,i  #aad? ,,congress  #a/ ,session  ,h4 
,r4 #ccji  ,,9 ,,! ,,h\se ,,(           
,,repres5tatives  ,july #bi1 #bjae ,mrs4
 ,ellm]s ( ,nor? ,c>ol9a introduc$ !    
foll[+ bill2 :i* 0 ref]r$ to !          
,committee on ,en]gy & ,comm]ce1 & 9    
addition to ! ,committee on ,ways &     
,means1 = a p]iod to be subsequ5tly     
det]m9$ by ! ,speak]1 9 ea* case =      
consid]ation ( su* provisions z fall )9 
! jurisdiction ( ! committee conc]n$  ,a
 ,,bill  ,to am5d titles ,,xviii & ,,xix
 ( ! ,social ,security ,act to improve !
 electronic heal? records mean+ful use  
programs "u ! ,m$ic>e & ,m$icaid        
programs1 & = o!r purposes4  #a4 ,%ort  
title2 table ( cont5ts  7a7 ,%ort title 
,?is ,act may be cit$ z ! ,fur!r        
,flexibility 9 ,,hit ,report+ & ,advanc+
 ,int]op]ability ,act or ! ,flex-,,x #b 
,act4  7b7 ,table ( cont5ts ,! table (  
cont5ts ( ?is ,act is z foll[s3  ,sec4  
#a4 ,%ort title2 table ( cont5ts4 ,title
 ,i--,alignm5t ( ,mean+ful ,use         
,rulemak+ to ,m]it-,bas$ ,inc5tive      

,paym5t ,sy/em ,rulemak+ ,sec4 #aja4    
,paus+ mean+ful use rulemak+4 ,title    
,,ii--,improv+ ,mean+ful ,use ,sec4     
#bja4 ,remov+ ! pass-fail approa* ( !   
,m$ic>e & ,m$icaid mean+ful use program4
 ,sec4 #bjb4 ,align+ quality report+ 9 !
 ,m$ic>e & ,m$icaid mean+ful use        
program4 ,sec4 #bjc4 ,exp&+ ! h>d%ip    
exception to ! ,m$ic>e ,,ehr paym5t     
adju/m5ts4 ,sec4 #bjd4 ,promot+         
int]op]ability ?r\gh ,,ehr c]tification 
process4 ,sec4 #bje4 ,improv+ ! tim+ ( !
 adoption ( m /r+5t measures ( mean+ful 
use "u ! ,m$ic>e & ,m$icaid mean+ful use
 program4 ,sec4 #bjf4 ,?ree-mon? ,,ehr  
report+ p]iods = ! ,m$ic>e & ,m$icaid   
,,ehr inc5tive paym5t programs4 ,sec4   
#bjg4 ,provid+ eligible pr(essionals &  
eligible hospitals ! option to meet a m 
advanc$ /age ( mean+ful use4  ,i        
,alignm5t ( ,mean+ful ,use ,rulemak+ to 
,m]it-,bas$ ,inc5tive ,paym5t ,sy/em    
,rulemak+  #aja4 ,paus+ mean+ful use    
rulemak+  7a7 ,s5se ( ! congress ,x is !
 s5se ( ,congress t ! ,secret>y ( ,heal?

 & ,human ,s]vices 79 ?is section ref]r$
 to z ! ,secret>y7 %\ld n f9alize !     
propos$ rules relat+ to ,/age #c crit]ia
 = ! mean+ful use ( c]tifi$ ,,ehr       
te*nology 7z def9$ 9 section #cjjj ( !  
,public ,heal? ,s]vice ,act 7#db        
,u4,s4,c4 #cjj;jj77 & ! issuance ( #bjae
 ,,ehr c]tification crit]ia & %\ld      
in/ead enc\rage int]op]ability1         
usability1 & improv$ outcomes ) respect 
to electronic heal? records4  7b7 ,no   
issuance ( /age #c crit]ia or ( ,,ehr   
c]tification crit]ia be=e #bjag unless  
conditions met ,unless "o ( ! conditions
 describ$ 9 subsection 7c7 has be5 met1 
! ,secret>y %all n issue1 prior to      
,janu>y #a1 #bjag--  7#a7 any propos$ or
 f9al rule t w\ld modify ! def9ition ( !
 t]m ,mean+ful ,,ehr us] "u section     
#die4d ( title #db1 ,code ( ,f$]al      
,regulations 7or any successor          
regulation71 by add+ ,/age #c crit]ia = 
eligible pr(essionals or eligible       
hospitals2 or  7#b7 any propos$ or f9al 
rule t w\ld add new c]tification crit]ia

