‘‘(F) 3-YEAR EXCEPTION FOR CERTAIN EL-
IGIBLE 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 pay-
ment 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 ex-
emption. 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 profes-
sional 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 pro-
fessional services during the EHR report-
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ing period for 2015 in a physician practice 
that is a solo practice.’’. 
(b) EXCEPTION FOR CERTAIN PHYSICIANS NEAR RE-
TIREMENT
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 sen-
tences, 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 pe-
riod 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: 
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‘‘(G) NOTIFICATION.—Not later than 30 
days after the date on which the Secretary de-
termines an eligible professional is exempt pur-
suant 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 APPLI-
CATION OF MEDICARE EHR PAYMENT AD-
JUSTMENT 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 serv-
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ices furnished by an eligible professional 
and then during such calendar year the eli-
gible professional meets the criteria for es-
tablishing 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 sub-
section for such services for such year is 
the fee schedule amount that would other-
wise apply to such services under this sub-
section without application of this para-
graph.’’. 
(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).’’. 
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SEC. 4. ADDITIONAL EXCEPTIONS TO APPLICATION OF 
MEDICARE PAYMENT ADJUSTMENT FOR CER-
TAIN MEDICAID AND HOSPITAL-BASED ELIGI-
BLE 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 sub-
paragraph (H); and 
(3) by inserting after subparagraph (F) the fol-
lowing new subparagraph: 
‘‘(G) ADDITIONAL EXCEPTIONS FOR CER-
TAIN MEDICAID PROVIDERS PARTICIPATING IN 
MEDICAID EHR INCENTIVE PROGRAM.—In the 
case of an eligible professional who is a Med-
icaid 
provider 
described 
in 
section 
1903(t)(2)(A), the Secretary shall exempt such 
eligible professional from the application of the 
Medicare payment adjustment under subpara-
graph (A), with respect to a year, if such year 
is the first year that such professional received 
payment under section 1903(t).’’. 
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(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 deter-
mination 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
REQUIRE-
MENT.—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 PUR-
POSES OF ELIGIBLE PROFESSIONALS SATIS-
FYING MEANINGFUL USE REQUIREMENTS 
UNDER MEDICARE. 
(a) MEANINGFUL USE OF CERTIFIED REGISTRIES 
TREATED
AS MEANINGFUL USE
OF CERTIFIED EHR 
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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 pre-
ceding clause (i), by inserting ‘‘and subject to sub-
paragraph (D)’’ after ‘‘paragraph (1)’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(D) MEANINGFUL USE OF CERTIFIED NA-
TIONAL SPECIALTY REGISTRIES.— 
‘‘(i) In applying paragraph (1) for 
purposes of subsection (a)(7), an eligible 
professional shall be treated as a meaning-
ful EHR user for an EHR reporting pe-
riod for a year if, in lieu of the require-
ments under subparagraph (A), the eligible 
professional demonstrates to the satisfac-
tion 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 submit-
ting clinical data through such system to 
measure quality improvement and patient 
safety. 
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‘‘(ii) By not later than January 1, 
2015, for purposes of clause (i), the Sec-
retary 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 sys-
tems for specialties of eligible profes-
sionals. 
‘‘(iv) For purposes clause (i), the term 
‘certified national specialty registry system’ 
means, with respect to a specialty of eligi-
ble 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 Secu-
rity Act (42 U.S.C. 1395w–4(m)(2)(D)), as amend-
ed 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 sec-
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tion 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 insert-
ing 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 re-
spect 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 
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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 report-
ing 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 MEDI-
CARE BY AMBULATORY SURGICAL CENTERS. 
(a) 3-YEAR EXEMPTION FROM ENCOUNTERS CAL-
CULATION 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 ENCOUN-
TERS AT AMBULATORY SURGICAL CENTERS.— 
‘‘(i) IN GENERAL.—Subject to clause 
(ii), in applying this paragraph for pur-
poses of subsection (a)(7), any patient en-
counter of an eligible professional occur-
ring during the performance years for the 
2015, 2016, or 2017 payment determina-
tions at an ambulatory surgical center 
shall not be treated as a patient encounter 
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in determining whether an eligible profes-
sional qualifies as a meaningful EHR user. 
‘‘(ii) 
RULE
OF
CONSTRUCTION.— 
Nothing in clause (i) shall prohibit an eli-
gible professional from receiving an addi-
tional payment under paragraph (1) with 
respect to covered professional services fur-
nished in a payment year if the eligible 
professional is determined to be a mean-
ingful EHR user under this paragraph for 
the reporting period for such year. 
