123STA T .485PUBLIC LA W 111 – 5 —FE B.1 7, 2 0 0 9whompay m ent may b ema d e u nde r part A or i ndi v id - ua ls enrolled in an M A plan under a Medi c are Advan- ta g e organi z ation under this part as a proportion o f the estimated total number of patient-bed-days ( or dis- charges ) with respect to such hospital during such period .‘ ‘( B )A VOID I NG D UPL I CAT ION O F PA YME NT S . — ‘‘(i) I N GENE R AL.—In the case of a hospital that for a payment year is an eligible hospital described in paragraph ( 2 ) and for which at least one-third of their discharges (or bed-days) of Medicare patients for the year are covered under part A , payment for the payment year shall be made only under section 18 8 6 (n) and not under this subsection. ‘‘(ii) MET H ODS.—In the case of a hospital that is an eligible hospital described in paragraph (2) and also is eligible for an incentive payment under section 1886(n) but is not described in clause (i) for the same payment period, the S ecretary shall develop a process— ‘‘(I) to ensure that duplicate payments are not made with respect to an eligible hospital both under this subsection and under section 1886(n)
and ‘‘(II) to collect data from Medicare Advantage organizations to ensure against such duplicate pay- ments. ‘‘( 4 ) P AYMENT AD J USTMENT.— ‘‘(A) Sub j ect to paragraph ( 3 ),inthecaseofa q ualifying MA organization (as defined in section 18 5 3(l)(5)), if, according to the attestation of the organization submitted under subsection (l)(6) for an applicable period, one or more eligible hospitals (as defined in section 1886(n)(6)(A)) that are under common corporate governance with such organization and that serve individuals enrolled under a plan offered by such organization are not meaningful EHR users (as defined in section 1886(n)(3)) with respect to a period, the payment amount payable under this section for such organization for such period shall be the percent specified in subparagraph (B) for such period of the pay- ment amount otherwise provided under this section for such period. ‘‘(B) SPECIFIED PERCENT.— T he percent specified under this subparagraph for a year is 1 0 0 percent minus a number of percentage points equal to the product of— ‘‘(i) the number of the percentage point reduction effected under section 1886(b)(3)(B)(i x )(I) for the period; and ‘‘(ii) the Medicare hospital expenditure proportion specified in subparagraph ( C ) for the year. ‘‘(C) MEDICARE HOSPITAL E X PENDITURE PROPORTION.— The Medicare hospital expenditure proportion under this subparagraph for a year is the Secretary ’ s estimate of the proportion, of the expenditures under parts A and B that are not attributable to this part, that are attrib- utable to expenditures for inpatient hospital services.
