Oklahoma
Health Care Authority
Board Retreat
Thursday, August 26, 2010
Carol McFarland, CPA, CGFM
Performance & Reporting Manager
Melody Anthony, M.S.
Provider Services Director
Adolph Maren Jr., M.A.
Senior Planning Coordinator

Oklahoma EHR Incentive Program
Origin: American Recovery &
Reinvestment Act of 2009
Health Information Technology provisions of the ARRA
• Title XIII, Division A, HIT
• Title IV of Division B,
Medicare and Medicaid HIT
"HITECH Act"
The Health Information Technology for Economic and
Clinical Health Act established programs under
Medicare and Medicaid to provide incentive payments for the "meaningful use" of certified EHR technology.

Oklahoma EHR Incentive Program
 Major financial support to provider and States;
 Learning opportunities created and leverages through technical assistance from CMS and others;
 Will establish sustainable data-driven infrastructure that will create a framework for improving healthcare quality and outcomes

Oklahoma EHR Incentive Program
 Federal Partner responsibilities
 Centers for Medicare & Medicaid Services
 incentive program and meaningful use (MU)
 Final Rule for EHR Incentives & MU - July 13, 2010
 www.cms.gov/EHRIncentivePrograms/
 Office of the National Coordinator of Health Information
Technology
 certification standards program for EHR technology
 temporary certification program –
 final rule published June 18, 2010
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 effective June 24, 2010 permanent certification program is expected to be published this fall
 www.HealthIT.hhs.gov

Oklahoma EHR Incentive Program
 Adopt ( acquire and install)
 Implement (commenced utilization, train staff, deploy tools, exchange data)
Or…
 Upgrade (expand functionality or interoperability)
 Meaningfully Use (meet specified criteria)

Oklahoma EHR Incentive Program

Oklahoma EHR Incentive Program
Qualifying Eligible Professionals (EP)
1 Current SoonerCare Provider Contract
2 Hospital-based EPs are
NOT eligible
90% or more of services are performed in a hospital inpatient or emergency room setting.
3 Provider Type Physicians (MD,DO)
Pediatricians
Dentists
Certified Nurse Midwifes
Nurse Practitioners
Physician Assistants (PA) practicing at a FQHC/RHC so led by a PA
4 Patient Volume over a 90 day period
30% SoonerCare
20-29% SoonerCare - Pediatricians = 2/3 of incentive payment
30% Needy Individuals* Medical EPs practicing predominantly in FQHC or RHC
*Needy individuals = SoonerCare members, patients receiving uncompensated care and patients receiving services at reduced or no cost based upon ability to pay

Oklahoma EHR Incentive Program
Qualifying Eligible Hospitals (EH)
1 Current SoonerCare Provider Contract
2 Hospital Types Acute Care Hospital
(includes CAHs & cancer hospitals)
Avg. length of stay < 25 days
CCN* last 4 of
0001 – 0879; 1300 – 1399
Children’s Hospital CCN* last 4 of 3300 – 3399
Not applicable to children’s wings of larger hospitals
3 Patient Volume over a
90 day period
Acute Care Hospital
Children’s Hospitals
10% SoonerCare
No Requirement
* CCN - CMS Certification Number

Oklahoma EHR Incentive Program
 Based upon CMS final rule
 A Patient Volume Documentation worksheet will be provided as part of attestation process
 Provider defined 90 day period in the calendar year
Number of SoonerCare* member encounters
Number of total patient encounters
* or Needy Patient encounters for EPs providing services at a FQHC/RHC

Oklahoma EHR Incentive Program
 EPs and EHs are required to register with the Medicare and Medicaid registration and attestation system
 Name, NPI, business address, phone
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Tax payer ID Number (TIN)
Hospitals must provide the CCN
 EPs must select Medicare or Medicaid
 May switch once between programs before 2015
 If Medicaid, must select one state
 May switch states annually

