‘American Recovery and Reinvest-
ment Act of 2009’’.
Prepared by: Ira Morganstern, M.D.
3-4-09
H.R.1—353
TITLE IV—MEDICARE AND MEDICAID
HEALTH INFORMATION TECH-
NOLOGY; MISCELLANEOUS MEDICARE
PROVISIONS
1. Q. Who shall get incentives ?
A: Eligible professionals who are “meaningful” EHR users.
INCENTIVEPAYMENTS.—
(1) I
‘‘(A) INGENERAL.—
‘‘(i) INGENERAL.—Subject to the succeeding sub-
paragraphs of this paragraph, with respect to covered
professional services furnished by an eligible profes-
sional during a payment year (as defined in subpara-
graph (E)), if the eligible professional is a meaningful
EHR user (as determined under paragraph (2)) for
the EHR reporting period with respect to such year,
in addition to the amount otherwise paid under this
part, there also shall be paid to the eligible professional
(or to an employer or facility in the cases described
in clause (A) of section 1842(b)(6)), from the Federal
Supplementary Medical Insurance Trust Fund estab-
lished under section 1841 an amount equal to 75 per-
cent of the Secretary’s estimate (based on claims sub-
mitted not later than 2 months after the end of the
payment year) of the allowed charges under this part
for all such covered professional services furnished by
the eligible professional during such year.
‘‘(ii) NO INCENTIVEPAYMENTSWITHRESPECTTO
YEARSAFTER2016.—No incentive payments may be
MOUNT.—Subject to clauses (iii) through (v),
‘‘(ii) A
the applicable amount specified in this subparagraph
for an eligible professional is as follows:
Q: How much is the incentive and how is it distributed?
A: $15 k the first year, $12 the second, $8 the third, $4 the fourth, $2 the fifth, for a total of $41,000.
‘‘(I) For the first payment year for such profes-
sional, $15,000 (or, if the first payment year for
such eligible professional is 2011 or 2012, $18,000).
‘‘(II) For the second payment year for such
professional, $12,000.
‘‘(III) For the third payment year for such
professional, $8,000.
‘‘(IV) For the fourth payment year for such
professional, $4,000.
‘‘(V) For the fifth payment year for such profes-
sional, $2,000.
‘‘(VI) For any succeeding payment year for
such professional, $0.
Q: Any other incentives?
A: Yes, an extra 10% for physicians working in “health professional shortage areas.”
is 2013.
INCREASEFORCERTAINELIGIBLEPROFES-
‘‘(iv) I
SIONALS.—In the case of an eligible professional who
predominantly furnishes services under this part in
an area that is designated by the Secretary (under
section 332(a)(1)(A) of the Public Health Service Act)
as a health professional shortage area, the amount
that would otherwise apply for a payment year for
such professional under subclauses (I) through (V) of
clause (ii) shall be increased by 10 percent. In imple-
Q: Is there a cut off for these incentives?
A: Yes, incentives end in 2014. There are no incentives for eligible professionals who apply in 2014 or subsequently
‘‘(v) NO INCENTIVEPAYMENTIFFIRSTADOPTING
AFTER2014.—If the first payment year for an eligible
professional is after 2014 then the applicable amount
specified in this subparagraph for such professional
for such year and any subsequent year shall be $0.
E) P
‘‘(i) I
NGENERAL.—For purposes of this subsection,
the term ‘payment year’ means a year beginning with
2011.
‘‘(ii) FIRST, SECOND, ETC. PAYMENTYEAR.—The
term ‘first payment year’ means, with respect to cov-
ered professional services furnished by an eligible
professional, the first year for which an incentive pay-
ment is made for such services under this subsection.
The terms ‘second payment year’, ‘third payment year’,
‘fourth payment year’, and ‘fifth payment year’ mean,
with respect to covered professional services furnished
by such eligible professional, each successive year
immediately following the first payment year for such
professional.
Q: What does “meaningful use of Certified HIT mean?
A: It means what the Secretary defines it to mean, but means that the EHR is certified and that e-prescribing is included.
‘‘(i) MEANINGFULUSEOFCERTIFIEDEHRTECH-
NOLOGY.—The eligible professional demonstrates to the
satisfaction of the Secretary, in accordance with
subparagraph (C)(i), that during such period the profes-
sional is using certified EHR technology in a meaning-
ful manner, which shall include the use of electronic
prescribing as determined to be appropriate by the
Secretary.
Q: How do you prove you are using Certified EHR in a meaningful way?
A: You can “attest” to it.
‘‘(C) DEMONSTRATIONOFMEANINGFULUSEOFCERTIFIED
TECHNOLOGYANDINFORMATIONEXCHANGE.—
‘‘(i) INGENERAL.—A professional may satisfy the
demonstration requirement of clauses (i) and (ii) of
subparagraph (A) through means specified by the Sec-
retary, which may include—
‘‘(I) an attestation;
‘‘(II) the submission of claims with appropriate
coding (such as a code indicating that a patient
encounter was documented using certified EHR
technology);
‘‘(III) a survey response;
‘‘(IV) reporting under subparagraph (A)(iii);
And
Q: Are there separate incentives for Hospitals?
A: Yes.
SEC. 4102. INCENTIVES FOR HOSPITALS.
(a) INCENTIVE PAYMENT.—
(1) I
NGENERAL.—Section 1886 of the Social Security Act
(42 U.S.C. 1395ww) is amended by adding at the end the
following new subsection:
Q: How much is the incentive to a hospital?
A: $2 million from this bill and $2 million from the
‘‘(n) INCENTIVESFOR ADOPTIONAND MEANINGFUL USEOF CER-
TIFIED EHR TECHNOLOGY.—
NGENERAL.—Subject to the succeeding provisions of
‘‘(1) I
this subsection, with respect to inpatient hospital services fur-
nished by an eligible hospital during a payment year (as defined
in paragraph (2)(G)), if the eligible hospital is a meaningful
EHR user (as determined under paragraph (3)) for the EHR
reporting period with respect to such year, in addition to the
amount otherwise paid under this section, there also shall
be paid to the eligible hospital, from the
Insurance Trust Fund established under section 1817, an
amount equal to the applicable amount specified in paragraph
(2)(A) for the hospital for such payment year.
‘(2) P
‘‘(A) INGENERAL.—Subject to the succeeding subpara-
graphs of this paragraph, the applicable amount specified
in this subparagraph for an eligible hospital for a payment
year is equal to the product of the following:
NITIALAMOUNT.—The sum of—
‘‘(i) I
‘‘(I) the base amount specified in subparagraph
(B); plus
‘‘(II) the discharge related amount specified
in subparagraph (C) for a 12-month period selected
by the Secretary with respect to such payment
year.
‘‘(ii) M
EDICARESHARE.—The Medicare share as
specified in subparagraph (D) for the eligible hospital
for a period selected by the Secretary with respect
to such payment year.
‘‘(iii) TRANSITIONFACTOR.—The transition factor
specified in subparagraph (E) for the eligible hospital
for the payment year.
‘‘(B) BASEAMOUNT.—The base amount specified in this
subparagraph is $2,000,000.
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