,i #aacth ,,congress #ast ,session ,h4 ,r4 #acca ,,in ,,the ,,house ,,of ,,representatives ,march #ba1 #bjac ,mrs4 ,black 7for herself1 ,mr4 ,chabot1 ,mr4 ,grimm1 ,mr4 ,harris1 and ,mrs4 ,blackburn7 introduced the following bill2 which was referred to the ,committee on ,energy and ,commerce1 and in addition to the ,committee on ,ways and ,means1 for a period to be subsequently determined by the ,speaker1 in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned ,a ,,bill ,to amend certain requirements and penalties implemented under the ,medicare and ,medicaid programs by the ,,hitech ,act of #bjji1 which would otherwise impede eligible professionals from adopting electronic health records to improve patient care4 #a4 ,short title2 table of contents 7a7 ,short title ,this ,act may be cited as the ,electronic ,health ,records ,improvement ,act4 7b7 ,table of contents ,the table of contents of this ,act is as follows3 ,sec4 #a4 ,short title2 table of contents4 ,sec4 #b4 ,exception for certain eligible professionals from application of ,medicare payment adjustment for not demonstrating ,,ehr meaningful use4 ,sec4 #c4 ,shortening ,,ehr reporting period for application of ,medicare ,,ehr payment adjustment to eligible professionals4 ,sec4 #d4 ,additional exceptions to application of ,medicare payment adjustment for certain ,medicaid and hospital-based eligible professionals not demonstrating ,,ehr meaningful use4 ,sec4 #e4 ,alternate meaningful use criteria for eligible professionals utilizing electronic health records and specialty registry systems4 ,sec4 #f4 ,enhancing ,medicare ,,ehr meaningful use among eligible professionals who are rural health care providers4 ,sec4 #g4 ,improving ,,ehr meaningful use under ,medicare by eligible professionals who practice in ambulatory surgical centers4 ,sec4 #h4 ,exemption from certain ,,ehr meaningful use requirements for certain eligible professionals for purposes of ,medicare payment adjustment4 ,sec4 #i4 ,additional administrative provisions relating to ,medicare eligible professionals' ,,ehr incentives4 ,sec4 #aj4 ,non-application of provisions and amendments to eligible professional ,medicare incentives for certain ,,ma organizations and ,medicaid incentives for adoption and meaningful use of certified ,,ehr technology4 #b4 ,exception for certain eligible professionals from application of ,medicare payment adjustment for not demonstrating ,,ehr meaningful use 7a7 ,exception for certain small physician practices ,section #ahdh7;a77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77#g77 is amended-- 7#a7 in subparagraph 7,a77i71 by striking subparagraphs 7,b7 and 7,d7 and inserting subparagraphs 7,b71 7,d71 and 7,f72 and 7#b7 by adding at the end the following new subparagraph3 7,f7 #c-year exception for certain eligible professionals 7i7 ,in general ,the ,secretary shall exempt an eligible professional whom the ,secretary determines is described in clause 7ii7 from the application of the payment adjustment under subparagraph 7,a7 for each of the payment years #bjae through #bjag4 ,the ,secretary shall make a determination under the previous sentence1 with respect to such an exemption for an eligible professional1 only if such eligible professional submits a request for such exemption4 ,the ,secretary shall determine whether or not an eligible professional is described in clause 7ii7 not later than #cj days after the date such eligible professional submits a request pursuant to the previous sentence4 7ii7 ,eligible professionals in small physician practices ,an eligible professional described in this clause is an eligible professional furnishing covered professional services during the ,,ehr reporting period for #bjae in a physician practice that is a solo practice4 4 7b7 ,exception for certain physicians near retirement age ,subparagraph 7,f7 of section #ahdh7;a77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77#g771 as added by subsection 7a71 is amended-- 7#a7 in clause 7i71 in the first and third sentences1 by striking clause 7ii7 and inserting clause 7ii7 or 7iii72 and 7#b7 by adding at the end the following new clause3 7iii7 ,eligible professionals at or near retirement age ,an eligible professional described in this clause is an eligible professional who as of the last day of #bjae has attained early retirement age 7as defined in section #baf7l77#b77 or who will attain such age during the #e-year period following such day4 4 7c7 ,notification of eligibility for exceptions from payment adjustment ,section #ahdh7;a77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77#g771 as amended by subsection 7a71 is further amended by adding at the end the following new subparagraph3 7,g7 ,notification ,not later than #cj days after the date on which the ,secretary determines an eligible professional is exempt1 pursuant to subparagraph 7,f71 from the application of the payment adjustment under subparagraph 7,a71 the ,secretary shall provide such eligible