S 890 ISCommentsClose CommentsPermalink

To provide for the use of improved health information technology with respect to certain safety net health care providers.CommentsClose CommentsPermalink

April 23, 2009CommentsClose CommentsPermalink

Mr. REID (for himself and Mr. ROCKEFELLER) introduced the following bill; which was read twice and referred to the Committee on Health, Education, Labor, and PensionsCommentsClose CommentsPermalink

To provide for the use of improved health information technology with respect to certain safety net health care providers.CommentsClose CommentsPermalink

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

SECTION 1. SHORT TITLE.

This Act may be cited as the ‘Health Information Technology (IT) Public Utility Act of 2009’.CommentsClose CommentsPermalink

SEC. 2. DEFINITIONS.

In this Act:CommentsClose CommentsPermalink





(1) BOARD- The term ‘Board’ means the Federal Consolidated Health Information Technology Board established under section 3.CommentsClose CommentsPermalink





(2) RPMS- The term ‘RPMS’ means the Resource and Patient Management System of the Indian Health Service.CommentsClose CommentsPermalink





(3) SECRETARY- The term ‘Secretary’ means the Secretary of Veterans Affairs.CommentsClose CommentsPermalink





(4) VISTA- The term ‘VistA’ means the VistA software program utilized by the Department of Veterans Affairs.CommentsClose CommentsPermalink

SEC. 3. FEDERAL CONSOLIDATED HEALTH INFORMATION TECHNOLOGY BOARD.

(a) Establishment- To facilitate the implementation of electronic health record systems among safety-net health care providers (particularly small, rural providers) there shall be established within the Office of the National Coordinator for Health Information Technology of the Department of Health and Human Services, a Federal Consolidated Health Information Technology Board.CommentsClose CommentsPermalink





(b) Board of Directors- The Board shall be administered by a board of directors that shall be composed of the following individuals or their designees:CommentsClose CommentsPermalink





(1) The Secretary.CommentsClose CommentsPermalink





(2) The Under Secretary for Health of the Department of Veterans Affairs.CommentsClose CommentsPermalink





(3) The Director of the Indian Health Service.CommentsClose CommentsPermalink





(4) The Secretary of Defense.CommentsClose CommentsPermalink





(5) The Secretary of Health and Human Services.CommentsClose CommentsPermalink





(6) The Director of the Agency for Healthcare Research and Quality.CommentsClose CommentsPermalink





(7) The Administrator of the Health Resources and Services Administration.CommentsClose CommentsPermalink





(8) The Chairman of the Federal Communications Commission.CommentsClose CommentsPermalink





(c) Duties- The Board shall--CommentsClose CommentsPermalink





(1) provide ongoing communication with existing VistA and RPMS user groups to ensure that there is constant interoperability between such groups and to provide for the sharing of innovative ideas and technology;CommentsClose CommentsPermalink





(2) update VistA and RPMS open source software (including health care provider-based electronic health records, personal health records, and other software modules) on a timely basis;CommentsClose CommentsPermalink





(3) implement and administer the 21st Century HIT Grant Program under section 4, including providing for notice in the Federal Register as well as--CommentsClose CommentsPermalink





(A) determining specific health information technology grant needs based on health care provider settings;CommentsClose CommentsPermalink





(B) developing benchmarks for levels of implementation in each year that 21st Century grant funding is provided; andCommentsClose CommentsPermalink





(C) providing ongoing VistA and RPMS technical assistance to grantees under such program (either through the provision of direct technical support or through the awarding of competitive contracts to other qualified entities);CommentsClose CommentsPermalink





(D) develop mechanisms to integrate VistA and RPMS with records and billing systems utilized under the Medicaid and State children’s health insurance programs under titles XIX and XXI of the Social Security Act (42 U.S.C. 1396 and 1397aa et seq.);CommentsClose CommentsPermalink





(4) establish a child-specific electronic health record, consistent with the parameters to be set for child electronic health records as provided for in the American Recovery and Reinvestment Act of 2009, to be used in the Medicaid and State children’s health insurance programs under titles XIX and XXI of the Social Security Act, and under other Federal children’s health programs determined appropriate by the board of directors;CommentsClose CommentsPermalink





(5) develop and integrate quality and performance measurement into the VistA and RPMS modules;CommentsClose CommentsPermalink





(6) integrate the 21st Century HIT Grant Program under section 4 with the Federal Communications Commission’s Rural Health Care Pilot Program, with Department of Veterans Affairs hospital systems, and with other Federal health information technology health initiatives; andCommentsClose CommentsPermalink





(7) carry out other activities determined appropriate by the board of directors.CommentsClose CommentsPermalink





(d) Annual Audits- The Comptroller General of the United States shall annually conduct an audit of the activities of the Board during the year and submit the results of such audits to the appropriate committees of Congress.CommentsClose CommentsPermalink





