The Medicaid EHR Incentive Program
An Opportunity for Transformation in Puerto Rico
Jessica Kahn, MPH
Technical Director for Health IT
Center for Medicaid, CHIP, Survey and Certification
http://www.cms.gov/EHRIncentivePrograms/
The state of the States and
Territories
• 17 launched their Medicaid EHR Incentive Programs
– Of these 12 have paid out nearly $126 million
• Medicaid has already paid over $86 million to 92
hospitals in 12 States since January 2011
• CMS has awarded 50 States, DC, USVI, Guam and
Puerto Rico over $320.2 million in administrative
funding
– 25 States have received implementation funding
– 54 States and Territories have received planning funding
http://www.cms.gov/EHRIncentivePrograms/
Puerto Rico
• Was awarded $1,998,040 approximately 15 months
ago in planning funds with which to develop a State
Medicaid HIT Plan (SMHP) and associated funding
request document (called an I-APD)
• The SMHP details how the Medicaid EHR Incentive
Program will be implemented, what the current HIT
landscape looks like, what the vision is and how
program oversight and auditing will be handled
• Could see over $100 million in EHR incentives for
Puerto Rican providers
• Puerto Rican hospitals can ONLY participate in the
Medicaid EHR Incentive Program per statute
http://www.cms.gov/EHRIncentivePrograms/
States & Territories Continued
• What does “launch” mean?
• Reminder: this is a voluntary program for
States/Territories
• States get 90/10 matching funds to administer their
program.
• HIT has bi-partisan support with significant provider
and stakeholder involvement
• CMS is investing tremendous time and resources
into technical assistance
– State Medicaid HIT Plans
– Communities of Practice
– Peer to Peer support
http://www.cms.gov/EHRIncentivePrograms/
What can administrative funding
be spent on?
• Administration of Medicaid payments to
Medicaid eligible providers
• Oversight of the Medicaid EHR Incentive
Program, including tracking of meaningful use
attestation and reporting mechanisms
• Pursuit of initiatives that encourage the
adoption of certified EHR technology for the
promotion of healthcare quality and the
electronic exchange of health information.
http://www.cms.gov/EHRIncentivePrograms/
Why Launch in 2011?
• Momentum of provider and Federal interest and
funding
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HIE and REC grants
MMIS
Eligibility Systems
Accountable Care Organizations
• Opportunities to improve healthcare for Puerto
Ricans; lower healthcare costs
• Economic stimulus to the healthcare sector
(jobs!)
http://www.cms.gov/EHRIncentivePrograms/
Guidance, Guidance, Guidance
• “Dear State Medicaid Director” letters
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September 2009: Planning Funding
August 2010: Implementation Funding
April 2011: Disregard the net average allowable costs
May 2011: Medicaid Funding for Health Information
Exchange
• Frequently Asked Questions and Tools
– Patient volume
– Have to define what will be audited & how
– Intersections with the RECs and HIE Grantees
http://www.cms.gov/EHRIncentivePrograms/
Lessons Learned from “Pace Car” States
• Providers need a lot of assistance with
registration and attestation
• Engage other partners (RECS, professional
associations, etc)
• Emphasize other benefits of access to clinical
data (e.g. lab results) for administrative
simplification (prior authorizations, level of
care determinations, etc)
http://www.cms.gov/EHRIncentivePrograms/
More Lessons Learned
• States are understaffed
• Consultants with HITECH experience are good
resources to help fill in the gaps, conduct the
environmental scans, help write the SMHPs,
convene stakeholders, etc.
• SMHPs are dynamic documents- priorities
evolve, not all the answers are clear at the
present
• Incremental steps still = progress
http://www.cms.gov/EHRIncentivePrograms/
Next Steps for CMS
• NPRM for Stage 2 (ETA: January 2012)
• Public Comment Period
• Final Rule for Stage 2 (ETA: June 2012)
• States beginning to collect Medicaid providers’ meaningful
use data for 2012
• Subject to funding availability, States investing along with
other payers and providers in Health Information Exchange
• Alignment with enhanced Medicaid eligibility systems,
Health Insurance Exchanges and Accountable Care
Organizations
http://www.cms.gov/EHRIncentivePrograms/
Resources
• www.cms.hhs.gov/EHRIncentiveprograms
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Videos
FAQs
Email list-serv
EP Users’ Guides for Registration and Attestation
EH Users’ Guide for Registration and Attestation
Helpful Links
Monthly data on provider registration, attestation and
payment
• www.healthit.hhs.gov
• www.MedicaidHitechTA.org
http://www.cms.gov/EHRIncentivePrograms/