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Medicaid Electronic Health Record Incentive

Medicaid Promoting Interoperability/Electronic Health Record Incentive Program

The Department of Health Care Finance offers incentives for utilizing electronic health record (EHR) systems to deliver patient care and connect with patients and other providers.

The DC Medicaid Promoting Interoperability (PI) Program, previously known as the Medicaid EHR Incentive Program or Meaningful Use, has already rewarded hundreds of District providers who adopted, implemented, upgraded, or demonstrated meaningful use of Certified Electronic Health Record Technology (CEHRT) in ways that improve quality, safety, and effectiveness of patient-centered care.


WHO IS ELIGIBLE TO EARN INCENTIVES FOR PARTICIPATION IN THE PI PROGRAM? 

Eligible professionals (EPs) may receive incentive payments up to $63,750 over a six-year period upon demonstrating meaningful use of the EHRs. The following provider types are eligible to participate in the DC Medicaid PI Program: (1) Physicians, (2) Dentists, (3) Nurse Practitioners, and (4) Certified Nurse Midwives. To participate, EPs must also have a minimum of 30% Medicaid patient volume (20% for pediatricians) or practice predominantly in a FQHC and have a minimum of 30% patient volume attributable to needy individuals. 

Eligible hospitals (EHs) may receive payments based on two calculated components - EHR amount and Medicaid share – over a three-year period upon demonstrating meaningful use. The following hospitals are eligible to participate in the DC Medicaid PI Program: (1) Acute Care Hospitals, and (2) Children’s Hospitals. 

The last year to enter the DC Medicaid PI program was 2017 and the final year for participation in the program is 2021. 

HOW DO PROVIDERS EARN PI PROGRAM INCENTIVES?

Providers may earn incentives by using their certified EHR system to meet a set of objectives and measures related to improving health outcomes, securely exchanging health information, expanding patient access to their health data, as well as protecting the privacy and security of patient health data. The requirements for the program are set by a October 6, 2015 rule from the Centers for Medicare & Medicaid Services titled, CMS EHR Incentive Program Stage 3 and Modifications to Meaningful Use in 2015 through 2017. This Final Rule addresses the most recent requirements for the incentive program for both EPs and EHs. 

WHEN DID THE PROGRAM START AND HOW MUCH HAS BEEN PAID TO DISTRICT MEDICAID PROVIDERS?

As part of the 2009 American Recovery and Reinvestment (ARRA) Act, The Health Information Technology for Economic and Clinical Health Act (HITECH) established the Medicare and Medicaid EHR Incentive Programs, now known as the Promoting Interoperability Program. 

The District originally launched the Medicaid Promoting Interoperability Program in 2013. Enrollment in the program has gradually increased. As of October 2019, the following payment amounts have been made to eligible providers and hospitals in the District:

  Eligible Professionals Eligible Hospitals
Adopt, Implement or Upgrade (AIU) 264 5
MU 301 10
Amount Paid $8,168,500 $25,468,439
Total Paid   $33,636,939

*updated September 2020

 

IS TECHNICAL ASSISTANCE OFFERED FOR PROVIDERS PARTICIPATING IN THE PI PROGRAM?

The District has continued its partnership with eHealthDC, a DC Primary Care Association program, to 
provide free technical assistance to District Medicaid providers.

eHealthDC leads a multi-year technical assistance program intended to:

  • Assist staff and providers with better utilization of EHRs in accordance with the current practice workflows and program requirements 
  • Provide exceptional Promoting Interoperability technical and on-site support to improve in weak performance areas to meet the program requirements 

All eligible District providers interested in taking advantage of eHealthDC’s free technical assistance support should contact eHealthDC staff directly at [email protected] or call (202) 552-2331. Please visit their website for more information.

HOW DO I ATTEST TO THE DC PI PROGRAM? 

The Promoting Interoperability Program operates in Program Years. A Program Year is a full calendar year during which a provider can meet the Program Requirements. Program Year 2020 runs from January 1, 2020 to December 31, 2020. 

DHCF is pleased to announce the opening of Program Year 2020 for the DC Medicaid PI Program on October 15, 2020. Attestation for Program Year 2020 will close promptly on March 15, 2021. DHCF does not anticipate an extension to this deadline. Providers may attest to the program requirements through the new State-Level Repository here: https://dcslr.thinkhts.com.

Below are some important tips you need to know about meeting the Promoting Interoperability Program requirements in Program Year 2020.

Requirements to Meet the PI Program Requirements:

  • All EPs must attest to the Stage 3 Objective and Measure requirements. All providers are required to attest to a single set of 8 objectives and measures.
  • View the Stage 3 Specification Sheets for EPs here. 
  • To meet Stage 3 requirements, all providers must use technology certified to the 2015 Edition. A provider who has technology certified to a combination of the 2015 Edition and 2014 Edition may potentially attest to the Stage 3 requirements, if the mix of certified technologies would not prohibit them from meeting the Stage 3 measures. However, a provider who has technology certified to the 2014 Edition only may not attest to Stage 3.
  • There are changes to the measure calculations policy, which specifies that actions included the numerator must occur within the EHR reporting period if that period is a full calendar year, or if it is less than a full calendar year, within the calendar year in which the EHR reporting period occurs. Specific measures affected are identified in the Additional Information section of the specification sheets.
  • All EPs must report Clinical Quality Measures (CQMs) of a continuous 90-day period from January 1, 2020 through December 31, 2020. 
  • EPs must conduct their Security Risk Assessment during Calendar Year 2020. 
  • In 2020, for all returning participants, the EHR reporting period is a minimum of any continuous 90 days between January 1 and December 31, 2020.

Stage 3 includes flexibility within certain objectives to allow providers to choose the measures most relevant to their patient population or practice. The Stage 3 objectives with flexible measure options include:

  • Coordination of Care through Patient Engagement – Providers must attest to all three measures and must meet the thresholds for at least two measures to meet the objective.
  • Health Information Exchange – Providers must attest to all three measures and must meet the thresholds for at least two measures to meet the objective.
  • Public Health Reporting – Eligible professionals must report on two measures and eligible hospitals must report on four measures.

To determine eligibility for the PI Program, EPs will be required to submit supporting documentation to validate all attested Stage 3 objectives and measures. For more guidance, please refer here:

WHAT OTHER RESOURCES ARE AVAILABLE?

WHO SHOULD I CONTACT FOR ASSISTANCE?

If you need assistance with DHCF's Medicaid Promoting Interoperability Program, please contact:

Specialty Area Contact Email Phone
MEIP General Inquiries Eduarda Koch [email protected] (202) 673-3561
MEIP Pre-Payment Verification Adaeze Okonkwo [email protected] (202) 478-9227