Stage 2 Meaningful Use

Stage 2 Topics Overview 2014 Reporting Changes Medicaid Provider Eligibility Measures Overview Core Objectives Comparison Menu Objectives Comparison Clinical Quality Measures 2

High Level Overview (1 of 2) Does everyone move to Stage 2 in 2014? No, everyone must do TWO years of Stage 1 before they move to Stage 2 If you have not completed a second year of attesting for Stage 1, you do not need to worry about most these changes until you complete the second year of stage 2 Which Meaningful Use stage do providers need to demonstrate in 2014? If you demonstrated MU Stage 1 for the first time in 2011 or 2012, then you must demonstrate Stage 2 in 2014 If you demonstrated MU Stage 1 for the first time in 2013 (or have never demonstrated MU), then you must demonstrate Stage 1 in 2014 3

High Level Overview (2 of 2) How long is the attestation period in 2014? All providers, regardless of their stage of MU, are only required to demonstrate MU for a three-month EHR reporting period in 2014: Medicare Providers - three-month reporting period is fixed to the quarter of calendar year for EPs Medicaid Providers - three-month reporting period is not fixed Which Certified EHR Technology Do I Need to Use in 2014? Regardless of the Meaningful Use Stage, if you are demonstrating in 2014 you must use 2014 Certified EHR Technology All 2011 certifications expire on 12/31/13

Triple Aim for Meeting Meaningful Use Stage 3: Improved Patient Outcomes Stage 1: Data Capture and Patient Access More Affordable Patient Care Better Health for Populations Stage 2: Information Exchange and Care Coordination Better Patient Care 5

Core Measures Comparison Stage 1 Stage 2 6

2014 Reporting Changes Reporting Period Reduced to Three Months Allows providers time to adopt 2014 certified EHR technology and prepare for Stage 2 All participants will have a three-month reporting period in 2014 Stage 2 rule allows for batch reporting Starting in 2014, groups will be allowed to submit attestation information for all of their individual EPs in one file for upload to the Attestation System, rather than having each EP individually enter data 8

All EPs, EHs, and CAHs: Upgrade to 2014 Edition certified EHR Starting with the 2014 meaningful use reporting period all EPs, EHs, and CAHs need to upgrade to 2014 Edition EHR technology only regardless of the meaningful use stage they need to meet The 2014 Edition EHR certification criteria support both revised MU Stage 1 and new Stage 2 requirements 2011 Edition will no longer be acceptable for the purposes of meeting the Certified EHR Technology definition and from a regulatory perspective 2011 Edition certifications will expire come the 2014 MU reporting period

2014 has a Special MU Reporting Period Length Medicare For non-first time Medicare EPs, EHs, and CAHs One calendar quarter during the reporting year (e.g., April 1, 2014 through June 30, 2014 would be a Medicare EP s 2nd quarter and an EH/CAH s 3rd quarter) Medicaid All Medicaid EPs, EHs, and CAHs (as determined by their state) will have an any continuous 90-day or 3- month reporting period during 2014 All new EPs, EHs, and CAHs continue to have an any continuous 90-day reporting period

Penalties Add Up for Medicare Providers! Year erx EHR PQRS Penalty Total 2012 1.0% No penalty No penalty 1.0% 2013 1.5% No penalty No penalty 1.5% 2014 2.0% No penalty No penalty 2.0% 2015 2016 2017 No penalty No penalty No penalty 1.0% 1.5% 2.5% 2.0% 2.0% 4.0% 3.0% 2.0% 5.0% 11

Medicaid Differences Medicaid EHR Incentive Program policy is different in two respects: 1. The Medicaid program does not have payment adjustments, so hardship exceptions are unnecessary 2. Medicaid providers are not required to participate in consecutive years of the Medicaid EHR Incentive Program For example, if a Medicaid EP skips 2014 (which would otherwise be their Stage 1, Year 2 ) and also skips 2015 but comes back to the Medicaid program in 2016, they would be required to demonstrate Stage 1, Year 2 in 2016 as if they never left the Medicaid program for those two years

2014 is the Last Year Medicare EPs Can Start MU to Get Incentive Payments As stated in the Health Information Technology for Economic and Clinical Health (HITECH) Act, no incentives can be paid to Medicare EPs that begin MU after 2014 EPs that start MU in 2014 could still earn as much as $24,000 in incentives if they demonstrate MU from 2014 through 2016

2014 is the basis 2016 Medicare Payment Adjustment For EPs this potentially means a -2% reduction to the Medicare physician fee schedule (PFS) amount for covered professional services furnished by the EP during 2016 The payment adjustment calculation for EHs and CAHs is a little more complicated and different for each. Here s a link to CMS EH/CAH tip sheet.

