123STA T .47 3 PUBLIC LA W 111 –5—FE B. 17 , 2 0 0 9tha tth epro port i o n o f e l i g i b le profe s sionals w ho are m eaningf u l EHR users ( as d etermined under sub - se c tion (o ) ( 2 )) is less than 75 percent , the applicable percent shall be decreased b y1 percentage point from the applicable percent in the preceding year, but in no case shall the applicable percent be less than 9 5 percent .‘ ‘( B ) SIGN I F I CA N TH A RDS HI PEX CEPTI O N. —T he Secretary may, on a case-by-case basis, e x empt an eligible profes- sional from the application of the payment ad j ustment under subparagraph ( A ) if the Secretary determines, sub- ject to annual renewal, that compliance with the re q uire- ment for being a meaningful EHR user would result in a significant hardship, such as in the case of an eligible professional who practices in a rural area without sufficient I nternet access. In no case may an eligible professional be granted an exemption under this subparagraph for more than 5 years. ‘‘( C ) APP L ICATION OF PH Y SICIAN REPORTING SYSTE M R U LES.— P aragraphs (5), ( 6 ),and( 8 ) of subsection ( k ) shall apply for purposes of this paragraph in the same manner as they apply for purposes of such subsection. ‘‘( D ) N ON-APPLICATION TO HOSPITAL- B ASED ELIGIBLE PROFESSIONALS.—No payment adjustment may be made under subparagraph (A) in the case of hospital-based eligible professionals (as defined in subsection (o)(1)(C)(ii)). ‘‘(E) DEFINITIONS.— F or purposes of this paragraph
‘‘(i) CO V ERED PROFESSIONAL SERVICES.—The term ‘co v ered professional services ’ has the meaning given such term in subsection (k)( 3 ). ‘‘(ii) EHR REPORTING PERIOD.—The term ‘EHR reporting period’ means, with respect to a year, a period (or periods) specified by the Secretary. ‘‘(iii) ELIGIBLE PROFESSIONAL.—The term ‘eligible professional’ means a physician, as defined in section 1861(r).’’. (c) APPLICATION TO CERTAIN M A-AFFILIATED ELIGIBLE PROFES- SIONALS.—Section 1853 of the Social Security Act ( 4 2 U .S.C. 1395w – 23) is amended by adding at the end the following new subsection: ‘‘(l) APPLICATION OF ELIGIBLE PROFESSIONAL INCENTIVES FOR CERTAIN MA O RGANI Z ATIONS FOR ADOPTION AND MEANINGFUL USE OF CERTIFIED EHR TECHNOLOGY.— ‘‘(1) IN GENERAL.—Subject to paragraphs (3) and (4), in the case of a qualifying MA organi z ation, the provisions of sections 1848(o) and 1848(a)(7) shall apply with respect to eligible professionals described in paragraph (2) of the organiza- tion who the organization attests under paragraph (6) to be meaningful EHR users in a similar manner as they apply to eligible professionals under such sections. Incentive pay- ments under paragraph (3) shall be made to and payment adjustments under paragraph (4) shall apply to such qualifying organizations. ‘‘(2) ELIGIBLE PROFESSIONAL DESCRIBED.— W ith respect to a qualifying MA organization, an eligible professional described in this paragraph is an eligible professional (as defined for purposes of section 1848(o)) who— ‘‘(A)(i) is employed by the organization
or
