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Minnesota Medicaid Electronic Health Records (EHR) Incentive Program (MEIP)

The nation's health care system is undergoing a transformation to improve quality, safety and efficiency of care, from the upgrade to ICD-10 to the adoption of certified electronic health records (EHR) technology and increased capacity for health information exchange. The federal Health Information Technology for Economic and Clinical Health (HITECH) Act is part of the American Recovery and Reinvestment Act (ARRA) of 2009. HITECH supports the adoption of EHR technology by providing Medicare and Medicaid-funded financial incentives to eligible professionals and hospitals that implement and demonstrate “meaningful use” of certified EHR technology. The Centers for Medicare and Medicaid Services (CMS) is administering Medicare EHR incentives, and states are administering Medicaid EHR incentives.

In November 2011, DHS received CMS approval of the Minnesota State Medicaid HIT Plan (SMHP), required for administration of the Medicaid EHR Provider Incentive Program (MEIP). The SMHP was developed with input from Minnesota stakeholders through the Minnesota e-Health Initiative. The content of the SMHP does not reflect final requirements for the program and will be refined as implementation moves forward; however it may be helpful in understanding the DHS approach for developing MEIP and documentation that may be requested during the application process when it becomes available.

• Eligible Professionals (EPs)

• Is my practice eligible to receive incentive payments?

• How much are the incentive payments for EPs?

• Eligible Hospitals

• How much are the incentive payments for eligible hospitals?

• Hospital Incentive Payment Calculation

• When will Minnesota begin making incentive payments?

• What can we do to get ready for MEIP?

• Helpful Links

Eligible Professionals

Eligible professionals (EPs) for MEIP are:

• Physicians

• Dentists

• Certified nurse-midwives

• Nurse practitioners

• Clinical nurse specialists

• Physician assistants practicing in Federally Qualified Health Centers (FQHCs) or Rural Health Clinics (RHCs) led by a physician assistant

To be eligible for Medicaid EHR incentive payments, EPs must meet a minimum Medicaid patient volume threshold. For most providers, this volume threshold is 30%.

• For pediatricians, the Medicaid patient volume threshold is 20% Medicaid. Pediatricians who meet this lower threshold receive only 2/3 of the incentive payment. Pediatricians who are able to meet a 30% Medicaid patient volume are eligible to receive the full amount of incentive payments

• EPs who predominantly practice (50% or more) in an FQHC or RHC can include “needy individual” patient encounter services which encompasses Medicaid, Children’s Health Insurance Program (CHIP), and sliding scale or uncompensated care

• EPs must not be hospital-based. Hospital-based means an EP who furnishes 90% or more of his or her Medicaid covered professional services during the relevant EHR reporting period in an inpatient (POS 21) or emergency department (POS 23) setting

Is my practice eligible to receive incentive payments?

Incentive payments can be made only to eligible professionals, but they are allowed to reassign their incentive payment to their employer.

How much are the incentive payments for eligible professionals (EPs)?

Each EP may receive a maximum total incentive of $63,750 over six payment years. The first payment year’s maximum amount is $21,250, and payment years two through six are capped at $8,500 each year. To receive the first year’s incentive payment, providers must demonstrate adopting or implementing certified EHR technology or upgrading to certified EHR technology. To continue receiving incentives in payment years two through six, providers must achieve and maintain the meaningful use criteria described in the final regulations.

Eligible Hospitals

Eligible MEIP hospitals are those whose last four digits of their CMS Certification Number (CCN) fall into one of the following ranges:

• 0001-0879 for acute care hospitals

• 1300-1399 for critical access hospitals

• 3300-3399 for children’s hospitals

To be eligible for a Medicaid EHR incentive payment, acute care and critical access hospitals must have at least a 10% Medicaid patient volume. Children's hospitals have no Medicaid patient volume requirements.

How much are the incentive payments for eligible hospitals?

The hospital incentive payment is based on a formula that includes $2 million base + per discharge amount x Medicaid share. To calculate the formula, the following items are needed:

• Annual discharges

• Medicaid inpatient-bed days (most recent year)

• Total inpatient-bed days (most recent year)

• Historical trending information for discharges (most recent 3 years)

Hospital Incentive Payment Calculation

Calculate base payment amount	$2 million + ([discharge bonus] 200) Discharge bonus = $200 per total discharge between 1,150 and 23,000
Calculate four years	Year 1 = 100% of base payment amount Year 2 = 75% of base payment amount adjusted for historical trend Year 3 = 50% of base payment amount adjusted for historical trend Year 4 = 25% of base payment amount adjusted for historical trend
Base Hospital EHR amount	Year 1 + Year 2 + Year 3 + Year 4
Multiply by “Medicaid Share”	Medicaid inpatient days / (total inpatient days X [gross revenue – charity care charges] / total charges)
Total Hospital Incentive	Base Hospital EHR Amount x Medicaid Share

In any one payment year, the total incentive payment cannot exceed 50% of the total hospital incentive amount. Also, over a two-year period, the incentive payments cannot exceed 90 % of the total hospital incentive amount.

Hospital Calculation Spreadsheet

The calculations in the Minnesota EHR Hospital Incentive Payment Calculation Spreadsheet and SAMPLE EHR Hospital Calculation Spreadsheet are based on calculations as provided in the final meaningful use rule published in the Federal Register on July 28, 2010, and found at 42 CFR 495.2, et seq. These spreadsheets are intended to be a tool for providers to estimate the amount of incentive payment based on their facility data as submitted in previous years’ Medicare cost reports. Hospital providers will be required to attest to the accuracy of the data provided at the time of payment and will agree to cooperate with the MEIP verification and audit requirements. These spreadsheets are not a promise of payment.

When will Minnesota begin making incentive payments?

DHS expects providers to be able to submit applications by mid-year 2012. Updates to this development timeline will be made on this website as developments occur. Sign up for email updates from MEIP.

What can we do to get ready for the MEIP?

To get ready for MEIP, follow the steps below:

1.	Learn more about the Medicaid and Medicare EHR Incentives for Eligible Providers from the CMS EHR website by clicking on the CMS EHR Incentive icon at the top of this page.
2.	Adopt, implement or upgrade to a certified EHR system (site allows you to check if your EHR is certified; if it is not, ask your EHR vendor when they expect their product to be certified).
3.	Determine if you may be eligible.
4.	Review CMS Registration User Guides for eligible professionals (PDF) and eligible hospitals (PDF), and gather necessary documentation.
5.	Register for the Medicaid or Medicare incentive program on the CMS Registration and Attestation System. (We will link to the CMS Registration and Attestation System here when Minnesota begins to accept requests for Medicaid EHR incentives).
6.	Keep up-to-date with latest news and information about the Medicaid EHR Incentive Program. Save this page and the CMS EHR website as a favorite in your browser and come back frequently for updates.
7	Sign up for the MEIP email list

Helpful Links

• CMS Final Rule: Medicare and Medicaid Electronic Health Records Incentive Program (PDF)

• Regional Extension Assistance Center for HIT (REACH) (provides assistance in adopting and meaningfully using an EHR)

• MN e-Health website (e-Health is bigger than just electronic health records. See what is happening locally and nationally)

• A Practical Guide to Effective Use of EHR Systems (PDF) (2009, Minnesota Department of Health)

National EHR Information Center Hours of Operation: 7:30 a.m. – 6:30 p.m. (Central Time) Monday through Friday, except federal holidays.
1-888-734-6433 (primary number) or 1-888-734-6563 (TTY number)

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