Medicaid Meaningful Use Incentive Program and Statewide by hcj


									         By James Phelps
        Actuarial Specialist
       Reimbursement Unit
Utah Medicaid and Health Financing
“Utah is a place where

   Secure and efficient use and exchange of electronic health information will

           Result in improved health care,

               Better health care,

                         Lower cost and healthier communities”
 Must demonstrate qualification for incentive Payment
    First year must demonstrate that they are engaged in
    efforts to adopt, implement, or upgrade to certified EHR

    Attest to meeting the Medicaid volumes for the
    Incentive payment program.

    Second – Sixth year demonstrate “Meaningful Use” and
    meet the Medicaid volume level each year.
 American Recovery and Reinvestment Act of 2009
   provide incentive payments for the meaningful use of
    certified EHR technology
 Stage 1
   “The criteria for meaningful use focus on electronically
    capturing health information in a coded format, using
    that information to track key clinical conditions,
    communicating that information for care coordination
    purposes, and initiating the reporting of clinical quality
    measures and public health information.”
 Stage 2
   “ Would expand upon the Stage 1 criteria in the areas of
    disease management, clinical decision support,
    medication management, support for patient access to
    their health information, transitions in care, quality
    measurement and research, and bi-directional
    communication with public health agencies.”
 Stage 3
   “Would focus on achieving improvements in quality,
    safety and efficiency, focusing on decision support for
    national high priority conditions, patient access to self
    management tools, access to comprehensive patient
    data, and improving population health outcomes.”
                                                        Minimum 90 Day Medicaid
Entity                                                  Patient Volume Threshold
Physicians                                                          30%
Pediatricians                                                       20%
Dentist                                                             30%
Certified Nurse Midwives                                            30%
*Physicians Assistants                                              30%
Nurse Practitioner                                                  30%
Acute Care Hospitals                                                10%
Children Hospitals                                             Eligible
Or the Medicaid EP practices predominantly in FQHC or RHC-30% "needy individual" patient
volume threshold
*Physicians Assistants only when practicing at an FQHC/RHC supervised by a physician
Cap on Net Average            85% Allowed for EP     Maximum Cumulative
Allowable Costs                                    Incentive over 6 Yr Period
$25,000 for Year 1 for most        $21,250
$10,000 in Years 2-6 for            $8,500
most professionals
$16,667 in Year 1 for              $14,167
Pediatricians with minimum
20% patient volume, but
less than 30% Medicaid
patient volume
$6,667 in Years 2-6 for             $5,667
pediatricians with a
minimum 20% patient
volume, but less than 30%
Medicaid patient volume
 2 Million Dollar Base

 Plus $200 for Discharges 1,150 - 23,000

Note: CMS is finalizing a formula/definition of eligible hospitals for this
 100% FFP for Medicaid Incentive Payments

 Hospitals FFY 2011

 Individual Physicians CY 2011
 Survey
    Part One: General Respondent and Practice Information

   Part Two: Provider Organizational Information

   Part Three: Provider Incentive Eligibility

   Part Four: Health information Technology

   Part Five: Requirements Concerns
 Estimated 55% EHR Penetration as of 1/1/10 for
   15 yrs Experience providing administrative exchange
   Currently includes 95% of state’s providers
   State’s cHIE
 Providers’ Use
   826 independent physicians connect to Intermountain
   Mountain Star/HCA interface with three of the largest
    practices in the area.
                                                    Source: HealthInsight

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