Connecticut Medicaid Electronic Health Record Incentive Program

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1 1. What is the Electronic Health Record (EHR) Incentive Program? The EHR incentive program was established by the Health Information Technology for Economic and Clinical Health (HITECH) Act of the American Recovery & Reinvestment Act of The program aims to transform the nation s health care system and improve the quality, safety, and efficiency of patient health care through the use of electronic health records. Effective July 13, 2010, the U.S. Department of Health Services (HHS), the Centers for Medicare & Medicaid Services (CMS) and the Office of National Coordinator (ONC) released the final rule providing the parameters and requirements for the Medicaid EHR incentive program under the HITECH Act. The Department of Social Services (DSS) is in the process of developing a system to manage incentive payments for Connecticut s eligible providers. 2. What is an Electronic Health Record? An EHR is a systematic collection of electronic health information on individual patients. EHR s are patient health records in a digital format which includes a range of data in comprehensive or summary form, such as demographics, medical history, medication and allergies, immunization status, laboratory test results, radiology images, vital signs, personal stats like age The purpose of the EHR is to collect complete records and weight, and billing information. The purpose of the EHR is to collect complete records of patient encounters and allowing the automation and streamlining of the workflow in health care settings and increasing safety through evidence-based decision support, quality management, and outcomes reporting. 3. What is a CMS EHR Certification ID? Eligible Hospitals are required to obtain a CMS EHR Certification ID using either of the following Web sites to link to the Office of the National Coordinator for Health Information Technology (ONC) at: Or at the CMS EHR Incentive Program link at: The CMS EHR Certification Number is required for attestation for the Medicaid Incentive Program. 4. What does it mean to adopt, implement, or upgrade a certified EHR system? Adopt Acquire, purchase, or install a certified EHR system. Implement Install or commence use of certified EHR technology and have started one of the following: o A training program for the certified EHR technology; o o Data entry of patient demographic and administrative data into the EHR; Establishment of data exchange agreements and a relationship between the provider s certified EHR technology and other providers (such as laboratories, pharmacies, or health information exchanges).

2 Upgrade Expand the available functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, including staffing, maintenance, and training, or upgrade from existing EHR technology to certified EHR technology per the Office of the National Coordinator (ONC) EHR certification criteria. Some examples of upgrading the existing EHR technology are the addition of clinical decision support, e-prescribing functionality, and computerized physician order entry. 5. When does the program start? Medicaid EHR Incentive programs are voluntarily offered by individual states Connecticut began accepting registrations for the CT Medicaid EHR Incentive Program in July When can I register and where do I register? CMS encourages Eligible Hospitals to start the registration process for the Medicare and Medicaid EHR Incentive Program(s) as soon as possible. CMS launched the Medicare and Medicaid EHR Incentive Program Registration and Attestation System in January Providers applying for either incentive payment program must begin by registering with the CMS EHR Incentive Program Registration and Attestation System through this site: IMPORTANT NOTE: Once registered with CMS, CMS will pass the Medicaid registration record to the state. Hospitals that select the CT Medicaid Incentive Program will have the record placed into a pending status at CMS until CT s program is able to receive the record. Once CT is able to receive the CMS record it will be matched to the hospital information in the Medicaid Management Information System (MMIS). 7. What do I need in order to register? In order to register, providers will need to have: PECOS Enrollment - All EHs must have enrollment information in PECOS to register for the EHR Incentive Programs. PECOS is the Medicare Provider Enrollment, Chain, and Ownership System and manages, tracks, and validates enrollment data for Medicare providers and suppliers. If a provider has never enrolled in PECOS, they will need to do so ( ). If a hospital enrolled in Medicare before November, 2003 and has not updated their enrollment information since then, they will also need to enroll through PECOS. If a hospital enrolled in Medicare after November, 2003 or enrolled before November 2003 and has updated its Medicare enrollment information since November 2003, no further action is required. Providers can check to see if they are enrolled in PECOS at the link provided above. CMS Identity and Access Management (I&A) User ID and Password A National Provider Identifier (NPI). Hospitals will also need a CMS Certification Number (CCN) An active web user account in the National Plan and Provider Enumeration System (NPPES). Taxpayer Identification Number (TIN) or Employer Identification Number (EIN). More information about these requirements (including PECOS and NPPES links) can be found at

