Medicaid Electronic Health Records Meaningful Use Lisa Reuland, Program Manager October 15, 2015 1
Agenda Medicaid Overview Stage 1: Meaningful Use Stage 2: Meaningful Use CQM Reporting Stage 3: Meaningful Use Q &A
What is Medicaid? Medicaid is one of the largest healthcare insurers in South Dakota. Federal-State partnership governed by Medicaid State Plan (agreement with federal government on who is served and what services are covered). Each state s plan is different. Makes comparisons between states difficult. Different than Medicare - 100% federal coverage for older and some disabled adults.
Who We Serve Low income children, pregnant women, adults and families Elderly or disabled Children in foster care Adult coverage is limited to: Elderly or disabled Parent/Caregiver/Relatives of Low Income Children - 53% FPL (family of three $10,489 annual income) 68% children and 32% adults
What is Meaningful Use? Meaningful use means providers need to show the EHR technology is being used in ways that can be measured significantly in quality and results. Meaningful Use is using certified EHR technology to Improve quality, safety, efficiency, and reduce health disparities Engage patients and families in their health care Improve care coordination Improve population and public health All the while maintaining privacy and security Provider will use certified EHR technology: In a meaningful manner, such as e-prescribing With an electronic exchange of health information to improve the quality of the care To submit clinical quality
Meaningful Use There are two general MU requirements necessary for meeting MU. These requirements include: At least 80% of unique patients must have their data in a certified EHR during the EHR reporting period. At least 50% of all encounters for providers who work in multiple sites must take place at a location with a CEHRT system.
Meaningful Use Stage 1 Basic Overview of Stage 1 Meaningful Use: Reporting period is 90 day for first year and 1 year subsequently Reporting through attestation Objectives and Clinical Quality Measures Reporting may be yes/no or numerator/denominator attestation To meet certain objectives/measures 80% of patients must have records in the certified EHR technology Medicaid MU requirements for Stage 1 consist of the following: Core Objectives: All eligible providers must meet each core objective or meet an exclusion criteria Menu objectives: Eligible providers must select and meet five menu objectives. (Providers must select at least one public health measure.)
Requirements of Stage 1 Meaningful Use Stage 1 Objectives and Measures Reporting Eligible Professionals must complete 15 core objectives 5 objectives out of 10 from menu set 6 total Clinical Quality Measures (3 core or alternate core, and 3 out of 28 from additional set) Hospitals must complete 14 core objectives 5 objectives out of 10 from menu set 15 Clinical Quality Measures
Meaningful Use Denominators Two types of percentage based measures are included in demonstrating Meaningful Use: Denominator is all patients seen or admitted during the EHR reporting period The denominator is all patients regardless of whether their records are kept using certified EHR technology Denominator is actions or subsets of patients seen or admitted during the EHR reporting period The denominator only includes patients, or actions taken on behalf of those patients, whose records are kept using certified EHR technology
CQM Reporting In addition to reporting on core and menu measures, providers must also report on CQMs in order to meet the MU requirements. CMS selected all CQMs to align with the HHS National Quality Strategy (NQS) priorities for healthcare quality improvement and the following six measure domains: Patient and Family Engagement Patient Safety Care Coordination Population and Public Health Efficient Use of Healthcare Resources Clinical Processes/Effectiveness When selecting CQMs to report, providers must select CQMs that cover at least three out of the six domains.