Medicaid Provider Eligibility Expansion Patient Encounters The definition of what constitutes a Medicaid patient encounter has changed. The rule includes encounters for anyone enrolled in a Medicaid program, including Medicaid expansion encounters (except stand-alone Title 21), and those with zero-pay claims The rule adds flexibility in the look-back period for overall patient volume 16

Medicaid Patient Volume Calculation Medicaid Encounters Previously under Stage 1 Rule prior to 2013 Service rendered on any one day where Medicaid paid for all or part of the service or Medicaid paid the co-pays, cost-sharing, or premiums Changed in Stage 2 Rule (applicable to all stages) Service rendered on any one day to a Medicaid-enrolled individual, regardless of payment liability Includes zero-pay claims and encounters with patients in Title 21-funded Medicaid expansions (but not separate CHIPs) Zero-pay claims include Claim denied - Medicaid beneficiary has maxed out the service limit Claim denied - service wasn t covered under the State s Medicaid program Claim paid at $0 - another payer s payment exceeded the Medicaid payment Claim denied - claim wasn t submitted timely 17

Medicaid Patient Volume Calculation Using Children s Health Insurance Program Encounters Stage 1 rule Only CHIP encounters for patients in Title 19 Medicaid expansion programs Stage 2 rule CHIP encounters for patients in Title 19 and Title 21 Medicaid expansion programs As before, encounters with patients in stand-alone CHIP programs cannot be included in Medicaid patient volume calculation 18

Medicaid Provider Eligibility Patient Volume Calculation Under Stage 1 rule prior to 2013 Medicaid patient volume for providers calculated across 90-day period in last calendar year Under Stage 2 rule (applicable to all stages) States also have option to allow providers to calculate Medicaid patient volume across 90-day period in last 12 months preceding provider s attestation Also applies to needy individual patient volume Applies to patient panel methodology, too With at least one Medicaid encounter taking place in the 24 months prior to 90- day period (expanded from 12 months prior) 19

Stage 2 Topics Overview Medicaid Provider Eligibility 2014 Reporting Changes Measures Overview Core Objectives Comparison Menu Objectives Comparison Clinical Quality Measures 20

Stages of Meaningful Use

Meaningful Use Stage 2 Objectives Stage 1 Objectives 15 Core Objective 5 out of 10 Menu Objectives 6 out of 44 CQMs 3 Core or 3 Alt Core 3 Additional CQMs Stage 2 Objectives 17 Core Objectives 3 out of 6 Menu Objectives 9 out of 64 CQMs 1 from at least 3 NQS domains 22

Core Objectives - Minor Changes

Measures Using A Patient Portal

Interoperability: Provider to Provider

Other Core Measures

Menu Measures

Clinical Quality Measures Must be submitted electronically Unless 2014 is Year 1 for you PQRS???? Plan is to have aligned and co-reported with CQM s

Core Objective 1 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Use CPOE for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines More than 30% of unique patients with at least one medication in their medication list seen by the EP have at least one medication order entered using CPOE Use CPOE for medication, laboratory and radiology orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines More than 60% of medication, 30% of laboratory, and 30% of radiology orders created by the EP during the EHR reporting period are recorded using CPOE 30

Core Objective 2 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Generate and transmit permissible prescriptions electronically (erx) More than 40% of all permissible prescriptions written by the EP are transmitted electronically using certified EHR technology Objective not changed More than 50% of all permissible prescriptions written by the EP are compared to at least one drug formulary and transmitted electronically using Certified EHR Technology 31

Core Objective 3 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Record demographics Preferred language Gender Race Ethnicity Date of birth More than 50% of all unique patients seen by the EP have demographics recorded as structured data Objective not changed More than 80% of all unique patients seen by the EP have demographics recorded as structured data 32

