Personalized Health Information Act of 2006 - Requires the Secretary of Health and Human Services to establish a program to provide financial incentives for the establishment of interactive qualifying personal health records for Medicare and other patients and their health care providers in order to: (1) provide patients access to and control over their personal health data and information and educational information; and (2) make available to authorized health care providers a more accurate minimum data set of patient information. Directs that under the program each qualified physician receives an incentive payment for each qualifying patient.
Directs the Secretary to: (1) publish a list of qualifying physicians who participate in Medicare and have received such payments; and (2) take steps to educate Medicare beneficiaries and providers and other patients about the benefits of qualifying personal health records.
Sets forth requirements for a qualified personal health record, including that such record: (1) is controlled solely by the patient; (2) meets minimum security standards; (3) complies with interoperability data standards; (4) is capable of sending patient-specific patient education, reminders, and clinical messages to the patient; and (5) is capable of providing de-identified data for public health analysis and research purposes.
Requires the Secretary to: (1) set minimum security, privacy, and data use standards for such health records; (2) establish a consumer protection board to recommend standards and procedures to the Secretary; and (3) establish a PHR Incentive Fund to make incentive payments. Provides that such Fund shall accept contributions from: (1) the Secretary for Medicare beneficiaries; (2) drug manufacturers for messages regarding medical adherence programs; and (3) other Fund partners.
[Congressional Bills 109th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6289 Introduced in House (IH)]
109th CONGRESS
2d Session
H. R. 6289
To establish a program to provide financial incentives for the
establishment of interactive personal health records.
_______________________________________________________________________
IN THE HOUSE OF REPRESENTATIVES
September 29, 2006
Mr. Kennedy of Rhode Island introduced the following bill; which was
referred to the Committee on Energy and Commerce, and in addition to
the Committee on Ways and Means, for a period to be subsequently
determined by the Speaker, in each case for consideration of such
provisions as fall within the jurisdiction of the committee concerned
_______________________________________________________________________
A BILL
To establish a program to provide financial incentives for the
establishment of interactive personal health records.
Be it enacted by the Senate and House of Representatives of the
United States of America in Congress assembled,
SECTION 1. SHORT TITLE.
This Act may be cited as the ``Personalized Health Information Act
of 2006''.
SEC. 2. PERSONAL HEALTH RECORD (PHR) INCENTIVE PROGRAM.
(a) Establishment.--The Secretary of Health and Human Services (in
this section referred to as the ``Secretary'') shall establish a
program (in this section referred to as the ``program'') to provide
financial incentives for the establishment of interactive qualifying
personal health records for Medicare and other patients and their
health care providers in order to--
(1) provide patients (or their authorized representatives)
access to and control over their personal health data and
information and educational information so as to become
healthier and more informed and engaged health care consumers;
(2) make available to authorized health care providers a
more accurate minimum data set of patient information at all
points of care;
(3) protect patient security and privacy;
(4) improve patients' adherence to evidence-based care
guidelines, preventive care, and screening protocols, thereby
improving health outcomes and lowering health care costs;
(5) improve medication adherence by patients, thereby
improving health outcomes and lowering health care costs;
(6) provide patients with more accurate, timely, and
appropriate information related to their health care benefits
and related administrative information;
(7) improve the quality and efficiency of communication
between health care providers and patients;
(8) create a direct communications channel to patients in
the event of health emergencies; and
(9) provide access with appropriate privacy safeguards to
de-identified health care information to evaluate and advance
public health and health research goals.
(b) Incentive Payments.--
(1) In general.--Under the program, each qualified
physician (as defined in subsection (c)) that has a qualifying
patient (as defined in subsection (d)) shall receive an
incentive payment from the PHR Incentive Fund established under
subsection (f). In the case of such a patient of more than one
physician, each such physician (who does not share in the same
group practice, as defined by the Secretary, with another
qualifying physician of that patient) may receive such a
payment.
(2) Amount of payment.--
(A) In general.--Except as otherwise provided, the
amount of the incentive payment to a qualifying
physician under the program shall be at least $2 per
year for each qualifying patient of the physician.
