Connecticut Medicaid EHR Incentive Program Checklist for Eligible Professionals Last Revision: 07/01/2013

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1 Connecticut Medicaid EHR Incentive Program Checklist for Eligible Professionals Last Revision: 07/01/2013 The Medicaid EHR incentive programs provide incentive payments to eligible professionals (EPs) to promote adoption and Meaningful Use (MU) of a certified Electronic Health Record (EHR). MU occurs in three stages: Stage 1 (data capture and sharing) ; Stage 2 (advanced clinical processes) ; and Stage 3 (improved outcomes) expected to be implemented in In general, EPs will demonstrate MU in Stage 1 by using certified EHR technology to meet MU objectives and report on clinical quality measures (CQM). This optional Medicaid EHR Incentive Program checklist provides detailed steps to attest to adopting, implementing, or upgrading a certified EHR technology and meaningful use to qualify for Medicaid incentive payments in years 1, 2 and 3. This form is intended to be used by the provider or staff attesting on behalf of the provider. Whenever possible, links for further information are provided. Determine Eligibility for Medicaid EHR Incentives To qualify for incentive payments health care professionals must meet certain eligibility criteria. Adopt/implement/upgrade to (A/I/U) a Certified EHR Be an Eligible Professional Meet Patient Volume Requirements A/I/U Certified EHR The provider must verify (attest) that they are using an EHR product certified by the Office of the National Coordinator (ONC). Take these steps to assure you are using appropriate EHR technology for achieving MU. Adopt/Implement/Upgrade (A/I/U) to a certified EHR. A comprehensive listing of certified EHR products can be found at the ONC Certified Health IT Product List at Providers should retain and when asked, provide or upload appropriate documentation in their EHR Incentive Payment application (e.g. invoices, license agreements, purchase orders, and contracts) which support their attestation for certified EHR technology covering the appropriate EHR Incentive Program reporting period. CT Medicaid Eligible Professional Checklist 1 07/01/2013

2 Qualifying as Eligible Professionals EPs can determine if they meet the eligibility requirements for Medicaid EHR Incentive Programs by reviewing the following table. If you check one of the items below, you may qualify as an EP under the Medicaid program. Eligible professionals under the Medicaid Incentive Program include: Physician (MDs and DOs) Physician assistant practicing in a Dentist Federally Qualified Health Center Certified nurse-midwife (FQHC) or Rural Health Center led Nurse practitioner by a physician assistant In addition, a Medicaid EP for each year for which the EP seeks an EHR incentive payment: Must not be hospital-based. A hospital-based EP is defined as an EP who furnishes 90% or more of their covered professional services in either the inpatient or emergency department of a hospital and cannot claim an allowed hospital exclusion under CFR4955. Must be licensed in the State of Connecticut. Must not have any current sanctions that have temporarily or permanently barred them from participation in the Medicare or State Medicaid programs. Qualifying for Patient Volume Requirements under the Medicaid EHR Incentive Programs To be eligible to receive an incentive under the Medicaid EHR Incentive Program, an EP must meet one of the following patient volume criteria during a consecutive 90-day period in the preceding calendar year or preceding 12 month period from date of attestation: Have at least 30% of your encounters furnished to Medicaid patients (20% for pediatricians)* OR Practice predominately in an FQHC or RHC with a 30% needy individual patient volume threshold. Needy patient volume is defined as patients who are enrolled in the Medicaid or Children s Health Insurance Program (CHIP), receive uncompensated care, or receive care on a reduced fee scale. Medicaid patients include individuals receiving services under HUSKY A, Husky C (formerly known as Medicaid Fee for Service) and HUSKY D (formerly known as Medicaid for Low Income Adults MLIA) programs. * Children's Health Insurance Program (CHIP) patients, known as HUSKY B patients in Connecticut, do not count toward the Medicaid patient volume criteria. For more information on eligibility, go to CMS EHR Incentive Program Eligibility page at CT Medicaid Eligible Professional Checklist 2 07/01/2013

