Connecticut Medicaid EHR Incentive Program of Meaningful Use-Year 1 and A/I/U

Key Points for Behavioral Health Providers who want to participate in CT EHR Incentive Program

• For year 1 of Medicaid program, eligible professionals can attest once a certified EHR is purchased.

• Although CMHA’s are not eligible for the program, rendering providers can reassign the incentive dollars back to the agency.

• In order to participate, a provider must have an individual CT Medical Assistance Program provider ID.

• What you can do now-– Have the discussion with your providers about MU and the

reassignment of incentive dollars– Pull together all necessary data required for registration and

attestation including the individual provider ID. • If your provider does not have an individual Medicaid provider ID number,

begin the application process now.

Year 1 CT Medicaid EHR Incentive Program for Eligible Professionals

For year 1, of the Medicaid EHR Incentive Program only, an Eligible Professional can earn the first year incentive payment by attesting to A/I/U

Connecticut Medicaid defines Adopt, Implement or Upgrade (A/I/U)

For year 1 of the Medicaid EHR Incentive Program only, an Eligible Professional can earn the first year incentive payment by attesting to A/I/U

Adopt - Acquire, purchase or install a certified EHR system.Implement - Install or commence use of certified EHR technology and have started one of the following:Upgrade - Expand the available functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, including staffing, maintenance, and training, or upgrade from existing EHR technology to certified EHR technology per the Office of the National Coordinator (ONC) EHR certification criteria.

Non hospital based

A hospital-based EP is defined as an EP who furnishes 90% or more of their covered professional services in either the inpatient or emergency department of a hospital;

Which provider types are eligible to participate in the CT Medicaid EHR Incentive program?

1. Physician (primarily doctors of medicine and doctors of osteopathy)

2. Nurse Practitioner 3. Certified Nurse-Midwife 4. Dentist 5. Physician Assistant who furnishes services in

a Federally Qualified Health Center (FQHC) or Rural Health Clinic that is led by a physician assistant

Additional eligibility requirements

• Must be licensed in the state of Connecticut; • Must have an individual Medicaid

Provider ID number• Must not have any current sanctions

that have temporarily or permanently barred them from participation in the Medicare or State Medicaid programs.

Must meet Patient Volume requirements

To qualify for an incentive payment under the Medicaid EHR Incentive Payment Program, an EP must meet one of the following criteria over any continuous 90-day period in the preceding calendar year:

1. Have a minimum 30% Medicaid patient volume; 2. Have a minimum 20% Medicaid patient volume, and is a pediatrician; 3. Practice predominantly in a FQHC or Rural Health Center and have a

minimum 30% patient volume attributable to needy individuals.

• Medicaid patients include individuals receiving services under Medicaid Fee-for-Service (FFS), Medicaid for Low Income Adults (MLIA) and the HUSKY A programs.

Patient Volume: Individual or group by proxy

• EPs that are members of group practices or clinics can either use their individual claim volume or use the group practice/clinic claim volume to calculate patient volume. Using the group practice/clinic claim volume will be subject to the following limitations:

1. The clinic or group practice’s patient volume is appropriate as a patient volume methodology calculation for the EP.

2. There is an auditable data source to support the clinic’s or group practice’s patient volume determination.

3. All EPs in the group practice or clinic must use the same methodology for the payment year.

4. The clinic or group practice uses the entire practice or clinic’s patient volume and does not limit patient volume in any way.

5. If an EP works inside and outside of the clinic or practice, then the patient volume calculation includes only those encounters associated with the clinic or group practice, and not the EPs outside encounters.

How to complete the calculation

To calculate patient volume an EP must Total Medicaid patient encountersTotal patient encounters

Both numerator and denominator must come from the same consecutive

90-day period in the previous calendar year.

An encounter is defined as services rendered to

– a Medicaid FFS,– MLIA or HUSKY A

individual on any one day where Medicaid, MLIA or a Medicaid Managed Care Organization paid for part or all of the service; or paid all or part of the individuals’ premiums, co-payments, and cost-sharing.

What each eligible professional will need for registration and attestation at CMS

• National Plan and Provider Enumeration System (NPPES) User ID and Password

• National Provider Identifier (NPI) • Provider Tax Identification Number • Payee Tax Identification Number if you

are reassigning your incentive payments • Payee National Provider Identifier if you

are reassigning your incentive payments

If you do not have any of these numbers..