 = c]tifi$ ,,ehr te*nology "u "p #agj ( 
title #de1 ,code ( ,f$]al ,regulations4 
7c7 ,conditions ,! conditions describ$ 9
 ?is subsection are ! foll[+3 7#a7 ,!   
,secret>y c]tifies t #ge p]c5t ( bo?    
eligible hospitals & eligible           
pr(essionals h successfully atte/$ to ! 
,/age #b crit]ia e/abli%$ "u section    
#die4f ( title #db1 ,code ( ,f$]al      
,regulations4  7#b7 ,! ,secret>y        
promulgates a f9al rule to implem5t !   
,m]it-,bas$ ,inc5tive ,paym5t ,sy/em    
e/abli%$ "u section #ahdh7q7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#aciew-#d7q774  7d7 ,flexibility ,to    
,adju/ exi/+ mean+ful use & c]tification
 crit]ia ,no?+ 9 ?is section %all be    
con/ru$ z affect+ ! au?ority ( !        
,secret>y to *ange1 modify1 susp5d1 or  
revoke mean+ful use & c]tification      
crit]ia effective on ! date ( ! enactm5t
 ( ?is ,act1 includ+ ! ,/age #b crit]ia 
e/abli%$ "u section #die4f ( title #db1 
,code ( ,f$]al ,regulations1 & ! #bjad  
,edition c]tifi$ heal? record crit]ia "u

 subp>t ,c1 "p #agj ( title #de1 ,code (
 ,f$]al ,regulations1 = any ( ! foll[+  
reasons3  7#a7 ,! *ange1 modification1  
susp5sion1 or revocation relates to !   
recomm5dations = a*iev+ widespread      
int]op]ability made by ! ,secret>y      
pursuant to section #ajf ( ! ,m$ic>e    
,access & ,,*ip ,reau?orization ,act (  
#bjae4  7#b7 ,! crit]ia may negatively  
impact ! quality ( c>e =1 or may risk   
h>m to1 a pati5t4  7#c7 ,! *ange1       
modification1 susp5sion1 or revocation  
is necess>y to reflect advances 9 sci5ce
 or te*nology1 or to improve transp>5cy4
  ,,ii ,improv+ ,mean+ful ,use  #bja4   
,remov+ ! pass-fail approa* ( ! ,m$ic>e 
& ,m$icaid mean+ful use program  7a7    
,eligible pr(essionals  7#a7 ,9 g5]al   
,section #ahdh7o77#b7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7o77#b77 is am5d$ by add+ at ! 
end ! foll[+ new subp>agraph3  7,e7     
,consid]ation ( te*nological & co/      
b>ri]s ,9 apply+ clauses 7i71 7ii71 &   
7iii7 ( subp>agraph 7,a7 to det]m9e :e!r

 a pr(essional is us+ c]tifi$ ,,ehr     
te*nology 9 a mean+ful mann] = a p]iod  
describ$ 9 su* subp>agraph = a ye> aft] 
#bjae1 ! ,secret>y--  7i7 may n require 
t ! pr(essional1 9 ord] to be consid]$ a
 mean+ful ,,ehr us] = su* p]iod1 meet e 
requirem5t or objective specifi$        
pursuant to su* clauses b in/ead %all   
apply a l9e> scale2  7ii7 %all e/abli% a
 me?od to det]m9e if an eligible        
pr(essional is a p>tial mean+ful us]    
consi/5t ) su* l9e> scale2 &  7iii7 %all
 consid] diff]5ces among pr(essionals   
7su* z diff]5ces 9 ! specialties &      
pati5t populations ( pr(essionals7 z    
well z te*nological & co/ b>ri]s 9      
det]m9+ :i* ( ! requirem5ts or          
objectives mu/ be met by ! pr(essional  
dur+ su* p]iod 9 ord] = ! pr(essional to
 be s consid]$4  4  7#b7 ,inc5tive      
paym5t ,section #ahdh7o77#a77;,a77i7 ( !
 ,social ,security ,act 7#db ,u4,s4,c4  
#aciew-#d7o77#a77;,a77i77 is am5d$--    
7,a7 by ins]t+ or1 = #bjaf1 p>tial      
mean+ful ,,ehr us] aft] mean+ful ,,ehr  

