MARYLAND STATE-REGULATED PAYOR ELECTRONIC HEALTH RECORD ADOPTION INCENTIVE PROGRAM

Transcription

1 MARYLAND STATE-REGULATED PAYOR ELECTRONIC HEALTH RECORD ADOPTION INCENTIVE PROGRAM

2 MARYLAND EHR ADOPTION INCENTIVES Background Eligible Practices Incentive Components Application Process 2

3 BACKGROUND

4 ELECTRONIC HEALTH RECORDS Electronic health records (EHRs) have the potential to improve health care quality, patient safety, care coordination, and continuity, while reducing health care costs Ambulatory Physician EHR Adoption Rates Maryland Data Maryland Board of Physicians National Data National Center for Health Statistics Dash lines within the chart indicate 2010 data are preliminary 4

5 FORMATION OF STATE INCENTIVES Maryland is the first State to build on the Medicare and Medicaid adoption incentive programs under the American Recovery and Reinvestment Act of 2009 (ARRA), requiring State-regulated payors to provide incentives for the adoption of EHRs The State incentives are separate and independent of the federal Medicare and Medicaid incentives for EHR adoption; there are different eligibility and participation requirements for each of the programs Current Legislation The 2009 House Bill 706 Electronic Health Records Regulation and Reimbursement (HB 706) requires establishing regulations to require State-regulated payors to provide incentives to providers to promote the adoption of EHRs The 2011 House Bill 736 Electronic Health Records Incentives for Health Care Providers Regulations (HB 736) further clarify the incentive program established under HB 706 5

6 REGULATION DEVELOPMENT The Commission adopted as final COMAR , Electronic Health Record Incentives on April 21, 2011 HB 736 requires the incentives to be paid in cash unless a provider and payor agree on an incentive of equivalent value The Commission approved this change to the regulation along with a number of nonsubstantive wording changes at its June 16 th meeting. COMAR was published in the Maryland Register on July 29, 2011 for public comment as a proposed modified regulation The MHCC received two comments that included substantive changes Staff proposed changes to the incentive program to the Commission on September 15 th and the changes were approved by the Commission The regulations were approved as emergency by the Joint Committee on Administrative, Executive and Legislative Review on October 21 st

7 PAYOR PARTICIPATION Since 2010, the (MHCC) has been working with the six largest private payors in the State to identify ideas to include in the EHR adoption incentive program The six largest private payors required to provide incentives account for almost 92% of the health care premium volume in Maryland and include : Aetna CareFirst Cigna Coventry Kaiser Permanente United Healthcare 7

8 INCENTIVE ELIGIBILITY

9 STATE INCENTIVES Primary care practices that meet the requirements may receive an adoption incentive for electronic health record adoption Note: The payment is per practice, not per provider Payors are required to provide incentive payments to each eligible primary care practice that adopts and uses an EHR, including those owned by a hospital An EHR must be certified by an Authorized Testing and Certification Body designated by the Office of the National Coordinator for Health Information Technology and contain health-related information on an individual that: Includes patient demographic and clinical health information; and Has the capacity to: Provide clinical decision support; Support physician order entry; Capture and query information relevant to health care quality; and Exchange electronic health information with and integrate the information from other sources. 9

10 ELIGIBLE SPECIALTIES Primary Care practices include: Family General Internal Medicine Pediatrics Geriatrics Gynecology 10

11 INCENTIVE COMPONENTS

12 INCENTIVES WHAT ARE THEY? A one-time cash incentive per payor or Incentive of equivalent value, if agreed upon by practice and payor, that includes: Specific services Gain-sharing arrangements Rewards for quality and efficiency In-kind payment Other items that can be assigned a specific value A payor must provide a description of the incentive and a timeframe for distribution 12

13 AVAILABLE INCENTIVES Base Incentive based on the practice s panel members Additional Incentive based on advanced EHR use and may include Contracts with a State Designated Management Service Organization (MSO) or an MSO in Candidacy status for EHR adoption or implementation services Demonstrates advanced use of EHRs as determined by each payor Participates in the payor s quality improvement outcomes initiative and achieves the performance goals established by the payor Maximum value of $15,000 per practice per payor 13

14 BASE INCENTIVE An incentive from each payor based on the payor s share of members treated by the practice Calculated at $8 per member and limited to Maryland residents Based on each patient assigned to a provider within the primary care practice who is a member of the payor at the time a practice makes a request for the incentive payment In cases where the payor does not assign patients to a provider within a primary care practice, the patients enrolled with that payor who have been treated by the primary care practice in the last 24 months, if the practice is credentialed and participating with the payor Member eligibility used in the calculation is based on enrollment with the payor at the time a practice makes a request for the incentive payment Up to $7,500 available per practice per payor 14

15 ADDITIONAL INCENTIVES An Additional Incentive of up to $7,500 per payor may be available to practices that have achieved one of the following in the immediate 90 days prior to submitting the payment request: Practice adopts an EHR or uses services through a State Designated MSO or MSO in Candidacy status; State Designated MSOs are entities that offer hosted EHR solutions to practices and provide technical assistance, guidance, outreach, and education to support providers in achieving meaningful use Practice demonstrates advanced use of an EHR as determined by the payor; or Practice participates in quality improvement initiative(s) and has achieved established performance goals 15

16 APPLYING FOR THE INCENTIVE

17 APPLICATION PROCESS WHAT DO PRACTICES HAVE TO DO? Practices can complete and submit to each payor the EHR Adoption Incentive Application (application) The payor will use the application to consider the practice for the incentives The EHR adoption incentive program is from October 21, 2011 through January 1, 2015 Applications must be submitted prior to June 30, 2014 Practices may submit an application no earlier than six months in advance of requesting the incentive Payors will issue an EHR adoption incentive application acknowledgement letter to the practice within 90 days of receiving the application 17

18 EHR INCENTIVE APPLICATION WHAT IS INCLUDED? General practice information Estimated number of members: On the practice panel, when PCP is assigned by payor, or Treated by the practice in the last 24 months, when PCP is not assigned by payor Name and version of the certified EHR system implemented by the practice Description of the EHR functions that have been implemented or expected implementation date Signed attestation Other information as specified within the application 18

19 EHR INCENTIVE PAYMENT REQUEST The EHR Adoption Incentive Payment Request (payment request) is a uniform request for the incentive payment It is to be completed by each practice and submitted to each payor It cannot be submitted earlier then six months after submitting the application It must be submitted no later than January 1, 2015 Payors must process and pay in full each payment request within 90 days of receipt Practices have the option to request the Base Incentive and the Additional Incentive at the same time or request the Additional Incentive in a subsequent payment request. 19

20 EHR INCENTIVE PAYMENT REQUEST WHAT IS INCLUDED? A copy of the EHR Adoption Incentive Application acknowledgement letter A report that includes identification information of the practice members: On the practice panel, when PCP is assigned by payor, or Treated by the practice in the last 24 months, when PCP is not assigned by payor Other information as specified within the payment request form A payor may request additional information to validate the payment request A payor may exclude members in the incentive calculation that were previously included in another practice s incentive calculation 20

21 EHR INCENTIVE SAMPLE TIME-LINE 3 months Start July 2012 Application Submitted 3 months 3 months October 2012 Acknowledgment Letter Received January 2013 Payment Request Submitted 6 months after application submission 6 months 9 months April 2013 Incentive Payment 9 months after application submission 21

22 EHR INCENTIVE SAMPLE CALCULATION Payor 1 Payor 2 Payor 3 Total Base Incentive Number of Members ,800 Total Base Incentive $7,200 * $4,000 * $3,200 * $14,400 * Additional Incentive MSO $0 * $0 * $0 * $0 * Advanced EHR use $0 * $7,500 * $7,500 * $15,000 * QI Participation $0 * $0 * $0 * $0 * Total Additional Incentive $0 * $7,500 * $7,500 * $15,000 * Total Incentive $7,200 * $11,500 * $10,700 * $29,400 * * Incentives are only estimations of what a practice might receive. 22

23 EHR ADOPTION INCENTIVE KEY TAKEAWAYS One-time incentive per practice per payor Incentives are per payor and include a Base and Additional Incentive Primary care practices qualify Practice submits an EHR Incentive Application and EHR Incentive Payment Request The maximum incentive amount available is $15,000 per practice per payor Program ends January 1,

24 MORE INFORMATION Incentive Website: For more information about applying for the State-Regulated Payor EHR Adoption Incentives, please contact the payor to which you plan or have applied to using the information below. The following address and/or contact information was provided by each payor. Aetna, Inc. Coventry Health Care Kaiser Permanente Maryland EHR Incentives 509 Progress Drive, Suite 118 Linthicum, MD Fax: (860) Attn: Provider Relations Department Dolores Shores 750 Prides Crossing, Suite 300 Newark, DE Phone: (800) ext Fax: (866) Provider Contracting and Network Management 2101 E. Jefferson St. Rockville, MD Phone: (301) Fax: (301) CareFirst BlueCross BlueShield CIGNA Health Care Mid-Atlantic Region UnitedHealthcare, MidAtlantic Region External Mandates, Mailstop: Mill Run Circle Owings Mills, MD C/O EHR Incentive Coordinator Fax: (410) Contracting, Electronic Health Records Fax: (888) Attention: MD EHR Lisa Kahl 800 King Farm Blvd, Suite 600 Rockville, MD Fax: (855)