[Congressional Bills 112th Congress]
[From the U.S. Government Publishing Office]
[H.R. 6598 Introduced in House (IH)]

112th CONGRESS
  2d Session
                                H. R. 6598

   To amend certain requirements and penalties implemented under the 
 Medicare and Medicaid programs by the HITECH Act of 2009, which would 
otherwise impede eligible professionals from adopting electronic health 
                    records to improve patient care.


_______________________________________________________________________


                    IN THE HOUSE OF REPRESENTATIVES

                           November 16, 2012

   Mrs. Black (for herself, Mr. Roskam, Mr. Chabot, and Mr. Broun of 
   Georgia) introduced the following bill; which was referred to the 
 Committee on Energy and Commerce, and in addition to the Committee on 
   Ways and Means, for a period to be subsequently determined by the 
  Speaker, 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 2009, which would 
otherwise impede eligible professionals from adopting electronic health 
                    records to improve patient care.

    Be it enacted by the Senate and House of Representatives of the 
United States of America in Congress assembled,

SECTION 1. SHORT TITLE; TABLE OF CONTENTS.

    (a) Short Title.--This Act may be cited as the ``Electronic Health 
Records Improvement Act''.
    (b) Table of Contents.--The table of contents of this Act is as 
follows:

Sec. 1. Short title; table of contents.
Sec. 2. Exception for certain eligible professionals from application 
                            of Medicare payment adjustment for not 
                            demonstrating EHR meaningful use.
Sec. 3. Shortening EHR reporting period for application of Medicare EHR 
                            payment adjustment to eligible 
                            professionals.
Sec. 4. Additional exceptions to application of Medicare payment 
                            adjustment for certain Medicaid and 
                            hospital-based eligible professionals not 
                            demonstrating EHR meaningful use.
Sec. 5. Certain specialty registry systems for purposes of eligible 
                            professionals satisfying meaningful use 
                            requirements under Medicare.
Sec. 6. Enhancing Medicare EHR meaningful use among eligible 
                            professionals who are rural health care 
                            providers.
Sec. 7. Improving EHR meaningful use under Medicare by ambulatory 
                            surgical centers.
Sec. 8. Exemption from certain EHR meaningful use requirements for 
                            certain eligible professionals for purposes 
                            of Medicare payment adjustment.
Sec. 9. Additional administrative provisions relating to Medicare 
                            eligible professionals' EHR incentives.
Sec. 10. 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 technology.

SEC. 2. EXCEPTION FOR CERTAIN ELIGIBLE PROFESSIONALS FROM APPLICATION 
              OF MEDICARE PAYMENT ADJUSTMENT FOR NOT DEMONSTRATING EHR 
              MEANINGFUL USE.

    (a) Exception for Certain Small Physician Practices.--Section 
1848(a)(7) of the Social Security Act (42 U.S.C. 1395w-4(a)(7)) is 
amended--
            (1) in subparagraph (A)(i), by striking ``subparagraphs (B) 
        and (D)'' and inserting ``subparagraphs (B), (D), and (F)''; 
        and
            (2) by adding at the end the following new subparagraph:
                    ``(F) 3-year exception for certain eligible 
                professionals.--
                            ``(i) In general.--The Secretary shall 
                        exempt an eligible professional whom the 
                        Secretary determines is described in clause 
                        (ii) from the application of the payment 
                        adjustment under subparagraph (A) for each of 
                        the payment years 2015 through 2017. The 
                        Secretary shall make a determination under the 
                        previous sentence, with respect to such an 
                        exemption for an eligible professional, only if 
                        such eligible professional submits a request 
                        for such exemption. The Secretary shall 
                        determine whether or not an eligible 
                        professional is described in clause (ii) not 
                        later than 30 days after the date such eligible 
                        professional submits a request pursuant to the 
                        previous sentence.
                            ``(ii) 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 
                        2015 in a physician practice that is a solo 
                        practice.''.
    (b) Exception for Certain Physicians Near Retirement Age.--
Subparagraph (F) of section 1848(a)(7) of the Social Security Act (42 
U.S.C. 1395w-4(a)(7)), as added by subsection (a), is amended--
            (1) in clause (i), in the first and third sentences, by 
        striking ``clause (ii)'' and inserting ``clause (ii) or 
        (iii)''; and
            (2) by adding at the end the following new clause:
                            ``(iii) 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 2015 has 
                        attained early retirement age (as defined in 
                        section 216(l)(2)) or who will attain such age 
                        during the 5-year period following such day.''.
    (c) Notification of Eligibility for Exceptions From Payment 
Adjustment.--Section 1848(a)(7) of the Social Security Act (42 U.S.C. 
1395w-4(a)(7)), as amended by subsection (a), is further amended by 
adding at the end the following new subparagraph:
                    ``(G) Notification.--Not later than 30 days after 
                the date on which the Secretary determines an eligible 
                professional is exempt pursuant to subparagraph (F) 
                from the application of the payment adjustment under 
                subparagraph (A), the Secretary shall provide such 
                eligible professional notice of such determination.''.

