Vermont Medicaid EHR Incentive Payment Program

1. Vermont Medicaid EHR Incentive Payment Program Update and Status September 7, 2011 VITL Summit 9/07/2011 - Terry Bequette

2. Today’s agenda • Vermont’s Incentive Payment Program • Requirements for incentive payments • Registration and attestation • Payment and appeals • Help • Schedule • Q&A VITL Summit 9/07/2011 - Terry Bequette

3. Requirements • To qualify for a Vermont Medicaid EHR incentive payment you must: • Be an eligible professional (EP) • Using a federally certified EHR system for your patient encounters • Where you have at least Acquired, Implemented, or Upgraded (AIU) that system • With a Medicaid patient encounter ratio that satisfies the federal requirement. • You must register at the CMS Registration & Attestation (R&A) web portal and then enter your status and attestation data into the Vermont MAPIR web portal. • AIU only in year 1; VT cannot accept a MU filing. VITL Summit 9/07/2011 - Terry Bequette

4. Eligibility: What is a Medicaid Eligible Provider? Eligible Professionals (EPs) Physicians Pediatricians have special eligibility & payment rules Clarified: physician for Medicaid = MDs; DOs Nurse practitioners (NPs) Certified Nurse Midwives (CNMs) Dentists Physician Assistants (PAs) when practicing at an FQHC/RHC that is so led by a PA Eligible Hospitals Acute Care hospitals (including CAHs and cancer hospitals) Children’s hospitals VITL Summit 9/07/2011 - Terry Bequette

5. Who is Eligible? • EPs cannot be hospital based, meaning that not “substantially all” (more than 90%) of covered professional services are conducted in either the inpatient hospital or hospital emergency department. • EPs must be enrolled as a Vermont Medicaid provider without sanctions or exclusions. If not currently enrolled, do so before applying for an incentive. VITL Summit 9/07/2011 - Terry Bequette

6. Hospital-based EP • Hospital-based EP is an EP who furnishes 90 percent or more of his or her covered professional services in a hospital setting in the year preceding the payment year…a setting is considered a hospital setting if it is a site of service that would be identified by the codes used in the HIPAA standard transactions as an inpatient hospital, or emergency room setting. • Codes 21, 23. VITL Summit 9/07/2011 - Terry Bequette

7. More on Eligibility: Practices Predominantly & Needy Individuals EP is also eligible when practicing predominantly in FQHC/RHC providing care to needy individuals Practicing predominantly is when FQHC/RHC is the clinical location for over 50% of total encounters over a period of 6 months in the most recent calendar year Needy individuals (specified in statute) include: Medicaid or CHIP enrollees; Patients furnished uncompensated care by the provider; Furnished services at either no cost or on a sliding scale VITL Summit 9/07/2011 - Terry Bequette

8. More on Eligibility: Physician Assistants Physician Assistants are eligible when working at an FQHC or RHC that is so led by a physician assistant In response to comments, CMS clarified “so led” to mean: When a PA is the primary provider in a clinic When a PA is a clinical or medical director at a clinical site of practice When a PA is an owner of an RHC VITL Summit 9/07/2011 - Terry Bequette

9. Federally Certified EHR System • ONC Certified Health IT Product List (CHPL): • http://onc-chpl.force.com/ehrcert • CHPL site provides ID number for each certified EHR • ID number needed on MAPIR for attestation • Make sure your system is certified by an Authorized Testing and Certification Body (ATCB) VITL Summit 9/07/2011 - Terry Bequette

10. AIU and MU: Overview Adopt, Implement, Upgrade (AIU) First participation year only No EHR reporting period Meaningful Use (MU) Successive participation years; and Early adopters and some dually-eligible hospitals in year 1 Medicaid Providers’ AIU/MU does not have to be over six consecutive years States may propose to CMS for approval of limited revisions to MU as it pertains to 4 public health related objectives (VT proposed no revisions) VITL Summit 9/07/2011 - Terry Bequette

11. AIU and MU: AIU Adopted: Acquired and installed ‘Acquired’ can mean ordered ‘Installed’ – e.g., some evidence of installation prior to incentive Implemented: Commenced utilization of e.g., staff training, data entry of patient demographic information into EHR Upgraded: Expanded e.g., upgraded to certified EHR technology or added new functionality to meet the definition of certified EHR technology Vermont expects some proof of purchase: a receipt, invoice, contract, purchase order; etc. VITL Summit 9/07/2011 - Terry Bequette

12. Eligibility: Patient Volume VITL Summit 9/07/2011 - Terry Bequette

13. Eligibility: Patient Volume • General approach: • Total (Medicaid) patient encounters • In any 90-day period in the preceding • Calendar year • ________________________________ x 100 • Total patient encounters in • That same 90-day period • - May also be used to calculate needy individual patient volume • May be used for hospitals and EPs (Hospitals count ‘inpatient bed days’) VITL Summit 9/07/2011 - Terry Bequette

14. Patient Encounters • Generally stated, a patient encounter is any one day where Medicaid paid for all or part of the service or Medicaid paid the co-pays, cost-sharing, or premiums for the service…In general, the same concept applies to needy individuals. VITL Summit 9/07/2011 - Terry Bequette

