New Jersey Medicaid New Jersey Medicaid EHR Incentive ProgramEHR Incentive Program

Hospital OverviewHospital Overview

Presentation SummaryPresentation Summary

Medicaid EHR Incentive Program Medicaid EHR Incentive Program OverviewOverview

EligibilityEligibility Adopt, Implement, Upgrade, and Adopt, Implement, Upgrade, and

Meaningful Use DefinitionsMeaningful Use Definitions Payment Calculation and SchedulePayment Calculation and Schedule Registration and AttestationRegistration and Attestation Questions and AnswersQuestions and Answers

Program Program OverviewOverview

Program OverviewProgram Overview The Medicaid EHR Incentive Program will The Medicaid EHR Incentive Program will

provide incentive payments to eligible provide incentive payments to eligible hospitals as they adopt, implement, or hospitals as they adopt, implement, or upgrade certified EHR technology in their upgrade certified EHR technology in their first year of participation and demonstrate first year of participation and demonstrate meaningful use for two additional years.meaningful use for two additional years.

Program OverviewProgram Overview Incentive payments to hospitals will begin Incentive payments to hospitals will begin

being distributed in January – February being distributed in January – February 2012.2012.

The last year a Medicaid eligible hospital may The last year a Medicaid eligible hospital may begin the program is 2016. begin the program is 2016.

Hospital payments will vary by facility based Hospital payments will vary by facility based on hospital size and Medicaid concentrationon hospital size and Medicaid concentration

Hospitals may receive payments from BOTH Hospitals may receive payments from BOTH the Medicare and Medicaid EHR Incentive the Medicare and Medicaid EHR Incentive ProgramsPrograms

EligibilityEligibility

EligibilityEligibility Acute Care HospitalsAcute Care Hospitals

General hospitals, cancer hospitals and critical access General hospitals, cancer hospitals and critical access hospitalshospitals

Average length of patient stay of 25 days or fewerAverage length of patient stay of 25 days or fewer CMS Certification Number (CCN) with the last four digits CMS Certification Number (CCN) with the last four digits

in the series 0001 – 0879 and 1300-1399in the series 0001 – 0879 and 1300-1399 10% Medicaid Patient Volume based on encounters10% Medicaid Patient Volume based on encounters

Children’s HospitalsChildren’s Hospitals CCN with last four digits in the series 3300 – 3399CCN with last four digits in the series 3300 – 3399 No patient volume requirementNo patient volume requirement

Eligibility: Medicaid EncounterEligibility: Medicaid Encounter

A hospital encounter occurs only in a A hospital encounter occurs only in a hospital’s inpatient department, or hospital’s inpatient department, or emergency department on any one dayemergency department on any one day

One Medicaid encounter is tallied: One Medicaid encounter is tallied: For each inpatient discharge For each inpatient discharge IF IF Medicaid paid Medicaid paid

for any part of the patient’s stay, and for any part of the patient’s stay, and For each emergency department visit (no For each emergency department visit (no

more than one per patient per day), more than one per patient per day), IF IF Medicaid paid for any part of that ER visit. Medicaid paid for any part of that ER visit.

Patient Volume CalculationPatient Volume Calculation Medicaid Encounter count for a selected Medicaid Encounter count for a selected

90 day period divided by90 day period divided by Total inpatient discharges + emergency Total inpatient discharges + emergency

room visits for the same periodroom visits for the same period If the total is greater than 10%, the If the total is greater than 10%, the

hospital is eligible for a Medicaid EHR hospital is eligible for a Medicaid EHR Incentive PaymentIncentive Payment

New Jersey Medicaid recommends that New Jersey Medicaid recommends that hospitals use their Medicare or Medicaid hospitals use their Medicare or Medicaid cost reports for all calculations.cost reports for all calculations.