SEC. 3. SHORTENING EHR REPORTING PERIOD FOR APPLICATION OF MEDICARE EHR 
              PAYMENT ADJUSTMENT TO ELIGIBLE PROFESSIONALS.

    (a) In General.--Section 1848(a)(7)(E)(ii) of the Social Security 
Act (42 U.S.C. 1395w-4(a)(7)(E)(ii)) is amended by inserting ``, so 
long as all of such period (or periods) occurs during the year in which 
the corresponding adjustment, if any, under this paragraph would be 
applied to the eligible professional involved'' after ``a period (or 
periods) specified by the Secretary''.
    (b) Rebates.--Section 1848(a)(7)(A) of the Social Security Act (42 
U.S.C. 1395w-4(a)(7)(A)) is amended by adding at the end the following 
new clause:
                            ``(iii) Special rule.--The Secretary shall 
                        establish a process under which if for a 
                        calendar year, beginning with 2015, 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 
                        technology, 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 paragraph.''.
    (c) Conforming Amendment.--Section 1848(o)(5)(B) of the Social 
Security Act is amended by adding at the end the following new 
sentence: ``Such term, as used under this subsection with respect to 
subsection (a)(7) and a year beginning with 2015, shall have the 
meaning given such term under subsection (a)(7)(E)(ii).''.

SEC. 4. ADDITIONAL EXCEPTIONS TO APPLICATION OF MEDICARE PAYMENT 
              ADJUSTMENT FOR CERTAIN MEDICAID AND HOSPITAL-BASED 
              ELIGIBLE PROFESSIONALS NOT DEMONSTRATING EHR MEANINGFUL 
              USE.

    (a) Eligible Professionals Participating in Medicaid EHR Incentive 
Program.--Section 1848(a)(7) of the Social Security Act (42 U.S.C. 
1395w-4(a)(7)), as amended by section 2, is further amended--
            (1) in subparagraph (A)(i), by striking ``(D), and (F)'' 
        and inserting ``(D), (F), and (G)'';
            (2) by redesignating subparagraph (G) as subparagraph (H); 
        and
            (3) by inserting after subparagraph (F) the following new 
        subparagraph:
                    ``(G) 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 
                1903(t)(2)(A), the Secretary shall exempt such eligible 
                professional from the application of the Medicare 
                payment adjustment under subparagraph (A), with respect 
                to a year, if such year is the first year that such 
                professional received payment under section 1903(t).''.
    (b) Hospital-Based Eligible Professionals.--Section 1848(a)(7)(D) 
of the Social Security Act (42 U.S.C. 1395w-4(a)(7)(D)) is amended by 
adding at the end the following new sentence: ``In applying the 
definition under subsection (o)(1)(C)(ii) for purposes of the previous 
sentence, the reference to `substantially all' under such subsection 
shall mean 90 percent or more and a determination described in such 
subsection, with respect to an eligible professional, may only be made 
by the Secretary pursuant to a request of the professional that is 
submitted to the Secretary before 2015, and shall be effective for such 
professional for 2015 and each subsequent year.''.
    (c) Application of Notification Requirement.--Subparagraph (H) of 
section 1848(a)(7) of the Social Security Act (42 U.S.C. 1395w-
4(a)(7)), as added by section 2(c) and redesignated by subsection 
(a)(2), is amended by striking ``subparagraph (F)'' and inserting 
``subparagraph (B), (D), (F), or (G)''.

