By now you are very aware that Behavioral Health Providers (psychiatrists, D.O.'s, APRNS, etc) are participating in and successfully collecting the Meaningful Use incentive dollars. Year 1 of the Medicaid EHR Incentive payments alone are $21,250 per eligible provider! But how do you get started? It’s all so overwhelming! *Exactly what is “patient volume"? *Do I have to be using the certified EHR in order to participate? *Is there anything I can do to prepare NOW while I am still looking for the right EHR? If you have these questions or any others about how to take advantage of the Medicaid EHR Incentive program, be sure and watch this one-hour webinar. Mary Givens, Meaningful Use Program Manager, and her team will also be available to follow up with you about the rules in your state if you want to take advantage of some additional 1-on-1 help with the process of participating in the Medicaid EHR Incentive program.

1. MUforBH.com Presents:
The Medicaid EHR Incentive Program for Behavioral
Health Eligible Professionals: Understanding A/I/U

2. Presenter
Mary Givens, Chief Contributor for
www.MUforBH.com and Manager of
Meaningful Use
for Qualifacts Systems, Inc.
www.MUforBH.com

3. Topics for today:
• Medicaid vs. Medicare Programs for Eligible Professionals
(EPs)
• Reassignment of Incentive Dollars
• Eligibility for Medicaid EHR Incentive Program -EPs
• Rules for attesting to Adopt/Implement /or Upgrade for year 1
of the Medicaid EHR Incentive program
www.MUforBH.com

4. Professionals who are eligible
for both programs
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Slide taken from the CMS website: https://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/EducationalMaterials.html

5. A side by side comparison of Medicare and Medicaid
EHR Incentive Programs for Eligible Professionals.
www.MUforBH.com
Slide taken from the CMS website: https://www.cms.gov/Regulations-andGuidance/Legislation/EHRIncentivePrograms/EducationalMaterials.html

6. Medicaid EP EHR Incentive Program
Reimbursement Schedule
www.MUforBH.com

7. Stage 1 – Program Year 1
Medicaid EHR Program for Eligible Professionals
• For year 1 only, EP can
choose to attest to A/I/or U
– Adopted > acquired,
purchased or secured
access to
– Implemented > installed or
commenced utilization of
– Upgraded to certified EHR
technology
• The meaningful use of an
EHR is not required for
Stage 1-Year 1
www.MUforBH.com

8. Eligibility requirements for Eligible Professionals-
Medicare and Medicaid
• Incentive payments for eligible professionals are
based on individual practitioners.
• If you are part of a practice, each eligible
professional may qualify for an incentive payment
if each eligible professional successfully
demonstrates meaningful use of certified EHR
technology.
• Each eligible professional is only eligible for one
incentive payment per year, regardless of how
many practices or locations at which he or she
provide services.
• Hospital-based eligible professionals are not
eligible for incentive payments. An eligible
professional is considered hospital-based if 90%
or more of his or her services are performed in a
hospital inpatient (Place Of Service code 21) or
emergency room (Place Of Service code 23)
setting.
www.MUforBH.com

9. Medicaid:
Types of Professionals are Eligible
• Physicians (primarily doctors of medicine and doctors
of osteopathy)
• Nurse practitioner
• Certified nurse-midwife
• Dentist
• Physician assistant who furnishes services in a
Federally Qualified Health Center or Rural Health
Clinic that is led by a physician assistant.
www.MUforBH.com

10. This Means..
For the Medicaid
EHR Incentive
Program Year 1,
the EP can collect
$21,250 for
attesting to A/I/U!
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11. Other Eligibility requirements:
Patient Volume, licensed
professional in good standing
• Patient Volume
Must Either
– have ≥ 30% Medicaid patient
volume (≥ 20% for pediatricians
only);
– or
– Practice predominantly in an
FQHC or RHC with ≥30%
needy individual patient volume
• Must be
Licensed, credentialed with
an individual Medicaid
Provider ID
• No OIG exclusions, living www.MUforBH.com

12. In order to determine patient volume, you must
understand the definition of an encounter?
For purposes of calculating Eligible Professional patient
volume, a Medicaid encounter means services rendered
to an individual on any one day where—
• Medicaid (or a Medicaid demonstration project
approved under section 1115 of the Act) paid for part
or all of the service; or
• Medicaid (or a Medicaid demonstration project
approved under section 1115 of the Act) paid all or
part of the individual’s premiums, co-payments, and
cost-sharing.
www.MUforBH.com

13. Stage 1 Final rule
495.306 Establishing
Patient Volume for
Eligible Professionals
Patient volume requirement must be met
annually for a Medicaid provider
Each state has these options for
determining patient volume:
Methodology, patient encounter for
eligible professionals:
Method (1) To calculate individual
Medicaid patient volume, an EP must
divide:
NUMERATOR: The total Medicaid
patient encounters in any representative,
continuous 90-day period in the
preceding calendar year; by
________________________________
DENOMINATOR: The total patient
encounters in the same 90-day period.
www.MUforBH.com

