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 123STA T . 222 PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9of f undswith in 2year s of the date that funds b e c a m ea v ai l able to them for obli g ation , and 10 0 p ercent of funds within 3 years of such date, and the S ecretary may recapture une x pended funds in violation of the 2 - year expenditure re q uirement and reallocate such funds to grantees in compliance with that requirement
 * Pro-vide

d fu r th er ,T hat the Secretary may waive statutory or regulatory provisions ( except provisions for fair housing, nondiscrimination, labor standards, and the environment ) necessary to facilitate the timely expenditure of funds: Provided further, That the Secretary shall publish a notice to establish such requirements as may be necessary to carry out the provisions of this section within 30 days of enactment of this A ct and that this notice shall ta k e effect upon issuance: Provided further, That of the funds provided under this heading, up to .5 percent shall be available for staffing, training, technical assistance, technology, monitoring, research and evaluation activities: Provided further, That funds set aside under the previous proviso shall remain available until September 30, 2012: Provided further, That any funds made available under this heading used by the Secretary for personnel expenses related to administering funding under this heading shall be transferred to ‘ ‘ C ommunity P lanning and D evelopment Personnel Compensation and B enefits ’ ’ and shall retain the terms and conditions of this account including reprogramming provisions except that the period of availability set forth in the previous proviso shall govern such transferred funds: Provided further, That any funds made available under this heading used by the Secretary for training or other administrative expenses shall be transferred to ‘‘Administration, O perations, and M anagement’’ for non-personnel expenses of the Department of H ousing and U rban Development: Provided further, That any funding made available under this heading used by the Secretary for technology shall be transferred to ‘‘ W orking Capital F und.’’ H OUSING P R OGR AM S ASSIS TEDH OUSING STA B I L IT Y AND ENERGY AND GREEN RETRO F IT IN V ESTMENTS For assistance to owners of properties receiving pro j ect-based assistance pursuant to section 202 of the Housing Act of 1 9 59 (12 U.S.C. 1 7 012), section 8 11 of the Cranston- G on z alez N ational Affordable Housing Act ( 4 2 U.S.C. 8013), or section 8 of the United States Housing Act of 1937 as amended (42 U.S.C. 1437f), $ 2,250,000,000, of which $2,000,000,000 shall be for an additional amount for paragraph (1) under the heading ‘‘Project-Based R ental Assistance’’ in Public L aw 110 – 1 6 1 for payments to owners for 12-month periods, and of which $250,000,000 shall be for grants or loans for energy retrofit and green investments in such assisted housing: Provided, That projects funded with grants or loans pro- vided under this heading must comply with the requirements of subchapter IV of chapter 31 of title 40, United States Code: Provided further, That such grants or loans shall be provided through the policies, procedures, contracts, and transactional infrastructure of the authorized programs administered by the Office of Affordable Housing Preservation of the Department of Housing and Urban Development, on such terms and conditions as the Secretary of Housing and Urban Development deems appropriate to ensure the Publicat i on.N otic e . D ea d line. Ef fecti v e date. W aive r aut h orit y .


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 123STA T . 223 PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9mainte nan c ean dpr e s er v ati o no f t h e propert y, the contin u ed oper - ation and maintenance of ener g y efficiency techno l ogies, and the timely e x penditure of funds
 * Provide

d fu r th er ,T hat the S ecretary may provide incentives to o w ners to underta k e energy or green retrofits as a part of such grant or loan terms, including, b ut not limited to, fees to cover investment oversight and implementa- tion by said owner, or to encourage j ob creation for low-income or very low-income individuals: Provided further, That the Secretary may share in a portion of future property utility savings resulting from improvements made by grants or loans made available under this heading: Provided further, That the grants or loans shall include a financial assessment and physical inspection of such prop- erty: Provided further, That eligible owners must have at least a satisfactory management review rating, be in substantial compli- ance with applicable performance standards and legal re q uirements, and commit to an additional period of affordability determined by the Secretary, but of not fewer than 15 years: Provided further, That the Secretary shall undertake appropriate underwriting and oversight with respect to grant and loan transactions and may set aside up to 5 percent of the funds made available under this heading for grants or loans for such purpose: Provided further, That the Secretary shall take steps necessary to ensure that owners receiving funding for energy and green retrofit investments under this heading shall expend such funding within 2 years of the date they received the funding: Provided further, That in administering funds appropriated or otherwise made available under this heading, the Secretary may waive or specify alternative requirements for any provision of any statute or regulation in connection with the obligation by the Secretary or the use of these funds ( except for requirements related to fair housing, nondiscrimination, labor standards, and the environment ) , upon a finding that such a waiver is necessary to expedite or facilitate the use of such funds: Provided further, That of the funds provided under this heading for grants and loans, up to 1 percent shall be available for staffing, training, technical assistance, technology, monitoring, research and evalua- tion activities: Provided further, That funds set aside in the previous proviso shall remain available until September 30, 2012: Provided further, That funding made available under this heading and used by the Secretary for personnel expenses related to administering funding under this heading shall be transferred to ‘ ‘ H ousing P er- sonnel C ompensation and B enefits ’ ’ and shall retain the terms and conditions of this account including reprogramming provisos except that the period of availability set forth in the previous proviso shall govern such transferred funds: Provided further, That any funding made available under this heading used by the Sec- retary for training and other administrative expenses shall be trans- ferred to ‘‘ A dministration, O perations and M anagement’’ for non- personnel expenses of the D epartment of Housing and U rban Development: Provided further, That any funding made available under this heading used by the Secretary for technology shall be transferred to ‘‘ W orking Capital F und . ’’ O F F ICEO F L E AD HA Z A R DCO NT RO L AND HEALT HY HO M E S For an additional amount for the ‘‘Lead Ha z ard R eduction Program’’, as authorized by section 1011 of the Residential Lead- Based Paint Hazard Reduction Act of 1 9 92, and by sections 501 Waiver a utho rit y.

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 123STA T . 22 4PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9and502oftheH o usi n g and Urb an D e v e l o pm ent Ac tof 1974,$ 100,000,000, to remain available until S eptember 3 0, 2011
 * Pro-vide

d ,T hat for purposes of environmental revie w , pursuant to the N ational E nvironmental P olic y Act of 19 6 9 ( 42U . S. C . 4321 et se q . ) and other provisions of law that further the purposes of such Act, a grant under the Healthy Homes I nitiative, O peration L ead Elimination Action Plan (LEAP), or the Lead Technical Studies program under this heading or under prior appropriations Acts for such purposes under this heading, shall be considered to be funds for a special pro j ect for purposes of section 305(e) of the M ultifamily Housing Property Disposition R eform Act of 1994: Provided fu r th er, That funds shall be awarded first to applicants which had applied under the Lead Ha z ard Reduction Program Notices of F unding Availability for fiscal year 200 8, and were found in the application review to be qualified for award, but were not awarded because of funding limitations, and that any funds which remain after reservation of funds for such grants shall be added to the amount of funds to be awarded under the Lead Hazard Reduction Program Notices of Funding Availability for fiscal year 2009: Provided further, That each applicant for the Lead Hazard Program Notices of Funding Availability for fiscal year 2009 shall submit a detailed plan and strategy that dem - onstrates adequate capacity that is acceptable to the Secretary to carry out the proposed use of funds: Provided further, That recipients of funds under this heading shall e x pend at least 50 percent of such funds within 2 years of the date on which funds become available to such jurisdictions for obligation, and expend 100 percent of such funds within 3 years of such date: Provided further, That if a recipient fails to comply with the 2-year expendi- ture requirement, the Secretary shall recapture all remaining funds awarded to the recipient and reallocate such funds to recipients that are in compliance with those requirements: Provided further, That if a recipient fails to comply with the 3-year expenditure requirement, the Secretary shall recapture the balance of the funds awarded to the recipient: Provided further, That in administering funds appropriated or otherwise made available under this heading, the Secretary may waive or specify alternative requirements for any provision of any statute or regulation in connection with the obligation by the Secretary or the use of these funds (except for requirements related to fair housing, nondiscrimination, labor standards and the environment), upon a finding that such a waiver is necessary to expedite or facilitate the use of such funds: Provided further, That of the funds made available under this heading, up to .5 percent shall be available for staffing, training, technical assistance, technology, monitoring, travel, enforcement, research and evaluation activities: Provided further, That funds set aside in the previous proviso shall remain available until September 30, 2012: Provided further, That any funds made available under this heading used by the Secretary for personnel expenses related to administering funding under this heading shall be transferred to ‘ ‘Personnel Compensation and B enefits, Office of Lead Hazard Control and Healthy Homes ’ ’ and shall retain the terms and condi- tions of this account, including reprogramming provisions, except that the period of availability set forth in the previous proviso shall govern such transferred funds: Provided further, That any funds made available under this heading used by the Secretary for training or other administrative expenses shall be transferred Waiver a utho rit y.D ea dl i n e s. P lans. S trate g y.


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 123STA T . 22 5PUBLIC LA W 111 – 5 —FE B.1 7, 2 0 0 9to‘ ‘ Admin i s t ra tion ,Ope rations, and M ana g ement ’ ’, f or non - per- sonne l e x penses of t h e D epartment of H o u sing and U r b an De v elop- ment
 * Provide

d fu r th er ,T hat an y funds made available under this heading used by the S e c retary for technology shall be transferred to ‘‘ W or k ing C apital F und’’ . M AN A GEM EN T AN D ADM I NI S T R ATI O N O F FI C EOFINS P ECTOR GENERA L For an additional amount for the necessary salaries and expenses of the Office of I nspector G eneral in carrying out the Inspector General Act of 1978 , as amended, $ 1 5, 0 00,000, to remain available until September 3 0, 2 013: Provided, That the Inspector General shall have independent authority over all personnel issues w ithin this office. G EN E R A LP RO V ISIONS — DEPARTMENT OF HOUSING AND UR B AN DEVELOPMENT SEC. 1202. FHA LOAN LIMITS FOR 2009. ( a ) LOAN LIMIT FLOOR BASED ON 20 0 8 LE V ELS.—For mortgages for which the mortgagee issues credit approval for the borrower during calendar year 2009, if the dollar amount limitation on the principal obligation of a mortgage determined under section 203(b)(2) of the National Housing Act (12 U.S.C. 1709(b)(2)) for any si z e residence for any area is less than such dollar amount limitation that was in effect for such size residence for such area for 2008 pursuant to section 202 of the Economic Stimulus Act of 2008 (Public Law 110 – 185 122 Stat. 6 20), notwithstanding any other provision of law, the maximum dollar amount limitation on the principal obligation of a mortgage for such size residence for such area for purposes of such section 203(b)(2) shall be considered (except for purposes of section 255(g) of such Act (12 U.S.C. 1715z–20(g))) to be such dollar amount limitation in effect for such size residence for such area for 2008. (b) DISCRETIONAR Y A U T H ORITY FOR SU B -AREAS.—Notwith- standing any other provision of law, if the Secretary of Housing and Urban Development determines, for any geographic area that is smaller than an area for which dollar amount limitations on the principal obligation of a mortgage are determined under section 203(b)(2) of the National Housing Act, that a higher such maximum dollar amount limitation is warranted for any particular size or sizes of residences in such sub-area by higher median home prices in such sub-area, the Secretary may, for mortgages for which the mortgagee issues credit approval for the borrower during calendar year 2009, increase the maximum dollar amount limitation for such size or sizes of residences for such sub-area that is otherwise in effect (including pursuant to subsection (a) of this section), but in no case to an amount that exceeds the amount specified in section 202(a)(2) of the Economic Stimulus Act of 2008. SEC. 1203. GSE CONFORMING LOAN LIMITS FOR 2009. (a) LOAN LIMIT FLOOR BASED ON 2008 LEVELS.—For mortgages originated during calendar year 2009, if the limitation on the maximum original principal obligation of a mortgage that may be purchased by the Federal National Mortgage Association or the Federal Home Loan Mortgage Corporation determined under section 302(b)(2) of the Federal National Mortgage Association Charter Act (12 U.S.C.


