The NC Medicaid EHR
Incentive Program
Presented by:
Rachael Williams, Program Manager
Layne Roberts, Data Specialist
The Basics…
Eligible Provider Type?
Certified EHR
Technology?
Medicaid Patient Volume Threshold?
EPs – 30%*
EHs – 10%
*Exception for Peds & FQHC/RHCs
Statewide
The first milestone on this
journey is AIU.
Meaningful Use
is the goal.
AIU
Nation’s Conceptual Approach to MU
Stage 3:
Improved
Outcomes
2016
Stage 2:
Advanced
Clinical
Processes
2014
Stage 1:
Data capture
and sharing
2012
8
Meaningful Use Timeline
Stage 1
Changes
Effective - EHs
9/4/12
1st day EHs
may attest for
MU with Stage
1 Changes
10/1/12 1/1/13
Stage 2 Final
Rule Released
12/31/12
Stage 1
Changes
Effective - EPs
Stage 2 MU
Effective - EHs
4/1/13 10/01/13 1/1/14
1st day EPs
may attest for
MU with Stage
1 Changes
Stage 2 MU
Effective - EPs
**Note: There will be new 2014 certification standards and your system must be
upgraded to allow for these changes. So this 90 days is giving providers a grace period
from the 365-day requirement to allow for adjustment to the new standards.
Medicare Penalties



Medicare EPs who are not meaningful
users will be subject to a payment
adjustment beginning on January 1, 2015
The payment adjustment is 1% per year
and is cumulative for every year that an
EP is not a meaningful user.
Medicare EPs must demonstrate
meaningful use prior to the 2015
calendar year in order to avoid the
adjustments.
More information can be found here:
www.cms.gov/Regulations-andguidance/Legislation/EHRIncentivePrograms/Downloads/PaymentA
dj_HardshipExcepTipSheetforEP.pdf
Meeting Stage 1 MU (for EPs/EHs)
13
Core
Measures
5
Menu
Measures
6
CQMs
Meaningful
Use
NOTE:
EHs will submit their MU data to CMS prior to attesting on the NC
Medicaid Incentive Payment System (NC-MIPS).
EPs will submit MU data directly through NC-MIPS.
5
For EPs
15 for EHs
Report on ALL core measures
or
Report exclusions where the
measure doesn’t pertain to your
practice
Report on 5 out of 10 menu measures
and
One of the 5 must be a public health
measure …
Once DPH allows electronic
submission of data
EP CQM Formula
3
Core
CQMs
Alternate
CQMs
(report
even if
zero)
(1 for every
core zero, if
applicable)
0 to 3
3
Additional
CQMs
6 to 9
CQMs
(choose 3 out
of 38)
EHs need to attest to
all 15 CQMs
15
Stage 1 Changes – Patient Volume




Medicaid-enrolled, regardless of payment
liability
Can now include Medicaid expansion
programs funded by Title 21 funds (MCHIP)
More flexibility for the 90-day PV reporting
period
More flexibility for the six-month PV
reporting period for practicing
predominantly
Stage 1 Changes - Measures

Two core measures are no longer required



Reporting CQMs
Exchanging key clinical information
Three core measures were changed to
give providers more flexibility in
demonstrating MU:



