HealthBridge Meaningful Use and Health Care Transformation Conference Medicare & Medicaid EHR Incentive Programs Registration and Attestation

Session Overview Medicare and Medicaid Differences Brief look: Medicare and Medicaid Registration Attestation Current Registration & Payment Data Resources

Notable Differences Between Medicare and Medicaid Programs MedicareMedicaid Federal Government will implement (will be an option nationally) Voluntary for States to implement Payment reductions begin in 2015 for providers that do not demonstrate Meaningful Use No Medicaid payment reductions Must demonstrate MU in Year 1A/I/U option for 1 st participation year Maximum incentive is $44,000 for EPs (bonus for EPs in HPSAs) Maximum incentive is $63,750 for EPs MU definition is common for MedicareStates can adopt certain additional requirements for MU with CMS approval Last year a provider may initiate program is 2014; Last year to register is 2016; Payment adjustments begin in 2015 Last year a provider may initiate program is 2016; Last year to register is 2016 Only physicians, subsection (d) hospitals and CAHs 5 types of EPs, acute care hospitals (including CAHs) and children’s hospitals

REGISTRATION FOR THE MEDICARE & MEDICAID EHR INCENTIVE PROGRAMS

What is Needed to Participate Be enrolled in Medicare FFS, MA, or Medicaid (FFS or managed care) All Medicare providers and Medicaid eligible hospitals must have an enrollment record in the Provider Enrollment, Chain and Ownership System (PECOS)!!! They will not be able to complete registration if they do not have a PECOS enrollment record To determine if they have an enrollment record, they can go to 5

What is Needed to Participate All providers must: Use certified EHR technology Medicaid providers may adopt, implement, or upgrade in their first year Register via the EHR Incentive Program website Have a National Provider Identifier (NPI) and have a National Plan and Provider Enumeration System (NPPES) web user account. The NPPES user ID and password will be used to log into the incentive program system. 6

One Front Door All eligible providers can register for both the Medicare and Medicaid EHR Incentive Programs at the CMS site For Medicare- registration was launched January 3 rd and providers can now attest to meeting meaningful use of certified EHR technology. (As of April 18, 2011) For Medicaid- registration launched January 3 rd and 15 states have launched their programs.

Registration Hand-Off to States After registration, eligible providers who selected Medicaid (or eligible hospitals who selected “both”), are sent to a link to the States’ website URLs for States with live Medicaid EHR Incentive Programs They then log in at those URLs and complete the submission of required information and attest to AIU, etc

ATTESTATION FOR MEANINGFUL USE FOR MEDICARE PROVIDERS

As of April 18, 2011 Medicare eligible professionals and eligible hospitals are demonstrating meaningful use through CMS' web- based Medicare and Medicaid EHR Incentive Program Registration and Attestation System. In the Registration and Attestation System, providers fill in numerators and denominators for the meaningful use objectives and clinical quality measures, indicate if they qualify for exclusions to specific objectives, and legally attest that they have successfully demonstrated meaningful use.

From here, the user can navigate to the Registration and Attestation tabs. By clicking the Status tab, the user can view the current status of their registration, attestation, and payment(s). To begin attestation, the user can click on the Attestation tab.

ATTESTATION REQUIREMENTS IN STAGE 1 MEANINGFUL USE

What are the Requirements of Stage 1? Stage 1 Meaningful Use: Reporting period is 90 days for first year and 1 year for second year Reporting through attestation MU measures Clinical Quality Measures Reporting may be yes/no or numerator/denominator attestation To meet certain objectives/measures, 80% of patients must have records in the certified EHR technology

What are the Requirements of Stage 1? Eligible Professionals must complete: 15 core objectives 6 total Clinical Quality Measures (CQM) (3 core or alternate core, and 3/38 from menu set) 5 objectives out of 10 from menu set Hospitals must complete: 14 core objectives 15 CQM 5 objectives out of 10 from menu set

Meaningful Use Denominators Two types of percentage based measures are included in demonstrating Meaningful Use: 1.Denominator is all patients seen or admitted during the EHR reporting period The denominator is all patients regardless of whether their records are kept using certified EHR technology 2.Denominator is actions or subsets of patients seen or admitted during the EHR reporting period The denominator only includes patients, or actions taken on behalf of those patients, whose records are kept using certified EHR technology

Resources to Get Help and Learn More about MU and Attestation Meaningful Use Specification Sheets aningful_Use.asp#TopOfPage Attestation User Guide Downloads/EP_Attestation_User_Guide.pdf

ATTESTATION FOR MEDICAID PROVIDERS

Medicaid Attestation For the Medicaid EHR Incentive Program, providers will follow a similar process using their State's Attestation System. – Adopt, implement, upgrade of Certified EHR Technology – Other Medicaid eligibility requirements – States that have launched also have users guides online for their attestation systems

Which States launched so far? Alaska, Iowa, Kentucky, Louisiana, Michigan, Mississippi, North Carolina, Oklahoma, South Carolina, Tennessee, Texas, Alabama, Missouri, Indiana and Ohio (15) Of these, Alaska, Indiana, Iowa, Kentucky, Louisiana, Oklahoma, South Carolina, North Carolina, and Texas issued EHR Incentive Payments between January- May – Kentucky and Oklahoma both made over $5m total in EHR incentive payments in the 1 st three days Wondering about the status of your State? – The CMS website lists our latest information (updated monthly) about States’ timelines (and States are posting their approved State Medicaid HIT Plans)

Medicaid Hot Topics CMS is issuing a new State Medicaid Directors Letter providing States with further guidance about use of the 90/10 administrative matching funds for health information exchange (infrastructure development, interfaces, etc). – This builds off of the August 2010 SMD letter that already indicated support for Medicaid contributions to core HIE components, such as Master Patient Indexes and Provider Directories

3 rd Annual CMS Medicaid HITECH Conference May th in Baltimore If not attending in person, visit: to watch all of the plenary sessions and many of the concurrent sessions live (including the plenary that discusses what CMS will/won’t approve for HIE funding). Post-conference, all presentation will be available on that website.

Timeline/What’s Next Additional CMS and ONC coordination: – Linked oversight of Federally-funded HIT efforts at the State level – HIT Policy and Standards Committee – Quality Measure Development – Joint Site Visits – Collaboration on technical assistance efforts And of course…. – The 2012 CMS and ONC NPRMs and Final Rules on Stage 2 of Meaningful Use and the EHR Certification Criteria (ETA: January and June 2012)

Current Registration & Payment Data as of April 30 th, 2011 Medicaid - Medicaid EPs registered: 2,014 Total Medicaid EPs paid: $17,000,003 Total Medicaid payments to EHs: $66,294,775 Total as of May : $83,294,778 (and from only 7 States!) Medicare- Medicare EPs registered: 40,379 Medicare only EHs registered: 64 Dually-Eligible Hospitals registered: 1,149 First Medicare payments to be released by May 20th

Other Resources EHR Information Center: :30 a.m. – 6:30 p.m. (Central Time) Monday –Friday Submit a question online at: Visit our website Review the Frequently Asked Questions-Select “Frequently Asked Questions (FAQs)” from the left hand menu on the website