1
S.C. Medicaid EHR Incentive Program:
Incentives
for
Eligible Hospitals
Eligible Hospitals (EH)
An acute care hospital, defined as a health care facility with:
An average length of patient stay of 25 days or fewer
A CMS Certification Number (CCN) with last four digits
in range of 0001-0879 or 1300-1399
A children’s hospital, defined as a separately certified
children’s hospital with a CCN with last four digits in range of 3300-3399.
An EH that meets the requirements of both the Medicare and Medicaid incentive programs may receive incentives from
both programs.
Additional Requirements for the EH
An EH must: Meet at minimum a Medicaid patient volume threshold of
10%. (A children’s hospital is not required to meet Medicaid patient volume requirements.)
Meet the requirements of AIU (option for first
participation year only), or MU.
Have no state or federal exclusions that prevent receipt of
federal funding.
Be actively enrolled in the S.C. Medicaid Program.
Participation Year (Payment Year)
An EH that qualifies for the incentive payment may begin
to receive the incentives in any year from 2011 to 2016.
A Participation Year (aka Payment Year) is defined in
terms of a federal fiscal year (FFY). For example, the 2012 Participation Year is October 1, 2011 – September 30,
2012.
Attestation Tail Period: The S.C. Medicaid EHR Incentive
First Step: Register with CMS!
CMS Registration & Attestation System
Eligible providers who wish to participate in either the
Medicare or Medicaid program must first register with CMS’ Registration & Attestation System (aka NLR).
The official Web site for the CMS Medicare and Medicaid
EHR Incentive Program is:
www.cms.gov/EHRIncentivePrograms
CMS’ EHR Information Center is open to assist with
inquiries: 1-888-734-6433, 6:30 a.m. until 5:30 p.m.
(Eastern Time), Monday through Friday, except federal holidays.
First Step: Register with CMS!
CMS Registration & Attestation System
Important Registration Note:To participate in both the Medicare and the Medicaid
incentive programs in the same year, select "Both Medicare and Medicaid" during the CMS registration process.
First Step: Register with CMS!
CMS Registration & Attestation System
Important Note: Once successfully registered with CMS, we recommend that you do NOT return to your CMS account unless you need to modify registration
information.
If you return to the CMS account (even just to view
without modifying your data), you must take steps to re-submit your registration with CMS. A CMS status of “Registration Started/Modified,” or “In Progress,”
indicates the registration is NOT in a submitted status.
SCDHHS Validation of CMS Registration
CMS transmits registration to the S.C. State Level
Repository on a nightly basis.
The SCDHHS HIT Division validates that the EH is
licensed, enrolled as a Medicaid provider, and is not excluded from receiving federal funds.
After this validation pre-check, HIT sends info to CMS to
accept the registration, and opens the attestation tool.
(CMS sends an email to the EH to remind them to proceed with attestation.)
SCDHHS Validation of CMS Registration
In order for incentive payments to process through the S.C. Medicaid Management Information System, (MMIS), the NPI used in the CMS registration must be one that is associated with the Medicaid ID for “inpatient hospital” in the MMIS.
During the pre-check process, HIT will notify the EH if the EH NPI is not one associated with inpatient hospital. The EH will need to send a request to Medicaid Provider Enrollment to tie the NPI to an active Medicaid ID for an inpatient provider type.
Questions about registration?
Next Step: Attestation with S.C. Medicaid
The SLR is available at www.scdhhs.gov/slr .
Please allow 24-48 hours after successful CMS registration
before attempting to access the SLR.
To log in to the SLR attestation tool, use the provider NPI
and the CMS Registration ID.
The CMS Registration ID remains the same for all
participation years.
If you have not retained your CMS Registration ID,
contact the CMS EHR HelpDesk for assistance.
Eligibility to Participate – 12-Month Cost Report
For an Eligible Hospital, the law defines a Payment Year in
terms of a federal fiscal year (FFY) beginning with FFY2011.
The EH will use the cost report for the full 12-month
Cost Report Period (
Example: 2012 PY)
For the 2012 Participation Year (10/1/11-9/30/12), the base year cost reporting period that will be used in the payment calculation will be as follows:
Fiscal Year End Month Cost Report Year End
Attestation: AIU or MU?
