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Medicaid Health IT Today
February 29, 2012 - Volume 2, Issue 3
The Health IT Project Team is putting the finishing touches on a very successful 2011 program year and moving into 2012, the program's second year. As we noted in earlier, EPs who have completed and submitted their application by today - February 29 - will be eligible for the 2011 program start year.
But there is no need to worry!
Again, this transition to the 2012 start year does not impact your ability to apply for an incentive or affect the total amount you may receive. EP's can enter the program as late at 2016 and still receive the full incentive amount with six years of participation. The Health IT Project Team will continue to process applications as they come to us regardless of their start year. Of note, the state application will automatically know you are applying for 2012 when you use your 2011 Medicaid data.
EPs WHO SUBMITTED AN APPLICATION BY FEB. 29, 2012
EPs WHO DID NOT SUBMIT AN APPLICATION BY FEB. 29, 2012
ü The Health IT Project Team is working to deliver security credentials to a security administrator in your organization. Our immediate goal is to ensure an administrator in your organization is credentialed. Should a different security administrator need to be assigned for future work, please contact us at [log in to unmask][log in to unmask]>.
ü Complete and submit your application by February 29, 2012 using your 2010 Medicaid data. This includes faxing the proper AIU documentation demonstration your use of certified EHR technology. You may find faxing instructions here.
ü Follow your application's status in eMIPP via Provider One.
ü The Health IT Project Team intends to deliver security credentials using a new automated process to a security administrator in your organization beginning in March.
ü Complete and submit your application by February 29, 2013 using your 2011 Medicaid data. This includes faxing the proper AIU documentation demonstrating your use of certified EHR technology. You may find faxing instructions here.
ü Follow your application's status in eMIPP via ProviderOne .
Program Integrity Notes
The "practices predominantly" requirement has generated many questions and proven to be a critical eligibility requirement for EPs applying as part of federally qualified health centers and rural health centers (FQHCs and RHCs). Though the requirement is related to the patient volume requirement, the two are not the same. Patient volume is about HOW MANY encounters; "practices predominately" is more about WHERE an EP practiced in the previous calendar year.
Per §495.304(c), EPs can reach patient volume by three methods:
(1) Reaching 30% Medicaid patient volume
(2) Reaching 20% Medicaid patient volume, and be a pediatrician (an MD)
(3) Practice predominantly in a FQHC/RHC and have a minimum 30% patient volume attributable to "needy individuals" (the sum of all Medicaid, CHIP, uncompensated, no cost, reduced cost, and sliding scale encounters). Per §495.302, "Practices predominantly means an EP for whom the clinical location for over 50 percent of his or her total patient encounters over a period of 6 months in the most recent calendar year occurs at a federally qualified health center or rural health clinic."
In terms of eligibility, this regulation means:
· If an EP or group calculation reaches 30% with Medicaid encounters alone, the patient volume requirement has been met under method (1), which does not require EPs to practice predominantly. This holds true even if the EP or FQHC/RHC has included non-Medicaid "needy individual" encounters on their application; if 30% is reached with Medicaid encounters only, there is no "practices predominantly" requirement.
· The same holds true for pediatricians at 20%, under method (2).
· However, if 30% can be reached ONLY IF non-Medicaid "needy individual" encounters are included in the calculation, every EP so applying must practice predominantly (method (3)), per the definition above.
For a fuller explanation with examples, please review our White Paper on this subject.
Thank you again for your interest in the EHR Incentive Program. Should you have any additional questions, please visit our website or email us at [log in to unmask][log in to unmask]>.
The Health IT Project Team
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