us]2 &  7,b7 by ins]t+ 7or1 = #bjaf1 9  
accordance ) ! l9e> scale appli$        
pursuant to p>agraph 7#b77;,e71 equal to
 n m ?an7 aft] equal to4  7#c7 ,paym5t  
adju/m5t ,section #ahdh7;a77#g77;,a77i7 
( ! ,social ,security ,act 7#db         
,u4,s4,c4 #aciew-#d7;a77#g77;,a77i77 is 
am5d$-- 7,a7 by ins]t+ or1 = su* a ye>  
aft] #bjae1 p>tial mean+ful ,,ehr us]   
aft] mean+ful ,,ehr us]2 &  7,b7 by     
ins]t+ 7or1 = su* a ye> aft] #bjae1 9   
accordance ) ! l9e> scale appli$        
pursuant to p>agraph 7#b77;,e71 equal to
 at lea/7 aft] equal to4  7b7 ,eligible 
hospitals  7#a7 ,9 g5]al ,section       
#ahhf7n77#c7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #acieww7n77#c77 is am5d$ 
by add+ at ! end ! foll[+ new           
subp>agraph3  7,d7 ,consid]ation (      
te*nological & co/ b>ri]s ,9 apply+     
clauses 7i71 7ii71 & 7iii7 ( subp>agraph
 7,a7 to det]m9e :e!r a hospital is us+ 
c]tifi$ ,,ehr te*nology 9 a mean+ful    
mann] = an ,,ehr report+ p]iod = a      
fiscal ye> aft] fiscal ye> #bjae1 !     

,secret>y--  7i7 may n require t !      
hospital1 9 ord] to be consid]$ a       
mean+ful ,,ehr us] = su* p]iod1 meet e  
su* requirem5t or objective specifi$    
pursuant to su* clauses b in/ead %all   
apply a l9e> scale2  7ii7 %all e/abli% a
 me?od to det]m9e if an eligible        
pr(essional is a p>tial mean+ful us]    
consi/5t ) su* l9e> scale2 &  7iii7 %all
 consid] diff]5ces among hospitals 7su* 
z diff]5ces 9 ! type ( hospital1        
specialties available at & pati5t       
populations ( hospitals7 9 det]m9+ :i* (
 ! requirem5ts or objectives mu/ be met 
by ! hospital dur+ su* p]iod 9 ord] = ! 
hospital to be s consid]$4  4  7#b7     
,inc5tive paym5t ,section #ahhf7n77#a7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acieww7n77#a77 is am5d$-- 7,a7 by     
ins]t+ or1 = a fiscal ye> aft] fiscal   
ye> #bjae1 p>tial mean+ful ,,ehr us]    
aft] mean+ful ,,ehr us]2 &  7,b7 by     
ins]t+ 7or1 = a fiscal ye> aft] fiscal  
ye> #bjae1 9 accordance ) ! l9e> scale  
appli$ pursuant to p>agraph 7#b77;,d71  

equal to n m ?an7 aft] equal to4  7#c7  
,paym5t adju/m5t ,section               
#ahhf7;b77#c77;,b77ix77,i7 ( ! ,social  
,security ,act 7#db ,u4,s4,c4           
#acieww7b77#c77;,b77ix77,i77 is am5d$-- 
7,a7 9 subclause 7,i7-- 7i7 by ins]t+   
or1 = a fiscal ye> aft] fiscal ye>      
#bjae1 p>tial mean+ful ,,ehr us] aft]   
mean+ful ,,ehr us]2 &  7ii7 by ins]t+   
7or1 = a fiscal ye> aft] fiscal ye>     
#bjae1 9 accordance ) ! l9e> scale      
appli$ pursuant to section              
#ahhf7n77#b77;,d71 equal to at lea/7    
aft] equal to2 &  7,b7 9 subclause      
7,,iii71 by ins]t+ or1 = a fiscal ye>   
aft] fiscal ye> #bjae1 p>tial mean+ful  
,,ehr us] aft] mean+ful ,,ehr us]4  7c7 
,application "u ,m$icaid ,section       
#aijc7t77#h7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #acif;b7t77#h77 is am5d$ 
by ins]t+ aft] ! second s5t5ce ! foll[+3
 ,9 do+ s1 ! ,secret>y %all ensure t !  
provisions ( subp>agraph 7,e7 ( section 
#ahdh7o77#b7 & subp>agraph 7,d7 (       
section #ahhf7n77#c7 apply "u ?is title 

