Connecticut Medicaid EHR Incentive Program Checklist for ...

1 Connecticut Medicaid EHR Incentive Program Checklist for eligible Professionals Last Revision: 07/01/2013. The Medicaid EHR Incentive programs provide Incentive payments to eligible professionals (EPs) to promote adoption and Meaningful Use (MU) of a certified Electronic Health Record (EHR). MU occurs in three stages: Stage 1 (data capture and sharing) 2011-2013; Stage 2. (advanced clinical processes) 2014-15; and Stage 3 (improved outcomes) expected to be implemented in 2016. In general, EPs will demonstrate MU in Stage 1 by using certified EHR. technology to meet MU objectives and report on clinical quality measures (CQM). This optional Medicaid EHR Incentive Program Checklist provides detailed steps to attest to adopting, implementing, or upgrading a certified EHR technology and meaningful use to qualify for Medicaid Incentive payments in years 1, 2 and 3. This form is intended to be used by the provider or staff attesting on behalf of the provider.

2 Whenever possible, links for further information are provided. Determine Eligibility for Medicaid EHR incentives To qualify for Incentive payments health care professionals must meet certain eligibility criteria. Adopt/implement/upgrade to (A/I/U) a Certified EHR. Be an eligible professional Meet Patient Volume Requirements A/I/U Certified EHR. The provider must verify (attest) that they are using an EHR product certified by the Office of the National Coordinator (ONC). Take these steps to assure you are using appropriate EHR. technology for achieving MU. Adopt/Implement/Upgrade (A/I/U) to a certified EHR. A comprehensive listing of certified EHR products can be found at the ONC Certified Health IT Product List at Providers should retain and when asked, provide or upload appropriate documentation in their EHR Incentive Payment application ( invoices, license agreements, purchase orders, and contracts) which support their attestation for certified EHR technology covering the appropriate EHR Incentive Program reporting period.

3 CT Medicaid eligible professional Checklist 1 07/01/2013 Qualifying as eligible Professionals EPs can determine if they meet the eligibility requirements for Medicaid EHR Incentive programs by reviewing the following table. If you check one of the items below, you may qualify as an EP under the Medicaid Program . eligible professionals under the Medicaid Incentive Program include: Physician (MDs and DOs) Physician assistant practicing in a Dentist Federally Qualified Health Center Certified nurse-midwife (FQHC) or Rural Health Center led Nurse practitioner by a physician assistant In addition, a Medicaid EP for each year for which the EP seeks an EHR Incentive payment: Must not be 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 and cannot claim an allowed hospital exclusion under CFR4955.

4 Must be licensed in the State of Connecticut . Must not have any current sanctions that have temporarily or permanently barred them from participation in the Medicare or State Medicaid programs . Qualifying for Patient Volume Requirements under the Medicaid EHR Incentive programs To be eligible to receive an Incentive under the Medicaid EHR Incentive Program , an EP must meet one of the following patient volume criteria during a consecutive 90-day period in the preceding calendar year or preceding 12 month period from date of attestation: Have at least 30% of your encounters furnished to Medicaid patients (20% for pediatricians)* OR. Practice predominately in an FQHC or RHC with a 30% needy individual patient volume threshold. Needy patient volume is defined as patients who are enrolled in the Medicaid or Children's Health Insurance Program (CHIP), receive uncompensated care, or receive care on a reduced fee scale.

5 Medicaid patients include individuals receiving services under HUSKY A, Husky C (formerly known as Medicaid Fee for Service) and HUSKY D (formerly known as Medicaid for Low Income Adults MLIA) programs . * Children's Health Insurance Program (CHIP) patients, known as HUSKY B patients in Connecticut , do not count toward the Medicaid patient volume criteria. For more information on eligibility, go to CMS EHR Incentive Program Eligibility page at CT Medicaid eligible professional Checklist 2 07/01/2013 Calculating Patient Volume for Medicaid The patient volume for Medicaid is calculated by dividing Medicaid encounters for the EP. during a consecutive 90-day period in the calendar year prior to or preceding 12 month period from the date of attestation by the total encounters over the same period. The numerator is the number of Medicaid encounters during the 90-day period selected.

