Health Information Technology (HIT) Initiative Information Technology (HIT) Initiative Medical Assistance Health Information Technology Initiative (HIT) 2 Agenda • • • Enrollment

Medical Assistance Health Information Technology Initiative (HIT)

Pennsylvania Department of Public Welfare Office of Medical Assistance Programs

Health Information Technology (HIT) Initiative


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Agenda

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• Enrollment Process

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Medicare / Medicaid Program Differences

Eligibility Standards

Incentive Payment Overview

Meaningful Use Overview

Available Support


Differences Between Medicaid and Medicare Medicare Medicaid

Payment reductions begin in 2015 for providers that do not demonstrate MU

No Medicaid payment reductions

Must demonstrate MU in Year 1 Adoption, Implementation, Upgrade option for first 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 Medicare States can adopt certain additional requirements for MU

Only physicians, subsection (d) hospitals and CAHs

5 types of EPs, acute care hospitals (including CAHs) and children’s hospitals

Eligible hospitals can receive both Medicaid and Medicare payments

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Eligible Providers and Requirements

Provider Type Minimum Medicaid patient volume threshold

Physicians 30%- Pediatricians 20%

Dentists 30%

CNMs 30%

NPs 30%

FQHCs / RHCs 30% Needy individuals

Acute care hospitals (includes CAHs) 10%

Children’s hospitals No requirement

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Patient Volume

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Eligible Professionals (EPs) - Minimum 30% Medical Assistance (MA) encounters except for pediatricians with a minimum 20% MA encounters

Federally Qualified Health Center or Rural Health Clinic – Same percentages for EP’s but includes both MA encounters and encounters with “needy individuals”

Hospitals – Minimum of 10% for Acute Care Hospitals (includes Critical Access Hospitals); no minimum for Children’s Hospitals



Patient VolumeCalculations based on continuous 90-day period in the

preceding calendar year

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Eligible Professionals

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Physician defined as MDs and DOs

Practitioners must be licensed and are within the scope of practice defined under State law

Medicaid EPs may not be hospital-based. A Medicaid EP is considered hospital-based if 90% or more of the EP's services are performed in a hospital inpatient or emergency room setting.



Eligible Hospitals

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Medicaid eligible hospitals must be enrolled in PECOS

One CMS Certification Number (CCN) = one hospital

Acute care hospital––

Average length of stay of ≤25 days + CCN [0001-0879; 1300-1399]Includes: Cancer hospitals; CAHs; and general, short- term stay

Children’s hospital––

77 children’s hospitals, CCN [3300-3399]Not children’s wings of larger hospitals

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Additional Requirements

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Eligible professionals must be enrolled as a MA providerFor additional information please go to: http://www.dpw.state.pa.us/PartnersProviders/PROMISe/003680607.htmOr call: 1-800-537-8862 (select provider enrollment option)

Providers must have registered an National Provider Identifier (NPI) with Medical AssistanceProviders can apply for an NPI online at the National Provider and Plan Enumeration System (NPPES) website https://nppes.cms.hhs.gov


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Incentive Program Enrollment

Easy Application Process

Medical Assistance Health Information Technology Initiative (HIT) Legal Entity Name __Pre-populate from NLR_____NPI (Servicing) __ Pre-populate from NLR ___

Personal TIN ____ Pre-populate from NLR ____Payee TIN ___ Pre-populate from NLR_______

Provider Applicant Eligibility Determination

Multi‐Select Drop Down – 15 Specialties + “Other – Typ e Below” and

“Not Board Certified”

1. What type of provider are you (check all that apply)?

Physician Dentist Midwife CRNP Pediatrician

2. Are you board‐certified? Select all board specialties that apply?

If “Other”, please explain _______________________

3. Are you a hospital based physician ? (hover button will define hosp‐based)

Yes No4. As an eligible professional, you must choose between participating in the Medicaid or Medicare incentive in one state. Please confirm that you are choosing the Medicaid incentive program in Pennsylvania.

Yes No

5. Are you participating in another state’s Medicaid EHR incentive payment program? Yes No

6. Do you have any sanctions or pending sanctions with Medicare or Medicaid in any state (Confirm with NLR)?

Yes No

7. Are you currently in compliance with all parts of the HIPAA regulations? Yes No

8. Are you licensed to practice in Pennsylvania? Yes No

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PTAN/CCN ____ Pre-populate from NLR ____Payee TIN ___ Pre-populate from NLR_______

Hospital Applicant Eligibility Determination

1 . What type of hospital are you?Children’sHosp

Acute Care

2. If applying as an Acute Care hospital, you must demonstrate that you serve the PA Medicaid population to participate. Please indicate the service locations in which you are meeting the MA patient volume requirements. Select a 90 day range and complete the following table with discharge data to determine eligibility in the chart below.

Pop‐up calendar for provider to select 90‐day period for Acute care hospitals only.