15. Overview of the EHR Incentive Program (EHRIP) Process • 1. Register with the CMS Incentive Program Registration and Attestation System (R&A) website • https://ehrincentives.cms.gov/hitech/login.action • Provide information such as: • Individual and Payee NPI and TIN • Option of Medicare or Vermont Medicaid • If Medicaid, pick the state from the drop down menu (Only states that have launched their programs are in the list; Vermont is not yet there) • You won’t be able to register for Medicaid until Vermont is ready to launch its program – on or near October 3, 2011 as currently planned! • CMS EHR Certification Number • Email contact information VITL Summit 9/07/2011 - Terry Bequette

16. Overview of the EHRIP Process • 2. Vermont Green Mountain Care Internet Portal • Following CMS R&A, EP receives an email (a few business days later) notification that you can register in Vermont’s MAPIR system • MAPIR is a repository of information for attestations, payments, appeals, oversight functions and interface with R&A • Use your GMC Internet Portal user ID and password to log in. If you are an EP type then you will see a MAPIR application link. • An EP can delegate someone to enter data in the portal • MAPIR looks for a registration record from the R&A and the application process can begin. VITL Summit 9/07/2011 - Terry Bequette

17. Overview of the EHRIP Process • 3. Vermont GMC Internet Portal (con’t) • Verify the data displayed in MAPIR, enter additional data elements, and attest to the accuracy of the data elements; demonstrate that you meet: • Medicaid patient volume thresholds • Adopting, Implementing or Upgrading a federally certified EHR system, and • Meet all other federal program requirements • Submit proof of purchase via email attachment VITL Summit 9/07/2011 - Terry Bequette

18. Overview of the EHRIP Process • 4. Department of Vermont Health Access (DVHA) actions • Review applications and make approval decisions • Inform applications of approval or denial via email • Based on federal rules about the EHRIP. • Payments via standard GMC payment system. You will see approved payments on your remittance advices and your annual 1099’s. • You may be contacted during this process if there are questions • Appeals rights are available (e.g., if payment is denied) and there will be instructions on the website. • Applicants can reassign their payments to their employer or a contractual entity allowed to bill and receive payment for the applicant’s covered professional services. VITL Summit 9/07/2011 - Terry Bequette

19. Preparation • A valid email address for the CMS registration process • A GMC Internet portal User ID and password • NPI and TIN provided to CMS must match the NPI and Payee TIN information in the GMC system (should be same as used for Medicaid claim payment purposes) • Proof of EHR acquisition • Can also work through the sample EP MAPIR applications on our website when that is available. VITL Summit 9/07/2011 - Terry Bequette

20. A Little More MAPIR • Tab-oriented progress flow • Get Started • R&A Contact Information • Eligibility • Patient Volumes • Attestation • Review • Submit VITL Summit 9/07/2011 - Terry Bequette

21. A Little More MAPIR • Attesting to an EHR Phase – e.g., Implementation Questions VITL Summit 9/07/2011 - Terry Bequette

22. A Little More MAPIR • The MAPIR system returns a summary of your entries… VITL Summit 9/07/2011 - Terry Bequette

23. A Little More MAPIR • As you work through the tabs you can save your work, log out and return to where you were • Very much like Turbo Tax • Opportunities to review each section • Opportunity to review the overall attestation and get a printout • Once you electronically sign and submit your attestation, you cannot change the data in MAPIR, but can work with DVHA administrative support to make corrections. VITL Summit 9/07/2011 - Terry Bequette

24. Schedule • We are currently holding to an October 3, 2011 launch • Must be on the first Monday of a month • Much to accomplish to make this happen: • Website materials (State and portal websites) • Provider Manuals for EPs and Hospitals • System testing • Administrative procedures • May launch but delay attestations until fully ready VITL Summit 9/07/2011 - Terry Bequette

25. Request for Early Attesters • If you think you will be ready to attest when we launch, and are counting on an incentive payment for the 2011 payment year, send an email with contact information to • Terry.bequette@ahs.state.vt.us VITL Summit 9/07/2011 - Terry Bequette

26. Helpful Links • ONC (Office of the National Coordinator): • http://healthit.hhs.gov • CMS pages: • EHR Incentive Payments: http://www.cms.gov/EHRIncentivePrograms/ • CMS EHR FAQs: • http://www.cms.gov/EHRIncentivePrograms/95_FAQ.asp#TopOfPage • VITL: http://www.vitl.net/medicaid • Vermont pages: • Health Care Reform: http://hcr.vermont.gov/ • DVHA: http://ovha.vermont.gov/ • GMC Provider Portal: http://www.vtmedicaid.com/ VITL Summit 9/07/2011 - Terry Bequette

27. Terry Bequette Assoc. State HIT Coordinator Department of Vermont Health Access 289 Hurricane Lane Williston VT 05495 Terry.bequette@ahs.state.vt.us 802.879.5996 Paul Forlenza Vice President, Policy and Special Projects Vermont Information Technology Leaders, Inc. Vermont’s Regional Extension Center 144 Main Street, Suite 1 Montpelier VT 05602 pforlenza@vitl.net 802.839.1942 Carol Kulczyk Director of Program Implementation Vermont Information Technology Leaders, Inc. Vermont’s Regional Extension Center 144 Main Street, Suite 1 Montpelier VT 05602 ckulczyk@vitl.net 802.839.1957 Contact Information VITL Summit 9/07/2011 - Terry Bequette

28. Questions?