professional notice of such determination4 4 #c4 ,shortening ,,ehr reporting period for application of ,medicare ,,ehr payment adjustment to eligible professionals 7a7 ,in general ,section #ahdh7;a77#g77;,e77ii7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77#g77;,e77ii77 is amended by inserting 1 so long as all of such period 7or periods7 occurs during the year in which the corresponding adjustment1 if any1 under this paragraph would be applied to the eligible professional involved after a period 7or periods7 specified by the ,secretary4 7b7 ,rebates ,section #ahdh7;a77#g77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77#g77;,a77 is amended by adding at the end the following new clause3 7iv7 ,special rule ,the ,secretary shall establish a process under which if for a calendar year1 beginning with #bjae1 an adjustment is made under this paragraph with respect to covered professional services furnished by an eligible professional and then during such calendar year the eligible professional meets the criteria for establishing meaningful use of certified ,,ehr technology1 the ,secretary shall provide to the eligible professional a rebated amount such that the total amount of payment that the provider receives under this subsection for such services for such year is the fee schedule amount that would otherwise apply to such services under this subsection without application of this paragraph4 4 7c7 ,conforming amendment ,section #ahdh7o77#e77;,b7 of the ,social ,security ,act is amended by adding at the end the following new sentence3 ,such term1 as used under this subsection with respect to subsection 7a77#g7 and a year beginning with #bjae1 shall have the meaning given such term under subsection 7a77#g77;,e77ii744 #d4 ,additional exceptions to application of ,medicare payment adjustment for certain ,medicaid and hospital-based eligible professionals not demonstrating ,,ehr meaningful use 7a7 ,eligible professionals participating in ,medicaid ,,ehr incentive program ,section #ahdh7;a77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77#g771 as amended by section #b1 is further amended-- 7#a7 in subparagraph 7,a77i71 by striking 7,d71 and 7,f7 and inserting 7,d71 7,f71 and 7,g72 7#b7 by redesignating subparagraph 7,g7 as subparagraph 7,h72 and 7#c7 by inserting after subparagraph 7,f7 the following new subparagraph3 7,g7 ,additional exceptions for certain ,medicaid providers participating in ,medicaid ,,ehr incentive program ,in the case of an eligible professional who is a ,medicaid provider described in section #aijc7t77#b77;,a71 the ,secretary shall exempt such eligible professional from the application of the ,medicare payment adjustment under subparagraph 7,a71 with respect to a year1 if such year is the first year that such professional received payment under section #aijc7t74 4 7b7 ,hospital-,based eligible professionals ,section #ahdh7;a77#g77;,d7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77#g77;,d77 is amended by adding at the end the following new sentence3 ,in applying the definition under subsection 7o77#a77;,c77ii7 for purposes of the previous sentence1 the reference to substantially all under such subsection shall mean #ij percent or more and a determination described in such subsection1 with respect to an eligible professional1 may only be made by the ,secretary pursuant to a request of the professional that is submitted to the ,secretary before #bjae1 and shall be effective for such professional for #bjae and each subsequent year44 7c7 ,application of notification requirement ,subparagraph 7,h7 of section #ahdh7;a77#g7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77#g771 as added by section #b7;c7 and redesignated by subsection 7a77#b71 is amended by striking subparagraph 7,f7 and inserting subparagraph 7,b71 7,d71 7,f71 or 7,g74 #e4 ,alternate meaningful use criteria for eligible professionals utilizing electronic health records and specialty registry systems ,section #ahdh7o77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#b77 is amended-- 7#a7 in subparagraph 7,a77iii71 by striking ,subject to and inserting ,for such period1 the eligible professional satisfactorily uses a qualified national specialty registry system that measures quality improvement or improves patient safety 7as described in subparagraph 7,d771 or1 subject to2 and 7#b7 by adding at the end the following new subparagraph3 7,d7 ,qualified national specialty registries 7i7 ,not later than ,january #a1 #bjae1 the ,secretary shall specify1 pursuant to rulemaking1 criteria for determining-- 7,i7 if a national speciality registry system is a qualified national speciality registry system1 for purposes of this paragraph2 and 7,,ii7 if an eligible professional has demonstrated satisfactory use 7as determined by the ,secretary7 of a qualified national speciality registry system for a period4 7ii7 ,for purposes of this paragraph1 the term qualified national specialty registry system