Minnesota EHR Incentive Program (MEIP) Guidance Manual for Eligible Professionals and Hospitals

Transcription

1 Guidance Manual fr Eligible Prfessinals and Hspitals

2 Table f Cntents Sectin 1: Guidance fr Eligible Prfessinals (EP) Page 1.1 Prerequisites Part I: Preparatin and Registratin with CMS Prerequisites Part II: Preparing, Enrlling & Attesting fr MEIP Medicaid Patient Vlume (MPV) Calculatin fr Eligible Prfessinals (EP) Attesting fr Medicaid Patient Vlume (MPV) Using Grup Vlumes.13 Sectin 2: Guidance fr Eligible Hspitals (EH) 2.1 Prerequisites Part I: Preparatin and Registratin with CMS Prerequisites Part II: Preparing, Enrlling & Attesting fr MEIP Medicaid Patient Vlume (MPV) Calculatin fr Eligible Hspitals (EH).23 Sectin 3: Appendices 3.1 Appendix A Supprting Dcumentatin fr Eligible Prfessinals and Hspitals Appendix B Sample Grup Vlume Cnsent Frm Appendix C Sample Hspital Calculatin wrksheet Appendix D Hspital First Enrllment and Attestatin Mnth Appendix E Hspital Fiscal Year Start Page 2 f 26

3 Sectin 1: Guidance fr Eligible Prfessinals (EPs) 1.1 Prerequisites fr EPs Part I: Preparatin and Registratin with CMS Prir t registratin in the at the Centers fr Medicare and Medicaid Services (CMS) website, a prvider shuld first determine if they have the infrmatin necessary t cmplete the initial registratin and eventual enrllment in the MEIP. 1. Determine if yu are ptentially eligible t participate in the MEIP. The CMS Eligibility Tl can help yu determine whether yu may be eligible. 2. Cnfirm yu have an individual Natinal Prvider ID (NPI) valid fr participatin in the Centers fr Medicare and Medicaid Services (CMS) Medicare and Minnesta EHR Incentive Prgrams. Nte: The NPI will need t be an active Individual NPI, nt a grup NPI. 3. Cnfirm yu are enrlled in Minnesta Health Care Prgrams (MHCP). The enrllment linked t yur NPI must be active and in gd standing. If yu are nt enrlled in MHCP, r yu are nt in gd standing in MHCP, yu will nt be allwed by rule t participate in the prgram. Q: What can I d if I am nt currently enrlled in Minnesta Health Care Prgrams r have questins abut my enrllment standing? A: Yu will need t cmplete yur Minnesta Medicaid enrllment first, prir t participating in the MEIP. Cntact MHCP Prvider Enrllment at (651) ; Tllfree line at (800) ; Fax at (651) Cnfirm yur NPI is enrlled in the MHCP system as an Eligible Prvider Type Accrding t the CMS Final Rule fr the Medicaid EHR Incentive Prgram and the Minnesta State Medicaid HIT Plan, Eligible Prvider Types fr the Medicaid EHR Incentive Prgram are: Physicians Dentists Certified Nurse-Midwifes Nurse Practitiners. This includes Clinical Nurse Specialists wh meet the federal and MN state plan definitin f Nurse Practitiners. Physician Assistants practicing in Federally Qualified Health Centers (FQHCs), Rural Health Centers (RHCs) r Indian Health Services (IHSs) which Page 3 f 26

4 is led by a Physician Assistant MEIP Guidance fr Eligible Prfessinals and Hspitals Q: What can I d if I am nt currently enrlled as an eligible prvider type in MHCP? A: Yu will need t cmplete a full enrllment with MHCP. This prcess includes validatin f current certificatins and licenses. Cntact MHCP Prvider Enrllment at (651) ; Tll-free line at (800) ; Fax at (651) Cnfirm yur Electrnic Health Recrds system is certified by the Offices f the Natinal Crdinatr (ONC) fr Health Infrmatin Technlgy (HIT). If yu are currently adpting, implementing, upgrading, r using an electrnic health recrds system yu can determine if yur system is certified by ONC by perfrming a search n this site: ONC EHR Certificatin Search Q: What if I d nt have my EHR Certificatin Number at this time? A: Yu may register with CMS fr prgram participatin prir t receiving the EHR Certificatin Number; hwever yu will be required t enter this number in MEIP prtal during yur enrllment and attestatin in rder t meet prgram eligibility requirements and achieve payment. 6. Cnfirm yur Payment Assignment By rule, a prvider may assign payment t himself/herself, r t anther entity such as a facility r grup. In rder t assign payment fr MEIP, the fllwing is required: a. The Payee NPI and Payee TIN/SSN identified by the Prvider at the time f CMS EHR Incentive Prgram registratin must be enrlled in MHCP. The Payee NPI and Payee TIN/SSN must match exactly t the MHCP Enrllment data. Nte: When assigning a payee during CMS registratin enter a TIN and NPI fr the clinic r a TIN/SSN and NPI fr the EP, d nt enter a clinic TIN and an EP s NPI. If this ccurs n payee will appear in MEIP. b. The enrllment linked t yur chsen payee must be active and in gd standing. If the Payee NPI and Payee TIN/SSN d nt match an enrllment with MHCP, r the Payee NPI and Payee TIN/SSN matches an enrllment with MHCP which is nt in gd standing, the payee selectin will nt be allwed fr MEIP. Q: What can I d if my Payee NPI and TIN cmbinatin is nt knwn t MHCP? Page 4 f 26

5 A: The Prvider may: (1) Chse a new payee NPI and payee TIN/SSN cmbinatin which is currently enrlled in MHCP; r (2) Request the Payee assciated with the Payee NPI and Payee TIN/SSN cmbinatin cmplete a full enrllment in MHCP. Cntact MHCP Prvider Enrllment at (651) ; Tll-free line at (800) ; Fax at (651) Q: What can I d if my Payee NPI and Payee TIN/SSN cmbinatin is currently enrlled in MHCP, but is nt in an active status r gd standing? A: The Prvider may chse a new payee NPI and payee TIN/SSN cmbinatin which is currently enrlled and in gd standing in Minnesta Medicaid. The Payee may cntact MHCP t discuss the standing f their enrllment. If yu are currently enrlled, but have questins abut yur enrllment standing, Cntact MHCP Prvider Enrllment at (651) ; Tll-free line at (800) ; Fax at (651) Nte: A prvider may register with CMS fr prgram participatin prir t finalizing MHCP Payee Enrllment; hwever, the prvider will nt be able t cmplete the MEIP attestatin prcess required t achieve payment until this infrmatin is finalized. 7. Register fr participatin in the MEIP at CMS EHR Incentive Prgram registratin website: CMS EHR Incentive Registratin. Yur registratin, if accepted, will be sent t the Minnesta EHR Incentive Prgram the next day. Registratins are prcessed by CMS and Minnesta 7 days a week. Page 5 f 26

