I 

114TH CONGRESS 

1ST SESSION H. R. 3309 

To amend titles XVIII and XIX of the Social Security Act to improve 

the electronic health records meaningful use programs under the Medicare and Medicaid programs, and for other purposes. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 29, 2015 

Mrs. ELLMERS of North Carolina 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 titles XVIII and XIX of the Social Security Act 

to improve the electronic health records meaningful use 

programs under the Medicare and Medicaid programs, 

and for other purposes. 

1 Be it enacted by the Senate and House of Representa2 tives of the United States of America in Congress assembled, 

3 SECTION 1. SHORT TITLE; TABLE OF CONTENTS. 

4 (a) SHORT TITLE.—This Act may be cited as the 

5 ‘‘Further Flexibility in HIT Reporting and Advancing 

6 Interoperability Act’’ or the ‘‘Flex-IT 2 Act’’. 


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1 (b) TABLE OF CONTENTS.—The table of contents of 

2 this Act is as follows: 

Sec. 1. Short title; table of contents. 

TITLE I—ALIGNMENT OF MEANINGFUL USE RULEMAKING TO 

MERIT-BASED INCENTIVE PAYMENT SYSTEM RULEMAKING 

Sec. 101. Pausing meaningful use rulemaking. 

TITLE II—IMPROVING MEANINGFUL USE 

Sec. 201. Removing the pass-fail approach of the Medicare and Medicaid meaningful use program. 

Sec. 202. Aligning quality reporting in the Medicare and Medicaid meaningful 

use program. 

Sec. 203. Expanding the hardship exception to the Medicare EHR payment adjustments. 

Sec. 204. Promoting interoperability through EHR certification process. 

Sec. 205. Improving the timing of the adoption of more stringent measures of 

meaningful use under the Medicare and Medicaid meaningful 

use program. 

Sec. 206. Three-month EHR reporting periods for the Medicare and Medicaid 

EHR incentive payment programs. 

Sec. 207. Providing eligible professionals and eligible hospitals the option to 

meet a more advanced stage of meaningful use. 

3 TITLE I—ALIGNMENT OF MEAN4 INGFUL USE RULEMAKING TO 

5 MERIT-BASED INCENTIVE 

6 PAYMENT SYSTEM RULE7 MAKING 

8 SEC. 101. PAUSING MEANINGFUL USE RULEMAKING. 

9 (a) SENSE OF THE CONGRESS.—It is the sense of 

10 Congress that the Secretary of Health and Human Serv11 ices (in this section referred to as the ‘‘Secretary’’) should 

12 not finalize the proposed rules relating to Stage 3 criteria 

13 for the meaningful use of certified EHR technology (as 

14 defined in section 3000 of the Public Health Service Act 

15 (42 U.S.C. 300jj)) and the issuance of 2015 EHR certifiVerDate Sep 11 2014 20:25 Aug 05, 2015 Jkt 049200 PO 00000 Frm 00002 Fmt 6652 Sfmt 6201 E:\BILLS\H3309.IH H3309

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1 cation criteria and should instead encourage interoper2 ability, usability, and improved outcomes with respect to 

3 electronic health records. 

4 (b) NO ISSUANCE OF STAGE 3 CRITERIA OR OF EHR 

5 CERTIFICATION CRITERIA BEFORE 2017 UNLESS CONDI6 TIONS MET.—Unless one of the conditions described in 

7 subsection (c) has been met, the Secretary shall not issue, 

8 prior to January 1, 2017— 

9 (1) any proposed or final rule that would mod10 ify the definition of the term ‘‘Meaningful EHR 

11 user’’ under section 495.4 of title 42, Code of Fed12 eral Regulations (or any successor regulation), by 

13 adding Stage 3 criteria for eligible professionals or 

14 eligible hospitals; or 

15 (2) any proposed or final rule that would add 

16 new certification criteria for certified EHR tech17 nology under part 170 of title 45, Code of Federal 

18 Regulations. 

19 (c) CONDITIONS.—The conditions described in this 

20 subsection are the following: 

21 (1) The Secretary certifies that 75 percent of 

22 both eligible hospitals and eligible professionals have 

23 successfully attested to the Stage 2 criteria estab24 lished under section 495.6 of title 42, Code of Fed25 eral Regulations. 