SEC. 5. CERTAIN SPECIALTY REGISTRY SYSTEMS FOR PURPOSES OF ELIGIBLE 
              PROFESSIONALS SATISFYING MEANINGFUL USE REQUIREMENTS 
              UNDER MEDICARE.

    (a) Meaningful Use of Certified Registries Treated as Meaningful 
Use of Certified EHR Technology.--Section 1848(o)(2) of the Social 
Security Act (42 U.S.C. 1395w-4(o)(2)) is amended--
            (1) in subparagraph (A), in the matter preceding clause 
        (i), by inserting ``and subject to subparagraph (D)'' after 
        ``paragraph (1)''; and
            (2) by adding at the end the following new subparagraph:
                    ``(D) Meaningful use of certified national 
                specialty registries.--
                            ``(i) In applying paragraph (1) for 
                        purposes of subsection (a)(7), an eligible 
                        professional shall be treated as a meaningful 
                        EHR user for an EHR reporting period for a year 
                        if, in lieu of the requirements under 
                        subparagraph (A), the eligible professional 
                        demonstrates to the satisfaction of the 
                        Secretary, in accordance with such criteria 
                        specified by the Secretary, that during such 
                        period the professional is using a certified 
                        national specialty registry system (as defined 
                        in clause (iv)) in a meaningful manner, 
                        including by submitting clinical data through 
                        such system to measure quality improvement and 
                        patient safety.
                            ``(ii) By not later than January 1, 2015, 
                        for purposes of clause (i), the Secretary shall 
                        pursuant to rulemaking specify measures for 
                        determining meaningful use of a certified 
                        national specialty registry system.
                            ``(iii) Not later than January 1, 2015, the 
                        Secretary shall certify registry systems as 
                        certified national specialty registry systems 
                        for specialties of eligible professionals.
                            ``(iv) For purposes clause (i), the term 
                        `certified national specialty registry system' 
                        means, with respect to a specialty of eligible 
                        professionals, an electronic health record 
                        system certified for such specialty by the 
                        Secretary under clause (iii).''.
    (b) Conforming Amendments.--
            (1) Section 1848(m)(2)(D) of the Social Security Act (42 
        U.S.C. 1395w-4(m)(2)(D)), as amended by section 5(b), is 
        further amended by striking ``subsection (o)(4)'' and inserting 
        ``subsection (o)(4)(A)''.
            (2) Section 1886(n)(5) of the Social Security Act (42 
        U.S.C. 1395ww(n)(5)), as amended by section 5(b), is further 
        amended by striking ``section 1848(o)(4)'' and inserting 
        ``section 1848(o)(4)(A)''.

SEC. 6. ENHANCING MEDICARE EHR MEANINGFUL USE AMONG ELIGIBLE 
              PROFESSIONALS WHO ARE RURAL HEALTH CARE PROVIDERS.