3 Calculating Patient Volume for Medicaid The patient volume for Medicaid is calculated by dividing Medicaid encounters for the EP during a consecutive 90-day period in the calendar year prior to or preceding 12 month period from the date of attestation by the total encounters over the same period. The numerator is the number of Medicaid encounters during the 90-day period selected. Medicaid encounter is defined as any services that were rendered on any day to an individual enrolled in HUSKY A, HUSKY C (previously known as Medicaid FFS) or HUSKY D (previously known as MLIA) program. The denominator is all patient encounters for the same EP over the same 90-day period. For example, if the EP had 100 encounters and 30 were Medicaid encounters, they would have a 30% patient volume. The calculation formula is: [Total Medicaid patient encounters in any representative continuous 90-day period in the preceding calendar year or preceding 12 month period from the date of attestation/total patient encounters in that same 90-day period] *100 There is an option to calculate or aggregate patient volume for the entire organization and then each EP would use the organization's patient volume as a proxy for their individual patient volumes. However, in this case you would count encounters for ALL PROVIDERS - not just eligible professionals - when you calculate the group patient volume. Thus, if you have providers who see a lot of patients but those encounters are not for Medicaid patients, it can lower your group rate. The opposite also could be true. If you elect to use group volume as proxy, all EPs within the practice must use the same group volume across all EP provider types. Register with Federal and Enroll in the State Operated EHR Incentive Programs Before registering, EPs will need to decide whether to register under the Medicare or Medicaid Incentive program. EPs who qualify for Medicare and Medicaid programs may only participate in one program in a given year. Before 2015, EPs may switch incentive programs only once after the first incentive payment is initiated. EPs who can receive EHR incentive payments under both programs will maximize their payments by choosing the Medicaid EHR Incentive Program. Incentive payments for EPs are based on individual practitioners. If you re part of a practice, each EP may qualify for an incentive payment if each EP successfully demonstrates MU of certified EHR technology. This checklist only covers the Medicaid EHR Incentive Program. Third Party Registration CMS implemented functionality that allows an EP to designate a third party to register and attest on his or her behalf. To do so, users working on behalf of an EP must have an Identity and Access Management System (I&A) Web user account (User ID/Password), and be associated to the EP's NPI. If you are working on behalf of an EP(s) and do not have an I&A Web user account, please visit I&A Security Check at to create one. CT Medicaid Eligible Professional Checklist 3 07/01/2013

4 Gathering Information for Initial Registration in the CMS Medicare and Medicaid EHR Incentive Program Registration & Attestation system: Prior to registering for the CMS EHR Incentive Program, EPs will need to gather the following information. This will help expedite the registration process. You should also identify one individual from your organization that will be responsible for completing registration and attestation information. National Provider Identifier (NPI) o To locate your NPI number, go to NPPES NPI Registry page at o If you do not have an NPI number, to apply go to NPPES home page at National Plan and Provider Enumeration System (NPPES) User and ID and Password. If you do not have an NPPES Web user account, go to NPPES home page at Payee Tax Identification Number (TIN, for reassignment of individual provider benefits to an organization) Payee National Provider Identifier (NPI) (for reassignment of individual provider benefits to an organization) Note: In order to qualify for the CT Medicaid EHR Incentive payments, the EP and the Payee provider must be enrolled providers with Connecticut Medicaid. The payee Tax ID No. and Payee NPI No. must match what is in the provider s Medicaid Management Information System (MMIS) account with the State of Connecticut. This combination should be the same NPI/TIN that is used for the Connecticut interchange MMIS for claim payment purposes. If you have questions regarding your Connecticut Medicaid enrollment please contact the CT EHR Provider Assistance Center toll free at How to Register & Apply for Medicaid EHR Incentive Program Now that all the information has been gathered, the next step is to register with CMS. All EPs who are participating in the EHR Incentive Program must register for either the Medicare or Medicaid Incentive programs through CMS. This can be done using CMS s Step-by-Step Guides on Registration for the EHR Incentive Programs at Guidance/Legislation/EHRIncentivePrograms/RegistrationandAttestation.html. You will not be able to start your CT Medicaid EHR application in the CT Medical Assistance Provider Incentive Repository (MAPIR) until you have registered with CMS. Register for CMS Registration & Attestation (R&A) System at o This is the first step for the first payment year you participate o If already registered in a previous program year, go directly to the MAPIR application and do not go back to the CMS R&A Web site unless there is a change in TIN or NPI numbers due to a change in the payee receiving the incentive payment. If the provider is actively enrolled in the CT Medical Assistance Program, in approximately 48 hours post-registration, the CT MAPIR system will generate a Welcome which will be sent to the contact person designated in CMS R&A system. The states the MAPIR system can be accessed by logging onto Use the Quick Login to access your secure provider Web portal account. There is an Eligible Professional User Manual that is available on the EHR Incentive Program Web page to assist you with using MAPIR. If the provider does not have a secure Web portal ID, they are directed to contact the CT EHR Provider Assistance Center at or an ID may be requested by sending an to ctmedicaid-ehr@hp.com. Please ALWAYS include the Provider s Name and CT Medicaid Eligible Professional Checklist 4 07/01/2013

