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Alaska Medicaid Electronic Health Record (EHR) Incentive Program EHR Incentive Program A federal program that provides major financial support to incent providers to adopt, implement, or upgrade to certified EHR technology and to meet meaningful use standards Goals: Enhance care coordination and patient safety Reduce paperwork and improve efficiencies Facilitate information sharing across providers, payers, and state lines Enable sharing using state Health Information Exchanges (HIE) and the National Health Information Network (NHIN) Purpose: Improve outcomes, facilitate access, simplify care, and reduce costs of health care nationwide EHR Incentive Program Requirements Incentive Requirements Adopt, Implement or Upgrade “certified” EHR technology Meet the “meaningful use” criteria in the employment of the certified EHR technology Be an “eligible” professional (EP) or hospital (EH) Meet EP or EH Medicaid Patient Volume Criteria Use Certified EHR Technology Adopt – Acquire, purchase, or secure access to certified EHR technology Implement – Install or commence utilization of certified EHR technology capable of meeting meaningful use requirements Upgrade – Expand the availability 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 Meaningful Use Use Certified EHR Technology In a meaningful manner - have certain electronic capabilities, such as e-prescribing For electronic exchange of health information - to improve quality/coordination of health care, reduce costs To submit clinical quality and other measures - measures change over time to show progress Meaningful Use Criteria Set of measures Quality (outcomes) Process ( use of best practices/data capture) Capabilities (computerized functions) Providers must submit and attest to these quality measures to receive funds Must use Federal Meaningful Use definition as a floor Medicare or Medicaid Eligibility Eligible Professionals (EPs) Must choose to participate in Medicare or Medicaid Program Before 2015, EPs may switch programs once after the first incentive payment For Medicaid: Potentially as high as $63,750 over 6 yrs For Medicare: Potentially as high as $48,000 Medicare or Medicaid Eligibility Medicaid Eligible Professionals or Eligible Hospitals may be eligible for the program if they: adopt, implement or upgrade to a certified EHR technology or successfully demonstrate meaningful use of certified EHR technology Medicare Eligible Professionals or Eligible Hospitals may be eligible for the program if they: successfully demonstrate meaningful use of certified EHR technology Medicaid EHR Incentive Program Eligible Provider Types Medicaid Eligible Professionals Physician (MD,DO) Dentist Certified Nurse Mid-Wife Nurse Practitioner, and Physician Assistant if practicing in a Rural Health Clinic or a Federally Qualified Health Center led by a physician assistant Non-Hospital Based Hospital-based EPs are not eligible for incentive payments An EP is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (POS 21) or emergency room (POS 23) setting Medicaid Patient Volume Criteria For Eligible Professionals (EPs) Provider Type Minimum Medicaid Patient Volume Threshold Physicians 30% -Pediatrician 20% Dentists 30% Certified Nurse Midwife 30% Nurse Practitioners 30% PA's when practicing at an FQHC/RHC that is led by a PA 30% ** Or the Medicaid EP practices predominantly in an FQHC or RHC-30% needy individuals patient volume threshold For Eligible Hospitals (EHs) Acute Care Hospital and Critical Access Hospitals Children’s Hospital 10% No Medicaid volume requirement Needy Individual Patient Volume Needy Individual encounters can be used by Eligible Professionals (EPs) who practice predominately in an FQHC or RHC. Needy Individual encounters include: Services paid by TXIX Medicaid Services paid by TXXI Children’s Health Insurance Program (CHIP) Furnished by the provider as uncompensated care Furnished at either no cost or reduced cost based on a sliding scale Potential EP Payment Timeline (for Medicaid EHR Incentive Program) Potential EH Payment EH payments are based on a number of factors, beginning with a $2 million base payment. Hospitals cannot initiate payments after 2016 and payment years must be consecutive after 2016 EHR Incentive Program Enrollment To enroll in the incentive program EPs and EHs must: Register at the CMS EHR Incentive Program Registration site Register and attest at the Alaska Medicaid State Level Registry (SLR) Alaska Medicaid Provider Outreach Page Centralized “one stop” launching pad of available tools for Providers to manage their EHR Incentive Program Information The Provider Outreach portal provides: A link "Want to get a jump start?" with step-by-step instructions on how to complete the registration process by role (individual eligible professional, eligible hospital or group administrator) Attestation workbooks for Eligibility and Adopt / Implement / Upgrade to help gather all the necessary information to register for the program Ability to access the CMS EHR Incentive Registration site Ability to create an account with the Alaska Medicaid SLR Ability for Eligible Professionals and Eligible Hospitals to attest to information submitted Alaska Medicaid SLR Getting Started Step by Step Instructions Alaska Medicaid SLR Registration To register in the SLR you must be: An eligible professional, eligible hospital or a group administrator Enrolled in Alaska Medicaid Have your National Provider Identifier (NPI) and Tax Identifier Number (TIN) The NPI and TIN used in the SLR needs to be the same as what was entered for the CMS EHR Incentive Registration Attestation Preparation Determine which method of Certified EHR technology you will be attesting to — adopt, implement, or upgrade Verify that your EHR is on the list from ONC as certified EHR technology Obtain a copy of your signed contract with a vendor for the purchase, implementation or upgrade of a certified EHR system Select the 90 day period to determine the Medicaid or needy individual patient volume you will be reporting using the number of encounters Obtain your active Alaska Medicaid Provider number Obtain your medical license number, licensing board name and state in which it was issued Eligible Hospitals (EHs) need to have four (4) years worth of cost reports in order to complete the attestation process Where do I go to log into the SLR? SLR Create Account SLR Create Login Must be between 8 – 20 characters No spaces / special characters allowed Must have between 8 - 20 characters, at least 1 upper and 1 lower case letter, 1 number, 1 special character (@ or # or !), not your User ID and not an old password SLR Login Enter User ID and Password you created SLR – End User License Agreement Legalese User agrees and proceeds; user disagrees and cannot complete registration SLR Home Page Steps guide users through Attestation workflow SLR Step 1 – Eligible Professional (EP) About You SLR Step 1 – EP About You SLR Step 1 – Eligible Hospital (EH) About You SLR Step 2 – EP Confirm Eligibility SLR Step 2 – EH Confirm Eligibility SLR Step 2 – EH Hospital Demographics SLR Step 3 – Attestation Method SLR Step 3 – AIU Method SLR Step 3 – EHR Certification ONC CHPL ONC CHPL ONC CHPL Add to SLR EHR Certification ID field SLR Step 3 – Meaningful Use (MU) EHR Reporting Period SLR Step 3 – EP MU Core Objectives EP will have to attest to each of the 15 Meaningful Use Core Objectives The 15 Meaningful Use Core Objectives are: Use computerized provider order entry (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 Implement drug-drug and drug-allergy interaction checks Maintain an up-to-date problem list of current and active diagnoses Generate and transmit permissible prescriptions electronically (eRx) Maintain active medication list. Maintain active medication allergy list Record all the demographics Record and chart changes in vital signs SLR Step 3 – EP MU Core Objectives Record smoking status for patients 13 years old or older Report ambulatory clinical quality measures to the State Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance to that rule Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request Provide clinical summaries for patients for each office visit Capability to exchange key clinical information (for example, problem list, medication list, allergies, diagnostic test results), among providers of care and patient authorized entities electronically Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities SLR Step 3 – EP MU Core Objectives SLR Step 3 – EH MU Core Objectives EH will have to attest to each of the 14 Meaningful Use Core Objectives Use computerized physician order entry (CPOE) Implement drug-drug and drug-allergy interaction checks Maintain an up-to-date problem list of current and active diagnoses Maintain active medication list Maintain active medication allergy list Record all of the demographics: preferred language, gender, race, ethnicity, date of birth, date and preliminary cause of death in event of mortality Record and chart changes in vital signs Record smoking status for patients 13 years or older Report hospital clinical decision support rule related to a high priority hospital condition Provide patients with an electronic copy of their health information Provide patients with an electronic copy of their discharge instructions Capability to exchange key clinical information Protect electronic health information created or maintained by certified EHR technology through the implementation of appropriate technical capabilities SLR Step 3 – EH MU Core Objectives SLR Step 3 – EP MU Menu Objectives EP has to attest to at least one menu objective from the public health list, even if the exclusion applies to both: Capability to submit electronic data to immunization registry or immunization information system Capability to submit electronic syndromic surveillance data to public health agencies EP must attest to additional menu objectives until a total of 5 MU Menu Objectives have been selected: Implement drug formulary checks Incorporate clinical lab-test results into EHR as structured data Generate lists of patients by specific conditions Send reminders to patients Provide patients with timely electronic access to their health information Use certified EHR technology to identify patient-specific education resources Perform medication reconciliation if patient is received from another care setting or provider Provide summary of care record for any transition of care or referral SLR Step 3 – EP MU Menu Objectives SLR Step 3 – EH MU Menu Objectives EH has to attest to at least one menu objective from the public health list, even if the exclusion applies to both: Capability to submit electronic data to immunization registry or immunization information system Capability to submit electronic syndromic surveillance data to public health agencies Capability to submit electronic data on reportable lab results to public health agencies EP must attest to additional menu objectives until a total of 5 MU Menu Objectives have been selected: Implement drug formulary checks Record advance directives for patients 65 years or older Incorporate clinical lab-test results into certified EHR as structured data Generate lists of patients by specific