0990-PatientPerspectiveApp A ARRA

123 STAT. 226

PUBLIC LAW 111–5—FEB. 17, 2009

1717(b)(2)) or section 305(a)(2) of the Federal Home Loan Mortgage
Corporation Act (12 U.S.C. 1754(a)(2)), respectively, for any size
residence for any area is less than such maximum original principal
obligation limitation that was in effect for such size residence
for such area for 2008 pursuant to section 201 of the Economic
Stimulus Act of 2008 (Public Law 110–185; 122 Stat. 619), notwithstanding 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) DISCRETIONARY AUTHORITY FOR SUB-AREAS.—Notwithstanding 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 principal 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 otherwise 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 REVERSE MORTGAGE LOAN LIMITS 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 require 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)).
Health
Information
Technology for
Economic and
Clinical Health
Act.
42 USC 201 note.

TITLE XIII—HEALTH INFORMATION
TECHNOLOGY
SEC. 13001. SHORT TITLE; TABLE OF CONTENTS OF TITLE.

(a) SHORT TITLE.—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. 13001. Short title; table of contents of title.
Subtitle A—Promotion of Health Information Technology
PART 1—IMPROVING HEALTH CARE QUALITY, SAFETY,

AND

EFFICIENCY

Sec. 13101. ONCHIT; standards development and adoption.

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‘‘TITLE XXX—HEALTH INFORMATION TECHNOLOGY AND QUALITY
‘‘Sec. 3000. Definitions.

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PUBLIC LAW 111–5—FEB. 17, 2009

123 STAT. 227

‘‘Subtitle A—Promotion of Health Information Technology
‘‘Sec. 3001. Office of the National Coordinator for Health Information Technology.
‘‘Sec. 3002. HIT Policy Committee.
‘‘Sec. 3003. HIT Standards Committee.
‘‘Sec. 3004. Process for adoption of endorsed recommendations; adoption of initial set of standards, implementation specifications, and certification
criteria.
‘‘Sec. 3005. Application and use of adopted standards and implementation specifications by Federal agencies.
‘‘Sec. 3006. Voluntary application and use of adopted standards and implementation specifications by private entities.
‘‘Sec. 3007. Federal health information technology.
‘‘Sec. 3008. Transitions.
‘‘Sec. 3009. Miscellaneous provisions.
Sec. 13102. Technical amendment.
PART 2—APPLICATION

USE OF ADOPTED HEALTH INFORMATION TECHNOLOGY
STANDARDS; REPORTS
Sec. 13111. Coordination of Federal activities with adopted standards and implementation specifications.
Sec. 13112. Application to private entities.
Sec. 13113. Study and reports.
AND

Subtitle B—Testing of Health Information Technology
Sec. 13201. National Institute for Standards and Technology testing.
Sec. 13202. Research and development programs.
Subtitle C—Grants and Loans 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
EHR technology.
‘‘Sec. 3015. Demonstration 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. Authorization for appropriations.
Subtitle D—Privacy
Sec. 13400. Definitions.
PART 1—IMPROVED PRIVACY PROVISIONS AND SECURITY 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; accounting 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 requirement 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.

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PART 2—RELATIONSHIP

OTHER LAWS; REGULATORY REFERENCES; EFFECTIVE
DATE; REPORTS
Sec. 13421. Relationship to other laws.

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123 STAT. 228

PUBLIC LAW 111–5—FEB. 17, 2009

Sec. 13422. Regulatory references.
Sec. 13423. Effective date.
Sec. 13424. Studies, reports, guidance.

Subtitle A—Promotion of Health
Information Technology
PART 1—IMPROVING HEALTH CARE QUALITY,
SAFETY, AND EFFICIENCY
SEC. 13101. ONCHIT; STANDARDS DEVELOPMENT AND ADOPTION.

The Public Health Service Act (42 U.S.C. 201 et seq.) is
amended by adding at the end the following:

‘‘TITLE XXX—HEALTH INFORMATION
TECHNOLOGY AND QUALITY

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42 USC 300jj.

‘‘SEC. 3000. DEFINITIONS.

‘‘In this title:
‘‘(1) CERTIFIED EHR TECHNOLOGY.—The term ‘certified EHR
technology’ means a qualified electronic health record that is
certified pursuant to section 3001(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 physicians or an inpatient hospital electronic health record for hospitals).
‘‘(2) ENTERPRISE INTEGRATION.—The term ‘enterprise
integration’ means the electronic linkage of health care providers, health plans, the government, and other interested parties, to enable the electronic exchange and use of health
information among all the components in the health care infrastructure in accordance with applicable law, and such term
includes related application protocols and other related standards.
‘‘(3) HEALTH CARE PROVIDER.—The term ‘health care provider’ 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 1913(b)(1)), renal dialysis facility, blood center,
ambulatory surgical center described in section 1833(i) of the
Social Security Act, emergency medical services provider, Federally qualified health center, group practice, a pharmacist, a
pharmacy, a laboratory, a physician (as defined in section
1861(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-Determination and Education Assistance Act), tribal organization, 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 340B, an ambulatory surgical center
described in section 1833(i) of the Social Security Act, a therapist (as defined in section 1848(k)(3)(B)(iii) of the Social Security
Act), and any other category of health care facility, entity,