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1 (2) The Secretary promulgates a final rule to 

2 implement the Merit-Based Incentive Payment Sys3 tem established under section 1848(q) of the Social 

4 Security Act (42 U.S.C. 1395w–4(q)). 

5 (d) FLEXIBILITY TO ADJUST EXISTING MEANING6 FUL USE AND CERTIFICATION CRITERIA.—Nothing in 

7 this section shall be construed as affecting the authority 

8 of the Secretary to change, modify, suspend, or revoke 

9 meaningful use and certification criteria effective on the 

10 date of the enactment of this Act, including the Stage 2 

11 criteria established under section 495.6 of title 42, Code 

12 of Federal Regulations, and the 2014 Edition certified 

13 health record criteria under subpart C, part 170 of title 

14 45, Code of Federal Regulations, for any of the following 

15 reasons: 

16 (1) The change, modification, suspension, or 

17 revocation relates to the recommendations for 

18 achieving widespread interoperability made by the 

19 Secretary pursuant to section 106 of the Medicare 

20 Access and CHIP Reauthorization Act of 2015. 

21 (2) The criteria may negatively impact the 

22 quality of care for, or may risk harm to, a patient. 

23 (3) The change, modification, suspension, or 

24 revocation is necessary to reflect advances in science 

25 or technology, or to improve transparency. 


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1 TITLE II—IMPROVING 

2 MEANINGFUL USE 

3 SEC. 201. REMOVING THE PASS-FAIL APPROACH OF THE 

4 MEDICARE AND MEDICAID MEANINGFUL USE 

5 PROGRAM. 

6 (a) ELIGIBLE PROFESSIONALS.— 

7 (1) IN GENERAL.—Section 1848(o)(2) of the 

8 Social Security Act (42 U.S.C. 1395w–4(o)(2)) is 

9 amended by adding at the end the following new 

10 subparagraph: 

11 ‘‘(E) CONSIDERATION OF TECHNOLOGICAL

12 AND COST BARRIERS.—In applying clauses (i), 

13 (ii), and (iii) of subparagraph (A) to determine 

14 whether a professional is using certified EHR 

15 technology in a meaningful manner for a period 

16 described in such subparagraph for a year after 

17 2015, the Secretary— 

18 ‘‘(i) may not require that the profes19 sional, in order to be considered a mean20 ingful EHR user for such period, meet 

21 every requirement or objective specified 

22 pursuant to such clauses but instead shall 

23 apply a linear scale; 

24 ‘‘(ii) shall establish a method to deter25 mine if an eligible professional is a partial 


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1 meaningful user consistent with such linear 

2 scale; and 

3 ‘‘(iii) shall consider differences among 

4 professionals (such as differences in the 

5 specialties and patient populations of pro6 fessionals) as well as technological and cost 

7 barriers in determining which of the re8 quirements or objectives must be met by 

9 the professional during such period in 

10 order for the professional to be so consid11 ered.’’. 

12 (2) INCENTIVE PAYMENT.—Section 

13 1848(o)(1)(A)(i) of the Social Security Act (42 

14 U.S.C. 1395w–4(o)(1)(A)(i)) is amended— 

15 (A) by inserting ‘‘or, for 2016, partial 

16 meaningful EHR user’’ after ‘‘meaningful EHR 

17 user’’; and 

18 (B) by inserting ‘‘(or, for 2016, in accord19 ance with the linear scale applied pursuant to 

20 paragraph (2)(E), equal to not more than)’’ 

21 after ‘‘equal to’’. 

22 (3) PAYMENT ADJUSTMENT.—Section 

23 1848(a)(7)(A)(i) of the Social Security Act (42 

24 U.S.C. 1395w–4(a)(7)(A)(i)) is amended— 


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1 (A) by inserting ‘‘or, for such a year after 

2 2015, partial meaningful EHR user’’ after 

3 ‘‘meaningful EHR user’’; and 

4 (B) by inserting ‘‘(or, for such a year after 

5 2015, in accordance with the linear scale ap6 plied pursuant to paragraph (2)(E), equal to at 

7 least)’’ after ‘‘equal to’’. 

