covered professional services
(7) Incentives for meaningful use of certified EHR technology (A) Adjustment (i) In general Subject to subparagraphs (B) and (D), with respect to covered professional services furnished by an eligible professional during each of 2015 through 2018, if the eligible professional is not a meaningful EHR user (as determined under subsection (o)(2)) for an EHR reporting period for the year, the fee schedule amount for such services furnished by such professional during the year (including the fee schedule amount for purposes of determining a payment based on such amount) shall be equal to the applicable percent of the fee schedule amount that would otherwise apply to such services under this subsection (determined after application of paragraph (3) but without regard to this paragraph). (ii) Applicable percent Subject to clause (iii), for purposes of clause (i), the term “applicable percent” means— (I) for 2015, 99 percent (or, in the case of an eligible professional who was subject to the application of the payment adjustment under subsection (a)(5) for 2014, 98 percent); (II) for 2016, 98 percent; and (III) for 2017 and 2018, 97 percent. (iii) Authority to decrease applicable percentage for 2018 For 2018, if the Secretary finds that the proportion of eligible professionals who are meaningful EHR users (as determined under subsection (o)(2)) is less than 75 percent, the applicable percent shall be decreased by 1 percentage point from the applicable percent in the preceding year. (B) Significant hardship exception The Secretary may, on a case-by-case basis (and, with respect to the payment adjustment under subparagraph (A) for 2017, for categories of eligible professionals, as established by the Secretary and posted on the Internet website of the Centers for Medicare & Medicaid Services prior to December 15, 2015 , an application for which must be submitted to the Secretary by not later than March 15, 2016 ), exempt an eligible professional from the application of the payment adjustment under subparagraph (A) if the Secretary determines, subject to annual renewal, that compliance with the requirement 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 Internet access. The Secretary shall exempt an eligible professional from the application of the payment adjustment under subparagraph (A) with respect to a year, subject to annual renewal, if the Secretary determines that compliance with the requirement for being a meaningful EHR user is not possible because the certified EHR technology used by such professional has been decertified under a program kept or recognized pursuant to section 300jj–11(c)(5) of this title . In no case may an eligible professional be granted an exemption under this subparagraph for more than 5 years. (C) Application of physician reporting system rules Paragraphs (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) Non-application to hospital-based and ambulatory surgical center-based eligible professionals (i) Hospital-based 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)). (ii) Ambulatory surgical center-based Subject to clause (iv), no payment adjustment may be made under subparagraph (A) for 2017 and 2018 in the case of an eligible professional with respect to whom substantially all of the covered professional services furnished by such professional are furnished in an ambulatory surgical center. (iii) Determination The determination of whether an eligible professional is an eligible professional described in clause (ii) may be made on the basis of— (I) the site of service (as defined by the Secretary); or (II) an attestation submitted by the eligible professional. Determinations made under subclauses (I) and (II) shall be made without regard to any employment or billing arrangement between the eligible professional and any other supplier or provider of services. (iv) Sunset Clause (ii) shall no longer apply as of the first year that begins more than 3 years after the date on which the Secretary determines, through notice and comment rulemaking, that certified EHR technology applicable to the ambulatory surgical center setting is available. (E) Definitions For purposes of this paragraph: (i) Covered professional services The term “covered 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 1395x(r) of this title .