New York State Medicaid EHR Incentive Program Amendments to Hospital Incentive Payment Calculation

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1 New York State Medicaid EHR Incentive Program Amendments to Hospital Incentive Payment Calculation February 13, 2012 Effective immediately, the NYS Department of Health (DOH) is amending the guidance set forth in the June 20, 2011 version of the New York State Medicaid Health Information Technology Plan (NY-SMHP) on the calculation of the incentive payment calculation for Eligible Hospitals in the NY Medicaid EHR Incentive Program. This document explains the changes to the incentive payment calculation and details the implementation plan for executing this change. The updated guidance will also be included in the next version of the NY-SMHP. Background The amount of the incentive payment to each hospital deemed eligible to participate in the NY Medicaid EHR Incentive Program is based on a number of factors relative to the hospital s practice as reported to the State in the Institutional Cost Report (ICR) for a specific year, based on the hospital s fiscal year and the date the hospital first applies to the EHR Incentive Program. The NY-SMHP lists each input to the incentive payment calculation and details the appropriate derivation of the input based on specific locations in the ICR. These derivations are also listed in various other documents posted on the emedny.org website, including the Eligible Hospital Workbook and Eligible Hospital Manual. In response to feedback received from individual hospitals and hospital associations, the Department conducted a thorough re-review of the calculation methodology. As a result, the derivation for the following inputs is amended: Total Acute Discharges Total Acute Inpatient Bed Days Medicaid Acute Inpatient Bed Days Total Charges (formerly known as Total Acute Charges) Total Charity Care Charges (formerly known as Total Acute Charity Care Charges) The updated guidance for the derivation from the ICR of the inputs to the incentive payment calculation is listed below. Fe brua ry 13, 2012 Page 1 of 7

2 Total Acute Discharges Source: Exhibit 3, Class Code 0090 Derivation: Subtract Line 007 from Line 008 Total Acute Inpatient Bed Days Source: Exhibit 3, Class Code 0694 Derivation: Subtract Line 007 from Line 008 Source: Exhibit 32 Derivation: Sum of Line 011 from each of the following Class Codes: Class Code 4320 Class Code 4497 Class Code 4390 Class Code 4450 Class Code 4440 Class Code 4460 Class Code 4501 ALSO add Line 011 from Class Code 4470 (Other) if and only if the unit reported in Class Code 4470 is considered acute under the Medicare IPPS. Hospitals eligible to participate in the EHR Incentive Program as separately certified children s hospitals that report all discharges in Class Code 4490 under specific direction from the NYS Department of Health should use Line 011 from Class Code Source: Exhibit 32 Derivation: Sum of Line 011 from each of the following Class Codes: Class Code 4318 Class Code 4496 Class Code 4388 Class Code 4448 Class Code 4438 Class Code 4458 Class Code 4500 ALSO add Line 011 from Class Code 4468 (Other) if and only if the unit reported in Class Code 4468 is considered acute under the Medicare IPPS. Hospitals eligible to participate in the EHR Incentive Program as separately certified children s hospitals that report all bed days in Class Code 4488 under specific direction from the NYS Department of Health should use Line 011 from Class Code Fe brua ry 13, 2012 Page 2 of 7

3 Medicaid Acute Inpatient Bed Days Source: Exhibit 3, Class Code 0693 Derivation: Subtract Line 007 from Line 008 Source: Exhibit 32 Derivation: Sum of Lines 014 and 200 from each of the following Class Codes: Class Code 4318 Class Code 4496 Class Code 4388 Class Code 4448 Class Code 4438 Class Code 4458 Class Code 4500 ALSO add the sum of Lines 014 and 200 from Class Code 4468 (Other) if and only if the unit reported in Class Code 4468 is considered acute under the Medicare IPPS. The hospital may also add bed days where Medicaid made a nonzero payment as a secondary payer, provided Medicare was not the primary payer. Additional documentation may be required. Hospitals eligible to participate in the EHR Incentive Program as separately certified children s hospitals that report all bed days in Class Code 4488 under specific direction from the NYS Department of Health should use the sum of Lines 014 and 200 from Class Code Total Charges Note: According to rules and instructions promulgated by CMS, the total charges should be inclusive of all units in the hospital, including inpatient and outpatient as well as acute and sub-acute units. Source: Exhibit 46 Derivation: Gross acute inpatient charges, less inpatient charges for subprovider I, sub-provider II, and newborn. Source: Exhibit 46 (Parts I & II) Derivation: Sum of Line 200 from each of the class codes included in the State s Indigent Care Pool Calculation (see appendix). Total Charity Care Charges Note: According to rules and instructions promulgated by CMS, the total charity care charges should be inclusive of all units in the hospital, including inpatient and outpatient as well as acute and sub-acute units. Charity care charges should be assessed at their full initial value prior to any deductions for payments received. Source: Exhibit 46 Derivation: Gross acute inpatient charity care charges, less inpatient charity care charges for subprovider I, sub-provider II, and newborn Source: Exhibit 46 (Parts I & II) Derivation: Sum of Line 313 from each of the class codes included in the State s Indigent Care Pool Calculation (see appendix). Fe brua ry 13, 2012 Page 3 of 7