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 123STA T . 22 6PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 917 17 (b) ( 2 )) orsecti o n305 ( a )(2) o f t h e F e d era lH o m e L oan M ort g age C or p oration A ct (12 U.S .C. 175 4 (a)(2)), respecti v el y ,foranysi z e residence for any area is less than s u ch ma x imum original principal obligation limitation that w as in effect for such size residence for such area for 200 8 pursuant to section 201 of the E conomic Stimulus Act of 2008 ( P ublic Law 110 – 185 122 Stat. 6 1 9 ), notwith - standing any other provision of law, the limitation on the maximum original principal obligation of a mortgage for such Association and Corporation for such size residence for such area shall be such maximum limitation in effect for such size residence for such area for 2008. (b) DISCRET I ONA R Y A U T H ORITY F OR SU B -AREAS. —N otwith- standing any other provision of law, if the Director of the Federal Housing Finance Agency determines, for any geographic area that is smaller than an area for which limitations on the maximum original principal obligation of a mortgage are determined for the Federal National Mortgage Association or the Federal Home Loan Mortgage Corporation, that a higher such maximum original prin- cipal obligation limitation is warranted for any particular size or sizes of residences in such sub-area by higher median home prices in such sub-area, the Director may, for mortgages originated during 2009, increase the maximum original principal obligation limitation for such size or sizes of residences for such sub-area that is other- wise in effect (including pursuant to subsection (a) of this section) for such Association and Corporation, but in no case to an amount that exceeds the amount specified in the matter following the comma in section 201(a)(1)( B ) of the Economic Stimulus Act of 2008. SEC. 1204. FHA R E V ERSE MORT G AGE LOAN LI M ITS FOR 2009. For mortgages for which the mortgagee issues credit approval for the borrower during calendar year 2009, the second sentence of section 255(g) of the National Housing Act (12 U.S.C. 1715z–20(g)) shall be considered to re q uire that in no case may the benefits of insurance under such section 255 exceed 150 percent of the maximum dollar amount in effect under the sixth sentence of section 305(a)(2) of the Federal Home Loan Mortgage Corporation Act (12 U.S.C. 1454(a)(2)). TI T LEX III —H E A LTH I NFORM ATION TE C HNOLO GYSEC.130 01. S HORT T I T L E T AB LEO F CO N TENTS OF TITLE. (a) SHORT T IT L E.—This title (and title IV of division B) may be cited as the ‘ ‘Health Information Technology for Economic and Clinical Health Act ’ ’ or the ‘‘HITECH Act’’. (b) TABLE OF CONTENTS OF TITLE.—The table of contents of this title is as follows
 * Sec.130

01. S hort t i t l e t ab leo f co n tent s of title. S u btitle A—P ro m otion of H ealth I nformation T echnolo gy P ART 1—I MP R OVING H E A L T HC ARE QU ALIT Y, SA F ETY, AN DE FFI C IENCY Sec. 13101. ON CHIT; stan d ards de v elo p ment and adoption. ‘ ‘TIT L E X XX—HEALTH IN F O RM ATION TECHNOLO GY AN D Q U ALITY ‘‘Sec. 3000. Definitions. 42USC 2 01note.H e al t hI n f o rm at i on T e c hnolo gy for E conomic an d Clinical Health A ct.


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 123STA T . 22 7PUBLIC LA W 111 –5—FE B. 17 , 2 0 0 9‘ ‘ Subti t leA—Prom otio n o fH e a lt hI nformation T e c hnolo gy ‘‘Sec .30 0 1 . O ffice of the N ational C oor d inator for Health Information Tech - nology. ‘‘Sec. 300 2 . HIT Policy Committee. ‘‘Sec. 3003. HIT Standard s Committee. ‘‘Sec. 300 4 . Process for ado p tion of endorsed recommendations adoption of ini- tial set of standards , implementation specifications, and certification criteria. ‘‘Sec. 300 5 . Application and use of adopted standards and implementation spec- ifications by F ederal agencies. ‘‘Sec. 300 6 . V oluntary application and use of adopted standards and implemen- tation specifications by pri v ate entities. ‘‘Sec. 300 7 . Federal health information technology. ‘‘Sec. 300 8 . Transitions. ‘‘Sec. 300 9 . M iscellaneous provisions. Sec. 13102. Technical amendment. P ART 2—A P P LIC ATI ON AN DUSE O F ADOPTED HEALT H INFOR M ATION TECHNOLO GY STANDARDS; R EPORTS Sec. 13111. Coordination of Federal activities w ith adopted standards and imple- mentation specifications. Sec. 13112. Application to private entities. Sec. 13113. Study and reports. Subtitle B —Testing of Health Information Technology Sec. 13201. National Institute for Standards and Technology testing. Sec. 13202. Research and development programs. Subtitle C— G rants and L oans Funding Sec. 13301. Grant, loan, and demonstration programs. ‘‘Subtitle B—Incentives for the Use of Health Information Technology ‘‘Sec. 3011. Immediate funding to strengthen the health information technology infrastructure. ‘‘Sec. 3012. Health information technology implementation assistance. ‘‘Sec. 3013. State grants to promote health information technology. ‘‘Sec. 3014. Competitive grants to States and Indian tribes for the development of loan programs to facilitate the widespread adoption of certified E HR technology. ‘‘Sec. 3015. D emonstration program to integrate information technology into clinical education. ‘‘Sec. 3016. Information technology professionals in health care. ‘‘Sec. 3017. General grant and loan provisions. ‘‘Sec. 3018. Authori z ation for appropriations. Subtitle D—Privacy Sec. 13400. Definitions. PART 1—IMPRO V ED PRIVACY PROVISIONS AND SEC U RITY PROVISIONS Sec. 13401. Application of security provisions and penalties to business associates of covered entities; annual guidance on security provisions. Sec. 13402. Notification in the case of breach. Sec. 13403. Education on health information privacy. Sec. 13404. Application of privacy provisions and penalties to business associates of covered entities. Sec. 13405. Restrictions on certain disclosures and sales of health information; ac- counting of certain protected health information disclosures; access to certain information in electronic format. Sec. 13406. Conditions on certain contacts as part of health care operations. Sec. 13407. Temporary breach notification re q uirement for vendors of personal health records and other non-HIPAA covered entities. Sec. 13408. Business associate contracts required for certain entities. Sec. 13409. Clarification of application of wrongful disclosures criminal penalties. Sec. 13410. Improved enforcement. Sec. 13411. Audits. PART 2—RELATIONSHIP TO OTHER LA W S; REGULATORY REFERENCES; EFFECTIVE DATE; REPORTS Sec. 13421. Relationship to other laws.


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 123STA T . 22 8PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9Sec.1342 2. R e gulatory re f ere n ce s . Sec. 13423. E ffect iv e d ate. Sec. 13424. Studies , re p orts, guidance. Subti t leA—Prom otio n o fH e a lt hI nformation T e c hnolo gyPART1—IM PR OV I NGHE A L TH C ARE QU ALIT Y,S A F ETY, AN D EFFICIENCY SEC.13 1 0 1. ON C HIT; ST A N D A R DS DE V E L O PM ENT AND ADOPTION. ThePublicH e a l t h S e rv ice A ct (42U. S. C . 2 01 et s e q . ) is a m e nd edb y addin g at the end the fo llo w ing

‘TIT LEX XX—HEALTH I NFORM ATION TE C HNOLO GY AN DQU ALITY ‘ ‘SEC. 3000. DE F INITIONS. ‘ ‘ I n this title: ‘‘(1) C ERTIF IE D E H RTE C H NOL O GY . — The term ‘certified E H R technology ’ means a qualified electronic health record that is certified p ursuant to section 3 001(c)( 5 ) as meeting standards adopted under section 3004 that are applicable to the type of record involved (as determined by the Secretary, such as an ambulatory electronic health record for office - based physi- cians or an inpatient hospital electronic health record for hos- pitals). ‘‘(2) ENTER P RI S E INTEGR A TION.—The term ‘enterprise integration’ means the electronic lin k age of health care pro- viders, health plans, the government, and other interested par- ties, to enable the electronic e x change and use of health information among all the components in the health care infra- structure in accordance with applicable law, and such term includes related application protocols and other related stand- ards. ‘‘(3) HEALTH CARE PRO V IDER.—The term ‘health care pro- vider’ includes a hospital, skilled nursing facility, nursing facility, home health entity or other long term care facility, health care clinic, community mental health center (as defined in section 1 9 13(b)(1)), renal dialysis facility, blood center, ambulatory surgical center described in section 1 8 33(i) of the Social Security Act, emergency medical services provider, F eder- ally qualified health center, group practice, a pharmacist, a pharmacy, a laboratory, a physician (as defined in section 18 6 1(r) of the Social Security Act), a practitioner (as described in section 1842(b)(18)(C) of the Social Security Act), a provider operated by, or under contract with, the Indian Health Service or by an Indian tribe (as defined in the Indian Self- D etermina- tion and Education Assistance Act), tribal organi z ation, or urban Indian organization (as defined in section 4 of the Indian Health Care Improvement Act), a rural health clinic, a covered entity under section 340 B , an ambulatory surgical center described in section 1833(i) of the Social Security Act, a thera- pist (as defined in section 1848(k)(3)(B)(iii) of the Social Security Act), and any other category of health care facility, entity, 42USC30 0 j j.