8 (b) ELIGIBLE HOSPITALS.— 

9 (1) IN GENERAL.—Section 1886(n)(3) of the 

10 Social Security Act (42 U.S.C. 1395ww(n)(3)) is 

11 amended by adding at the end the following new 

12 subparagraph: 

13 ‘‘(D) CONSIDERATION OF TECHNOLOGICAL

14 AND COST BARRIERS.—In applying clauses (i), 

15 (ii), and (iii) of subparagraph (A) to determine 

16 whether a hospital is using certified EHR tech17 nology in a meaningful manner for an EHR re18 porting period for a fiscal year after fiscal year 

19 2015, the Secretary— 

20 ‘‘(i) may not require that the hospital, 

21 in order to be considered a meaningful 

22 EHR user for such period, meet every such 

23 requirement or objective specified pursuant 

24 to such clauses but instead shall apply a 

25 linear scale; 


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1 ‘‘(ii) shall establish a method to deter2 mine if an eligible professional is a partial 

3 meaningful user consistent with such linear 

4 scale; and 

5 ‘‘(iii) shall consider differences among 

6 hospitals (such as differences in the type of 

7 hospital, specialties available at and pa8 tient populations of hospitals) in deter9 mining which of the requirements or objec10 tives must be met by the hospital during 

11 such period in order for the hospital to be 

12 so considered.’’. 

13 (2) INCENTIVE PAYMENT.—Section 1886(n)(1) 

14 of the Social Security Act (42 U.S.C. 1395ww(n)(1)) 

15 is amended— 

16 (A) by inserting ‘‘or, for a fiscal year after 

17 fiscal year 2015, partial meaningful EHR user’’ 

18 after ‘‘meaningful EHR user’’; and 

19 (B) by inserting ‘‘(or, for a fiscal year 

20 after fiscal year 2015, in accordance with the 

21 linear scale applied pursuant to paragraph 

22 (2)(D), equal to not more than)’’ after ‘‘equal 

23 to’’. 


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1 (3) PAYMENT ADJUSTMENT.—Section 

2 1886(b)(3)(B)(ix)(I) of the Social Security Act (42 

3 U.S.C. 1395ww(b)(3)(B)(ix)(I)) is amended— 

4 (A) in subclause (I)— 

5 (i) by inserting ‘‘or, for a fiscal year 

6 after fiscal year 2015, partial meaningful 

7 EHR user’’ after ‘‘meaningful EHR user’’; 

8 and 

9 (ii) by inserting ‘‘(or, for a fiscal year 

10 after fiscal year 2015, in accordance with 

11 the linear scale applied pursuant to section 

12 1886(n)(2)(D), equal to at least)’’ after 

13 ‘‘equal to’’; and 

14 (B) in subclause (III), by inserting ‘‘or, for 

15 a fiscal year after fiscal year 2015, partial 

16 meaningful EHR user’’ after ‘‘meaningful EHR 

17 user’’. 

18 (c) APPLICATION UNDER MEDICAID.—Section 

19 1903(t)(8) of the Social Security Act (42 U.S.C. 

20 1396b(t)(8)) is amended by inserting after the second sen21 tence the following: ‘‘In doing so, the Secretary shall en22 sure that the provisions of subparagraph (E) of section 

23 1848(o)(2) and subparagraph (D) of section 1886(n)(3) 

24 apply under this title with respect to demonstrating meanVerDate Sep 11 2014 02:43 Aug 04, 2015 Jkt 049200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H3309.IH H3309

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1 ingful use in a similar manner as such provisions apply 

2 under title XVIII.’’. 