means1 with respect to a medical speciality1 a nationally available registry-- 7,i7 that is administered or endorsed by a national medical specialty society2 7,,ii7 that collects clinical data for purposes of measuring quality improvement or improving patient safety related to the type of care provided or conditions treated by the types of eligible professionals that are typically part such national medical specialty society2 and 7,,iii7 that is determined to be a qualified national speciality registry system by the ,secretary under clause 7ii74 4 #f4 ,enhancing ,medicare ,,ehr meaningful use among eligible professionals who are rural health care providers 7a7 ,extension of ,medicare ,,ehr incentives to eligible professionals practicing in rural health clinics 7#a7 ,,ehr payment adjustment ,section #ahdh7;a77#g77;,e77i7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7;a77#g77;,e77i77 is amended by inserting before the period at the end the following3 and1 with respect to payment years after #bjad1 includes rural health clinic services 7as defined in section #ahfa7;aa77#a77 furnished by an eligible professional4 7#b7 ,,ehr increased payments ,section #ahdh7o77#e77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#e77;,a77 is amended by inserting before the period at the end the following3 and1 with respect to payment years after #bjad1 includes rural health clinic services 7as defined in section #ahfa7;aa77#a77 furnished by an eligible professional4 7b7 ,extension of ,medicare e,rx and quality reporting incentives to rural health clinics ,section #ahdh7m77#f77;,a7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7m77#f77;,a77 is amended by inserting before the period at the end the following3 except that the term covered professional services shall1 with respect to reporting periods for #bjae or a subsequent year1 include rural health clinic services 7as defined in section #ahfa7;aa77#a77 furnished by an eligible professional4 #g4 ,improving ,,ehr meaningful use under ,medicare by eligible professionals who practice in ambulatory surgical centers 7a7 #c-,year exemption from encounters calculation ,to demonstrate ,,ehr meaningful use for purposes of payment adjustment ,section #ahdh7o77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#b771 as amended by section #e1 is further amended by adding at the end the following new subparagraph3 7,e7 ,treatment of patient encounters at ambulatory surgical centers 7i7 ,in general ,subject to clause 7ii71 in applying this paragraph for purposes of subsection 7a77#g71 any submissions of claims for items or services furnished by an eligible professional at an ambulatory surgical center during performance years for the #bjae1 #bjaf1 or #bjag payment determinations shall not be included in the data used to determine if such eligible professional is a meaningful ,,ehr user4 7ii7 ,rule of construction ,nothing in clause 7i7 shall prohibit an eligible professional from receiving an additional payment under paragraph 7#a7 with respect to covered professional services furnished in a payment year if the eligible professional is determined to be a meaningful ,,ehr user under this paragraph for the reporting period for such year4 7iii7 ,limitation of payment adjustment ,in applying clause 7i7 for purposes of subsection 7a77#g7 and a year1 if an eligible professional is not a meaningful ,,ehr user pursuant to such clause for an ,,ehr reporting period for the year1 any adjustment under such subsection shall not apply to the fee schedule amount for covered professional services furnished by such eligible professional during the year in an ambulatory surgical center4 4 7b7 ,reinstatement of batching process ,subparagraph 7,e7 of section #ahdh7o77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#b771 as added by subsection 7a71 is amended by adding at the end the following new clause3 7iv7 ,use of batching process ,in applying this paragraph for purposes of subsection 7a77#g7 and with respect to a patient encounter occurring at an ambulatory surgical center1 if an eligible professional creates a record of such patient encounter without using certified ,,ehr technology at the ambulatory surgical center and subsequently inputs the information of such record of such encounter into certified ,,ehr technology at a different location1 certified ,,ehr technology shall be treated as being available at such patient encounter4 4 #h4 ,exemption from certain ,,ehr meaningful use requirements for certain eligible professionals for purposes of ,medicare payment adjustment ,section #ahdh7o77#b7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#b771 as amended by section #g1 is further amended by adding at the end the following new subparagraph3 7,f7 ,exceptions for certain eligible professionals ,in applying this paragraph for purposes of subsection 7a77#g71 the following shall apply3 7i7 ,in the case of an eligible professional who is an anesthesiologist or physician of any