[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 4157 Engrossed in House (EH)]
109th CONGRESS
2d Session
H. R. 4157
_______________________________________________________________________
AN ACT
To promote a better health information system.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
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.
Sec. 206. Report on appropriateness of classification methodologies and
codes for additional purposes.
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. Ensuring health care providers participating in PHSA
programs, Medicaid, SCHIP, or the MCH
program may maintain health information in
electronic form.
Sec. 405. Ensuring health care providers participating in the Medicare
program may maintain health information in
electronic form.
Sec. 406. Study and report on State, regional, and community health
information exchanges.
Sec. 407. Promoting health information technology as a tool for chronic
disease management.
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) provides for the confidentiality and security of
individually identifiable health information, 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;
``(12) promotes the efficient and streamlined development,
submission, and maintenance of electronic health care clinical
trial data; and
``(13) improves the availability of information and
resources for individuals with low or limited literacy or
language skills.
``(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 No. 13335.--Executive Order No.
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 No. 13335.
(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.
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.
(5) Recommendations on the inclusion of emergency contact
or next-of-kin information (including name and phone number) in
interoperable electronic health records.
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;
``(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; or
``(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.
``(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.''.
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.
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' 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.''.
(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' 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.''.
(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. 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. 405. 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. 406. 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.
SEC. 407. 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.
Passed the House of Representatives July 27, 2006.
Attest:
Clerk.
109th CONGRESS
2d Session
H. R. 4157
_______________________________________________________________________
AN ACT
To promote a better health information system.