An EH may attest to AIU (Adopt, Implement, or Upgrade)
in Year One of participation in the Medicaid EHR Incentive Program.
The EH must attest to MU (meaningful use) in Year One
of participation in the Medicare EHR Incentive Program.
All other participation years in both Programs are paid by
meeting the MU objectives.
Attestation: MU Reporting Period
Two factors determine the MU EHR reporting period for
an EH eligible for both the Medicare and the Medicaid EHR Incentive Programs:
The EH Participation Year
Timing of the attestation to the two Programs.
Any 90-day meaningful use reporting period is always followed by a full-year reporting period in the following
Participation Year. (The two Programs align for meaningful use.)
Attestation: MU Reporting Period
Example:In 2011, an EH attests to Medicaid under AIU, then to Medicare using a 90-day MU reporting period. In 2012, the EH will need to attest using a full-year MU reporting period for both Programs.
Example:
In 2011, an EH attests to Medicaid under AIU, but does not attest to Medicare. The EH waits until 2013 to attest to MU. The MU reporting period in 2013 would be a 90-day MU reporting period for both Medicare and Medicaid.
State Level Repository (SLR) Sign-In Screen
State Level Repository
Attestation Tool – Summary of Screens
The SLR attestation tool is comprised of a series of screens
that display data and allow collection of attestation data:
CMS/NLR Screen
Hospital Eligibility Details Screen
Incentive Payment Calculations Screen EHR Details Screen
MU Questionnaire (Year 2 Only) Document Upload Screen
State Level Repository
Attestation –Communication & Alternate Contacts
E-mails regarding the EH attestation are sent to the e-mail
address on record from the CMS registration.
The EH representative may also designate alternate
contacts, and request copies of e-mails sent from the SLR, by completing the Alternate Contact screen.
State Level Repository
CMS/NLR Screen
SLR
CMS/NLR Screen
Displays EH registration data from the CMS registration.
Possible action required: If data displayed is incorrect,
the EH rep must return to CMS to make the correction.
Displays S.C. Medicaid ID(s) associated with the EH NPI
and TIN provided during registration.
Possible action required: If there are multiple choices,
SLR
CMS/NLR Screen – Status Messages
PreCheck inProcess: SCDHHS is checking provider eligibility to participate PreCheck_Completed: SCDHHS has completed the eligibility check and the
provider may begin attestation
Attest_inProcess: Provider has begun the attestation, but has not yet submitted Attest_Completed: Provider has submitted the attestation to the SLR
DHHSCheck_inProcess: SCDHHS is checking the provider attestation against requirements
DHHSCheck_Completed: SCDHHS has completed the requirements check NLRDupCheck_inProcess: SCDHHS has sent CMS their intent to pay the
incentives
NLRDupCheck_Completed: CMS has responded to SCDHHS’ request MMISPayment_inProcess: SCDHHS is processing payment
Paid: SCDHHS has disbursed the incentive
SLR
CMS/NLR Screen – Year
One
SLR
CMS/NLR Screen – Year
One
SLR
CMS/NLR Screen – Year
Two
Add screenshot of CMS/NLR Screen
Questions about CMS/NLR Screen?
SLR
Attestation: Hospital Eligibility Details Screen
Collects EH attestation data related to: Patient Volume
EHR Details (AIU or MU) Growth Rate
Medicaid Share
Provides templates for required worksheets for EH completion.
HIT Hospital Worksheet
SLR
Hospital Eligibility Details Screen – Patient Volume
An EH must meet the Medicaid patient volume threshold of 10%. The formula for calculating patient volume is:
30
*Total Medicaid patient encounters in
any representative continuous 90-day (3 month) period in the preceding fiscal year
Total patient encounters in that same 90-day (3 month)
period
*100
SLR
Hospital Eligibility Details Screen – Patient Volume
No CHIP beneficiaries may be included in the Total Medicaid Encounters.
Select the EH county from the drop-down reference table
that is included in the SLR.
The SLR will offset the Medicaid encounters by the CHIP
percentage for that county when calculating the patient volume.
Since this CHIP adjustment factor is required by SCDHHS, this is not included as part of a post-payment audit.
