Florida Medicaid EHR Incentive Program Overview for Eligible Hospitals

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1 Florida Medicaid EHR Incentive Program Overview for Eligible Hospitals Funding is provided through the American Recovery and Reinvestment Act (ARRA) to encourage eligible professionals and eligible hospitals to adopt, implement, or upgrade (AIU) a certified Electronic Health Record (EHR) system, and demonstrate meaningful use (MU) of EHR systems. Heidi Fox, Program Administrator Rev. August/2011 Version 1.3

2 EHR Technology Benefits The adoption of electronic records by providers means better care for the State s most vulnerable citizens through: Improved quality and safety; Enhanced care coordination; More involvement with patients and families; and Reductions in errors and cost of care.

3 Policy Overview Payments are not meant to be reimbursements. Instead, they are meant to help defray the costs of a certified EHR system Dually eligible hospitals may receive incentive payments from Medicare and Medicaid if they meet all program eligibility criteria select Both Medicare and Medicaid during the registration process Registration for first year payment begins September 5, 2011, and the last year to apply is 2016 Payments end in 2021

4 Who is an Eligible Hospital? Acute Care Hospitals including Critical Access Hospitals (CAHs) and cancer hospitals with 10% Medicaid patient volume Children s Hospitals (no patient volume requirements)

5 Participation for Year 1 For year 1 participation, hospitals do not need to report meaningful use data, only adopt, implement, or upgrade (AIU) to a certified EHR system Documentation identifying that the hospital has acquired, purchased, or contracted to purchase a certified EHR system will need to be uploaded while completing the Florida application, And a copy of the certification page showing the EHR certification number from the Certified HIT Product List (CHPL)

6 Things You Will Need To Participate Web user account from the National Plan and Provider Enumeration System (NPPES) Enrollment in Provider Enrollment, chain and Ownership System (PECOS) CMS Certification Number (CCN) Acquired, purchased, or contracted for a certified EHR system EHR certification number from the Certified HIT Product List (CHPL) Access to the Medicaid secure provider portal

7 Registration With CMS CMS Registration and Attestation (R&A) website: Click Registration Tab (Use NPPES/NPI web username and password) Hospitals dually eligible for Medicaid and Medicare Incentives select Both Medicare and Medicaid to maintain program option Step-by-Step guides on how to register can be found at: on.asp

8 Florida Medicaid Application Process CMS R&A sends a file of hospitals who have registered for the incentive to Florida Medicaid An is sent directing the hospital to enter the Florida Medicaid provider portal and complete the application and attestation process Hospital logs in at the Florida Medicaid web portal and enters data Payment is calculated Payment suspends for staff review Incentive Program Staff confirm the payment amount calculation with Medicaid Hospital Cost Reports, and the hospital patient volume by using hospital administrative data

9 Calculating Patient Volume Medicaid patient volume calculations are based on discharges where Medicaid paid any part. This also includes emergency department visits and can include managed care encounters. Patient volume is measured over a continuous 90-day period in the previous hospital fiscal year and for all locations. Total Medicaid encounters in any continuous 90-day period from the preceding hospital fiscal year Total encounters in the same 90-day period = % Medicaid Patient Volume

10 Medicaid Incentive Payment Calculation Base calculation is made up of two factors: Overall EHR Amount, and Medicaid Share Base calculation uses data from the hospital fiscal year that ends in the Federal Fiscal Year (FFY) prior to the year incentive payment is initiated As an example, if a hospital is applying in September 2011 and their hospital fiscal year runs from July 1st - June 30th, they would use data from their FY 7/1/09-6/30/10. The Federal Fiscal Year runs from October 1st - September 30th.

11 Medicaid Incentive Payment Calculation Con t The initial amount is the sum of a $2 million base amount and the product of a per discharge amount of $200 and the number of discharges (for discharges between 1,150 and 23,000) The Medicaid share is set at 1 for each year The transition factor phases down the incentive payment over a theoretical 4 year period (Payment Year 1 = 1, Payment Year 2 =.75, Payment Year 3 =.50, and Payment Year 4 =.25)

12 Medicaid Incentive Payment Calculation Con't Formula for Calculating: Overall EHR Amount = Medicaid Share = [Sum over 4 years of {(Base Amount ($2 million) + applicable discharge related amount for each year) x applicable transition factor for each year}] x [(Medicaid inpatient bed days + Medicaid HMO inpatient bed days) {(total inpatient bed days) x (estimated total charges charity care charges) (estimated total charges)}]

13 Data Source for Payment Calculations Florida Medicaid Hospital Cost Reports submitted per the FLORIDA TITLE XIX INPATIENT HOSPITAL REIMBURSEMENT PLAN, rule 59G-6.020, Payment Methodology for Inpatient Hospital Services Templates to assist with the payment calculation can be found under the Incentive Payments tab on our website:

14 Medicaid Memorial Hospital

15 Medicaid Memorial Hospital

16 Medicaid Memorial Hospital

17 Important Things to Remember If you go back into the R&A after submitting your R&A Registration, you must save before exiting even if you made no changes. Exiting the R&A after viewing your registration and not saving will delay processing your incentive payment request. Print the page from the CHPL site with your assigned EHR Certification Number (this will have to be uploaded when registering in MAPIR)

18 Contact Information Mail: Agency For Health Care Administration 2727 Mahan Drive Mail Stop #16 Tallahassee, FL, Website: