emipp Extending Medicaid Connectivity for Managing EHR Incentive Payments Overview

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1 Extending Medicaid Connectivity for Managing EHR Incentive Payments JANUARY 2011 Registration for EHR Incentive Program begins APRIL 2011 Attestation for the Medicare EHR Incentive Program begins NOVEMBER 30, 2011 Last day for eligible hospitals and CAHs to register and attest to receive an incentive payment for CY 2011 Last year to initiate participation in the Medicare EHR Incentive Program Last year to receive a Medicare EHR Incentive Payment Last year to initiate participation in Medicaid EHR Incentive Program Winter 2012 Fall 2011 Spring 2011 Winter 2011 Fall 2010 Certified EHR Technology Available and Listed on ONC Website JANUARY 2011 For Medicaid providers, States may launch their programs if they so choose MAY 2011 EHR Incentive Payments begin FEBRUARY 29, 2012 Last day for EPs to register and atleast to receive an incentive payment for CY 2011 Medicare payment adjustments begin for EPs and eligible hospitals that are not meaningful users of EHR Technology Overview The US healthcare landscape is undergoing a historic transformation in an effort to improve quality, safety and efficiency of care; where state and federal health and human services agencies are preparing for technology initiatives from ICD-10 implementation to setting up Health Information Exchanges (HIE) and supporting the adoption of Electronic Health Records (EHR). The Health Information Technology for Economic and Clinical Health Act, or the "HITECH Act", established programs under Medicare and Medicaid to provide incentive payments to eligible professionals (EPs) and eligible hospitals (EHs) as they adopt, implement, or upgrade certified EHR technology and demonstrate meaningful use. The state Medicaid agencies will play a critical part in enabling this transformation, by not only supporting and facilitating EHR adoption via the incentive payment program, but also by leveraging the HIE infrastructure to manage the continuum of healthcare delivery, reduce costs, and improve outcomes for their beneficiary population. As your providers get registered to showcase their EHR implementations, is your agency ready to meet this timeline for managing incentive payments as well as monitoring the health data s Meaningful Use in the coming few years? 2021 Last year to receive Medicaid EHR Incentive Payment Measuring Meaningful fluse for the Future

2 The Urgency of Now! CNSI s successful and proven solution,, is now taking the Medicaid program in the new age of a connected healthcare infrastructure. is a modular solution to manage the EHR Medicaid Incentive Payment Program (MP), Medicaid Health Record (MHR), and HIE Connectivity. It offers a comprehensive and configurable solution to measure and demonstrate the EHR superior outcomes as outlined by CMS guidelines. This solution builds on the MITA principles and uses a services-based framework, thus enabling the solution modules to leverage and re-use existing state systems and quickly comply with CMS defined timeline. CNSI s solution is built on a true services framework and can integrate with any existing MMIS system or other state systems and HIEs. The overall solution leverages a set of reusable services (provider registry, eligibility service etc.) to support state Medicaid agencies in administering the incentive payment program and meet federal audit and control standards. The solution also provides an independent data set that combines clinical and administrative data sets; leverages the open source CONNECT framework; and integrates with external services like CMS National Level Repository (NLR) and with the Office of the National Coordinator (ONC) to support and track the evolving requirements around meaningful use. The platform provides the following key business benefits: Online, secure, real time collaboration with the provider community: CNSI s solution provides a complete web based user interface. The web based interface enables eligible providers to register for incentive payments. The providers are able to view, request an update, or track status of their registration and data forms in a self service mode. This not only reduces state administrative burden but also allows the providers and state agencies to communicate in a more effective manner. End-to-End Business Process Automation Workflow Management: CNSI s solution not only provides a web-based user interface, but also implements a workflow framework allowing users to interactively navigate through a series of intutive steps to complete either a partial or entire business process. This feature allows the business processes to be streamlined and flexible for continuous improvement to adapt to changing business needs. Interface with CMS-NLR: CNSI s solution utilizes a powerful repository (ISR) framework to communicate with CMS-NLR to streamline and fulfill the registration requirements of hospitals and eligible professionals. Smart Event Viewer: CNSI s has a smart event viewer screen that provides quick access to an actionable task list from the state registration workflow, time based alerts generated by the system and data driven threshold reminders. The event management framework driving the user interface also facilitates timely user action (through escalation and reminders) and can initiate new business processes and/or execute a business action automatically. Services Based Integration: CNSI s solution is completely based on MITA initiated Service Oriented Architecture (SOA) which provides the flexibility to be integrated with any existing state managed provider management applications. CMS Finalizes Requirements for Medicaid EHR Incentive Program Source: CMS Media Release Database The Recovery Act amended the Medicaid statute to provide for a 100 percent Federal financial participation (FFP) match for state expenditures for provider incentive payments to encourage Medicaid health care providers to adopt, implement, upgrade or meaningfully use certified EHR technology. It also established a 90 percent FFP match for reasonable state expenses related to administration of the incentive payments and to promote EHR adoption and health information exchange. Key Features Implementation of payment and eligibility rules for the Medicaid Incentive Payment Program. o Interface with CMS NLR database to provide accurate registration and payment information. Self-service portal for providers with easy to use wizards to maintain and access data in a secure environment. Smart user interface coupled with workflow management for routing of requests with support for alerts, reminders and notifications. Built in payment and eligibility rules for the program. Out-of-the-box utilization and audit reporting. Extensible to support reporting needs for tracking meaningful use.