4 Implementation of Updated Calculation The following procedures will be followed for implementing the new guidance. 1. Hospitals that have not yet completed their attestations as of the date of this notice will be required to follow the amended guidance when they submit their attestation. Attestations will be validated against the updated guidance and the Department will contact hospitals whose attested values differ significantly from the data on file to either update their attestation or, where appropriate, submit additional documentation supporting their attestation. 2. Hospitals that completed CMS registration on or before December 29, 2011 will have sixty days from the date of this notice to submit attestations for Payment Year 2011 according to the new guidance, regardless of whether or not they have already submitted attestations. Hospitals who submit acceptable values within this time frame will receive the incentive payment for Payment Year 2011 and will be allowed to subsequently attest for their second participation year as early as Payment Year Hospitals that have completed their attestations but have not yet been approved for payment will be required to re-submit their attestations using the new guidance. NY Medicaid will be contacting each of these hospitals individually to discuss the process for re-submitting. 4. Hospitals that have already been approved for payment or paid for Payment Year 2011 will be required to submit updated attestations according to the new guidance before receiving payment for their second year of participation in the EHR Incentive Program. These hospitals second year payment will be adjusted to account for any difference between the incentive payment they received for Payment Year 2011 and the incentive payment amount calculated under the new guidance. Fe brua ry 13, 2012 Page 4 of 7

5 Appendix: Class Codes Included in Indigent Care Pool Calculation The following table shows the class codes from Exhibit 46 of the Institutional Cost Report that are used in the State s Indigent Care Pool calculation. The same class codes should be used when calculating the Total Charges and Total Charity Care Charges components of the hospital incentive payment calculation under the NY Medicaid EHR Incentive Program. Description (2009 ICR) ICR Cost Center Code Exhibit 46 Class Code Inpatient Service Cost Center Line Assignments (99) Medical Surgical Inpatients Pediatric Unit Maternity Unit Epilepsy Unit Psychiatric Rehabilitation Medicine Traumatic Brain Injury/Coma Tuberculosis H.I.V. Care Chemical Dependency - Drug Rehab Chemical Dependency - Drug Detox Chemical Dependency - Alcohol Rehab Chemical Dependency - Alcohol Detox Bone Marrow Unit Intensive Care Unit Pediatric ICU Cardiac ICU Coronary Care Unit Burn Intensive Care Unit Surgical Intensive Care Unit Neonatal Intensive Care Unit Traumatic Brain Injury/Coma Nursery - Premature Any Additional Inpatient Component Outpatient Service Cost Center Line Assignment (98) Clinic Alcohol Clinic Alcohol Day Rehab Clinic Chemotherapy Clinic Day Hospital Early Intervention Family Clinic Fe brua ry 13, 2012 Page 5 of 7

6 Description (2009 ICR) ICR Cost Center Code Exhibit 46 Class Code Family Planning Head Injury Clinic H.I.V. Clinics Hyperbaric Clinic Oncology Clinic Pediatric Clinic Rehabilitation Clinic Cardiac Rehabilitation Clinic Dental Clinic Diabetes Clinic PCAP Clinic Sleep Clinic Wound Care Clinic Mental Health Clinic Mental Health Continuing Day Treatment Mental Health Day Treatment Mental Health Intensive Psychiatric Rehab. Outpatient Mental Health Partial Hosp All Other OMH Programs O/P All Other OASAS Programs O/P Mental Health Outpatient ACT Programs Mental Health Outpatient ICM Programs Mental Health Outpatient SCM Programs Comprehensive PROS with Clinic Comprehensive PROS Limited License PROS PROS Rehabilitation and Support Ambulatory Surgical Service Referred Ambulatory Service Renal Dialysis Methadone Maintenance Treatment Program Women and Infant Children Program (WIC) Emergency Service CPEP Poison Control Observation Beds (Non-Distinct Part) Observation Beds (Distinct Part) CPEP Observation Beds (Psychiatric) Other Outpatient Cost Centers Federally Qualified Health Center (FQHC) Fe brua ry 13, 2012 Page 6 of 7

7 Description (2009 ICR) ICR Cost Center Code Exhibit 46 Class Code Other Reimbursable Cost Center Line Assignments (50) Home Program Dialysis Ambulance Services HHA - Administrative & General HHA - Skilled Nursing Care HHA - Physical Therapy HHA - Occupational Therapy HHA - Speech Pathology HHA - Medical Social Services Home Health Aide Other HHA Services Additional Other Reimbursable Cost Centers , Special Purpose Cost Center Line Assignments (50) Lung Acquisition Kidney Acquisition Liver Acquisition Heart Acquisition Pancreas Acquisition Intestinal Acquisition Islet Cell Acquisition Other Organ Acquisition (specify) Ambulatory Surgical Center (Distinct Part) Hospice Inpatient Additional Special Purpose Cost Centers Fe brua ry 13, 2012 Page 7 of 7

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