conditions Use certified EHR technology to identify patient-specific education resources Perform medication reconciliation if patient is received from another care setting or provider Provide summary of care record for any transition of care or referral SLR Step 3 – EH MU Menu Objectives SLR Step 3 – EP Core Clinical Quality Measures EP must attest to all three (3) Core Clinical Quality Measures If any of the Core Clinical Quality Measures have a denominator of zero (0) an Alternative Core Clinical Quality Measure must also be submitted Core Clinical Quality Measures: Hypertension: Blood Pressure Measurement Preventive Care and Screening Measure Pair Adult Weight Screening and Follow-up Alternate Clinical Quality Measures: Weight Assessment and Counseling for Children and Adolescents Preventive Care and Screening: Influenza Immunization for Patients > or = 50 years old Childhood Immunization Status SLR Step 3 – EP Core Clinical Quality Measures SLR Step 3 – EP Alternate Clinical Quality Measures SLR Step 3 – EP Additional Clinical Quality Measures EP must select three (3) Additional Clinical Quality Measures from list: Asthma assessment Appropriate testing for children with pharyngitis Initiation and engagement of alcohol and other drug dependence treatment Prenatal care: screening for HIV Prenatal care: anti-D immune globulin Controlling high blood pressure Smoking and tobacco use cessation Breast cancer screening Cervical cancer screening Chlamydia screening for women Colorectal cancer screening Use of appropriate medications for asthma Pneumonia vaccination status for older adults Asthma pharmacologic therapy Low back pain: use of imaging studies Diabetes: eye exam Diabetes: foot exam Diabetes: hemoglobin A1c poor control Diabetes: blood pressure management SLR Step 3 – EP Additional Clinical Quality Measures Additional clinical quality measures continued: Diabetes: urine screening Diabetes: low density lipoprotein (LDL) management and control Coronary artery disease: oral antiplatelet therapy prescribed Ischemic vascular disease: use of aspirin or another antithrombotic Coronary artery disease: beta-blocker therapy Ischemic vascular disease: blood pressure management Coronary artery disease: drug therapy for lowering LDL-cholesterol Ischemic vascular disease: complete lipid panel and LDL control Heart failure: angiotensein Heart failure: beta-blocker therapy for LVSD Heart failure: Waifarin therapy for patients with atrial fibrillation Primary open angle glaucoma: optic nerve evaluation Diabetic retinopathy: documentation of presence or absences of macular edema and level of severity Diabetic retinopathy: communication with the physician mapping ongoing diabetes care Anti-depressant medication management Oncology colon cancer: chemotherapy for stage III colon cancer patients Oncology breast cancer: hormonal therapy for stage IC-IIIC estrogen receptor/progesterone receptor positive breast cncer Prostate cancer: avoidance of overuse of bone scan for staging low risk prostate cancer patients Diabetes: hemoglobin A1c control SLR Step 3 – EH Core Clinical Quality Measures EP must attest to all fifteen (15) Core Clinical Quality Measures Emergency department (ED): median time from ED arrival to time of departure from ED ED: median time from admit decision time to time of departure from ED Ischemic stroke: discharge on anti-thrombotics Ischemic stroke: anticoagulation for A-fib/flutter Ischemic stroke: thrombolytic therapy for patients arriving within 2 hours of symptom onset Ischemic or hemorrhagic stroke: antithrombotic therapy by day 2 Ischemic stroke: discharge on statins SLR Step 3 – EH Core Clinical Quality Measures Ischemic or hemorrhagic stroke: stroke education Ischemic or hemorrhagic stroke: rehabilitation assessment VTE prophylaxis within 24 hours of arrival Intensive care unit VTE prophylaxis Anticoagulation overlap therapy Platelet monitoring on unfractionated heparin VTE discharge instructions Incidence of potentially preventable VTE SLR Step 4 - Attestation Need to download Attestation, review for accuracy, sign and upload to SLR. Original signed Attestation must be mailed to SOA EHR Incentive Program Office SLR Step 5 – Submit Attestation Don’t Forget To Mail original signed EHR Incentive Program Attestation Agreement Form, Substitute Form - W9 and EDI Payment Agreement Form (if applicable) to: State of Alaska Department of Health and Social Services Division of Health Care Services EHR Incentive Program Office 1835 South Bragaw St., Suite 300 Anchorage, AK 99508-3469 Your attestation is not complete until the signed Attestation Agreement has been received by the State of Alaska. SLR – EP Payment Calculation Report SLR – EH Payment Calculation Report Where to Find Information? DHSS HIT http://www.hss.state.ak.us/hit/ Preparation Checklist Centers for Medicare & Medicaid (CMS) EHR Incentive Program http://www.cms.gov/EHRIncentivePrograms Program overview, eligibility, FAQs CMS EHR Incentive Program Registration https://ehrincentives.cms.gov/hitech/login.action ONC Certified Health IT Product List (CHPL) http://oncchpl.force.com/ehrcert Alaska Medicaid SLR Provider Outreach Portal / EHR Incentive Program Registration http://ak.arraincentive.com/default.aspx Centralized “one stop” launching pad of available tools for Providers to manage their EHR Incentive Program Information Contact Information Paul Cartland, State HIT Coordinator State of AK, DHSS [email protected] 907-269-6097 Beth Davidson, HIT Deputy Coordinator State of AK, DHSS [email protected] 907-375-7725 JoLynn Cagle, EHR Program Manager State of AK, DHSS [email protected] 907-334-4489