Alaska Medicaid Electronic Health Record (EHR) Incentive Program

1. Alaska Medicaid Electronic Health Record (EHR) Incentive Program

2. EHR Incentive Program A federal program that provides major financial support to incent providers to adopt, implement, or upgrade to certified EHR technology and to meet meaningful use standards Goals: Enhance care coordination and patient safety Reduce paperwork and improve efficiencies Facilitate information sharing across providers, payers, and state lines Enable sharing using state Health Information Exchanges (HIE) and the National Health Information Network (NHIN) Purpose: Improve outcomes, facilitate access, simplify care, and reduce costs of health care nationwide

3. EHR Incentive Program Requirements • Incentive Requirements • Adopt, Implement or Upgrade “certified”EHR technology • Meet the “meaningful use” criteria in the employment of the certified EHR technology • Be an “eligible”professional (EP) or hospital (EH) • Meet EP or EH Medicaid Patient Volume Criteria

4. Use Certified EHR Technology Adopt – Acquire, purchase, or secure access to certified EHR technology Implement – Install or commence utilization of certified EHR technology capable of meeting meaningful use requirements Upgrade – Expand the availability functionality of certified EHR technology capable of meeting meaningful use requirements at the practice site, including staffing, maintenance, and training, or upgrade from existing EHR technology to certified EHR technology per the Office of the National Coordinator (ONC) EHR certification criteria

5. Meaningful Use • Use Certified EHR Technology • In a meaningful manner - have certain electronic capabilities, such as e-prescribing • For electronic exchange of health information - to improve quality/coordination of health care, reduce costs • To submit clinical quality and other measures - measures change over time to show progress • Meaningful Use Criteria • Set of measures • Quality (outcomes) • Process ( use of best practices/data capture) • Capabilities (computerized functions) • Providers must submit and attest to these quality measures to receive funds • Must use Federal Meaningful Use definition as a floor

6. Medicare or Medicaid Eligibility • Eligible Professionals (EPs) • Must choose to participate in Medicare or Medicaid Program • Before 2015, EPs may switch programs once after the first incentive payment • For Medicaid: Potentially as high as $63,750 over 6 yrs • For Medicare: Potentially as high as $48,000

7. Medicare or Medicaid Eligibility • Medicaid Eligible Professionals or Eligible Hospitals may be eligible for the program if they: • adopt, implement or upgrade to a certified EHR technology or • successfully demonstrate meaningful use of certified EHR technology • Medicare Eligible Professionals or Eligible Hospitals may be eligible for the program if they: • successfully demonstrate meaningful use of certified EHR technology

8. Medicaid EHR Incentive ProgramEligible Provider Types • Medicaid Eligible Professionals • Physician (MD,DO) • Dentist • Certified Nurse Mid-Wife • Nurse Practitioner, and • Physician Assistant if practicing in a Rural Health Clinic or a Federally Qualified Health Center led by a physician assistant • Non-Hospital Based • Hospital-based EPs are not eligible for incentive payments • An EP is considered hospital-based if 90% or more of his or her services are performed in a hospital inpatient (POS 21) or emergency room (POS 23) setting

9. Medicaid Patient Volume Criteria

10. Needy Individual Patient Volume • Needy Individual encounters can be used by Eligible Professionals (EPs) who practice predominately in an FQHC or RHC. • Needy Individual encounters include: • Services paid by TXIX Medicaid • Services paid by TXXI Children’s Health Insurance Program (CHIP) • Furnished by the provider as uncompensated care • Furnished at either no cost or reduced cost based on a sliding scale

11. Potential EP Payment Timeline(for Medicaid EHR Incentive Program)

12. Potential EH Payment EH payments are based on a number of factors, beginning with a $2 million base payment. Hospitals cannot initiate payments after 2016 and payment years must be consecutive after 2016

13. EHR Incentive Program Enrollment • To enroll in the incentive program EPs and EHs must: • Register at the CMS EHR Incentive Program Registration site • Register and attest at the Alaska Medicaid State Level Registry (SLR)

14. Alaska Medicaid Provider Outreach Page • Centralized “one stop” launching pad of available tools for Providers to manage their EHR Incentive Program Information • The Provider Outreach portal provides: • A link "Want to get a jump start?" with step-by-step instructions on how to complete the registration process by role (individual eligible professional, eligible hospital or group administrator) • Attestation workbooks for Eligibility and Adopt / Implement / Upgrade to  help gather all the necessary information to register for the program • Ability to access the CMS EHR Incentive Registration site • Ability to create an account with the Alaska Medicaid SLR • Ability for Eligible Professionals and Eligible Hospitals to attest to information submitted

15. Alaska Medicaid SLR

16. Getting Started

17. Step by Step Instructions

18. Alaska Medicaid SLR Registration • To register in the SLR you must be: • An eligible professional, eligible hospital or a group administrator • Enrolled in Alaska Medicaid • Have your National Provider Identifier (NPI) and Tax Identifier Number (TIN) • The NPI and TIN used in the SLR needs to be the same as what was entered for the CMS EHR Incentive Registration

19. Attestation Preparation • Determine which method of Certified EHR technology you will be attesting to —  adopt, implement, or upgrade • Verify that your EHR is on the list from ONC as certified EHR technology • Obtain a copy of your signed contract with a vendor for the purchase, implementation or upgrade of a certified EHR system • Select the 90 day period to determine the Medicaid or needy individual patient volume you will be reporting using the number of encounters • Obtain your active Alaska Medicaid Provider number • Obtain your medical license number, licensing board name and state in which it was issued • Eligible Hospitals (EHs) need to have four (4) years worth of cost reports in order to complete the attestation process

