An Opportunity for Transformation in Puerto Rico Jessica Kahn, MPH Technical Director for Health IT Center for Medicaid, CHIP, Survey and Certification The Medicaid EHR Incentive Program

The state of the States and Territories 17 launched their Medicaid EHR Incentive Programs – Of these 12 have paid out nearly $126 million Medicaid has already paid over $86 million to 92 hospitals in 12 States since January 2011 CMS has awarded 50 States, DC, USVI, Guam and Puerto Rico over $320.2 million in administrative funding – 25 States have received implementation funding – 54 States and Territories have received planning funding

Puerto Rico Was awarded $1,998,040 approximately 15 months ago in planning funds with which to develop a State Medicaid HIT Plan (SMHP) and associated funding request document (called an I-APD) The SMHP details how the Medicaid EHR Incentive Program will be implemented, what the current HIT landscape looks like, what the vision is and how program oversight and auditing will be handled Could see over $100 million in EHR incentives for Puerto Rican providers Puerto Rican hospitals can ONLY participate in the Medicaid EHR Incentive Program per statute

States & Territories Continued What does “launch” mean? Reminder: this is a voluntary program for States/Territories States get 90/10 matching funds to administer their program. HIT has bi-partisan support with significant provider and stakeholder involvement CMS is investing tremendous time and resources into technical assistance – State Medicaid HIT Plans – Communities of Practice – Peer to Peer support

What can administrative funding be spent on? Administration of Medicaid payments to Medicaid eligible providers Oversight of the Medicaid EHR Incentive Program, including tracking of meaningful use attestation and reporting mechanisms Pursuit of initiatives that encourage the adoption of certified EHR technology for the promotion of healthcare quality and the electronic exchange of health information.

Why Launch in 2011? Momentum of provider and Federal interest and funding – HIE and REC grants – MMIS – Eligibility Systems – Accountable Care Organizations Opportunities to improve healthcare for Puerto Ricans; lower healthcare costs Economic stimulus to the healthcare sector (jobs!)

Guidance, Guidance, Guidance “Dear State Medicaid Director” letters – September 2009: Planning Funding – August 2010: Implementation Funding – April 2011: Disregard the net average allowable costs – May 2011: Medicaid Funding for Health Information Exchange Frequently Asked Questions and Tools – Patient volume – Have to define what will be audited & how – Intersections with the RECs and HIE Grantees

Lessons Learned from “Pace Car” States Providers need a lot of assistance with registration and attestation Engage other partners (RECS, professional associations, etc) Emphasize other benefits of access to clinical data (e.g. lab results) for administrative simplification (prior authorizations, level of care determinations, etc)

More Lessons Learned States are understaffed Consultants with HITECH experience are good resources to help fill in the gaps, conduct the environmental scans, help write the SMHPs, convene stakeholders, etc. SMHPs are dynamic documents- priorities evolve, not all the answers are clear at the present Incremental steps still = progress

Next Steps for CMS NPRM for Stage 2 (ETA: January 2012) Public Comment Period Final Rule for Stage 2 (ETA: June 2012) States beginning to collect Medicaid providers’ meaningful use data for 2012 Subject to funding availability, States investing along with other payers and providers in Health Information Exchange Alignment with enhanced Medicaid eligibility systems, Health Insurance Exchanges and Accountable Care Organizations

Resources Videos FAQs list-serv EP Users’ Guides for Registration and Attestation EH Users’ Guide for Registration and Attestation Helpful Links Monthly data on provider registration, attestation and payment