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Medical Assistance Health Information Technology Initiative (HIT) Provider Name ____________________________NPI (Servicing) __________________________________ Legal Entity Name __Pre-populate from NLR_____NPI (Servicing) __ Pre-populate from NLR ___

Personal TIN ______________________________Payee TIN _________________________________Personal TIN ____ Pre-populate from NLR ____Payee TIN ___ Pre-populate from NLR_______ ______

Provider Application Attestations (4)Adoption, Implementation, and Upgrade Incentive Payments*

1. Please indicate for which of the following phase (select one) you would like to receive an incentive payment.A d o p t i o n : A c q u i s i t i o n a n d in s t a l l a t io n o f a n E H R s y s t e m . * *

I m p l e m e n t a t i o n : Y o u h a v e in s t a l l e d c e r t i f i e d E H R t e c h n o lo g y a n d h a v e s t a r t e d u s in g t h e t r a in in g in t h e c e r t i f i e d E H R t e c h n o lo g y , t h e d a t a e n t r y o f t h e i r p a t i e n t s ’ d em o g r a p h ic a n d a d m in i s t r a t iv e d a t a in t o t h e E H R , o r e s t a b l i s h in g d a t a e x c h a n g e a g r e e m e n t s a n d r e l a t io n s h ip s b e tw e e n t h e p r o v id e r ’ s c e r t i f i e d E H R t e c h n o lo g y a n d o th e r p r o v id e r s , s u c h a s l a b o r a t o r i e s , p h a rm a c ie s , o r H IE s .* * *U p g r a d e : E x p a n s io n o f f u n c t io n a l i t y o f t h e c e r t i f i e d E H R t e c h n o lo g y , s u c h a s t h e a d d i t io n o f c l in i c a l d e c i s io n s u p p o r t , e ‐p r e s c r ib in g f u n c t io n a l i t y , C P O E o r o th e r e n h a n c e m e n t s t h a t f a c i l i t a t e t h e m e a n in g fu l u s e o f c e r t i f i e d E H R t e c h n o lo g y .* * * *M e a n in g f u l U s e : Y o u h a v e a n E H R s y s t e m a l r e a d y c a p a b l e o f c a p t u r in g m e a n in g fu l u s e m e a s u r e s .

Based on the selection above, one of the three sets of questions below will appear as the next screen. There will be standard drop down selections and an “Other” with a fill‐in for questions for each phase.

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PTAN/CCN ____ Pre-populate from NLR ____Payee TIN ___ Pre-populate from NLR_______

Application Submittal Confirmation/Digital Signature (6)

This is to certify that the foregoing information is true, accurate, and complete. I understand that Medicaid EHR incentive payments submitted under this provider number will be from Federal funds, and thatany falsification, or concealment of a material fact may be prosecuted under Federal and State The Department may ask for additional information on any of the information submitted as part of this form. The Department will pursue repayment in all instances of improper or duplicate payment.Digital Signature of Provider Receiving Incentive Payment – Provide r Initials, NPI, Personal TIN, Confirmation

If prepared by someone other than the applicant, please assure attest to the above and provide your relationship to the applicant (self, office manager, assistant, etc.)

Digital Signature of Preparer – Preparer Initials, Relationship to Applicant , Confirmation

Your application is complete and has been submitted for further review. You will be receiving an email within the next XX days.

Please print this application for your records. Questions can be referred to the following email.

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Incentive Program Enrollment – Key Dates

Objective Target Submit State Medicaid HIT Plan September 2010

Begin provider education on enrollment process

Fall 2010

Initial NLR enrollment Beginning of 2011Medicaid application and incentive payments to providers would be available in. Depending on NLR implementation.

Spring 2011

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Incentive Payments – Eligible Professionals••

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First payment year is for adoption, implementation, upgradePayments do not have to be in consecutive years and amounts below are only an estimate of maximum paymentsPediatricians who do not meet the 30% threshold would receive no more than $14,167 in year one and $5,667 in subsequent years

CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016

CY 2011 $21,250

CY 2012 $8,500 $21,250

CY 2013 $8,500 $8,500 $21,250

CY 2014 $8,500 $8,500 $8,500 $21,250

CY 2015 $8,500 $8,500 $8,500 $8,500 $21,250

CY 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250

CY 2017 $8,500 $8,500 $8,500 $8,500 $8,500

CY 2018 $8,500 $8,500 $8,500 $8,500

CY 2019 $8,500 $8,500 $8,500

CY 2020 $8,500 $8,500

CY 2021 $8,500

TOTAL $63,750 $63,750 $63,750 $63,750 $63,750 $63,750


Incentive Payments for Eligible Hospitals

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Federal Fiscal Year

$2M base + per discharge amount (based on Medicare/Medicaid share)

There is no maximum incentive amount

Hospitals meeting Medicare MU requirements may be deemed eligible for Medicaid payments

Medicaid hospitals: Cannot initiate payments after 2016

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Meaningful Use (MU) Overview

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Eligible Professionals 25 Objectives (15 Core and 10 Menu set)

EPs have to report on 20 of 25 MU objectives in Stage 1

44 Clinical Quality Measures (CQMs) for EPs – must report total of 6

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24 measures for eligible hospitals (14 Core and 10 Menu set)

Hospitals must report on 19 of 24 MU objectives in Stage 1

15 CQM for eligible hospitals – must report on all

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Provider SupportResources Available to

Providers•

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State Medicaid HIT website: http://www.dpw.state.pa.us/PartnersProviders/MedicalAssistance/MAHITI/

Join listserv to get updates and additional information:http://listserv.dpw.state.pa.us/ma-health-it-initiative.html

Email: Matt McGeorge, OMAP HIT Operations [email protected]

PROMISe™ : https://promise.dpw.state.pa.us/– Training on Internet Portal:

http://www.dpw.state.pa.us/omap/promise/provconfcalltrng_process.asp

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State Medicaid Health IT Website

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Documents

Health Information Technology (HIT) Initiative Information Technology (HIT) Initiative Medical Assistance Health Information Technology Initiative (HIT) 2 Agenda • • • Enrollment