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 123STA T . 22 9PUBLIC LA W 111 –5—FE B.1 7, 2 0 09 practi ti one r , orc l inician d eter m ined appropriate by t h e S ec - retary .‘ ‘ (4)HEALTHINFORM ATION. —T he term ‘health in f ormation ’ ha s the meanin g gi v ens u ch term in section 1 1 7 1(4) of the Social Security A ct. ‘‘( 5 ) HEALTH INFORMATION TE C HNOLO GY .—The term ‘health information technology’ means hard w are, software, integrated technologies or related licenses, intellectual property, upgrades, or pac k aged solutions sold as services that are designed for or support the use by health care entities or patients for the electronic creation, maintenance, access, or e x change of health information ‘‘( 6 ) HEALTH P LAN.—The term ‘health plan’ has the meaning given such term in section 1171(5) of the Social Security Act. ‘‘(7) H I T POLICY COMMITTEE.—The term ‘HIT P olicy C om- mittee’ means such Committee established under section 30 0 2 (a). ‘‘( 8 ) HIT S TAN D ARDS COMMITTEE.—The term ‘HIT Standards Committee’ means such Committee established under section 3003(a). ‘‘( 9 ) INDI V ID U ALLY IDENTIFIA B LE HEALTH INFORMATION.— The term ‘individually identifiable health information’ has the meaning given such term in section 1171(6) of the Social Secu- rity Act. ‘‘(10) L ABORATORY.—The term ‘laboratory’ has the meaning given such term in section 353(a). ‘‘(11) N ATIONAL COORDINATOR.—The term ‘National Coordi- nator’ means the head of the O ffice of the National Coordinator for Health Information Technology established under section 3001(a). ‘‘(12) PHARMACIST.—The term ‘pharmacist’ has the meaning given such term in section 804(2) of the F ederal Food, D rug, and Cosmetic Act. ‘‘(13) Q UALIFIED ELECTRONIC HEALTH RECORD.—The term ‘ q ualified electronic health record’ means an electronic record of health-related information on an individual that— ‘‘(A) includes patient demographic and clinical health information, such as medical history and problem lists and ‘‘( B ) has the capacity— ‘‘(i) to provide clinical decision support; ‘‘(ii) to support physician order entry; ‘‘(iii) to capture and query information relevant to health care quality; and ‘‘(iv) to exchange electronic health information with, and integrate such information from other sources. ‘‘(14) STATE.—The term ‘State’ means each of the several States, the District of Columbia, Puerto R ico, the V irgin Islands, G uam, American Samoa, and the Northern M ariana Islands.


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 123STA T . 23 0PUBLIC LA W 111 –5—FE B.1 7, 200 9‘ ‘ Subti t leA—Prom otio n o fH e a lt hI nformation T e c hnolo gy‘ ‘ SEC.30 0 1 . OF F I CE OF TH E NA TIONA L COO RD INATOR FOR HEALTH INFOR M ATION TECHNOLO GY . ‘ ‘ (a)ESTABLI S HMEN T .—Ther e is es t a bl ishe dw ithi n the D e p art -m ent ofH ealth and H u man S er v i c es an O ffice of the N ational C oordinator for Health I nformation Technolo gy (referred to in this section as the ‘Office ’ ). The Office shall be headed by a National Coordinator who shall be appointed by the Secretary and shall report directly to the Secretary. ‘‘(b) PURPO SE.—The National Coordinator shall perform the duties under subsection (c) in a manner consistent with the develop- ment of a nationwide health information technology infrastructure that allows for the electronic use and e x change of information and that— ‘‘( 1 ) ensures that each patient’s health information is secure and protected , in accordance with applicable law ‘‘( 2 ) improves health care q uality, reduces medical errors, reduces health disparities, and advances the delivery of patient- centered medical care; ‘‘( 3 ) reduces health care costs resulting from inefficiency, medical errors, inappropriate care, duplicative care, and incom- plete information; ‘‘( 4 ) provides appropriate information to help guide medical decisions at the time and place of care; ‘‘( 5 ) ensures the inclusion of meaningful public input in such development of such infrastructure; ‘‘( 6 ) improves the coordination of care and information among hospitals, laboratories, physician offices, and other enti- ties through an effective infrastructure for the secure and authori z ed exchange of health care information; ‘‘( 7 ) improves public health activities and facilitates the early identification and rapid response to public health threats and emergencies, including bioterror events and infectious dis- ease outbrea k s; ‘‘( 8 ) facilitates health and clinical research and health care quality; ‘‘( 9 ) promotes early detection, prevention, and management of chronic diseases; ‘‘(1 0 ) promotes a more effective marketplace, greater com- petition, greater systems analysis, increased consumer choice, and improved outcomes in health care services; and ‘‘(11) improves efforts to reduce health disparities. ‘‘(c) DUTIES O F THE NATIONAL COOR D INATOR.— ‘‘(1) STANDARDS.—The National Coordinator shall— ‘‘( A ) review and determine whether to endorse each standard, implementation specification, and certification criterion for the electronic exchange and use of health information that is recommended by the HIT Standards Committee under section 3003 for purposes of adoption under section 3004; ‘‘( B ) make such determinations under subparagraph (A), and report to the Secretary such determinations, not later than 45 days after the date the recommendation is received by the Coordinator; and Reports.D e adlin e. 42USC30 0 j j –1 1.


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 123STA T . 231 PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9‘ ‘ (C)revi e wF e d er alh eal t hi nfo r m ation te c hnolo gy inve s tments to ens u re that Federal health information technology p rograms are meeting the o bj ectives of the stra - tegic plan published under paragraph ( 3 ) . ‘‘( 2 ) HITPOLICY COO RD I NAT ION. — ‘‘( A )IN GE NERAL.—The N ational Coordinator shall coordinate health information technology policy and pro- grams of the D epartment with those of other relevant e x ecutive branch agencies with a goal of avoiding duplica- tion of efforts and of helping to ensure that each agency underta k es health information technology activities pri- marily within the areas of its greatest expertise and tech- nical capability and in a manner towards a coordinated national goal. ‘‘( B ) HIT POLICY AND S TANDARDS CO M MITTEES.—The National Coordinator shall be a leading member in the establishment and operations of the HIT P olicy Committee and the HIT S tandards Committee and shall serve as a liaison among those two Committees and the Federal G overnment. ‘‘(3) STRATEGIC PLAN.— ‘‘(A) IN GENERAL.—The National Coordinator shall , in consultation with other appropriate Federal agencies (including the National Institute of Standards and Tech- nology), update the Federal Health IT Strategic Plan (devel- oped as of J une3,2 0 0 8 ) to include specific objectives, milestones, and metrics with respect to the following ‘‘(i) The electronic exchange and use of health information and the enterprise integration of such information. ‘‘(ii) The utili z ation of an electronic health record for each person in the U nited States by 20 14 . ‘‘(iii) The incorporation of privacy and security protections for the electronic exchange of an individ- ual ’ s individually identifiable health information. ‘‘(iv) E nsuring security methods to ensure appro- priate authorization and electronic authentication of health information and specifying technologies or methodologies for rendering health information unus- able, unreadable, or indecipherable. ‘‘(v) Specifying a framework for coordination and flow of recommendations and policies under this sub- title among the Secretary, the National Coordinator, the HIT Policy Committee, the HIT Standards Com- mittee, and other health information exchanges and other relevant entities. ‘‘(vi) M ethods to foster the public understanding of health information technology. ‘‘(vii) Strategies to enhance the use of health information technology in improving the q uality of health care, reducing medical errors, reducing health disparities, improving public health, increasing preven- tion and coordination with community resources, and improving the continuity of care among health care settings. ‘‘(viii) Specific plans for ensuring that populations with unique needs, such as children, are appropriately


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 123STA T . 232 PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9ad d res sed inth ete c hn ol o gy design , asa p propriate, w hich m ay incl u de technology that automates enroll - ment and retention f or eligi b le indi v iduals .‘ ‘ (B)COL L AB O R A TI O N . —T he strategic plan shall be updated through collaboration of public and private enti- ties. ‘‘(C) ME A SU RABLE OUT C O M E G OALS.—The strategic plan update shall include measurable outcome goals. ‘‘( D ) P UBLICATION.—The N ational Coordinator shall republish the strategic plan, including all updates. ‘‘( 4 ) W EBSITE.—The National Coordinator shall maintain and fre q uently update an I nternet website on which there is posted information on the wor k , schedules, reports, rec- ommendations, and other information to ensure transparency in promotion of a nationwide health information technology infrastructure. ‘‘( 5 ) CERTI F ICATION.— ‘‘( A ) IN GENERAL.—The National Coordinator, in con- sultation with the Director of the National Institute of S tandards and Technology, shall keep or recogni z eapro- gram or programs for the voluntary certification of health information technology as being in compliance with applicable certification criteria adopted under this subtitle. Such program shall include, as appropriate, testing of the technology in accordance with section 1320 1(b) of the H ealth Information Technology for E conomic and Clinical Health Act. ‘‘(B) CERTIFICATION CRITERIA D ESCRIBED.—In this title, the term ‘certification criteria ’ means, with respect to stand- ards and implementation specifications for health informa- tion technology, criteria to establish that the technology meets such standards and implementation specifications. ‘‘( 6 ) R E P ORTS AND PUBLICATIONS.— ‘‘(A) REPORT ON ADDITIONAL FUNDING OR AUT H ORIT Y NEEDED.—Not later than 12 months after the date of the enactment of this title, the National Coordinator shall submit to the appropriate committees of j urisdiction of the House of Representatives and the Senate a report on any additional funding or authority the Coordinator or the HIT Policy Committee or HIT Standards Committee requires to evaluate and develop standards, implementa- tion specifications, and certification criteria, or to achieve full participation of stakeholders in the adoption of a nationwide health information technology infrastructure that allows for the electronic use and e x change of health information. ‘‘(B) IMPLEMENTATION REPORT.—The National Coordi- nator shall prepare a report that identifies lessons learned from major public and private health care systems in their implementation of health information technology, including information on whether the technologies and practices developed by such systems may be applicable to and usable in whole or in part by other health care providers. ‘‘(C) ASSESSMENT OF IMPACT OF HIT ON COMMUNITIES W ITH HEALTH DISPARITIES AND UNINSURED, UNDERINSURED, AND MEDICALLY UNDERSER V ED AREAS.—The National Coordinator shall assess and publish the impact of health