3 When registering at CMS, please enter the EHR Certification Number. Although this number is not required for registering at CMS, it will be required for registration for the CT Medicaid EHR Incentives Payment Program. IMPORTANT NOTE: Once registered with CMS, CMS will pass the Medicaid registration record to the state. Hospitals that select the CT Medicaid Incentive Program will have the record placed into a pending status at CMS until CT s program is able to receive the record through the Medical Assistance Provider Incentive Repository (MAPIR). Once CT is able to receive the CMS record it will be matched to the hospital information in the Medicaid Management Information System (MMIS). More detailed information on the CMS registration can be found in the EHR Hospital Registration User Guide: 8. What is CT s Medical Assistance Provider Incentive Repository (MAPIR)? MAPIR is a web-based application that will interface with the CMS Medicare & Medicaid EHR Incentive Program Registration and Attestation System for the exchange of data regarding state selection and subsequent provider payments. MAPIR will utilize the information received from the CMS EHR system to match the provider information in the MMIS. The data that will be matched is the NPI, provider TIN, and CCN. Upon MAPIR s receipt of the CMS registration information, providers will be notified to log into MAPIR, via the secure provider web portal, to view and validate the information MAPIR has received from the CMS EHR Registration and Attestation system. For the CT Medicaid EHR Incentive Program, EHs will have to provide and attest to the following information: EHR Certification Number for the EHR Technology adopted, implemented or upgraded, Patient Volume (acute care hospitals), Data on Medicaid discharges, total discharges, Medicaid inpatient days, total inpatient days, hospital s total charges and charity care charges. The Department will utilize the hospital cost report data that is reported to the Office of Health Care Access (OHCA), to audit the information submitted in the hospital s attestation. DSS and Hewlett Packard Enterprise will provide more detailed information as MAPIR progresses through development. 9. What do I need to do to access MAPIR when it is available? Designated individuals from the hospital will be able to access MAPIR via the secure provider portal at Each hospital will need to designate the appropriate individual(s) in the organization to apply for the CT Medicaid EHR Incentive Payment Program. Designated individuals within the hospital should contact their hospital s Master User to create a clerk account that can be used to access MAPIR via the secure provider portal.

4 In addition, each hospital will need to provide Hewlett Packard Enterprise with its CMS Certification Number CCN (previously known as the Medicare provider number). The MMIS needs to store this information in order to match the data provided by the CMS Registration and Attestation System. Please go to the following link and fill out the information requested: The following information will be required: National Provider Identifier (NPI) Hospital Name Automated Voice Response System (AVRS) ID CMS Certification Number (CCN) This will be matched with the information provided by CMS Contact name(s) and (s) of authorized individuals attesting to adoption, implementation, or upgrading of certified EHR technology and patient volume. Contact telephone number(s) 10. How are some providers eligible for Medicaid? In order to qualify for incentives under the Medicaid EHR Incentive program, acute care hospitals must meet specific patient volume requirements. Children's hospitals are eligible but not subject to patient volume requirements. To qualify for an EHR incentive payment, Medicaid eligible hospitals must meet one of the following criteria: Be an acute care hospital, which includes Critical Access Hospitals, with at least 10% Medicaid patient volume (Last four digits of the CMS Certification Number (CCN) of the hospital falls between or ) Be a children s hospital (CCN between ) 11. What is the difference between the Medicare & Medicaid EHR Incentive programs? Medicare Implemented by the Federal Government Hospitals must successfully demonstrate meaningful use of certified EHR technology to receive incentive payments in Year 1 Medicaid Voluntary for States to implement Connecticut is targeting July 2011 to begin accepting registrations for the CT Medicaid EHR Incentive Program Providers can qualify for an EHR incentive payment for adopting, implementing upgrading or demonstrating meaningful use of certified EHR technology in the first participation year. Required to demonstrate meaningful use of certified EHR technology in each subsequent year to qualify for further EHR payments.

