42 U.S.C. § 300jj–34 — Competitive grants to States and Indian tribes for the development of loan programs to facilitate the widespread adoption of certified EHR technology

(a) In general: The National Coordinator can give competitive grants to eligible groups. The money is used to start loan programs. Health care providers can then use those loans for the activities listed in part (e). (b) Eligible entity defined: An "eligible entity" is a State or an Indian tribe. To get a grant, it must: (1) send the National Coordinator an application, in whatever form and with whatever information the National Coordinator asks for; (2) send in a strategic plan (part (d) explains what this plan must include) and promise to update it every year; (3) promise to set up a Loan Fund, as described in part (c); (4) promise it won't give a provider a loan unless the provider agrees to (A) report on federal quality measures within 90 days after the measures are adopted — to Medicare/Medicaid's administrator if the provider is in those programs, or to the Secretary otherwise, (B) prove to the Secretary that any EHR technology bought or supported with the loan is actually used to share health information in ways that follow the law and improve health care quality, such as better coordination of care, (C) follow any other rules the entity or the Secretary sets, (D) include a plan for how it will keep the EHR technology working and supported over time, and (E) include a plan for how it will maintain and support the specific technology bought with the loan, including what resources it expects to use and any other information the State or tribe wants; and (5) agree to provide matching funds, as required in part (h). (c) Establishment of fund: An eligible entity must set up a "Loan Fund" for certified EHR technology. Any grant it gets under this section goes into that fund. Money meant for other purposes under this part of the law can't be put into the Loan Fund. (d) Strategic plan: The strategic plan must say how the entity plans to use its Loan Fund money. Each year, the plan must include (A) a list of the projects the Loan Fund will help pay for that year, (B) a description of the rules and methods used to decide who gets money from the fund, (C) a description of the fund's financial condition as of the date the plan is submitted, and (D) the fund's short-term and long-term goals. (e) Use of funds: Money in the Loan Fund — including loan repayments and interest — can only be used to make loans or loan guarantees, to make certain reimbursements described in part (g)(4)(A), or as backup security for larger loans whose proceeds go into the fund. Health care providers can use these loans to (1) help pay for certified EHR technology, (2) improve how they use certified EHR technology, including upgrades needed to make it certified, (3) train staff to use the technology, or (4) improve the secure electronic sharing of health information. (f) Types of assistance: Unless state law says otherwise, Loan Fund money can only be used for (1) making loans that follow these rules: the interest rate can't be higher than the market rate, the borrower must start paying back principal and interest within 1 year and pay the loan off completely within 10 years, and the fund gets credited with all the loan's payments; (2) guaranteeing or insuring a local obligation, if doing so makes credit easier to get or lowers the interest rate; (3) backing up bonds the entity issues, if the bond proceeds go into the Loan Fund; (4) earning interest on the fund's money; and (5) making the reimbursements described in part (g)(4)(A). (g) Administration of loan funds: (1) An entity may combine the Loan Fund's financial management with another revolving fund it runs, to save on administrative costs, as long as state law allows it. (2) An entity may use up to 4% of its grant money each year to pay for reasonable costs of running the program, including costs of setting up the fund after February 17, 2009. (3) The National Coordinator must publish guidance and rules needed to run this section, including rules to make sure entities spend their money efficiently and to prevent waste, fraud, and abuse. (4) A Loan Fund can accept money from private companies, but those companies can't pick who gets the loans. The entity may pay the company back, but not more than what the company originally gave. The entity must publicly say who gave money and how much, and may give the company a certificate of thanks (but nothing with financial value). (h) Matching requirements: The National Coordinator won't give a grant unless the entity promises to add at least $1 of its own money (cash, possibly from public or private donors) for every $5 of federal grant money. When figuring out how much non-federal money the entity has added, the National Coordinator can't count any money the entity got from the federal government. (i) Effective date: The Secretary can't make an award under this section before January 1, 2010.