• If you do not have a CT Medicaid provider ID, you must register asap as a CT Medical Assistance Program as either a performing or billing provider http://www.chnct.org/providers.aspx

• If you do not know or to locate your NPI number, visit: https://nppes.cms.hhs.gov/NPPES/NPIRegistryHome.do

• If you do not have an NPPES login account, you must get one. https://nppes.cms.hhs.gov/NPPES

Reassigning Incentive payments

• If the eligible professional (EP) is a rendering physician for your agency/clinic , you will want to ask the EP to reassign the incentive dollars to your agency. • We recommend each agency should

negotiate and execute a written reassignment of incentive payment agreement

Required supporting documentation needed for attestation in MAPIR system

• Documentation supporting A/I/U of Certified EHR Technology including invoices, license agreements, purchase orders, and contracts (Required)

• CMS Certification EHR ID Cart page showing certification ID and certified EHR product(s) used (Required)

• Documentation supporting patient volume calculations (e.g. Practice Management System reports) (Optional, but strongly recommended)

• Dashboard screenshots, printouts or reports from the certified EHR technology supporting the Meaningful Use attestation (Required)

• Dashboard screenshots, printouts or reports from the certified EHR technology supporting the Clinical Quality Measures (Optional)

• Public health meaningful use measure exclusion letter, if applicable (Optional)

• Please Note: Only PDF format documents, no greater 2 Mega Bytes (MB) in size, can be uploaded into MAPIR.

Step by step• Gather all required numbers and other information (NPI, Individual

Medicaid ID, NPPES login info, etc)

• Execute Reassignment of incentive agreement

• Register at CMS

• Wait up to 48 hours

• Print out supporting documentation needed for upload in MAPIR system

• Attest at CT State Medicaid using MAPIR system

• Wait for incentive payment

Links to the sources and authorities on the EHR Incentive Programs

• Connecticut EHR Incetive Program User Manual for EPs• CT Medicaid EHR Incentive Program site>Connecticut EHR Incentive Program website link

• CT EHR Incentive Program Resources: Please contact the following for assistance: – 1-855-313-6638, Monday through Friday from 8:00 am to 5:00 pm EST – ctmedicaid-ehr@hp.com

• Eligibility Requirements for EPS in Connecticut> https://www.ctdssmap.com/CTPortal/portals/0/StaticContent/Publications/EHR%20Eligibility%20for%20Professionals.pdf

• Centers for Medicaid and Medicaid Services, EHR Incentive Program> http://www.cms.gov/ehrincentiveprograms/

• The Meaningful Use specification Sheets on each of the Core and Menu Measures > http://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf

• EP eligibility Decision Tool> https://www.cms.gov/EHRIncentivePrograms/15_Eligibility.asp

• Department of Health and Human Services (HHS) Frequently Asked Questions>http://questions.cms.hhs.gov/app/answers/list/p/21,26,1139

Other links you may find helpful

• HITECH Answers> www.HITECHAnswers.net

• TWITTER LINKS: http://twitter.com/ONC_HealthIT http://twitter.com/HITECHAnswers http://twitter.com/CMSGov http://twitter.com/GovHIT http://twitter.com/AHRQNews

Disclaimer

It is important that each individual take responsibility for understanding of the final rules and regulations of the Medicaid and Medicare EHR Incentive Programs. Qualifacts Systems Inc and www.MUforBH.com offers these free webinars as a service and makes every effort to provide accurate information. We make no claim that our information is complete or contains no inaccuracies.

Under no circumstances shall anyone associated with Qualifacts Systems Inc. be liable for any incidental, indirect, consequential or special damages or loss of any kind including those resulting from the expected incentives themselves.

Qualifacts Systems, Inc and www.MUforBH.com in no way considers itself the ultimate authority or expert on the final rules and regulations of the Medicare and Medicaid EHR Incentive Programs and expects that each individual will consult the state specific Medicaid EHR Incentive Program website for their specific states rules and/or the CMS website for the EHR Incentive Program Rules.

It is important that each Eligible Professional note that CMS views the EP as ultimately responsible for the numerator and denominator and their Medicaid Encounter volume as well as the data used for attestation on the measures of Meaningful Use. CMS has announced there will be audits. “There are numerous pre-payment edit checks built into the EHR Incentive Programs’ systems to detect inaccuracies in eligibility, reporting and payment. Post-payment audits will also be completed during the course of the EHR Incentive Programs.”

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