Missouri Code of State Regulations › Title 13 - DEPARTMENT OF SOCIAL SERVICES › Division 70 - MO HealthNet Division › Chapter 3 - Conditions of Provider Participation, Reimbursement, and Procedure of General Applicability › Section 13 CSR 70-3.220 - Electronic Health Record Incentive Program

Current through Register Vol. 49, No. 14, July 15, 2024
PURPOSE: The Health Information Technology and
				  Clinical Health Act (HITECH) offers incentive payments to encourage eligible
				  professionals and hospitals to adopt certified Electronic Health Records
				  (EHRs). This rule establishes the basis on which eligible hospitals and
				  professionals participating in the MO HealthNet Program will be eligible to
				  receive payments when they successfully demonstrate that they have adopted,
				  implemented, or upgraded to certified EHR technology in the first year and
				  meaningfully use certified electronic health record technology in subsequent
				  years.
(1) Definitions.
				Patient volume shall be calculated as outlined in
				42
				CFR 495.302 -
				495.306.
(2) Eligible Providers. To qualify for
				Medicaid incentive payments during the first year, eligible professionals and
				hospitals must complete registration and attestation requirements, meet volume
				thresholds for Medicaid patients, and show that they have adopted, implemented,
				or upgraded to certified electronic health record (EHR) technology. In
				subsequent years, payments require demonstration of meaningful use of certified
				EHR technology. To be deemed an "eligible professional or hospital" for the
				electronic health record incentive program, a professional or hospital must
				satisfy the following criteria:
(A) The
				eligible professional or hospital must be currently enrolled as a MO Health-Net
				provider, either in the fee for service program or a managed care organization
				which has a contract with the state of Missouri;
(B) The provider must be one (1) of the
				following:
1. An eligible professional,
				listed as-
A. A physician;
B. A dentist;
C. A certified nurse midwife;
D. A nurse practitioner; or
E. A physician assistant practicing in a
				federally-qualified health center or rural health clinic when a physician
				assistant is the primary provider, director, or owner of the site;
2. An acute care hospital, defined
				as a health care facility where the average length of stay is twenty-five (25)
				days or fewer, which has a Centers for Medicare and Medicaid Services (CMS)
				certification number with the last four digits in the series 0001-0879 or
				1300-1399; or
3. A children's
				hospital, defined as a separately certified children's hospital, either
				freestanding or a hospital-within-hospital, that predominately treats
				individuals under twenty-one (21) years of age and has a CMS certification
				number with the last four digits in the series 3300-3399;
(C) For the year for which the provider is
				applying for an incentive payment-
1. An
				eligible professional must have at least thirty percent (30%) of the
				professional's patient volume covered by Medicaid, except that-
A. A pediatrician must have at least twenty
				percent (20%) Medicaid patient volume;
B. A professional practicing at a
				federally-qualified health center or rural health clinic must have at least
				fifty percent (50%) of patient encounters in a federally-qualified health
				center or rural health clinic, with a minimum thirty percent (30%) patients who
				are medically needy, defined as those furnished uncompensated care, or services
				either at no cost or at a reduced cost based on a sliding scale or ability to
				pay, or patients covered by the MO HealthNet program or the state's Children's
				Health Insurance Program (CHIP); and
C. Professionals have the option to base
				their volume on either-
(I) Their individual
				Medicaid patient encounters as a percentage of their total individual
				encounters; or
(II) The practice's
				total Medicaid encounters as a percentage of the practice's total patient
				encounters;
2. An acute care hospital must have ten
				percent (10%) Medicaid patient volume; and
3. A children's hospital is presumed to meet
				the Medicaid patient volume requirement;
(D) Application and Agreement. Any eligible
				provider who wants to participate in the Missouri electronic health record
				incentive program must declare the intent to participate by electronically
				registering with the Centers for Medicare and Medicaid Services (CMS) using the
				Medicare and Medicaid electronic health record incentive program registration
				and attestation website. CMS will notify the Department of Social Services of
				an eligible provider's registration for the Medicaid incentive payment program.
1. The department will maintain a website and
				secure portal with instructions for submitting documentation of patient volume,
				certified technology, and other information required to apply for the Medicaid
				EHR incentive at the website, http://mo.arraincentive.com.
2. The applicant shall use the website to-
A. Attest to the applicant's qualifications
				to receive the incentive payment; and
B. Submit an electronic copy of a signed
				attestation form.
3. The
				department may request any missing or additional information from the provider.
				If missing or additional information is required, the department will notify
				the provider by electronic mail of the specific information needed. If the
				provider fails to submit the required information, the department will
				determine the registration incomplete and application will remain in an
				incomplete status until the required information is submitted.
4. The department may request additional
				information from sources other than the provider to validate the provider's
				attestation submitted as a result of this rule;
(E) Record Retention. Providers must retain
				records to support their eligibility for the incentive payment for a minimum of
				six (6) years. The department will select providers for audit after issuance of
				an incentive payment. Incentive payment recipients shall cooperate with the
				department by providing proof of-
1.
				Eligibility for the incentive program;
2. Medicaid patient volume
				thresholds;
3. Purchase of
				certified electronic health record technology; and
4. Meaningful use of electronic health record
				technology;
(F) Patient
				Consent Form. Providers must retain records to support the disclosure of
				patient health information to all treating providers; and
(G) Administrative Appeal. Any eligible
				provider or any provider that claims to be an eligible provider and who has
				been subject to adverse actions related to the electronic health record
				incentive program may seek review of the department's action pursuant to
				section
				621.055,
				RSMo. Appealable issues include:
1. Provider
				eligibility determination;
2.
				Medicaid patient volume thresholds;
3. Incentive payment amounts; or
4. Demonstration of adopting, implementing,
				upgrading, and meaningful use of technology.