‘‘(iii) LIMITATION
OF
PAYMENT
AD-
JUSTMENT.—In applying clause (i) for 
purposes of subsection (a)(7) and a year, 
if an eligible professional is not a meaning-
ful 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 cov-
ered professional services furnished by 
such eligible professional during the year 
in an ambulatory surgical center.’’. 
(b) REINSTATEMENT OF BATCHING PROCESS.—Sub-
paragraph (D) of section 1848(o)(2) of the Social Security 
Act (42 U.S.C. 1395w–4(o)(2)), as added by subsection 
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(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 pa-
tient 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 subse-
quently 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 encoun-
ter.’’. 
SEC. 8. EXEMPTION FROM CERTAIN EHR MEANINGFUL USE 
REQUIREMENTS 
FOR 
CERTAIN 
ELIGIBLE 
PROFESSIONALS FOR PURPOSES OF MEDI-
CARE 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 fur-
ther amended by adding at the end the following new sub-
paragraph: 
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‘‘(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 profes-
sional who is an anesthesiologist or physi-
cian of any other specialty or subspecialty 
identified through rulemaking as not con-
ducting traditional office visits, in order to 
be treated as a meaningful EHR user for 
an EHR reporting period under such sub-
section for a year such eligible professional 
shall not be required to— 
‘‘(I) provide clinical summaries to 
patients; or 
‘‘(II) provide patients, upon re-
quest, 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 profes-
sional who is an anesthesiologist or physi-
cian of any other specialty that does not 
traditionally order prescription drugs be-
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fore administration of such drugs, as speci-
fied through rulemaking, in order to be 
treated as a meaningful EHR user for an 
EHR reporting period under such sub-
section for a year such eligible professional 
shall not be required to utilize EHR tech-
nology that provides for checks on pre-
scription drug interactions until— 
‘‘(I) EHR technology is available 
to accommodate checks on inter-
actions between prescription drugs ad-
ministered 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 RELAT-
ING 
TO 
MEDICARE 
ELIGIBLE 
PROFES-
SIONALS’ EHR INCENTIVES. 
(a) APPEALS PROCESS.—Section 1848(o)(3) of the 
Social Security Act (42 U.S.C. 1395w–4(o)(3)) is amend-
ed— 
(1) in subparagraph (C), by striking ‘‘There 
shall be no’’ and inserting ‘‘Except as provided 
under subparagraph (E), there shall be no’’; and 
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(2) by adding at the end the following new sub-
paragraph: 
‘‘(E) APPEALS PROCESS BEFORE APPLICA-
TION 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 adjust-
ment under subsection (a)(7)(A) with respect to 
such an eligible professional, a review of the de-
termination 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 infor-
mation: 
(A) Improvements in streamlining require-
ments among various programs under the Medi-
care program under title XVIII of the Social 
Security Act regarding similar information 
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(such as for purposes of meaningful use of cer-
tified EHR technology, physician quality report-
ing, and electronic prescribing). 
(B) Improvements certified EHR tech-
nology vendors have made in interoperability. 
(C) The progress of the adoption of cer-
tified EHR technology by physician specialty 
groups and the percentage of eligible profes-
sionals (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 recommenda-
tions for making such registries more inter-
active with EHR technology. 
(2) DATE SPECIFIED.—For purposes of para-
graph (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 Secu-
rity Act) have satisfied the requirements of stage 2 
of meaningful use of certified EHR technology (as 
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defined by the Secretary of Health and Human 
Services). 
SEC. 10. NON-APPLICATION OF PROVISIONS AND AMEND-
MENTS TO ELIGIBLE PROFESSIONAL MEDI-
CARE INCENTIVES FOR CERTAIN MA ORGANI-
ZATIONS AND MEDICAID INCENTIVES FOR 
ADOPTION AND MEANINGFUL USE OF CER-
TIFIED EHR TECHNOLOGY. 
(a) ELIGIBLE PROFESSIONAL MEDICARE INCEN-
TIVES
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 Improve-
ment 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.’’. 
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(b) MEDICAID INCENTIVES FOR ELIGIBLE INCEN-
TIVES.—Section 1903(t) of the Social Security Act is 
amended by adding at the end the following new para-
graph: 
‘‘(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).’’. 
Æ 
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