) respect to demon/rat+ mean+ful use 9 a
 simil> mann] z su* provisions apply "u 
title ,,xviii44  7d7 ,application to    
,m$ic>e ,advantage ,section #ahec ( !   
,social ,security ,act 7#db ,u4,s4,c4   
#aciew-#bc7 is am5d$-- 7#a7 9 subsection
 7l7--  7,a7 9 p>agraph 7#a71 by ins]t+ 
or1 = a ye> aft] #bjae1 p>tial mean+ful 
,,ehr us]s1 aft] mean+ful ,,ehr us]s2   
7,b7 9 p>agraph 7#d77;,a71 by ins]t+    
7or1 = a ye> aft] #bjae1 9 accordance ) 
! l9e> scale appli$ pursuant to section 
#ahdh7o77#b77;,e71 equal to at lea/7    
aft] equal to2 &  7,c7 9 p>agraph 7#f71 
9 ea* ( subp>agraphs 7,a7 & 7,b71 by    
ins]t+ or1 = a ye> aft] #bjae1 p>tial   
mean+ful ,,ehr us]1 aft] mean+ful ,,ehr 
us]2 &  7#b7 9 subsection 7m7--  7,a7 9 
p>agraph 7#a71 by ins]t+ or1 = a fiscal 
ye> aft] fiscal ye> #bjae1 p>tial       
mean+ful ,,ehr us]s1 aft] mean+ful ,,ehr
 us]s2 &  7,b7 9 p>agraph 7#d77;,a71 by 
ins]t+ or1 = a fiscal ye> aft] fiscal   
ye> #bjae1 p>tial mean+ful ,,ehr us]s1  
aft] mean+ful ,,ehr us]s4  7e7          

,application to critical access         
hospitals ,section #ahad7l7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#acie;f7l77 is am5d$-- 7#a7 9 p>agraph  
7#c77;,a71 by ins]t+ or1 = a fiscal ye> 
aft] #bjae1 p>tial mean+ful ,,ehr us]1  
aft] mean+ful ,,ehr us]2  7#b7 9        
p>agraph 7#c77;,a77ii77,i71 by ins]t+   
7or1 = a fiscal ye> aft] fiscal ye>     
#bjae1 9 accordance ) ! l9e> scale      
appli$ pursuant to section              
#ahhf7n77#b77;,d71 equal to n m ?an7    
aft] equal to2 &  7#c7 9 p>agraph 7#d7--
 7,a7 9 subp>agraph 7,a71 by ins]t+ or1 
= a fiscal ye> aft] #bjae1 p>tial       
mean+ful ,,ehr us]1 aft] mean+ful ,,ehr 
us]2 &  7,b7 9 subp>agraph 7,b71 by     
ins]t+ 7or1 = a fiscal ye> aft] fiscal  
ye> #bjae1 9 accordance ) ! l9e> scale  
appli$ pursuant to section              
#ahhf7n77#b77;,d71 a p]c5t equal to at  
lea/ ! applicable p]c5t7 aft] applicable
 p]c5t4  #bjb4 ,align+ quality report+ 9
 ! ,m$ic>e & ,m$icaid mean+ful use      
program  7a7 ,eligible pr(essionals     

7#a7 ,te/+ ( measures ,section          
#ahdh7k77#b77;,c7 ( ! ,social ,security 
,act 7#db ,u4,s4,c4                     
#aciew-#d7k77#b77;,c77 is am5d$ by add+ 
at ! end ! foll[+ new clause3  7iii7    
,te/+ ,aft] ,decemb] #ca1 #bjae1 !      
,secret>y may only specify a cl9ical    
quality measure "u ?is subp>agraph if ! 
,secret>y has demon/rat$1 ?r\gh field   
te/s among multiple & v>i$ eligible     
pr(essionals1 t x is feasible = su*     
pr(essionals to electronically submit   
valid & accurate in=mation on ! measure4
  4  7#b7 ,deem$ compliance if satisfy  
,,pqrs ,section #ahdh7o77#b77;,b77iii7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #aciew-#d7o77#b77;,b77iii77 is am5d$ by
 add+ at ! end ! foll[+3  ,9 implem5t+ !
 prec$+ s5t5ce1 ! ,secret>y %all treat  
an eligible pr(essional :o1 = a p]iod "u
 subsection 7k7 = cov]$ pr(essional     
s]vices furni%$ 9 a ye> aft] #bjae1     
satisfies ! requirem5ts ( clauses 7i7 or
 7ii7 ( subsection 7k77#b77;,c71 or :o  
satisfactorily p>ticipates 9 a qualifi$ 

