Code of Maine Rules › 10 - DEPARTMENT OF HEALTH AND HUMAN SERVICES › 144 - DEPARTMENT OF HEALTH AND HUMAN SERVICES - GENERAL › Chapter 101 - MAINECARE BENEFITS MANUAL (FORMERLY MAINE MEDICAL ASSISTANCE MANUAL) › Chapter I - Specific Policies By Service › Sec2 144-101-I-2 - State Medicaid Health Information Technology (HIT) Program › Subsection 144-101-I-2.04 - ELIGIBLE PROFESSIONAL

Current through 2024-29, July 17, 2024
A. An Eligible
					 Professional must meet the requirements established in
					 42 C.F.R.
					 §495.304(c) unless
					 exempt under
					 42 C.F.R.
					 §495.304(d).Title
					 42 C.F.R.§§
												495.310(a) through (e)
					 governs payments to EPs.
B.
Medicaid or Needy Individual threshold requirements
Table 1
lists the minimum percentage of
						Medicaid or Needy Individual encounters for each type of Professional for this
						Program. See Title
						42 C.F.R.
						§495.304(c).
Types of Professionals that may apply for
								  the incentive payment program
Minimum Medicaid or Needy Individual
								  encounters
Physician, certified nurse-midwife, nurse
								  practitioner, dentist
30% Medicaid encounters
Pediatrician
20% Medicaid encounters
Physician, certified nurse-midwife, nurse
								  practitioner, or a dentist who practices predominantly in an FQHC or RHC
30% Needy Individual encounters
Physician assistant who practices predominantly
								  in an FQHC or RHC that is led by a physician assistant
30% Needy Individual Encounters
C.
Application Process for EPs
1. A Professional must register with CMS
					 through the CMS National Level Repository (NLR) system.
2. After a Professional registers, CMS sends
					 an electronic notification to OMS of the registration.
3. Using the contact information from the NLR
					 registration, OMS will contact the Professional to begin the application
					 process.
4. A Professional must
					 establish that he or she is an EP and meet the following requirements:
a. Using the encounter method, establish that
					 he or she has met the minimum Medicaid patient volume required under
					 42 C.F.R.
					 §495.304(c)(1),
or
practices predominantly in a Federally Qualified Health Center
					 (FQHC) or in a Rural Health Clinic (RHC) and has met the minimum Needy
					 Individual volume under
					 42 C.F.R.
					 §495.304(c);
					 and
b. Attest that he or she has
					 adopted, implemented or upgraded electronic health records to be eligible for
					 the first payment year,
or
that he or she has met Meaningful Use
					 requirements under the applicable stage to be eligible for subsequent payment
					 years; and
c. Attest that he or she
					 uses an EHR that is included on the list of certified EHRs maintained by CMS;
					 and
d. Attest that he or she has
					 not received an incentive payment for that year from another state;
					 and
e. Attest that he or she has
					 not received an incentive payment under the Medicare incentive payment program
					 for that year; and
f.
					 Satisfactorily complete the application process; and
g. Meet the meaningful use reporting
					 requirement set forth under
					 42 C.F.R.
					 §495.312(b).
5. After confirming that the
					 Professional meets the requirements enumerated in this section 2.04, MaineCare
					 will notify CMS that a payment is being issued, and will issue a payment to the
					 EP according to the requirements of
					 42 C.F.R.
					 §495.312(e)(1).
6. If the Department determines that a
					 Professional has not met the requirements of this Section 2.04, it will notify
					 the Professional in writing within two (2) business days of making that
					 determination.