CPOE
eRx
Vital Signs
Here’s the numbers…

Sweet data slides.
Paid Providers
Eligible professionals (EPs)
Eligible hospitals (EHs)
3,118 EPs
$69,253,792
74 EHs
$66,567,879
$135,821,671
Paid Providers
Paid Providers
In Towns & Cities with Populations of under 50,000
Paid Providers
In Towns & Cities with Populations of 50,000+
Paid EHs
Paid EPs
Payments to EPs for AIU & MU
# of payments
Payments to EHs for AIU & MU
Number of Days Between AIU and MU Payments
800
700
600
500
400
Mean = 399 days
Mean = 392 days
300
200
100
0
EPs
EHs
mu data
Meeting Stage 2 MU
Stage 2 MU for EPs
17
Core
Measures
3
Menu
Measures
9 of 68
CQMs
MU!
Stage 2 MU for EHs
16
Core
Measures
3
Menu
Measures
16 of 29
CQMs
MU!
5
EPs/EHs select CQMs from at least three of
these six domains:
1. Patient and Family Engagement
2. Patient Safety
3. Care Coordination
4. Population and Public Health
5. Efficient Use of Healthcare Resources
6. Clinical Processes/Effectiveness
-EPs are required to electronically submit this information to the state from their
EHRs through the state-designated NC HIE.
-EHs will submit their CQMs to CMS.
Stage 2 Core Measures
Stage 2 Menu Measures
EPs:
EHs:
New Stage 2 Core Objectives
For EPs Only


Use secure electronic
messaging to communicate
with patients on relevant
health information
Provide patients the ability to
view online, download and
transmit their health
information within four
business days of the
information being available to
the EP
For EHs Only


Automatically track medications
from order to administration
using assistive technologies in
conjunction with an electronic
medication administration record
(eMAR)
Provide patients the ability to
view online, download and
transmit their health information
within 36 hours after discharge
from the hospital
Emphasis on HIE


For more than 10% of transitions and referrals, EPs, eligible
hospitals, and CAHs that transition or refer their patient to
another setting of care or provider of care must provide a
summary of care record electronically.
The EP, eligible hospital, or CAH that transitions or refers their
patient to another setting of care or provider of care must
either a) conduct one or more successful electronic
exchanges of a summary of care record with a recipient using
technology that was designed by a different EHR developer
than the sender's, or b) conduct one or more successful tests
with the CMS-designated test EHR during the EHR reporting
period.
Public Health

Required Core Measures:



NCIR
Electronic lab reporting
Optional Menu Measures:



Syndromic Surveillance
Cancer Registry
Other disease registries
NC Medicaid’s Preparation for MU

Stage 1 MU



NC-Medicaid Incentive Payment System (NC-MIPS)
Manual key-in of aggregate data
Stage 2 MU

NC HIE as conduit for exchange and electronically reporting:




Immunizations;
Reportable labs;
Patient information to cancer and disease registries; and,
Clinical quality measures (Quality Reporting Document Architecture I/III)
FAQs for Stage 2



What happens if I switch systems during my
MU reporting period?
How do I onboard new providers?
For the Stage 2 Toolkit, visit
www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms
/Downloads/Stage2Overview_Tipsheet.pdf
From CMS’ FAQs: For meaningful use Stage 2's transitions of care and
referrals objective, in what ways can I meet the second measure that
requires more than 10% of the summary care records I provide for
transitions of care and referrals to be electronically transmitted?
An EP, eligible hospital, or CAH could use 3 distinct approaches (which could also be
used in combination) to meet this measure. The first two rely solely on the use of
CEHRT, while the third is slightly different.

For the first two approaches, this measure can only be met if the EP, eligible hospital,
or CAH uses the capabilities and standards included as part of its Certified EHR
Technology (CEHRT) to electronically transmit summary care records for transitions
of care and referrals (specifically those capabilities certified to the certification
criterion adopted by ONC at 45 CFR 170.314(b)(2) “transitions of care – create and
transmit transition of care/referral summaries,” which specifies standards for data
content and transport).

