable any basic 
                        feature of any hardware or software 
                        component of such remuneration that 
                        would permit interoperability.
                  ``(B) Health information technology 
                defined.--For purposes of this paragraph, the 
                term `health information technology' means 
                hardware, software, license, right, 
                intellectual property, equipment, or other 
                information technology (including new versions, 
                upgrades, and connectivity) designed or 
                provided primarily for the electronic creation, 
                maintenance, or exchange of health information 
                to better coordinate care or improve health 
                care quality, efficiency, or research.
                  ``(C) Specified entity defined.--For purposes 
                of this paragraph, the term `specified 
                entity'--
                          ``(i) means an entity that is a 
                        hospital, group practice, prescription 
                        drug plan sponsor, a Medicare Advantage 
                        organization, or any other such entity 
                        specified by the Secretary, considering 
                        the goals and objectives of this 
                        section, as well as the goals to better 
                        coordinate the delivery of health care 
                        and to promote the adoption and use of 
                        health information technology; and
                          ``(ii) includes, effective October 1, 
                        2011, any entity.''.
  (b) Effective Date; Effect on State Laws.--
          (1) Effective date.--The amendment made by subsection 
        (a) shall take effect on the date that is 120 days 
        after the date of the enactment of this Act.
          (2) Preemption of state laws.--No State (as defined 
        in section 1101(a) of the Social Security Act (42 
        U.S.C. 1301(a)) for purposes of title XI of such Act) 
        shall have in effect a State law that imposes a 
        criminal or civil penalty for a transaction described 
        in section 1877(b)(6) of such Act, as added by 
        subsection (a), if the conditions described in such 
        section, with respect to such transaction, are met.
  (c) Study and Report to Assess Effect of Exception on Health 
System.--
          (1) In general.--The Secretary of Health and Human 
        Services shall conduct a study to determine the impact 
        of the exception under section 1877(b)(6) of such Act 
        (42 U.S.C. 1395nn(b)(6)), as added by subsection (a). 
        In particular, the study shall examine the following:
                  (A) The effectiveness of the exception in 
                increasing the adoption of health information 
                technology.
                  (B) The types of health information 
                technology provided under the exception.
                  (C) The extent to which the financial or 
                other business relationships between providers 
                under the exception have changed as a result of 
                the exception in a way that adversely affects 
                or benefits the health care system or choices 
                available to consumers.
                  (D) The impact of the adoption of health 
                information technology on health care quality, 
                cost, and access under the exception.
          (2) Report.--Not later than three years after the 
        effective date described in subsection (b)(1), the 
        Secretary of Health and Human Services shall submit to 
        Congress a report on the study under paragraph (1).

SEC. 303. RULES OF CONSTRUCTION REGARDING USE OF CONSORTIA.

  (a) Application to Safe Harbor From Criminal Penalties.--
Section 1128B(b)(3) of the Social Security Act (42 U.S.C. 
1320a-7b(b)(3)) is amended by adding after and below 
subparagraph (J), as added by section 301(b)(1), the 
following:``For purposes of subparagraph (J), nothing in such 
subparagraph shall be construed as preventing a specified 
entity, consistent with the specific requirements of such 
subparagraph, from forming a consortium composed of health care 
providers, payers, employers, and other interested entities to 
collectively purchase and donate health information technology, 
or from offering health care providers a choice of health 
information technology products in order to take into account 
the varying needs of such providers receiving such products.''.
  (b) Application to Stark Exception.--Paragraph (6) of section 
1877(b) of the Social Security Act (42 U.S.C. 1395nn(b)), as 
added by section 302(a), is amended by adding at the end the 
following new subparagraph:
                  ``(D) Rule of construction.--For purposes of 
                subparagraph (A), nothing in such subparagraph 
                shall be construed as preventing a specified 
                entity, consistent with the specific 
                requirements of such subparagraph, from--
                          ``(i) forming a consortium composed 
                        of health care providers, payers, 
                        employers, and other interested 
                        entities to collectively purchase and 
                        donate health information technology; 
                        or
                          ``(ii) offering health care providers 
                        a choice of health information 
                        technology products in order to take 
                        into account the varying needs of such 
                        providers receiving such products.''.

                    TITLE IV--ADDITIONAL PROVISIONS

SEC. 401. PROMOTION OF TELEHEALTH SERVICES.