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 123STA T . 233 PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9informat ion t ech no l o gy in comm u nitie sw ith health d is p ari - ties and in areas with a high proportion of indi v iduals who are uninsured , underinsured, and medically under- served individuals ( including ur b an and rural areas ) and identify practices to increase the adoption of such tech- nology by health care providers in such communities, and the use of health information technology to reduce and better manage chronic diseases .‘ ‘( D ) EVALU A TION O FBE NEFIT S AN DC OSTS OF T H E ELEC- T R ONIC USE AND E X CHAN G E OF HEALTH INFOR M ATION. —T he N ational C oordinator shall evaluate and publish evi- dence on the benefits and costs of the electronic use and e x change of health information and assess to whom these benefits and costs accrue. ‘‘(E) R ESOURCE RE Q UIREMENTS.—The National Coordi- nator shall estimate and publish resources re q uired annually to reach the goal of utili z ation of an electronic health record for each person in the U nited S tates by 2014 , including— ‘‘(i) the required level of F ederal funding ‘‘(ii) expectations for regional, State, and private investment; ‘‘(iii) the expected contributions by volunteers to activities for the utilization of such records; and ‘‘(iv) the resources needed to establish a health information technology wor k force sufficient to support this effort (including education programs in medical informatics and health information management). ‘‘( 7 ) A SSISTANCE.—The National Coordinator may provide financial assistance to consumer advocacy groups and not-for- profit entities that work in the public interest for purposes of defraying the cost to such groups and entities to participate under, whether in whole or in part, the National Technology Transfer Act of 1 9 9 5 (15 U.S.C. 272 note). ‘‘( 8 ) G OVERNANCE FOR NATION W IDE HEALTH INFORMATION NETWOR K .—The National Coordinator shall establish a govern- ance mechanism for the nationwide health information network. ‘‘(d) DETAIL OF FEDERAL EM P LO Y EES.— ‘‘(1) I N GENERAL.—Upon the request of the National Coordi- nator, the head of any Federal agency is authorized to detail, with or without reimbursement from the O ffice, any of the personnel of such agency to the Office to assist it in carrying out its duties under this section. ‘‘(2) EFFECT OF DETAIL.—Any detail of personnel under paragraph (1) shall— ‘‘(A) not interrupt or otherwise affect the civil service status or privileges of the Federal employee; and ‘‘( B ) be in addition to any other staff of the Department employed by the National Coordinator. ‘‘( 3 ) ACCEPTANCE OF DETAILEES.—Notwithstanding any other provision of law, the Office may accept detailed personnel from other Federal agencies without regard to whether the agency described under paragraph (1) is reimbursed. ‘‘(e) CHIEF P RIVACY OFFICER OF THE OFFICE OF THE NATIONAL COORDINATOR.—Not later than 12 months after the date of the enactment of this title, the Secretary shall appoint a Chief Privacy Officer of the Office of the National Coordinator, whose duty it Deadlin e .Est a b lis hm ent.


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 123STA T . 23 4PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9shal l beto a dvi se the N atio n al C oo r dinator on p riva cy, sec u rity, and data ste w ardship o f electronic health infor m ation and to coordi - nate with other F ederal a g encies ( and similar privacy officers in such agencies ) , with S tate and regional efforts, and with foreign countries with regard to the privacy, security, and data stewardship of electronic individually identifiable health information .‘ ‘ SEC.30 0 2 . HITPOL IC Y CO M MITTEE. ‘ ‘(a) ESTABLI S HMEN T. —T here is established a HI T P olicy Com- mittee to ma k e policy recommendations to the National Coordinator relating to the implementation of a nationwide health information technology infrastructure, including implementation of the strategic plan described in section 30 0 1 (c)(3). ‘‘(b) DU TIES.— ‘‘(1) R E CO MMEN D ATIONS ON HEALTH IN F O R MATION TECH- NOLO GY INFRASTRUCTURE.—The HIT Policy Committee shall recommend a policy framework for the development and adop- tion of a nationwide health information technology infrastruc- ture that permits the electronic e x change and use of health information as is consistent with the strategic plan under sec- tion 3001(c)(3) and that includes the recommendations under paragraph ( 2 ). The Committee shall update such recommenda- tions and make new recommendations as appropriate. ‘‘(2) S P ECIFIC AREAS OF STANDARD DE V ELOPMENT.— ‘‘( A ) IN GENERAL.—The HIT Policy Committee shall recommend the areas in which standards, implementation specifications, and certification criteria are needed for the electronic exchange and use of health information for pur- poses of adoption under section 300 4 and shall recommend an order of priority for the development, harmoni z ation, and recognition of such standards, specifications, and cer- tification criteria among the areas so recommended. Such standards and implementation specifications shall include named standards, architectures, and software schemes for the authentication and security of individually identifiable health information and other information as needed to ensure the reproducible development of common solutions across disparate entities. ‘‘( B ) AREAS RE Q UIRED FOR CONSIDERATION.—For pur- poses of subparagraph (A), the HIT Policy Committee shall make recommendations for at least the following areas ‘‘(i) Technologies that protect the privacy of health information and promote security in a q ualified elec- tronic health record, including for the segmentation and protection from disclosure of specific and sensitive individually identifiable health information with the goal of minimizing the reluctance of patients to seek care (or disclose information about a condition) because of privacy concerns, in accordance with applicable law, and for the use and disclosure of limited data sets of such information. ‘‘(ii) A nationwide health information technology infrastructure that allows for the electronic use and accurate exchange of health information. ‘‘(iii) The utilization of a certified electronic health record for each person in the U nited States by 2014. Recom me nda-ti on s.42USC30 0 j j –1 2.


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 123STA T . 23 5PUBLIC LA W 111 – 5 —FE B.1 7, 2 0 0 9‘ ‘ (iv)Technol o g ie st h a tasa p a r to f a qu alifie d electronic health record allo w for an accounting of disclosures m ade by a covered entity (as defined for purposes of regulations promulgated under section 264 (c) of the H ealth I nsurance P ortability and A ccount - ability Act of 19 96) for purposes of treatment , payment, and health care operations (as such terms are defined for purposes of such regulations) . ‘‘(v) The use of certified electronic health records to improve the quality of health care, such as by pro- moting the coordination of health care and improving continuity of health care among health care providers, by reducing medical errors, by improving population health, by reducing health disparities, by reducing chronic disease, and by advancing research and edu- cation. ‘‘(vi) Technologies that allow individually identifi- able health information to be rendered unusable, unreadable, or indecipherable to unauthori z ed individ- uals when such information is transmitted in the nationwide health information networ k or physically transported outside of the secured, physical perimeter of a health care provider, health plan, or health care clearinghouse. ‘‘(vii) The use of electronic systems to ensure the comprehensive collection of patient demographic data, including, at a minimum, race, ethnicity, primary lan- guage, and gender information. ‘‘(viii) Technologies that address the needs of chil- dren and other vulnerable populations. ‘‘( C ) OTHERA REA SFO R C O N S ID ERATION. — In making recommendations under subparagraph (A), the HIT Policy Committee may consider the following additional areas ‘‘(i) The appropriate uses of a nationwide health information infrastructure, including for purposes of— ‘‘(I) the collection of quality data and public reporting ‘‘(II) biosurveillance and public health; ‘‘(III) medical and clinical research; and ‘‘(I V ) drug safety. ‘‘(ii) S elf-service technologies that facilitate the use and e x change of patient information and reduce wait times. ‘‘(iii) Telemedicine technologies, in order to reduce travel requirements for patients in remote areas. ‘‘(iv) Technologies that facilitate home health care and the monitoring of patients recuperating at home. ‘‘(v) Technologies that help reduce medical errors. ‘‘(vi) Technologies that facilitate the continuity of care among health settings. ‘‘(vii) Technologies that meet the needs of diverse populations. ‘‘(viii) M ethods to facilitate secure access by an individual to such individual ’ s protected health information. ‘‘(ix) Methods, guidelines, and safeguards to facili- tate secure access to patient information by a family


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 123STA T . 23 6PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9me m b e r,ca re giv er, o rg u ar d ia n ac t ing on be h a lf of a p atient due to age - related and other di s abilit y , cog- nitive impairment, or dementia .‘ ‘ (x)A ny other technology that the HITP olicy C om- mittee finds to be among the technologies w ith the greatest potential to improve the q uality and efficiency of health care. ‘‘( 3 ) FORUM . — The HIT Policy Committee shall serve as a forum for broad sta k eholder input with specific expertise in policies relating to the matters described in paragraphs ( 1 )and( 2 ). ‘‘( 4 )CO NSI S TE N CYW IT H E VAL UATION CON D UCTED UNDER MI P PA.— ‘‘(A) R E Q UIREMENT F OR CONSISTENCY.—The HIT Policy Committee shall ensure that recommendations made under paragraph (2)( B )(vi) are consistent with the evaluation con- ducted under section 1 809 (a) of the S ocial Security Act. ‘‘(B) SCOPE.— N othing in subparagraph (A) shall be construed to limit the recommendations under paragraph (2)(B)(vi) to the elements described in section 1809(a)(3) of the Social Security Act. ‘‘(C) TIMIN G .—The requirement under subparagraph (A) shall be applicable to the extent that evaluations have been conducted under section 1809(a) of the Social Security Act, regardless of whether the report described in sub- section (b) of such section has been submitted. ‘‘(c) M EM B ERSHIP AND O PERATIONS.— ‘‘(1) IN GENERAL.—The National Coordinator shall take a leading position in the establishment and operations of the HIT Policy Committee. ‘‘(2) MEMBERSHIP.—The HIT Policy Committee shall be composed of members to be appointed as follows ‘‘(A) 3 members shall be appointed by the Secretary, 1 of whom shall be appointed to represent the D epartment of Health and Human Services and 1 of whom shall be a public health official. ‘‘(B) 1 member shall be appointed by the ma j ority leader of the Senate. ‘‘(C) 1 member shall be appointed by the minority leader of the Senate. ‘‘(D) 1 member shall be appointed by the Speaker of the House of Representatives. ‘‘( E ) 1 member shall be appointed by the minority leader of the House of Representatives. ‘‘(F) Such other members as shall be appointed by the President as representatives of other relevant Federal agencies. ‘‘( G ) 13 members shall be appointed by the Comptroller General of the U nited States of whom— ‘‘(i) 3 members shall advocates for patients or con- sumers ‘‘(ii) 2 members shall represent health care pro- viders, one of which shall be a physician; ‘‘(iii) 1 member shall be from a labor organi z ation representing health care workers; ‘‘(iv) 1 member shall have expertise in health information privacy and security; Presid e nt.Ap p l i cab ilit y .