Adopt, Implement, Adopt, Implement, Upgrade and Upgrade and

Meaningful UseMeaningful Use

Adopt, Implement or Upgrade (AIU)Adopt, Implement or Upgrade (AIU)

Hospitals must demonstrate one of these Hospitals must demonstrate one of these to receive a Year 1 incentive payment:to receive a Year 1 incentive payment:

AdoptAdopt – Acquire, purchase, or secure – Acquire, purchase, or secure access to certified EHR technologyaccess to certified EHR technology

ImplementImplement - Install or commence utilization - Install or commence utilization of certified EHR technologyof certified EHR technology

UpgradeUpgrade - Expand the available - Expand the available functionality of certified EHR technologyfunctionality of certified EHR technology

Adopt, Implement or Upgrade (AIU)Adopt, Implement or Upgrade (AIU)

Documentation proving AIU should be Documentation proving AIU should be uploaded into the attestation system, and uploaded into the attestation system, and should include the following:should include the following: Identification of the EHR technology being Identification of the EHR technology being

adopted or already in useadopted or already in use Signed contract or financial record indicating Signed contract or financial record indicating

the purchase, acquisition or lease of certified the purchase, acquisition or lease of certified EHR technologyEHR technology

Meaningful UseMeaningful Use

Hospitals must demonstrate meaningful Hospitals must demonstrate meaningful use to receive Year 2 and 3 incentive use to receive Year 2 and 3 incentive paymentspayments

Meaningful Use Includes:Meaningful Use Includes: Compliance with all 14 ONC “Core” Compliance with all 14 ONC “Core”

Meaningful Use objectivesMeaningful Use objectives Compliance with 5 of the 10 “Menu Set” Compliance with 5 of the 10 “Menu Set”

Meaningful Use objectivesMeaningful Use objectives All meaningful use attestations will be All meaningful use attestations will be

subject to audits performed by CMSsubject to audits performed by CMS

Payment Payment Calculation and Calculation and

ScheduleSchedule

Payment Calculation BasicsPayment Calculation Basics Payment is calculated once and will be Payment is calculated once and will be

distributed over three years:distributed over three years: 50% Year 1, 40% Year 2, 10% year 350% Year 1, 40% Year 2, 10% year 3

Complex formula based on projected Complex formula based on projected hospital discharge growth rates and hospital discharge growth rates and Medicaid patient volumeMedicaid patient volume

EHR Incentive Program Payment System EHR Incentive Program Payment System will perform the calculationwill perform the calculation

More detail on the calculation formula is More detail on the calculation formula is available at www.nj.gov/njhit/ehr. available at www.nj.gov/njhit/ehr.

Payment Calculation: Information NeededPayment Calculation: Information Needed Total acute inpatient discharges for the last 4 Total acute inpatient discharges for the last 4

completed hospital fiscal yearscompleted hospital fiscal years Total acute inpatient bed days for the entire Total acute inpatient bed days for the entire

hospital fiscal year completed in the most hospital fiscal year completed in the most recently completed federal fiscal yearrecently completed federal fiscal year

Acute inpatient bed days which Medicaid Acute inpatient bed days which Medicaid (Title XIX only, fee-for-service or managed (Title XIX only, fee-for-service or managed care) paid a share of for the same hospital care) paid a share of for the same hospital fiscal year fiscal year Excluding Medicaid/Medicare dual eligible daysExcluding Medicaid/Medicare dual eligible days

Payment Calculation: Information NeededPayment Calculation: Information Needed Total charges for the hospital fiscal year Total charges for the hospital fiscal year

completed in the most recently completed completed in the most recently completed federal fiscal yearfederal fiscal year

Total Charity Care charges for the hospital Total Charity Care charges for the hospital fiscal year completed in the most recently fiscal year completed in the most recently completed hospital fiscal yearcompleted hospital fiscal year

Payment Calculation: Additional PointsPayment Calculation: Additional Points Recommended Data Sources:Recommended Data Sources:

Medicare Cost ReportsMedicare Cost Reports Medicaid Cost ReportsMedicaid Cost Reports Financial Statements or Accounting RecordsFinancial Statements or Accounting Records

Six page description of the payment Six page description of the payment calculation process is available at calculation process is available at http://www.nj.gov/njhit/hospitals/calculation http://www.nj.gov/njhit/hospitals/calculation

Registration and Registration and AttestationAttestation

Registration and Attestation TimelineRegistration and Attestation Timeline

November 7, 2011 – National Level November 7, 2011 – National Level Repository registrations launchedRepository registrations launched

December 2011 – EHR Incentive Program December 2011 – EHR Incentive Program Attestation System launchesAttestation System launches

January/February 2012 – Initial EHR January/February 2012 – Initial EHR Incentive Program payments distributedIncentive Program payments distributed

National Level RegistrationNational Level Registration

CMS Administered Process with state CMS Administered Process with state verificationverification

Verifies that hospital meets the basic Verifies that hospital meets the basic eligibility criteria for the Medicaid EHR eligibility criteria for the Medicaid EHR Incentive ProgramIncentive Program

