Bill Would Create New MU Exemptions for Providers, Change Penalty Provisions

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By Kendra Casey Plank  

A bill (H.R. 1309) introduced March 21 by Rep. Diane Black (R-Tenn.) promises to remove barriers some eligible professionals face in participating in the Medicare and Medicaid Electronic Health Records Incentive programs.

The EHR Improvements Act would create two new, limited exemptions for Medicare-participating eligible professionals. The exemption provisions would:

• allow solo practitioners (small practices with one physician) to qualify for a hardship exemption because of limited capital, time, and staff resources; and

• allow physicians who will be eligible for Social Security by 2015 to qualify for a retirement exemption of no more than three years. 


According to a bill summary provided to BNA by Black's staff, the new exemptions are needed to protect from upcoming penalties those physicians--because of practice size or age--who may not be able to meet “meaningful use” requirements.

Medicare-participating eligible professionals who do not meet meaningful use program criteria by 2015 are subject to payment adjustments of 1 percent per year, up to a maximum of 5 percent. There are no such penalties under the Medicaid program.

The bill also would eliminate Medicare payment penalties for eligible professionals successfully participating in the Medicaid meaningful use program and earning Medicaid EHR Incentive Program payments, but not fully in compliance with the final phase of the program for Medicare purposes.

The Medicaid incentive program is being implemented by states over a longer time period than the Medicare program.

Provisions for Specialty Providers

Other bill provisions would allow certain physicians to meet meaningful use quality reporting requirements through participation in their specialties' disease or practice registry programs, as recognized by the health and human services secretary.

Certain specialists--such as anesthesiologists and others whose practices do not involve traditional office visits with patients--would be exempted from certain meaningful use requirements, under the bill.

The provisions address concerns from specialists who have argued to CMS that the program does not apply to their practices.

In a March 19 letter to Black, a coalition of specialty physician groups said the meaningful use program needed to be reformed, largely because of cost constraints on small practices to participate.

Among other provisions, the bill would require CMS to establish an appeals process no later than Jan. 1, 2015, for providers penalized under the Medicare incentive program for not meeting meaningful use criteria. CMS also would be required to align the meaningful use program with other programs that have similar requirements, including the Physician Quality Reporting System.

The bill has been sent to the House Energy and Commerce and Ways and Means committees.

The text of the bill is available at

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