20. Where do I go to log into the SLR?

21. SLR Create Account

22. SLR Create Login • Must have between 8 - 20 characters, • at least 1 upper and 1 lower case letter, 1 number, 1 special character (@ or # or !), not your User ID and not an old password Must be between 8 – 20 characters No spaces / special characters allowed

23. SLR Login Enter User ID and Password you created

24. SLR – End User License Agreement Legalese User agrees and proceeds; user disagrees and cannot complete registration

25. SLR Home Page Steps guide users through Attestation workflow

26. SLR Step 1 – Eligible Professional (EP) About You

27. SLR Step 1 – EP About You

28. SLR Step 1 – Eligible Hospital (EH) About You

29. SLR Step 2 – EP Confirm Eligibility

30. SLR Step 2 – EH Confirm Eligibility

31. SLR Step 2 – EH Hospital Demographics

32. SLR Step 3 – Attestation Method

33. SLR Step 3 – AIU Method

35. SLR Step 3 – EHR Certification

36. ONC CHPL

37. ONC CHPL

38. ONC CHPL Add to SLR EHR Certification ID field

39. SLR Step 3 – Meaningful Use (MU)EHR Reporting Period

40. SLR Step 3 – EP MU Core Objectives • EP will have to attest to each of the 15 Meaningful Use Core Objectives • The 15 Meaningful Use Core Objectives are: • Use computerized provider order entry (CPOE) for medication orders directly entered by any licensed healthcare professional who can enter orders into the medical record per state, local and professional guidelines • Implement drug-drug and drug-allergy interaction checks • Maintain an up-to-date problem list of current and active diagnoses • Generate and transmit permissible prescriptions electronically (eRx) • Maintain active medication list. • Maintain active medication allergy list • Record all the demographics • Record and chart changes in vital signs

41. SLR Step 3 – EP MU Core Objectives • Record smoking status for patients 13 years old or older • Report ambulatory clinical quality measures to the State • Implement one clinical decision support rule relevant to specialty or high clinical priority along with the ability to track compliance to that rule • Provide patients with an electronic copy of their health information (including diagnostic test results, problem list, medication lists, medication allergies), upon request • Provide clinical summaries for patients for each office visit • Capability to exchange key clinical information (for example, problem list, medication list, allergies, diagnostic test results), among providers of care and patient authorized entities electronically • Protect electronic health information created or maintained by the certified EHR technology through the implementation of appropriate technical capabilities

42. SLR Step 3 – EP MU Core Objectives

43. SLR Step 3 – EH MU Core Objectives • EH will have to attest to each of the 14 Meaningful Use Core Objectives • Use computerized physician order entry (CPOE) • Implement drug-drug and drug-allergy interaction checks • Maintain an up-to-date problem list of current and active diagnoses • Maintain active medication list • Maintain active medication allergy list • Record all of the demographics: preferred language, gender, race, ethnicity, date of birth, date and preliminary cause of death in event of mortality • Record and chart changes in vital signs • Record smoking status for patients 13 years or older • Report hospital clinical decision support rule related to a high priority hospital condition • Provide patients with an electronic copy of their health information • Provide patients with an electronic copy of their discharge instructions • Capability to exchange key clinical information • Protect electronic health information created or maintained by certified EHR technology through the implementation of appropriate technical capabilities

44. SLR Step 3 – EH MU Core Objectives

45. SLR Step 3 – EP MU Menu Objectives • EP has to attest to at least one menu objective from the public health list, even if the exclusion applies to both: • Capability to submit electronic data to immunization registry or immunization information system • Capability to submit electronic syndromic surveillance data to public health agencies • EP must attest to additional menu objectives until a total of 5 MU Menu Objectives have been selected: • Implement drug formulary checks • Incorporate clinical lab-test results into EHR as structured data • Generate lists of patients by specific conditions • Send reminders to patients • Provide patients with timely electronic access to their health information • Use certified EHR technology to identify patient-specific education resources • Perform medication reconciliation if patient is received from another care setting or provider • Provide summary of care record for any transition of care or referral

46. SLR Step 3 – EP MU Menu Objectives

47. SLR Step 3 – EH MU Menu Objectives • EH has to attest to at least one menu objective from the public health list, even if the exclusion applies to both: • Capability to submit electronic data to immunization registry or immunization information system • Capability to submit electronic syndromic surveillance data to public health agencies • Capability to submit electronic data on reportable lab results to public health agencies • EP must attest to additional menu objectives until a total of 5 MU Menu Objectives have been selected: • Implement drug formulary checks • Record advance directives for patients 65 years or older • Incorporate clinical lab-test results into certified EHR as structured data • Generate lists of patients by specific conditions • Use certified EHR technology to identify patient-specific education resources • Perform medication reconciliation if patient is received from another care setting or provider • Provide summary of care record for any transition of care or referral

48. SLR Step 3 – EH MU Menu Objectives

49. SLR Step 3 – EP Core Clinical Quality Measures • EP must attest to all three (3) Core Clinical Quality Measures • If any of the Core Clinical Quality Measures have a denominator of zero (0) an Alternative Core Clinical Quality Measure must also be submitted • Core Clinical Quality Measures: • Hypertension: Blood Pressure Measurement • Preventive Care and Screening Measure Pair • Adult Weight Screening and Follow-up • Alternate Clinical Quality Measures: • Weight Assessment and Counseling for Children and Adolescents • Preventive Care and Screening: Influenza Immunization for Patients > or = 50 years old • Childhood Immunization Status

50. SLR Step 3 – EP Core Clinical Quality Measures