5 Payment reductions begin in 2015 for providers that do not demonstrate Meaningful Use Meaningful Use definition is common for Medicare Last year a provider may initiate program is 2014; Last year to register is 2016; Payment adjustments begin in 2015 Incentive amounts are linked to the participation year and decrease year by year. Once a participant receives an incentive payment, they are locked into a payment year succession. No Medicaid payment reductions. States can adopt certain additional requirements for Meaningful Use Last year a provider may initiate program is 2016; Last year to register is 2016 Incentives can be paid for nonconsecutive participation (i.e. you can skip participation years) through 2015 for EHs. 12. How do I know if the hospital is eligible? Hospital Eligibility Information An eligible hospital for Medicaid incentive payments is an acute care hospital with at least 10% Medicaid patient volume, or a children's hospital (no Medicaid volume requirements). Acute care hospitals for the Medicaid incentive program include short term general stay hospitals where the average length of stay is 25 days or fewer and the last four digits of the CMS Certification Number (CCN) falls between or This includes some specialty hospitals, cancer hospitals, and CAHs. Children's hospitals will have a CCN between and will not be pediatric wings of larger hospitals. NOTE: Medicaid acute care hospitals that are also Medicare subsection (d) hospitals) may receive incentive payments from both Medicare and Medicaid if they meet all eligibility criteria. DSS will provide incentive payments to eligible hospitals over a 3-year period. Incentive payments to hospitals will be distributed at 50, 30 and 20% respectively. In the first year of the incentive program, the EH must demonstrate that during the payment year, it has adopted, implemented, or upgraded certified EHR technology. In the two subsequent payment years, the EH must demonstrate that it has been a meaningful user during the EHR reporting period for the applicable payment year. 13. How is patient volume calculated? A Medicaid enrolled acute care hospital must annually meet patient volume requirements. To calculate Medicaid patient volume, divide The total CT Medicaid encounters in any representative, continuous 90-day period in the preceding fiscal year; by The total encounters in the same 90-day period.

6 For purposes of calculating hospital patient volume a Medicaid encounter means Services rendered to a Medicaid FFS, Medicaid for Low Income Adults (MLIA) or HUSKY A individual per inpatient discharge where Medicaid, MLIA or HUSKY A paid for part or all of the service, or paid for part or all of the individual s premiums, co-payments and/or cost-sharing; or, Services rendered in an emergency department (ED) in any one day where Medicaid, MLIA or HUSKY A paid for part or all of the service, or paid for part or all of the individual s premiums, copayments and/or cost-sharing. EXAMPLE: The hospital is applying to the EHR Incentive Program in Federal Fiscal Year 2011 (Oct 1, 2010 Sept 30, 2011). The following is an example of a representative, consecutive 90-day period from the previous federal fiscal year April 1, 2010 June 29, FFY 2010 Medicaid FFS, MLIA, and HUSKY A Inpatient Discharges and ED Visits Total Hospital Inpatient Discharges and ED Visits 2,225 6,725 The eligibility calculation is as follows: (Medicaid Discharges + Medicaid ED Visits) (Total Discharges + Total ED Visits) (2,225) = Medicaid Patient Volume (6,725) 33% 14. What is meaningful use? I keep hearing about it, but I don't understand what it means. Meaningful Use refers to the three main components of Meaningful Use specified by the ARRA: The use of a certified EHR in a meaningful manner, such as e-prescribing. The use of certified EHR technology for electronic exchange of health information to improve quality of health care. The use of certified EHR technology to submit clinical quality and other measures. To demonstrate meaningful use, providers need to show they are using certified EHR technology in ways that can be measured significantly in quality and in quantity. Eligible hospitals will need to demonstrate meaningful use in their second and third year of participation in the CT Medicaid incentive program in order to receive additional incentive payments. Additional information is available at the following link: In the first year of the incentive program, the EH must demonstrate that during the payment year, it has adopted, implemented, or upgraded certified EHR technology.

7 In the two subsequent payment years, the EH must demonstrate that it has been a meaningful user during the EHR reporting period for the applicable payment year. 15. How much are the incentive payments being made to hospitals? An EH may receive a Medicaid incentive payment from only one State in a payment year. The rule allows for the payment to be paid over a minimum 3-year period and maximum 6-year period. DSS has selected the 3-year period for the payments to be made. The total hospital incentive payments received over the 3 payment years of the program cannot be greater than the aggregate EHR amount. No single incentive payment for a payment year can exceed 50 percent of the aggregate EHR hospital incentive payment. And no incentive payment over a 2-year period may exceed 90 percent of the aggregate EHR hospital payment amount. No hospital may begin receiving incentive payments for any year after Fiscal Year (FY) 2016, and after FY 2016, a hospital may not receive an incentive payment unless it received an incentive payment in the prior fiscal year. Prior to FY 2016, payments can be made to eligible hospitals on a non-consecutive, annual basis for the fiscal year. Calculating the overall incentive payment is a multi-step process and utilizes hospital data on total discharges to compute a growth rate which is used to determine projected eligible discharges. A base amount of $2,000,000 is added to the eligible discharge amount and a transition factor is applied to arrive at the overall EHR amount. The overall EHR amount needs to be adjusted for charity care before Medicaid s share can be calculated. Hospitals will be required to provide and attest to the following information for the incentive payment to be calculated: Total Discharges (inpatient) for the most recent 4 fiscal years Total Number of Medicaid Inpatient Bed Days Total Charges for All Discharges Total Charges for Charity Care for all discharges 16. How is the Connecticut Medicaid incentive payment calculated? This is an example of the steps that will be followed to calculate incentive payments to eligible hospitals. MAPIR will be making these calculations based on data the hospital will enter into MAPIR at the time of registration and attestation.