Core Objective 4 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Record and chart changes in vital signs: Height Weight Blood pressure Calculate and display BMI Plot and display growth charts for children 2-20 years, including BMI For more than 50% of all unique patients age 2 and over seen by the EP, blood pressure, height and weight are recorded as structured data Record and chart changes in vital signs: Height Weight Blood pressure (age 3 and over) Calculate and display BMI Plot and display growth charts for patients 0-20 years, including BMI More than 80% of all unique patients seen by the EP have blood pressure (for patients age 3 and over only) and height and weight (for all ages) recorded as structured data 33

Core Objective 5 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Record smoking status for patients 13 years old or older More than 50% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data Objective not changed More than 80% of all unique patients 13 years old or older seen by the EP have smoking status recorded as structured data 34

Core Objective 6 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Implement 1 clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance that rule Implement one clinical decision support rule Use clinical decision support to improve performance on high-priority health conditions 1. Implement 5 clinical decision support interventions related to 4 or more clinical quality measures, if applicable, at a relevant point in patient care for the entire EHR reporting period. 2. The EP has enabled the functionality for drug-drug and drugallergy interaction checks for the entire EHR reporting period 35

Core Objective 7 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Incorporate clinical lab-test results into certified EHR technology as structured data (Menu Item) More than 40% of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in certified EHR technology as structured data Objective not changed More than 55% of all clinical lab tests results ordered by the EP during the EHR reporting period whose results are either in a positive/negative or numerical format are incorporated in Certified EHR Technology as structured data 36

Core Objective 8 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Generate lists of patients by specific conditions to use for quality improvement, reduction of disparities, research or outreach (Menu Item) Generate at least one report listing patients of the EP with a specific condition Objective not changed Measure not changed 37

Core Objective 9 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Send reminders to patients per patient preference for preventive/ follow up care (Menu Item) More than 20% of all unique patients 65 years or older or 5 years old or younger were sent an appropriate reminder during the EHR reporting period Use clinically relevant information to identify patients who should receive reminders for preventive/followup care Use EHR to identify and provide reminders for preventive/followup care for more than 10% of patients with two or more office visits in the last 2 years 38

Core Objective 10 Comparison (1 of 2) Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request More than 50% of all patients of the EP who request an electronic copy of their health information are provided it within 3 business days Provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP 1. More than 50% of all unique patients seen by the EP during the EHR reporting period are provided timely (available to the patient within 4 business days after the information is available to the EP) online access to their health information 39

Core Objective 10 Comparison (2 of 2) Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request More than 50% of all patients of the EP who request an electronic copy of their health information are provided it within 3 business days Provide patients the ability to view online, download and transmit their health information within 4 business days of the information being available to the EP 2. More than 5% of all unique patients seen by the EP during the EHR reporting period (or their authorized representatives) view, download, or transmit to a third party their health information 40

Core Objective 11 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Provide clinical summaries for patients for each office visit Clinical summaries provided to patients for more than 50% of all office visits within 3 business days Objective not changed Clinical summaries provided to patients within 1 business day for more than 50% of office visits 41

Core Objective 12 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Use CEHRT to identify patientspecific education resources and provide those resources to the patient if appropriate (Menu Item) More than 10% of all unique patients seen by the EP are provided patientspecific education resources Objective not changed Patient-specific education resources identified by CEHRT are provided to patients for more than 10% of all unique patients 42

Core Objective 13 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure NEW NEW Use secure electronic messaging to communicate with patients on relevant health information A secure message was sent using the electronic messaging function of CEHRT by more than 5% of unique patients seen during the EHR reporting period 43

Core Objective 14 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure The EP who receives a patient from another setting of care or provider of care or believes an encounter is relevant should perform medication reconciliation (Menu item) The EP performs medication reconciliation for more than 50% of transitions of care in which the patient is transitioned into the care of the EP Objective not changed Measure not changed 44

Core Objective 15 Comparison (1 of 2) Stage 1 Objective Stage 1 Measure The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral (Menu) The EP who transitions or refers their patient to another setting of care or provider of care provides a summary of care record for more than 50% of transitions of care and referrals 45