3 has been successfully tested with CMS It is in production in the state of Michigan, and is scheduled to be rolled out during the second half of 2011 for the state of Washington. As a webbased stand-alone system with a service-based framework for interoperability, supports: MP provider registration and payments for years 1 to 6. State review of registration, attestation, and generation of state authorized payments. Tracking long-term data elements related to quality of care. As a standalone solution, supports payments and reconciled by interfacing with the state accounting system or routing the payment requests through the existing MMIS. The solution is designed on CMS standards and provides a re-usable service stack that can be ported to any state. The solutions functionalities and services can be divided under two categories: Figure 1: The functional architecture of the solution A standard stack which contains the proven CMS interfaces along with provider registration functionalities to perform provider regis tration, state review and approval of registrations. This standard stack will help payments tied to the first and second year which for adopt/implement/upgrade (A/I/U) of EHR technologies and the related usage attestation for meaningful use of the EHR technology. A highly customizable stack with configuration items required to house State specific rules and required interface component to integrate with existing State Medicaid systems.

4 Online Functionalities Online Functionalities caters to the needs of all stakeholders including providers, State MP program administrators and CMS. The online functionalities helps providers to register for the MP program based on CMS mandated business rules and also help providers to track MP payments. For MP program administrators, the system offers functionalities to review provider registrations, initiate MP yearly payments and to track payments. The solution also offers guided workflows to assist in the application review process. The workflows could be customized and currently offers automated workflow tasks for Medicaid provider credentialing and for EHR system certification number verification with ONC. All business rules are housed under rules engine which provides the required transparency, adaptability and required maintainability for any State specific rules EHR Provider Registration Functionality The online portal will allow EPs and EHs to register in state s EHR MP program to receive the yearly payment. Prior to registering at the State level all providers must register with the NLR and obtain an NLR Registration ID. NLR will then notify the State about each registered provider via one of the dedicated CMS-NLR interfaces. As part of the registration process the system will collect the provider s EHR certification information. For EPs, it will collect their Medicaid patient and total encounter volume for the stipulated reporting period to confirm their eligibility. For EHs the state will use existing cost report data to confirm eligibility and calculate payments. EHR Provider Registration Approval (State) Functionality This functionality facilitates State staff review of the information given by the providers as part of the registration process including Medicaid patient volume and attestation and to approve the registration. The functionality also includes automated interfaces with Medicaid to populate the MP with data from Medicaid allowing State Administrators to review consistency between data provided to the two sources. State Administrators may use this data as part of decision criteria for approval or denial of a registration. The will automatically convey this information to CMS, as required via another dedicated interface. EHR Initiate Provider Incentive Payment Functionality This functionality will allow authorized State users to approve payments to eligible providers for years 1 through 6. When a payment is approved, all required information will be sent to the State accounting systems or routed through the State Medicaid system to initiate the payment using the gross adjustment functionality. EHR Provider Payment Reporting Functionality will provide reports related to registration as well as payment data. Registration related reports would provide information on registration requests, approvals and denials, and payment related reports would provide information on incentive payments issued to EPs and EHs by payment type and period (weekly, monthly, etc.). The Solution The online solution allows the providers to register for the e MP program and facilitates state administrators to review provide registrations and authorize incentive payments for approved providers. All payment authorizations are sent through interfaces to the Medicaid system for provider reimbursements and remittance reporting. Online Screen functionalities EHR Provider Registration and Attestation EHR Provider Registration Approval (state) EHR Initiate Provider Incentive Payment tracking EHR Provider Payment Reporting