3 (d) APPLICATION TO MEDICARE ADVANTAGE.—Sec4 tion 1853 of the Social Security Act (42 U.S.C. 1395w– 

5 23) is amended— 

6 (1) in subsection (l)— 

7 (A) in paragraph (1), by inserting ‘‘or, for 

8 a year after 2015, partial meaningful EHR 

9 users,’’ after ‘‘meaningful EHR users’’; 

10 (B) in paragraph (4)(A), by inserting ‘‘(or, 

11 for a year after 2015, in accordance with the 

12 linear scale applied pursuant to section 

13 1848(o)(2)(E), equal to at least)’’ after ‘‘equal 

14 to’’; and 

15 (C) in paragraph (6), in each of subpara16 graphs (A) and (B), by inserting ‘‘or, for a year 

17 after 2015, partial meaningful EHR user,’’ 

18 after ‘‘meaningful EHR user’’; and 

19 (2) in subsection (m)— 

20 (A) in paragraph (1), by inserting ‘‘or, for 

21 a fiscal year after fiscal year 2015, partial 

22 meaningful EHR users,’’ after ‘‘meaningful 

23 EHR users’’; and 

24 (B) in paragraph (4)(A), by inserting ‘‘or, 

25 for a fiscal year after fiscal year 2015, partial 


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1 meaningful EHR users,’’ after ‘‘meaningful 

2 EHR users’’. 

3 (e) APPLICATION TO CRITICAL ACCESS HOS4 PITALS.—Section 1814(l) of the Social Security Act (42 

5 U.S.C. 1395f(l)) is amended— 

6 (1) in paragraph (3)(A), by inserting ‘‘or, for a 

7 fiscal year after 2015, partial meaningful EHR 

8 user,’’ after ‘‘meaningful EHR user’’; 

9 (2) in paragraph (3)(A)(ii)(I), by inserting ‘‘(or, 

10 for a fiscal year after fiscal year 2015, in accordance 

11 with the linear scale applied pursuant to section 

12 1886(n)(2)(D), equal to not more than)’’ after 

13 ‘‘equal to’’; and 

14 (3) in paragraph (4)— 

15 (A) in subparagraph (A), by inserting ‘‘or, 

16 for a fiscal year after 2015, partial meaningful 

17 EHR user,’’ after ‘‘meaningful EHR user’’; and 

18 (B) in subparagraph (B), by inserting 

19 ‘‘(or, for a fiscal year after fiscal year 2015, in 

20 accordance with the linear scale applied pursu21 ant to section 1886(n)(2)(D), a percent equal 

22 to at least the applicable percent)’’ after ‘‘appli23 cable percent’’. 


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1 SEC. 202. ALIGNING QUALITY REPORTING IN THE MEDI2 CARE AND MEDICAID MEANINGFUL USE PRO3 GRAM. 

4 (a) ELIGIBLE PROFESSIONALS.— 

5 (1) TESTING OF MEASURES.—Section 

6 1848(k)(2)(C) of the Social Security Act (42 U.S.C. 

7 1395w–4(k)(2)(C)) is amended by adding at the end 

8 the following new clause: 

9 ‘‘(iii) TESTING.—After December 31, 

10 2015, the Secretary may only specify a 

11 clinical quality measure under this sub12 paragraph if the Secretary has dem13 onstrated, through field tests among mul14 tiple and varied eligible professionals, that 

15 it is feasible for such professionals to elec16 tronically submit valid and accurate infor17 mation on the measure.’’. 

18 (2) DEEMED COMPLIANCE IF SATISFY PQRS.— 

19 Section 1848(o)(2)(B)(iii) of the Social Security Act 

20 (42 U.S.C. 1395w–4(o)(2)(B)(iii)) is amended by 

21 adding at the end the following: 

22 ‘‘In implementing the preceding sentence, the Sec23 retary shall treat an eligible professional who, for a period 

24 under subsection (k) for covered professional services fur25 nished in a year after 2015, satisfies the requirements of 

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1 torily participates in a qualified clinical data registry for 

2 a reporting period (as defined in subsection (m)(6)(C)) as 

3 determined by the Secretary pursuant to subsection 

4 (k)(2)(C) and subsection (m)(3)(D), as satisfying the re5 quirement of subparagraph (A) for the corresponding pe6 riod described in such subparagraph for such year.’’. 