    (a) Extension of Medicare EHR Incentives to Eligible Professionals 
Practicing in Rural Health Clinics.--
            (1) EHR payment adjustment.--Section 1848(a)(7)(E)(i) of 
        the Social Security Act (42 U.S.C. 1395w-4(a)(7)(E)(i)) is 
        amended by inserting before the period at the end the 
        following: ``and, with respect to payment years after 2014, 
        includes rural health clinic services (as defined in section 
        1861(aa)(1)) furnished by an eligible professional''.
            (2) EHR increased payments.--Section 1848(o)(5)(A) of the 
        Social Security Act (42 U.S.C. 1395w-4(o)(5)(A)) is amended by 
        inserting before the period at the end the following: ``and, 
        with respect to payment years after 2014, includes rural health 
        clinic services (as defined in section 1861(aa)(1)) furnished 
        by an eligible professional''.
    (b) Extension of Medicare ERx and Quality Reporting Incentives to 
Rural Health Clinics.--Section 1848(m)(6)(A) of the Social Security Act 
(42 U.S.C. 1395w-4(m)(6)(A)) is amended by inserting before the period 
at the end the following: ``except that the term `covered professional 
services' shall, with respect to reporting periods for 2015 or a 
subsequent year, include rural health clinic services (as defined in 
section 1861(aa)(1)) furnished by an eligible professional''.

SEC. 7. IMPROVING EHR MEANINGFUL USE UNDER MEDICARE BY AMBULATORY 
              SURGICAL CENTERS.

    (a) 3-Year Exemption From Encounters Calculation To Demonstrate EHR 
Meaningful Use for Purposes of Payment Adjustment.--Section 1848(o)(2) 
of the Social Security Act (42 U.S.C. 1395w-4(o)(2)) is amended by 
adding at the end the following new subparagraph:
                    ``(D) Treatment of patient encounters at ambulatory 
                surgical centers.--
                            ``(i) In general.--Subject to clause (ii), 
                        in applying this paragraph for purposes of 
                        subsection (a)(7), any patient encounter of an 
                        eligible professional occurring during the 
                        performance years for the 2015, 2016, or 2017 
                        payment determinations at an ambulatory 
                        surgical center shall not be treated as a 
                        patient encounter in determining whether an 
                        eligible professional qualifies as a meaningful 
                        EHR user.
                            ``(ii) Rule of construction.--Nothing in 
                        clause (i) shall prohibit an eligible 
                        professional from receiving an additional 
                        payment under paragraph (1) 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 year.
                            ``(iii) Limitation of payment adjustment.--
                        In applying clause (i) for purposes of 
                        subsection (a)(7) and a year, if an eligible 
                        professional is not a meaningful EHR user 
                        pursuant to such clause for an EHR reporting 
                        period for the year, 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 center.''.
    (b) Reinstatement of Batching Process.--Subparagraph (D) of section 
1848(o)(2) of the Social Security Act (42 U.S.C. 1395w-4(o)(2)), as 
added by subsection (a), is amended by adding at the end the following 
new clause:
                            ``(iv) Use of batching process.--In 
                        applying this paragraph for purposes of 
                        subsection (a)(7) and with respect to a patient 
                        encounter occurring at an ambulatory surgical 
                        center, 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 
                        location, certified EHR technology shall be 
                        treated as being available at such patient 
                        encounter.''.

SEC. 8. EXEMPTION FROM CERTAIN EHR MEANINGFUL USE REQUIREMENTS FOR 
              CERTAIN ELIGIBLE PROFESSIONALS FOR PURPOSES OF MEDICARE 
              PAYMENT ADJUSTMENT.

    Section 1848(o)(2) of the Social Security Act (42 U.S.C. 1395w-
4(o)(2)), as amended by section 8, is further amended by adding at the 
end the following new subparagraph:
                    ``(E) Exceptions for certain eligible 
                professionals.--In applying this paragraph for purposes 
                of subsection (a)(7), the following shall apply:
                            ``(i) 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 visits, 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--
                                    ``(I) provide clinical summaries to 
                                patients; or
                                    ``(II) provide patients, upon 
                                request, with an electronic copy of the 
                                health information of such patients 
                                (including diagnostic test results, 
                                problem lists, medication lists, and 
                                medication allergies).
                            ``(ii) 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 drugs, as specified 
                        through rulemaking, 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--
                                    ``(I) EHR technology is available 
                                to accommodate checks on interactions 
                                between prescription drugs administered 
                                in operating rooms or other 
                                anesthetizing locations.
                        The Secretary shall provide notice to each 
                        eligible professional to whom clause (i) or 
                        (ii) applies of such application.''.

