Montana Medicaid Electronic Health Records Incentive Program for Eligible Hospitals This presentation will focus on information related to your registration for the Medicaid incentive program for hospitals. I’ll leave the discussion of meaningful use to Rick Yearry from the Regional Extension Center. But I’m really excited to show you what we’ve been working on to make your interaction with the EHR Incentive Program as automated and painless as possible. First, a brief overview of the highlights of the program…

What is the Medicaid EHR Incentive Program 100% Federal funds for the adoption, implementation, upgrade, and meaningful use of certified EHR technology Voluntary participation by DPHHS Medicaid DPHHS is working diligently to provide a highly automated registration process that will limit the impact on your organization. 100% Federal incentive funding authorized by the ARRA – HITECH (Stimulus) of 2009. More than $27 billion dollars set aside for EHR incentives. 100% federal funding passed through the state Medicaid program. Voluntary for State Medicaid programs to participate. Funding authority granted to DPHHS as part of HB 2 Budget Bill. State HIT roadmap approved by CMS in April. Development of the State Level Repository began in July.

What is the Medicaid EHR Incentive Program State Level Provider registration is targeted to begin November 7, 2011. Incentive payment distribution will begin approximately 45 days following initiation of registration. Your ongoing participation is subject to audit by the state. Retaining attestation documentation is essential. State level registration available on November 7. Strongly advise providers wait until November to begin Federal and State registration at same time. Payments will begin about a month after registration opens. We intend to be very cautious in approval of payments in order to reduce the potential for payment errors. Due to the small number of providers in Montana, there is a very good chance that your organization will be audited. The DPHHS Quality Assurance Division will conduct random audits of providers to ensure compliance, so be sure to maintain your documentation.

Who Can Participate? Acute Care and Critical Access Hospitals that qualify Medicaid Patient Volume of greater than or equal to 10% for a period of 90 days or more Average length of stay must be less than or equal to 25 days The last 4 digits of CMS Certification Number or “CCN” is equal to 0001 through 0879 or 1300 through 1399. Hospitals are eligible for both Medicare and Medicaid incentive programs Your facility must meet all of these requirements for the duration of your participation in order to qualify

How much incentive money is available? Varies by hospital based on Medicaid volume and other factors Hospitals must register by 2016 Hospitals receive the following percentage of their Aggregate Overall EHR amount per year The hospital incentive amount calculation is very complex, and takes into account the number of Medicaid discharges, uncompensated care, and other factors. We’ll take a look at it in a minute Hospitals wishing to participate must initiate registration by 2016. The overall EHR amount will be paid out over a period of 4 years. We wanted hospitals to receive the bulk of the incentive payment as soon as possible, which is reflected by the fact that you will receive 80% over the first two years of participation. But we also want to ensure that we can continue to collect information regarding the use of your EHR systems as you move through the different stages of meaningful use.

DPHHS Provider Outreach Page http://mt.arraincentive.com/ DPHHS has developed the Provider Outreach Page or POP to provide valuable tools for providers to use to prepare for registering for the incentive programs. The actual State Level Repository registration site will not be available until November 7, but the POP will allow you to get a head start on collecting information necessary to register with both the National and State Level Repositories.

You can login to the SLR Web application from the Provider Outreach Web portal. This webpage features provider education resources as it relates to the ARRA and HITECH acts and also provides a link to the SLR application login page If you click on “CLICK HERE!”, you go to….

…a page of useful tools and links that will help you begin the process of gathering the information you will need to register for both the Federal System and the State Level Registry including: An eligibility workbook to help you determine if your hospital meets the 10% Medicaid patient volume requirement. And an AIU Attestation Workbook that will help you gather the information necessary to document the status of your certified EHR. But it all starts with Federal Registration….

Federal Registration Process First, all hospitals must register with the Medicare and Medicaid EHR Incentive Program Registration and Attestation System https://ehrincentives.cms.gov/hitech/login.action Remember that you cannot register for the Montana Medicaid Incentive program without first registering with the Medicare and Medicaid HER Incentive Program Registration and Attestation System. They used to call it the National Level Registry, or NLR, but I guess that wasn’t impressive enough for them. The national registration system serves two purposes: It is the registration site for the Medicare Incentive Program It is the federal registry that is used to ensure that EPs participate in only 1 incentive program, and that hospitals participate in only 1 state Medicaid incentive program. So this registration site looks like this….