For the third approach, the EP, eligible hospital, or CAH must use its CEHRT to
create a summary care record for transitions of care and referrals, but instead of
using a transport standard specified in ONC’s certification criterion at 45 CFR
170.314(b)(2) (included as part of its CEHRT) to electronically transmit the summary
care record, the EP, eligible hospital, or CAH may use a NwHIN Exchange participant
to facilitate the electronic transmission to the recipient.
From CMS’ FAQs: If multiple eligible professionals or eligible hospitals
contribute information to a shared portal or to a patient's online personal
health record (PHR), how is it counted for meaningful use when the patient
accesses the information on the portal or PHR?
This answer is relevant to the following meaningful use measure:
For Eligible Professionals:
If an eligible professional sees a patient during the EHR reporting period, the eligible professional may count the patient
in the numerator for this measure if the patient (or an authorized representative) views online, downloads, or transmits
to a third party any of the health information from the shared portal or online PHR.
For Eligible Hospitals and Critical Access Hospitals:
The same would apply for an eligible hospital or CAH if a patient is discharged during the EHR reporting period. The
respective eligible professional, eligible hospital, or CAH must have contributed at least some of the information
identified in the Stage 2 final rule to the shared portal or online PHR for the patient. However, the respective provider
need not have contributed the particular information that was viewed, downloaded, or transmitted by the patient.
Although availability varies by state and geographic location, some Health Information Exchanges (HIEs) provide
shared portal or PHR services. If a provider uses an HIE for these services to make information available to patients, in
order to meet meaningful use requirements the provider must use an HIE that is certified as an EHR Module for that
purpose. The HIE must be able to verify whether a particular provider actually contributed some of the information
identified in the Stage 2 final rule to the shared portal or PHR for a particular patient. If a provider elects to use the HIE
for these shared portal or PHR services, the provider must include the HIE’s certification number as part of their
attestation.
Attesting for Program Year 2014
• All program participants are granted a onetime 90-day MU reporting period in 2014
to allow time to upgrade to the new 2014
certification standards
• Visit ONC’s Health IT Product List to see if
your certified EHR technology is compliant
with the 2014 certification standards
• Look for the ‘14E’
• Update the CEHRT number on CMS’ R&A
Portal
• Register your intent with DPH within 60 days of
starting your 2014 MU reporting period
• For EHs, Medicare sets your attestation
schedule for more information regarding
attestation schedules, see the next slides.
• Keep all documentation for at least six years
post-payment in case of audit
• Visit our website at
http://www.ncdhhs.gov/dma/provider/ehr.htm
Remember… Attest early!
Examples of Attestation Scenarios
Scenario 1: EH attests with Medicaid 1st and then attests with Medicare in
2012.
Attested to Medicaid
before Medicare in same
year
Payment Schedule
(Based of FFY)
Earliest Date to Attest with
Medicaid in the NC-MIPS MU
Portal (for Year 2 MU payment)
In 2012:
For Medicaid – attest to AIU
For Medicare – attest to 90
days of MU
10/1/13 (after attestation with
Medicare) – need a full fiscal
year to report on 365 days of MU
In 2013 & beyond:
For Medicaid & Medicare –
will attest to 365 days of MU
For Medicaid Participation: Attest to AIU the first payment year, then attest to 365 days of MU for each of the
following payment years (payment years 2 and 3).
Further explanation: If the EH attests with Medicaid first in 2012 and would like to attest with Medicare in the
same year, the EH will attest to AIU during its first payment year in the NC Medicaid EHR Incentive Program, and
will then attest to 90 days of MU with Medicare.
Because Medicare requires an EH to attest to 90 days of MU during its first payment year, when the EH comes
back to attest with Medicaid (in payment years 2 and 3), it will be attesting to 365 days of MU for both Medicaid
& Medicare. The EH will NOT attest to 90 days of MU with Medicaid, but will skip from AIU to 365 MU.
