New Jersey Medicaid EHR Incentive Program Hospital Overview

Presentation Summary Medicaid EHR Incentive Program Overview Eligibility Adopt, Implement, Upgrade, and Meaningful Use Definitions Payment Calculation and Schedule Registration and Attestation Questions and Answers

Program Overview

Program Overview The Medicaid EHR Incentive Program will provide incentive payments to eligible hospitals as they adopt, implement, or upgrade certified EHR technology in their first year of participation and demonstrate meaningful use for two additional years.

Program Overview Incentive payments to hospitals will begin being distributed in January – February 2012. The last year a Medicaid eligible hospital may begin the program is 2016. Hospital payments will vary by facility based on hospital size and Medicaid concentration Hospitals may receive payments from BOTH the Medicare and Medicaid EHR Incentive Programs

Eligibility

Eligibility Acute Care Hospitals Children’s Hospitals General hospitals, cancer hospitals and critical access hospitals Average length of patient stay of 25 days or fewer CMS Certification Number (CCN) with the last four digits in the series 0001 – 0879 and 1300-1399 10% Medicaid Patient Volume based on encounters Children’s Hospitals CCN with last four digits in the series 3300 – 3399 No patient volume requirement

Eligibility: Medicaid Encounter A hospital encounter occurs only in a hospital’s inpatient department, or emergency department on any one day One Medicaid encounter is tallied: For each inpatient discharge IF Medicaid paid for any part of the patient’s stay, and For each emergency department visit (no more than one per patient per day), IF Medicaid paid for any part of that ER visit.

Patient Volume Calculation Medicaid Encounter count for a selected 90 day period divided by Total inpatient discharges + emergency room visits for the same period If the total is greater than 10%, the hospital is eligible for a Medicaid EHR Incentive Payment New Jersey Medicaid recommends that hospitals use their Medicare or Medicaid cost reports for all calculations.

Adopt, Implement, Upgrade and Meaningful Use

Adopt, Implement or Upgrade (AIU) Hospitals must demonstrate one of these to receive a Year 1 incentive payment: Adopt – Acquire, purchase, or secure access to certified EHR technology Implement - Install or commence utilization of certified EHR technology Upgrade - Expand the available functionality of certified EHR technology

Adopt, Implement or Upgrade (AIU) Documentation proving AIU should be uploaded into the attestation system, and should include the following: Identification of the EHR technology being adopted or already in use Signed contract or financial record indicating the purchase, acquisition or lease of certified EHR technology

Meaningful Use Hospitals must demonstrate meaningful use to receive Year 2 and 3 incentive payments Meaningful Use Includes: Compliance with all 14 ONC “Core” Meaningful Use objectives Compliance with 5 of the 10 “Menu Set” Meaningful Use objectives All meaningful use attestations will be subject to audits performed by CMS

Payment Calculation and Schedule

Payment Calculation Basics Payment is calculated once and will be distributed over three years: 50% Year 1, 40% Year 2, 10% year 3 Complex formula based on projected hospital discharge growth rates and Medicaid patient volume EHR Incentive Program Payment System will perform the calculation More detail on the calculation formula is available at www.nj.gov/njhit/ehr.

Payment Calculation: Information Needed Total acute inpatient discharges for the last 4 completed hospital fiscal years Total acute inpatient bed days for the entire hospital fiscal year completed in the most recently completed federal fiscal year Acute inpatient bed days which Medicaid (Title XIX only, fee-for-service or managed care) paid a share of for the same hospital fiscal year Excluding Medicaid/Medicare dual eligible days

Payment Calculation: Information Needed Total charges for the hospital fiscal year completed in the most recently completed federal fiscal year Total Charity Care charges for the hospital fiscal year completed in the most recently completed hospital fiscal year

Payment Calculation: Additional Points Recommended Data Sources: Medicare Cost Reports Medicaid Cost Reports Financial Statements or Accounting Records Six page description of the payment calculation process is available at http://www.nj.gov/njhit/hospitals/calculation

Registration and Attestation

Registration and Attestation Timeline November 7, 2011 – National Level Repository registrations launched December 2011 – EHR Incentive Program Attestation System launches January/February 2012 – Initial EHR Incentive Program payments distributed

National Level Registration CMS Administered Process with state verification Verifies that hospital meets the basic eligibility criteria for the Medicaid EHR Incentive Program Opened for the New Jersey Medicaid EHR Incentive Program on 11/7/11

National Level Registration Hospitals that already registered as dually-eligible for the Medicaid and Medicare programs have already completed this process Hospitals that have never registered can go to ehrincentives.cms.gov to begin the process Registration User Guide is available at www.nj.gov/njhit/ehr

National Level Registration Information Needed to Complete the Process: Name of the eligible hospital National Provider Identifier (NPI) Provider Enrollment, Chain, and Ownership System (PECOS) Provider Number CCN (CMS Certification Number) Business address and phone number Valid Email address Taxpayer Identification Number (TIN)

State Level Attestation Begins once NLR Registration is successfully completed Allows hospitals to enter their Medicaid patient volume information, upload AIU documentation, and enter information needed for payment calculation Application will be available within the provider portal section of www.njmmis.com All information entered will be subject to audit that could result in recoupment

State Level Attestation Information Needed to Complete Attestation: Medicaid Provider ID 90 day period for patient volume calculation Medicaid Fee-for-Service and Managed Care encounters for the selected 90 day period Total encounters for the selected 90 day period Any out-of-state Medicaid fee-for-service or managed care patient encounters Total discharges for the four most recently completed hospital fiscal years

State Level Attestation Information Needed to Complete Attestation: Medicaid fee-for-service and managed care acute inpatient bed days for the most recently completed hospital fiscal year Total acute inpatient bed days for the most recently completed hospital fiscal year Total Hospital Charges (including Charity Care charges) Charity Care Charges CMS EHR Certification Number

State Level Attestation Additional Attestation Information: Once all information is entered, hospitals will have 72 hours to change any information included in the attestation The attestation system will verify all Medicaid information entered against information available in NJMMIS New Jersey Medicaid recommends using Medicare cost reports to complete the attestation process. The lines that should be used are available at www.nj.gov/njhit/ehr

Additional Information EHR Incentive Program Website www.nj.gov/njhit/ehr NJMMIS Provider Services 1-800-776-6334, Option 7 Have your Medicaid Provider ID number Program e-mail address MAHS.ehrincentives@dhs.state.nj.us