Every night, the federal system will send a provider update to the Montana SLR. So once you have confirmation from the federal system that your registration is complete, you will wait about 24 hours to try to establish your SLR account. If after 24 hours you still cannot register for the SLR, please contact our help desk us so that we can resolve the issue with you. After setting up your account, the initial registration page will look like this…

This is the SLR home page This is the SLR home page. Registration for the Montana Medicaid incentive is completed in five easy steps.

Located to the left side of the page, the Reports section displays the following items that are visible on the home page. Some of these items only become usable as you progress through the appropriate step of the registration process. So to get started with registration, clicking the “About You” link on the EH homepage directs you to the “About You” page…

This is where you enter your basic registration information so that we know how to contact you. This is extremely important so that we can assist you through the process. The next step will take you to the “Confirm Montana Medicaid Program Eligibility” page….

This is where you enter the hospital’s eligibility information This is where you enter the hospital’s eligibility information. Simply answer the questions and the SLR will calculate patient percentages. This is a pretty straightforward calculation, but it is important to keep a few things in mind when you are gathering your patient data…

Patient Volume Calculations Eligible Hospitals Hospital Calculation Providers may count all out of state Medicaid patients for whom you provide services, as long as they are accounted for in both categories of discharges Count your Emergency Department encounters Do not count Healthy Montana Kids (CHIP) encounters as Medicaid Medicaid Inpatient Discharges ÷ Total Inpatient Discharges × 100 ≥ 10% Medicaid discharges include any service where: 1. Medicaid paid for part or all of the service; or 2. Medicaid paid all or part of the individual's premiums, co-payments, and/or cost-sharing Be sure to count all of your Emergency Department encounters. Once this step is complete, you will move on to the section of the SLR that deals with calculating your attestation statements and EHR incentive payment calculation….

The first step of completing this section is to choose your type of attestation: Adopt, Implement, or Upgrade. You will only be able to access this section once you complete the “About You” and “Confirm Medicaid Eligibility” pages. The next step is to enter your EHR certification information….

Once you have selected your attestation type, you will then be able to upload documents related to your EHR and enter the certification number of your EHR . Finally, its on to the Payment Calculator!!!!!.....

This is the Eligible Hospital Payment calculator. We’ve built this calculator into the portal so that you simply have to enter the requested information in order to determine your Aggregate EHR Incentive Amount. This calculation is terribly complex. If you need assistance, we have a fully staffed help desk with representative available to walk through the require information with you. You can find the number in the “Contact Us” area in the upper left hand corner of the page.

Questions? DPHHS EHR E-mail Medicaid Provider Outreach Page MedicaidEHR@mt.gov Medicaid Provider Outreach Page http://mt.arraincentive.com/ State Level Registry Help Desk 866-879-0109 CMS EHR Program Information https://www.cms.gov/EHRIncentivePrograms/

Extra Slides

Who Can Participate? Eligible Professionals Eligible Hospitals Doctor of medicine or osteopathy (MDs and DOs) Doctor of dental surgery or dental medicine Nurse practitioner Certified nurse-midwife Physician Assistant when practicing at an FQHC/RCH led by a physician assistant Acute Care Hospitals Critical Access Hospitals (CAHs)

Federal Rules for Hospital Eligibility Medicaid Patient Volume of greater than or equal to 10% for a period of 90 days Average length of stay must be less than or equal to 25 days The last 4 digits of CMS Certification Number or “CCN” is equal to 0001 through 0879 or 1300 through 1399. Hospitals are eligible for both Medicare and Medicaid incentive programs

How much incentive money is available? Eligible Professionals Eligible Hospitals $63,750 or less paid in fixed amounts over a period of 6 years Provider may interrupt participation, but must participate for the full 6 years to receive all funding. Provider must register by 2016 Provider may switch between incentive programs once before 2015 Varies based on Medicaid volume and other factors, beginning with a $2 million base amount Hospitals paid over 4 year period Hospitals must register by 2016 Payment years must be consecutive after 2016