**Note that 2014 is a 3-month reporting period for all hospitals to allow for system upgrades.
Examples of Attestation Scenarios
Scenario 2: EH attested with Medicaid in 2011 and then attests with
Medicare for the first time in 2012.
Payment Schedule
(Based on FFY)
Attested with Medicaid in
In 2011: 1st payment year
2011, and then attests with For Medicaid – attested to
Medicare in 2012
AIU
Earliest Date to Attest with
Medicaid in the NC-MIPS
MU Portal
8/20/12 (after attestation
with Medicare) - opening of
NC-MIPS MU Portal
In 2012:
For Medicare & Medicaid attest to 90 days of MU
In 2013:
For Medicare & Medicaid –
will attest to 365 days of MU
For Medicaid Participation: Attest to AIU in the first payment year, attest to 90 days of MU in the second payment
year, and attest to 365 days of MU in the third payment year.
Further Explanation: If the EH attested with Medicaid in 2011 and waits until 2012 to attest with Medicare, it
attested to AIU for its first payment year with the NC Medicaid EHR Incentive Program.
When the EH comes back to attest for its second payment year with Medicaid in 2012, it will attest to 90 days
of MU. When the EH comes back to attest for its third year with Medicaid, it will attest to 365 days of MU.
**Note that 2014 is a 3-month reporting period for all hospitals to allow for system upgrades.
Examples of Attestation Scenarios
Scenario 3: EH attests with Medicare 1st and then attests with Medicaid in
2012.
Payment Schedule
(Based on FFY)
Attests with Medicare before
Medicaid in same year
In 2012: 1st payment year
For Medicare & Medicaid –
attest to 90 days of MU
Earliest Date to Attest with
Medicaid in the NC-MIPS
MU Portal
8/20/12 (after attestation
with Medicare) - opening of
NC-MIPS MU Portal
In 2013 & beyond:
For Medicare & Medicaid –
will attest to 365 days of MU
For Medicaid Participation: Attest to 90 days of MU for the first payment year, then attest to 365 days of MU for
each of the following payment years (payment years 2 and 3). The EH will attest to Medicare first each year.
Further explanation: If the EH first attested with Medicare, and would like to attest with Medicaid in the same
year, the EH will follow the Medicare reporting requirements when attesting with Medicaid.
This means, if the EH reported 90 days of MU with Medicare in 2012, it will report 90 days of MU in 2012 with
Medicaid as well – even if 2012 is its first payment year with the Medicaid EHR Incentive Program.
Furthermore, after its first year of participation, the EH will attest to 365 days of MU for every additional year it
participates with Medicaid (payment years 2 and 3). If the EH attests with Medicare first, the EH will NOT
attest to AIU for the Medicaid program.
**Note that 2014 is a 3-month reporting period for all hospitals to allow for system upgrades.
Examples of Attestation Scenarios
Scenario 4: EH attested with Medicare in 2011 and wishes to attest with
Medicaid for the first time in 2012.
Payment Schedule
(Based on FFY)
Attested with Medicare in
2011, and then attested to
Medicaid in 2012
Earliest Date to Attest with
Medicaid in the NC-MIPS
MU Portal
In 2011: 1st payment year
10/1/12 (after attestation
For Medicare – attested to 90 with Medicare) - need a full
days of MU
fiscal year to report on 365
days of MU
In 2012 & beyond:
For Medicare & Medicaid –
will attest to 365 days of MU
For Medicaid Participation: Attest to 365 days of MU for the first payment year and beyond (payment years 1,
2, and 3).
Further Explanation: If the EH successfully attested with Medicare in 2011 and waits until 2012 to attest with
Medicaid for the first time, it will be required to attest to 365 days of MU with Medicaid, in keeping with the
consecutive attestation schedule with Medicare.
If the EH attests with Medicaid a year after attesting with Medicare, it will NOT attest to AIU or 90 days MU
with Medicaid. Instead, it will attest to 365 days of MU for every year of its participation in the Medicaid
Incentive Program (payment years 1, 2, and 3).
**Note that 2014 is a 3-month reporting period for all hospitals to allow for system upgrades.
Technical Assistance
NCHICA
919-558-9258
http://www.nchica.org
NCHA
919-677-2400
https://www.ncha.org/
Help is Here!

We are here to help!
By Phone: 919-814-0180
OR
 Email: ncmedicaid.hit@dhhs.nc.gov


Visit our website
http://www.ncdhhs.gov/dma/provider/ehr.htm
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