6 1.2 Prerequisites fr EPs Part II: Preparing, Enrlling & Attesting fr MEIP 1. Upn receipt f yur CMS registratin, Minnesta EHR Incentive Prgram will send yu an including instructins n t start yur MEIP attestatin, if the MHCP enrllment matching yur registratin NPI is: (1) Fund in the MHCP system; (2) In gd standing/nt sanctined in the MHCP system; and (3) A prvider type eligible t participate in the MEIP. Q: Hw d I seek assistance if an issue is fund with my prgram MHCP enrllment? A: Fr assistance with yur MHCP enrllment, cntact MHCP Prvider Enrllment at (651) ; Tll-free line at (800) ; Fax at (651) Q: Hw d I seek assistance fr questins related t MEIP enrllment? A: Fr assistance with MEIP enrllment, cntact the MEIP help desk at MN.Supprt@MN-MEIP.cm r call Gather and prepare dcumentatin that will be needed during the MEIP enrllment and attestatin prcess. Appendix A: MEIP Guidance n Supprting Dcumentatin prvides the list f dcumentatin ptins that will appear in the drp dwn menu as yu are uplading dcumentatin in supprt f yur enrllment and attestatin. Nte: There are multiple ptins fr dcumentatin in each f the primary categries. Sme categries are required, while thers wuld be situatinal. Under n circumstances shuld a prvider uplad any dcumentatin cntaining persnal health infrmatin (PHI). 3. Cmplete yur attestatin in the MEIP. Prviders will be required t enter and attest t the fllwing types f data: a. Attesting as a pediatrician b. Attesting as part f an FQHC/RHC/IHS c. Attesting as part f a grup. MHCP requires hspitals and clinic prviders t review their prvider affiliatins with individual prviders per MHCP Prvider Update Prvider Affiliatins d. Cnfirmatin f the Payee selectin e. Vlume Attestatin by Encunter Methd f. Validatin f the EHR Certificatin number g. Attestatin t Meaningful Use criteria (Participatin year 2 thrugh 6) h. Signing f a Legal Ntice cnfirming attested data Page 6 f 26

7 i. Cnfirming and Submitting yur attestatin as cmplete j. Uplad f Certified EHR system wnership dcumentatin MEIP Guidance fr Eligible Prfessinals and Hspitals 4. Pre-Payment Review Based n DHS Minnesta EHR Incentive Prgram plicy, prviders will be prcessed thrugh autmated, and in sme cases, manual pre-payment verificatin prcedures. If selected, prviders may be required t uplad additinal infrmatin t supprt the data entered at the time f attestatin. 5. If determined eligible, payment will be received fllwing the cmpletin f the attestatin in the MEIP within 45 days f the final attestatin Cnfirm and Submit. Payments will be disbursed by DHS n a bi-weekly basis and will appear as a grss adjustment n yur remittance advice. Page 7 f 26

8 1.3 Medicaid Patient Vlume (MPV) Calculatin fr EPs DHS has received several requests fr clarificatin language cntained in the State Medicaid HIT Plan (SMHP) related t which participants may be cunted tward their Medicaid Patient Vlume (MPV) fr purpses f the Minnesta Medicaid EHR Incentive Prgram (MEIP). This resurce is intended t prvide clarificatin n the prcess used by MHCP t calculate MPV based n the Minnesta Health Care Prgrams (MHCP) that meet the definitins fr eligible encunters in the federal regulatins. Minnesta s apprved SMHP indicated the fllwing fr EP: Minnesta EPs use Optin 1: Patient Encunter, as described in the rule, fr calculating their Medicaid patient encunters and can: Chse the 90-day perid; Cunt ut-f-state encunters; Calculate vlume using the grup clinic/prxy methdlgy; and Cunt participants in: MA (Medicaid) EH (Medicaid cverage f certain nncitizens fr medical cnditins) FF (federally funded demnstratin; MinnestaCare fr parents and adult caretakers) LL (federally funded demnstratin; MinnestaCare fr pregnant wmen and children) FP (Family Planning services; family planning services nly) QM (Medicare Part A & B premiums, and cst sharing) SL (Medicare Part B premiums) WD (Medicare Part A premium nly) EPs practicing predminantly in FQHC/RHC and Physician Assistants als include: NM with eligibility type PC (CHIP prgram) Services prvided n a sliding scale r that were uncmpensated MA, r Medical Assistance, is Minnesta s Medicaid prgram. It is jintly funded with state and federal funds. The Minnesta Department f Human Services versees the prgram statewide. The federal Centers fr Medicare and Medicaid Services versees Medicaid natinally. All Medical Assistance subcategries/prducts (see belw) are cuntable fr purpses f determining Medicaid Patient Vlume Page 8 f 26

9 under the Minnesta Electrnic Health Recrd Incentive Prgram. MA is administered thrugh bth feefr-service and managed care. Additinal details n the managed care prducts fr MA are prvided belw. Relevant language frm CMS Respnse and Analysis n Cmments in the Final Rule: In establishing the Medicaid patient vlume threshlds fr EPs and acute care hspitals, sectin 1902(t)(2) f the Act requires that individuals enrlled in a Medicaid managed care plan be included. We interpret this t mean that individuals enrlled in MCOs, prepaid inpatient health plans (PIHPs), r prepaid ambulatry health plans (PAHPs), under 42CFR Part 438 be included in the calculatin. Clarificatin n DHS Prgrams Administered Thrugh Managed Care Organizatins: In an effrt t assist Minnesta prviders with identifying encunters that can be included, the fllwing verview prvides additinal details n the DHS prgrams administered thrugh Managed Care Organizatins. MCO s were asked t prvide the grup numbers that crrespnd t the prgram cdes that are eligible fr inclusin in the Medicaid Patient Vlume calculatin under the Minnesta Medicaid Electrnic Health Recrd Incentive Prgram. Medical Assistance with Federal Financial Participatin (FFP): Sub-categries identified under DHS Majr Prgram Cde MA include: MA12 Prepaid Medical Assistance Prgram MA20 Prepaid Medical Assistance Prgram MA17 Special Needs Basic Care (SNBC Integrated Medicare) MA19 Special Needs Basic Care (SNBC PIN Nn-integrated Medicare) MA37 Special Needs Basic Care (SNBC Nn-integrated Medicare) MA30 Minnesta Senir Care Plus (MSC+) MA35 Minnesta Senir Care Plus (MSC+) MA02 Minnesta Senir Health Optins (MSHO) Page 9 f 26

10 Other Prgrams Administered by Managed Care Organizatins with Federal Financial Participatin: MinnestaCare MinnestaCare is a publicly subsidized prgram fr Minnesta residents wh d nt have access t affrdable health care cverage. This prgram is als administered by managed care rganizatins, and is funded by a state tax n Minnesta hspitals and health care prviders, as well as federal Medicaid matching funds (in sme cases), and enrllee premiums. The MinnestaCare Prducts that are eligible fr FFP and cuntable fr purpses f determining Medicaid Patient Vlume under the Minnesta Medicaid Electrnic Health Recrd Incentive Prgram (MEIP) include: MinnestaCare Basic Plus Tw (parents & adult caretakers with incme 275% FPL) MinnestaCare Basic Plus ( parents and adult caretakers with incme 275% FPL) MinnestaCare Expanded (MinnestaCare fr children under age 21 and pregnant wmen) MinnestaCare Expanded (MinnestaCare fr adults withut children up t 250% FPL) The MinnestaCare prgrams that are nt eligible fr FFP and are exclusively funded by the state that are nt cuntable fr purpses f determining Medicaid Patient Vlume under MEIP include: MinnestaCare fr nncitizen parents/caretakers with incme 275%FPL MinnestaCare fr nncitizen children under 21 and pregnant wmen Children s Health Insurance Prgram (CHIP) The Children s Health Insurance Prgram (CHIP) is a federal prgram that prvides health cverage t children in families with incmes t high t qualify fr Medicaid, but that can t affrd private cverage. Signed int law in 1997, CHIP prvides federal matching funds t states t prvide this cverage. Under the Medicaid EHR Incentive Prgram, CHIP enrllees are included in the definitin f needy individuals wh may be cunted tward Medicaid patient vlume, but nly fr eligible prfessinals practicing predminantly in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC) r Indian Health Services clinic (IHS). Individuals in the CHIP prgram are identified under the fllwing cde: CHIP fr unbrn children f nncitizen mthers ineligible fr federally funded MA Page 10 f 26

11 Additinal Rules fr Cunting Encunters fr EPs MEIP Guidance fr Eligible Prfessinals and Hspitals MHCP will filter EP-Specific claim queries in accrdance with the fllwing rules: Identify and separate MHCP encunters frm private health plan encunters Multiple visits by an individual t the same rendering prvider n ne day will cunt as ne encunter EP services prvided within a hspital r Emergency Department (ED) setting with Place f Service 21 Inpatient Hspital r 23 Emergency Department Hspital are included in the EP patient vlumes Claim lines paid fr thrugh State-nly funded prgrams will be remved If yu are attesting as an individual: 1. Determine Surce f Patient Vlume 2. Determine yur reprting perid 3. Calculate Medicaid Patient Encunters 4. Calculate Ttal Patient Encunters 5. Divide Medicaid Patient Encunters by the Ttal Patient Encunters Determine yur reprting perid. The reprting perid is any 90-day cnsecutive perid in the previus calendar year T calculate encunters, use the fllwing calculatin: Medicaid encunters divided by Ttal patient encunters times 100: Yur Medicaid Patient Encunters * X 100 Yur Ttal Patient Encunters ** * Use all Medicaid encunters frm all places where yu practice. ** Use all patient encunters frm all places where yu practice. Page 11 f 26

12 EXAMPLE A Prvider #9 als has his wn practice in additin t prviding services at Grup A clinic and will attest as an individual EP: Chses t attest t sl practice patient vlume Chses t attest frm March 1, 2011 thrugh May 31, 2011 Attests t 75 Medicaid patients and 180 ttal patients seen during this perid fr a 41% ttal. Table 1. Prvider #9 Patient Vlume Prvider Medicaid Patients Ttal Patients Ttals Prvider #9 Patient Vlume 41% Page 12 f 26

13 1.4 Attesting fr Medicaid Patient Vlume (MPV) Using Grup Vlumes If yu are attesting as part f a grup r clinic, the fllwing shuld be cnsidered: 1. Grup as defined under MEIP is a unique pair f Federal Tax Identificatin Number (TIN) and Natinal Prvider Identifier (NPI). Appendix B MEIP Grup Cnsent Frm prvides a template fr prviders t accunt fr all prfessinals emplyed by the grup. 2. All Medicaid encunters perfrmed as part f the grup are included fr every practitiner in the grup/clinic (numeratr and denminatr), regardless f whether the practitiner is eligible fr the incentive prgram. D nt include encunters frm utside the attestatin grup r the clinic. 3. If an eligible prfessinal (EP) chses nt t participate in the grup/clinic, the encunters generated by that EP may still be used in the calculatin (numeratr and denminatr) fr that particular grup/clinic. The EP cannt use thse encunters fr calculating vlumes fr anther practice r individually if the grup/clinic has already included them in their vlume calculatin. 4. Fr Grup Attestatins: a. The first persn attesting will enter the reprting perid, the number f members in the grup, the grup name, and the grup vlume (numeratr and denminatr). Each subsequent persn in the grup t attest will select the grup they are attesting with, attest t infrmatin prvided by the first persn in the grup, and prvide ther required infrmatin pertaining t their attestatin. See Determining yur Grup s Patient Vlume belw fr infrmatin n hw t calculate yur grup s vlume. 5. Fr Clinic Attestatins: a. Each Eligible Prfessinal attesting as part f an FQHC/RHC/IHS will be required t indicate the clinic r individual vlume at the time f attestatin. Nte: Attesting as part f a Clinic may nly be dne by thse Eligible Prfessinals chsing t attest as part f an FQHC/RHC/IHS. Clinics are nt cnsidered Grups in the Minnesta EHR Incentive Prgram (MEIP). Selectin f n when prmpted with the questin Are yu attesting as a grup? directs an EP t the FQHC/RHC/IHS vlume attestatin screen. The FQHC/RHC/IHS screen prvides individual r clinic vlume attestatin f Needy Patient Encunters. Page 13 f 26