(e) Authorization of Appropriations- There is authorized to be appropriated such sums as may be necessary to carry out this section.CommentsClose CommentsPermalink

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

(a) Establishment- The Board shall establish a grant program, to be known as the 21st Century Health Information Technology (HIT) Grant program, to award competitive grants to eligible safety-net health care providers to enable such providers to fully implement VistA or RPMS with respect to the patients served by such providers.CommentsClose CommentsPermalink





(b) Eligibility-CommentsClose CommentsPermalink





(1) IN GENERAL- To be eligible to receive a grant under subsection (a), an entity shall--CommentsClose CommentsPermalink





(A) be--CommentsClose CommentsPermalink





(i) a public or nonprofit health care provider (as defined in section 254(h)(7)(B) of the Communications Act of 1934 (47 U.S.C. 254(h)(7)(B)), including--CommentsClose CommentsPermalink





(I) post-secondary educational institutions offering health care instruction, teaching hospitals, and medical schools;CommentsClose CommentsPermalink





(II) a community health center receiving a grant under section 330 of the Public Health Service Act (42 U.S.C. 254) or a health center that provides health care to migrants;CommentsClose CommentsPermalink





(III) a local health department or agency, including a dedicated emergency department of rural for-profit hospitals;CommentsClose CommentsPermalink





(IV) a community mental health center;CommentsClose CommentsPermalink





(V) a nonprofit hospitals;CommentsClose CommentsPermalink





(VI) a rural health clinics, including a mobile clinic;CommentsClose CommentsPermalink





(VII) a consortia of health care providers, that consists of 1 or more of the entities described in clauses (i) through (vi); andCommentsClose CommentsPermalink





(VIII) a part-time eligible entity that is located in an otherwise ineligible facility (as described in section 5(b); orCommentsClose CommentsPermalink





(ii) a free clinic (as defined in paragraph (4); andCommentsClose CommentsPermalink





(B) submit to the Board as application at such time, in such manner, and containing such information as the Board may require.CommentsClose CommentsPermalink





(2) NON-ELIGIBLE ENTITIES-CommentsClose CommentsPermalink





(A) IN GENERAL- An entity shall not be eligible to receive a grant under this section if such entity is a for-profit health care entity (except as provided for in paragraph (1)(A)), or any other type of entity that is not described in such paragraph, including--CommentsClose CommentsPermalink





(i) an entity described in paragraph (1)(A) that is implementing an existing electronic health records system;CommentsClose CommentsPermalink





(ii) an entity that is receiving grant funding under the Federal Communication Commission Rural Health Pilot Program;CommentsClose CommentsPermalink





(iii) an entity receiving funding for health information technology through a Medicaid transformation grant under title XIX of the Social Security Act (42 U.S.C. 1936 et seq.);CommentsClose CommentsPermalink





(iv) a private physician office or clinic;CommentsClose CommentsPermalink





(v) a nursing home or other long-term care facility (such as an assisted living facility);CommentsClose CommentsPermalink





(vi) an emergency medical service facility;CommentsClose CommentsPermalink





(vii) a residential substance abuse treatment facility;CommentsClose CommentsPermalink





(viii) a hospice;CommentsClose CommentsPermalink





(ix) a for-profit hospital;CommentsClose CommentsPermalink





(x) a home health agency;CommentsClose CommentsPermalink





(xi) a blood bank;CommentsClose CommentsPermalink





(xii) a social service agency; andCommentsClose CommentsPermalink





(xiii) a community center, vocational rehabilitation center, or youth center.CommentsClose CommentsPermalink





(B) OTHER ENTITIES- An entity shall not be eligible to receive a grant under this section if such entity is receiving Medicare or Medicaid incentive funding under any of the amendments made by title IV of division B of the American Recovery and Reinvestment Act of 2009.CommentsClose CommentsPermalink





(3) PREFERENCE- In awarding grant under this section the Board shall give preference to applicants that--CommentsClose CommentsPermalink





(A) are located in geographical areas that have a greater likelihood of serving the same patients and utilizing interoperability to promote coordinated care management; orCommentsClose CommentsPermalink





(B) demonstrate the greatest need for such award (as determined by the Secretary).CommentsClose CommentsPermalink





(4) DEFINITION- In this subsection, the term ‘free clinic’ means a safety-net health care organization that--CommentsClose CommentsPermalink





(A) utilizes volunteers to provide a range of medical, dental, pharmacy, or behavioral health services to economically disadvantaged individuals the majority of whom are uninsured or underinsured; andCommentsClose CommentsPermalink





(B) is a community-based tax-exempt organization under section 501(c)(3) of the Internal Revenue Code of 1986, or that operates as a program component or affiliate of such a 501(c)(3) organization.CommentsClose CommentsPermalink





An entity that is otherwise a free clinic under this paragraph, but that charge a nominal fee to patients, shall still be considered to be a free clinics if the entity delivers essential services regardless of the patient’s ability to pay.CommentsClose CommentsPermalink