SEC. 9. ADDITIONAL ADMINISTRATIVE PROVISIONS RELATING TO MEDICARE 
              ELIGIBLE PROFESSIONALS' EHR INCENTIVES.

    (a) Appeals Process.--Section 1848(o)(3) of the Social Security Act 
(42 U.S.C. 1395w-4(o)(3)) is amended--
            (1) in subparagraph (C), by striking ``There shall be no'' 
        and inserting ``Except as provided under subparagraph (E), 
        there shall be no''; and
            (2) by adding at the end the following new subparagraph:
                    ``(E) Appeals process before application of 
                penalties.--The Secretary shall, by not later than 
                January 1, 2015, establish and have in place a process 
                for eligible professionals to seek, before application 
                of a payment adjustment under subsection (a)(7)(A) with 
                respect to such an eligible professional, a review of 
                the determination that the eligible professional did 
                not qualify as a meaningful EHR user under paragraph 
                (2).''.
    (b) Semi-Annual Progress Report.--
            (1) 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 (2), the Secretary of 
        Health and Human Services, through the Administrator of the 
        Centers for Medicare & Medicaid Services, shall submit to 
        Congress a report that contains the following information:
                    (A) Improvements in streamlining requirements among 
                various programs under the Medicare program under title 
                XVIII of the Social Security Act regarding similar 
                information (such as for purposes of meaningful use of 
                certified EHR technology, physician quality reporting, 
                and electronic prescribing).
                    (B) Improvements certified EHR technology vendors 
                have made in interoperability.
                    (C) The progress of the adoption of certified EHR 
                technology by physician specialty groups and the 
                percentage of eligible professionals (as defined in 
                section 1848(a)(7)(E)) who are eligible for incentive 
                payments under the Medicare program for meaningful use 
                of certified EHR technology.
                    (D) The reporting capabilities of certified 
                national specialty reporting systems (as defined in 
                section 1848(o)(4)(B) of the Social Security Act, as 
                added by section 5) and recommendations for making such 
                registries more interactive with EHR technology.
            (2) Date specified.--For purposes of paragraph (1), the 
        date specified in this paragraph is the date on which 75 
        percent of all eligible professionals (as defined in section 
        1848(o)(5) of the Social Security Act) have satisfied the 
        requirements of stage 2 of meaningful use of certified EHR 
        technology (as defined by the Secretary of Health and Human 
        Services).

SEC. 10. 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 TECHNOLOGY.

    (a) Eligible Professional Medicare Incentives for Certain MA 
Organizations.--Section 1853(l) of the Social Security Act (42 U.S.C. 
1395w-23(l)) is amended--
            (1) in paragraph (1), by striking ``paragraphs (3) and 
        (4)'' and inserting ``paragraphs (3), (4), and (9)''; and
            (2) by adding at the end the following new paragraph:
            ``(9) Non-application of provisions of electronic health 
        records improvement act.--The provisions of, including the 
        amendments made by, the Electronic Health Records Improvement 
        Act (other than sections 7 and 11 of such Act) shall not apply 
        for purposes of this subsection to qualifying MA organizations 
        or eligible professionals described in paragraph (2) of such 
        organizations.''.
    (b) Medicaid Incentives for Eligible Incentives.--Section 1903(t) 
of the Social Security Act is amended by adding at the end the 
following new paragraph:
    ``(11) The provisions of, including the amendments made by, the 
Electronic Health Records Improvement Act (other than section 11 of 
such Act) shall not apply for purposes of this subsection or subsection 
(a)(3)(F).''.
                                 <all>