  (a) Facilitating the Provision of Telehealth Services Across 
State Lines.--The Secretary of Health and Human Services shall, 
in coordination with physicians, health care practitioners, 
patient advocates, and representatives of States, encourage and 
facilitate the adoption of State reciprocity agreements for 
practitioner licensure in order to expedite the provision 
across State lines of telehealth services.
  (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Secretary of Health and Human 
Services shall submit to Congress a report on the actions taken 
to carry out subsection (a).
  (c) State Defined.--For purposes of this subsection, the term 
``State'' has the meaning given that term for purposes of title 
XVIII of the Social Security Act.

SEC. 402. STUDY AND REPORT ON EXPANSION OF HOME HEALTH-RELATED 
                    TELEHEALTH SERVICES.

  (a) Study.--The Secretary of Health and Human Services shall 
conduct a study to determine the feasibility, advisability, and 
the costs of--
          (1) including coverage and payment for home health-
        related telehealth services as part of home health 
        services under title XVIII of the Social Security Act; 
        and
          (2) expanding the list of sites described in 
        paragraph (4)(C)(ii) of section 1834(m) of the Social 
        Security Act (42 U.S.C. 1395m(m)) to include county 
        mental health clinics or other publicly funded mental 
        health facilities for the purpose of payment under such 
        section for the provision of telehealth services at 
        such clinics or facilities.
  (b) Specifics of Study.--Such study shall demonstrate whether 
the changes described in paragraphs (1) and (2) of subsection 
(a) will result in the following:
          (1) Enhanced health outcomes for individuals with one 
        or more chronic conditions.
          (2) Health outcomes for individuals furnished 
        telehealth services or home health-related telehealth 
        services that are at least comparable to the health 
        outcomes for individuals furnished similar items and 
        services by a health care provider at the same location 
        of the individual or at the home of the individual, 
        respectively.
          (3) Facilitation of communication of more accurate 
        clinical information between health care providers.
          (4) Closer monitoring of individuals by health care 
        providers.
          (5) Overall reduction in expenditures for health care 
        items and services.
          (6) Improved access to health care.
  (c) Home Health-Related Telehealth Services Defined.--For 
purposes of this section, the term ``home health-related 
telehealth services'' means technology-based professional 
consultations, patient monitoring, patient training services, 
clinical observation, patient assessment, and any other health 
services that utilize telecommunications technologies. Such 
term does not include a telecommunication that consists solely 
of a telephone audio conversation, facsimile, electronic text 
mail, or consultation between two health care providers.
  (d) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Secretary of Health and Human 
Services shall submit to Congress a report on the study 
conducted under subsection (a) and shall include in such report 
such recommendations for legislation or administration action 
as the Secretary determines appropriate.

SEC. 403. STUDY AND REPORT ON STORE AND FORWARD TECHNOLOGY FOR 
                    TELEHEALTH.

  (a) Study.--The Secretary of Health and Human Services, 
acting through the Director of the Office for the Advancement 
of Telehealth, shall conduct a study on the use of store and 
forward technologies (that provide for the asynchronous 
transmission of health care information in single or multimedia 
formats) in the provision of telehealth services. Such study 
shall include an assessment of the feasibility, advisability, 
and the costs of expanding the use of such technologies for use 
in the diagnosis and treatment of certain conditions.
  (b) Report.--Not later than 18 months after the date of the 
enactment of this Act, the Secretary of Health and Human 
Services shall submit to Congress a report on the study 
conducted under subsection (a) and shall include in such report 
such recommendations for legislation or administration action 
as the Secretary determines appropriate.

SEC. 404. METHODOLOGY FOR REPORTING UNIFORM PRICE DATA FOR INPATIENT 
                    AND OUTPATIENT HOSPITAL SERVICES.

