(1) in subparagraph (A)(iii), by striking ‘‘Sub-
ject to’’ and inserting ‘‘For such period, the eligible 
professional satisfactorily uses a qualified national 
specialty registry system that measures quality im-
provement or improves patient safety (as described 
in subparagraph (D)), or, subject to’’; and 
(2) by adding at the end the following new sub-
paragraph: 
‘‘(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 reg-
istry system is a qualified national 
speciality registry system, for pur-
poses 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 reg-
istry system’ means, with respect to a 
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medical speciality, a nationally available 
registry— 
‘‘(I) that is administered or en-
dorsed by a national medical specialty 
society; 
‘‘(II) that collects clinical data 
for purposes of measuring quality im-
provement or improving patient safety 
related to the type of care provided or 
conditions treated by the types of eli-
gible 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 
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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 
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’’. 
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SEC. 7. IMPROVING EHR MEANINGFUL USE UNDER MEDI-
CARE BY ELIGIBLE PROFESSIONALS WHO 
PRACTICE IN AMBULATORY SURGICAL CEN-
TERS. 
(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)), as amended by section 5, is further amended by 
adding at the end the following new subparagraph: 
‘‘(E) 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 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 de-
terminations shall not be included in the 
data used to determine if such eligible pro-
fessional is 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 
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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 (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 pa-
tient encounter occurring at an ambulatory 
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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 7, is fur-
ther amended by adding at the end the following new sub-
paragraph: 
‘‘(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 profes-
sional who is an anesthesiologist or physi-
cian of any other specialty or subspecialty 
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