CQM Reporting Beginning in 2014: CQMs are no longer a core objective for MU; however, reporting CQMs is still a requirement for MU. A complete list of CQMs that are required for reporting and their associated NQS domains are reported on the CMS EHR Incentive Programs Web site CMS will include the following recommended core set of CQMs for EPs that focus on high-priority health conditions and best practices for care delivery: Nine for adult populations Nine for pediatric populations Remember, core and menu measures have thresholds that providers must meet; however, CQMs do not have thresholds. The provider s CEHRT does all the work. It calculates the measures and offers the numbers reported by the provider
Meaningful Use Stage 2 2014: All providers, regardless of their stage of MU, are only required to demonstrate MU for a three-month EHR reporting period in 2014. The ninety-day reporting period for 2014 will apply to all providers, regardless of whether they are new to the EHR Incentive Program or started participating in the Program prior to 2014. SMAs have the flexibility to allow Medicaid providers to select any continuous ninetyday EHR reporting period during 2014 as defined by the State Medicaid Program, or, if the state so chooses, any three month calendar quarter in 2014. CMS allowed this one-time, three month reporting period only in 2014 to give providers upgrading to 2014 CEHRT adequate time to implement their new certified EHR systems Beginning in 2014, a provider cannot select a menu objective to report and claim an exclusion, if there are other menu objectives they could select and meet. Providers can claim exclusions for menu objectives, if they qualify for the exclusions for the remaining menu objectives. This change prevents providers from selecting and/or excluding menu objectives when there are other menu objectives they can legitimately meet.
Meaningful Use Stage 2 There are different MU objectives (core and menu) that EPs and EHs must meet to demonstrate MU, which qualifies them for a Medicaid EHR incentive payment: EPs must meet 20 out of 23 objectives to qualify (17 core + 3 menu objectives) EHs must meet 10 out of 22 objectives to qualify (16 core + 3 menu objectives) Both EPs and EHs must meet all core objectives and select three out of six menu objectives. Providers must attest and receive verification from the SMA that they met the MU objectives and measures.
Rule Changes for 2015 for Eligible Professionals Changes to Specific Objectives/Measures Stage 2 Patient Electronic Access, Measure 2: For 2015, instead of the 5 percent threshold, this measure requires that at least 1 patient seen by the EP during the HER reporting period (or patient authorized representative) views, downloads, or transmits to a third party his or her health information during the EHR reporting period. Stage 2 Secure Electronic Messaging: The 5 percent threshold has been changed to the capability for patients to send and receive a secure electronic message with the EP was fully enabled the EHR reporting period (yes/no). Public Health Reporting: The public health reporting objectives have been consolidated into one objective with three measure options for EPs.
Rule Changes for 2015 for Eligible Hospitals and CAHs Changes to Specific Objectives/Measures Stage 2 Patient Electronic Access, Measure 2: For 2015, instead of the 5 percent threshold, this measure requires that at least 1 patient who is discharged from the inpatient or emergency department (POS 21 or 23) of an eligible hospital or CAH (or patient-authorized representative) views, downloads or transmits to a third party his or her health information during the EHR reporting period. Public Health Reporting: The public health reporting objectives have been consolidated into one objective with four measure options for eligible hospitals and CAHs.
EHR Reporting Period EHR Reporting Period for Eligible Professionals Starting in 2015, the EHR reporting period for ALL Providers will be based on the calendar year. In 2015 only, the EHR reporting period for all providers will be any continuous 90-day period. EPs may select an EHR reporting period of any continuous 90 day period from January 1, 2015 through December 31, 2015 EHR Reporting Period for Eligible Hospitals and CAHs Starting in 2015, the EHR reporting period for ALL Providers will be based on the calendar year. In 2015 only, the EHR reporting period for all providers will be any continuous 90-day period. Eligible hospitals and CAHs may select an EHR reporting period of any continuous 90 day period from October 1, 2014 to December 31, 2015.
Meaningful Use Stage 3 Stage 3 will start 2017 All providers will be required to participate in Stage 3 in 2018 Meaningful Use in Stage 3 8 objectives for eligible professionals, eligible hospitals, and CAHs. Must use 2015 Edition CEHRT for attestation
Questions? CMS Electronic Health Records: https://www.cms.gov/regulations-and- Guidance/Legislation/EHRIncentivePrograms/index.html?red irect=/ehrincentiveprograms/ South Dakota Electronic Health Records Incentive Program 605-773-3495 Lisa.Reuland@state.sd.us