Oklahoma EHR Incentive Program
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Connect to federal repository to facilitate provider attestation
Continue verification of eligibility
Disburse payment after cross-checking for potential duplicative, inappropriate payments and verification of supporting documentation
Disburse payment to one eligible TIN
Notify the national repository upon payment

Oklahoma EHR Incentive Program
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Provider registers with CMS
CMS directs providers to the OHCA website for enrollment in the Oklahoma EHR incentive program
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Providers fill out attestation
Identify your ONC-ATCB* certified EHR system
Complete patient volume worksheet
Electronically sign contract ammendment and fax requested documention to OHCA
*Office of the National Coordinator for Health Information
Technology
– Authorized Testing and Certificaiton Body

Oklahoma EHR Incentive Program
 Provider is not a hospital based professional
 Provider must provide services in Oklahoma
 Provider is not receiving an incentive payment from another state for that calendar year
 Provider has adopted, implemented or upgraded a certified EHR
 Provider inputs the certification number for the ONC-ATCB certified
EHR system
 Provider list number of FTE jobs created by implementing a certified product
 Provider reports cash payments made for the certified EHR
 Provider confirms assignment of payment to a qualified TIN
 Providers percentage of SoonerCare patient volume is equal to or greater than the allowed
 Provider has specified the patient volume date range of 90 days during the calendar year

Oklahoma EHR Incentive Program
 Hospital is not currently receiving an incentive payment from another state for that federal fiscal year
 Hospital must be located in Oklahoma
 Hospitals (Medicaid only) have adopted, implemented or upgraded a certified EHR, or meaningfully used a certified EHR
 ONC-ATCB EHR Certification number is included
 Hospital list number of FTE jobs created by implementing a certified product
 Hospital (acute care) percentage of SoonerCare discharges is at least 10%; Children's hospitals have no discharge percentage

Oklahoma EHR Incentive Program
 Adopted – Acquired and Installed
 Implemented – Commenced Utilization
 Upgraded – Expanded Upgraded to certified EHR technology or added new functionality to meet the definition of certified
EHR technology
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 Must be certified EHR technology capable of meeting meaningful use
No EHR reporting period
Only for first participation year

Oklahoma EHR Incentive Program
The Recovery Act specifies the following 3 components of Meaningful Use:
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Use of certified EHR in a meaningful manner
Use of certified EHR technology for electronic exchange of health information to improve quality of health care
Use of certified EHR technology to submit clinical quality measures(CQM) and other such measures selected by the
Secretary

Oklahoma EHR Incentive Program
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 Improve quality, safety, efficiency, and reduce health disparities
Engage patients and families in their health care
Improve care coordination
Improve population and public health
Ensure adequate privacy and security protections for personal health information

Oklahoma EHR Incentive Program
Meaningful Use of EHR
 3 Stages currently proposed
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Stage 1
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EP: 20 of 25 Objectives / Measures
EH: 19 of 24 Objectives / Measures
To meet certain objectives/measures, 80% of patients must have records in the certified EHR technology
Reporting Period –90 days for first year; one year subsequently
Oklahoma will adopt MU measures as published.
CMS intends to propose 2 additional stages through future rulemaking.
At this time, CMS plans on transitioning the Stage 12 menu set into the Stage 2 core set.

Oklahoma EHR Incentive Program
Eligible Professionals –15 Core Objectives
1.
Computerized Physician Order Entry (CPOE)
2.
E-Prescribing (eRx)
3.
Report ambulatory clinical quality measures to CMS/States
4.
Implement one clinical decision support rule
5.
Provide patients with an electronic copy of their health information, upon request
6.
Provide clinical summaries for patients for each office visit
7.
Drug-drug and drug-allergy interaction checks
8.
Record demographics
9.
Maintain an up-to-date problem list of current and active diagnoses
10.
Maintain active medication list
11.
Maintain active medication allergy list
12.
Record and chart changes in vital signs
13.
Record smoking status for patients 13 years or older
14.
Capability to exchange key clinical information among providers of care and patient-authorized entities electronically
15.
Protect electronic health information