8 The aggregate EHR hospital incentive payment is calculated as the product of the [overall EHR amount] times [the Medicaid Share Calculating the overall EHR amount is a multistep process and requires the hospital to provide the following information: Total Hospital Discharges (Sum of all inpatient discharges) for the most recent 4 years, Total Number of Medicaid Inpatient Bed Days (Medicaid FFS, MLIA and HUSKY A managed care patients), Medicaid discharges (Inpatient discharges for Medicaid FFS, MLIA and HUSKY A managed care patients), Hospital s total charges for all patients, and Charity Care Charges for all discharges Step 1: Calculating the Average Annual Growth Rate: To calculate the average annual growth rate the hospital will report the total discharges from the 4 most recent hospital fiscal year cost reports. Total discharges are the sum of all inpatient discharges. Fiscal Year Total Discharges Calculating Annual Growth rate Average Annual Growth Rate , ,800 26,900 25,800 25,800 = 4.3% 25,800 24,700 24,700 = 4.5% ,700 24,700-23,500 23,500 = 5.1% = , = growth rate = 4.6% Average Annual Growth Rate 4.6% Step 2: Apply the Average Annual Growth Rate to the Base Number of Discharges projected out

9 over the next 3 years; The number of discharges for the Base Year of Fiscal Year 2010 is multiplied by the average annual growth rate of 4.6%. Projected Inpatient Discharges Fiscal Year ,900 Fiscal Year 2011 Fiscal Year 2012 Fiscal Year X 28, X 29,432 X ,786 Step 3: Determine the number of eligible discharges and multiply by the appropriate discharge payment amount 1. For the first through the 1,149 th discharge, $0 2. For the 1,150 th through the 23,000 th discharge, $200 per discharge 3. For any discharge greater than the 23,000 th, $0 In this example, discharges for each year were greater than both1,149 and 23,000, so the maximum number of discharges that can be counted are 21,851 (23,000 1,149) which then gets multiplied by the $200 per discharge. Fiscal Year Calculated Discharges Eligible $200 Per Discharge Eligible Discharge Payment ,900 21,851 $200 $4,370, ,137 21,851 $200 $4,370, ,432 21,851 $200 $4,370, ,786 21,851 $200 $4,370,200

10 Step 4: Add the Base Year Amount of $2,000,000 per payment year to the eligible discharge payment Fiscal Year Base Year Amount Eligible Discharge Payment Total Eligible Discharge Payment 2010 $2,000,000 + $4,370,200 = $6,370, $2,000,000 + $4,370,200 = $6,370, $2,000,000 + $4,370,200 = $6,370, $2,000,000 + $4,370,200 = $6,370,200 Step 5: Multiply the Medicaid Transition Factor to the Eligible Discharge Payment to arrive at the Overall EHR Amount The transition factor equals 1 for year 1, ¾ for year 2, ½ for year 3 and ¼ for year 4. All four years are then added together. Total Fiscal Year Eligible Discharge Payment Medicaid Transition Factor Overall EHR Amount 2010 $ 6,370,200 X 1 = $ 6,370, $ 6,370,200 X 0.75 = $ 4,777, $ 6,370,200 X 0.5 = $ 3,185, $ 6,370,200 X 0.25 = $ 1,592,550 Total EHR Amount $ 15,925,500