14 Determining yur Grup s r Clinic s Patient Vlume T crrectly determine the patient vlume fr a Grup: a. Determine number f EPs attesting b. Determine yur reprting perid c. Calculate Medicaid Patient Encunters d. Calculate Ttal Patient Encunters e. Divide Medicaid Patient Encunters by the Ttal Patient Encunters Determine yur reprting perid. The reprting perid is a 90-day cnsecutive perid in the previus calendar year. T calculate encunters, use the fllwing calculatin: Medicaid encunters divided by Ttal patient encunters times 100: Yur Medicaid Patient Encunters *, *** X 100 Yur Ttal Patient Encunters **, *** * Use all Medicaid encunters frm all practitiners in the grup, even thse wh are nt eligible fr incentives and thse wh chse nt t participate. ** Use all patient encunters frm all practitiners in the grup, even thse wh are nt eligible fr incentives and thse wh chse nt t participate. *** Prviders attesting as part f a Clinic (FQHC/RHC/IHS) include the Needy Patient Vlume in the numeratr and denminatr. EXAMPLE B Grup A has a ttal f 10 Prfessinals wrking in their clinic. Of the 10 prfessinals: 5 EPs will attest t their patient vlume as part f Grup A 3 EPs have elected t attest t their patient vlume as an individual using vlume frm ther clinics 2 prfessinals are nt eligible fr MEIP Page 14 f 26

15 Grup A will add Medicaid and Ttal patient vlume frm all 10 prfessinals Grup A has chsen t attest t March 1, 2011 t May 31, 2011 fr their 90-day perid Table 2. Grup A Patient Vlume Prvider Medicaid Patients Ttal Patients Ttals Grup Patient Vlume 38% Page 15 f 26

16 Sectin 2: Guidance fr Eligible Hspitals (EHs) 2.1 Prerequisites Part I: Preparatin and Registratin with CMS Prir t registratin in the at the Centers fr Medicare and Medicaid Services (CMS) website, a prvider shuld first determine if they have the infrmatin necessary t cmplete the initial registratin and eventual enrllment in the MEIP. 1. Determine if the Eligible Hspital (EH) is ptentially eligible t participate in the MEIP. The CMS Eligibility Tl can help yu determine whether yu may be eligible. 2. Cnfirm the EH has an individual Natinal Prvider ID (NPI) valid fr participatin in the Centers fr Medicare and Medicaid Services (CMS) Medicare and Minnesta EHR Incentive Prgrams. 3. Cnfirm the EH is enrlled in Minnesta Health Care Prgrams (MHCP). The enrllment linked t the EH s NPI must be active and in gd standing. If the EH is nt enrlled in MHCP, r the EH is nt in gd standing in MHCP, the EH will nt be allwed by rule t participate in the prgram. Q: What can I d if the EH is nt currently enrlled in Minnesta Health Care Prgrams r have questins abut my enrllment standing? A: Yu will need t cmplete yur Minnesta Medicaid enrllment first, prir t participating in the MEIP. Cntact MHCP Prvider Enrllment at (651) ; Tllfree line at (800) ; Fax at (651) Cnfirm yur NPI is enrlled in the MHCP system as an Eligible Prvider Type Accrding t the CMS Final Rule fr the Medicaid EHR Incentive Prgram and the Minnesta State Medicaid HIT Plan, EHs fr MEIP are thse whse last fur digits f their CMS Certificatin Number (CCN) fall int ne f the fllwing ranges: fr acute care hspitals fr critical access hspitals fr children s hspitals Q: What can I d if I am nt currently enrlled as an eligible prvider type in MHCP? A: Yu will need t cmplete a full enrllment with MHCP. This prcess includes validatin f current certificatins and licenses. Cntact MHCP Prvider Enrllment at (651) ; Tll-free line at (800) ; Fax at (651) Page 16 f 26

17 5. Cnfirm yur Electrnic Health Recrds system is certified by the Offices f the Natinal Crdinatr (ONC) fr Health Infrmatin Technlgy (HIT). If yu are currently adpting, implementing, upgrading, r using an electrnic health recrds system yu can determine if yur system is certified by ONC by perfrming a search n this site: ONC EHR Certificatin Search Q: What if I d nt have my EHR Certificatin Number at this time? A: Yu may register with CMS fr prgram participatin prir t receiving the EHR Certificatin Number; hwever yu will be required t enter this number in MEIP prtal during yur enrllment and attestatin in rder t meet prgram eligibility requirements and achieve payment. 6. Cnfirm yur Payment Assignment By rule, a prvider assigns payment t the EH. In rder t assign payment fr MEIP, the fllwing is required: c. The Payee NPI and Payee TIN identified by the Prvider at the time f CMS EHR Incentive Prgram registratin must be enrlled in MHCP. The Payee NPI and Payee TIN must match exactly t the MHCP Enrllment data. d. The enrllment linked t yur payee must be active and in gd standing. If the Payee NPI and Payee TIN d nt match an enrllment with MHCP, r the Payee NPI and Payee TIN matches an enrllment with MHCP which is nt in gd standing, the payee selectin will nt be allwed fr MEIP. Q: What can I d if my Payee NPI and TIN cmbinatin is nt knwn t MHCP? A: The Prvider may: Request the Payee assciated with the Payee NPI and Payee TIN cmbinatin cmplete a full enrllment in MHCP. Cntact MHCP Prvider Enrllment at (651) ; Tll-free line at (800) ; Fax at (651) Q: What can I d if my Payee NPI and Payee TIN cmbinatin is currently enrlled in MHCP, but is nt in an active status r gd standing? A: The Payee may cntact MHCP t discuss the standing f their enrllment. If yu are currently enrlled, but have questins abut yur enrllment standing, Cntact MHCP Prvider Enrllment at (651) ; Tll-free line at (800) ; Fax at (651) Page 17 f 26

18 Nte: A prvider may register with CMS fr prgram participatin prir t finalizing MHCP Payee Enrllment; hwever, the prvider will nt be able t cmplete the MEIP attestatin prcess required t achieve payment until this infrmatin is finalized. 7. Register fr participatin in the MEIP at CMS EHR Incentive Prgram registratin website: CMS EHR Incentive Registratin. Yur registratin, if accepted, will be sent t the Minnesta EHR Incentive Prgram the next day. Registratins are prcessed by CMS and Minnesta 7 days a week. Page 18 f 26

