Promoting Quality and Efficient Health Care in 
                Federal Government Administered or Sponsored Health 
                Care Programs

                By the authority vested in me as President by the 
                Constitution and the laws of the United States, and in 
                order to promote federally led efforts to implement 
                more transparent and high-quality health care, it is 
                hereby ordered as follows:

                Section 1. Purpose. It is the purpose of this order to 
                ensure that health care programs administered or 
                sponsored by the Federal Government promote quality and 
                efficient delivery of health care through the use of 
                health information technology, transparency regarding 
                health care quality and price, and better incentives 
                for program beneficiaries, enrollees, and providers. It 
                is the further purpose of this order to make relevant 
                information available to these beneficiaries, 
                enrollees, and providers in a readily useable manner 
                and in collaboration with similar initiatives in the 
                private sector and non-Federal public sector. 
                Consistent with the purpose of improving the quality 
                and efficiency of health care, the actions and steps 
                taken by Federal Government agencies should not incur 
                additional costs for the Federal Government.

                Sec. 2. Definitions. For purposes of this order:

                (a) ``Agency' means an agency of the Federal 
                Government that administers or sponsors a Federal 
                health care program.

                (b) ``Federal health care program' means the Federal 
                Employees Health Benefit Program, the Medicare program, 
                programs operated directly by the Indian Health 
                Service, the TRICARE program for the Department of 
                Defense and other uniformed services, and the health 
                care program operated by the Department of Veterans 
                Affairs. For purposes of this order, ``Federal health 
                care program' does not include State operated or 
                funded federally subsidized programs such as Medicaid, 
                the State Children's Health Insurance Program, or 
                services provided to Department of Veterans' Affairs 
                beneficiaries under 38 U.S.C. 1703.

                (c) ``Interoperability' means the ability to 
                communicate and exchange data accurately, effectively, 
                securely, and consistently with different information 
                technology systems, software applications, and networks 
                in various settings, and exchange data such that 
                clinical or operational purpose and meaning of the data 
                are preserved and unaltered.

                (d) ``Recognized interoperability standards' means 
                interoperability standards recognized by the Secretary 
                of Health and Human Services (the ``Secretary'), in 
                accordance with guidance developed by the Secretary, as 
                existing on the date of the implementation, 
                acquisition, or upgrade of health information 
                technology systems under subsections (1) or (2) of 
                section 3(a) of this order.

                Sec. 3. Directives for Agencies. Agencies shall perform 
                the following functions:

                (a) Health Information Technology.

(1) For Federal Agencies. As each agency implements, acquires, or upgrades 
health information technology systems used for the direct exchange of 
health information between agencies and with non-Federal entities, it shall 
utilize, where available, health information technology systems and 
products that meet recognized interoperability standards.

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(2) For Contracting Purposes. Each agency 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 
available, health information technology systems and products that meet 
recognized interoperability standards.

                (b) Transparency of Quality Measurements.

(1) In General. Each agency shall implement programs measuring the quality 
of services supplied by health care providers to the beneficiaries or 
enrollees of a Federal health care program. Such programs shall be based 
upon standards established by multi-stakeholder entities identified by the 
Secretary or by another agency subject to this order. Each agency shall 
develop its quality measurements in collaboration with similar initiatives 
in the private and non-Federal public sectors.

(2) Facilitation. An agency satisfies the requirements of this subsection 
if it participates in the aggregation of claims and other appropriate data 
for the purposes of quality measurement. Such aggregation shall be based 
upon standards established by multi-stakeholder entities identified by the 
Secretary or by another agency subject to this order.

                (c) Transparency of Pricing Information. Each agency 
                shall make available (or provide for the availability) 
                to the beneficiaries or enrollees of a Federal health 
                care program (and, at the option of the agency, to the 
                public) the prices that it, its health insurance 
                issuers, or its health insurance plans pay for 
                procedures to providers in the health care program with 
                which the agency, issuer, or plan contracts. Each 
                agency shall also, in collaboration with multi-
                stakeholder groups such as those described in 
                subsection (b)(1), participate in the development of 
                information regarding the overall costs of services for 
                common episodes of care and the treatment of common 
                chronic diseases.

                (d) Promoting Quality and Efficiency of Care. Each 
                agency shall develop and identify, for beneficiaries, 
                enrollees, and providers, approaches that encourage and 
                facilitate the provision and receipt of high-quality 
                and efficient health care. Such approaches may include 
                pay-for-performance models of reimbursement consistent 
                with current law. An agency will satisfy the 
                requirements of this subsection if it makes available 
                to beneficiaries or enrollees consumer-directed health 
                care insurance products.

                Sec. 4. Implementation Date. Agencies shall comply with 
                the requirements of this order by January 1, 2007.

                Sec. 5. Administration and Judicial Review.

                (a) This order does not assume or rely upon additional 
                Federal resources or spending to promote quality and 
                efficient health care. Further, the actions directed by 
                this order shall be carried out subject to the 
                availability of appropriations and to the maximum 
                extent permitted by law.

                (b) This order shall be implemented in new contracts or 
                new contract cycles as they may be renewed from time to 
                time. Renegotiation outside of the normal contract 
                cycle processes should be avoided.

                (c) This order is not intended to, and does not, create 
                any right or benefit, substantive or procedural, 
                enforceable at law or in equity against the United

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                States, its departments, agencies, or entities, its 
                officers, employees, or agents, or any other person.

                    (Presidential Sig.)B

                THE WHITE HOUSE,

                    August 22, 2006.