7 (b) ELIGIBLE HOSPITALS.— 

8 (1) TESTING OF MEASURES.—Section 

9 1886(n)(3)(B)(i) of the Social Security Act (42 

10 U.S.C. 1395ww(n)(3)(B)(i)) is amended by adding 

11 at the end the following new subclause: 

12 ‘‘(III) After September 30, 2015, 

13 the Secretary may only select a clin14 ical quality measure under this sub15 paragraph if the Secretary has dem16 onstrated, through field tests in mul17 tiple and varied hospitals, that it is 

18 feasible for such hospitals to electroni19 cally submit valid and accurate infor20 mation on the measure.’’. 

21 (2) DEEMED COMPLIANCE IF SATISFY HOS22 PITAL INPATIENT QUALITY REPORTING REQUIRE23 MENTS.—Section 1886(n)(3)(B)(iii) of the Social 

24 Security Act (42 U.S.C. 1395ww(n)(3)(B)(iii)) is 

25 amended by adding at the end the following: ‘‘In imVerDate Sep 11 2014 02:43 Aug 04, 2015 Jkt 049200 PO 00000 Frm 00013 Fmt 6652 Sfmt 6201 E:\BILLS\H3309.IH H3309

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1 plementing the preceding sentence, the Secretary 

2 shall treat an eligible hospital that, for a period 

3 under subsection (b)(3)(B)(viii) for a fiscal year 

4 after fiscal year 2015, satisfies the requirements of 

5 such subsection as satisfying the requirement of sub6 paragraph (A) for the corresponding reporting pe7 riod for such fiscal year.’’. 

8 (c) APPLICATION UNDER MEDICAID.—Section 

9 1903(t)(8) of the Social Security Act (42 U.S.C. 

10 1396b(t)(8)), as amended by section 201(c), is further 

11 amended in the third sentence— 

12 (1) by inserting ‘‘and the last sentence of sub13 paragraph (B)(iii)’’ after ‘‘subparagraph (E)’’; and 

14 (2) by inserting ‘‘and the last sentence of sub15 paragraph (B)(i)(III)’’ after ‘‘subparagraph (D)’’. 

16 SEC. 203. EXPANDING THE HARDSHIP EXCEPTION TO THE 

17 MEDICARE EHR PAYMENT ADJUSTMENTS. 

18 (a) ELIGIBLE PROFESSIONALS.—Section 

19 1848(a)(7)(B) of the Social Security Act (42 U.S.C. 

20 1395w–4(a)(7)(B)) is amended to read as follows: 

21 ‘‘(B) SIGNIFICANT HARDSHIP EXCEP22 TION.— 

23 ‘‘(i) IN GENERAL.—Subject to clause 

24 (ii), the Secretary may, on a case-by-case 

25 basis, exempt an eligible professional from 


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1 the application of the payment adjustment 

2 under subparagraph (A) if the Secretary 

3 determines, subject to annual renewal, that 

4 compliance with the requirement for being 

5 a meaningful EHR user would result in a 

6 significant hardship, such as in the case of 

7 an eligible professional who practices in a 

8 rural area without sufficient Internet ac9 cess. 

10 ‘‘(ii) REQUIRED EXCEPTION.—Subject 

11 to clause (iii), beginning for 2015, the Sec12 retary shall, on a case-by-case basis, ex13 empt an eligible professional from the ap14 plication of the payment adjustment under 

15 subparagraph (A) if the Secretary deter16 mines, subject to annual renewal, the eligi17 ble professional— 

18 ‘‘(I) encounters unforeseen cir19 cumstances (including technological 

20 difficulties and other disruptive situa21 tions) that present barriers to compli22 ance with the requirement for being a 

23 meaningful EHR user; 

24 ‘‘(II) changes certified EHR 

25 technology vendors, or changes from 


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1 self-developed electronic health 

2 records to certified EHR technology 

3 from a vendor; 

4 ‘‘(III) is an anesthesiologist, ra5 diologist, pathologist, hospitalist, or is 

6 in any other physician specialty or 

7 subspecialty identified through rule8 making as a specialty or subspecialty 

9 that presents physicians in the spe10 cialty or subspecialty with unique dif11 ficulties in complying with such re12 quirement; 

13 ‘‘(IV) is at or near retirement 

14 age (as defined by the Secretary); or 

15 ‘‘(V) is not able to be in compli16 ance with any such requirement be17 cause the certified EHR technology 

18 used by such professional is not capa19 ble of sending, receiving, and 

20 seamlessly incorporating data from 

21 other certified EHR technology. 

22 ‘‘(iii) LIMITATION.—In no case may 

23 an eligible professional be granted an ex24 emption under this subparagraph for more 

25 than 5 years.’’. 


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1 (b) ELIGIBLE HOSPITALS.—Section 

2 1886(b)(3)(B)(ix)(II) of the Social Security Act (42 

3 U.S.C. 1395ww(b)(3)(B)(ix)(II)) is amended to read as 

4 follows: 

5 ‘‘(II)(aa) Subject to item (cc), 

6 the Secretary may, on a case-by-case 

7 basis, exempt a subsection (d) hos8 pital from the application of subclause 

9 (I) with respect to a fiscal year if the 

10 Secretary determines, subject to an11 nual renewal, that requiring such hos12 pital to be a meaningful EHR user 

13 during such fiscal year would result in 

14 a significant hardship, such as in the 

15 case of a hospital in a rural area with16 out sufficient Internet access. 

17 ‘‘(bb) Subject to item (cc), begin18 ning for fiscal year 2015, the Sec19 retary shall, on a case-by-case basis, 

20 exempt a subsection (d) hospital from 

21 the application of subclause (I) with 

22 respect to a fiscal year if the Sec23 retary determines, subject to annual 

24 renewal, that the hospital encounters 

25 unforeseen circumstances (including 


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1 technological difficulties and other dis2 ruptive situations) that present bar3 riers to compliance with the require4 ment for such hospital to be a mean5 ingful EHR user during such fiscal 

6 year, changes certified EHR tech7 nology vendors, changes from self-de8 veloped electronic health records to 

9 certified EHR technology from a ven10 dor, or is not able to be in compliance 

11 with any such requirement because 

12 the certified EHR technology used by 

13 such hospital is not capable of send14 ing, receiving, and seamlessly incor15 porating data from other certified 

16 EHR technology. 

17 ‘‘(cc) In no case may a hospital 

18 be granted an exemption under this 

19 subclause for more than 5 years.’’. 

20 SEC. 204. PROMOTING INTEROPERABILITY THROUGH EHR 

21 CERTIFICATION PROCESS. 

22 Section 3004(a)(1) of the Public Health Service Act 

23 (42 U.S.C. 300jj–14(a)(1)) is amended by adding at the 

24 end the following new sentence: ‘‘The Secretary may not 

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1 fications, or certification criteria unless such standards, 

2 implementation specifications, or certification criteria, re3 spectively, have been successfully tested for widespread 

4 use by end users for at least a one-year period.’’. 

5 SEC. 205. IMPROVING THE TIMING OF THE ADOPTION OF 

6 MORE STRINGENT MEASURES OF MEANING7 FUL USE UNDER THE MEDICARE AND MED8 ICAID MEANINGFUL USE PROGRAM. 

9 (a) ELIGIBLE PROFESSIONALS.—Section 1848(o)(2) 

10 of the Social Security Act (42 U.S.C. 1395w–4(o)(2)), as 

11 amended by section 201(a), is further amended— 

12 (1) in subparagraph (A), in the matter fol13 lowing clause (iii), by striking ‘‘shall seek’’ and in14 serting ‘‘shall, in accordance with subparagraph (F), 

15 seek’’; and 

16 (2) by adding at the end the following new sub17 paragraph: 

18 ‘‘(F) PROVISIONS RELATING TO IN19 CREASED STRINGENCY OF MEASURES.—The 

20 Secretary shall implement the last sentence of 

21 subparagraph (A) (relating to requirements for 

22 more stringent measures of meaningful use se23 lected under this paragraph) in accordance with 

24 the following: 


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1 ‘‘(i) ENSURING PREDICTABILITY.— 

2 Subject to clause (ii), in the case that the 

3 Secretary selects measures of meaningful 

4 use, including any objectives associated 

5 with such measures, the Secretary may not 

6 change or modify such selection for a pe7 riod of three years. 