19 2.2 Prerequisites Part II: Preparing, Enrlling & Attesting fr MEIP The fllwing prcess will need t be fllwed in rder t participate in the Minnesta EHR Incentive Prgram (MEIP): 1. Upn receipt f yur CMS registratin, Minnesta EHR Incentive Prgram will send yu an including instructins n t start yur MEIP attestatin, if the MHCP enrllment matching yur registratin NPI is: (1) Fund in the MHCP system; (2) In gd standing/nt sanctined in the MHCP system; and (3) A prvider type eligible t participate in the MEIP. Q: Hw d I seek assistance if an issue is fund with my prgram MHCP enrllment? A: Fr assistance with yur MHCP enrllment, cntact MHCP Prvider Enrllment at (651) ; Tll-free line at (800) ; Fax at (651) Q: Hw d I seek assistance fr questins related t MEIP enrllment? A: Fr assistance with MEIP enrllment, cntact the MEIP help desk at MN.Supprt@MN-MEIP.cm r call Gather and prepare dcumentatin that will be needed during the MEIP enrllment and attestatin prcess. Appendix A: MEIP Guidance n Supprting Dcumentatin prvides the list f dcumentatin ptins that will appear in the drp dwn menu as yu are up-lading dcumentatin in supprt f yur enrllment and attestatin. Nte: There are multiple ptins fr dcumentatin in each f the primary categries. Sme categries are required, while thers wuld be situatinal. Under n circumstances shuld a prvider uplad any dcumentatin cntaining persnal health infrmatin (PHI). 3. Cmplete Payee designatin. As part f the CMS EHR Registratin prcess, the Hspital Payee is defaulted t the Hspital NPI and Hspital Tax Identificatin Number (TIN) used at the time f registratin. Unlike Eligible Prfessinals, hspitals may nt designate their payments t ther Medicaid prfessinals r entities. Payments will be made t the Medicaid Hspital Enrllment which matches the Hspital s registratin NPI and TIN. The MEIP will require the attesting hspital t: a) Cnfirm the Payee NPI and TIN as part f the attestatin prcess. This will help ensure the apprpriate Medicaid payee receives the EHR Incentive payment, if the hspital is determined eligible fr an EHR Incentive payment. Page 19 f 26

20 4. Attest t Patient Discharge Vlume. The CMS EHR Incentive Prgram Final Rule requires hspitals t meet a 10% Medicaid Discharge vlume in rder t participate in the prgram.* *Children s Hspitals are nt required t meet a Medicaid Discharge vlume percentage in rder t participate. The MEIP will require attesting hspitals (nn-children s hspitals) t: a) Select the vlume reprting perid. The reprting perid is any 90-day cnsecutive perid in the previus federal fiscal year. b) Input the numeratr cunting discharges where Medicaid paid part r all f the inpatient discharge and emergency rm services n any ne day. c) Input the denminatr fr ttal discharges and ED encunters (Medicaid Paid and nn- Medicaid Paid). d) Derive the numeratr and denminatr frm the same cntinuus three-mnth perid in the preceding Fiscal year. The calculatin appears as fllws: Medicaid Discharges + Medicaid ED Encunter Ttal Discharges + ED Encunters X Cnfirm EHR Certificatin Number. The MEIP requires hspitals t input their Certified EHR Number during the attestatin prcess. The number is then validated real-time against the Office f the Natinal Crdinatr (ONC) Certificatin database. The (MEIP) will require attesting hspitals t Enter the CMS EHR certificatin identificatin number n the AIU attestatin page. Attestatin cannt cntinue withut the entry f yur EHR slutin s Certificatin Number. a. Yu can determine if yur EHR slutin is certified by the ONC r btain an EHR Certificatin number by visiting this site: ONC EHR Certificatin website 6. Payment Calculatin Attestatin. The CMS EHR Incentive Prgram Final Rule dcuments the payment calculatin t be used by Medicaid states. MEIP payments are t made t hspitals which have been determined eligible t participate in the prgram. The EH can reference the fllwing tips n hw t prepare fr attestatin: Page 20 f 26

21 A multi-site hspital with ne CCN is cnsidered ne hspital fr purpses f attestatin and payment. It is suggested the hspital use an auditable data surce, such as the latest Medicare cst reprt and HAR t cmplete the EHR Incentive Payment Calculatin attestatin. Hspitals are t use their MN Hspital Annual Reprt (HAR) when necessary. If the EH has nly ne year f data the EH wuld use the first year data and enter zeres fr the ther years then as the years prgress the EH wuld update the wrksheet frm year t year. The EH is required t review the wrksheet amunts every year, attest the amunts are still crrect and adjust them if they have changed due t an audit. If an EH has experienced a merge f tw facilities and has had t submit cst reprts in six mnth increments during this perid f change which cst reprt shuld the EH use n the wrksheet, the EH must g back t the first full 12-mnth reprt fr year ne. T estimate yur hspital payment, access and dwnlad the MEIP Hspital Calculatin wrksheet link fund n the MEIP Eligible Hspitals page. The wrksheet identifies the Medicare Cst Reprt data and HAR fields used t verify hspital payment attestatin data. The MEIP Hspital Calculatin Sample prvides EHs with an example f a cmpleted estimated EHR incentive payment. Appendix C Sample MEIP Hspital Calculatin prvides an example f a cmpleted MEIP Hspital Calculatin wrksheet. 7. Select enrllment year. Eligible hspitals can chse t enrll fr 2013 as the Year 1 EHR incentive payment. The fllwing tables can assist the decisin: a) Appendix D: MEIP First Enrllment and Attestatin Mnth prvides the Payment Year ptins based n when the EH has submitted the CMS R&A registratin and the mnth they are perfrming their attestatin in MEIP. b) Appendix E: MEIP Hspital Fiscal Year Start prvides the time perid t be used fr discharge vlumes, charges and inpatient days in the MEIP incentive payment calculatin based n the desired first payment year. If the EH is enrlling fr the 2012 payment year, the EH shuld review when the EH calendar year ends. The EH must use the cst reprt year that verlaps the mst recent federal fiscal year. If the EH calendar year ends n August 31 fr the 2012 payment year then the EH wuld use the 2010 cst reprt. T determine the discharge-related amunt fr the three subsequent payment years that are included in determining the verall EHR amunt, the number f discharges will be based n the Page 21 f 26

22 average annual grwth rate fr the hspital ver the mst recent three years f available data. Per a CMS.gv utreach dcument, Fr the first payment year, data n hspital discharges frm the hspital fiscal year that ends during the federal fiscal year prir t the hspital fiscal year that serves as the first payment year will be used as the basis fr determining the discharge-related amunt. 8. Pre-Payment Review Based n DHS Minnesta EHR Incentive Prgram plicy, prviders will be prcessed thrugh autmated, and in sme cases, manual pre-payment verificatin prcedures. If selected, prviders may be required t uplad additinal infrmatin t supprt the data entered at the time f attestatin. Fllwing the cmpletin f the attestatin prcess, a Pre-Payment Review may be cnducted. 9. If determined eligible, payment will be received fllwing the cmpletin f the attestatin in the MEIP within 45 days f the final attestatin Cnfirm and Submit. Payments will be disbursed by DHS n a bi-weekly basis and will appear as a grss adjustment n yur remittance advice. Page 22 f 26