14. Methodology, patient encounter for eligible
professionals continued
Method (2) To calculate individual Medicaid patient volume
using the payer panel, an EP must divide:
• Numerator: The total Medicaid patients assigned to the EP’s
panel in any representative, continuous 90-day period in the
preceding calendar year when at least one Medicaid
encounter took place with the Medicaid patient in the year
prior to the 90-day period; plus (+) Unduplicated Medicaid
encounters in the same 90-day period; by
• Denominator: The total patients assigned to the provider in
that same 90-day period with at least one encounter taking
place with the patient during the year prior to the 90-day
period; plus (+) all unduplicated patient encounters in the
same 90-day period. www.MUforBH.com

15. Group practices: Leverage a clinic or group practices
patient volume as a proxy for the individuals.
Clinics or group practices will be permitted
to calculate patient volume at the group
practice/clinic level, but only in
accordance with all of the following
limitations:
(1) The clinic or group practice’s patient
volume is appropriate as a patient volume
methodology calculation for the EP.
(2) There is an auditable data source to
support the clinic’s or group practice’s
patient volume determination.
(3) All EPs in the group practice or clinic
must use the same methodology for the
payment year.
www.MUforBH.com

16. Question 4: How are your EPs preparing for
Group practices: Leverage a clinic or group practices
reportingvolume as aquality for the individuals. 2?
patient on clinical proxy measures for stage
• (4) The clinic or group practice uses the entire practice or clinic’s
patient volume and does not limit patient volume in any way.
• (5) If an EP works inside and outside of the clinic or practice,
then the patient volume calculation includes only those
encounters associated with the clinic or group practice, and not
the EP’s outside encounters.
FAQ from CMS website that provides a great demonstration of group by proxy method
https://questions.cms.hhs.gov/app/answers/detail/a_id/10362/kw/patient%20volume
www.MUforBH.com

17. Question 4: How are your EPs preparing for
Register or Attest on measures of the EP
reporting on clinical quality behalf for stage 2?
• CMS allows an eligible professional
to designate a third party to
register and attest on his or her
behalf.
– To do so, users working on behalf of an
eligible professional must have an
Identity and Access Management
System (I&A) web user account (User
ID/Password), and be associated to the
eligible professional's National
Provider Identifier (NPI).
– If you are working on behalf of one or
more eligible professionals and do not
have an I&A web user account, please
visit I&A Security Check to create one.
www.MUforBH.com

18. The reassignment
of Incentive Dollars
• EPs are permitted to reassign their
incentive payments to their
employer or to an entity with which
they have a contractual arrangement
allowing the employer or entity to
bill and receive payment for the EP’s
covered professional services
• EPs can only reassign incentive
payments to one employer or entity
per program year.
• Employers should put in place a
formal reassignment of incentive
dollar agreement
www.MUforBH.com

19. Looking forward to
program years two,
three, four, five, and six
• Eligibility must be met each year
(non hospital based, patient
volume, etc).
• AND for year 2 and beyond, the EP
will have to demonstrate the
meaningful use of a certified EHR
for a designated reporting period
– For year two, the reporting period for
the meaningful use of an EHR is 90
consecutive days during a calendar
year.
– For year 3,4,5,6, the reporting period
for the meaningful use of an EHR is a
calendar year. www.MUforBH.com

20. The Meaningful Use of an EHR
• In order to demonstrate the meaningful
use of a certified EHR, an EP must be able
to meet the
–15 core objectives
–5 of the 10 objectives from menu set or,
be eligible for an exclusion
www.MUforBH.com

21. Ambulatory Measures of
Meaningful Use
CORE MENU
1. *CPOE 1. *Implement drug formulary
checks
2. Drug : drug and drug : allergy checks
2. *Incorporate Lab test results
3. Up to date problem list 3. Generate patient lists
4. *eRx 4. *Patient Reminders
5. Active Medication list 5. *Provide patients Electronic
Access
6. Active Medication Allergy list
6. Patient Specific Education
7. Demographics Resources
8. *Vital Signs 7. *Medication Reconciliation
9. *Smoking Status 8. *Summary of Care record upon
transition
10. Clinical Quality Measures
9. *Submit Electronic data to
11. Clinical Decision support rule immunization registry
12. *Electronic copy of Health Info upon 10. *Submit syndromic surveillance
request data to public health agency
13. *Clinical Summaries after each visit
* Measures that have exclusions
14. Exchange Key Clinical Information
15. Protect Health Information
www.MUforBH.com