8 ‘‘(ii) FLEXIBILITY TO ADJUST CER9 TAIN MEASURES.— 

10 ‘‘(I) PERMISSIBLE REASON FOR

11 CHANGES OR MODIFICATIONS TO

12 MEASURES.—The Secretary may 

13 change or modify a measure of mean14 ingful use before the end of the three15 year period described in clause (i) if 

16 the Secretary makes one or more of 

17 the following determinations: 

18 ‘‘(aa) The measure may neg19 atively impact the quality of care 

20 for, or may risk harm to, a pa21 tient. 

22 ‘‘(bb) There is a new hard23 ship demonstrated by eligible 

24 professionals specific to the 

25 measure. 


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1 ‘‘(cc) An adjustment to the 

2 measure is necessary to reflect 

3 advances in science or tech4 nology. 

5 ‘‘(II) REQUEST FOR REVIEW OF

6 CLINICAL QUALITY MEASURES.—The 

7 Secretary shall establish a process 

8 under which stakeholders may, in the 

9 case that new information is available 

10 with respect to a clinical quality meas11 ure selected by the Secretary for qual12 ity reporting under subparagraph 

13 (A)(iii), request that the Secretary 

14 change or modify such measure for a 

15 reason described in subclause (I).’’. 

16 (b) ELIGIBLE HOSPITALS.—Section 1886(n)(3) of 

17 the Social Security Act (42 U.S.C. 1395ww(n)(3)), as 

18 amended by section 201(b), is further amended— 

19 (1) in subparagraph (A), in the matter fol20 lowing clause (iii), by striking ‘‘shall seek’’ and in21 serting ‘‘shall, in accordance with subparagraph (E), 

22 seek’’; and 

23 (2) by adding at the end the following new sub24 paragraph: 


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1 ‘‘(E) PROVISIONS RELATING TO IN2 CREASED STRINGENCY OF MEASURES.—The 

3 Secretary shall implement the last sentence of 

4 subparagraph (A) (relating to requirements for 

5 more stringent measures of meaningful use se6 lected under this paragraph) in accordance with 

7 the following: 

8 ‘‘(i) ENSURING PREDICTABILITY.— 

9 Subject to clause (ii), in the case that the 

10 Secretary selects measures of meaningful 

11 use, including any objectives associated 

12 with such measures, the Secretary may not 

13 change or modify such selection for a pe14 riod of three years. 

15 ‘‘(ii) FLEXIBILITY TO ADJUST CER16 TAIN MEASURES.— 

17 ‘‘(I) PERMISSIBLE REASON FOR

18 ADJUSTMENTS TO MEASURES.—The 

19 Secretary may change or modify a 

20 measure of meaningful use before the 

21 end of the three-year period described 

22 in clause (i) if the Secretary makes 

23 one or more of the following deter24 minations: 


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1 ‘‘(aa) The measure may neg2 atively impact the quality of care 

3 for, or may risk harm to, a pa4 tient. 

5 ‘‘(bb) There is a new hard6 ship demonstrated by eligible 

7 hospitals specific to the measure. 

8 ‘‘(cc) An adjustment to the 

9 measure is necessary to reflect 

10 advances in science or tech11 nology. 

12 ‘‘(II) REQUEST FOR REVIEW OF

13 CLINICAL QUALITY MEASURES.—The 

14 Secretary shall establish a process 

15 under which stakeholders may, in the 

16 case that new information is available 

17 with respect to a clinical quality meas18 ure selected by the Secretary for qual19 ity reporting under subparagraph 

20 (A)(iii), request that the Secretary 

21 change or modify such measure for a 

22 reason described in subclause (I).’’. 

23 (c) APPLICATION UNDER MEDICAID.—Section 

24 1903(t)(8) of the Social Security Act (42 U.S.C. 