23 2.3 Medicaid Patient Vlume (MPV) Calculatin fr EHs DHS has received several requests fr clarificatin language cntained in the State Medicaid HIT Plan (SMHP) related t which participants may be cunted tward their Medicaid Patient Vlume (MPV) fr purpses f the Minnesta Medicaid EHR Incentive Prgram (MEIP). This resurce is intended t prvide clarificatin n the prcess used by MHCP t calculate MPV based n which Minnesta Health Care Prgrams (MHCP) meet the definitins fr eligible encunters in the federal regulatins. Minnesta s apprved SMHP indicated the fllwing: Eligible Hspitals The SMA fllws the definitin in federal regulatins fr EH Medicaid patient encunters where an EH Medicaid patient-encunter, is defined as services rendered t an individual per inpatient discharge r n any ne day in the emergency rm where Title XIX Medicaid r anther state s Medicaid prgram paid fr part r all f the service, their premiums, c-payments, and/r cst-sharing. Per federal regulatins, children s hspitals are nt required t meet any Medicaid patient-vlume percentage, and d nt prvide infrmatin n patient encunters. Minnesta has created a hspital incentive calculatin template which is available n ur EHR Incentive website. Minnesta EHs use Inpatient Discharges and Emergency Department (ED) visits, as described in the rule, fr calculating their Medicaid patient encunters and EHs can: Chse the 90-day perid; Cunt ut-f-state encunters; Calculate vlume using the grup clinic/prxy methdlgy; and Cunt participants in: MA (Medicaid) EH (Medicaid cverage f certain nncitizens fr medical cnditins) FF (federally funded demnstratin; MinnestaCare fr parents and adult caretakers) LL (federally funded demnstratin; MinnestaCare fr pregnant wmen and children) FP (Family Planning services; family planning services nly) Page 23 f 26

24 QM (Medicare Part A & B premiums, and cst sharing) SL (Medicare Part B premiums) WD (Medicare Part A premium nly) EPs practicing predminantly in FQHC/RHC and Physician Assistants als include: NM with eligibility type PC (CHIP prgram) Services prvided n a sliding scale r that were uncmpensated MA, r Medical Assistance, is Minnesta s Medicaid prgram. It is jintly funded with state and federal funds. The Minnesta Department f Human Services versees the prgram statewide. The federal Centers fr Medicare and Medicaid Services versees Medicaid natinally. All Medical Assistance subcategries/prducts (see belw) are cuntable fr purpses f determining Medicaid Patient Vlume under the Minnesta Electrnic Health Recrd Incentive Prgram. MA is administered thrugh bth feefr-service and managed care. Additinal details n the managed care prducts fr MA are prvided belw. Relevant language frm CMS Respnse and Analysis n Cmments in the Final Rule: In establishing the Medicaid patient vlume threshlds fr EPs and acute care hspitals, sectin 1902(t)(2) f the Act requires that individuals enrlled in a Medicaid managed care plan be included. We interpret this t mean that individuals enrlled in MCOs, prepaid inpatient health plans (PIHPs), r prepaid ambulatry health plans (PAHPs), under 42CFR Part 438 be included in the calculatin. Clarificatin n DHS Prgrams Administered Thrugh Managed Care Organizatins: In an effrt t assist Minnesta prviders with identifying encunters that can be included, the fllwing verview prvides additinal details n the DHS prgrams administered thrugh Managed Care Organizatins. MCO s were asked t prvide the grup numbers that crrespnd t the prgram cdes that are eligible fr inclusin in the Medicaid Patient Vlume calculatin under the Minnesta Medicaid Electrnic Health Recrd Incentive Prgram. Medical Assistance with Federal Financial Participatin (FFP): Sub-categries identified under DHS Majr Prgram Cde MA include: MA12 Prepaid Medical Assistance Prgram Page 24 f 26

25 MA20 Prepaid Medical Assistance Prgram MA17 Special Needs Basic Care (SNBC Integrated Medicare) MA19 Special Needs Basic Care (SNBC PIN Nn-integrated Medicare) MA37 Special Needs Basic Care (SNBC Nn-integrated Medicare) MA30 Minnesta Senir Care Plus (MSC+) MA35 Minnesta Senir Care Plus (MSC+) MA02 Minnesta Senir Health Optins (MSHO) Other Prgrams Administered by Managed Care Organizatins with Federal Financial Participatin: MinnestaCare MinnestaCare is a publicly subsidized prgram fr Minnesta residents wh d nt have access t affrdable health care cverage. This prgram is als administered by managed care rganizatins, and is funded by a state tax n Minnesta hspitals and health care prviders, as well as federal Medicaid matching funds (in sme cases), and enrllee premiums. The MinnestaCare Prducts that are eligible fr FFP and cuntable fr purpses f determining Medicaid Patient Vlume under the Minnesta Medicaid Electrnic Health Recrd Incentive Prgram (MEIP) include: MinnestaCare Basic Plus Tw (parents & adult caretakers with incme 275% FPL) MinnestaCare Basic Plus ( parents and adult caretakers with incme 275% FPL) MinnestaCare Expanded (MinnestaCare fr children under age 21 and pregnant wmen) MinnestaCare Expanded (MinnestaCare fr adults withut children up t 250% FPL) The MinnestaCare prgrams that are nt eligible fr FFP and are exclusively funded by the state that are nt cuntable fr purpses f determining Medicaid Patient Vlume under MEIP include: MinnestaCare fr nncitizen parents/caretakers with incme 275%FPL MinnestaCare fr nncitizen children under 21 and pregnant wmen Page 25 f 26