  (a) In General.--The Secretary of Health and Human Services 
shall develop a method for the reporting of uniform price data 
for inpatient and outpatient hospital services. Such method 
shall provide for the reporting by each hospital of such data 
for selected procedures or services based on a range of charges 
and a range of prices actually paid for inpatient and 
outpatient hospital services grouped by type of payer, with 
each of the following treated as a separate type of payer: the 
Medicare program, the Medicaid program, other public health 
insurance coverage (including public group health plan 
coverage), private health insurance coverage (including private 
group health plan coverage), other insurance coverage, and 
self-pay.
  (b) GAO Study and Report.--
          (1) Study.--The Comptroller General of the United 
        States shall conduct a study to assess the structure 
        and methodology for permanent uniform reporting of 
        price data for health care services.
          (2) Report.--Not later than January 1, 2008, the 
        Comptroller General shall submit to Congress a report 
        on the study under paragraph (1). Such report shall 
        include the following:
                  (A) Recommendations on a structure and 
                methodology, for timely reporting of charges 
                and prices actually paid for health care 
                services, that minimize administrative 
                requirements for providers and maximize 
                efficient reporting utilizing health 
                information technology.
                  (B) Options for facilitating public 
                disclosure of such information in a manner 
                accessible and useful to consumers.
                  (C) Review of the strengths and weaknesses of 
                the reporting requirements imposed beginning 
                with fiscal year 2008 under section 405.

SEC. 405. INCLUSION OF UNIFORM PRICE DATA.

  Data required to be submitted pursuant to section 
1886(b)(3)(B)(viii) of the Social Security Act (42 U.S.C. 
1395ww(b)(3)(B)(viii)) shall include, effective with fiscal 
year 2008, the data described in section 404(a), with respect 
to inpatient hospital services, submitted in accordance with 
the method developed under such section, as well as the 
aggregate volume of selected procedures or services for which 
the data are reported.

SEC. 406. ENSURING HEALTH CARE PROVIDERS PARTICIPATING IN PHSA 
                    PROGRAMS, MEDICAID, SCHIP, OR THE MCH PROGRAM MAY 
                    MAINTAIN HEALTH INFORMATION IN ELECTRONIC FORM.

  Part D of title II of the Public Health Service Act, as added 
by section 101(a) and amended by sections 103 and 105, is 
further amended by adding at the end the following new section:

``SEC. 274. ENSURING HEALTH CARE PROVIDERS MAY MAINTAIN HEALTH 
                    INFORMATION IN ELECTRONIC FORM.

  ``(a) In General.--Any health care provider that participates 
in a health care program that receives Federal funds under this 
Act, or under title V, XIX, or XXI of the Social Security Act, 
shall be deemed as meeting any requirement for the maintenance 
of data in paper form under such program (whether or not for 
purposes of management, billing, reporting, reimbursement, or 
otherwise) if the required data is maintained in an electronic 
form.
  ``(b) Relation to State Laws.--Beginning on the date that is 
one year after the date of the enactment of this section, 
subsection (a) shall supersede any contrary provision of State 
law.
  ``(c) Construction.--Nothing in this section shall be 
construed as--
          ``(1) requiring health care providers to maintain or 
        submit data in electronic form;
          ``(2) preventing a State from permitting health care 
        providers to maintain or submit data in paper form; or
          ``(3) preventing a State from requiring health care 
        providers to maintain or submit data in electronic 
        form.''.

SEC. 407. ENSURING HEALTH CARE PROVIDERS PARTICIPATING IN THE MEDICARE 
                    PROGRAM MAY MAINTAIN HEALTH INFORMATION IN 
                    ELECTRONIC FORM.

  Section 1871 of the Social Security Act (42 U.S.C. 1395hh) is 
amended by adding at the end the following new subsection:
  ``(g)(1) Any provider of services or supplier shall be deemed 
as meeting any requirement for the maintenance of data in paper 
form under this title (whether or not for purposes of 
management, billing, reporting, reimbursement, or otherwise) if 
the required data is maintained in an electronic form.
  ``(2) Nothing in this subsection shall be construed as 
requiring health care providers to maintain or submit data in 
electronic form.''.

SEC. 408. STUDY AND REPORT ON STATE, REGIONAL, AND COMMUNITY HEALTH 
                    INFORMATION EXCHANGES.

