I 

112TH CONGRESS 

1ST SESSION H. R. 2500 

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

application of EHR payment incentives in cases of multi-campus hospitals. 

IN THE HOUSE OF REPRESENTATIVES 

JULY 12, 2011 

Mr. BURGESS (for himself, Mr. ENGEL, Mr. BRADY of Texas, Mr. RANGEL, 

Mr. GRIMM, Mr. SESSIONS, Mrs. MALONEY, Mrs. CAPITO, Mr. HINCHEY, 

Mr. SCALISE, Mr. GERLACH, Mr. KING of New York, Mr. GENE GREEN

of Texas, Mr. HIGGINS, Mr. CROWLEY, Mrs. BLACKBURN, Mr. KIND, Mr. 

LEWIS of Georgia, Mr. GONZALEZ, Mr. OLSON, Mr. ACKERMAN, Mr. 

STIVERS, Mr. BUCSHON, Mrs. LOWEY, Mrs. ELLMERS, Mr. BRADY of 

Pennsylvania, Ms. CLARKE of New York, Mr. MARINO, Mr. PASCRELL, 

Mr. FRANK of Massachusetts, Mr. STARK, Mr. PETRI, Mr. LATOURETTE, 

Mr. SHUSTER, Mr. FARR, Mr. TIBERI, Mr. POMPEO, Mr. LEVIN, Mr. 

HANNA, Mr. BOSWELL, Mr. RUNYAN, Mr. NEAL, Mr. MCGOVERN, Mr. 

NADLER, Mr. BUTTERFIELD, Mr. HEINRICH, Mr. BECERRA, Mr. 

MCDERMOTT, Ms. BERKLEY, Mr. SCHOCK, Mr. MARCHANT, Ms. JACKSON LEE of Texas, and Mr. CANSECO) introduced the following bill; 

which was referred to the Committee on Ways and Means, and in addition to the Committee on Energy and Commerce, 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 clarify the application of EHR payment incentives 

in cases of multi-campus hospitals. 

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


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1 SECTION 1. SHORT TITLE. 

2 This Act may be cited as the ‘‘Equal Access and Par3 ity for Multi-Campus Hospitals Act’’. 

4 SEC. 2. CLARIFICATION OF INCENTIVES FOR MULTI-CAM5 PUS HOSPITALS FOR ADOPTION AND MEAN6 INGFUL USE OF CERTIFIED ELECTRONIC 

7 HEALTH RECORDS. 

8 (a) SPECIAL RULE FOR APPLYING MEDICARE EHR 

9 INCENTIVE PAYMENTS TO REMOTE INPATIENT LOCA10 TIONS OF A HOSPITAL.—Section 1886(n) of the Social Se11 curity Act (42 U.S.C. 1395ww(n)) is amended— 

12 (1) in paragraph (2), by adding at the end the 

13 following new subparagraph: 

14 ‘‘(H) SPECIAL RULE FOR REMOTE INPA15 TIENT LOCATIONS OF A HOSPITAL.— 

16 ‘‘(i) IN GENERAL.—In the case of an 

17 eligible hospital that consists of a qualified 

18 main provider and one or more qualified 

19 remote inpatient locations, the hospital 

20 may elect (in such form and manner as 

21 specified by the Secretary) for all applica22 ble payment years to— 

23 ‘‘(I) substitute the base amount 

24 alternative described in clause (ii) for 

25 the base amount described in subpara26 graph (A)(i)(I); or 


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1 ‘‘(II) substitute the discharge re2 lated amount alternative described in 

3 clause (iii) for the discharge related 

4 amount described in subparagraph 

5 (A)(i)(II). 

6 The election described in the previous sen7 tence, with respect to an eligible hospital, 

8 shall be made once for such hospital and 

9 shall apply to such hospital for all applica10 ble payment years. 

11 ‘‘(ii) BASE AMOUNT ALTERNATIVE.— 

12 The base amount alternative described in 

13 this clause with respect to an eligible hos14 pital is the product of— 

15 ‘‘(I) the base amount specified in 

16 subparagraph (B); and 

17 ‘‘(II) the total number of all 

18 qualified component facilities of the 

19 hospital. 

20 An election to substitute the base amount 

21 alternative described in this clause shall 

22 not affect the computation of the discharge 

23 related amount specified in subparagraph 

24 (C) for the eligible hospital. 


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1 ‘‘(iii) DISCHARGE RELATED AMOUNT

2 ALTERNATIVE.—The discharge related 

3 amount alternative described in this clause 

4 with respect to an eligible hospital for a 

5 12-month period is determined as follows: 

6 ‘‘(I) First, compute the amount 

7 under subparagraph (C) as if the 

8 phrase ‘estimated based upon total 

9 discharges for the eligible hospital (re10 gardless of any source of payment) for 

11 the period divided by the total number 

12 of all component facilities of the hos13 pital’ were substituted for the phrase 

14 ‘estimated based upon total discharges 

15 for the eligible hospital (regardless of 

16 any source of payment) for the pe17 riod’. 

18 ‘‘(II) Then multiply the amount 

19 computed under subclause (I) by the 

20 total number of all qualified compo21 nent facilities of such hospital. 

22 ‘‘(iv) DEFINITIONS.—For purposes of 

23 this subsection: 

24 ‘‘(I) APPLICABLE PAYMENT

25 YEAR.—The term ‘applicable payment 


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1 year’ means the first payment year 

2 for which a hospital makes an election 

3 described in clause (i) and each subse4 quent payment year applicable to such 

5 hospital. 

6 ‘‘(II) COMPONENT FACILITY; 

7 QUALIFIED COMPONENT FACILITY.— 

8 The term ‘component facility’ means, 

9 with respect to an eligible hospital, 

10 the main provider or any remote inpa11 tient location of such hospital. The 

12 term ‘qualified component facility’ 

13 means, with respect to a main pro14 vider, a qualified main provider and, 

15 with respect to a remote inpatient lo16 cation, a qualified remote inpatient lo17 cation. 

18 ‘‘(III) MAIN PROVIDER; QUALI19 FIED MAIN PROVIDER.—The term 

20 ‘main provider’, with respect to an eli21 gible hospital, has the meaning given 

22 such term in section 413.65(a)(2) of 

23 title 42, Code of Federal Regulations. 

24 The term ‘qualified main provider’ 

25 means a main provider that is a 


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1 meaningful EHR user for the report2 ing period involved. 

3 ‘‘(IV) REMOTE INPATIENT LOCA4 TION; QUALIFIED REMOTE INPATIENT

5 LOCATION.—The term ‘remote inpa6 tient location’ means, with respect to 

7 an eligible hospital, a remote location 

8 of a hospital, as defined in and ap9 plied under section 413.65 of title 42, 

10 Code of Federal Regulations, that 

11 provides inpatient hospital services 

12 that are paid for under subsection (d). 

13 The term ‘qualified remote inpatient 

14 location’ means, with respect to an eli15 gible hospital, a location for which the 

16 eligible hospital has submitted to the 

17 Secretary, for the reporting period in18 volved, an attestation (in such form 

19 and manner as specified by the Sec20 retary) that certifies that the location 

21 is a remote inpatient location and a 

22 meaningful EHR user for such pe23 riod.’’; and 

24 (2) in paragraph (4)(A)— 


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1 (A) at the end of clause (ii), by striking 

2 ‘‘and’’; 

3 (B) at the end of clause (iii), by striking 

4 the period and inserting a semicolon; and 

5 (C) by adding at the end the following new 

6 clauses: 

7 ‘‘(iv) the methodology and standards 

8 for determining a remote inpatient loca9 tion, a qualified remote inpatient location, 

10 a component facility, a qualified compo11 nent facility, a main provider, and a quali12 fied main provider, as such terms are de13 fined in paragraph (2)(H)(iv), and which 

14 such locations, facilities, and providers are 

15 qualified remote inpatient locations, quali16 fied component facilities, and qualified 

17 main providers, as such terms are defined 

18 in such paragraph; and 

19 ‘‘(v) the methodology and standards 

20 for the election described in paragraph 

21 (2)(H).’’. 

22 (b) IMPLEMENTATION AND ADMINISTRATION.— 

23 (1) IMPLEMENTATION.—Notwithstanding any 

24 other provision of law, the Secretary of Health and 


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1 Human Services may implement by program instruc2 tion or otherwise this section. 

3 (2) ADMINISTRATION.—Chapter 35 of title 44, 

4 United States Code, shall not apply to the collection 

5 of information to carry out the amendments made 

6 by this section. 

7 (c) EFFECTIVE DATE.—The amendments made by 

8 this section shall apply as if included in the enactment 

9 of the American Recovery and Reinvestment Act of 2009 

10 (Public Law 111–5). 

11 SEC. 3. CLARIFICATION FOR MEDICAID EHR PAYMENT IN12 CENTIVES. 

13 (a) IN GENERAL.—Section 1903(t)(5) of the Social 

14 Security Act (42 U.S.C. 1396b(t)(5)) is amended— 

15 (1) by adding at the end the following new sub16 paragraph: 

17 ‘‘(E) For purposes of determining the ap18 plicable amounts specified in subparagraph (A) 

19 of section 1886(n)(2), as applied by the first 

20 sentence of subparagraph (B)— 

21 ‘‘(i) the provisions of subparagraph 

22 (H) of such section shall apply to a Med23 icaid provider described in paragraph 

24 (2)(B) consisting of a qualified main pro25 vider and one or more qualified remote inVerDate Mar 15 2010 03:48 Jul 13, 2011 Jkt 099200 PO 00000 Frm 00008 Fmt 6652 Sfmt 6201 E:\BILLS\H2500.IH H2500

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1 patient locations (as such terms are de2 fined in clause (iv) of such subparagraph 

3 (H)) in the same manner and to the same 

4 extent that such subparagraph applies to 

5 an eligible hospital described in clause (i) 

6 of such subparagraph, except that— 

7 ‘‘(I) in applying the second sen8 tence of clause (iv)(IV) of such sub9 paragraph, with respect to a Medicaid 

10 provider described in paragraph 

11 (2)(B), in lieu of certifying that a re12 mote inpatient location is a meaning13 ful EHR user, the Medicaid provider 

14 shall certify that the remote inpatient 

15 location is described in paragraph 

16 (2)(B) and is in compliance with 

17 paragraph (6)(C) of this subsection 

18 for the year of payment involved; and 

19 ‘‘(II) the first sentence of clause 

20 (iv)(IV) of such subparagraph shall be 

21 applied in the case of a Medicaid pro22 vider described in paragraph (2)(B)(i) 

23 without regard to the requirement 

24 that inpatient hospital services proVerDate Mar 15 2010 02:01 Jul 13, 2011 Jkt 099200 PO 00000 Frm 00009 Fmt 6652 Sfmt 6201 E:\BILLS\H2500.IH H2500

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1 vided are paid for under section 

2 1886(d); and 

3 ‘‘(ii) an election made under subpara4 graph (H) of such section by an eligible 

5 hospital described in clause (i) of such sub6 paragraph that is a Medicaid provider de7 scribed in paragraph (2)(B), shall apply. 

8 The Secretary may make appropriate adjust9 ments to the overall hospital EHR amount 

10 under subparagraph (B), with respect to a 

11 Medicaid provider described in paragraph 

12 (2)(B), to take into account the provisions of 

13 this subparagraph.’’; and 

14 (2) in the first sentence of subparagraph (B), 

15 by inserting ‘‘and subject to subparagraph (E)’’ 

16 after ‘‘For purposes of this paragraph’’. 

17 (b) EFFECTIVE DATE.—The amendments made by 

18 this section shall apply as if included in the enactment 

19 of the American Recovery and Reinvestment Act of 2009 

20 (Public Law 111–5). 

Æ 


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