26 Children s Health Insurance Prgram (CHIP) The Children s Health Insurance Prgram (CHIP) is a federal prgram that prvides health cverage t children in families with incmes t high t qualify fr Medicaid, but that can t affrd private cverage. Signed int law in 1997, CHIP prvides federal matching funds t states t prvide this cverage. Under the Medicaid EHR Incentive Prgram, CHIP enrllees are included in the definitin f needy individuals wh may be cunted tward Medicaid patient vlume, but nly fr eligible prfessinals practicing predminantly in a Federally Qualified Health Center (FQHC), Rural Health Clinic (RHC) r Indian Health Service Clinic (IHS). Individuals in the CHIP prgram are identified under the fllwing cde: CHIP fr unbrn children f nncitizen mthers ineligible fr federally funded MA Additinal Rules fr Cunting Medicaid Encunters fr EHs MHCP will filter EH-Specific claim queries in accrdance with the fllwing rules: If a persn has an Emergency Department (ED) visit and n inpatient stay n a given day, the ED is ne encunter If a persn has an inpatient stay but n ED visit, the inpatient discharge is ne encunter If a persn ges t an ED and is admitted t an inpatient stay where the DISCHARGE frm that inpatient stay is any day FOLLOWING the ED visit is TWO encunters If a persn has an inpatient stay and is discharged and ges t the ED n the same day as the discharge t the same prvider, that will be cunted as ONE encunter Cntiguus inpatient stays frm the same prvider are merged and cunted as ONE encunter The measurement span includes ne mnth prir and ne mnth after the actual measurement year t evaluate inpatient discharge dates Inpatient discharge must ccur between the start and end dates f the measurement span t be included as an encunter Page 26 f 26

27 Appendix A - MEIP Guidance n Supprting Dcumentatin Categry Dcument Optins Required/Situatinal Adpt, Implement, Upgrade Recnsideratin Appeal Pre-Payment Audit Pst-Payment Audit EHR Slutin Grup AIU Other Cntract Purchase Order/Invice/Receipt Recnsideratin Request Supprting Dcumentatin MEIP Appeal Frm Pre-Payment Audit Dcumentatin Pst-Payment Audit Dcumentatin EHR Cntract EHR Other EHR Purchase Order EHR Sftware License Grup Attestatin Dcument Grup Members Cnsent Dcumentatin Grup Other Grup Vlumes Supprting Dcumentatin Required first year nly. In the first year, prviders will be required t uplad at least ne frm f AIU dcumentatin. This dcumentatin must clearly shw the relatinship between the certified EHR vendr, the entity that adpted, implemented r upgraded t the system, and the licensed user. Situatinal. This dcumentatin type wuld nly be used if a prvider is requesting a recnsideratin f an initial payment decisin. Situatinal. This dcumentatin type wuld nly be used if a prvider is filing a frmal appeal f a payment decisin. Situatinal. This dcumentatin type wuld nly be used if a prvider has been asked fr additinal dcumentatin during a pre-payment desk audit. Situatinal. This dcumentatin type wuld nly be used if a prvider has been asked fr additinal dcumentatin during a pst-payment audit. Required secnd year and beynd. Prviders will be required t uplad at least ne frm f EHR slutin dcumentatin in year 2 and beynd. This dcumentatin must clearly shw the relatinship between the certified EHR vendr, the entity using the system, and the licensed user. Situatinal. Prviders attesting using a grup Medicaid Patient Vlume (MPV), will be required t uplad dcumentatin listing the EPs, whether they intend t attest as part f the grup, and dcumenting their cnsent t include their patient vlume included in the grup. The MEIP Grup Cnsent Frm available n the MEIP Reference Material website prvides a template fr prviders t accunt fr all prfessinals emplyed by the grup.

28 Legal Ntice Categry Dcument Optins Required/Situatinal Situatinal. This dcument is autmatically generated and upladed t the Disagreed with Legal Ntice prvider s file if the prvider indicates that they disagree with the legal ntice. Signed & Affirmed Legal Ntice Required. This dcument is autmatically generated and upladed t the prvider s file when they electrnically sign the legal ntice. Prviders are ffered the pprtunity t print a cpy f this dcument fr their recrds upn attestatin. Meaningful Use Patient Vlume Payment Pediatrician Attestatin FQHC/RHC/IHS Attestatin MU Other Hspital Based Patient Encunter Patient Vlumes Other Out f State Vlume EH Average Length f Stay EH Charity Expenses Supprting Dcumentatin EH Discharge Dcumentatin EH Schedule Adjustment EH Medicaid Share EH Cst Reprt and/r HAR EP Adjustment Payment Other Pediatrician Certificatin PA S-Led Dcumentatin Situatinal. If a prvider is attesting fr meaningful use, they may use this ptin t uplad any related dcumentatin in supprt f their MU attestatin. Situatinal. Prviders may uplad dcumentatin in supprt f their Medicaid patient vlume. This is required in situatins where prviders are including ut-fstate encunters in their MPV attestatin. Dcumentatin f ut-f-state encunters shuld specify the number and state in which the encunters ccurred. Situatinal. Hspitals will be required t submit dcumentatin relevant t their payment calculatin. Categries are als available in the event that an EP wuld need t uplad any payment related dcumentatin. Situatinal. Prviders may uplad dcumentatin in supprt f their pediatrician attestatin. Per MN Statute, (f) "Pediatrician" means a physician wh is certified by either the American Bard f Pediatrics r the American Ostepathic Bard f Pediatrics. Situatinal. Prviders may uplad dcumentatin in supprt f their PA-S-Led attestatin. Page f the Final Rule clarifies the CMS definitin f Physician Assistant (PA) s-led. The MEIP PA S-Led Frm is available n the MEIP Reference Material website fr prviders t attest t being emplyed in a s-led facility.

29 Appendix B. MEIP EP Individual and Grup Vlume Wrksheet Frm Date (m/d/yy) T Date (m/d/yy) PV Numeratr PV Denminatr Medicaid Prvider Name NPI Grup NPI Ttal Medicaid EP Encunters Ttal Encunters Attesting with Grup (Y/N) Cnsent t include yur patient vlume in the grup (Y/N) Signature f Cnsent t attest with the grup Nte: The Medicaid patient vlume will be calculated based n any cntinuus three mnth reprting perid in the previus calendar year starting the first day f the mnth.