5 NPI in your correspondence. Once requested the provider or authorized representative is sent two s, one with a PIN and another with their AVRS ID. Instructions are sent in the on how to set up the secure provider account. If the provider is not currently enrolled, contact will be made via instructing the provider how to enroll in the CT Medical Assistance Program. Demonstrate Achievement of Stage 1 Meaningful Use for Medicaid As stated under the section Eligibility for Medicare and Medicaid Incentive Payments, EPs must demonstrate meaningful use. This section covers how to demonstrate MU, calculate the MU reporting period, and verify achievement of MU. In the first year of Stage 1, adopt, implement, or upgrade (A/I/U) to a certified EHR. After the first year, demonstrate MU of a certified EHR as noted in the next three rows Report on all 13 core objectives and 5 out of 10 menu set objectives in year 2. You will have to report numerators, denominators and exclusions. See EP MU Core and Menu Set Objectives found at Guidance/Legislation/EHRIncentivePrograms/downloads/EP-MU-TOC.pdf. Meet performance targets for each MU objective. Report on a total of six clinical quality measures (3 core or alternative core, 3 from the additional set of 38). If the denominator for any of the three core measures is zero, the EP must report on the three alternate core measures. If all six of the measures have a denominator of zero, the EP must still report on any three measures shown in the additional set. If any of the additional set measures have a denominator of zero, the EP must choose other additional set measures that do not have a denominator of zero. Note: For Stage 1 MU, there are no performance targets. Reporting Period for Demonstrating Meaningful Use The reporting periods for demonstrating MU for Medicaid are listed below. The 90-day reporting period begins AFTER the practice or organization has installed all versions/patches that will comprise the certified version of EHR technology in an ambulatory setting. Use the same reporting period for all measures. For Medicaid, A/I/U of certified EHR technology during the first calendar year. If the Medicaid EP attests to A/I/U in the first year of payment and demonstrates MU in the second year of payment, then the EHR reporting period in the second year of payment is a continuous 90-day period within the calendar year. Subsequent to that, the EHR reporting period is the entire calendar year. o A/I/U in the first payment year o 90-day continuous reporting period in the second payment year o 1-year continuous reporting period in all subsequent payment years, except in 2014 CT Medicaid Eligible Professional Checklist 5 07/01/2013

6 Verify Achievement of General Meaningful Use and Certified EHR Technology Thresholds You will be asked to provide numerators and denominators for each of these items and attest to their accuracy. At least 50% of all your encounters occur in a location(s) where certified EHR technology is being used. At least 80% of all unique patients have their data in the certified EHR during the EHR reporting period. Verify Achievement of Meaningful Use Your complete EHR typically provides reports or a dashboard to help you verify achievement of Meaningful Use (MU) requirements. Run or Review MU Report/Dashboard to verify achievement of MU requirements during the appropriate 90-day (EHR incentive payment year 2) or 1 year period (subsequent payment years) Run Clinical Quality Measure Report/Dashboard to verify achievement of CQM measure requirements Print and retain the above documentation (on paper and/or electronically) to support your attestation Supply this documentation electronically as part of your application. Attest for Incentive Payments Medicaid EPs will have to demonstrate meaningful use through Connecticut s web-based MAPIR System. Providers will enter 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. A complete EHR system will typically provide a report or dashboard with the numerators, denominators and other information for most measures. If any MU measure fails to meet the threshold, MAPIR will display a message and offer the EP an opportunity to make corrections during the submission process. Providers will qualify for a Medicaid EHR incentive payment upon completing a successful online submission through the MAPIR System. Applications will be reviewed by DSS staff prior to authorizing payments. Please verify that you have the information below available for attestation. MAPIR Guide Review the MAPIR User Guide for EPs at StaticContent/Publications/ehr%20ep%20user%20manual.pdf, which provides step-by-step instructions for login, completing the attestation and uploading documents. CT Medicaid Eligible Professional Checklist 6 07/01/2013

7 Information from CMS EHR Incentive Program R&A System Information submitted to the CMS Medicare and Medicaid EHR Incentive Program Registration & Attestation (R&A) system including registration ID, payee NPI, payee TIN, and address CMS EHR Certification ID CMS EHR Certification ID for attestation. This ID is available when you add your certified EHR product(s) to your cart at Print and retain your CMS EHR Certification ID to enter into the MAPIR system and upload a copy of the Certification ID cart web page in PDF format. Patient Volume Data Practice locations addresses Dates for the consecutive 90-day period related to Patient Volume Number of In-state Medicaid encounter volume Number of Out of state encounter volume Total unduplicated number of encounter volume Documentation for a consecutive 90-day period in calendar year prior to the payment year or preceding 12 month period from the date of attestation. Meaningful Use and Clinical Quality Measures Printouts or calculations documenting that you meet the general 50% and 80% rules or thresholds for using certified EHR technology Dashboard printouts, reports or other documents and information that show the numerator, denominator, and exclusions for the 13 core and 5 menu set meaningful use objectives as shown in the certified EHR technology Public health MU exclusion letter for 1 of the 2 required public health menu set items and/or status/outcome, dates and times of the required tests that you performed Reports, screenshots or other materials and documents that show the numerator, denominator and exclusions for the 3 core (or alternative core) and 3 additional CQMs Documents to Upload into MAPIR (Must be in Excel, Word or PDF format and no greater than 5 MB) Documentation supporting A/I/U of Certified EHR Technology including invoices, license agreements, purchase orders, and contracts [Required for all applications in all years] CMS EHR Certification ID cart page showing CMS EHR Certification ID and certified EHR product(s) used [Required for all applications in all years] Documentation supporting patient volume calculations (e.g. Practice Management System reports) [Optional, but strongly recommended] Dashboard screenshots, printouts or reports from the certified EHR technology supporting the Meaningful Use attestation [Required, if attesting to MU] Dashboard screenshots, printouts or reports from the certified EHR technology supporting the Clinical Quality Measures [Optional] Public health MU exclusion letter (if applicable) [Optional, but also keep it for your records] CT Medicaid Eligible Professional Checklist 7 07/01/2013