Core Objective 15 Comparison (2 of 2) Stage 2 Objective Stage 2 Measure The EP who transitions their patient to another setting of care or provider of care or refers their patient to another provider of care should provide summary of care record for each transition of care or referral 1. EP provides a summary of care record for more than 50% of transitions of care and referrals 2. EP provides a summary of care record either a) electronically transmitted to a recipient using CEHRT or b) where the recipient receives the summary of care record via exchange facilitated by an organization that is a NwHIN Exchange participant or is validated through an ONC established governance mechanism to facilitate exchange for 10% of transitions and referrals 3. EP provider of care must either a) conduct one or more successful electronic exchanges of a summary of care record with a recipient using technology that was designed by a different EHR developer than the sender's, or b) conduct one or more successful tests with the CMSdesignated test EHR during the EHR reporting period 46

Core Objective 16 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Capability to submit electronic data to immunization registries or Immunization Information Systems and actual submission except where prohibited and in accordance with applicable law and practice (Menu) Performed at least one test of certified EHR technology's capacity to submit electronic data to immunization registries and follow up submission if the test is successful Objective not changed Successful ongoing submission of electronic immunization data from Certified EHR Technology to an immunization registry or immunization information system for the entire EHR reporting period 47

Core Objective 17 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Protect electronic health information created or maintained by the Certified EHR Technology through the implementation of appropriate technical capabilities Conduct or review a security risk analysis per 45 CFR 164.308 (a)(1) and implement security updates as necessary and correct identified security deficiencies as part of its risk management process Objective not changed Conduct or review a security risk analysis in accordance per 45 CFR 164.308 (a)(1), including addressing the encryption/security of data at rest and implement security updates as necessary and correct identified security deficiencies as part of its risk management process 48

Menu Measures Comparison Stage 1 Stage 2 50

Menu Measures Comparison Stage 1 required providers to select 5 out of 10 Menu Measures 7 of the 10 Stage 1 Menu Measures are now Core Measures Stage 2 requires providers to select 3 out of 6 Menu Measures 5 of the 6 Stage 2 Menu Measures are brand new 51

Menu Objective 1 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure NEW NEW Imaging results consisting of the image itself and any explanation or other accompanying information are accessible through CEHR More than 10% of all scans and tests whose result is an image ordered by the EP for patients seen during the EHR reporting period are incorporated into or accessible through CEHR Technology 52

Menu Objective 2 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure NEW NEW Record patient family health history as structured data More than 20% of all unique patients seen by the EP during the EHR reporting period have a structured data entry for one or more first-degree relatives or an indication that family health history has been reviewed 53

Menu Objective 3 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure NEW NEW Capability to identify and report cancer cases to a State cancer registry, except where prohibited, and in accordance with applicable law and practice Successful ongoing submission of cancer case information from Certified EHR Technology to a cancer registry for the entire EHR reporting period 54

Menu Objective 4 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure NEW NEW Capability to identify and report specific cases to a specialized registry (other than a cancer registry), except where prohibited, and in accordance with applicable law and practice Successful ongoing submission of specific case information from Certified EHR Technology to a specialized registry for the entire EHR reporting period 55

Menu Objective 5 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure NEW NEW Record electronic notes in patient records Enter at least one electronic progress note created, edited and signed by an EP for more than 30% of unique patients 56

Menu Objective 6 Comparison Stage 1 Objective Stage 1 Measure Stage 2 Objective Stage 2 Measure Capability to submit electronic syndromic surveillance data to public health agencies and actual submission except where prohibited and in accordance with applicable law and practice Performed at least one test of certified EHR technology's capacity to provide electronic syndromic surveillance data to public health agencies and follow-up submission if the test is successful Objective not changed Successful ongoing submission of electronic syndromic surveillance data from Certified EHR Technology to a public health agency for the entire EHR reporting period 57

Topic 5 - Clinical Quality Measures All providers must select CQMs from at least 3 of the 6 HHS National Quality Strategy (NQS) domains Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Processes/Effectiveness Medicaid providers will electronically report their CQM data to their state Provider Prior to 2014 2014 and Beyond 59 EPs Complete 6 out of 44 3 core or 3 alt. core 3 menu Complete 9 out of 64 Choose at least 1 measure in 3 NQS domains Recommended core CQMs include: 9 CQMs for the adult population 9 CQMs for the pediatric population Prioritize NQS domains

Questions? QUESTIONS? 60

Thank You! THANK YOU, If you have any questions, contact Len at: lberkstr@health.usf.edu (813) 455-8949 Or, Becky at: rkane1@health.usf.edu (813) 455-8950 61