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1 1396b(t)(8)), as amended by sections 201(c) and 202(c), 

2 is further amended in the third sentence— 

3 (1) by striking ‘‘and the last sentence of sub4 paragraph (B)(iii)’’ and inserting ‘‘, the last sen5 tence of subparagraph (B)(iii), and subparagraph 

6 (F)’’; and 

7 (2) by striking ‘‘and the last sentence of sub8 paragraph (B)(i)(III)’’ and inserting ‘‘, the last sen9 tence of subparagraph (B)(i)(III), and subparagraph 

10 (E)’’. 

11 SEC. 206. THREE-MONTH EHR REPORTING PERIODS FOR 

12 THE MEDICARE AND MEDICAID EHR INCEN13 TIVE PAYMENT PROGRAMS. 

14 (a) EHR REPORTING PERIOD.— 

15 (1) ELIGIBLE PROFESSIONALS.—Section 

16 1848(a)(7)(E)(ii) of the Social Security Act (42 

17 U.S.C. 1395w–4(a)(7)(E)(ii)) is amended by adding 

18 at the end the following: ‘‘Such period (or periods) 

19 shall consist of a three-month reporting period, with20 out regard to the payment year or the stage criteria 

21 (as established under section 495.6 of title 42, Code 

22 of Federal Regulations) involved.’’. 

23 (2) ELIGIBLE HOSPITALS.—Subsections 

24 (b)(3)(B)(ix)(IV) and (n)(6)(A) of section 1886 of 

25 the Social Security Act (42 U.S.C. 1395ww) are 


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1 each amended by adding at the end the following: 

2 ‘‘Such period (or periods) shall consist of a three3 month reporting period, without regard to the pay4 ment year or the stage criteria (as established under 

5 section 495.6 of title 42, Code of Federal Regula6 tions) involved.’’. 

7 (3) APPLICATION UNDER MEDICAID.—Section 

8 1903(t)(8) of the Social Security Act (42 U.S.C. 

9 1396b(t)(8)), as amended by sections 201(c), 

10 202(c), and 205(c), is further amended by adding at 

11 the end the following new sentence: ‘‘Such reporting 

12 periods shall consist of a three-month reporting pe13 riod, without regard to payment year or the stage 

14 criteria (as established under section 495.6 of title 

15 42, Code of Federal Regulations).’’. 

16 (b) REGULATIONS.—Not later than 3 months after 

17 the date of enactment of this Act, the Secretary of Health 

18 and Human Services shall promulgate regulations to carry 

19 out the amendments made by subsection (a). Such regula20 tions shall apply beginning with the 2016 EHR reporting 

21 period. 


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1 SEC. 207. PROVIDING ELIGIBLE PROFESSIONALS AND ELI2 GIBLE HOSPITALS THE OPTION TO MEET A 

3 MORE ADVANCED STAGE OF MEANINGFUL 

4 USE. 

5 (a) MEANINGFUL EHR USER.—A ‘‘meaningful EHR 

6 user’’, as defined under section 495.4 of title 24, Code 

7 of Federal Regulations, shall include eligible professionals 

8 and eligible hospitals who demonstrate meaningful use of 

9 certified EHR technology by meeting the applicable objec10 tives and associated measures of either of the following: 

11 (1) The stage of meaningful use that the eligi12 ble professional or eligible hospital is scheduled to 

13 meet during the applicable ‘‘EHR reporting period’’, 

14 as such term is defined under section 495.4 of title 

15 24, Code of Federal Regulations. 

16 (2) Any other stage of meaningful use, provided 

17 that such stage of meaningful use selected by the eli18 gible professional or eligible hospital is more ad19 vanced than the stage of meaningful use that the eli20 gible professional or eligible hospital is scheduled to 

21 meet during the applicable EHR reporting period. 

22 (b) DEFINITION.—In this subparagraph, the term 

23 ‘‘stage of meaningful use’’ means the stage criteria estab24 lished by the Secretary of Health and Human Services 


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1 under section 495.6 of title 42, Code of Federal Regula2 tions. 

Æ 


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