123STA T .49 2 PUBLIC LA W 111 –5—FE B.1 7, 2 0 09 ‘ ‘ (i)then et av e r a g ea l l ow a b le c o s ts u n d er this sub - section f or the first y ear of p ay m ent (which may not be later than 2016 ) , which is intended to cover the costs described in paragraph ( 3 )( C )(i), e x ceed $ 2 5 ,000 (or such lesser amount as the S ecretary determines based on studies conducted under subparagraph (C))
‘‘(ii) the net average allowable costs under this sub- section for a subse q uent year of payment, which is intended to cover costs described in paragraph (3)(C)(ii), exceed $10,000; and ‘‘(iii) payments be made for costs described in clause (ii) after 2021 or over a period of longer than 5 years . ‘‘( B ) I n the case of M edicaid provider described in paragraph (2)( A )(ii), the dollar amounts specified in subparagraph (A) shall be 2⁄3 of the dollar amounts otherwise specified. ‘‘(C) F or the purposes of determining average allowable costs under this subsection, the Secretary shall study the average costs to Medicaid providers described in paragraph (2)(A) of purchase and initial implementation and upgrade of certified EHR technology described in paragraph (3)(C)(i) and the average costs to such providers of operations, maintenance, and use of such technology described in paragraph (3)(C)(ii). In determining such costs for such providers, the Secretary may utili z e studies of such amounts submitted by States. ‘‘(5)(A) In no case shall the payments described in paragraph (1)(B) with respect to a Medicaid provider described in paragraph (2)(B) exceed — ‘‘(i) in the aggregate the product of— ‘‘(I) the overall hospital EHR amount for the pro- vider computed under subparagraph (B); and ‘‘(II) the Medicaid share for such provider com- puted under subparagraph (C); ‘‘(ii) in any year 50 percent of the product described in clause (i); and ‘‘(iii) in any 2-year period 9 0 percent of such product. ‘‘(B) For purposes of this paragraph, the overall hospital EHR amount, with respect to a Medicaid provider, is the sum of the applicable amounts specified in section 1 8 86(n)(2)(A) for such pro- vider for the first 4 payment years (as estimated by the Secretary) determined as if the Medicare share specified in clause (ii) of such section were 1. T he Secretary shall establish, in consultation with the State, the overall hospital EHR amount for each such Medicaid provider eligible for payments under paragraph (1)(B). For purposes of this subparagraph in computing the amounts under section 1886(n)(2)(C) for payment years after the first payment year, the Secretary shall assume that in subsequent payment years discharges increase at the average annual rate of growth of the most recent 3 years for which discharge data are available per year. ‘‘(C) The Medicaid share computed under this subparagraph, for a Medicaid provider for a period specified by the Secretary, shall be calculated in the same manner as the Medicare share under section 1886(n)(2)( D ) for such a hospital and period, except that there shall be substituted for the numerator under clause (i) of such section the amount that is equal to the number of inpatient-bed-days (as established by the Secretary) which are attributable to individuals who are receiving medical assistance Study.