cl9ical data regi/ry = a report+ p]iod  
7z def9$ 9 subsection 7m77#f77;,c77 z   
det]m9$ by ! ,secret>y pursuant to      
subsection 7k77#b77;,c7 & subsection    
7m77#c77;,d71 z satisfy+ ! requirem5t ( 
subp>agraph 7,a7 = ! correspond+ p]iod  
describ$ 9 su* subp>agraph = su* ye>4 4 
7b7 ,eligible hospitals  7#a7 ,te/+ (   
measures ,section #ahhf7n77#c77;,b77i7 (
 ! ,social ,security ,act 7#db ,u4,s4,c4
 #acieww7n77#c77;,b77i77 is am5d$ by    
add+ at ! end ! foll[+ new subclause3   
7,,iii7 ,aft] ,septemb] #cj1 #bjae1 !   
,secret>y may only select a cl9ical     
quality measure "u ?is subp>agraph if ! 
,secret>y has demon/rat$1 ?r\gh field   
te/s 9 multiple & v>i$ hospitals1 t x is
 feasible = su* hospitals to            
electronically submit valid & accurate  
in=mation on ! measure4  4  7#b7 ,deem$ 
compliance if satisfy hospital inpati5t 
quality report+ requirem5ts ,section    
#ahhf7n77#c77;,b77iii7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#acieww7n77#c77;,b77iii77 is am5d$ by   

add+ at ! end ! foll[+3 ,9 implem5t+ !  
prec$+ s5t5ce1 ! ,secret>y %all treat an
 eligible hospital t1 = a p]iod "u      
subsection 7b77#c77;,b77viii7 = a fiscal
 ye> aft] fiscal ye> #bjae1 satisfies ! 
requirem5ts ( su* subsection z satisfy+ 
! requirem5t ( subp>agraph 7,a7 = !     
correspond+ report+ p]iod = su* fiscal  
ye>44  7c7 ,application "u ,m$icaid     
,section #aijc7t77#h7 ( ! ,social       
,security ,act 7#db ,u4,s4,c4           
#acif;b7t77#h771 z am5d$ by section     
#bja7;c71 is fur!r am5d$ 9 ! ?ird       
s5t5ce--  7#a7 by ins]t+ & ! la/ s5t5ce 
( subp>agraph 7,b77iii7 aft] subp>agraph
 7,e72 &  7#b7 by ins]t+ & ! la/ s5t5ce 
( subp>agraph 7,b77i77,,iii7 aft]       
subp>agraph 7,d74  #bjc4 ,exp&+ ! h>d%ip
 exception to ! ,m$ic>e ,,ehr paym5t    
adju/m5ts  7a7 ,eligible pr(essionals   
,section #ahdh7;a77#g77;,b7 ( ! ,social 
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7;a77#g77;,b77 is am5d$ to read
 z foll[s3  7,b7 ,significant h>d%ip    
exception  7i7 ,9 g5]al ,subject to     

clause 7ii71 ! ,secret>y may1 on a      
case-by-case basis1 exempt an eligible  
pr(essional f ! application ( ! paym5t  
adju/m5t "u subp>agraph 7,a7 if !       
,secret>y det]m9es1 subject to annual   
r5ewal1 t compliance ) ! requirem5t =   
be+ a mean+ful ,,ehr us] w\ld result 9 a
 significant h>d%ip1 su* z 9 ! case ( an
 eligible pr(essional :o practices 9 a  
rural area )\t suffici5t ,int]net       
access4  7ii7 ,requir$ exception        
,subject to clause 7iii71 beg9n+ =      
#bjae1 ! ,secret>y %all1 on a           
case-by-case basis1 exempt an eligible  
pr(essional f ! application ( ! paym5t  
adju/m5t "u subp>agraph 7,a7 if !       
,secret>y det]m9es1 subject to annual   
r5ewal1 ! eligible pr(essional--  7,i7  
enc\nt]s un=ese5 circum/ances 7includ+  
te*nological difficulties & o!r         
disruptive situations7 t pres5t b>ri]s  
to compliance ) ! requirem5t = be+ a    
mean+ful ,,ehr us]2  7,,ii7 *anges      
c]tifi$ ,,ehr te*nology v5dors1 or      
*anges f self-develop$ electronic heal? 