  (a) Study.--The Secretary of Health and Human Services shall 
conduct a study on issues related to the development, 
operation, and implementation of State, regional, and community 
health information exchanges. Such study shall include the 
following, with respect to such health information exchanges:
          (1) Profiles detailing the current stages of such 
        health information exchanges with respect to the 
        progression of the development, operation, 
        implementation, organization, and governance of such 
        exchanges.
          (2) The impact of such exchanges on healthcare 
        quality, safety, and efficiency, including--
                  (A) any impact on the coordination of health 
                information and services across healthcare 
                providers and other organizations relevant to 
                health care;
                  (B) any impact on the availability of health 
                information at the point-of-care to make timely 
                medical decisions;
                  (C) any benefits with respect to the 
                promotion of wellness, disease prevention, and 
                chronic disease management;
                  (D) any improvement with respect to public 
                health preparedness and response;
                  (E) any impact on the widespread adoption of 
                interoperable health information technology, 
                including electronic health records;
                  (F) any contributions to achieving an 
                Internet-based national health information 
                network;
                  (G) any contribution of health information 
                exchanges to consumer access and to consumers' 
                use of their health information; and
                  (H) any impact on the operation of--
                          (i) the Medicaid and Medicare 
                        programs;
                          (ii) the State Children's Health 
                        Insurance Program (SCHIP);
                          (iii) disproportionate share 
                        hospitals described in section 1923 of 
                        the Social Security Act;
                          (iv) Federally-qualified health 
                        centers; or
                          (v) managed care plans, if a 
                        significant number of the plan's 
                        enrollees are beneficiaries in the 
                        Medicaid program or SCHIP.
          (3) Best practice models for financing, 
        incentivizing, and sustaining such health information 
        exchanges.
          (4) Information identifying the common principles, 
        policies, tools, and standards used (or proposed) in 
        the public and private sectors to support the 
        development, operation, and implementation of such 
        health information exchanges.
          (5) A description of any areas in which Federal 
        government leadership is needed to support growth and 
        sustainability of such health information exchanges.
  (b) Report.--Not later than one year after the date of 
enactment of this Act, the Secretary of Health and Human 
Services shall submit to Congress a report on the study 
described in subsection (a), including such recommendations as 
the Secretary determines appropriate to facilitate the 
development, operation, and implementation of health 
information exchanges.
  Amend the title so as to read: ``A Bill to promote a better 
health information system.''.

   PART B--TEXT OF THE AMENDMENT IN THE AMENDMENT IN THE NATURE OF A 
                    SUBSTITUTE CONSIDERED AS ADOPTED

  In section 1128B of the Social Security Act, amend subsection 
(g), as added by section 301(b)(2) of the bill, to read as 
follows:
  ``(g) Specified Entity Defined.--For purposes of subsection 
(b)(3)(J), the term `specified entity' means an entity that is 
a hospital, group practice, prescription drug plan sponsor, a 
Medicare Advantage organization, or any other such entity 
specified by the Secretary, considering the goals and 
objectives of this section, as well as the goals to better 
coordinate the delivery of health care and to promote the 
adoption and use of health information technology.''.
  In paragraph (6) of section 1877(b) of the Social Security 
Act, as added by section 302(a) of the bill, amend subparagraph 
(C) to read as follows:
                  ``(C) Specified entity defined.--For purposes 
                of this paragraph, the term `specified entity' 
                means an entity that is a hospital, group 
                practice, prescription drug plan sponsor, a 
                Medicare Advantage organization, or any other 
                such entity specified by the Secretary, 
                considering the goals and objectives of this 
                section, as well as the goals to better 
                coordinate the delivery of health care and to 
                promote the adoption and use of health 
                information technology.''.
  Strike section 404 (relating to methodology for reporting 
uniform price data for inpatient and outpatient hospital 
services) and section 405 (relating to inclusion of uniform 
price data), and redesignate the succeeding sections 
accordingly.

              PART C--TEXT OF THE AMENDMENTS MADE IN ORDER

 1. An Amendment To Be Offered by Representative Hinojosa of Texas, or 
                 His Designee, Debatable for 10 Minutes

  In section 271(b)(8) of the Public Health Service Act, as 
added by section 101(a) of the Bill, strike ``is consistent'' 
and insert ``provides for the confidentiality and security of 
individually identifiable health information, consistent''.
  In section 271(b) of the Public Health Service Act, as added 
by section 101(a) of the Bill, strike ``and'' at the end of 
paragraph (11), strike the period at the end of paragraph (12) 
and insert ``; and'', and add at the end the following new 
paragraph:
          ``(13) improves the availability of information and 
        resources for individuals with low or limited literacy 
        or language skills.''.
                              ----------                              


 2. An Amendment To Be Offered by Representative Towns of New York, or 
                 His Designee, Debatable for 10 Minutes

