Who is Eligible

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					Vermont Medicaid EHR
Incentive Payment Program

    Update and Status
    September 7, 2011

      VITL Summit 9/07/2011 - Terry Bequette   1
Today’s agenda
 Vermont‟s Incentive Payment Program
     Requirements for incentive payments
     Registration and attestation
     Payment and appeals
     Help
     Schedule
 Q&A

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 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
      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.

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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
    Children‟s hospitals

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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.

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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
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

         Furnished services at either no cost or on a sliding


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More on Eligibility: Physician
 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:
  1.   When a PA is the primary provider in a clinic
  2.   When a PA is a clinical or medical director at
       a clinical site of practice
  3.   When a PA is an owner of an RHC

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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)

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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)
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 Adopted: Acquired and installed
    „Acquired‟ can mean ordered
    „Installed‟ – e.g., some evidence of installation prior to
 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
 Vermont expects some proof of purchase: a receipt,
  invoice, contract, purchase order; etc.

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Eligibility: Patient Volume

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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’)

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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

                VITL Summit 9/07/2011 - Terry Bequette
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

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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
      MAPIR looks for a registration record from the R&A
       and the application process can begin.

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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

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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
      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.

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 A valid email address for the CMS registration
   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
   Proof of EHR acquisition
   Can also work through the sample EP MAPIR
    applications on our website when that is available.

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A Little More MAPIR
 Tab-oriented progress flow
     Get Started
     R&A Contact Information
     Eligibility
     Patient Volumes
     Attestation
     Review
     Submit

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A Little More MAPIR
 Attesting to an EHR Phase – e.g., Implementation Questions

                                                             Planned   Complete

            Workflow Analysis

            Workflow Redesign                                    

            Software Installation                                         

            Hardware Installation                                         

            Peripherals Installation

            Internet / Broadband

            Electronic Prescribing                                        

            Health Information Exchange (labs;
            Physical Redesign of Workspace


                             VITL Summit 9/07/2011 - Terry Bequette               21
A Little More MAPIR
 The MAPIR system returns a summary of
 your entries…

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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
 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.

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 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
                       VITL Summit 9/07/2011 - Terry Bequette   24
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

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Helpful Links
 ONC (Office of the National Coordinator):
    http://healthit.hhs.gov
 CMS pages:
    EHR Incentive Payments:
    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/
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Contact Information
   Terry Bequette                                              Carol Kulczyk
     Assoc. State HIT Coordinator                                  Director of Program Implementation
     Department of Vermont Health Access                           Vermont Information Technology Leaders, Inc.
     289 Hurricane Lane                                            Vermont‟s Regional Extension Center
     Williston VT 05495                                            144 Main Street, Suite 1
     Terry.bequette@ahs.state.vt.us                                Montpelier VT 05602
     802.879.5996                                                  ckulczyk@vitl.net
   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

                                       VITL Summit 9/07/2011 - Terry Bequette                                     27

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