30 Appendix C. MEIP Hspital Calculatin Sample MEIP Hspital Incentive Payment Calculatin Wrksheet Versin 1.0 Last updated: 09/26/2012 Step 1: Calculate grwth rate Ttal Difference Discharges Previus Year Previus Year Percent Change (Surce1: CMS Medicare Cst Reprt Wrksheet S-3, Part I, cl. 15, line 14) OR (Surce2: CMS Medicare Cst Reprt Wrksheet S-3, Part I, Cl. 15, Line 12) Year 1 (Federal Fiscal (FF) Year 18,015-18,131 = (116) 18,131 = prir t payment year)) Year 2 (1st Previus FF Year) Year 3 (2nd Previus FF Year) Year 4 (3rd Previus FF Year) 18,131-17,297 = ,297 = ,297-16,773 = ,773 = Years f Data Average Grwth Rate 16, = 2.44% Step 2: Calculate initial payments Ttal Discharges Average Grwth Rate Adjusted Discharges Allwed Discharges (max=21,850) Discharges Rate Discharge Cst Base Amunt Transitin Factr Year 1 18, = 18,015 16,865 $200 = $3,373,000 + $2,000,000 1 = $5,373,000 Year 2 18, % = 18,454 17,304 $200 = $3,460,744 + $2,000, = $4,095,558 Year 3 18, % = 18,903 17,753 $200 = $3,550,625 + $2,000, = $2,775,313 Year 4 18, % = 19,363 18,213 $200 = $3,642,695 + $2,000, = $1,410,674 Nte: There is n dischange allwance fr discharges less than 1,150 and mre than 23,000 (23,000-1,150 Overall EHR Amunt: $13,654, = 21,850). Step 3: Calculate Medicaid share Ttal Charges (Surce1: CMS Medicare Cst Reprt Wrksheet C, Part I, cl. 8, line 200) OR (Surce2: CMS Medicare Cst Reprt Wrksheet C, Part I, Cl. 8, Line 101) Charity Care Charges* (Surce1: CMS Medicare Cst Reprt Wrksheet S- 10, cl. 3, line 20 minus HAR 0621) OR (Surce2: CMS Medicare Cst Reprt Wrksheet S-10, Line 30 minus HAR 0621) OR (Surce3: HAR line 0762) Ttal Charges % f Nncharity Charges Ttal Inpatient Days (Surce1: CMS Medicare Cst Reprt Wrksheet S- 3 part I, cl. 8, line 1, 2 + lines 8-12) OR (Surce2: CMS Medicare Cst Reprt Wrksheet S-3, Part I, Cl. 6, Line 1, 2 +lines 6-10) Adjusted Inpatient Days Medicaid Inpatient Days FFS** (Surce1: CMS Medicare Cst Reprt Wrksheet S- 3 part I, cl. 7, line 1 + lines 8-12) OR (Surce2: CMS Medicare Cst Reprt Wrksheet S-3, Part I, Cl. 5, Line 1 + lines 6-10) Medicaid Inpatient Days MC*** (Surce1: CMS Medicare Cst Reprt Wrksheet S-3 part I, cl. 7, line 2) OR (Surce2: CMS Medicare Cst Reprt Wrksheet S-3, Part I, Cl. 5, Line 2) Initial EHR Payment Adjusted Inpatient Days Medicaid Share Current Yr $939,854, $44,821, $939,854,524 = ,530 = 92,879 8, ,309 92,879 = 31.44% Step 4: Calculate aggregate amunt Overall EHR Amunt Medicaid Aggregate EHR Share Amunt Current Yr $13,654, % = $4,292, MEIP Hspital Calculatin Wrksheet ftntes * Charity Care Charges - Charges amunt n CMS Medicare Cst Reprt Wrksheet S-10, cl. 3, line 20 and CMS Medicare Cst Reprt Wrksheet S-10, Line 30 is Step 5: Apply MN hspital incentive payut schedule an Uncmpensated amunt and nt exclusive t Charity Care. T calculate Charity Care when using r , Bad Debt must be lcated n HAR Reprt 0621 then Aggregate EHR Amunt Payut Percentage Annual Incentive Payment Subtracted frm the Uncmpensated amunt. Year 1 $4,292,535 50% = $2,146, ** Medicaid Inpatient Days FFS - T calculate net value, SUBTRACT Managed Care (MC) patient days, Medicaid eligible days fr which n payment was received and nursery days Year 2 $4,292,535 40% = $1,717, after discharge frm CMS Medicare Cst Reprt Wrksheet S-3 part I, cl. 7, line 1 + lines 8-12 r CMS Medicare Cst Reprt Wrksheet S-3, Part I, Cl. 5, Year 3 $4,292,535 10% = $429, line 1 +lines $4,292, *** Medicaid Inpatient Days MC T calculate net value, SUBTRACT Medicaid Fee-Fr-Service (FFS) secndary payer patient days, Medicaid eligible days fr which n payment was received and nursery days after discharge frm CMS Medicare Cst Reprt Wrksheet S-3 part I, cl. 7, line 2 r CMS Medicare Cst Reprt Wrksheet S-3, Part I, Cl. 5, Line 2. Requirement: Hspitals are required t use their CMS apprved cst reprt. If a CMS apprved cst reprt is nt used then supprting dcumentatin will be required. Hspitals are t use their MN Hspital Annual Reprt (HAR) when necessary.

31 CMS R & A Registratin Date SEPT 2012 r earlier OCT 2012 NOV 2012 DEC 2012 JAN 2013 FEB 2013 MAR 2013 APR 2013 MAY 2013 JUN 2013 JUL 2013 AUG 2013 SEP 2013 OCT 2013 NOV 2013 DEC 2013 JAN 2012 r r r 2013 Appendix D. MEIP First Enrllment and Attestatin Mnth 2012 r OCT NOV DEC JAN FEB MAR APR MAY JUN JUL AUG SEP OCT 2013 NOV 2013 DEC 2013 JAN 2013

32 Appendix E - MEIP Hspital Fiscal Year Start Hspital Fiscal Year Start 2012 Payment Year Payment Year 2 January January 1, December 31, 2010 January 1, December 31, 2011 February February 1, January 31, 2011 February 1, January 31, 2012 March March 1, February 28, 2011 March 1, February 28, 2012 April April 1, March 31, 2011 April 1, March 31, 2012 May May 1, April 30, 2011 May 1, April 30, 2012 June June 1, May 31, 2011 June 1, May 31, 2012 July July 1, June 30, 2011 July 1, June 30, 2012 August August 1, July 31, 2011 August 1, July 31, 2012 September September 1, August 31, 2011 September 1, August 31, 2012 Octber Octber 1, September 30, 2011 Octber 1, September 30, 2012 Nvember Nvember 1, Octber 31, 2010 Nvember 1, Octber 31, 2011 December December 1, Nvember 30, 2010 December 1, Nvember 30, EH must have registered with CMS Registratin and Attestatin (R&A) prir t September 30, During the 120 day grace perid frm Octber 1, 2012 January 31, 2013, EHs that have cmpleted the CMS R&A registratin per ftnte 1, have the chice f selecting payment year 2012 r 2013.