  Add at the end of section 101 the following:
  (d) Study of Health Information Technology in Medically 
Underserved Communities.--
          (1) Study.--The National Coordinator for Health 
        Information Technology shall conduct a study on the 
        development and implementation of health information 
        technology in medically underserved communities. The 
        study shall--
                  (A) identify barriers to successful 
                implementation of health information technology 
                in these communities;
                  (B) examine the impact of health information 
                technology on providing quality care and 
                reducing the cost of care to these communities;
                  (C) examine urban and rural community health 
                systems and determine the impact that health 
                information technology may have on the capacity 
                of primary health providers; and
                  (D) assess the feasibility and the costs of 
                associated with the use of health information 
                technology in these communities.
          (2) Report.--Not later than 18 months after the date 
        of the enactment of this Act, the National Coordinator 
        shall submit to Congress a report on the study 
        conducted under paragraph (1) and shall include in such 
        report such recommendations for legislation or 
        administrative action as the Coordinator determines 
        appropriate.
                              ----------                              

                              ----------                              


3. An Amendment To Be Offered by Representative Jackson of Illinois, or 
                 His Designee, Debatable for 10 Minutes

    In section 102, add at the end the following new paragraph:
                  (5) Recommendations on the inclusion of 
                emergency contact or next-of-kin information 
                (including name and phone number) in 
                interoperable electronic health records.
                              ----------                              


 4. An Amendment To Be Offered by Representative Cuellar of Texas, or 
                 His Designee, Debatable for 10 Minutes

  In section 330M(d) of the Public Health Service Act, as added 
by section 104 of the Bill, strike ``or'' at the end of 
paragraph (1), strike the period at the end of paragraph (2) 
and insert ``; or'', and add at the end the following new 
paragraph:
          ``(3) if the project to be funded through such a 
        grant will emphasize the improvement of access to 
        medical care and medical care for medically underserved 
        populations which are geographically isolated or 
        located in underserved urban areas.''.
                              ----------                              


 5. An Amendment To Be Offered by Representative Price of Georgia, or 
                 His Designee, Debatable for 10 Minutes

  Add at the end of title II the following new section:

SEC. 206. REPORT ON APPROPRIATENESS OF CLASSIFICATION METHODOLOGIES AND 
                    CODES FOR ADDITIONAL PURPOSES.

  Not later than the date that is 180 days after the date of 
the enactment of this Act, the Secretary of Health and Human 
Services shall submit to Congress a report that evaluates--
          (1) the applicability of health care classification 
        methodologies and codes for purposes beyond the coding 
        of services for diagnostic documentation or billing 
        purposes;
          (2) the usefulness, accuracy, and completeness of 
        such methodologies and codes for such purposes; and
          (3) the capacity of such methodologies and codes to 
        produce erroneous or misleading information, with 
        respect to such purposes.
                              ----------                              


6. An Amendment To Be Offered by Representative McMorris of Washington, 
               or His Designee, Debatable for 10 Minutes

  At the end of title IV, insert the following new section:

SEC. 409. PROMOTING HEALTH INFORMATION TECHNOLOGY AS A TOOL FOR CHRONIC 
                    DISEASE MANAGEMENT.

  (a) In General.--The Secretary of Health and Human Services 
shall establish a two-year project to demonstrate the impact of 
health information technology on disease management for 
individuals entitled to medical assistance under a State plan 
under title XIX of the Social Security Act.
  (b) Structure of Project.--The project under subsection (a) 
shall--
          (1) create a web-based virtual case management tool 
        that provides access to best practices for managing 
        chronic disease; and
          (2) provide chronic disease patients and caregivers 
        access to their own medical records and to a single 
        source of information on chronic disease.
  (c) Competition.--Not later than the date that is 90 days 
after the date of the enactment of this Act, the Secretary of 
Health and Human Services shall seek proposals from States to 
carry out the project under subsection (a). The Secretary shall 
select not less than four of such proposals submitted, and at 
least one proposal selected shall include a regional approach 
that features access to an integrated hospital information 
system in at least two adjoining States and that permits the 
measurement of health outcomes.
  (d) Report.--Not later than the date that is 90 days after 
the last day of the project under subsection (a), the Secretary 
of Health and Human Services shall submit to Congress a report 
on such project and shall include in such report the amount of 
any cost-savings resulting from the project and such 
recommendations for legislation or administrative action as the 
Secretary determines appropriate.

                                  
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