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 123STA T . 23 7PUBLIC LA W 111 –5—FE B. 17 , 2 0 0 9‘ ‘ (v)1me m b e rshal lhavee xp er ti sei n impr o vin g the health o f v u lnerable populations ‘‘(vi) 1 member shall be from the resear c h commu - nit y ‘‘(vii) 1 member shall represent health plans or other thir d -party payers; ‘‘(viii) 1 member shall represent information tech- nology vendors; ‘‘(ix) 1 member shall represent purchasers or employers; and ‘‘(x) 1 member shall have expertise in health care q uality measurement and reporting . ‘‘( 3 ) PARTIC I P ATI ON . —T he members of the HI T Policy C om- mittee appointed under paragraph ( 2 ) shall represent a balance among various sectors of the health care system so that no single sector unduly influences the recommendations of the Policy Committee. ‘‘( 4 )T E R MS .— ‘‘( A )IN G ENERA L .—The terms of the members of the HIT Policy Committee shall be for 3 years , except that the Comptroller G eneral shall designate staggered terms for the members first appointed. ‘‘( B ) V ACANCIES.—Any member appointed to fill a vacancy in the membership of the HIT Policy Committee that occurs prior to the expiration of the term for w hich the member ’ s predecessor was appointed shall be appointed only for the remainder of that term. A member may serve after the expiration of that member’s term until a successor has been appointed. A vacancy in the HIT Policy Committee shall be filled in the manner in which the original appoint- ment was made. ‘‘( 5 ) OU TSI D EIN V OLVEMENT.—The HIT Policy Committee shall ensure an opportunity for the participation in activities of the Committee of outside advisors, including individuals with expertise in the development of policies for the electronic exchange and use of health information, including in the areas of health information privacy and security. ‘‘( 6 ) Q UORUM.—A ma j ority of the member of the HIT Policy Committee shall constitute a quorum for purposes of voting, but a lesser number of members may meet and hold hearings. ‘‘( 7 ) F AILURE O F INITIAL APPOINTMENT.—If, on the date that is 45 days after the date of enactment of this title, an official authori z ed under paragraph (2) to appoint one or more members of the HIT Policy Committee has not appointed the full number of members that such paragraph authorizes such official to appoint, the S ecretary is authorized to appoint such members. ‘‘( 8 ) CONSIDERATION.—The N ational Coordinator shall ensure that the relevant and available recommendations and comments from the National Committee on Vital and Health Statistics are considered in the development of policies. ‘‘(d) APPLICATION OF FACA.—The Federal Advisory Committee Act (5 U .S.C. App.), other than section 14 of such Act, shall apply to the HIT Policy Committee. ‘‘(e) PU B LICATION.—The Secretary shall provide for publication in the Federal R egister and the posting on the Internet website of the Office of the National Coordinator for Health Information Fed e ralR e gist er ,pub li c ati on.W eb posting. D eadline.


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 123STA T . 23 8PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9Technol o gy o fa ll p ol i cy r eco m men d a t ion s made b y the HI T P olicy C ommittee u nder this section .‘ ‘ SEC.30 03. HIT ST AND A R DSC OM MITTEE. ‘ ‘ ( a )ESTABLI S HMEN T. — There is established a committee to be k no w nastheHIT S tandards Committee to recommend to the N ational Coordinator standards , implementation specifications, and certification criteria for the electronic e x change and use of health information for purposes of adoption under section 30 0 4, consistent with the implementation of the strategic plan described in section 300 1 (c)(3) and beginning with the areas listed in section 300 2 (b)(2)( B ) in accordance with policies de v eloped by the HIT Policy Committee. ‘‘(b) DU TIES.— ‘‘(1) STAN D A R DS DE V EL OP MENT.— ‘‘( A )IN G ENERAL.—The HIT Standards Committee shall recommend to the National Coordinator standards, implementation specifications, and certification criteria described in subsection (a) that have been developed, har - moni z ed, or recognized by the HIT Standards Committee. The HIT Standards Committee shall update such rec- ommendations and make new recommendations as appro- priate, including in response to a notification sent under section 3004(a)(2)(B). Such recommendations shall be con- sistent with the latest recommendations made by the HIT Policy Committee. ‘‘(B) HARMONI Z ATION.—The HIT Standards Committee recognize harmonized or updated standards from an entity or entities for the purpose of harmonizing or updating standards and implementation specifications in order to achieve uniform and consistent implementation of the standards and implementation specifications. ‘‘(C) PILOT TESTING O F STANDARDS AND IMPLEMENTA- TION SPE C IFICATIONS.—In the development, harmonization, or recognition of standards and implementation specifica- tions, the HIT Standards Committee shall, as appropriate, provide for the testing of such standards and specifications by the National Institute for Standards and Technology under section 13201(a) of the Health Information Tech- nology for Economic and Clinical Health Act. ‘‘(D) CONSISTENC Y .—The standards, implementation specifications, and certification criteria recommended under this subsection shall be consistent with the standards for information transactions and data elements adopted pursu- ant to section 11 7 3 of the Social Security Act. ‘‘(2) F ORUM.—The HIT Standards Committee shall serve as a forum for the participation of a broad range of stakeholders to provide input on the development, harmonization, and rec- ognition of standards, implementation specifications, and cer- tification criteria necessary for the development and adoption of a nationwide health information technology infrastructure that allows for the electronic use and exchange of health information. ‘‘(3) SCHEDULE.—Not later than 9 0 days after the date of the enactment of this title, the HIT Standards Committee shall develop a schedule for the assessment of policy rec- ommendations developed by the HIT Policy Committee under Deadlin e .R e com menda -t ion s . 42USC30 0 j j –1 3.


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 123STA T . 23 9PUBLIC LA W 111 –5—FE B.1 7, 2 0 09 section30 0 2.Th e HI T S t a n d a r ds C o m mittee sha l l up date such schedule annuall y . The Secretary shall pu b lish such schedule in the F ederal R e g ister. ‘ ‘ (4)PUBLIC I NP U T . — The HIT Standards Committee shall conduct open public meetings and de v elop a process to allo wf or public comment on the schedule described in paragraph (3) and recommendations described in this subsection. U nder such process comments shall be submitted in a timely manner after the date of publication of a recommendation under this subsection. ‘‘( 5 )C O N S I DERA TION.—The N ational Coordinator shall ensure that the relevant and available recommendations and comments from the National Committee on V ital and Health Statistics are considered in the development of standards. ‘‘(c) M E M BERS H IP AND O PERATIONS.— ‘‘( 1 )IN G ENERAL.—The National Coordinator shall ta k ea leading position in the establishment and operations of the HIT Standards Committee. ‘‘(2) MEMBERSHIP.—The membership of the HIT Standards Committee shall at least reflect providers , ancillary healthcare workers, consumers, purchasers, health plans, technology ven - dors, researchers, relevant Federal agencies, and individuals with technical e x pertise on health care q uality, privacy and security, and on the electronic exchange and use of health information. ‘‘(3) PARTICIPATION.—The members of the HIT Standards Committee appointed under this subsection shall represent a balance among various sectors of the health care system so that no single sector unduly influences the recommendations of such Committee. ‘‘(4) OUTSIDE IN V OLVEMENT.—The HIT Policy Committee shall ensure an opportunity for the participation in activities of the Committee of outside advisors, including individuals with expertise in the development of standards for the electronic exchange and use of health information, including in the areas of health information privacy and security. ‘‘(5) B ALANCE AMONG SECTORS.—In developing the proce- dures for conducting the activities of the HIT Standards Com- mittee, the HIT Standards Committee shall act to ensure a balance among various sectors of the health care system so that no single sector unduly influences the actions of the HIT Standards Committee. ‘‘( 6 ) A SSISTANCE.—For the purposes of carrying out this section, the Secretary may provide or ensure that financial assistance is provided by the HIT Standards Committee to defray in whole or in part any membership fees or dues charged by such Committee to those consumer advocacy groups and not for profit entities that work in the public interest as a part of their mission. ‘‘(d) APPLICATION O F FACA.—The Federal Advisory Committee Act (5 U.S.C. App.), other than section 14, shall apply to the HIT Standards Committee. ‘‘(e) PUBLICATION.—The Secretary shall provide for publication in the Federal Register and the posting on the Internet website of the Office of the National Coordinator for Health Information Technology of all recommendations made by the HIT Standards Committee under this section. Fed e ralR e gist er ,pub li c ati on.W eb posting. Federal Register, publication. D eadline.


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 123STA T . 2 40PUBLIC LA W 111 –5—FE B.1 7, 200 9‘ ‘ SEC.30 0 4 . PRO CESS F OR AD OP TI O N OF ENDORSED RECO M MENDA - TIONS ADOPTION OF INITIA L SET OF STANDARDS , IMPLEMENTATION SPECIFICATIONS, AND CERTIFI- CATION CRITERIA. ‘ ‘ (a)PROCES S F OR AD O PTI O N OF E NDORSED R ECO M MEND A- TIONS .— ‘‘( 1 )RE V IE W OF ENDORSED STANDARDS , IMP L EMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA.— Notl at er t h a n90d a ys a f ter the date of re c e ip t of standards, i m plementation specifications, or certification criteria endorsed u nder section 3 001(c), the S ecretary, in consultation w ith representati v es of other relevant F ederal a g encies, shall j ointly review such stand- ards, implementation specifications, or certification criteria and shall determine whether or not to propose adoption of such standards, implementation specifications, or certification cri- teria. ‘‘( 2 ) D ETERMINATION TO ADOPT STANDARDS, IMPLEMENTA- TION SPECIFICATIONS, AND CERTIFICATION CRITERIA.— I f the Sec- retary determines— ‘‘(A) to propose adoption of any grouping of such stand- ards, implementation specifications, or certification criteria, the Secretary shall, b y regulation under section 5 53 of title 5, U nited States C ode, determine whether or not to adopt such grouping of standards, implementation speci- fications, or certification criteria or ‘‘( B ) not to propose adoption of any grouping of stand- ards, implementation specifications, or certification criteria, the Secretary shall notify the National Coordinator and the H I T Standards Committee in writing of such deter- mination and the reasons for not proposing the adoption of such recommendation. ‘‘(3) P UB LICATION.—The Secretary shall provide for publica- tion in the Federal Register of all determinations made by the Secretary under paragraph (1). ‘‘(b) ADOPTION OF STANDARDS, IMPLEMENTATION SPECIFICA- TIONS, AND CERTIFICATION CRITERIA.— ‘‘(1) IN G ENERAL.—Not later than December 31, 2009, the Secretary shall, through the rulema k ing process consistent with subsection (a)(2)(A), adopt an initial set of standards, implementation specifications, and certification criteria for the areas re q uired for consideration under section 3002(b)(2)(B). The rulemaking for the initial set of standards, implementation specifications, and certification criteria may be issued on an interim, final basis. ‘‘(2) APPLICATION OF CURRENT STANDARDS, IMPLEMENTATION SPECIFICATIONS, AND CERTIFICATION CRITERIA.—The standards, implementation specifications, and certification criteria adopted before the date of the enactment of this title through the process e x isting through the O ffice of the National Coordinator for Health Information Technology may be applied towards meeting the requirement of paragraph (1). ‘‘(3) SUBSE Q UENT STANDARDS ACTIVIT Y .—The Secretary shall adopt additional standards, implementation specifications, and certification criteria as necessary and consistent with the schedule published under section 3003(b)(2). Deadlin e .F ede r al R e g i st er ,pub li c ati o n. N oti f ication. Deadline. 42USC30 0 j j –1 4.


