VITL Meaningful Use Webinar 8/18/ Terry Bequette1 Vermont Medicaid EHR Incentive Payment Program Update and Status August 18, 2011

VITL Meaningful Use Webinar 8/18/ Terry Bequette2 Today’s agenda Vermont’s Incentive Payment Program Requirements for incentive payments Registration and attestation Payment and appeals Help Schedule Q&A

VITL Meaningful Use Webinar 8/18/ Terry Bequette3 Requirements To qualify for a Vermont Medicaid EHR incentive payment you must: Be an eligible professional (EP) Using a federally certified EHR system for your patient encounters Where you have at least Acquired, Implemented, or Upgraded (AIU) that system With a Medicaid patient encounter ratio that satisfies the federal requirement. You must register at the CMS Registration & Attestation (R&A) web portal and then enter your status and attestation data into the Vermont MAPIR web portal. For payment year 2011, VT will only accept AIU and cannot accept a MU filing.

VITL Meaningful Use Webinar 8/18/ Terry Bequette4 Eligibility: What is a Medicaid Eligible Provider? Eligible Professionals (EPs) Physicians Pediatricians have special eligibility & payment rules Clarified physician for Medicaid = MDs; DOs Nurse practitioners (NPs) Certified Nurse Midwives (CNMs) Dentists Physician Assistants (PAs) when practicing at an FQHC/RHC that is so led by a PA Eligible Hospitals Acute Care hospitals (including CAHs and cancer hospitals) Children’s hospitals

VITL Meaningful Use Webinar 8/18/ Terry Bequette5 Who is Eligible? EPs cannot be hospital based, meaning that not “substantially all” (more than 90%) of covered professional services are conducted in either the inpatient hospital or hospital emergency department. EPs must be enrolled as a Vermont Medicaid provider without sanctions or exclusions. If not currently enrolled, do so before applying for an incentive.

VITL Meaningful Use Webinar 8/18/ Terry Bequette 6 Hospital-based EP Hospital-based EP is an EP who furnishes 90 percent or more of his or her covered professional services in a hospital setting in the year preceding the payment year…a setting is considered a hospital setting if it is a site of service that would be identified by the codes used in the HIPAA standard transactions as an inpatient hospital, or emergency room setting. Codes 21, 23.

VITL Meaningful Use Webinar 8/18/ Terry Bequette7 More on Eligibility: Practices Predominantly & Needy Individuals EP is also eligible when practicing predominantly in FQHC/RHC providing care to needy individuals Practicing predominantly is when FQHC/RHC is the clinical location for over 50% of total encounters over a period of 6 months in the most recent calendar year Needy individuals (specified in statute) include: Medicaid or CHIP enrollees; Patients furnished uncompensated care by the provider; Furnished services at either no cost or on a sliding scale

VITL Meaningful Use Webinar 8/18/ Terry Bequette8 More on Eligibility: Physician Assistants Physician Assistants are eligible when working at an FQHC or RHC that is so led by a physician assistant In response to comments, CMS clarified “so led” to mean: 1. When a PA is the primary provider in a clinic 2. When a PA is a clinical or medical director at a clinical site of practice 3. When a PA is an owner of an RHC

VITL Meaningful Use Webinar 8/18/ Terry Bequette9 Federally Certified EHR System ONC Certified Health IT Product List (CHPL): CHPL site provides ID number for each certified EHR ID number needed on MAPIR (Medical Assistance Provider Repository) for attestation Make sure your system is certified by an Authorized Testing and Certification Body (ATCB)

VITL Meaningful Use Webinar 8/18/ Terry Bequette10 AIU and MU: Overview Adopt, Implement, Upgrade (AIU) First participation year only No EHR reporting period Meaningful Use (MU) Successive participation years; and Early adopters and some dually-eligible hospitals in year 1 Medicaid Providers’ AIU/MU does not have to be over six consecutive years States may propose to CMS for approval of limited revisions to MU as it pertains to 4 public health related objectives (VT proposed no revisions)

VITL Meaningful Use Webinar 8/18/ Terry Bequette11 AIU and MU: AIU Adopted: Acquired and installed ‘Acquired’ can mean ordered ‘Installed’ – e.g., some evidence of installation prior to incentive Implemented: Commenced utilization of e.g., staff training, data entry of patient demographic information into EHR Upgraded: Expanded e.g., upgraded to certified EHR technology or added new functionality to meet the definition of certified EHR technology Vermont expects some proof of purchase: a receipt, invoice, contract, purchase order; etc.

VITL Meaningful Use Webinar 8/18/ Terry Bequette12 Eligibility: Patient Volume

VITL Meaningful Use Webinar 8/18/ Terry Bequette13 Eligibility: Patient Volume General approach: Total (Medicaid) patient encounters In any 90-day period in the preceding Calendar year ________________________________ x 100 Total patient encounters in That same 90-day period - May also be used to calculate needy individual patient volume - May be used for hospitals and EPs

VITL Meaningful Use Webinar 8/18/ Terry Bequette 14 Patient Encounters Generally stated, a patient encounter is any one day where Medicaid paid for all or part of the service or Medicaid paid the co-pays, cost-sharing, or premiums for the service…In general, the same concept applies to needy individuals.

