Medi-Cal EHR Incentive Program
What is the Electronic Health Record (EHR) Incentive Program?
The EHR incentive program was established by the Health Information Technology for Economic and Clinical Health (HITECH) Act of the American Recovery & Reinvestment Act of 2009. The program aims to transform the nation’s health care system and improve the quality, safety and efficiency of patient health care through the use of electronic health records.
Effective July 13, 2010, the U.S. Department of Health and Human Services (HHS), the Centers for Medicare & Medicaid Services (CMS) and the Office of National Coordinator (ONC) released the final rule providing the parameters and requirements for the Medicaid EHR incentive program under the HITECH Act.
Medi-Cal is in the process of developing a system to manage incentive payments for California’s eligible providers.
EHR Incentive Program Eligibility
The following eligible professionals and hospitals may participate in the EHR incentive program:
- Nurse practitioners
- Certified nurse-midwives
- Physician assistants who are working in a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC) that is led by a physician assistant
Providers can review the EHR Incentive Programs: Eligibility page on the CMS website for more information.
- Acute care hospitals (including critical access hospitals and cancer hospitals)
- Children’s hospitals
Incentive Payments – Eligible Professionals
- Maximum incentives are $63,750 over six years
- First year payment is $21,250 if a provider adopts, implements or upgrades certified EHR technology
- Incentive payments are same regardless of starting year
- Must begin by 2016 to receive incentive payments
Providers can review the EHR Incentive Programs: Overview page on the CMS website for more information.
Incentive Payments – Eligible Hospitals
Hospital incentive payments are based on a formula provided in the statute that can be reviewed on the EHR Incentive Programs: Hospitals page and the Medicaid Hospital Incentive Payment Calculations document.
EHR Incentive Program Eligibility for Medi-Cal
Eligible professionals must be fully licensed and credentialed in California and may not be excluded from federal funding.
Eligible professionals and hospitals must demonstrate adoption, implementation or upgrade of a certified EHR system and “meaningful use” of the technology in order to qualify for the incentive payments.
“Meaningful use” is defined as using certified EHR technology to:
- Improve quality, safety, efficiency and reduce health disparities
- Engage patients and families in their health care
- Improve care coordination
- Improve population and public health
- All the while maintaining privacy and security
To learn about certification and certified EHRs, as well as other programs designed to support providers, please review the Electronic Health Records and Meaningful Use page on the HHS website.
Medi-Cal is currently refining some of the eligibility requirements in alignment with the CMS final rule.
Medi-Cal EHR Incentive Program Eligibility: Professionals
Professionals must not be hospital-based (may not perform 90 percent or more of their services in a hospital inpatient or emergency room setting) and must meet at least one of the following criteria:
- Have a minimum 30 percent Medicaid patient volume
- Have a minimum 20 percent Medicaid patient volume if they are a pediatrician
- Practice predominantly in a FQHC or RHC and have a minimum 30 percent patient volume attributable to needy individuals
Providers can review the EHR Incentive Programs: Medicaid Eligible Professional page on the CMS website for more information.
Medi-Cal EHR Incentive Program Eligibility: Hospitals
Acute Care Hospitals
Acute care hospitals include cancer hospitals, critical access hospitals and short term general hospitals that meet all of the following criteria:
- Hospitals that have a CMS Certification Number (CCN) with the last four digits ending in the series 0001 – 0879 or 1300 – 1399 are eligible.
- It must have 10 percent Medicaid patient discharges in order to participate.
- It is a primary health care facility where the average length of patient stay is 25 days or less.
Only those hospitals that have CCNs in the 3300 – 3399 series are considered eligible children’s hospitals.
Providers can review the EHR Incentive Programs: Hospitals page on the CMS website for more information.
EHR Incentive Program Start Date
Medi-Cal will begin the enrollment of qualified providers in early 2011. Information about the payment process will be published in future Medi-Cal Updates.
EHR Incentive Program Provider Registration
All providers must register with the National Level Repository (NLR) through CMS. There will be additional registration required with Medi-Cal once CMS reports on registered providers. More details about the registration for Medi-Cal providers will be published in future Medi-Cal Updates.
When the program begins, a link on the “Registration” page of the CMS website will be available. Providers can use this central website to get information about the program and link to its online registration system.
The HITECH Act created Health Information Technology Regional Extension Centers (RECs) to provide "on-the-ground assistance” to help providers to successfully adopt, implement, upgrade and achieve meaningful use of EHRs within two years. In California, the federally designated RECs include:
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