NY Medicaid. EHR Incentive Program Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC)

Transcription

1 Federally Qualified Health Center (FQHC) and Rural Health Clinic (RHC) Registration and Attestation Webinar 1

2 Background Original Legislation The Health Information Technology for Economic and Clinical Health (HITECH) Act, part of the American Recovery and Reinvestment Act of 2009 (ARRA). The HITECH Act Established: Medicaid Medicare Office of the National Coordinator for Health Information Technology (ONC) ONC Certified EHR Technology Goals of the HITECH Act: Promote the adoption and meaningful use of health information technology Improve patient quality of care Increase health information exchange Standardize health information technology 2

3 Medicaid Provides incentive payments to: eligible professionals eligible hospitals as providers: adopt, implement, or upgrade, and subsequently: demonstrate meaningful use of ONC certified EHR technology 3

4 How to get providers ready Eligible Professionals must: Be one of the eligible practitioner types Be actively enrolled in as a fee-for-service provider in good standing Meet minimum patient volume criteria (Medicaid/needy) Adopt, implement or upgrade to an ONC-certified EHR system in the first participation year Not be hospital-based (i.e., render less than 90% of covered Medicaid services in the inpatient and emergency department settings) Meet the meaningful use criteria and submit clinical quality measures as required in the second and subsequent participation years Register using the CMS Medicare & Medicaid Registration and Attestation System Attest using the New York Medicaid Administrative Support Service (MEIPASS) 4

5 What are the eligible practitioner types? Physicians (M.D. or D.O. ) Nurse practitioners Certified nurse-midwives Dentists Physician assistants, who practice predominately in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) that is led by a physician assistant 5

6 What are the patient volume criteria? Eligible Professionals must meet one of the following conditions: Demonstrate a minimum 30% Medicaid patient volume, or Be a pediatrician* and demonstrate a minimum 20% Medicaid patient volume, or Practice predominantly in a Federally Qualified Health Center or Rural Health Center and demonstrate a minimum 30% patient volume attributable to needy individuals * For the purposes of the Medicaid, NY defines a pediatrician as an M.D. or D.O. who satisfies at least one of the following: 1. Has a current board certification in pediatrics or a pediatric subspecialty from the American Board of Pediatrics (ABP) or the American Osteopathic Board of Pediatrics (AOBP) 2. Focuses on treating patients 18 years old and younger, and attests that the majority of care (at least 50% of encounters) were for patients 18 years old or younger 6

7 Patient Volume Methodology Patient volume is calculated over a 90-day period (of the provider s choice) from the prior calendar year New York will allows providers to select either of two methods of calculating patient volume: 1. Standard patient volume: number of Medicaid encounters divided by number of total patient encounters 2. Alternate method: accounts for managed care patient panel as well as encounters with patients not on managed care panel Group practices and clinics may use their aggregate patient volume (standard or alternate method) as a proxy for all individual providers Providers at FQHCs/RHCs may substitute needy patient encounters in any method (standard/alternate and individual/aggregate) 7

8 Needy Patient Volume Requirements To qualify eligible professionals must: Practice predominantly in a FQHC or RHC Have a minimum 30% patient volume attributable to needy individuals Needy Individual must meet one of the following conditions: 1. Receives medical assistance from Medicaid or Children's Health Insurance Program(CHIP) 2. Furnished uncompensated care by the provider 3. Furnished services at either no cost or reduced cost based on a sliding scale determined by the individual's ability to pay Practice predominantly definition: Clinical location for more than 50% of the eligible professional s total patient encounters over a period of six months is an FQHC or RHC 8 8

9 What counts as a Medicaid/Needy Encounter? Type of Service Medicaid Encounter Needy Encounter Medicaid Fee-for-Service Medicaid Managed Care Family Health Plus Child Health Plus Uncompensated Care Sliding Scale 9

10 Aggregate Patient Volume Group practices and clinics with more than one eligible provider will be allowed to use the aggregate Medicaid and overall patient volume for the entire practice/clinic as a proxy for each provider's individual patient volume. Requirements and Restrictions Applies to all providers who render service in the practice or clinic, regardless of how much of their overall practice is within the practice or clinic. Each provider will be required to attest that use of the aggregate value is appropriate for that provider. Aggregate values must represent the entire practice's patient volume and not limit it in any way (including not limiting it to only patients seen by eligible professionals). 10

11 Attestation: Participation Year 1 Attest: To authenticate officially In the first year of program participation, providers must legally attest that they have successfully adopted, implemented or upgraded (A/I/U) certified EHR technology Attestation begins in MEIPASS, but requires a physical signature to complete Providers must print, sign, and return (by mail) an attestation form before payment may be issued 11

12 Adopt/Implement/Upgrade Adopt: Acquire, purchase, or secure access to certified EHR technology Requires either installation of the certified EHR technology, OR a financial commitment to purchasing or using the EHR Does NOT require that the technology be in use in the clinical setting Implement: Install or commence utilization of certified EHR technology Qualifying activities include integration, training, and data transfer Upgrade: Expanding functionality of existing certified EHR, or moving from non-certified to certified version Requires installation OR a financial commitment to purchase or use the certified version 12