records to c]tifi$ ,,ehr te*nology f a  
v5dor2  7,,iii7 is an ane/hesiologi/1   
radiologi/1 pa?ologi/1 hospitali/1 or is
 9 any o!r physician specialty or       
subspecialty id5tifi$ ?r\gh rulemak+ z a
 specialty or subspecialty t pres5ts    
physicians 9 ! specialty or subspecialty
 ) unique difficulties 9 comply+ ) su*  
requirem5t2  7,,iv7 is at or ne>        
retirem5t age 7z def9$ by ! ,secret>y72 
or  7,v7 is n able to be 9 compliance ) 
any su* requirem5t because ! c]tifi$    
,,ehr te*nology us$ by su* pr(essional  
is n capable ( s5d+1 receiv+1 &         
seamlessly incorporat+ data f o!r       
c]tifi$ ,,ehr te*nology4  7iii7         
,limitation ,9 no case may an eligible  
pr(essional be grant$ an exemption "u   
?is subp>agraph = m ?an #e ye>s4  4  7b7
 ,eligible hospitals ,section           
#ahhf7;b77#c77;,b77ix77,,ii7 ( ! ,social
 ,security ,act 7#db ,u4,s4,c4          
#acieww7b77#c77;,b77ix77,,ii77 is am5d$ 
to read z foll[s3  7,,ii7  7aa7 ,subject
 to item 7cc71 ! ,secret>y may1 on a    

case-by-case basis1 exempt a subsection 
7d7 hospital f ! application ( subclause
 7,i7 ) respect to a fiscal ye> if !    
,secret>y det]m9es1 subject to annual   
r5ewal1 t requir+ su* hospital to be a  
mean+ful ,,ehr us] dur+ su* fiscal ye>  
w\ld result 9 a significant h>d%ip1 su* 
z 9 ! case ( a hospital 9 a rural area  
)\t suffici5t ,int]net access4  7bb7    
,subject to item 7cc71 beg9n+ = fiscal  
ye> #bjae1 ! ,secret>y %all1 on a       
case-by-case basis1 exempt a subsection 
7d7 hospital f ! application ( subclause
 7,i7 ) respect to a fiscal ye> if !    
,secret>y det]m9es1 subject to annual   
r5ewal1 t ! hospital enc\nt]s un=ese5   
circum/ances 7includ+ te*nological      
difficulties & o!r disruptive           
situations7 t pres5t b>ri]s to          
compliance ) ! requirem5t = su* hospital
 to be a mean+ful ,,ehr us] dur+ su*    
fiscal ye>1 *anges c]tifi$ ,,ehr        
te*nology v5dors1 *anges f self-develop$
 electronic heal? records to c]tifi$    
,,ehr te*nology f a v5dor1 or is n able 

to be 9 compliance ) any su* requirem5t 
because ! c]tifi$ ,,ehr te*nology us$ by
 su* hospital is n capable ( s5d+1      
receiv+1 & seamlessly incorporat+ data f
 o!r c]tifi$ ,,ehr te*nology4  7cc7 ,9  
no case may a hospital be grant$ an     
exemption "u ?is subclause = m ?an #e   
ye>s4  4  #bjd4 ,promot+ int]op]ability 
?r\gh ,,ehr c]tification process        
,section #cjjd7;a77#a7 ( ! ,public      
,heal? ,s]vice ,act 7#db ,u4,s4,c4      
#cjj;jj-#ad7;a77#a77 is am5d$ by add+ at
 ! end ! foll[+ new s5t5ce3 ,! ,secret>y
 may n propose adoption ( su* /&>ds1    
implem5tation specifications1 or        
c]tification crit]ia unless su* /&>ds1  
implem5tation specifications1 or        
c]tification crit]ia1 respectively1 h   
be5 successfully te/$ = widespread use  
by end us]s = at lea/ a "o-ye> p]iod44  
#bje4 ,improv+ ! tim+ ( ! adoption ( m  
/r+5t measures ( mean+ful use "u !      
,m$ic>e & ,m$icaid mean+ful use program 
7a7 ,eligible pr(essionals ,section     
#ahdh7o77#b7 ( ! ,social ,security ,act 