VITL Meaningful Use Webinar 8/18/ Terry Bequette15 Overview of the EHR Incentive Program (EHRIP) Process 1. Register with the CMS Incentive Program Registration and Attestation System (R&A) website Provide information such as: Individual and Payee NPI and TIN Option of Medicare or Vermont Medicaid If Medicaid, pick the state from the drop down menu (Only states that have launched their programs are in the list; Vermont is not yet there) You won’t be able to register for Medicaid until Vermont is ready to launch its program – on or near October 3, 2011 as currently planned! CMS EHR Certification Number contact information

VITL Meaningful Use Webinar 8/18/ Terry Bequette16 Overview of the EHRIP Process 2. Vermont Green Mountain Care Internet Portal Following CMS R&A, EP receives an (a few business days later) notification that you can register in Vermont’s MAPIR system MAPIR is a repository of information for attestations, payments, appeals, oversight functions and interface with R&A Use your GMC Internet Portal user ID and password to log in. If you are an EP type then you will see a MAPIR application link. An EP can delegate someone to enter data in the portal MAPIR looks for a registration record from the R&A and the application process can begin.

VITL Meaningful Use Webinar 8/18/ Terry Bequette17 Overview of the EHRIP Process 3. Vermont GMC Internet Portal (con’t) Verify the data displayed in MAPIR, enter additional data elements, and attest to the accuracy of the data elements; demonstrate that you meet: Medicaid patient volume thresholds Adopting, Implementing or Upgrading a federally certified EHR system, and Meet all other federal program requirements Submit proof of purchase via attachment

VITL Meaningful Use Webinar 8/18/ Terry Bequette18 Overview of the EHRIP Process 4. Department of Vermont Health Access (DVHA) actions Review applications and make approval decisions Inform applications of approval or denial via Based on federal rules about the EHRIP. Payments via standard GMC payment system. You will see approved payments on your remittance advices and your annual 1099’s. You may be contacted during this process if there are questions Appeals rights are available (e.g., if payment is denied) and there will be instructions on the website. Applicants can reassign their payments to their employer or a contractual entity allowed to bill and receive payment for the applicant’s covered professional services.

VITL Meaningful Use Webinar 8/18/ Terry Bequette19 Preparation A valid address for the CMS registration process A GMC Internet portal User ID and password NPI and TIN provided to CMS must match the NPI and Payee TIN information in the GMC system (should be same as used for Medicaid claim payment purposes) Proof of EHR acquisition Can also work through the sample EP MAPIR applications on our website when that is available.

VITL Meaningful Use Webinar 8/18/ Terry Bequette20 A Little More MAPIR Tab-oriented progress flow Get Started R&A Contact Information Eligibility Patient Volumes Attestation Review Submit

VITL Meaningful Use Webinar 8/18/ Terry Bequette21 A Little More MAPIR Attesting to an EHR Phase E.g., Implementation Questions Workflow AnalysisPlanned / Complete Workflow Redesign Software Installation Hardware Installation Peripherals Installation Internet Connectivity / Broadband Uploading Patient Data Electronic Prescribing Health Information exchange (labs; pharmacy) Physical Redesign of workspace Training

VITL Meaningful Use Webinar 8/18/ Terry Bequette22 A Little More MAPIR The MAPIR system returns a summary of your entries…

VITL Meaningful Use Webinar 8/18/ Terry Bequette23 A Little More MAPIR As you work through the tabs you can save your work, log out and return to where you were Very much like Turbo Tax Opportunities to review each section Opportunity to review the overall attestation and get a printout Once you electronically sign and submit your attestation, you cannot change the data in MAPIR, but can work with DVHA administrative support to make corrections.

VITL Meaningful Use Webinar 8/18/ Terry Bequette24 Schedule We are currently holding to an October 3, 2011 launch Must be on the first Monday of a month Much to accomplish to make this happen: Website materials (State and portal websites) Provider Manuals for EPs and Hospitals System testing Administrative procedures

VITL Meaningful Use Webinar 8/18/ Terry Bequette25 Request for Early Attesters If you think you will be ready to attest when we launch, and are counting on an incentive payment for the 2011 payment year, send an with contact information to

VITL Meaningful Use Webinar 8/18/ Terry Bequette26 Helpful Links ONC (Office of the National Coordinator): CMS pages: EHR Incentive Payments: CMS EHR FAQs: VITL: Vermont pages: Health Care Reform: DVHA: GMC Provider Portal:

VITL Meaningful Use Webinar 8/18/ Terry Bequette27 Contact Information Terry Bequette Assoc. State HIT Coordinator Department of Vermont Health Access 289 Hurricane Lane Williston VT Paul Forlenza Vice President, Policy and Special Projects Vermont Information Technology Leaders, Inc. Vermont’s Regional Extension Center 144 Main Street, Suite 1 Montpelier VT Carol Kulczyk Director of Program Implementation Vermont Information Technology Leaders, Inc. Vermont’s Regional Extension Center 144 Main Street, Suite 1 Montpelier VT

VITL Meaningful Use Webinar 8/18/ Terry Bequette28 HITECH Legislation: Purpose Improve outcomes, facilitate access, simplify care and reduce costs by providing: Major financial support to providers and States Learning opportunities created and leveraged through TA from CMS and others Will establish sustainable data-driven infrastructure that will create a framework for improving healthcare quality and outcomes

VITL Meaningful Use Webinar 8/18/ Terry Bequette29 Payments: EP Incentives

VITL Meaningful Use Webinar 8/18/ Terry Bequette 30 Payments: EP Adoption Timeline

VITL Meaningful Use Webinar 8/18/ Terry Bequette31 QUESTIONS