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 123STA T . 2 4 1 PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9‘ ‘ SEC.30 0 5 . AP P LI CA T I ON AN DU SEO F ADOPTED STANDA R DS AND I M PLEMENTATION SPECIFICATIONS BY FEDERAL A G EN - CIES. ‘ ‘ For r equi re m e nts re la tin g tot h ea p pli c ation an d use by Fed - eral agencies o f the standards and implementation specifications adopted under section 30 0 4, see section 1 3111 of the H ealth I nformation T echnology for E conomic and C linical Health A ct . ‘‘SEC. 300 6 . V OLUNTARY APPLICATION AND USE OF ADOPTED STAND- ARDS AND IMPLEMENTATION SPECIFICATIONS BY PRI- VATE ENTITIES. ‘‘ ( a ) I NGE NE RAL . — E x cept as pro v ided under section 1311 2 of the HITECH Act, nothing in such Act or in the amendments made by such Act shall be construed— ‘‘(1) to require a private entity to adopt or comply w ith a standard or implementation specification adopted under sec- tion 3004 or ‘‘(2) to provide a Federal agency authority, other than the authority such agency may have under other provisions of law, to require a private entity to comply with such a standard or implementation specification. ‘‘(b) RU LE OF CON ST RU C T I ON.— N othing in this subtitle shall be construed to require that a private entity that enters into a contract with the Federal Government apply or use the standards and implementation specifications adopted under section 3004 with respect to activities not related to the contract. ‘‘SEC. 300 7 . FEDERAL H EALTH INFORMATION TECHNOLOGY. ‘‘(a) IN GENERAL.—The National Coordinator shall support the development and routine updating of qualified electronic health record technology (as defined in section 3000) consistent with sub- sections (b) and (c) and ma k e available such qualified electronic health record technology unless the S ecretary determines through an assessment that the needs and demands of providers are being substantially and adequately met through the marketplace. ‘‘(b) CERTIFICATION.—In making such electronic health record technology publicly available, the National Coordinator shall ensure that the qualified electronic health record technology described in subsection (a) is certified under the program developed under section 3001(c)(3) to be in compliance with applicable standards adopted under section 3003(a). ‘‘(c) AUT H ORI Z ATION TO CHAR G EANO M INAL FEE.—The National Coordinator may impose a nominal fee for the adoption by a health care provider of the health information technology system developed or approved under subsection (a) and (b). Such fee shall take into account the financial circumstances of smaller providers, low income providers, and providers located in rural or other medically under- served areas. ‘‘(d) RULE OF CONSTRUCTION.—Nothing in this section shall be construed to require that a private or government entity adopt or use the technology provided under this section. ‘‘SEC. 300 8 . TRANSITIONS. ‘‘(a) O NCHIT.—To the extent consistent with section 3001, all functions, personnel, assets, liabilities, and administrative actions applicable to the National Coordinator for Health Informa- tion Technology appointed under Executive Order No. 1333 5 or the Office of such National Coordinator on the date before the 42USC30 0 j j –18. 42 USC 300jj–1 7 . 42 USC 300jj–1 6 . 42 USC 300jj–1 5.


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 123STA T . 2 4 2 PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9dateof t h ee n a c t m ent of th is tit l e shall b et r ansferred to the N ational C oordinator a p pointed u nder section 30 0 1( a ) and the O ffice of such National Coordinator as of the date of the enactment of this title .‘ ‘(b) N ATION A LEHE ALT H COLLA B O R ATI V E. — Nothin g in sections 300 2 or 3003 or this subsection shall be construed as prohibiting the A H I C S uccessor , Inc. doing business as the National eHealth Collaborati v e from modif y ing its charter, duties, membership, and any other structure or function re q uired to be consistent w ith section 3002 and 3003 so as to allow the Secretary to recogni z e such AHIC Successor, Inc. as the HI TP olicy Committee or the HIT Standards Committee. ‘‘(c) CON S ISTEN CY O FR ECO M MEN D ATIONS.—In carrying out sec - tion 3003(b)(1)(A), until recommendations are made by the HIT Policy Committee, recommendations of the HIT Standards Com- mittee shall be consistent with the most recent recommendations made by such AHIC Successor, Inc. ‘ ‘ SEC.30 0 9 . MI SCE L L AN E OU S PR O V ISIONS. ‘‘(a) RELATION TO HIPAA PRIVACY AND SEC U RITY L A W .— ‘‘(1) IN G ENERAL.— W ith respect to the relation of this title to HIPAA privacy and security law ‘‘(A) This title may not be construed as having any effect on the authorities of the Secretary under HIPAA privacy and security law. ‘‘( B ) The purposes of this title include ensuring that the health information technology standards and implementation specifications adopted under section 300 4 ta k e into account the requirements of HIPAA privacy and security law. ‘‘(2) D EFINITION.— F or purposes of this section, the term ‘HIPAA privacy and security law ’ means— ‘‘(A) the provisions of part C of title X I of the Social Security Act, section 2 6 4 of the Health Insurance Port- ability and Accountability Act of 1 9 96, and subtitle D of title I V of the Health Information Technology for Economic and Clinical Health Act and ‘‘(B) regulations under such provisions. ‘‘(b) FLE X IBILITY.—In administering the provisions of this title, the Secretary shall have fle x ibility in applying the definition of health care provider under section 3000(3), including the authority to omit certain entities listed in such definition when applying such definition under this title, where appropriate.’’. SEC. 1 310 2 . T EC H NICAL AMEN D MENT. Section 11 7 1( 5 ) of the Social Security Act (42 U .S.C. 1320d) is amended by striking ‘‘or C’’ and inserting ‘‘C, or D’’. PART2— APP LIC ATI ON AN DUSE O F ADOPTED H EALTH INFOR M ATION TECHNOLO GY STANDARDS REPORTS SEC. 13111. COORDINATION O F FEDERAL ACTIVITIES W ITH ADOPTED STANDARDS AND IMPLEMENTATION SPECIFICATIONS. (a) S P ENDING ON HEALTH INFORMATION TECHNOLOGY SYS- TEMS.—As each agency (as defined by the Director of the Office of M anagement and Budget, in consultation with the Secretary 42USC1790 1 . 42 USC 3 00 j j – 19.


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 123STA T . 2 4 3 PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9ofHealth a nd H um an S e rvic e s) im p lements, ac q uires, or up g rades health information technolog y systems used for the direct e x change of individually identifia b le health information bet w een agencies and with non -F ederal entities, it shall utili z e, where available, health information technology systems and products that meet standards and implementation specifications adopted under section 30 0 4 of the P ublic Health Service A ct, as added by section 1 3101 .( b)F ED E RALINFO R M A TI ON C OLLE C TION ACTI V ITIE S . —W ith respect to a standard or implementation specification adopted under section 3004 of the Public Health Service Act, as added by section 13101, the President shall ta k e measures to ensure that Federal activities involving the broad collection and submission of health information are consistent with such standard or implementation specification, respectively, within three years after the date of such adoption. (c) A P PLICATION OF D EFINITIONS.— T he definitions contained in section 3000 of the Public Health Service Act, as added by section 13101, shall apply for purposes of this part. SEC.13 11 2 . AP P LI CA T I ON TOP R I V ATE ENTITIES. E ach agency (as defined in such Executive O rder issued on August 2 2, 200 6, relating to promoting quality and efficient health care in Federal government administered or sponsored health care programs) shall require in contracts or agreements with health care providers, health plans, or health insurance issuers that as each provider, plan, or issuer implements, acquires, or upgrades health information technology systems, it shall utilize, where avail- able, health information technology systems and products that meet standards and implementation specifications adopted under section 3004 of the Public Health Service Act, as added by section 13101. SEC. 13113. ST UDY AND REPORTS. (a) R EPORT ON ADOPTION OF N ATION W IDE S Y STEM.—Not later than 2 years after the date of the enactment of this Act and annually thereafter, the Secretary of Health and Human Services shall submit to the appropriate committees of j urisdiction of the House of Representatives and the Senate a report that— (1) describes the specific actions that have been taken by the Federal G overnment and private entities to facilitate the adoption of a nationwide system for the electronic use and exchange of health information (2) describes barriers to the adoption of such a nationwide system; and (3) contains recommendations to achieve full implementa- tion of such a nationwide system. (b) REIM BU RSEMENT INCENTIVE STUDY AND REPORT.— (1) STUDY.—The Secretary of Health and Human Services shall carry out, or contract with a private entity to carry out, a study that examines methods to create efficient reimburse- ment incentives for improving health care quality in Federally qualified health centers, rural health clinics, and free clinics. (2) REPORT.—Not later than 2 years after the date of the enactment of this Act, the Secretary of Health and Human Services shall submit to the appropriate committees of jurisdic- tion of the House of Representatives and the Senate a report on the study carried out under paragraph (1). (c) A G ING SERVICES TEC H NOLOGY STUDY AND REPORT.— 42USC17903. 42 USC 17902.


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 123STA T . 2 4 4 PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9(1)INGE NE RAL.—TheS e cr e ta r yofH ea l tha nd H um an Ser vi ce s shall carry out , or contract w ith a p rivate entity to carry out, a study of matters relatin g to the potential use of new aging services technology to assist seniors, individuals with disa b ilities, and their caregivers throughout the aging process. ( 2 ) M A T TER S T OB EST UDI ED.—The study under paragraph (1) shall include— ( A ) an evaluation of— (i) methods for identifying current, emerging, and future health technology that can be used to meet the needs of seniors and individuals with disabilities and their caregivers across all aging services settings, as specified by the Secretary (ii) methods for fostering scientific innovation with respect to aging services technology within the business and academic communities; and (iii) developments in aging services technology in other countries that may be applied in the U nited States; and ( B ) identification of— (i) barriers to innovation in aging services tech - nology and devising strategies for removing such bar- riers; and (ii) barriers to the adoption of aging services tech- nology by health care providers and consumers and devising strategies to removing such barriers. ( 3 ) R E P ORT.— N ot later than 2 4 months after the date of the enactment of this Act, the Secretary shall submit to the appropriate committees of j urisdiction of the House of Rep- resentatives and of the Senate a report on the study carried out under paragraph (1). (4) D E F INITIONS.— F or purposes of this subsection (A) AGING SER V I C ES TEC H NOLOG Y .—The term ‘ ‘aging services technology ’ ’ means health technology that meets the health care needs of seniors, individuals with disabil- ities, and the caregivers of such seniors and individuals. (B) SENIOR.—The term ‘‘senior’’ has such meaning as specified by the Secretary. Subti t leB—T e s ti ngofH e a lt hI nfo rm ation Te c hnolog ySEC.1320 1. NATIO NA L INSTIT U TE F O R STAN D ARDS AND TEC H NOLO GY TESTING. (a) P ILOT TESTING OF STANDARDS AND I M PLEMENTATION SPECI- FICATIONS.—In coordination with the HIT Standards C ommittee established under section 3 0 03 of the Public Health Service Act, as added by section 13101, with respect to the development of standards and implementation specifications under such section, the Director of the National Institute for Standards and Technology shall test such standards and implementation specifications, as appropriate, in order to assure the efficient implementation and use of such standards and implementation specifications. (b) V OLUNTARY TESTING PROGRAM.—In coordination with the HIT Standards Committee established under section 3003 of the 42USC179 11 . C ontrac t s .