7#db ,u4,s4,c4 #aciew-#d7o77#b771 z     
am5d$ by section #bja7;a71 is fur!r     
am5d$--  7#a7 9 subp>agraph 7,a71 9 !   
matt] foll[+ clause 7iii71 by /rik+ %all
 seek & ins]t+ %all1 9 accordance )     
subp>agraph 7,f71 seek2 &  7#b7 by add+ 
at ! end ! foll[+ new subp>agraph3  7,f7
 ,provisions relat+ to increas$ /r+5cy (
 measures ,! ,secret>y %all implem5t !  
la/ s5t5ce ( subp>agraph 7,a7 7relat+ to
 requirem5ts = m /r+5t measures (       
mean+ful use select$ "u ?is p>agraph7 9 
accordance ) ! foll[+3  7i7 ,ensur+     
pr$ictability ,subject to clause 7ii71 9
 ! case t ! ,secret>y selects measures (
 mean+ful use1 includ+ any objectives   
associat$ ) su* measures1 ! ,secret>y   
may n *ange or modify su* selection = a 
p]iod ( ?ree ye>s4  7ii7 ,flexibility to
 adju/ c]ta9 measures  7,i7 ,p]missible 
reason = *anges or modifications to     
measures ,! ,secret>y may *ange or      
modify a measure ( mean+ful use be=e !  
end ( ! ?ree-ye> p]iod describ$ 9 clause
 7i7 if ! ,secret>y makes "o or m ( !   

foll[+ det]m9ations3  7aa7 ,! measure   
may negatively impact ! quality ( c>e =1
 or may risk h>m to1 a pati5t4  7bb7    
,!re is a new h>d%ip demon/rat$ by      
eligible pr(essionals specific to !     
measure4  7cc7 ,an adju/m5t to ! measure
 is necess>y to reflect advances 9      
sci5ce or te*nology4  7,,ii7 ,reque/ =  
review ( cl9ical quality measures ,!    
,secret>y %all e/abli% a process "u :i* 
/akehold]s may1 9 ! case t new in=mation
 is available ) respect to a cl9ical    
quality measure select$ by ! ,secret>y =
 quality report+ "u subp>agraph         
7,a77iii71 reque/ t ! ,secret>y *ange or
 modify su* measure = a reason describ$ 
9 subclause 7,i74  4  7b7 ,eligible     
hospitals ,section #ahhf7n77#c7 ( !     
,social ,security ,act 7#db ,u4,s4,c4   
#acieww7n77#c771 z am5d$ by section     
#bja7;b71 is fur!r am5d$--  7#a7 9      
subp>agraph 7,a71 9 ! matt] foll[+      
clause 7iii71 by /rik+ %all seek &      
ins]t+ %all1 9 accordance ) subp>agraph 
7,e71 seek2 &  7#b7 by add+ at ! end !  

foll[+ new subp>agraph3  7,e7           
,provisions relat+ to increas$ /r+5cy ( 
measures ,! ,secret>y %all implem5t !   
la/ s5t5ce ( subp>agraph 7,a7 7relat+ to
 requirem5ts = m /r+5t measures (       
mean+ful use select$ "u ?is p>agraph7 9 
accordance ) ! foll[+3  7i7 ,ensur+     
pr$ictability ,subject to clause 7ii71 9
 ! case t ! ,secret>y selects measures (
 mean+ful use1 includ+ any objectives   
associat$ ) su* measures1 ! ,secret>y   
may n *ange or modify su* selection = a 
p]iod ( ?ree ye>s4  7ii7 ,flexibility to
 adju/ c]ta9 measures  7,i7 ,p]missible 
reason = adju/m5ts to measures ,!       
,secret>y may *ange or modify a measure 
( mean+ful use be=e ! end ( ! ?ree-ye>  
p]iod describ$ 9 clause 7i7 if !        
,secret>y makes "o or m ( ! foll[+      
det]m9ations3  7aa7 ,! measure may      
negatively impact ! quality ( c>e =1 or 
may risk h>m to1 a pati5t4  7bb7 ,!re is
 a new h>d%ip demon/rat$ by eligible    
hospitals specific to ! measure4  7cc7  
,an adju/m5t to ! measure is necess>y to

 reflect advances 9 sci5ce or te*nology4
  7,,ii7 ,reque/ = review ( cl9ical     
quality measures ,! ,secret>y %all      
e/abli% a process "u :i* /akehold]s may1
 9 ! case t new in=mation is available )
 respect to a cl9ical quality measure   
select$ by ! ,secret>y = quality report+
 "u subp>agraph 7,a77iii71 reque/ t !   
,secret>y *ange or modify su* measure = 
a reason describ$ 9 subclause 7,i74  4  
7c7 ,application "u ,m$icaid ,section   
#aijc7t77#h7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #acif;b7t77#h771 z am5d$ 
by sections #bja7;c7 & #bjb7;c71 is     
fur!r am5d$ 9 ! ?ird s5t5ce--  7#a7 by  
/rik+ & ! la/ s5t5ce ( subp>agraph      
7,b77iii7 & ins]t+ 1 ! la/ s5t5ce (     
subp>agraph 7,b77iii71 & subp>agraph    
7,f72 &  7#b7 by /rik+ & ! la/ s5t5ce ( 
subp>agraph 7,b77i77,,iii7 & ins]t+ 1 ! 
la/ s5t5ce ( subp>agraph 7,b77i77,,iii71
 & subp>agraph 7,e74  #bjf4 ,?ree-mon?  
,,ehr report+ p]iods = ! ,m$ic>e &      
,m$icaid ,,ehr inc5tive paym5t programs 
7a7 ,,ehr report+ p]iod  7#a7 ,eligible 