SLR
Hospital Eligibility Details Screen – Patient Volume
Encounter: Services rendered to an individual:
Per inpatient discharge where Medicaid paid for part or
all of the service, or Medicaid paid all or part of the individual’s premiums, co-payments, and/or cost sharing;
and
In an emergency department on any one day where
Medicaid paid for part or all of the service, or Medicaid paid all or part of the individual’s premiums,
co-payments, and/or cost sharing.
SLR
Hospital Eligibility Details Screen
Ensure that the attestation of both Medicaid and Total
Discharges for the three-month patient volume period
includes the sum of the inpatient discharges and E/R visits.
Ensure that the Year One three-month patient volume
period falls within the base year cost report period being used to determine your Medicaid EHR aggregate incentive amount.
SLR
Hospital Eligibility Details Screen – Patient Volume
Additional information to provide:
If Nursery, Rehab, or Psych discharges are billed as a bill
type 11, the discharges can be used in the calculation. EHs provide more information about these discharges on the “HIT Hospital Worksheet.”
“HIT Volume Calculation Worksheet” must be completed
so that SCDHHS can test the validity of data submitted.
SLR
Hospital Eligibility Details Screen
Ensure that all supporting documentation used to determine
the “Medicaid Eligible” and “Total” inpatient discharges and E/R visits for the three-month period is uploaded into the SLR.
“Primary source document” will include copies of monthly
board minutes or monthly financial/statistical reports
prepared by hospital that provides info on discharges, ER visits, etc.
Where there is a difference between the number of “Medicaid
Eligible” and “Total” inpatient discharges and E/R visits reported on the primary source document, in comparison to the number of “Medicaid Eligible” and “Total” inpatient discharges and E/R visits reported in the HIT Volume Calculation worksheet, prepare and upload into the SLR a worksheet that will reconcile the difference(s).
SLR
Hospital Eligibility Details Screen – Patient Volume
SLR
Hospital Eligibility Details Screen – EHR Details
Adopt: acquiring, purchasing or securing access to certified
EHR technology
Implement: installing or commencing utilization of
certified EHR technology capable of meeting meaningful use requirements
Upgrade: expanding the available functionality of certified
EHR technology that facilitates meeting meaningful use (e.g., addition of clinical decision support, e-prescribing functionality, CPOE)
Meaningful Use: Required for Year Two
SLR
Hospital Eligibility Details Screen – EHR Details
The SLR has a specific screen to collect more information about the certified EHR technology (discussed later in this presentation).SLR
Payment
Aggregate EHR Incentive Amount
The aggregate EHR incentive amount is the total amount
the hospital could receive in Medicaid payments over a theoretical four years of the program. It is the product of two factors:
Payment
Aggregate EHR Incentive Amount - Overall EHR Amount
The overall EHR amount is based upon the sum over a theoretical four years of payment where
the amount for each year is the product of three factors:
An Initial Amount (base of $2Million, plus
discharge-related amount),
The Medicare Share (set at 1 by statute), and A Transition Factor applicable to each of the
Payment
Aggregate EHR Incentive Amount- Medicaid Share
The Medicaid Share is essentially the percentage of a hospital’s inpatient, non-charity care days that are attributable to Medicaid inpatients.
The numerator of the Medicaid Share is the sum of:
The estimated number of Medicaid inpatient-bed-days, and The estimated number of Medicaid managed care
Payment
Aggregate Incentive Amount- Medicaid Share
The denominator of the Medicaid Share is the product of: The estimated total number of inpatient-bed-days for the
eligible hospital during that period, and
The estimated total amount of the eligible hospital’s
SLR
Hospital Eligibility Details Screen-
Remember!
Ensure that any Medicaid sub provider (i.e., psych or
rehab) days and nursery days that may be reported as a
Medicaid HMO day on W/S S-3, Part 1, Column 7,
Line 2 (i.e. 2552-10) are excluded from the Medicaid
HMO days when entering this data into the SLR.
SLR
Hospital Eligibility Details Screen
The SLR Guide for Eligible Hospitals is a reference
source to the lines in the cost report that correspond to
the data needed for the calculation of the Medicaid
Share of the aggregate EHR incentive amount.
The SC HIT Payment Calculation Worksheet is also
available to provide a summary of W/S references and
an estimate of the aggregate payment amount.