22. Want state specific help with A/I/U?
If you would like a no cost, one to one consultation on the Medicaid A/I/U process in your state, please contact
the staff associated with your region to set it up.
 If your state is not incldued in one of the groups below, you can ask for help at www.MUforBH.com
Sean Peratikos: sean.peratikos@qualifacts.com 615-386-6755 ex:5503
Florida, Maryland, Tennessee, Pennsylvania, Virginia, Washington D.C., Delaware, Kentucky
Sam Huffman: sam.huffman@qualifacts.com 615-386-6755 ex:5522
Alaska, Arkansas, Georgia, Illinois, North Carolina, South Carolina, West Virginia, Texas,
Mississippi, Louisiana Alabama
Samantha Bunch: samantha.bunch@qualifacts.com 615-386-6755 ex:5504
Indiana, Michigan, Missouri, Ohio, Wisconsin, Iowa, North Dakota, South Dakota, Nebraska, Oklahoma
Sarah Rawlins: sarah.rawlins@qualifacts.com 615-386-6755 ex:5496
Connecticut, Massachusetts, New Jersey, New York, Maine, New Hampshire, Vermont, Rhode Island
Aaron Hall: aaron.hall@qualifacts.com 615-386-6755 ex:5501
Arizona, Colorado, Kansas, Minnesota, Oregon, Wyoming, California, Utah, Washington, Nevada, Montana,
Idaho, New Mexico, Hawaii
www.MUforBH.com

23. Links to the sources and authorities on
the EHR Incentive Programs
• Resource for Behavioral Health Eligible professionals> www.MUforBH.com
• List of state specific HIT EHR Incentive program websites>
http://www.cms.gov/apps/files/statecontacts.pdf
• Get information, tip sheets and more at CMS’ official website for the EHR incentive
programs: http://www.cms.gov/ehrincentiveprograms/
• The Meaningful Use specification Sheets on each of the Core and Menu Measures >
http://www.cms.gov/EHRIncentivePrograms/Downloads/EP-MU-TOC.pdf
• EP eligibility Decision Tool>
https://www.cms.gov/EHRIncentivePrograms/15_Eligibility.asp
• Department of Health and Human Services (HHS) Frequently Asked
Questions>http://questions.cms.hhs.gov/app/answers/list/p/21,26,1139
• Learn about certification and certified EHRs, as well as other ONC programs designed
to support providers as they make the transition: http://healthit.hhs.gov
www.MUforBH.com

24. Other links you may find helpful
• HITECH Answers> www.HITECHAnswers.net
• TWITTER LINKS:
http://twitter.com/ONC_HealthIT
http://twitter.com/HITECHAnswers
http://twitter.com/CMSGov
http://twitter.com/GovHIT
http://twitter.com/AHRQNews
www.MUforBH.com

25. Disclaimer
Please remember
We do our best to provide you with the most accurate information possible, but it is
ultimately your responsibility to fully understand and comply with the final rules and
regulations of the Medicaid and Medicare EHR Incentive Programs.
We highly recommend each individual consult the CMS website and the state-specific
Medicaid EHR Incentive Program website to confirm the rules and requirements.
Under no circumstances shall anyone associated with Qualifacts Systems Inc. Be liable for
any incidental, indirect, consequential or special damages or loss of any kind including
those resulting from the expected incentives themselves.
It is important that each Eligible Professional note that CMS views the EP as ultimately
responsible for the numerator and denominator and their Medicaid Encounter volume as
well as the data used for attestation on the measures of Meaningful Use.
www.MUforBH.com

26. www.MUforBH.com

27. www.MUforBH.com
A resource for behavioral health professionals seeking advice, guidance, and
information on meeting Meaningful Use requirements.
• FAQs
o Get quick answers to the most common Meaningful Use
questions
• Forum
o Chat and exchange ideas with others in your community
• Play the MU Game
o A step-by-step guide to claiming your Meaningful Use dollars
• Videos and Webinars
o Access past Meaningful Use presentations for additional help
or join our free live webinars
• MU State University
o Meaningful Use Education State by State www.MUforBH.com

28. Would you like more information on
meaningful use consulting services?
A resource for behavioral health professionals seeking advice, guidance, and
• If you like to learn more about how youUse requirements. with
information on meeting Meaningful can get assistance
– Understanding the rules of eligibility
– Understanding the rules for what belongs in the
numerator/denominator in the patient volume calculation
– How to re-engineer your current business process to more
easily integrate the meaningful use measures into your
business
– Or anything else about MU for EPs
You can send an email to meaningfuluse@qualifacts.com .
Please include a brief description of your anticipated needs.
We will contact you within 1 business day so we can set up a
call to tell you more about what types of services are available.
www.MUforBH.com