123STA T .48 3 PUBLIC LA W 111 –5—FE B.1 7, 2 0 0 9‘ ‘ (I I )TheS e cr e ta r ym ay ,on aca s e -b y-case bas i s,e x em p ta s u bsection ( d ) hospita lf rom the application of subclause (I) w ith respect to a fiscal year if the Secretary determines, sub j ect to annual renewal, that re q uirin g such hospital to be a meaningful EHR user during such fiscal year would result in a significant hardship, such as in the case of a hospital in a rural area without sufficient Internet access . In no case may a hospital be granted an exemption under this subclause for more than 5 years. ‘‘(III) F or fiscal year 201 5 and each subsequent fiscal year, a State in which hospitals are paid for ser v ices under section 1 8 1 4 (b)( 3 ) shall adjust the payments to each subsection (d) hospital in the State that is not a meaningful EHR user (as defined in subsection (n)(3)) in a manner that is designed to result in an aggregate reduction in payments to hospitals in the State that is equivalent to the aggregate reduction that would have occurred if payments had been reduced to each subsection (d) hospital in the State in a manner comparable to the reduction under the previous provisions of this clause. The State shall report to the Secretary the methodology it will use to ma k e the payment adjust- ment under the previous sentence. ‘‘(I V ) For purposes of this clause, the term ‘EHR reporting period ’ means, with respect to a fiscal year, any period (or periods) as specified by the Secretary.’’. (2) CRIT I CAL ACC ES S HO S P ITALS. — Section 1814(l) of the Social Security A ct (42 U .S.C. 13 9 5f(l)), as amended by sub- section (a)(2), is further amended by adding at the end the following new paragraphs
‘‘(4)(A) Subject to subparagraph (C), for cost reporting periods beginning in fiscal year 2015 or a subsequent fiscal year, in the case of a critical access hospital that is not a meaningful EHR user (as would be determined under paragraph (3) of section 188 6 (n) if such critical access hospital was treated as an eligible hospital under such section) for an EHR reporting period with respect to such fiscal year, paragraph (1) shall be applied by substituting the applicable percent under subparagraph ( B ) for the percent described in such paragraph (1). ‘‘(B) The percent described in this subparagraph is— ‘‘(i) for fiscal year 2015, 100.66 percent
‘‘(ii) for fiscal year 2016, 100.33 percent; and ‘‘(iii) for fiscal year 201 7 and each subsequent fiscal year, 100 percent. ‘‘(C) The provisions of subclause (II) of section 1886(b)(3)(B)(ix) shall apply with respect to subparagraph (A) for a critical access hospital with respect to a cost reporting period beginning in a fiscal year in the same manner as such subclause applies with respect to subclause (I) of such section for a subsection (d) hospital with respect to such fiscal year. ‘‘(5) There shall be no administrative or judicial review under section 1869, section 1878, or otherwise, of— ‘‘(A) the methodology and standards for determining the amount of payment and reasonable cost under paragraph (3) and payment adjustments under paragraph (4), including selec- tion of periods under section 1886(n)(2) for determining, and making estimates or using proxies of, inpatient-bed-days, hos- pital charges, charity charges, and M edicare share under subparagraph ( D ) of section 1886(n)(2); Ap p licab ili ty. Applicability. Re p or t s .