6 Medicaid encounter is defined as any services that were rendered on any day to an individual enrolled in HUSKY A, HUSKY C (previously known as Medicaid FFS) or HUSKY D (previously known as MLIA) Program . The denominator is all patient encounters for the same EP over the same 90-day period. For example, if the EP had 100 encounters and 30 were Medicaid encounters, they would have a 30% patient volume. The calculation formula is: [Total Medicaid patient encounters in any representative continuous 90-day period in the preceding calendar year or preceding 12 month period from the date of attestation/Total patient encounters in that same 90-day period] *100. There is an option to calculate or aggregate patient volume for the entire organization and then each EP would use the organization's patient volume as a proxy for their individual patient volumes. However, in this case you would count encounters for ALL PROVIDERS - not just eligible professionals - when you calculate the group patient volume.

7 Thus, if you have providers who see a lot of patients but those encounters are not for Medicaid patients, it can lower your group rate. The opposite also could be true. If you elect to use group volume as proxy, all EPs within the practice must use the same group volume across all EP provider types. Register with Federal and Enroll in the State Operated EHR Incentive programs Before registering, EPs will need to decide whether to register under the Medicare or Medicaid Incentive Program . EPs who qualify for Medicare and Medicaid programs may only participate in one Program in a given year. Before 2015, EPs may switch Incentive programs only once after the first Incentive payment is initiated. EPs who can receive EHR Incentive payments under both programs will maximize their payments by choosing the Medicaid EHR Incentive Program . Incentive payments for EPs are based on individual practitioners.

8 If you're part of a practice, each EP may qualify for an Incentive payment if each EP successfully demonstrates MU of certified EHR technology. This Checklist only covers the Medicaid EHR Incentive Program . Third Party Registration CMS implemented functionality that allows an EP to designate a third party to register and attest on his or her behalf. To do so, users working on behalf of an EP must have an Identity and Access Management System (I&A) Web user account (User ID/Password), and be associated to the EP's NPI. If you are working on behalf of an EP(s) and do not have an I&A Web user account, please visit I&A Security Check at to create one. CT Medicaid eligible professional Checklist 3 07/01/2013 Gathering Information for Initial Registration in the CMS Medicare and Medicaid EHR. Incentive Program Registration & Attestation system: Prior to registering for the CMS EHR Incentive Program , EPs will need to gather the following information.

9 This will help expedite the registration process. You should also identify one individual from your organization that will be responsible for completing registration and attestation information. National Provider Identifier (NPI). o To locate your NPI number, go to NPPES NPI Registry page at o If you do not have an NPI number, to apply go to NPPES home page at National Plan and Provider Enumeration System (NPPES) User and ID and Password. If you do not have an NPPES Web user account, go to NPPES home page at Payee Tax Identification Number (TIN, for reassignment of individual provider benefits to an organization). Payee National Provider Identifier (NPI) (for reassignment of individual provider benefits to an organization). Note: In order to qualify for the CT Medicaid EHR Incentive payments, the EP and the Payee provider must be enrolled providers with Connecticut Medicaid . The payee Tax ID No.

10 And Payee NPI No. must match what is in the provider's Medicaid Management Information System (MMIS) account with the State of Connecticut . This combination should be the same NPI/TIN. that is used for the Connecticut interChange MMIS for claim payment purposes. If you have questions regarding your Connecticut Medicaid enrollment please contact the CT EHR Provider Assistance Center toll free at 1-855-313-6638. How to Register & Apply for Medicaid EHR Incentive Program Now that all the information has been gathered, the next step is to register with CMS. All EPs who are participating in the EHR Incentive Program must register for either the Medicare or Medicaid Incentive programs through CMS. This can be done using CMS's Step-by-Step Guides on Registration for the EHR Incentive programs at Guidance/Legislation/ You will not be able to start your CT Medicaid EHR application in the CT Medical Assistance Provider Incentive Repository (MAPIR) until you have registered with CMS.