11 Step 6: Calculate the Medicaid Share The next step requires that the Medicaid Share be applied to the total EHR amount. The Medicaid Share is the percentage of inpatient bed-days (Medicaid, MLIA and HUSKY A managed care) divided by the estimated total inpatient bed days adjusted for charity care. To calculate the Medicaid Share, the hospital will need to provide the following information from the hospital fiscal year that ends during the federal fiscal year prior to the fiscal year that serves as the first payment year: Total Number of Inpatient Medicaid Bed Days Total Inpatient Days Total Charges for All Discharges Total Charity Care for All Discharges 7,000 21,000 $ 10,000,000 $ 1,300,000 Calculate the Non-Charity Care ratio by subtracting charity care from total charges for all discharges and dividing by total charges for all discharges The charity care adjustment is the percentage of the total charges that are not associated with charity care. Total charges $10,000, Charity Care $1,300,000 = $8,700,000 $8,700,000 $10,000,000 = 87% Charity Adjustment Care 87% Calculate the Medicaid Share: Medicaid Share = Medicaid Inpatient Bed-Days ( Total Inpatient Bed-Days X Charity Care Adjustment) 7,000 (21,000 X.87) = ,270 Medicaid Share 38.3% Step 7: Calculate the aggregate incentive amount. To arrive at the aggregate incentive amount multiply the overall EHR Amount of $15,925,500 by the Medicaid Share of 38.3%.

12 $15,925,500 X.383 = $6,099,467 Total Incentive Payment Amount $6,099,467 This is the total Incentive Amount a hospital can receive for this example Step 8: Distribute Incentive Payments over a 3 year period: The Department will issue hospital incentive payments over a 3 year period. The following illustrates the payments in 3 consecutive years at 50, 30 and 20% respectively. The hospital would need to continue to meet the eligibility requirements and meaningful use criteria in all incentive payment years. 50% 30% 20% $3,049,734 $1,829,840 $1,219, Can I receive the maximum allowable incentive payments if they total more than the cost of purchasing my EHR system? Yes, the incentives are not based on the cost of purchasing EHR technology. As long as a hospital meets all necessary requirements for qualifying for incentive payments, they may receive the maximum allowed amount regardless of what their EHR technology or implementation costs were. 18. The Recovery Act requires the electronic exchange of health information. Is there funding to pay for connectivity between clinical practices and hospitals? Will there be federal guidance, or will this be hashed out at a local/community level? The Office of the National Coordinator has established 56 Health Information Exchange Cooperative Programs to assist States and territories' efforts to rapidly build capacity for exchanging health information across the health care system both within and across stales. These exchanges will play a critical role in facilitating the exchange capacity of clinicians, laboratories, pharmacies and hospitals, etc in their jurisdictions to help them in meeting the health information exchange requirements which are part of meaningful use. More information on ONC's Health Information Exchange grantees can be found here: home/1204 Are nursery days and nursery discharges (for newborns) included as acute-inpatient services in the calculation of hospital incentives for the Medicare and Medicaid EHR Incentive Programs? No, nursery days and discharges are not included in inpatient bed-day or discharge counts in calculating hospital incentives. We exclude nursery days and discharges because they are not considered acute inpatient services based on the level of care provided during a normal nursery stay.

13 Pages and of the Stage 1 final rule preamble explain that for the Medicare calculation, the statutory language clearly restricts discharges and inpatient bed-days to those from the acute care portion of a hospital. This is because of the definition of eligible hospital in section 1886(n)(6)(B) of the Social Security Act. Page of the Stage 1 final rule explains that statutory parameters placed on Medicaid incentive payments to hospitals are largely based on the methodology applied to Medicare incentive payments. Therefore, as Medicaid is held to the same parameters as Medicare, the same limitations on counting inpatient bed-days and total discharges apply to Medicaid hospital incentive calculations. To view the Stage 1 final rule for the Medicare and Medicaid EHR incentive programs, please visit: It seems that each State has the latitude to define the 12-month period from which to derive the Medicaid share data for the purposes of the Medicaid Electronic Health Record (EHR) Incentive Program. Neither the preamble nor the regulatory text of the Stage 1 final rule explicitly stipulate that the 12-month period selected by the state for the Medicaid share data needs to be in the federal fiscal year (FY_ before the hospital's FY that serves as the first payment year. Am I correct in this interpretation? In other words, a state could use two different 12-month periods to calculate the discharge-related amount and the Medicaid share? No, this is not correct. The regulation is clear that the discharge-related amount must be calculated using a 12-month period that ends in the Federal fiscal year before the hospital s fiscal year that serves as the first payment year. 42 CFR (g)(1)((i)(B). This statement also was made in the preamble, where we stated: For purposes of administrative simplicity and timeliness, we require that States use data on the hospital discharges from the hospital fiscal year that ends during the Federal fiscal year prior to the fiscal year that serves as the first payment year 75 FR In addition, the regulation indicates that the period that is used for the Medicaid share is the same period as that used for the discharge-related amount. See 42 CFR (g)(2)(i) referring to the 12-month period selected by the State. Use of the in (g)(2) indicates that this is the same 12-month period that is used under (g)(1). In addition, we believe that using different periods for the Medicaid share versus the discharge-related amount would lead to inaccurate estimates, as data would be drawn from inconsistent periods. To view the Stage 1 final rule, please visit: For calculation of a Medicaid hospital s electronic health record (EHR) incentive payment, is the estimated growth rate for hospitals most recent three years based on growth in total days or growth in discharges? (The data sources for these are different.) The average annual growth rate should be for discharges (see 1903(t)(5)(B), referring to the annual rate of growth of the most recent 3 years for discharge data. ) We agree that the sources are different. Hospitals would probably have to use MMIS or auditable hospital records to get accurate discharge data rate of growth. To view the Stage 1 final rule, please visit:

