1. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Electronic Health Records Incentive Payment Program Provider Educational Event March 26, 2015

2. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Welcome and Introductions Medicaid HIT Team Mary Marinari (Medicaid HIT Coordinator) Willa Langdon (Medicaid HIT Analyst) Provider Incentive Program Team (PIP) Jean Heller (HPES Manager)

3. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Agenda Overview of Medicaid EHR Incentive Program Steps Before Applying (Applicant and Payee) Explanation of EHR Phases Auditing DMMA HITECH Information Contact Information Closing Remarks

4. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. The Medicaid EHR Provider Incentive Payment Program provides incentive payments to Eligible Professionals (EPs) and Eligible Hospitals (EHs) as they Adopt, Implement, Upgrade (A/I/U), or demonstrate Meaningful Use (MU) of certified EHR technology. EPs can receive up to $63,750 over a maximum of 6 years of participation in the program. EH payments are based on a number of factors and can be distributed over at least three years. The Medicaid EHR Incentive Payment Program is voluntarily offered by individual states and territories. Program Year 2016 is the last year to initiate participation in the Medicaid EHR Program. Overview of Medicaid EHR Incentive Program

5. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 5 Medicaid EHR Meaningful Use Timeline Medicaid EP Qualifies to Receive First Payment in 2011 Medicaid EP Qualifies to Receive First Payment in 2012 Medicaid EP Qualifies to Receive First Payment in 2013 Medicaid EP Qualifies to Receive First Payment in 2014 Medicaid EP Qualifies to Receive First Payment in 2015 Medicaid EP Qualifies to Receive First Payment in 2016 Payment Amount in 2011 $21,250.00$0.00 Payment Amount in 2012 $8,500.00$21,250.00$0.00 Payment Amount in 2013 $8,500.00 $21,250.00$0.00 Payment Amount in 2014 $8,500.00 $21,250.00$0.00 Payment Amount in 2015 $8,500.00 $21,250.00$0.00 Payment Amount in 2016 $8,500.00 $21,250.00 Payment Amount in 2017 $0.00$8,500.00 Payment Amount in 2018 $0.00 $8,500.00 Payment Amount in 2019 $0.00 $8,500.00 Payment Amount in 2020 $0.00 $8,500.00 Payment Amount in 2021 $0.00 $8,500.00 TOTAL Incentive Payments $63,750.00

6. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Overview of Medicaid EHR Program Totals EHR Provider Incentive Payments 2011 to 2014 (As of 1/31/2015) DE MA Over all MU Return Rate 77% Adopt/Implement/Upgrade (AIU) Meaningful Use (MU) Totals Number PaidAmount Paid Number Paid Amount Paid Number Paid Amount Paid Eligible Hospitals 7$7,691,538.437$5,539,169.9014$13,230,708.33 Eligible Professionals 532$11,276,668.00571$5,118,417.001103$16,395,085.00 Nurse Midwives 13$276,250.0012$102,000.0025$378,250.00 Dentists 5$106,250.000$05$106,250.00 Nurse Practitioners 98$2,082,500.0083$756,500.00181$2,839,000.00 Physicians 412$8,755,000.00475$4,254,250.00887$13,009,250.00 Pediatricians 4$56,668.001$5,667.005$62,335.00 Grand Total 539$18,968,206.43578$10,657,586.901117$29,625,793.33

7. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Steps Before Applying (Applicant/Payee) DMAP Status Fully Enrolled (not MCO only) Active Status Group Affiliations/Service Locations EFT Disclosure (Annual) License Unencumbered DMAP E-mail Registration (Main Correspondence) FQHC (6 Month Period)

8. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Steps Before Applying (Continued) Federal then State Registration and Attestation Systems Document CEHRT Editions & MU Stage Options Applicant/Payee Agreement/Group Responsibility Obligations Self Pay/1099 Ramifications Payee will receive 1099 and be responsible for taxes

9. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 9 CMS Flexibility Rule About - Allows providers to meet meaningful use with EHRs certified to the 2011 or the 2014 edition criteria, or a combination of both editions, for an EHR Reporting Period in Program Year 2014 only. Eligibility - Flexibility is only available to providers who are unable to fully implement 2014 edition CEHRT for an EHR reporting period in 2014 due to delays in 2014 edition CEHRT availability. The provider must choose a delay reason and have backup documentation from the vendor regarding the delay reason chosen or outlined in the application. What does “fully implement due to delays in 2014 CEHRT” mean? The delay must be attributable to the issues related to software development, certification, implementation, testing, or release of the product by the EHR vendor that affected 2014 CEHRT availability. Examples that do not count as delays in availability: Financial Issues Difficulty Meeting Measures Staffing Issues Provider Delays

10. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 10 Program Year 2014 Attestation Phases 2014 Adopt, Implement, Upgrade (A, I, U) Adoption, Implementation, Upgrade – Indicate Which Phase at Time of Attestation 2013 Definition Stage 1 Meaningful Use (Stage 1 MU) 2014 Definition Stage 1 Meaningful Use (Stage 1 MU) 2014 Stage 2 Meaningful Use (Stage 2 MU) 2014 Grace Period Extended EP’s – June 30, 2015 EH’s – April 30, 2015

11. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Program Year 2014 A I U Providers in their first year of the EHR Program attesting under the Adoption, Implementation, or Upgrade phases must have a 2014 Certified EHR System. Providers in their first year of the EHR Program MUST attest to Stage 1 Meaningful Use under the Flexibility Ruling if they have not adopted, implemented, or upgraded to a 2014 Certified EHR System. All providers attesting under the AIU phase must upload a full vendor contract and patient volume report listing patients by health plan payor with their attestation.

12. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Program Year 2014 Stage 1 Requirements (2013 Definition) (13) Core Set Measures (5) Menu Set Measures The minimum amount of measures must be met without taking an exclusion An exclusion may result in completing the remainder of the measures Public Health Measure Clinical Quality measures (CQMs) (3) Core CQMs Alternate CQMs - You will need to select one Alternate Clinical Quality Measure for each Core Clinical Quality Measure where you have entered a zero in the denominator field. (3) Additional CQMs

13. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. (13) Core Set Measures (5) Menu Set Measures The minimum amount of measures must be met without taking an exclusion An exclusion may result in completing the remainder of the measures Public Health Measure (9) Clinical Quality measures (CQMs) 3 Different Domains Program Year 2014 Stage 1 Requirements (2014 Definition)

14. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. (17) Core Set Measures (3) Menu Set Measures The minimum amount of measures must be met without taking an exclusion An exclusion may result in completing the remainder of the measures Public Health Measure (On-going Submission) (9) Clinical Quality measures (CQMs) 3 Different Domains Program Year 2014 Stage 2 Requirements

15. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Flexibility Ruling Payment Year 2011 CEHRT MU 2013 Stage 1 Objectives 2011/2014 CEHRT MU 2013 Stage 1 Objectives 2014 Stage 1 & 2 Objectives 2014 CEHRT AIUMU 2014 Stage 1 & 2 Objectives

16. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. New ONC Validation Screen

17. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. New Meaningful Use Reporting Options Screen

18. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. New Delay Reason Screen

19. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 19 Auditing Eligibility – Reports that support calculation of MA encounters Reports to support the overall encounter volume EMR certification information (contract, vendor letter) Meaningful Use – Reports showing provider achievement of Core and Menu measures Documentation to support any exclusions taken for any Meaningful Use measure Clinical Quality data Documents to Save for Six Years

20. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 20 Auditing (Continued) Security Risk Analysis – An SRA needs to be conducted or reviewed during each program year for Stage 1 and Stage 2. The SRA may be completed outside OR during the EHR reporting period timeframe, BUT -Must take place no earlier than the start of the EHR reporting year, AND -No later than the date the provider submits their attestation for that EHR reporting period. An SRA is required when certified EHR technology is adopted in the first reporting year. In subsequent reporting years, or when changes to the practice or electronic systems occur, a review must be conducted.

21. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 21 Auditing Documentation Documentation Required for Pre-Payment Audit: Patient Volume Reports Patient Identifier Insurance or Payor Date of Service CEHRT Vendor Letter for 2014 Service Location of CEHRT Meaningful Use Report

22. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. The trend over the last few years has been to focus on patient engagement. This is a proven method to improve outcomes and care coordination and is one of the six National Quality Strategy priorities, and a primary goal for CMS. Patient engagement is an important focus of the Medicare and Medicaid EHR Incentive Payments for Stage 2 of Meaningful Use. http://www.ahrq.gov/workingforquality/nqs/nqsfactsheet1.pdf Delaware Medicaid EHR Provider Incentive Payment Program

23. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 23 EHR Provider Incentive Payment Program in 2015 CMS is working on multiple tracks to realign the EHR program and is expected to announce a new proposed rulemaking this spring. This new rule is separate from the recently announced Stage 3 proposed rule that was released last Friday. The Stage 3 proposed rule scope will be limited by CMS to the requirements and criteria for meaningful use in 2017 and subsequent years.

24. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 24 Stage 3 Requirements CMS Notice of Proposed Rulemaking (NPRM) Released March 20, 2015, the proposed rule would streamline Stage 3 of the EHR Incentive Programs and allow providers more flexibility for reporting by: – Establishing a single, aligned reporting period for all providers based on the calendar year – Give providers the option of beginning Stage 3 in 2017 or 2018 – Aligning quality data for reporting via a single submission method for multiple CMS programs – Simplifying meaningful use reporting requirements to eight objectives that focus on advanced use of EHR technology and quality improvement This NPRM is limited to the requirements and criteria for meaningful use in 2017 and beyond.

25. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 25 Office of the National Coordinator (ONC) 2015 Edition Health IT Certification Criteria Proposed Rule The 2015 Edition Health IT Certification Criteria proposed rule aligns with the path toward interoperability identified in the ONC’s draft Nationwide Interoperability Roadmap. It will: Allow for the adoption of standards and certification criteria for data portability Allow for the adoption of standards that will support the goals of Health & Human Services (HHS) interoperability roadmap Allow for the secure, efficient, and effective sharing and use of health information. Include new and updated IT functionality and provisions that support the EHR Incentive Program care improvement, cost reduction, and patient safety across the health system.

26. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Separate Changes from Stage 3 for 2015 for the EHR Provider Incentive Payment Program In response to input from health care providers and other stakeholders, CMS is considering the following changes to the Medicare and Medicaid Electronic Health Record (EHR) Incentive Programs: 1. Shortening the 2015 reporting period to 90 days to address provider concerns about their ability to fully deploy 2014 Edition software 2. Realigning hospital reporting periods to the calendar year to allow eligible hospitals more time to incorporate 2014 Edition software into their workflows and to better align with other quality programs 3. Modifying other aspects of the programs to match long-term goals, reduce complexity, and lessen providers’ reporting burden

27. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. 27 Informative Links 2014 Stage 1 Requirements http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Meaningful_Use.html 2014 Stage 2 Requirements http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Stage_2.html EHR Participation Timeline http://cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Participation-Timeline.html Flexibility Rule Decision Tool https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/Downloads/CEHRT_Rule_DecisionTool.pdf DMAP EHR Information https://www.dmap.state.de.us/information/ehr.html Security Risk Analysis https://questions.cms.gov/faq.php?faqId=10754 CMS EHR Information Center (888) 734-6433 8:30am – 7:30pm Monday – Friday

28. © Copyright 2012 Hewlett-Packard Development Company, L.P. The information contained herein is subject to change without notice. Thank you Delaware EHR Provider Incentive Payment Team (PIP) DelawarePIPTeam@HP.com 1 (800) 999-3371 Option 0, 3