SLR
Hospital Eligibility Details Screen – Beyond Year 1
46
Each participation year, the EH must at least meet the
minimum threshold for Medicaid patient volume (10%).
Each participation year, the EH will review the information
SLR
Hospital Elig Details-Growth Rate & Medicaid Share
SLR
Hospital Eligibility Details Screen – Year
Two
48
Information from Year One attestation is displayed. Fields 10-18 are editable.
Year Two: Do you need to revise info provided in Year
Questions about Patient Volume or
Payment Calculation?
SLR
Incentive Payment Calculations Screen
This screen displays the EHR Amount calculations, the Medicaid Share calculations, and the total aggregate EHR incentive payment amount. During the attestation review process, it is possible that the
EH will be required to make corrections that could change this estimated aggregate amount. Once the attestation is approved (MMIS Payment in Process), the EH will be able to view the approved amount.
Amendments to the EH cost report may impact the
aggregate EHR incentive payment amount.
SLR
EHR Details
Certified EHR Technology – certified by an
ONC-Authorized Testing and Certification Body (ONC-ATCB) and reported to ONC.
The ONC Certified Health IT Product List is updated at
least weekly and serves as the official listing of certified products.
http://onc-chpl.force.com/ehrcert
Certified EHR Technology:
CHPL Number & CMS Certification ID
Certified EHR Technology:
CHPL Number
Certified EHR Technology:
CHPL Number
Certified EHR Technology:
CMS EHR Certification ID
56 Add to Cart to get CMS EHR
Certified EHR Technology:
CMS EHR Certification ID
SLR
EHR Details Screen
Year One: Provide the CMS EHR Certification ID, describe the certified EHR technology you have at the time of the attestation, and details about the legal or financial commitment to the
technology that meets 100% of the criteria for the Program.
Year Two: Review information from Year One. If you have had changes to the certified EHR technology, edit the CMS EHR
Certification ID information, and provide a description of the change in the text box.
The SLR will check against the ONC Certified Health IT Product List to validate that the CMS EHR Certification ID you enter is a valid ID.
SLR
EHR Details Screen – Year
One
SLR
EHR Details Screen – Beyond Year One
Questions about EHR Details Screen?
SLR
MU Questionnaire Screen
A hospital that is a meaningful EHR user under the
Medicare EHR Incentive Program is deemed to be a meaningful user for Medicaid.
A hospital that is dually eligible for both Programs must
complete and submit a meaningful use attestation with the Medicare EHR Incentive Program prior to completing the attestation process with Medicaid.
The Medicaid EHR Incentive Program receives
information from CMS to indicate that the EH has submitted an accepted meaningful use attestation.
SLR
MU Questionnaire Screen - Medicare Successful
64
SLR
MU Questionnaire Screen – No Medicare
Attestation
65
Error message if no MU
Document Upload Screen
SLR
Document Upload Screen
The EH must upload documentation to support the
attestation of Medicaid patient volume.
HIT Hospital Worksheet
HIT Volume Calculation Worksheet
Additional information from EH Checklist
The Document Upload Screen may be used during the
SLR
Attestation Screen
SLR
Attestation Screen
This final screen displays a summary of information from
the attestation for review, and an Attestation Statement.
To submit, the EH representative “signs” with initials, and
with the EH NPI; then, selects Submit.
Once submitted, the attestation is locked for review.
The attestation is reviewed both by the HIT Division, and
by the SCDHHS Bureau of Reimbursement Methodology and Policy.
Questions requiring clarification will be emailed to the
Final Approval by CMS
Once SCDHHS finds an attestation to have met the
requirements of the Program, a transaction is sent to CMS to notify of intent to pay.
CMS checks for federal exclusions; if none are found, the
Payment of the Incentives
The SCDHHS HIT Division will initiate an electronic
credit adjustment that will be processed by the MMIS system.
Incentive payments are incorporated into the weekly
payment schedule within 45 days of final determination that the EH has met the program requirements.
The EH representative will be notified of the payment via
Resources
www.cms.gov/EHRIncentivePrograms
SCDHHS Division of Health Information Technology
email address: [email protected]
SCDHHS HIT Web page:
www.scdhhs.gov/hit
- State Medicaid HIT Plan (SMHP)