Oklahoma EHR Incentive Program
Eligible Hospitals –14 Core Objectives
1.
CPOE
2.
Drug-drug and drug-allergy interaction checks
3.
Record demographics
4.
Implement one clinical decision support rule
5.
Maintain up-to-date problem list of current and active diagnoses
6.
Maintain active medication list
7.
Maintain active medication allergy list
8.
Record and chart changes in vital signs
9.
Record smoking status for patients 13 years or older
10.
Report hospital clinical quality measures to CMS or States
11.
Provide patients with an electronic copy of their health information, upon request
12.
Provide patients with an electronic copy of their discharge instructions at time of discharge, upon request
13.
Capability to exchange key clinical information among providers of care and patient-authorized entities electronically
14.
Protect electronic health information

Oklahoma EHR Incentive Program
Eligible Professionals –10 Menu Set Objectives
1.
Drug-formulary checks
2.
Incorporate clinical lab test results as structured data
3.
Generate lists of patients by specific conditions
4.
Send reminders to patients per patient preference for preventive/follow up care
5.
Provide patients with timely electronic access to their health information
6.
Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate
7.
Medication reconciliation
8.
Summary of care record for each transition of care/referrals
9.
*Capability to submit electronic data to immunization registries/systems
10.
*Capability to provide electronic syndromic surveillance data to public health agencies
*At least 1 public health objective must be selected

Oklahoma EHR Incentive Program
Eligible Hospitals –10 Menu Set Objectives
1.
Drug-formulary checks
2.
Record advanced directives for patients 65 years or older
3.
Incorporate clinical lab test results as structured data
4.
Generate lists of patients by specific conditions
5.
Use certified EHR technology to identify patient-specific education resources and provide to patient, if appropriate
6.
Medication reconciliation
7.
Summary of care record for each transition of care/referrals
8.
*Capability to submit electronic data to immunization registries/systems
9.
*Capability to provide electronic submission of reportable lab results to public health agencies
10.
*Capability to provide electronic syndromic surveillance data to public health agencies
*At least 1 public health objective must be selected

Oklahoma EHR Incentive Program

Oklahoma EHR Incentive Program
Eligible Professional Payments
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 Paid in alignment with the Calendar year
First year amount consistent regardless of stage (AIU or MU)
Maximum incentives are $63,750 over 6 years
Incentives are same regardless of start year
The first year maximum payment is $21,250
Must begin by 2016 to receive incentive payments
No requirement for “consecutive years” participation
Incentives available through 2021
Only 1 incentive payment per year

Oklahoma EHR Incentive Program
Eligible Hospital Payments
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Paid in alignment with the Federal Fiscal year (FFY)
First year amount consistent regardless of stage (AIU or MU)
$2M base + per discharge amount (based on Medicare/
Medicaid share)
Medicare Meaningful Use requirements may be deemed eligible for Medicaid payments
Payment is calculated, then disbursed over 3-6 years; we have proposed 3 year disbursement
No annual payment may exceed 50% of the total calculation; no 2-year payment may exceed 90%; we have proposed 50%
/ 40% / 10%
Hospitals cannot initiate payments after 2016 and payment years must be consecutive after 2016
States must use auditable data sources in calculating the hospital incentive (e.g., cost report)
Payments through 2021

Oklahoma EHR Incentive Program
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 Year 1: 50%
 Year 2: 40%
 Year 3: 10%

Oklahoma EHR Incentive Program
{Sum over 4 year of [(Base Amount)+ Discharge
Related Amount Applicable for Each Year) *
Transition Factor Applicable for Each Year]}
. . . multiplied by . . .
[Medicaid inpatient-bed-days / {(Total inpatient-beddays) * (estimated total charges – charity care charges) / (estimated total charges)}]

Oklahoma EHR Incentive Program

Oklahoma EHR Incentive Program
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Oklahoma EHR Incentive Program