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 123STA T . 2 45PUBLIC LA W 111 – 5 —FE B.1 7, 2 0 0 9PublicHea l thS e rv ice A ct , a s a d ded b y secti on13 1 0 1, w ith res p ect to the develop m ent o f standards and implementation specifications under such section, the D irector of the N ational I nstitute of Stand - ards and T echnolo g y shall support the establishment of a conform- ance testing infrastructure, including the development of technical test beds . The development of this conformance testing infrastruc- ture may include a program to accredit independent, non- F ederal laboratories to perform testing. SEC.1320 2. R ESE A RC H A ND DE V E LOPM EN T PRO G RAMS. ( a ) H EALTHC A R EI NFO R M AT I ON E NTER P RI S E INTE G RATION R ESEAR C H CENTERS. — (1) IN GENERAL.—The Director of the National Institute of Standards and Technology, in consultation with the Director of the National Science Foundation and other appropriate Fed- eral agencies, shall establish a program of assistance to institu- tions of higher education (or consortia thereof which may include nonprofit entities and Federal G overnment laboratories) to establish multidisciplinary Centers for Health Care Informa- tion Enterprise Integration. ( 2 )RE V IE W; COMPETITION.—Grants shall be awarded under this subsection on a merit-reviewed, competitive basis. (3) P U RPOSE.—The purposes of the Centers described in paragraph (1) shall be— (A) to generate innovative approaches to health care information enterprise integration by conducting cutting- edge, multidisciplinary research on the systems challenges to health care delivery; and ( B ) the development and use of health information technologies and other complementary fields. ( 4 ) RESEARCH AREAS.—Research areas may include— (A) interfaces between human information and commu- nications technology systems; (B) voice-recognition systems; (C) software that improves interoperability and connectivity among health information systems; (D) software dependability in systems critical to health care delivery; (E) measurement of the impact of information tech- nologies on the q uality and productivity of health care; (F) health information enterprise management; (G) health information technology security and integ- rity; and (H) relevant health information technology to reduce medical errors. ( 5 ) APPLICATIONS.—An institution of higher education (or a consortium thereof) see k ing funding under this subsection shall submit an application to the Director of the National Institute of Standards and Technology at such time, in such manner, and containing such information as the Director may require. The application shall include, at a minimum, a descrip- tion of— (A) the research pro j ects that will be undertaken by the Center established pursuant to assistance under para- graph (1) and the respective contributions of the partici- pating entities; Grants.E sta bli s hme nt. 42USC179 12.


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 123STA T . 2 46PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9(B)howt h eC e n te r w il l p ro m ote ac ti v e colla b oration amon gs cientists an d engineers f rom different disciplines , s u ch as information technolog y , biologic sciences, manage - ment, social sciences, and other appropriate disciplines (C) technology transfer activities to demonstrate and diffuse the research results, technologies, and k nowledge; and ( D ) how the Center will contribute to the education and training of researchers and other professionals in fields relevant to health information enterprise integration . (b) NATION A LI N F O RM ATION TECH NOLO GYR E S EARCH AN D DE V ELO P MENT P ROGRAM. — The National H igh-Performance Com- puting Program established by section 10 1 of the High-Performance Computing A ctof1 9 91 (1 5U . S .C. 5511) shall include F ederal research and development programs related to health information technology. Subti t leC—Gran t s an dLo ans F undin gSEC.13 3 0 1. GRANT,LO AN, AN D DE M ONSTRAT I ON P ROGRAMS. Title X XX of the Public Health Service Act, as added by section 1 3 101, is amended by adding at the end the following new subtitle

‘Subtitle B — I n c enti v es f ort h e U se of H ealth Infor m ation T echnolog y‘ ‘SEC. 3011. IMMEDIATE FU NDING TO STRENGT H EN THE HEALTH INFORMATION TECHNOLOG Y INFRASTRUCTURE. ‘ ‘(a) IN G ENERAL.—The Secretary shall, using amounts appro- priated under section 301 8, invest in the infrastructure necessary to allow for and promote the electronic e x change and use of health information for each individual in the United States consistent with the goals outlined in the strategic plan developed by the National Coordinator (and as available) under section 3001. The Secretary shall invest funds through the different agencies with expertise in such goals, such as the O ffice of the National Coordi- nator for Health Information Technology, the Health Resources and Services Administration, the Agency for Healthcare Research and Q uality, the Centers of M edicare & Medicaid Services, the Centers for Disease Control and Prevention, and the Indian Health Service to support the following: ‘‘(1) Health information technology architecture that will support the nationwide electronic exchange and use of health information in a secure, private, and accurate manner, including connecting health information exchanges, and which may include updating and implementing the infrastructure nec- essary within different agencies of the Department of Health and Human Services to support the electronic use and exchange of health information. ‘‘( 2 ) Development and adoption of appropriate certified elec- tronic health records for categories of health care providers not eligible for support under title X V III or XIX of the Social Security Act for the adoption of such records. ‘‘(3) Training on and dissemination of information on best practices to integrate health information technology, including 42USC30 0 j j – 3 1.


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 123STA T . 2 47PUBLIC LA W 111 –5—FE B. 17 , 2 0 0 9el e ctroni c h e a lth recor ds, into a p ro v ider ’ s deliver y o f care, consistent w ith b est practices learned fro m the H ealth I nforma - tion T echnolo g y R esearch C enter developed u nder section 3012( b ) , including community health centers receiving assist- ance under section 330, covered entities under section 3 4 0 B , and providers participating in one or more of the programs under titles XV III, XIX, and XXI of the S ocial Security A ct (relating to M edicare, Medicaid, and the State Children’s Health Insurance P rogram) .‘ ‘(4) Infrastructure and tools for the promotion of telemedi- cine, including coordination among F ederal agencies in the promotion of telemedicine. ‘‘( 5 ) Promotion of the interoperability of clinical data reposi- tories or registries. ‘‘( 6 ) Promotion of technologies and best practices that enhance the protection of health information by all holders of individually identifiable health information. ‘‘( 7 ) Improvement and e x pansion of the use of health information technology by public health departments. ‘‘(b) C O O RDINAT ION. — The Secretary shall ensure funds under this section are used in a coordinated manner with other health information promotion activities. ‘‘(c) ADDITIONA LUSE O F F U NDS.—In addition to using funds as provided in subsection (a), the Secretary may use amounts appro- priated under section 301 8 to carry out health information tech- nology activities that are provided for under laws in effect on the date of the enactment of this title. ‘‘(d) STANDARDS FOR A CQ UISITION OF HEALT H INFOR M ATION TECHNOLO GY .—To the greatest extent practicable, the Secretary shall ensure that where funds are expended under this section for the ac q uisition of health information technology, such funds shall be used to acquire health information technology that meets applicable standards adopted under section 3004. W here it is not practicable to expend funds on health information technology that meets such applicable standards, the Secretary shall ensure that such health information technology meets applicable standards otherwise adopted by the Secretary. ‘ ‘ SEC.3012 . H E ALT H INFORM ATION TECHNOLO GY IM P LEMENTATION ASSISTANCE. ‘‘(a) HEALTH INFORMATION TECHNOLOGY EX TENSION PRO- GRAM.—To assist health care providers to adopt, implement, and effectively use certified EHR technology that allows for the elec- tronic exchange and use of health information, the Secretary, acting through the O ffice of the N ational Coordinator, shall establish a health information technology extension program to provide health information technology assistance services to be carried out through the D epartment of Health and Human Services. The National Coordinator shall consult with other Federal agencies with demonstrated experience and expertise in information tech- nology services, such as the National Institute of Standards and Technology, in developing and implementing this program. ‘‘(b) HEALTH INFORMATION TECHNOLOGY RESEARCH CENTER.— ‘‘(1) IN GENERAL.—The Secretary shall create a Health Information Technology Research Center (in this section referred to as the ‘Center’) to provide technical assistance and develop or recogni z e best practices to support and accelerate Establi s hmen t .Co ns u ltation. 42US C 30 0 j j – 32.


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 123STA T . 2 48PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9ef f orts to ad o p t ,im p l eme n t, and effe c ti v el yu tili z e h ealth information technolo g y that allo w s for the electronic e x change and use of information in compliance with standards, implementation specifications, and certification criteria adopted under section 30 0 4.‘ ‘ (2)INPUT . —T he C enter shall incorporate input from— ‘‘( A ) other F ederal agencies with demonstrated experi - ence and expertise in information technology services such as the N ational Institute of S tandards and Technology ‘‘( B ) users of health information technology, such as providers and their support and clerical staff and others involved in the care and care coordination of patients, from the health care and health information technology industry; and ‘‘(C) others as appropriate. ‘‘(3) P U R P OSE S.—The purposes of the Center are to— ‘‘(A) provide a forum for the exchange of k nowledge and experience; ‘‘(B) accelerate the transfer of lessons learned from existing pu b lic and private sector initiatives, including those currently receiving Federal financial support; ‘‘(C) assemble, analyze, and widely disseminate evi- dence and experience related to the adoption, implementa- tion, and effective use of health information technology that allows for the electronic exchange and use of informa- tion including through the regional centers described in subsection (c); ‘‘( D ) provide technical assistance for the establishment and evaluation of regional and local health information networks to facilitate the electronic exchange of information across health care settings and improve the q uality of health care; ‘‘( E ) provide technical assistance for the development and dissemination of solutions to barriers to the exchange of electronic health information; and ‘‘(F) learn about effective strategies to adopt and utilize health information technology in medically underserved communities. ‘‘(c) H E AL T H IN F OR M AT I ON TE C HNOLO GYR EGIONAL E X TENSION CENTERS.— ‘‘( 1 ) IN GENERAL.—The Secretary shall provide assistance for the creation and support of regional centers (in this sub- section referred to as ‘regional centers ’ ) to provide technical assistance and disseminate best practices and other information learned from the Center to support and accelerate efforts to adopt, implement, and effectively utilize health information technology that allows for the electronic exchange and use of information in compliance with standards, implementation specifications, and certification criteria adopted under section 3004. Activities conducted under this subsection shall be con- sistent with the strategic plan developed by the National Coordinator, (and, as available) under section 3001. ‘‘(2) AFFILIATION.—Regional centers shall be affiliated with any U nited States-based nonprofit institution or organization, or group thereof, that applies and is awarded financial assist- ance under this section. Individual awards shall be decided on the basis of merit.