(c) Use of Funds- An entity shall use amounts received under a grant under this section to fully implement the VistA or RPMS with respect to the patients served by such entity. Such implementation shall include at least the meaningful use (as defined by the Secretary of Health and Human Services) of such systems, including any ongoing updates and changes to such definition.CommentsClose CommentsPermalink





(d) Term and Renewal- A grant under this section shall be for a period of not to exceed 5 years and may be renewed, as determined appropriate by the Board, based on the achievement of benchmarks required by the Board.CommentsClose CommentsPermalink





(e) Annual Reporting-CommentsClose CommentsPermalink





(1) BY GRANTEES- Not later than 1 year after the date on which an entity receives a grant under this section, and annually during each year in which such entity has received funds under such grant, such entity shall submit to the Board a report concerning the activities carried out under the grant.CommentsClose CommentsPermalink





(2) BY BOARD- Not later than 2 years after the date of enactment of this Act, and annually thereafter, the Board shall submit to the appropriate committees of Congress a report concerning the activities carried out under this section, including--CommentsClose CommentsPermalink





(A) a description of the grants that have been awarded under this section and the purposes of such grants;CommentsClose CommentsPermalink





(B) specific implementation information with respect to activities carried out by grantees;CommentsClose CommentsPermalink





(C) the costs and savings achieved under the program under this section;CommentsClose CommentsPermalink





(D) a description of any innovations developed by health care providers as a result of the implementation of activities under this grant;CommentsClose CommentsPermalink





(E) a description of the results of grant activities on patient care quality measurement (including reductions in medication errors and the provision of care management);CommentsClose CommentsPermalink





(F) a description of the extent of electronic health record use across health care provider settings;CommentsClose CommentsPermalink





(G) a description of the extent to which integration of VistA and RPMS with Medicaid and State children’s health insurance program billing has been achieved; andCommentsClose CommentsPermalink





(H) any other information determined necessary by the Board.CommentsClose CommentsPermalink





(f) Annual Audits- The Comptroller General of the United States shall annually conduct an audit of the grant program carried out under this section and submit the results of such audits to the Board and the appropriate committees of Congress.CommentsClose CommentsPermalink





(g) Authorization of Appropriations- There is authorized to be appropriated to carry out this section--CommentsClose CommentsPermalink





(1) $2,000,000,000 for each of fiscal years 2010 and 2011; andCommentsClose CommentsPermalink





(2) $1,000,000,000 for each of fiscal years 2012 through 2014.CommentsClose CommentsPermalink

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

(a) In General- The Board may use not to exceed 10 percent of the amount appropriate for each fiscal year under section 4(g) to award competitive grants to eligible long-term care providers for the conduct of demonstration projects to implement VistA or RPMS with respect to the individuals served by such providers.CommentsClose CommentsPermalink





(b) Eligibility-CommentsClose CommentsPermalink





(1) IN GENERAL- To be eligible to receive a grant under subsection (a), an entity shall--CommentsClose CommentsPermalink





(A) be a--CommentsClose CommentsPermalink





(i) nursing home or other long-term care facility (such as an assisted living facility);CommentsClose CommentsPermalink





(ii) a hospice; orCommentsClose CommentsPermalink





(iii) a home health agency; andCommentsClose CommentsPermalink





(B) submit to the Board as application at such time, in such manner, and containing such information as the Board may require, including a description of the manner in which the applicant will use grant funds to implement VistA or RPMS with respect to the individuals served by such applicant to achieve one or more of the following:CommentsClose CommentsPermalink





(i) Improve care coordination and chronic disease management.CommentsClose CommentsPermalink





(ii) Reduce hospitalizations.CommentsClose CommentsPermalink





(iii) Reduce patient churning between the hospital, nursing home, hospice, and home health entity.CommentsClose CommentsPermalink





(iv) Increase the ability of long-term care patients to remain in their homes and communities.CommentsClose CommentsPermalink





(v) Improve patient completion, and provider execution, of advance directives.CommentsClose CommentsPermalink





(2) NONELIGIBILITY- An entity shall not be eligible to receive a grant under this section if such entity is receiving Medicare or Medicaid incentive funding under any of the amendments made by title IV of division B of the American Recovery and Reinvestment Act of 2009.CommentsClose CommentsPermalink





(c) Use of Funds- An entity shall use amounts received under a grant under this section to implement the VistA or RPMS with respect to the individuals served by such entity. Such implementation shall include at least the meaningful use (as defined by the Secretary of Health and Human Services) of such systems, including any ongoing updates and changes to such definition.CommentsClose CommentsPermalink





(d) Duration- A grant under this section shall be for a period of not to exceed 3 years, as determined appropriate by the Board.CommentsClose CommentsPermalink





(e) Reporting- The Board, as part of the report submitted under section 4(e)(2), shall provide comprehensive information on the activities conducted under grants awarded under this section.CommentsClose CommentsPermalink