pr(essionals ,section                   
#ahdh7;a77#g77;,e77ii7 ( ! ,social      
,security ,act 7#db ,u4,s4,c4           
#aciew-#d7;a77#g77;,e77ii77 is am5d$ by 
add+ at ! end ! foll[+3 ,su* p]iod 7or  
p]iods7 %all consi/ ( a ?ree-mon?       
report+ p]iod1 )\t reg>d to ! paym5t ye>
 or ! /age crit]ia 7z e/abli%$ "u       
section #die4f ( title #db1 ,code (     
,f$]al ,regulations7 involv$44  7#b7    
,eligible hospitals ,subsections        
7b77#c77;,b77ix77,,iv7 & 7n77#f77;,a7 ( 
section #ahhf ( ! ,social ,security ,act
 7#db ,u4,s4,c4 #acieww7 are ea* am5d$  
by add+ at ! end ! foll[+3 ,su* p]iod   
7or p]iods7 %all consi/ ( a ?ree-mon?   
report+ p]iod1 )\t reg>d to ! paym5t ye>
 or ! /age crit]ia 7z e/abli%$ "u       
section #die4f ( title #db1 ,code (     
,f$]al ,regulations7 involv$44  7#c7    
,application "u ,m$icaid ,section       
#aijc7t77#h7 ( ! ,social ,security ,act 
7#db ,u4,s4,c4 #acif;b7t77#h771 z am5d$ 
by sections #bja7;c71 #bjb7;c71 &       
#bje7;c71 is fur!r am5d$ by add+ at !   

end ! foll[+ new s5t5ce3 ,su* report+   
p]iods %all consi/ ( a ?ree-mon? report+
 p]iod1 )\t reg>d to paym5t ye> or !    
/age crit]ia 7z e/abli%$ "u section     
#die4f ( title #db1 ,code ( ,f$]al      
,regulations744  7b7 ,regulations ,n    
lat] ?an #c mon?s aft] ! date ( enactm5t
 ( ?is ,act1 ! ,secret>y ( ,heal? &     
,human ,s]vices %all promulgate         
regulations to c>ry out ! am5dm5ts made 
by subsection 7a74 ,su* regulations %all
 apply beg9n+ ) ! #bjaf ,,ehr report+   
p]iod4  #bjg4 ,provid+ eligible         
pr(essionals & eligible hospitals !     
option to meet a m advanc$ /age (       
mean+ful use  7a7 ,mean+ful ,,ehr us] ,a
 mean+ful ,,ehr us]1 z def9$ "u section 
#die4d ( title #bd1 ,code ( ,f$]al      
,regulations1 %all include eligible     
pr(essionals & eligible hospitals :o    
demon/rate mean+ful use ( c]tifi$ ,,ehr 
te*nology by meet+ ! applicable         
objectives & associat$ measures ( ei!r (
 ! foll[+3  7#a7 ,! /age ( mean+ful use 
t ! eligible pr(essional or eligible    

hospital is s*$ul$ to meet dur+ !       
applicable ,,ehr report+ p]iod1 z su*   
t]m is def9$ "u section #die4d ( title  
#bd1 ,code ( ,f$]al ,regulations4  7#b7 
,any o!r /age ( mean+ful use1 provid$ t 
su* /age ( mean+ful use select$ by !    
eligible pr(essional or eligible        
hospital is m advanc$ ?an ! /age (      
mean+ful use t ! eligible pr(essional or
 eligible hospital is s*$ul$ to meet    
dur+ ! applicable ,,ehr report+ p]iod4  
7b7 ,def9ition ,9 ?is subp>agraph1 ! t]m
 /age ( mean+ful use means ! /age       
crit]ia e/abli%$ by ! ,secret>y ( ,heal?
 & ,human ,s]vices "u section #die4f (  
title #db1 ,code ( ,f$]al ,regulations4