(B) Adjustment; limitation.--The Secretary shall
annually retrospectively set the incentive payment
amount based on the amount of the contributions into
the PHR Incentive Fund. The Secretary shall pay PHR
incentives payments only from such Fund.
(C) Annual limitation.--The Secretary shall
establish a maximum annual payment under this section
to any qualifying physician.
(3) Duration.--Payments shall be made under the program
during a 3-year period beginning on the date of implementation
of the program, except that the Secretary may continue the
program for an additional two years if the Secretary determines
that continuation of the program for such period would be a
cost-effective way of achieving the goals of this Act.
(4) Program education.--
(A) Publication of names qualifying physicians.--In
order to assist patients in identifying health care
providers that use qualifying personal health records,
Secretary shall publish on the official website for the
Centers for Medicare & Medicaid Services (CMS), or
other online locations of the Secretary's choosing, a
list of qualifying physicians who participate in the
Medicare program and who have received incentive
payments under this section.
(B) Education.--
(i) Patient education.--The Secretary
shall, in consultation with appropriate
organizations that represent health care
consumers, take steps to educate Medicare
beneficiaries and other patients about the
health and convenience benefits of qualifying
personal health records.
(ii) Provider education.--The Secretary
shall take steps to educate Medicare providers
about the patient, provider and overall health
care benefits of using qualifying personal
health records.
(c) Qualified Physician Defined.--For purposes of this section, the
term ``qualified physician'' means a licensed physician (or other
licensed health care provider, such as a clinic, designated by the
Secretary) that meets the following requirements, with respect to a
qualifying patient of that physician and the qualifying personal health
record of that patient:
(1) The physician (or provider) uses the QPHR for
electronic patient registration for encounters, including
taking demographic information, insurance information,
medication list, problems list, family history, and other
information included within the QPHR.
(2) The physician (or provider) implements policies to
authenticate the patient's identities pursuant to standards
established by the Secretary in order to enable the QPHR to
receive electronic data feeds from appropriate third party
sources, such as pharmacies, pharmacy benefit managers,
laboratories, and health plans, including the Medicare program.
(3) The physician (or provider), or authorized
representative, updates the diagnosis and medication list
(including all current medications and new medications
prescribed or provided as samples) in the QPHR after each
patient encounter, if appropriate and authorized by the
patient, either by direct entry or through a data sharing
arrangement using an appropriate electronic means, such as an
electronic medical record or e-prescribing.
(4) The physician (or provider) uses the QPHR as
appropriate and authorized by the patient to communicate
appropriate patient education and care management messages.
(5) There is submitted to the Secretary by the physician
(or by the administrator of the QPHR on the physician's behalf)
on a regular basis, but no less frequently than annually, a
report documenting the number of such qualifying patients of
the physician (or provider) and the use of QPHRs of such
patients.
(6) The physician (or provider) meets other requirements as
the Secretary may establish.
(d) Qualifying Patient Defined.--For purposes of this section, the
term ``qualifying patient'' means an individual for whom a qualifying
personal health record has been established and is in operation under
the program and who is a Medicare beneficiary or is covered under a
health benefits or other plan the sponsor of which is participating as
a Fund partner under this section.
(e) Qualifying Personal Health Record (QPHR).--
(1) Definition.--For purposes of this section, the terms
``qualifying personal health record'' and ``QPHR'' mean a
record of health care related information that meets the
following requirements:
(A) Control.--
(i) In general.--The record is controlled
solely by the patient (or the patient's
authorized representative), with the patient
(or the patient's authorized representative)
able to access online, print, copy to
electronic media, or provide online access to
authorized third parties, including health care
providers, to all individually identifiable
health information held in the record at any
time.
(ii) Access rights.--The record guarantees
the control of the patient (or the patient's
authorized representative) over who accesses
the patient's individually identifiable
information contained in the record.
(iii) Termination rights.--The record
allows a patient to terminate the further use
of the record service at any time, including
elimination of the patient's personal health
information in the control of the administrator
of the record. Nothing in this clause shall
require a health care provider to eliminate a
patient's personal health information that is
in a medical record maintained by the provider.