Opened for the New Jersey Medicaid EHR Opened for the New Jersey Medicaid EHR Incentive Program on 11/7/11Incentive Program on 11/7/11

National Level RegistrationNational Level Registration Hospitals that already registered as dually-Hospitals that already registered as dually-

eligible for the Medicaid and Medicare programs eligible for the Medicaid and Medicare programs have already completed this processhave already completed this process

Hospitals that have never registered can go to Hospitals that have never registered can go to ehrincentives.cms.gov to begin the processehrincentives.cms.gov to begin the process

Registration User Guide is available at Registration User Guide is available at www.nj.gov/njhit/ehr www.nj.gov/njhit/ehr

National Level RegistrationNational Level Registration Information Needed to Complete the Information Needed to Complete the

Process:Process: Name of the eligible hospital Name of the eligible hospital National Provider Identifier (NPI) National Provider Identifier (NPI) Provider Enrollment, Chain, and Ownership Provider Enrollment, Chain, and Ownership

System (PECOS) Provider Number System (PECOS) Provider Number CCN (CMS Certification Number) CCN (CMS Certification Number) Business address and phone numberBusiness address and phone number Valid Email address Valid Email address Taxpayer Identification Number (TIN) Taxpayer Identification Number (TIN)

State Level AttestationState Level Attestation Begins once NLR Registration is Begins once NLR Registration is

successfully completedsuccessfully completed Allows hospitals to enter their Medicaid Allows hospitals to enter their Medicaid

patient volume information, upload AIU patient volume information, upload AIU documentation, and enter information documentation, and enter information needed for payment calculationneeded for payment calculation

Application will be available within the Application will be available within the provider portal section of provider portal section of www.njmmis.com www.njmmis.com

All information entered will be subject to All information entered will be subject to audit that could result in recoupmentaudit that could result in recoupment

State Level AttestationState Level Attestation Information Needed to Complete Attestation:Information Needed to Complete Attestation:

Medicaid Provider IDMedicaid Provider ID 90 day period for patient volume calculation90 day period for patient volume calculation Medicaid Fee-for-Service and Managed Care Medicaid Fee-for-Service and Managed Care

encounters for the selected 90 day periodencounters for the selected 90 day period Total encounters for the selected 90 day periodTotal encounters for the selected 90 day period Any out-of-state Medicaid fee-for-service or managed Any out-of-state Medicaid fee-for-service or managed

care patient encounterscare patient encounters Total discharges for the four most recently completed Total discharges for the four most recently completed

hospital fiscal yearshospital fiscal years

State Level AttestationState Level Attestation Information Needed to Complete Information Needed to Complete

Attestation:Attestation: Medicaid fee-for-service and managed care Medicaid fee-for-service and managed care

acute inpatient bed days for the most recently acute inpatient bed days for the most recently completed hospital fiscal yearcompleted hospital fiscal year

Total acute inpatient bed days for the most Total acute inpatient bed days for the most recently completed hospital fiscal yearrecently completed hospital fiscal year

Total Hospital Charges (including Charity Total Hospital Charges (including Charity Care charges)Care charges)

Charity Care ChargesCharity Care Charges CMS EHR Certification NumberCMS EHR Certification Number

State Level AttestationState Level Attestation Additional Attestation Information:Additional Attestation Information:

Once all information is entered, hospitals will Once all information is entered, hospitals will have 72 hours to change any information have 72 hours to change any information included in the attestationincluded in the attestation

The attestation system will verify all Medicaid The attestation system will verify all Medicaid information entered against information information entered against information available in NJMMISavailable in NJMMIS

New Jersey Medicaid recommends using New Jersey Medicaid recommends using Medicare cost reports to complete the Medicare cost reports to complete the attestation process. The lines that should be attestation process. The lines that should be used are available at www.nj.gov/njhit/ehrused are available at www.nj.gov/njhit/ehr

Additional InformationAdditional Information EHR Incentive Program WebsiteEHR Incentive Program Website

www.nj.gov/njhit/ehrwww.nj.gov/njhit/ehr

NJMMIS Provider ServicesNJMMIS Provider Services 1-800-776-6334, Option 71-800-776-6334, Option 7 Have your Medicaid Provider ID numberHave your Medicaid Provider ID number

Program e-mail addressProgram e-mail address MAHS.ehrincentives@dhs.state.nj.usMAHS.ehrincentives@dhs.state.nj.us