Payment Schedule for Hospitals Hospitals receive the following percentage of their Aggregate Overall EHR amount per year Year 1: 50% Year 2: 30% Year 3: 10% Year 4: 10% At the discretion of each State Medicaid Program

Step 1: Determine Discharge Related Amount Payment Calculations Eligible Hospitals Step 1: Determine Discharge Related Amount For hospitals with < 1,150 or > 23,000 total discharges, there is no calculated discharge related amount. For hospitals with between 1,150 and 23,000 discharges, the following calculation must be applied: This calculation is based on the 12 month period (FFY) prior to payment year, and the three year average annual growth rate is determined using the most recent three years of available data from an auditable source.  Number of discharges between 1,150 and 23,000 × 1 + three year average annual growth rate $200 = Discharge Amount This is very complex formula, fortunately the SLR will make these calculations easier for you. But just so that you have a feel for how the calculation is made, here are the steps. 1. Calculate the discharge related amount

Step 2: Determine Overall EHR amount Payment Calculations Eligible Hospitals Step 2: Determine Overall EHR amount Year 1:  ($2,000,000 + Discharge Related Amount)  x  1.0 Year 2:  ($2,000,000 + Discharge Related Amount)  x  .75 Year 3:  ($2,000,000 + Discharge Related Amount)  x  .50 Year 4:  ($2,000,000 + Discharge Related Amount)  x  .25 Total of all 4 years Determine the Overall EHR amount based on the base rate, discharge related amount, and the 4 year growth factor.

Total Inpatient bed days Total charges – charity care Payment Calculations Eligible Hospitals Step 3: Determine Medicaid Share Total Inpatient bed days × Total charges – charity care Total charges = Medicaid Share Determine your Medicaid share. Remember that all of your information must be defendable during an audit, so careful documentation related to the numbers to which you attest is critical.

Step 4: Determine Aggregate EHR Amount: Payment Calculations Eligible Hospitals Step 4: Determine Aggregate EHR Amount: Overall EHR Amount × Medicaid Share = Aggregate EHR Amount

DPHHS HIT/EHR Website This is the DPHHS HIT/EHR Website which was redesigned and re-launched on Sept 1. Contains links to important information. It is essential that you take the time to educate yourself regarding the complexities of participating in this program. The federal rules for participation are very complex, especially with respect to achieving meaningful use. http://medicaidprovider.hhs.mt.gov/providerpages/ehrincentives.shtml

Basics of Meaningful Use Simply put, "meaningful use" means providers need to show they're using certified EHR technology in ways that can be measured significantly in quality and in quantity. There are 3 main components of Meaningful Use: The use of a certified EHR in a meaningful manner, such as e-prescribing. The use of certified EHR technology for electronic exchange of health information to improve quality of health care. The use of certified EHR technology to submit clinical quality and other measures.

Basics of Meaningful Use Healthcare providers seeking to demonstrate MU are required to attest their EHRs can support these measures in 2011, and then submit electronically in 2012. Eligible professionals and hospitals must meet MU objectives beginning in year 2, and each subsequent year of participation. Stage 1 (2011 and 2012) sets the baseline for electronic data capture and information sharing. Stage 2 (est. 2014) and Stage 3 (est. 2015) will continue to expand on this baseline and be developed through future rule making.

Basics of Meaningful Use Core Objectives A set of “Core” objectives established by CMS and specific to EPs and EHs, and that must be satisfied for providers to receive meaningful use incentives. These objectives include items such as: Collecting demographic information, Supporting information exchange among providers, Computerization of physician order entry, and E-prescribing. 10 “Menu Set” objectives. Montana Medicaid will not require providers to meet additional optional objectives.

Basics of Meaningful Use Core Objectives For eligible hospitals, there are a total of 24 meaningful use objectives. To qualify for an incentive payment, 19 of these 24 objectives must be met. There are 14 required core objectives. The remaining 5 objectives may be chosen from the list of 10 menu set objectives.

Basics of Meaningful Use Public Health EPs and EHs must choose at least one public health objective from the set of menu objectives, which include: Immunization information Reportable electronic laboratory results Syndromic surveillance data.

E-mail HIT/EHR Questions to DPHHS MedicaidEHR@mt.gov Montana Provider Outreach Page DPHHS e-mail address for program information