14 What is the reporting period for eligible hospitals participating in the Medicaid Electronic Health Record (EHR) Incentive Program? For an eligible hospital or critical access hospital's first payment year, the EHR reporting period is a continuous 90-day period within a Federal fiscal year. In subsequent years (except 2014), the EHR reporting period for eligible hospitals and critical access hospitals (CAHs) is the entire Federal fiscal year. In 2014, an eligible hospital or CAH can use either the entire Federal fiscal year or a 3-month period aligned with the quarters of the Federal fiscal year. Are there any changes in the EHR Incentive Programs Stage 2 Rule to the base year for the Medicaid hospital incentive payment calculation? Yes. Previously Medicaid eligible hospitals calculated the base year using a 12 month period ending in the Federal fiscal year before the hospital's fiscal year that serves as the first payment year. In an effort to encourage timely participation in the program, (g)(1)(i)(B) of the Stage 2 Rule was amended to allow hospitals to use the most recent continuous 12 month period for which data are available prior to the payment year. This change went into effect upon publication of the Stage 2 Rule. Only hospitals that begin participation in the program after the publication date of the Stage 2 Rule (i.e., program years 2013 and later) will be affected by this change. Hospitals that began participation in the program prior to the Stage 2 Rule will not have to adjust previous calculations. If patients are dually eligible for Medicare and Medicaid, can they be counted twice by hospitals in their calculations for incentive payment if they are applying for both Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs? For purposes of calculating the Medicaid share, a patient cannot be counted in the numerator if they would count for purposes of calculating the Medicare share. Thus, in this respect the inpatient bed day of a dually eligible patient could not be counted in the Medicaid share numerator. (See 1903(t)(5)(C), stating that the numerator of the Medicaid share does not include individuals described in section 1886(n)(2)(D)(i). ) In other respects; however, the patient would count twice. For example, in both cases, the individual would count in the total discharges of the hospital. To view the Stage 1 final rule, please visit: Can eligible hospitals round their patient volume percentage when calculating patient volume in the Medicaid Electronic Health Records (EHR) incentive program? To participate in the Medicaid EHR incentive program, acute care hospitals are required to demonstrate a patient volume of at least 10% Medicaid patients over a 90-day period in the prior fiscal year preceding the hospital's payment year or in the 12 months before attestation. Hospitals' patient volume may be rounded from 9.5% and higher to 10%.

15 20. Who can I contact if I still have questions? Connecticut Medicaid Electronic Health Record Incentive Program representatives are available at Monday through Friday from 8:00 am until 5:00 pm or by at ctmedicaidehr@hpe.com for further questions. Frequently Used Acronyms AIU Adopt / Implement / Upgrade ARRA American Recovery & Reinvestment Act CCN CMS Certification Number CFR Code of Federal Regulations CMS Centers for Medicare & Medicaid Services DSS CT Department of Social Services ED Emergency Department EH Eligible Hospital EHR Electronic Health Record EIN Employer s Identification Number FFS Fee-for-Service FFY Federal Fiscal Year I&A Identification & Authentication System MAPIR Medical Assistance Provider Incentive Repository MLIA MMIS NPI NPPES OHCA ONC TIN Medicaid for Low Income Adults Medicaid Management Information System National Provider Identifier National Plan and Provider Enumeration System Office of Healthcare Access Office of the National Coordinator Tax Identification Number