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PUBLIC LAW 111–5—FEB. 17, 2009

123 STAT. 229

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practitioner, or clinician determined appropriate by the Secretary.
‘‘(4) HEALTH INFORMATION.—The term ‘health information’
has the meaning given such term in section 1171(4) of the
Social Security Act.
‘‘(5) HEALTH INFORMATION TECHNOLOGY.—The term ‘health
information technology’ means hardware, software, integrated
technologies or related licenses, intellectual property, upgrades,
or packaged 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 exchange of health
information
‘‘(6) HEALTH PLAN.—The term ‘health plan’ has the meaning
given such term in section 1171(5) of the Social Security Act.
‘‘(7) HIT POLICY COMMITTEE.—The term ‘HIT Policy Committee’ means such Committee established under section
3002(a).
‘‘(8) HIT STANDARDS COMMITTEE.—The term ‘HIT Standards
Committee’ means such Committee established under section
3003(a).
‘‘(9) INDIVIDUALLY IDENTIFIABLE HEALTH INFORMATION.—
The term ‘individually identifiable health information’ has the
meaning given such term in section 1171(6) of the Social Security Act.
‘‘(10) LABORATORY.—The term ‘laboratory’ has the meaning
given such term in section 353(a).
‘‘(11) NATIONAL COORDINATOR.—The term ‘National Coordinator’ means the head of the Office 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 Federal Food, Drug,
and Cosmetic Act.
‘‘(13) QUALIFIED ELECTRONIC HEALTH RECORD.—The term
‘qualified 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 Rico, the Virgin Islands,
Guam, American Samoa, and the Northern Mariana Islands.

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123 STAT. 230

PUBLIC LAW 111–5—FEB. 17, 2009

‘‘Subtitle A—Promotion of Health
Information Technology
42 USC 300jj–11.

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Reports.
Deadline.

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‘‘SEC. 3001. OFFICE OF THE NATIONAL COORDINATOR FOR HEALTH
INFORMATION TECHNOLOGY.

‘‘(a) ESTABLISHMENT.—There is established within the Department of Health and Human Services an Office of the National
Coordinator for Health Information Technology (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) PURPOSE.—The National Coordinator shall perform the
duties under subsection (c) in a manner consistent with the development of a nationwide health information technology infrastructure
that allows for the electronic use and exchange 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 quality, reduces medical errors,
reduces health disparities, and advances the delivery of patientcentered medical care;
‘‘(3) reduces health care costs resulting from inefficiency,
medical errors, inappropriate care, duplicative care, and incomplete 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 entities through an effective infrastructure for the secure and
authorized 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 disease outbreaks;
‘‘(8) facilitates health and clinical research and health care
quality;
‘‘(9) promotes early detection, prevention, and management
of chronic diseases;
‘‘(10) promotes a more effective marketplace, greater competition, greater systems analysis, increased consumer choice,
and improved outcomes in health care services; and
‘‘(11) improves efforts to reduce health disparities.
‘‘(c) DUTIES OF THE NATIONAL COORDINATOR.—
‘‘(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

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PUBLIC LAW 111–5—FEB. 17, 2009

123 STAT. 231

‘‘(C) review Federal health information technology
investments to ensure that Federal health information
technology programs are meeting the objectives of the strategic plan published under paragraph (3).
‘‘(2) HIT POLICY COORDINATION.—
‘‘(A) IN GENERAL.—The National Coordinator shall
coordinate health information technology policy and programs of the Department with those of other relevant
executive branch agencies with a goal of avoiding duplication of efforts and of helping to ensure that each agency
undertakes health information technology activities primarily within the areas of its greatest expertise and technical capability and in a manner towards a coordinated
national goal.
‘‘(B) HIT POLICY AND STANDARDS COMMITTEES.—The
National Coordinator shall be a leading member in the
establishment and operations of the HIT Policy Committee
and the HIT Standards Committee and shall serve as a
liaison among those two Committees and the Federal
Government.
‘‘(3) STRATEGIC PLAN.—
‘‘(A) IN GENERAL.—The National Coordinator shall, in
consultation with other appropriate Federal agencies
(including the National Institute of Standards and Technology), update the Federal Health IT Strategic Plan (developed as of June 3, 2008) 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 utilization of an electronic health record
for each person in the United States by 2014.
‘‘(iii) The incorporation of privacy and security
protections for the electronic exchange of an individual’s individually identifiable health information.
‘‘(iv) Ensuring security methods to ensure appropriate authorization and electronic authentication of
health information and specifying technologies or
methodologies for rendering health information unusable, unreadable, or indecipherable.
‘‘(v) Specifying a framework for coordination and
flow of recommendations and policies under this subtitle among the Secretary, the National Coordinator,
the HIT Policy Committee, the HIT Standards Committee, and other health information exchanges and
other relevant entities.
‘‘(vi) Methods to foster the public understanding
of health information technology.
‘‘(vii) Strategies to enhance the use of health
information technology in improving the quality of
health care, reducing medical errors, reducing health
disparities, improving public health, increasing prevention 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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