5 Services CMS NLR & Cost Reporting Interface Service solution offers proven portable ready state interface services to facilitate the required data exchanges with CMS NLR system for NLR ID verification, duplicate payment check and for MP program cost reporting. CMS has identified batch 6 interfaces (B6, B7, D16, D17, D18, and C5) with the NLR registry. These six interfaces have been tested with CMS and are readily available for any State implementation. ONC (Office of the National Coordinator) Interface Service This Proven interface is between EHR MP and the Office of the National Coordinator which comes as a standard service. This interface validates the Provider s EHR certification number. ONC manages the process for registry and certification of EHR technologies. When a provider uses registers for MP, they enter a certification number which is then validated via interface with ONC. State Accounting Data Exchange Service This service facilitates the solution to send the MP payment requests (entered via a payment screen in the system) directly to the State Accounting system for provider payments. This is an optional service for a State who may opt to send the payment directly to the State financial Accounting instead of routing through the existing Medicaid system. Medicaid Data Exchange Service This service is required to implement data exchanges with Medicaid for provider data and provider credentialing/validation with the existing Medicaid system and to send provider payment requests to the Medicaid system rather to the Sate Financial Accounting system. Data Audit Service supports tracking and logging of information at various levels. It provides auditability of payment information, data changes and user updates to support the required federal and state audits. A complete traceability on who changed, who approved the record including when was the data Changed and reason for changes are readily available. All decisions and user actions including supporting electronic documents are linked to the system record and can be viewed online. The EHR MP Solution allows the providers to register for the EHR MP program & facilitates State administrators to review provider registrations and authorize incentive payments for approved providers. All payment authorizations are sent through interfaces to the Medicaid system for provider reimbursements and remittance reporting Data Exchange Service Interfaces CMS NLR & Cost Reporting ONC EHR Certification Validation State Accounting System Medicaid Data Audit EHR Initiate Provider Incentive Payment EHR Provider Payment Reporting

6 Foresight for the Future Laying out the Foundation for Future Stages of the Meaningful Use Continuum CNSI s solution is planned with a modular and forwardlooking approach to meet the needs of the Meaningful Use Implementation Stages 1 through 3. This allows agencies to comply with the immediate regulations quickly while laying the groundwork for the next few years. MU-GOM Registry This registry acts as reference registry to evaluate compliance for meaningful use measures. The MU goals, objectives and measures (MU-GOM) registry will hold both CMS and state defined goals, objectives and the related compliance measure. Users can view and maintain the standard meaningful measures (25 provider measures and 23 hospital measures) and any custom state specific measures. ecams Healthcare Engine (HCE): This acts as the backbone of integration engine to facilitate standard health information exchanges between EHR providers and the solution. The healthcare engine is powered by NHIN CONNECT infrastructure, the Federal open standard for health care exchange and implements all relevant services to support health information exchange. The system also provides auxiliary services to process and transform the exchanged data into meaningful data sets. Meaningful Use Measures Metrics Repository: This holds all meaningful use metrics received from the EHR provider through the HCE. This MU measures metrics will be used to analyze and report on the EHR Provider meaningful use compliance. Health Beat: ecams Health Beat provides a framework to publish scorecards and dashboards to monitor the effectiveness of the overall program. It provides a graphical interface on each applicable measure by reporting period for each EHR provider. Implementation Models can implemented as: A State owned infrastructure solution. The State provides the required hardware and software for CNSI to implement and configure the solution. An ASP model, where the state is charged a startup along with monthly managed services fee to provide the underlying infrastructure (hardware/software) and the ongoing operations and maintenance (O&M) for the solution under defined Service Level Agreements (SLA).