[Congressional Bills 113th Congress]
[From the U.S. Government Publishing Office]
[H.R. 1331 Introduced in House (IH)]
113th CONGRESS
1st Session
H. R. 1331
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
March 21, 2013
Mrs. Black (for herself, Mr. Chabot, Mr. Grimm, Mr. Harris, and Mrs.
Blackburn) 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. Alternate meaningful use criteria for eligible professionals
utilizing electronic health records and
specialty registry systems.
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 eligible
professionals who practice in 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:
``(iv) 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. ALTERNATE MEANINGFUL USE CRITERIA FOR ELIGIBLE PROFESSIONALS
UTILIZING ELECTRONIC HEALTH RECORDS AND SPECIALTY
REGISTRY SYSTEMS.
Section 1848(o)(2) of the Social Security Act (42 U.S.C. 1395w-
4(o)(2)) is amended--
(1) in subparagraph (A)(iii), by striking ``Subject to''
and inserting ``For such period, the eligible professional
satisfactorily uses a qualified national specialty registry
system that measures quality improvement or improves patient
safety (as described in subparagraph (D)), or, subject to'';
and
(2) by adding at the end the following new subparagraph:
``(D) Qualified national specialty registries.--
``(i) Not later than January 1, 2015, the
Secretary shall specify, pursuant to
rulemaking, criteria for determining--
``(I) if a national speciality
registry system is a qualified national
speciality registry system, for
purposes of this paragraph; and
``(II) if an eligible professional
has demonstrated satisfactory use (as
determined by the Secretary) of a
qualified national speciality registry
system for a period.
``(ii) For purposes of this paragraph, the
term `qualified national specialty registry
system' means, with respect to a medical
speciality, a nationally available registry--
``(I) that is administered or
endorsed by a national medical
specialty society;
``(II) 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 society; and
``(III) that is determined to be a
qualified national speciality registry
system by the Secretary under clause
(ii).''.
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 ELIGIBLE
PROFESSIONALS WHO PRACTICE IN 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)), as amended by
section 5, is further amended by adding at the end the following new
subparagraph:
``(E) 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 submissions of claims
for items or services furnished by an eligible
professional at an ambulatory surgical center
during performance years for the 2015, 2016, or
2017 payment determinations shall not be
included in the data used to determine if such
eligible professional is 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 (E) 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 7, is further amended by adding at the
end the following new subparagraph:
``(F) 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 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 the
application of such clause.''.
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 (3), 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 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 (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) of the Social Security Act) who
are eligible for incentive payments under the Medicare
program for meaningful use of certified EHR technology.
(D) The reporting capabilities of qualified
national specialty reporting systems (as defined in
section 1848(o)(2) of the Social Security Act, as added
by section 5) and recommendations for making such
registries more interactive with EHR technology.
(E) The results of the most recent survey conducted
under paragraph (2).
(2) 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 (3), the
Secretary of Health and Human Services, through the
Administrator of the Centers for Medicare & Medicaid Services,
shall conduct a survey of physicians to identify barriers
encountered by physicians in achieving stage 3 of meaningful
use of certified EHR technology.
(3) Date specified.--For purposes of paragraphs (1) and
(2), 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 MEDICAID INCENTIVES FOR ADOPTION AND
MEANINGFUL USE OF CERTIFIED EHR TECHNOLOGY.
Section 1903(t) of the Social Security Act (42 U.S.C. 1396b(t)) 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 10 of
such Act) shall not apply for purposes of this subsection or subsection
(a)(3)(F).''.
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