Appendix

What is Meaningful Use? Meaningful Use is when a provider uses an Electronic Health Record (EHR) meaningfully According to CMS a provider uses their EHR meaningfully when they: Improve quality, safety, efficiency, and reduce health disparities Engage patients and families in their healthcare Improve care coordination Improve population and public health Ensure adequate privacy and security protections for personal health information 63

Overall Eligibility Requirements for Professionals Incentive payments for eligible professionals are based on individual practitioners If you are part of a practice, each eligible professional may qualify for an incentive payment if each eligible professional successfully demonstrates meaningful use of certified EHR technology Hospital-based eligible professionals are not eligible for incentive payments An eligible professional is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (Place Of Service code 21) or emergency room (Place Of Service code 23) setting. Each eligible professional is only eligible for one incentive payment per year, regardless of how many practices or locations at which he or she provide services 64

Meaningful Use Eligibility Medicare Eligible Professional Doctor of medicine or osteopathy Doctor of dental surgery or dental medicine Doctor of podiatry Doctor of optometry Chiropractor Cannot be hospital based (90% of services furnished inpatient or ED) Medicaid Eligible Professional Physician (MD/DO) Nurse practitioner Certified nurse-midwife Dentist Physician assistants who work at a PA-led FQHC or RHC Cannot be hospital based Must meet one of the following criteria: Have a minimum 30% Medicaid patient volume Have a minimum 20% Medicaid patient volume and is a pediatrician Practice predominantly in a FQHC or RHC and have a minimum 30% patient volume attributable to needy individuals 65 If you are eligible for both the Medicare and the Medicaid incentive programs, you can only participate in one program not both You may change incentives once over the incentive program duration If you practice in multiple locations, at least 50% of patients must be treated in locations that have certified EHRs that you use meaningfully

Can I Implement and Satisfy Requirements in the Same Year? (Yes, but watch dates!) 66 Medicare For the first payment year, the certified EHR reporting period is a continuous 90 day period within a calendar year In subsequent years, the EHR reporting period for eligible professionals will be the entire calendar year* * In 2014, everyone will report 90 days regardless of year Medicaid For the first participation year, eligible professionals only have to demonstrate that they have adopted, implemented or upgraded (AIU) certified EHR technology and meet the minimum volume threshold requirements for a 90 day period within the last 12 months There is no reporting period for this requirement; you simply have to have your EHR in use when you attest this fact to the state In subsequent years, the EHR reporting period for eligible professionals will be 90 days and then the entire calendar year*

Notable Differences Between Medicare and Medicaid EHR Incentive Program Medicare Federal government will implement Medicare fee schedule reductions begin in 2015 for physicians who are not meaningful users Meaningful use (attesting) begins in year 1 Maximum incentives for Eligible Professionals (EPs) is $44,000 ($39,000 if start in 2013, and $24,000 if start in 2014) Program sunsets in 2016; fee schedule reductions begin in 2015 Payments are proportional to Medicare allowed charges (75% of total allowed charges billed up to a cap each year) Payments after April 1, 2013 are subject to 2% sequestration Medicaid Voluntary for states to implement No Medicaid fee schedule reductions Adopt/Implement/Upgrade (AIU) for year 1 Maximum incentive for Eligible Professionals (EPs) is $63,750 Program sunsets in 2021; last year a provider may initiate program is in 2016 Payments are fixed and not proportional to Medicaid billings Payments are not subject to the 2% federal sequestration 67

Eligible for Both Programs? If eligible for both the Medicare and the Medicaid EHR incentive programs: Select one as you cannot receive incentive payments from both programs at the same time Medicare penalties will be incurred if Medicaid EHR incentive program is selected but you have not attested for 90 days of Meaningful Use before 2015 68

Meaningful Use Payment Medicare Adopt on or before 2011 2012 2013 2014 2015 2011 $18,000 2012 $12,000 $18,000 2013 $8,000 $12,000 $15,000 2014 $4,000 $8,000 $12,000 $12,000 2015 $2,000 $4,000 $8,000 $8,000-1% 2016 $0 $2,000 $4,000 $4,000-2% 2017 $0 $0 $0 $0-3% Total $44,000 $44,000 $39,000 $24,000 Negative Revenue 69