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 123STA T . 2 49PUBLIC LA W 111 –5—FE B.1 7, 2 0 09 ‘ ‘ (3)OBJECTIV E .—Theobj e ctiv eo f the r e g io nal center s is to enhance an dp ro m ote the adoption of health information technolog y thro u gh— ‘‘( A ) assistance w ith the implementation , effective use, upgrading, and ongoing maintenance of health information technology, including electronic health records, to healthcare providers nationwide ‘‘( B ) broad participation of individuals from industry, universities, and S tate governments; ‘‘( C ) active dissemination of best practices and research on the implementation, effective use, upgrading, and ongoing maintenance of health information technology, including electronic health records, to health care providers in order to improve the q uality of healthcare and protect the privacy and security of health information; ‘‘( D ) participation, to the e x tent practicable, in health information exchanges; ‘‘( E ) utili z ation, when appropriate, of the expertise and capability that exists in F ederal agencies other than the Department; and ‘‘(F) integration of health information technology, including electronic health records, into the initial and ongoing training of health professionals and others in the healthcare industry that would be instrumental to improving the quality of healthcare through the smooth and accurate electronic use and exchange of health informa - tion. ‘‘( 4 ) R E G I ONAL A S SISTANCE.—Each regional center shall aim to provide assistance and education to all providers in a region, but shall prioritize any direct assistance first to the following ‘‘(A) P ublic or not-for-profit hospitals or critical access hospitals. ‘‘(B) Federally qualified health centers (as defined in section 186 1(aa)(4) of the Social Security Act). ‘‘(C) Entities that are located in rural and other areas that serve uninsured, underinsured, and medically under- served individuals (regardless of whether such area is urban or rural). ‘‘(D) I ndividual or small group practices (or a consor- tium thereof) that are primarily focused on primary care. ‘‘( 5 ) FINANCIAL S UP PO R T.—The Secretary may provide financial support to any regional center created under this subsection for a period not to exceed four years. The Secretary may not provide more than 5 0 percent of the capital and annual operating and maintenance funds required to create and maintain such a center, except in an instance of national economic conditions which would render this cost-share require- ment detrimental to the program and upon notification to Con- gress as to the justification to waive the cost-share requirement. ‘‘(6) N OTICE O F PROGRA MD ESCRIPTION AND AVAILABILIT Y OF FUNDS.—The Secretary shall publish in the Federal Register, not later than 9 0 days after the date of the enactment of this title, a draft description of the program for establishing regional centers under this subsection. Such description shall include the following: ‘‘(A) A detailed explanation of the program and the programs goals. Fed e ralR e gist er ,pub li c ati on.D eadline.


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 123STA T . 2 50PUBLIC LA W 111 – 5 —FE B.1 7, 200 9‘ ‘ (B)Procedu re st o b e f o l lo w edb y t h e ap pl i ca n ts . ‘‘( C ) Criteria for deter m inin gq ualified applicants. ‘‘( D ) M a x imum support le v els expected to be available to centers under the program. ‘‘( 7 ) AP P LICAT I ONREV IE W . —T he S ecretary shall sub j ect each application under this subsection to merit review. I nma k ing a decision whether to approve such application and provide financial support , the Secretary shall consider at a minimum the merits of the application, including those portions of the application regarding— ‘‘(A) the ability of the applicant to provide assistance under this subsection and utili z ation of health information technology appropriate to the needs of particular categories of health care providers ‘‘(B) the types of service to be provided to health care providers; ‘‘(C) geographical diversity and extent of service area; and ‘‘(D) the percentage of funding and amount of in - kind commitment from other sources. ‘‘( 8 ) BIENNIAL EVAL U ATION.— E ach regional center which receives financial assistance under this subsection shall be evaluated biennially by an evaluation panel appointed by the Secretary. Each evaluation panel shall be composed of private experts, none of whom shall be connected with the center involved, and of F ederal officials. Each evaluation panel shall measure the involved center ’ s performance against the objective specified in paragraph ( 3 ). The Secretary shall not continue to provide funding to a regional center unless its evaluation is overall positive. ‘‘( 9 ) CONTINUIN GS UPPORT.—After the second year of assist- ance under this subsection, a regional center may receive addi- tional support under this subsection if it has received positive evaluations and a finding by the Secretary that continuation of Federal funding to the center was in the best interest of provision of health information technology extension services. ‘ ‘ SEC.301 3.S TA TE GR A N TST OP RO M OTE H EA L TH I N F ORMATION TECH - NOLOG Y . ‘‘(a) IN G ENERAL.—The Secretary, acting through the N ational Coordinator, shall establish a program in accordance with this section to facilitate and expand the electronic movement and use of health information among organizations according to nationally recognized standards. ‘‘(b) PLANNING GRANTS.—The Secretary may award a grant to a State or qualified State-designated entity (as described in subsection (f)) that submits an application to the Secretary at such time, in such manner, and containing such information as the Secretary may specify, for the purpose of planning activities described in subsection (d). ‘‘(c) I M PLEMENTATION GRANTS.—The Secretary may award a grant to a State or qualified State designated entity that— ‘‘( 1 ) has submitted, and the Secretary has approved, a plan described in subsection (e) (regardless of whether such plan was prepared using amounts awarded under subsection (b); and 42USC30 0 j j – 33 . C rite ri a . P r oc e du re s.


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 123STA T . 2 5 1 PUBLIC LA W 111 – 5 —FE B.1 7, 2 0 0 9‘ ‘ (2)submit s an a p p l i c ati o natsuc h tim e, in such manne r , an d containin g such in f ormation as the S ecretar y may specify . ‘‘(d) USEOFFUND S. —A mounts recei v ed under a grant under subsection (c) shall be used to conduct activities to facilitate and e x pand the electronic movement and use of health information among organi z ations according to nationally recognized standards through activities that include— ‘‘( 1 ) enhancing broad and varied participation in the author - ized and secure nation w ide electronic use and exchange of health information ‘‘(2) identifying State or local resources available towards a nationwide effort to promote health information technology; ‘‘( 3 ) complementing other Federal grants, programs, and efforts towards the promotion of health information technology; ‘‘( 4 ) providing technical assistance for the development and dissemination of solutions to barriers to the exchange of elec- tronic health information; ‘‘( 5 ) promoting effective strategies to adopt and utilize health information technology in medically underserved communities; ‘‘( 6 ) assisting patients in utilizing health information tech- nology; ‘‘( 7 ) encouraging clinicians to wor k with H ealth I nformation T echnology R egional E xtension C enters as described in section 3 0 12, to the extent they are available and valuable; ‘‘( 8 ) supporting public health agencies ’ authorized use of and access to electronic health information; ‘‘( 9 ) promoting the use of electronic health records for q uality improvement including through quality measures reporting; and ‘‘(10) such other activities as the Secretary may specify. ‘‘(e) PLA N.— ‘‘(1) IN G ENE R AL.—A plan described in this subsection is a plan that describes the activities to be carried out by a State or by the qualified State-designated entity within such State to facilitate and expand the electronic movement and use of health information among organizations according to nationally recognized standards and implementation specifica- tions. ‘‘(2) RE Q U I RED ELE M EN T S.—A plan described in paragraph (1) shall— ‘‘(A) be pursued in the public interest; ‘‘( B ) be consistent with the strategic plan developed by the N ational Coordinator, (and, as available) under sec- tion 3001; ‘‘(C) include a description of the ways the State or qualified State-designated entity will carry out the activi- ties described in subsection (b); and ‘‘( D ) contain such elements as the Secretary may require. ‘‘(f) Q UALIFIED STATE-DESIGNATED ENTIT Y .—For purposes of this section, to be a qualified State-designated entity, with respect to a State, an entity shall— ‘‘(1) be designated by the State as eligible to receive awards under this section; ‘‘(2) be a not-for-profit entity with broad stakeholder rep- resentation on its governing board;


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 123STA T . 2 5 2 PUBLIC LA W 111 – 5 —FE B.1 7, 2 0 0 9‘ ‘ (3)demonstra tet h atoneo fi ts p rin c ipa lg oals is to u se information technolog y to impro v e health care q uality and effi - ciency through the authori z ed and secure electronic e x change and use of health information ‘‘( 4 ) adopt nondiscrimination and conflict of interest policies that demonstrate a commitment to open , fair, and nondiscrim- inatory participation b y sta k eholders; and ‘‘( 5 ) conform to such other requirements as the S ecretary may establish . ‘‘(g) REQUIR E DCONS U LTA TION. —I n carrying out activities described in subsections (b) and (c), a State or qualified State- designated entity shall consult w ith and consider the recommenda- tions of— ‘‘( 1 ) health care providers (including providers that provide services to low income and underserved populations); ‘‘( 2 ) health plans; ‘‘(3) patient or consumer organizations that represent the population to be served; ‘‘(4) health information technology vendors; ‘‘(5) health care purchasers and employers; ‘‘( 6 ) public health agencies; ‘‘( 7 ) health professions schools, universities and colleges; ‘‘( 8 ) clinical researchers; ‘‘( 9 ) other users of health information technology such as the support and clerical staff of providers and others involved in the care and care coordination of patients; and ‘‘(1 0 ) such other entities, as may be determined appropriate by the Secretary. ‘‘(h) CONTINUOUS I MP RO V EMENT.— T he Secretary shall annually evaluate the activities conducted under this section and shall, in awarding grants under this section, implement the lessons learned from such evaluation in a manner so that awards made subsequent to each such evaluation are made in a manner that, in the deter- mination of the Secretary, will lead towards the greatest improve- ment in quality of care, decrease in costs, and the most effective authorized and secure electronic exchange of health information. ‘‘(i) REQUIRED M AT CH .— ‘‘(1) IN G ENERAL.— F or a fiscal year (beginning with fiscal year 2011), the Secretary may not make a grant under this section to a State unless the State agrees to make available non-Federal contributions (which may include in-kind contribu- tions) toward the costs of a grant awarded under subsection (c) in an amount equal to— ‘‘( A ) for fiscal year 2011, not less than $ 1 for each $10 of Federal funds provided under the grant; ‘‘( B ) for fiscal year 2012, not less than $1 for each $7 of Federal funds provided under the grant; and ‘‘(C) for fiscal year 2013 and each subsequent fiscal year, not less than $1 for each $3 of Federal funds provided under the grant. ‘‘(2) AUTHORIT Y TO REQUIRE STATE MATCH F OR FISCAL YEARS B EFORE FISCAL YEAR 201 1.—For any fiscal year during the grant program under this section before fiscal year 2011, the Sec- retary may determine the extent to which there shall be required a non-Federal contribution from a State receiving a grant under this section. Deadlin e .Ev al u a t i o n.