(iv) Transportability.--The patient's
rights to control of the record under this
subparagraph are not affected by changes in
relationships with particular providers or
health plans.
(B) Security.--The record meets minimum security
standards, including the rules promulgated under
section 264(c) of the Health Insurance Portability and
Accountability Act of 1996 (HIPAA) and other such
minimum standards as identified by the Secretary under
paragraph (2), and the administrator of the record
complies with any security and privacy standards,
policies, and practices adopted under such paragraph.
(C) Interoperability.--The record complies with
interoperability data standards specified by the
Secretary, to ensure the capability to integrate with
other QPHRs and other sources of individual data, such
as electronic health records, pharmacies, pharmacy
benefit managers, and health plans.
(D) Web-based.--The record is web-based and capable
of sharing information between patients and their
providers, and enabling patient-provider communication.
(E) Messaging capabilities.--
(i) Education reminders.--Subject to clause
(v), the record is capable of sending patient-
specific patient education, reminders, and
clinical messages to patients based upon data
in the record, but such messages shall not be
sent unless such messages comply with standards
adopted under paragraph (3). The Secretary
shall work with the Secretary of Homeland
Security and the Director of the Centers for
Disease Control and Prevention to optimize the
public health and emergency response
capabilities of the networks created by QPHRs.
(ii) Federal reminders.--Subject to clause
(v), the record provides for the sending on
behalf of Federal agencies of objective,
accurate, patient-specific messages to patients
concerning their health care or benefits, but
such messages shall not be sent unless the
messages comply with standards adopted under
paragraph (3).
(iii) Fund partner messages.--Subject to
clause (v), the record provides for the
sending, on behalf of Fund partners who
contribute to the Fund, appropriate patient-
specific messages to consumers (with whom such
partners have pre-existing relationships)
concerning the patients' health care,
medications, treatments, medical devices or
benefits, but such messages shall not be sent
unless such messages comply with standards
adopted under paragraph (3).
(iv) Health plan notification.--The QPHR
service notifies, no less frequently than
quarterly, each Fund partner that administers a
health benefit plan of the individuals who are
enrolled in the plan and who have a QPHR
established.
(v) Limitation on commercial
solicitation.--The record does not allow any
commercial solicitations, marketing, or
messages to patients unless the patient is a
patient or beneficiary of the sender, uses the
sender's product with a prescription or
recommendation of a provider, or has some other
pre-existing relationship (as defined by the
Secretary), or other messages that do not
comply with standards adopted under paragraph
(3), and the record ensures that every message
clearly identifies the source of the content.
(vi) Patient opt-out.--The record allow a
patient (or patient's authorized
representative) to opt out of receiving
messages entirely or from particular sources.
(F) Public health analysis and research.--The
record is capable of providing de-identified data for
public health analysis and for research purposes. The
Secretary shall consult with the Commissioner of the
Food and Drug Administration, the Director of the
National Institutes of Health, the Director of the
Centers for Disease Control and Prevention, and the
Administrator of the Agency for Healthcare Research and
Quality to optimize the public health and post-market
surveillance capabilities of the networks created by
QPHRs.
(2) Privacy and consumer protection standards.--
(A) In general.--The Secretary shall set minimum
security, privacy and data use standards for QPHRs, in
addition to such standards as required under
regulations promulgated under section 264(c) of the
Health Insurance Portability and Accountability Act of
1996 (HIPAA), in order to optimally protect and
safeguard patient health care information.
(B) Consumer protection board.--The Secretary shall
establish a consumer protection board, a majority of
whose members represent health care consumers,
including individuals with chronic diseases and with
mental and addictive disorders. Such board shall--
(i) recommend to the Secretary minimum
standards to protect patient-identifiable
information stored in or transmitted from a
QPHR;
(ii) recommend procedures to ensure the
objectivity, relevance, and accuracy of
messages sent to patients via their QPHRs; and
(iii) have the right to request and review
the security and privacy capabilities, policies
and practices of those entities administering
QPHRs.