Medicare Penalties Based on What Year? If you start the program in you must do. 2011 365 days in 2013 2012 365 days in 2013 to avoid payment adjustment in 2015! 2013 90 days in 2013 2014 90 days by October 1, 2014 Source: http://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/Downloads/PaymentAdj_HardshipExcepTipSheetforEP.pdf 70

Penalties Add Up for Medicare Providers! Year erx EHR PQRS Penalty Total 2012 1.0% No penalty No penalty 1.0% 2013 1.5% No penalty No penalty 1.5% 2014 2.0% No penalty No penalty 2.0% 2015 2016 2017 No penalty No penalty No penalty 1.0% 1.5% 2.5% 2.0% 2.0% 4.0% 3.0% 2.0% 5.0% 71

Medicare Incentive Payments EPs are eligible for payments: Equal to 75% of total Medicare allowable billings up to cap For total incentives over program duration of up to $44,000 For all payments made after April 1, 2013, 2% will be taken out due to federal sequestration Payments are based solely on achieving meaningful use There are no up front payments for adopting, implementing or upgrading EHRs Payments are paid over 5 years, up to 5 payments If you adopt later or achieve meaningful use later, both the number of payments and the amount per payment drops If you skip a year after you have begun the program, the payment for that year will be lost If meaningful use is not achieved one year after you begin, the payment for that year will be lost

Meaningful Use Payment Medicaid Calendar Year 2011 $21,250 CY 2011 CY 2012 CY 2013 CY 2014 CY 2015 CY 2016 2012 $8,500 $21,250 2013 $8,500 $8,500 $21,250 2014 $8,500 $8,500 $8,500 $21,250 2015 $8,500 $8,500 $8,500 $8,500 $21,250 2016 $8,500 $8,500 $8,500 $8,500 $8,500 $21,250 2017 $8,500 $8,500 $8,500 $8,500 $8,500 2018 $8,500 $8,500 $8,500 $8,500 2019 $8,500 $8,500 $8,500 2020 $8,500 $8,500 2021 $8,500 Total $63,750 $63,750 $63,750 $63,750 $63,750 $63,750 73

Medicaid Payment Year 1 AIU Providers must demonstrate that they have adopted, implemented or upgraded certified EHR Technology There is no reporting period for this requirement It simply has to be accomplished before you attest that fact to the State In the first year of AIU, you must prove: Volume (group or individual) for a 90 day period of the prior 12 months Verification/receipt of adopting, implementing, or upgrading certified EHR technology The first year a Medicaid provider demonstrates meaningful use the EHR reporting period is 90 days (starting the year after you attest to AIU)

Medicaid Incentive Payments Providers whose patient mix includes at least 30% Medicaid beneficiaries, either managed care, fee for service or secondary Medicaid are eligible for up to $63,750 Pediatric providers whose patient mix includes at least 20% Medicaid beneficiaries, either managed care or fee-for-service are eligible for up to $42,500, two thirds of the $63,750 (If they meet the 30% volume they are eligible for the entire $63,750) There are 2 types of payments The first payment is based on adopting, implementing or upgrading EHR (up to $21,250 for this first payment) The remaining 5 payments are based on achieving meaningful use You may receive up to 6 payments, paid over 6 years (must start by 2016) If you adopt /achieve meaningful use later, the number of payments available decreases, but not the amount per payment If you skip a year after you have begun the program, you can wait until the next year and try again If meaningful use is not achieved one year after you begin, you can wait until the next year and try again If you are a Medicare provider participating in the Medicaid incentive you must follow the Meaningful Use timeline to avoid payment penalties

How to Register and Attest CMS has excellent step by step instructions with screen shots on registration and attestation For detailed directions access the following link: http://www.cms.gov/ehrincentiveprograms/20_registrationandattest ation.asp Prior to registering, ensure that your Eligible Professionals (EP) know the following information National Provider Identifier (NPI) National Plan and Provider Enumeration System (NPPES) User ID and Password (same as PECOS log in and password) Payee Tax Identification Number (if you are reassigning your benefits) Payee National Provider Identifier (NPI)(if you are reassigning your benefits) 76

3 rd Party Registration 3 rd parties can register and attest on behalf of an Eligible Professionals (EP) if they complete a 3 rd Party Proxy Registration Create an I&A account https://nppes.cms.hhs.gov/nppes/iasecuritycheck.do Request to attest on behalf of provider(s) Provider authorizes request 77