13 Certified EHR Technology Standards, implementation specifications, and certification criteria for EHR technology have been adopted by the Secretary of Health and Human Services EHR technology is tested and certified by ONC-Authorized Testing and Certification Bodies (ONC-ATCBs) ONC-ATCBs certify EHR technology for one or more meaningful use criteria To be eligible for the s, providers must have an EHR system certified for all MU criteria To find a list of certified EHR systems and modules, consult the ONC Certified HIT Product List (CHPL): 13

14 How much will they get? Eligible professionals can receive up to $63,750 over six years: $21,250 for the first year of participation $8,500 for each of five additional participation years Pediatricians with a 20 30% Medicaid volume receive 2/3 of these amounts (i.e., $14,167 in the first year and $5,667 in each subsequent year) Participation years do NOT need to be consecutive; however: Providers must begin participating by 2016 The last year to receive a payment is 2021 There are no payment adjustments under Medicaid for failure to participate in the 14

15 EP Incentive Payment Disbursement Annual lump sum payment to each qualifying practitioner Payments issued monthly using existing Medicaid reimbursement process Payee (practitioner or assignee) must be registered with NY Medicaid to receive fee-for-service payments Payee must enroll in epaces or have an existing account. Nothing in the Act excludes such payments from taxation or as tax-free income. Providers should consult with a tax advisor or the Internal Revenue Service regarding how to properly report this income on their filings. 15

16 EP Incentive Payment Reassignment EPs are permitted to reassign their incentive payments to: their employer, or an entity with which they have a contractual arrangement allowing the employer or entity to bill and receive payment for the EP's covered professional services. Initial reassignment is completed during program registration in the CMS Medicare & Medicaid Registration & Attestation System. MEIPASS: Completing the process Payee (practitioner or assignee) must be registered with to receive fee-for service payments. EPs assigning payment to their group must have an established relationship with the group on file with Request for Medicaid participation as a group member form Medicaid ID retrieval form 16

17 Third-Party MEIPASS Registration ETIN / MEIPASS Assignment Eligible Professionals are allowed to designate a third party to register and attest in MEIPASS on their behalf. This third party is known as the submitter. emedny Requirements: The submitter must have a valid individual Electronic Transmitter Identification Number (ETIN) or have an epaces account associated with an entity that has a valid ETIN. Service bureau ETINs (which start with a 0) are not allowed for MEIPASS registration. The provider must be enrolled in epaces. If you are not enrolled in epaces, contact Provider Services at 1 (800) for assistance. The provider must have the original enrollment user ID and password that was generated during epaces enrollment. To retrieve a forgotten enrollment user ID and password, contact the MEIPASS helpdesk at 1 (877) The provider will use the enrollment user ID and password to access the submitter registration screen and enter the submitter s ETIN in the MEIPASS registration box. The epaces administrator associated with the submitter s ETIN will then need to log in to assign privileges to the submitter to perform the MEIPASS attestation on behalf of the provider. 17

18 Preparing to Apply 19

19 Recommendations: Review CMS webinar and user guide regarding registration at the national level EHR: Medicare, Medicaid Webinar for Eligible Professionals EHR Medicaid EP Registration User Guide Attend this Eligible Professional Registration and Attestation Webinar Requirements: Where do I start? Have already adopted certified EHR technology Meet the 30% Medicaid patient threshold Fall under the Medicaid Eligible Professional categories Be actively enrolled in Fee-For-Service 20

20 Application Prerequisites Eligible Professionals must: Have an individual National Provider Identifier (NPI) Have a National Plan and Provider Enumeration System (NPPES) account associated with the individual NPI Be enrolled in epaces and have the original enrollment user ID and password Have a valid ETIN, or designate a third party submitter who has a valid ETIN to perform the attestation on the EP s behalf Have a CMS EHR Certification ID (EHR) Have a CMS Registration ID (RID) Other information needed: Taxpayer Identification Number (TIN): SSN or EIN Name / EP Type / Group Name (if EIN) / Address / Phone # / 21

21 Application Walkthrough 22

22 epaces Login 23

23 Submitter Registration 24

24 Access Privileges 25

25 Login Part 1 26

26 Login Part 2 27

27 MEIPASS Homepage 28

28 NLR Registration ID Entry 29

29 Federal Information Review 30

30 Eligibility 31

31 Eligibility FQHC / RHC 32

32 Eligibility Information 33

33 Attestation and Registration 34

34 Confirmation 35

35 Confirmation and What s Next After registering you must Save and Print the provided PDF registration confirmation document. 36

36 State Resources Additional Resources Provider Information on emedny.org Application Process Overview MEIPASS: EP Login Other Resources New York State Medicaid HIT Plan (NY-SMHP) CMS Website for the Medicare and Medicaid s ONC Home Page 37

37 Questions? Provider Support Medicaid enrollment, epaces 1 (800) MEIPASS Call Center Login, Navigation, Troubleshooting meipasshelp@csc.com 1 (877) Support Calculation, Registration, Eligibility hit@health.state.ny.us 1 (800)