(3) Message standards.--The Secretary shall establish
minimum standards to ensure the objectivity, accuracy and
relevance of messages sent to individual patients under
paragraph (1)(E) from a QPHR and to protect against the use of
such records by Fund partners for commercial solicitations or
marketing. Such standards shall incorporate existing standards
established by the Food and Drug Administration or other
Federal agencies.
(f) PHR Incentive Fund.--
(1) In general.--The Secretary shall establish a PHR
Incentive Fund (in this section referred to as the ``PHR
Incentive Fund'' or ``Fund''). The Fund may receive
contributions from Fund partners for the sole purpose of paying
PHR incentives under subsection (a), conducting annual studies
under subsection (g), and otherwise carrying out the program.
(2) Funding partners.--
(A) In general.--The Secretary may enter into
contracts with public or private payers, drug
manufacturers, device manufacturers, or other public or
private entities (in this section referred to as ``Fund
partners'') to allow the Fund to receive contributions
in accordance with this subsection and other terms
determined by the Secretary.
(B) Federal partners.--The Secretary shall seek the
involvement and contributions of the Food and Drug
Administration, the Centers for Disease Control and
Prevention, the Agency for Healthcare Research and
Quality, and the Department of Homeland Security to
maximize the effectiveness of the QPHRs in meeting the
health, national security, emergency response,
biosurveillance, and research goals of the Federal
government in a manner consistent with this Act.
(C) Partner accounts.--The Fund shall include an
account for each Fund partner, including Medicare,
separately accounting for each Fund partner's
contributions to the Fund. Incentive payments shall be
debited from each account in accordance with this
subsection. Amounts in the account of a Fund partner
that are not paid in fiscal year remain available for
payment from such account in the subsequent fiscal
year.
(D) Contribution levels.--Contribution levels to
the Fund by Fund partners shall be set annually by the
Secretary, except that the contribution level for the
first year shall be as follows:
(i) Medicare contribution.--The Secretary
shall contribute $2 for each Medicare
beneficiary for whom any PHR incentive payment
is made during such year by transferring the
appropriate amount from the Medicare trust
funds under parts A and B of the Medicare
program, in such proportion as the Secretary
may specify.
(ii) FDA-messaging contributions.--Each
manufacturer shall contribute $2 for each
qualifying patient for each medication
adherence program for which one or more
messages are sent under subsection
(e)(1)(E)(iii) in the year.
(iii) Other contributions.--Any other fund
partner shall contribute $2 for each qualifying
patient for whom a PHR incentive payment is
made, except that the Secretary may establish
other contribution levels for device
manufacturers or other Fund partners that
employ messages sent under subsection
(e)(1)(D)(iii).
(E) Charging fund partners.--Each Fund partner's
account shall be debited according to the same formula
with which contributions were determined. In the event
that a Fund partner's account does not have a
sufficient balance to cover the Fund partner's
liability, the Fund partner shall make a supplemental
contribution to the Fund to cover the shortfall plus
such penalty as the Secretary may assess.
(F) Limitation on benefits.--Contributions by a
Fund partner to the Fund shall confer no preferential
access to data or information or any other benefit to
the partner other than public acknowledgment under
paragraph (5) and the ability to have messages sent to
qualifying patients under subsection (e)(1)(D)(iii).
(3) Publication of fund contributors.--The Secretary shall
publish on the official website of the Centers for Medicare &
Medicaid Services a list of Fund partners that have contributed
to the Fund.
(g) Annual Study.--
(1) In general.--The Secretary shall provide for an annual
study to assess changes patient engagement in their QPHR,
behavior changes, changes in health outcomes, and cost savings
resulting from implementation of the program. The study shall
include collection of aggregate data documenting the number of
qualifying patient, number and kind of messages sent to
patients, the percentage of messages opened by patients, and
other measures of the program's effectiveness.
(2) Funding.--There are available from the PHR Incentive
Fund not to exceed $2,000,000 each year to pay for the annual
study under paragraph (1). Amounts so used shall be debited
from each Fund partner's account on a pro-rata basis.
<all>
Introduced in House
Introduced in House
Sponsor introductory remarks on measure. (CR E1978-1979)
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned.
Referred to the Subcommittee on Health.
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