other specialty or subspecialty identified through rulemaking as not conducting traditional office visits1 in order to be treated as a meaningful ,,ehr user for an ,,ehr reporting period under such subsection for a year such eligible professional shall not be required to-- 7,i7 provide clinical summaries to patients2 or 7,,ii7 provide patients1 upon request1 with an electronic copy of the health information of such patients 7including diagnostic test results1 problem lists1 medication lists1 and medication allergies74 7ii7 ,in the case of an eligible professional who is an anesthesiologist or physician of any other specialty that does not traditionally order prescription drugs before administration of such drugs1 as specified through rulemaking1 in order to be treated as a meaningful ,,ehr user for an ,,ehr reporting period under such subsection for a year such eligible professional shall not be required to utilize ,,ehr technology that provides for checks on prescription drug interactions until ,,ehr technology is available to accommodate checks on interactions between prescription drugs administered in operating rooms or other anesthetizing locations4 ,the ,secretary shall provide notice to each eligible professional to whom clause 7i7 or 7ii7 applies of the application of such clause4 4 #i4 ,additional administrative provisions relating to ,medicare eligible professionals' ,,ehr incentives 7a7 ,appeals process ,section #ahdh7o77#c7 of the ,social ,security ,act 7#db ,u4,s4,c4 #aciew-#d7o77#c77 is amended-- 7#a7 in subparagraph 7,c71 by striking ,there shall be no and inserting ,except as provided under subparagraph 7,e71 there shall be no2 and 7#b7 by adding at the end the following new subparagraph3 7,e7 ,appeals process before application of penalties ,the ,secretary shall1 by not later than ,january #a1 #bjae1 establish and have in place a process for eligible professionals to seek1 before application of a payment adjustment under subsection 7a77#g77;,a7 with respect to such an eligible professional1 a review of the determination that the eligible professional did not qualify as a meaningful ,,ehr user under paragraph 7#b74 4 7b7 ,semi-,annual progress report 7#a7 ,in general ,not later than six months after the date of the enactment of this ,act and every six months thereafter until the date specified in paragraph 7#c71 the ,secretary of ,health and ,human ,services1 through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall submit to ,congress a report that contains the following information3 7,a7 ,improvements that have been made in streamlining requirements among various programs under the ,medicare program under title ,,xviii of the ,social ,security ,act regarding similar information 7such as for purposes of meaningful use of certified ,,ehr technology1 physician quality reporting1 and electronic prescribing74 7,b7 ,improvements certified ,,ehr technology vendors have made in interoperability4 7,c7 ,the progress of the adoption of certified ,,ehr technology by physician specialty groups and the percentage of eligible professionals 7as defined in section #ahdh7;a77#g77;,e7 of the ,social ,security ,act7 who are eligible for incentive payments under the ,medicare program for meaningful use of certified ,,ehr technology4 7,d7 ,the reporting capabilities of qualified national specialty reporting systems 7as defined in section #ahdh7o77#b7 of the ,social ,security ,act1 as added by section #e7 and recommendations for making such registries more interactive with ,,ehr technology4 7,e7 ,the results of the most recent survey conducted under paragraph 7#b74 7#b7 ,physician survey ,not later than six months after the date of the enactment of this ,act and every six months thereafter until the date specified in paragraph 7#c71 the ,secretary of ,health and ,human ,services1 through the ,administrator of the ,centers for ,medicare ,medicaid ,services1 shall conduct a survey of physicians to identify barriers encountered by physicians in achieving stage #c of meaningful use of certified ,,ehr technology4 7#c7 ,date specified ,for purposes of paragraphs 7#a7 and 7#b71 the date specified in this paragraph is the date on which #ge percent of all eligible professionals 7as defined in section #ahdh7o77#e7 of the ,social ,security ,act7 have satisfied the requirements of stage #b of meaningful use of certified ,,ehr technology 7as defined by the ,secretary of ,health and ,human ,services74 #aj4 ,non-application of provisions and amendments to eligible professional ,medicaid incentives for adoption and meaningful use of certified ,,ehr technology ,section #aijc7t7 of the ,social ,security ,act 7#db ,u4,s4,c4 #acif;b7t77 is amended by adding at the end the following new paragraph3 7#aa7 ,the provisions of1 including the amendments made by1 the ,electronic ,health ,records ,improvement ,act 7other than section #aj of such ,act7 shall not apply for purposes of this subsection or subsection 7a77#c77;,f74 4