,,ii  #aacth ,,congress  #ast ,session  
,s4 #abhf  ,,in ,,the ,,senate ,,of     
,,the ,,united ,,states  ,july #aa1     
#bjac ,mr4 ,rockefeller 7for himself1   
,mr4 ,whitehouse1 and ,mr4 ,franken7    
introduced the following bill2 which was
 read twice and referred to the         
,committee on ,finance  ,a ,,bill  ,to  
encourage the adoption and use of       
certified electronic health record      
technology by safety net providers and  
clinics4  #a4 ,short title ,this ,act   
may be cited as the ,medicaid           
,information ,technology to ,enhance    
,community ,health ,act of #bjac or the 
,,mitech ,act4  #b4 ,incentives for     
adoption and use of ,,ehr ,technology by
 safety net clinics and providers       
,section #aijc7t7 of the ,social        
,security ,act 7#db ,u4,s4,c4           
#acif;b7t77 is amended--  7#a7 in       
paragraph 7#b7--  7,a7 in subparagraph  
7,a7--  7i7 in clause 7i71 by inserting 
or ,,qsnc-based after hospital-based2   
7ii7 in clause 7ii7--  7,i7 by inserting

 or ,,qsnc-based after hospital-based2  
and  7,,ii7 by striking and at the end  
and inserting or2 and  7iii7 in clause  
7iii71 by striking who practices        
predominantly in a ,federally qualified 
health center or rural health clinic and
 inserting subject to paragraph         
7#aa77;,c71 who practices predominantly 
in a ,federally qualified health center1
 rural health clinic1 or qualified      
safety net clinic2 and  7,b7 in         
subparagraph 7,b7--  7i7 in clause 7i71 
by striking or2  7ii7 in clause 7ii71 by
 striking the period at the end and     
inserting 1 or2 and  7iii7 by adding at 
the end the following new clause3  7iii7
 subject to paragraph 7#aa71 a qualified
 safety net clinic 7as defined in       
paragraph 7#c77;,g774  2  7#b7 in       
paragraph 7#c7--  7,a7 in subparagraph  
7,b77v71 by striking rural health clinic
 and all that follows through the period
 and inserting rural health clinic1     
,federally qualified health center1 or  
qualified safety net clinic that is led 

by a physician assistant42 and  7,b7 by 
adding at the end the following new     
subparagraphs3  7,g7 ,the term qualified
 safety net clinic means a clinic or    
network of clinics that is operated by a
 private non-profit or public entity and
 that has at least #cj percent of its   
patient volume 7as estimated in         
accordance with a methodology           
established by the ,secretary7          
attributable to needy individuals 7as   
defined in subparagraph 7,f774  7,h7    
,the term ,,qsnc-based means1 with      
respect to an eligible professional1 an 
individual who furnishes substantially  
all of their professional services in a 
qualified safety net clinic and through 
the use of the facilities and equipment1
 including qualified electronic health  
records1 of the clinic4 ,the            
determination of whether an eligible    
professional is a ,,qsnc-based eligible 
professional shall be made on the basis 
of the site of service 7as defined by   
the ,secretary7 and without regard to   

any employment or billing arrangement   
between the eligible professional and   
any other provider4  2  7#c7 in         
paragraph 7#e7--  7,a7 in subparagraph  
7,a71 by inserting clause 7i7 or 7ii7 of
 before paragraph 7#b77;,b72 and  7,b7  
by adding at the end the following new  
subparagraph3  7,e7 ,for purposes of    
payments described in paragraph         
7#a77;,b7 to a ,medicaid provider       
described in paragraph 7#b77;,b77iii71  
the ,secretary shall establish a        
methodology for determining the maximum 
amount of payment permitted for each    
such provider4  2 and  7#d7 by adding at
 the end the following new paragraph3   
7#aa7 7,a7 ,not later than ,january #a1 
#bjae1 the ,secretary1 in consultation  
with ,states and other relevant         
stakeholders1 shall promulgate          
regulations to establish a procedure    
through which a qualified safety net    
clinic may demonstrate meaningful use of
 certified ,,ehr technology by such     
clinic for purposes of satisfying the   

requirement described in paragraph      
7#f77;,c77i77,,ii74  7,b7 ,a qualified  
safety net clinic shall not be eligible 
to receive payments described in        
paragraph 7#a77;,b7 before the date on  
which the ,secretary establishes the    
procedure described in subparagraph     
7,a74 ,on and after that date1 a        
qualified safety net clinic may receive 
such payments if the qualified safety   
net clinic notifies the ,secretary that 
the qualified safety net clinic elects  
to receive such payments in lieu of the 
,secretary making payments described in 
paragraph 7#a77;,a7 to the eligible     
professionals who practice predominately
 in the qualified safety net clinic4    
7,c7 ,on or after the date that the     
,secretary establishes the procedure    
described in subparagraph 7,a71 an      
eligible professional who practices     
predominately in a qualified safety net 
clinic1 as described in paragraph       
7#b77;,a77iii71 shall not be eligible to
 receive payments described in paragraph

 7#a77;,a7 if the qualified safety net  
clinic receives payments described in   
paragraph 7#a77;,b74  4